Cervical Vertebral Maturation Research Articles

Is hand-wrist radiography still necessary in orthodontic treatment planning?

The aim of our study is to compare the relationship between hand-wrist and cervical vertebra maturation stages with chronological age and to investigate the effect of malocclusion type on the relationship between these methods. Hand-wrist and cephalometric radiographs of 1000 patients (526 females, 474 males) with a mean age of 13.41 ± 1.83 were analyzed. The methods of Bacetti et al. were used for the cervical vertebra maturation stage, and Björk, Grave and Brown's methods were used for the hand-wrist maturation stage. One-way ANOVA test was applied to compare skeletal classes between them. Tukey post hoc test was used to determine the differences. The relationship between the malocclusion type, cervical vertebra and hand-wrist maturation stages was evaluated with the Spearman correlation test. Spearman's correlation coefficient was 0.831, 0.831 and 0.760 in Class I, II and III females, respectively. In males, it was calculated as 0.844, 0.889 and 0.906, respectively. When sex and malocclusion were not differentiated, the correlation was found to be 0.887. All were statistically significant (P < 0.001). The highest correlation was observed in class III males, while the lowest was found in class III females. Cervical vertebrae can be used safely to assess pubertal spurt without hand-wrist radiography. Diagnosing growth and development stages from cephalometric images is important in reducing additional workload and preventing radiation risk.

Mapping an intelligent algorithm for predicting female adolescents' cervical vertebrae maturation stage with high recall and accuracy.

The present study was designed to define a novel algorithm capable of predicting female adolescents' cervical vertebrae maturation stage with high recall and accuracy. A total of 560 female cephalograms were collected, and cephalograms with unclear vertebral shapes and deformed scales were removed. 480 films from female adolescents (mean age: 11.5 years; age range: 6-19 years) were used for the model development phase, and 80 subjects were randomly and stratified allocated to the validation cohort to further assess the model's performance. Derived significant predictive parameters from 15 anatomic points and 25 quantitative parameters of the second to fourth cervical vertebrae (C2-C4) to establish the ordinary logistic regression model. Evaluation metrics including precision, recall, and F1 score are employed to assess the efficacy of the models in each identified cervical vertebrae maturation stage (iCS). In cases of confusion and mispredictions, the model underwent modification to improve consistency. Four significant parameters, including chronological age, the ratio of D3 to AH3 (D3:AH3), anterosuperior angle of C4 (@4), and distance between C3lp and C4up (C3lp-C4up) were administered into the ordinary regression model. The primary predicting model that implements the novel algorithm was built and the performance evaluation with all stages of 93.96% for accuracy, 93.98% for precision, 93.98% for recall, and 93.95% for F1-score were obtained. Despite the hybrid logistic-based model achieving high accuracy, the unsatisfactory performance of stage estimation was noticed for iCS3 in the primary cohort (89.17%) and validation cohort (85.00%). Through bivariate logistic regression analysis, the posterior height of C4 (PH4) was further selected in the iCS3 to establish a corrected model, thus the evaluation metrics were upgraded to 95.83% and 90.00%, respectively. An unbiased and objective assessment of the cervical vertebrae maturation (CVM) method can function as a decision-support tool, assisting in the evaluation of the optimal timing for treatment in growing adults. Our novel proposed logistic model yielded individual formulas for each specific CVM stage and attained exceptional performance, indicating the capability to function as a benchmark for maturity evaluation in clinical craniofacial orthopedics for Chinese female adolescents.

