Three-dimensional changes of the upper airway in patients with Class II malocclusion treated with the Herbst appliance: A cone-beam computed tomography study

INTRODUCTION

This study aimed to determine the volumetric effects on the upper airways of growing patients with Class II malocclusion treated with the Herbst appliance (HA).

METHODS

Volumetric measurements of the upper airways of 42 skeletal Class II malocclusion patients (mean age: 13.8 ± 1.2 years; ranging from 12.0 to 16.9 years) were assessed using cone-beam computed tomography scans acquired before treatment (T0) and approximately 1 year later (T1). The sample comprised a Herbst appliance group (HA group [HAG]; n = 24), and a comparison group (comparison group [CG]; n = 18) of orthodontic patients who had received dental treatments other than mandibular advancement with dentofacial orthopedics.

RESULTS

In CG, nasopharynx and oropharynx volumes decreased slightly during the observation period (9% and 3%, respectively), whereas the nasal cavity volume increased significantly (12%; P = 0.046). In HAG, there was an increase in the volume of all regions (nasal cavity, 5.5%; nasopharynx, 11.7%; and oropharynx, 29.7%). However, only the oropharynx showed a statistically significant increase (P = 0.003), presenting significant volumetric changes along the time (T1-T0) in HAG.

CONCLUSION

Mandibular advancement with the HA significantly increased the volume of the oropharynx, but no significant volumetric modifications were observed in the nasal cavity and nasopharynx.

Bracket bonding to polymethylmethacrylate-based materials for computer-aided design/manufacture of temporary restorations: Influence of mechanical treatment and chemical treatment with universal adhesives

Objective

To assess shear bond strength and failure mode (Adhesive Remnant Index, ARI) of orthodontic brackets bonded to polymethylmethacrylate (PMMA) blocks for computer-aided design/manufacture (CAD/CAM) fabrication of temporary restorations, following substrate chemical or mechanical treatment.

Methods

Two types of PMMA blocks were tested: CAD-Temp® (VITA) and Telio® CAD (Ivoclar-Vivadent). The substrate was roughened with 320-grit sandpaper, simulating a fine-grit diamond bur. Two universal adhesives, Scotchbond Universal Adhesive (SU) and Assure Plus (AP), and a conventional adhesive, Transbond XT Primer (XTP; control), were used in combination with Transbond XT Paste to bond the brackets. Six experimental groups were formed: (1) CADTemp®/SU; (2) CAD-Temp®/AP; (3) CAD-Temp®/XTP; (4) Telio® CAD/SU; (5) Telio® CAD/AP; (6) Telio® CAD/XTP. Shear bond strength and ARI were assessed. On 1 extra block for each PMMA-based material surfaces were roughened with 180-grit sandpaper, simulating a normal/medium-grit (100 mm) diamond bur, and brackets were bonded. Shear bond strengths and ARI scores were compared with those of groups 3, 6.

Results

On CAD-Temp® significantly higher bracket bond strengths than on Telio® CAD were recorded. With XTP significantly lower levels of adhesion were reached than using SU or AP. Roughening with a coarser bur resulted in a significant increase in adhesion.

Conclusions

Bracket bonding to CAD/CAM PMMA can be promoted by grinding the substrate with a normal/medium-grit bur or by coating the intact surface with universal adhesives. With appropriate pretreatments, bracket adhesion to CAD/CAM PMMA temporary restorations can be enhanced to clinically satisfactory levels.

A multilevel analysis of craniofacial growth in subjects with untreated Class III malocclusion

OBJECTIVE

To analyse the craniofacial growth of a long-term semi-longitudinal sample of Caucasian subjects with untreated Class III malocclusion.

SETTING AND SAMPLE POPULATION

A total of 144 Caucasian subjects (of North American and Italian origin) with untreated Class III malocclusion.

MATERIALS AND METHODS

Subjects aged 2 years and 9 months up to 21 years and 7 months were selected. A multilevel model was used to calculate growth curves for ten variables for both each individual subject and for the whole sample.

RESULTS

There was a statistically significant increase for total mandibular length (Co-Gn. T2-T1 = 8.4 mm), midfacial length (Co-A. T2-T1 = 3.4 mm) and lower anterior facial height (ANS-Me. T2-T1 = 3.8 mm). The multilevel analysis showed two points of acceleration of growth (about 3-5 years of age and 11-15 years of age) for seven out of ten variables. For Co-Gn and Co-A variables, males presented points of maximum growth delayed by 1 year in comparison with females, with a greater duration (1 year longer) and a greater total growth of about 5 mm. Active mandibular growth continued for a long time after the pubertal spurt: increases in mandibular length ended at about 17 years of age in females and at 21 years and 7 months in males.

CONCLUSIONS

Untreated Class III malocclusion showed a specific growth curve, especially for the mandible, whose excesses added up over time. In males, the amounts of mandibular and midfacial growth during the whole observation time were greater and lasted longer than in females.

Three-dimensional comparison of the skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed appliances: A CBCT study

OBJECTIVES

To compare three-dimensional (3D) skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed orthodontic treatment in growing patients.

SETTING AND SAMPLE POPULATION

A sample of 35 adolescents with cone-beam computed tomography scans obtained prior to Herbst and Pendulum treatment (T1) and immediately after fixed appliance treatment (T2).

MATERIALS AND METHODS

Patients with Class II malocclusion was assessed retrospectively and divided into two treatment groups: Herbst group (n = 17, age: 12.0 ± 1.6 years) and Pendulum group (n = 18, age: 12.1 ± 1.5 years), with a mean treatment duration of 2.8 ± 0.8 years and 2.5 ± 0.7 years, respectively. Reconstructions of the maxillomandibular and dentoalveolar regions and data in 3D were obtained relative to cranial base, maxillary and mandibular regional superimpositions. Treatment outcomes (T2-T1) were compared between both groups using t tests for independent samples (P<.05).

RESULTS

Significant increase in mandibular length was observed in the Herbst group (7.3 ± 3.5 mm) relative to the Pendulum group (4.6 ± 4.5 mm). Inferior and anterior displacements of Pogonion were 2.2 mm and 1.6 mm greater in the Herbst group, respectively. The mesial displacement of the lower first molars was significantly greater in the Herbst group (1.9 mm). The upper first molars had contrasting results in sagittal displacement, with 0.6 ± 1.7 mm of distal displacement with the Pendulum and 1.4 ± 2.1 mm of mesial displacement with the Herbst. Lower incisor projection and proclination were similar between groups.

CONCLUSIONS

The Herbst and Pendulum appliances followed by comprehensive orthodontic treatment effectively corrected Class II malocclusion in growing patients, but with differing skeletal and dentoalveolar effects.

Condyle-glenoid fossa relationship after Herbst appliance treatment during two stages of craniofacial skeletal maturation: A retrospective study

OBJECTIVES

To perform a three-dimensional evaluation of the position of the condyles in patients treated with Herbst appliance (HA) in two stages of cervical vertebral maturation.

SETTING AND SAMPLE POPULATION

Retrospective case-control study. Pubertal Herbst group (PHG; n = 24, mean age 14.5 years, CS 3 and CS 4) and pre-pubertal Herbst group (PPHG; n = 17, mean age 9.9 years, CS 1 and CS 2) were contrasted with comparison groups of non-orthopaedically treated Class II patients in pubertal (PCG; n = 17, mean age 13.9 years) and pre-pubertal maturational stages (PPCG; n = 18, mean age 10.6 years).

MATERIALS AND METHODS

Cone-beam computer tomography scans were taken before treatment (T0) and at T1 after 8 to 12 months. Point-to-point measurements of the displacement of the condyles between T0 and T1, relative to the glenoid fossae, were performed in the X, Y, Z and 3D perspectives. Qualitative assessments using semi-transparent overlays and colour mapping also were produced.

RESULTS

The displacement of the condyles within the glenoid fossae in the treated groups was small (<0.75 mm; P > .05). Relative to the glenoid fossa, condylar position at T1 was similar to T0 in pre-pubertal and pubertal groups (P > .05). Similar condylar rotations from T0 to T1 were observed in Herbst and comparison groups, and no significant difference was found between pre-pubertal and pubertal patients.

CONCLUSIONS

Regardless the stage of skeletal maturation, HA treatment did not change the condyle-glenoid fossa relationship.

Treatment effects of the Carriere® Motion 3D™ appliance for the correction of Class II malocclusion in adolescents

OBJECTIVES

To determine the treatment effects produced in Class II patients by the Carriere^® Motion 3D™ appliance (CMA) followed by full fixed appliances (FFA).

MATERIALS AND METHODS

This retrospective study evaluated 34 adolescents at three time points: T1 (pretreatment), T2 (removal of CMA), and T3 (posttreatment). The comparison group comprised 22 untreated Class II subjects analyzed at T1 and T3. Serial cephalograms were traced and digitized, and 12 skeletal and 6 dentoalveolar measures were compared.

RESULTS

Phase I with CMA lasted 5.2 ± 2.8 months; phase II with FFA lasted 13.0 ± 4.2 months. CMA treatment restricted the forward movement of the maxilla at point A. There was minimal effect on the sagittal position of the chin at pogonion. The Wits appraisal improved toward Class I by 2.1 mm during the CMA phase but not during FFA. Lower anterior facial height increased twice as much in the treatment group as in controls. A clockwise rotation (3.9°) of the functional occlusal plane in the treatment group occurred during phase I; a substantial rebound (-3.6°) occurred during phase II. Overjet and overbite improved during treatment, as did molar relationship; the lower incisors proclined (4.2°).