Evaluation of reliability of salivary alkaline phosphatase in comparison to other methods of assessing the skeletal maturation

Evaluation of skeletal maturation is crucial to growth determination which in turn influences orthodontic treatment planning. Various methods employed for assessment are chronological age, hand wrist maturation, cervical vertebral maturation, and dental calcification. Recently, salivary Bone specific alkaline phosphatase (BALP) have been introduced due to its role in the bone mineralization process. To test the alternate hypothesis that salivary alkaline phosphatase is a reliable indicator of skeletal maturity in comparison with other methods of assessment of skeletal maturation. Total 112 subjects were selected out of 150 subjects on the basis of inclusion and exclusion criteria, for participation in the study. For each subject, personal details including chronological age was noted. Height and weight measurements were done for calculation of body mass index (BMI). Further, Lateral Cephalogram and Orthopantomogram were obtained for assessment of cervical vertebrae maturation stages and Demirjian index. Then, an unstimulated salivary sample was collected for evaluation of alkaline phosphatase activity by colorimetric method. The data obtained was analyzed using SPSS software. The results of the present study showed that the highest correlation for skeletal maturation assessment was found with alkaline phosphatase activity. The hypothesis is accepted. Salivary Alkaline Phosphatase proved to be reliable biomarker for assessment of skeletal maturation.

Evaluation of The Relationship Between Dental and Cervical Vertebrae Maturation in Terms of Age Determination

Aim: Age determination is a very important issue in anthropology, forensic science, and dentistry. Today, the most commonly used methods for age determination are the methods in which tooth and bone development are evaluated. This study aims to evaluate the relationship between gender, chronological age, dental maturation, and cervical vertebral maturation in individuals aged 8-25 years. Material and Method: Digital panoramic, lateral cephalometric radiographs of 500 patients aged 8-25 years were used in this study. Cervical vertebra maturation was evaluated using the dental maturation-modified Demirjian classification system of Baccetti et al. Means, minimum, maximum, and standard deviations were calculated and analyzed as descriptive statistics. Kolmogorov-Smirnov, Kappa, Kruskal-Wallis, Chi-Square, Linear Regression, and Spearman Correlation tests were used for statistical analysis. Results: There was a statistically significant difference between chronological age and dental maturation and cervical vertebral maturation levels (p &lt;0.01). While dental maturation levels did not differ significantly according to gender (p&gt; 0.05), cervical vertebra maturation was statistically different (p &lt;0.01). There was a positive correlation between chronological age and dental maturation, and cervical vertebral maturation levels (p &lt;0.01). There was a strong correlation between dental maturation and cervical vertebral maturation levels (p &lt;0.01). Conclusion: The findings of this study showed that skeletal maturity increased with the increase in chronological and dental age for both genders. The earlier formation was consistently observed for each stage of skeletal maturation in females. All correlations between skeletal and dental maturations were statistically significant.

Effect of maxillary distraction osteogenesis and LeFort-1 advancement orthognathic surgery on soft-tissue thickness and anterior soft-tissue to hard-tissue movement ratios among patients with complete unilateral cleft lip and palate

Objectives: The objective of this study was to compare the soft-tissue thickness and anterior soft-tissue to hard-tissue movement ratios in patients with unilateral cleft lip and/or palate (UCLP) following maxillary distraction osteogenesis using rigid external distractor device and maxillary advancement at LeFort I level using lateral cephalograms. Material and Methods: This retrospective study was conducted on 20 patients with UCLP who underwent either LeFort I maxillary advancement or maxillary distraction osteogenesis. Non-syndromic patients with complete UCLP anomalies and skeletal class III patterns due to maxillary hypoplasia were included in the study. The patients with a pre-surgical negative overjet of ≥5 mm were treated by maxillary distraction osteogenesis, while a negative overjet of &lt;5 mm was managed with maxillary advancement orthognathic surgery. The growth completion in all the patients was assessed using the cervical vertebrae maturation index (CS 6) on a lateral cephalogram. The lateral cephalograms taken before surgery at (T0) and after a minimum interval of six months (T1) of surgery were assessed for changes in soft-tissue thickness and hard-tissue to soft-tissue movement ratios among the two groups. Paired t-test was used to compare the mean values obtained within the same group at two different time intervals. Unpaired t-test was used to compare mean values between the Groups 1 and 2. Pearson’s correlation coefficient (r) test was used to assess the associations between the mean changes in hard- and soft-tissue variables. Results: Group 1 showed significantly greater maxillary advancement compared to Group 2 with a mean difference of 5.80 mm at Point A and 7.65 mm at the upper incisal edge. Soft-tissue thickness decreased significantly after advancement in Group 1 at subnasale (P &lt; 0.05), labrale superius, stomion, and labrale inferius (P &lt; 0.01) and at subnasale (P &lt; 0.05), stomion and labrale inferius (P &lt; 0.01) in Group 2. There was a significantly strong correlation between the hard- and soft-tissue movement in sagittal plane in both Group 1 and Group 2. In Groups 1 and 2, a statistical highly significant strong positive correlation was found between vertical change in dU1 to soft-tissue dLs and dStms. In Group 2, a statistical highly significant strong positive correlation was found between vertical change in dA to soft-tissue dC and dStms. Conclusion: The soft-tissue thickness reduced in patients with UCLP after maxillary advancement in both groups. The soft tissue followed the hard tissue in both groups. There was a greater downward movement of the maxillary base and soft-tissue lengthening in Group 1 compared to Group 2.

Correlation between dental and skeletal maturity in Korean children based on dental maturity percentile: a retrospective study

BackgroundThe correlation between dental maturity and skeletal maturity has been proposed, but its clinical application remains challenging. Moreover, the varying correlations observed in different studies indicate the necessity for research tailored to specific populations.AimTo compare skeletal maturity in Korean children with advanced and delayed dental maturity using dental maturity percentile.DesignDental panoramic radiographs and cephalometric radiographs were obtained from 5133 and 395 healthy Korean children aged between 4 and 16 years old. Dental maturity was assessed with Demirjian’s method, while skeletal maturity was assessed with the cervical vertebral maturation method. Standard percentile curves were developed through quantile regression. Advanced (93 boys and 110 girls) and delayed (92 boys and 100 girls) dental maturity groups were defined by the 50th percentile.ResultsThe advanced group showed earlier skeletal maturity in multiple cervical stages (CS) in both boys (CS 1, 2, 3, 4, and 6) and girls (CS 1, 3, 4, 5, and 6). Significant differences, as determined by Mann-Whitney U tests, were observed in CS 1 for boys (p = 0.004) and in CS 4 for girls (p = 0.037). High Spearman correlation coefficients between dental maturity and cervical vertebral maturity exceeded 0.826 (p = 0.000) in all groups.ConclusionA correlation between dental and skeletal maturity, as well as advanced skeletal maturity in the advanced dental maturity group, was observed. Using percentile curves to determine dental maturity may aid in assessing skeletal maturity, with potential applications in orthodontic diagnosis and treatment planning.

Assessment of mandibular trabecular structure and cervical vertebral maturation using fractal analysis.

Changes in bone trabeculae occur during skeletal maturation. Fractal analysis is a technique for assessing changes in the internal structure of the bone. The aim of this study was to investigate correlation of bone trabeculation measured on panoramic and lateral cephalometric radiographs with cervical vertebral maturation stages (CVMS). CVMS was evaluated on lateral cephalometric radiographs of 120 individuals aged 6 to 18 years. The subjects were divided into 6 groups (n= 20 each) according to CVMS. On panoramic and lateral cephalometric radiographs, fractal dimension (FD) analyses were performed in mandibular corpus, gonial and condylar regions and cervical vertebral bodies (C2, C3, C4). FD measurements from the mandibular corpus region bilaterally and C2-C4 vertebral bodies showed significant positive correlations with CVMS (r= 0.418, r= 0.412, r= 0.324, r= 0.304, r= 0.263, respectively). Significant differences were found in the FD values of the right/left mandibular corpus and C2 and C3 vertebrae compared to CVMS (P< 0.001, P< 0.001, P= 0.005, P= 0.019, respectively). Significant positive moderate correlations between the FD values of the right and left mandibular corpus and CVMS suggest that fractal analysis may be useful in determining skeletal maturity stage. The significant FD values obtained from the right/left mandibular corpus, and C2 and C3 vertebra indicate that the complexity of the internal trabecular structure increases with maturation.

Skeletal Growth Status Agreement in a Group of Thai Children and Adolescents: A Comparative Analysis of Fishman's Skeletal Maturation and Baccetti's Cervical Vertebral Maturation Indices

This study aimed to determine the agreement of skeletal maturation (SM) assessed by hand-wrist radiographs and cervical vertebral maturation (CVM) assessed by lateral cephalometric radiographs. It also explored the feasibility of using CVM as an alternative to hand-wrist radiographs among Thai children and adolescents. The samples comprised 95 males and 67 females from Thailand, aged 7–17 years. A total of 162 hand-wrist radiographs and lateral cephalometric radiographs were included. Two experienced oral radiologists independently assessed SM (using Fishman’s method) and CVM (using Baccetti’s method); a third referee observer resolved any discrepancies. The correlation and agreement between the methods were evaluated. The results found a substantial agreement (weighted kappa = 0.594) between SM and CVM. The interobserver discrepancy in categorizing SM stages was mostly found at stage 5, while the most common discrepancy for CVM was at stage 6. A significant positive correlation (Spearman’s correlation coefficient = 0.677, P &lt; 0.001) indicated a moderate to strong association between SM and CVM. The substantial agreement and moderate to strong correlation between CVM and SM highlighted the feasibility of using CVM to assess skeletal growth. However, to ensure reliability, it was necessary to precisely evaluate the appearance of the capping of the epiphyseal plate for SM and the distinction between a rectangular and square cervical spine shape at C3 and C4 for CVM differentiation. Keywords: Cervical spine, Hand, Radiographic evaluation, Orthodontics

Interobserver Reliability of Cervical Vertebral Maturation Staging

Background: the accurate identification of a patient's maturation stage, particularly during the pubertal growth spurt, takes on heightened importance, particularly when addressing cases of dentoskeletal problem Active growth determination is crucial for orthodontic treatment. Objectives: The objective of this study was to determine interobserver reliability of Cervical Vertebrae Maturation (CVM) stagingMaterial and Methods: This cross-sectional correlational study, conducted in the Department of Orthodontics on 70 subjects. Ten orthodontic clinicians, including 4 orthodontists and 6 orthodontic residents, with no prior experience in CVM staging, underwent comprehensive training. The study involved assessing 70 lateral cephalograms with clear visibility of cervical vertebrae, evaluated by two independent examiners using the Baccetti et al. staging system. The collected data were analyzed using R programming, including descriptive statistics for age, Spearman's correlation, and Cohen's Kappa for assessing interobserver agreement, with stratification by gender. Results: The mean age of participants was 12.60±3.93 years, with 38 females (54.29%) and 32 males (45.71%). The study revealed varying levels of agreement between two observers for different CVM stages, ranging from perfect agreement in CS1 to strong agreement in CS3. CS4, CS5, and CS6 also showed varying agreement rates. Additionally, there was robust and statistically significant agreement (p&lt;0.001) between observers in cervical maturation staging, supported by a high Spearman's rho value (r=0.927). Furthermore, substantial agreement was observed with a Kappa value of 0.748, indicating a strong consensus in cervical staging assessments.Conclusion: Cervical vertebral maturation staging is reliable in term of inter-observers agreement. Keywords: Cervical vertebral maturation, Interobserver agreement, Growth assessment

Craniocervical posture in patients with skeletal malocclusion and its correlation with craniofacial morphology during different growth periods

The association between craniocervical posture and craniofacial structures in the various sagittal skeletal malocclusion during different growth stages has been the focus of intense interest in fields of orthodontics, but it has not been conclusively demonstrated. Thus, this study aimed to investigate the association between craniofacial morphology and craniocervical posture in patients with sagittal skeletal malocclusion during different growth periods. A total of 150 from a large pool of cephalograms qualified for the inclusion and exclusion were evaluated and classified into three groups according to the Cervical Vertebral Maturation (CVM) by examining the morphological modifications of the second through fourth cervical vertebrae, each group consisted of 50 cephalograms. In each growth period, for the comparison of head and cervical posture differences among various skeletal classes, the radiographs were further subdivided into skeletal Class I (0° < ANB < 5°, n = 16), skeletal Class II (ANB ≥ 5°, n = 18), and skeletal Class III (0° ≤ ANB, n = 16) on the basis of their ANB angle. There was no significant difference in gender (P > 0.05). Some variables were found to be significant during pubertal growth and later in patients with sagittal skeletal malocclusion (P < 0.05). Most indicators describing craniocervical posture were largest in skeletal Class II and smallest in skeletal Class III during the peak growth periods and later. Cervical inclination variables were greater in skeletal Class III than in skeletal Class II. Variables of craniofacial morphology and craniocervical posture are more correlated during the pubertal growth period and later in patients with sagittal skeletal malocclusion. A tendency is an indication of the close interrelationship that a more extended head was in skeletal Class II while a flexed head was in skeletal Class III. Nevertheless, with the considerations of some limitations involved in this study, further longitudinal studies with large samples are required to elucidate the relationship clearly.

Determination of the pubertal growth spurt by artificial intelligence analysis of cervical vertebrae maturation in lateral cephalometric radiographs

ObjectiveThis study aimed to assess the performance of a convolutional neural network (CNN) model in detecting the pubertal growth spurt by analyzing cervical vertebrae maturation (CVM) in lateral cephalometric radiographs (LCRs). Study designIn total, LCRs of patients from 6 to 17 years old were selected. Three radiologists independently and blindly classified the maturation stages on the LCRs and defined the difficulty of each classification. Subsequently, the stage and level of difficulty were determined by consensus. LCRs were distributed between training, validation, and test sets across four CNN-based models. The models’ responses were compared with the radiologists’ reference standard, and the architecture with the highest success rate was selected for evaluation. Models were developed using full and cropped LCRs with original and simplified maturation classifications. ResultsIn the simplified classification, the Inception-v3 CNN yielded accuracy of 74% and 75%, with recall and precision values of 61% and 62%, for full and cropped LCRs, respectively. It achieved 61% and 62% success rates with full and cropped LCRs, respectively, reaching 72.7% for easy-to-classify cropped cases. ConclusionOverall, the CNN model demonstrated potential for determining whether the patient's maturation status regarding the pubertal growth spurt through images of the cervical vertebrae. It may be useful as an initial assessment tool or as an aid for optimizing the assessment and treatment decisions of the clinician.

Evaluation of Bone Thickness and Density Values in Resistance Regions in Rapid Maxillary Expansion Using Computed Tomography.

This study used computed tomography (CT) to compare the bone thickness and density values around the zygomaticomaxillary, zygomaticotemporal, and pterygomaxillary sutures that are resistant to rapid maxillary expansion (RME) treatment according to age, sex, and cervical vertebrae maturation (CVM) stage. The study included 200 paranasal sinus records obtained for medical diagnosis and examination in a radiology clinic. The records provided data on 110 males and 90 females aged between 4 and 28 years. Bone thickness and density values around the zygomaticomaxillary, zygomaticotemporal, and pterygomaxillary sutures were measured using CT imaging. The correlations of bone thickness and density values with the variables of age, sex, and CVM stage were evaluated. No statistically significant difference was revealed between the bone thickness values around the zygomaticomaxillary and zygomaticotemporal sutures and age, sex, CVM stage, and the right and left regions of the same individual (P>0.05). A strong correlation was identified between Hounsfield units (Hu) values on bone density in all 3 regions and age and sex (P<0.001). No correlation was found between the CVM stage and density values around the zygomaticomaxillary, zygomaticotemporal, and pterygomaxillary sutures (P>0.05). The Hu values of the records from females were higher than those of males in all age groups. It was observed that with increasing age, bone density values increased in all 3 regions, and thus circummaxillary region's Hu value increased.

Dento-Alveolar Changes after Maxillary Hybrid Expansion and Multi-Bracket Therapy: A Comparative Study at Three Different (Vertebral) Maturation Stages

Background: Rapid maxillary expansion is a common therapy when a palatal transversal discrepancy occurs. Different anchorage solutions have been proposed to obtain an effective skeletal expansion, even for adult patients. The aim of the present research was to evaluate the dentoskeletal effects of a hybrid expander and multi-bracket therapy, considering three groups of patients with different cervical vertebral maturation (CVM) stages. Materials and Methods: The study evaluated 68 consecutively treated patients. The age of the patients varied from 7 to 27 years old (mean age 13.45). The sample was divided into the following three groups based on CVM stage at the start of treatment: Group 1 (CS1–CS2) included 21 patients (mean age 10.21, SD 1.34), Group 2 (CS3–CS4) included 28 patients (mean age 13.37, SD 1.37) and Group 3 (CS5–CS6) was composed of 19 patients (mean age 17.14, SD 3.48). Each patient underwent orthodontic therapy where the first step was a palatal expansion by means of a hybrid expander; afterwards, the therapy was completed with a multi-bracket appliance. Expansion and torque values were observed at the end of treatment on digital models. Results: Significant intragroup differences in transversal expansion were found over time for all parameters in all groups. No significant differences were found among groups for longitudinal changes. No significant differences were found among groups for longitudinal changes of torque. Conclusions: The tooth–bone-borne maxillary expander and multi-bracket produced a significant clinical expansion with negligible dental compensation. The effect of the maxillary expansion and multi-bracket therapy showed no differences among the maturation groups in regard to transversal diameter changes and torque values.

The effect of vertical skeletal proportions, skeletal maturation, and age on midpalatal suture maturation: a CBCT-based study

BackgroundMidpalatal suture (MPS) maturation may be influenced by a range of parameters including age, gender, and vertical skeletal pattern. We therefore aimed to evaluate the effect of Frankfurt-mandibular angle (FMA), skeletal maturation, and age on the timing of MPS maturation.MethodsIn this cross-sectional study, cone-beam computed tomography (CBCT) and lateral cephalograms were used to assess the MPS and cervical vertebral maturation (CVM) stage. A proportional odds logistic regression model was used to assess associations between age adjusted for gender and MPS maturation, and a regression analysis was performed to analyze the effect of vertical pattern on these associations.ResultsA total of 201 patients (84 male and 117 female) with a mean age of 13.48 (SD 1.94) were included. With increasing age, the odds of belonging to a higher maturation stage increased (OR: 2.14; 95% CI 1.789; 2.567; P < 0.001); however, no association between FMA and MPS maturation was observed (OR: 1.01; 95% CI 0.964; 1.051; P = 0.76). A strong correlation between MPS maturation and CVM stage was not reported. Males had a higher probability of belonging to a lower MPS maturation stage (OR: 0.24; 95% CI 0.136; 0.415; P < 0.001).ConclusionsBased on this cross-sectional analysis, midpalatal sutural maturation classification is associated with chronological age and occurs later in males. Neither CVM staging nor variation in vertical skeletal proportions were useful predictors of midpalatal maturation stage.

Impact of initial lip competence on the outcome of class II functional appliances therapy

ObjectivesThe aim of this prospective clinical study was to evaluate the impact of initial lip position on class II functional appliance therapy.Materials and methodsIn total, 34 class II division 1 patients (23 females, 19 males; mean age 12.4 ± 0.9 years) that met the inclusion criteria (> ½ class II molar relationship, overjet > 6 mm, ANB > 4°, neutral or horizontal growth pattern, cervical vertebral maturation stage (CVMS) II – III, mean wear-time > 10 h/day) were consecutively divided into two groups (lip incompetence (LI); lip competence (LC)). All patients were treated with the Sander bite jumping appliance (BJA). Wear time was microelectronically measured. Lateral cephalograms were taken at the beginning (T0) and after 1 year of treatment (T1). An untreated class II group served as a control (CG). Inter-group comparisons were determined with Mann–Whitney U tests for independent samples.ResultsSignificant skeletal treatment effects were found in both treated groups when compared to the CG with significantly more pronounced mandibular skeletal effects in the LI than in the LC group (mandibular base length p < 0.001, composite mandibular base length p < 0.001, condylar head growth p = 0.002, co-pg p < 0.00, go-pg p = 0.003, reduction of the ANB angle p = 0.009, and Wits appraisal p < 0.001).ConclusionThe more pronounced mandibular effects in the LI group were composed of the functional orthopedic effect plus harmonization of the lip competence.Clinical relevanceFunctional harmonization of lip incompetence with BJA enhances mandibular growth stimulation. Lip incompetence seems to impede mandibular growth and its harmonization seems to be a preventive approach.

To Evaluate Correlation Between Cervical Vertebral Maturation Stages and Third Molar Maturation Stages in North Maharashtrian Population

Introduction Assessment of growth is crucial in the diagnosis and treatment planning in orthodontics. Skeletal development can be assessed by using hand-wrist radiographs and lateral cephalograms. The advantage of the panoramic radiograph over hand wrist radiograph is that patient exposure is reduced following the ALARA principle. Aim The aim of this study was to investigate the correlation between third molar calcification stages and skeletal maturity using the CVM stages in North Maharashtrian population. Methods Dental panoramic and lateral cephalograms of subjects ranged in age from 9 to 20 years were selected. Demirjians method was used to assess the dental maturation stages of third molars on both the sides. Hassel and Farman classification was used for classifying into cervical vertebral maturation indicator stages. The collected data were statistically analyzed. Result There was a statistically significant correlation between cervical maturation stages and third molar calcification stages in North Maharashtrian population.

Evaluation of an objective staging system for assessment of cervical vertebral maturation

BackgroundThe aim of this study was to evaluate an objective method for Cervical Vertebral Maturation (CVM) staging.MethodsAn initial sample of 647 Lateral Cephalometric Radiographs (LCR) were staged according to the CVM (Baccetti et al.) by 4 examiners. The final sample (n = 394) included LCR on which the staging of the 4 investigators matched. The objective staging was performed by a single operator. The sample was divided according to the maturational stages into pre-pubertal, pubertal and post-pubertal groups. Measurements were performed on the cervical vertebrae (C2, C3 and C4). The angle between posterior and superior borders for C3 and C4 was the Superior Wall Inclination Angle (SWIA). Concavity Depth (CD) for C2, C3 and C4, and Body Shape (BS) (ratio of width to height of C3 and C4). Measurements of the 3 groups were compared.ResultsReliability of subjective staging was high (intra-observer reliability, 0.948; inter-observer reliability, 0.967). Good agreement was observed for the outcomes measured. Intra-observer reliability was good (0.918, 0.885 and 0.722 for CD, BS and SWIA, respectively). The same was for the inter-observer reliability results (0.902, 0.889 and 0.728 for CD, BS and SWIA, respectively). Significant differences were observed for mean values of SWIA and BS and median values of CD within maturational stage. Similar findings were observed when the outcomes were compared at different phases (P < 0.001).ConclusionsA standardized, objective staging system using linear, angular measurements and ratios was applied for the determination of cervical vertebral maturation.

Dentoskeletal and soft-tissue changes concurrent to use of PowerScope appliance in treatment of Class II malocclusion – A retrospective study

Objectives: The most frequently encountered malocclusion in our daily clinical practice is Class II malocclusion with mandibular retrognathism. Treatment modalities for Class II malocclusion correction depend on numerous factors such as the severity of the malocclusion and the age at which the patient reports for the treatment. One of the innovations in Class II treatment is the PowerScope appliance. The objectives of this study were: (1) To evaluate dentoskeletal changes with the use of PowerScope appliance in the treatment of Class II division I malocclusion using lateral cephalograms in late adolescents. (2) To evaluate the soft-tissue changes with the use of PowerScope appliance in the treatment of Class II division I malocclusion using lateral cephalograms in late adolescents. Materials and Methods: This retrospective and cross-sectional study was done using pre- and post-treatment lateral cephalograms of 15 patients treated with PowerScope appliance who were under decelerated growth phase as assessed by cervical vertebrae maturation index (Stages 4, 5, and 6). All the lateral cephalograms were hand traced and measured by same investigator. Results: A highly statistically significant difference was observed between the pre-and post-angle formed by sella nasion plane and nasion to point B line (SNB), angle formed by nasion to point A line and nasion to point B line (ANB), condylion to point gnathion (Co–Gn), and distance between point A to nasion perpendicular (N perpendicular to Point A) to Pog skeletal parameters. It was found that a highly significant difference was noted for parameters upper molar to palatal plane (U6-PP), lower incisor to nasion to point B line (L1-NB), lower incisor to nasion to point B line (L1-NB*), lower incisor to mandibular plane angle (IMPA), and upper molar to pterygoid vertical line (U6-PTV). A significant difference was present for parameters upper incisor to nasion to point A line (U1-NA), while no difference was observed for upper incisor to sella nasion plane (U1-SN) and upper molar to pterygoid vertical line (U6-PTV). A significant statistical difference was observed between the pre-and post-lower lip to E line parameter. Conclusion: PowerScope caused significant skeletal changes by forward repositioning of the mandible as well as by an increase in the length of the mandible. There was significant retrusion of upper incisors and a highly significant increase in lower incisor protrusion, lower molar mesialization, and upper molar intrusion. Soft-tissue lower lip protrusion was significant.

Skeletal and dental effects of function-generating bite appliance compared to rapid palatal expander and untreated controls.

Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function-generating bite type M (FGB-M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. One hundred eighty-one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB-M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre-treatment (T0) and post-treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1-T0 interval was of 17.3 months (RPE), 24.6 months (FGB-M) and 18.2 months (controls). The statistical analysis showed that there were no statistically significant differences between the RPE and FGB-M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. The comparison between patients treated with RPE and FGB-M showed that there were no statistically significant differences between the RPE and FGB-M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results.

Dental and skeletal maturation of Chinese male children with unilateral cleft lip and palate.

The aim of this study was to determine whether the relationship between dental age (DA), cervical stage (CS) and chronological age (CA) in Chinese male children with unilateral cleft lip and palate (UCLP) is similar to that of children without clefts. Panoramic and cephalometric radiographs of 105 male UCLP patients, aged from 8 to 16 years, were collected and compared to 210 age-matched healthy control males. The Demirjian and cervical vertebral maturation (CVM) methods were used to visually examine the radiographs and Spearman's correlation analysis was used to identify differences between the two groups with regards to CS, DA and CA. There was a significant positive correlation between DA and CA in both groups and the mean CA-DA difference was significantly higher in children with UCLP when compared to controls (0.319 vs. 0.003, p < 0.05). A significant delay in tooth development was detected in UCLP children from 10 to 12 years-of-age. Both the UCLP and control groups showed high correlations between CS and DA. Calcification stage D appeared only before CS3; however, from CS5 to 6, all teeth have almost completed their maturation phase. Chinese male UCLP patients are likely to experience delayed tooth development compared to healthy controls, especially during the fast-growing period. Evaluating the stages of tooth mineralization could represent a rapid method to assess growth potential.