CONCLUSIONS

The CMA appliance is an efficient and effective way of correcting Class II malocclusion. The changes were mainly dentoalveolar in nature, but some skeletal changes also occurred, particularly in the sagittal position of the maxilla and in the vertical dimension.

Development and validation of a prediction model for long-term unsuccess of early treatment of Class III malocclusion

Aim

To develop and validate a prediction model to forecast long-term stability of early treatment with rapid maxillary expansion (RME) and facemask (FM) in a large sample of Class III growing patients.

Methods

The Brazilian Group (BG) consisted of 73 consecutively treated Caucasian Class III patients (41 females and 32 males). Mean age at T0 (before treatment) was 7.1 ± 1.6 years, while mean age at T1 (long-term follow-up) was 21.8 ± 3.2 years. The Italian Group (IG, validation cohort) comprised 28 consecutively treated Caucasian Class III patients (14 females and 14 males, mean age at T0 9.0 ± 1.3 years and mean age at T1 18.2 ± 1.4 years). Cephalometric analysis was performed on lateral cephalograms at T0. Gender and cephalometric variables, chronologic age, and dentition phase at T0 were used as predictors for long-term unsuccessful treatment at T1. All predictors for unsuccessful treatment in the BG were subjected to bivariate logistic regression. Only those statistically significant predictors in the bivariate logistic regression entered mixed stepwise logistic regression with P = 0.05 to enter and to leave. The validity of the prediction model derived from the BG was then tested on the IG.

Results

The prediction model consisted of only one cephalometric variable: the angle between the Condylar Axis and the Mandibular Plane (CondAx–MP) (odds ratio: 1.52, 95% confidence interval: 1.25–1.85, P &lt; 0.0001). Unsuccessful treatment at T1 was predicted for values of CondAx–MP at T0 greater than the cut-off value of 147.8 degrees. BG patients predicted incorrectly were 3 out of 22 for the unsuccessful cases and 1 out of 51 for the successful cases. Therefore, accuracy was 0.95, sensitivity 0.86, specificity 0.98, and positive and negative predictive values were 0.95 and 0.94. When the predictive model was applied on IG, all five unsuccessful cases were predicted correctly, while only 1 out of 23 successful patients was predicted incorrectly.

Conclusion

CondAx-ML was identified as a reliable predictor for long-term stability of early Class III treatment with RME and FM.

Soft tissue facial profile in Class III malocclusion: long-term post-pubertal effects produced by the Face Mask Protocol

Objectives

The objective of this study was to analyze soft tissue changes produced by rapid maxillary expansion and facial mask therapy in growing Class III patients.

Materials

The treated group consisted of 32 Caucasian patients (15 females and 17 males) with dentoskeletal Class III malocclusion treated with the Face Mask Protocol (FMP, rapid maxillary expander, facial mask, and removable lower bite-block). All patients were evaluated before treatment (T1; mean age, 8.4 years), at the end of active treatment (T2; mean age, 10.7 years), and at a post-pubertal follow-up observation (T3; mean age, 15.8 years). The treated group was compared with a matched control group of 20 untreated subjects (10 females and 10 males) with dentoskeletal Class III malocclusion. Statistical comparisons between two groups were performed with the independent samples t-test (P < 0.05).

Results

Significant improvements were found during the long-term T1–T3 interval for profile facial angle (–5.8°), nasolabial angle (–4.4°), mandibular sulcus (–10.3°), upper lip protrusion (+0.7 mm), and lower lip protrusion (–1.1 mm) in the treated group. No significant post-pubertal effects were found in terms of lower face percentage between two groups.

Limitations

This study has a retrospective design and it used a historical control sample.

Conclusion

The FMP induced positive effects on soft tissue facial profile with a good long-term post-pubertal stability.

Proteomic analysis of gingival crevicular fluid for novel biomarkers of pubertal growth peak

Background

Detection of pubertal growth peak is vital in orthodontic treatment timing and planning. Gingival crevicular fluid (GCF) contains abundant proteins from different sources and is an ideal source of biomarkers. The aim of this research is to detect candidate GCF biomarkers of pubertal growth by tandem mass tags (TMT) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) to help diagnosis and treatment planning of functional treatment.

Methods

Forty subjects were recruited and were divided into pubertal and post-pubertal groups according to cervical vertebral maturation method. GCF samples were collected by paper points. GCF proteome of pubertal and post-pubertal subjects was compared by TMT labelling coupled with LC-MS/MS.

Results

A total of 537 proteins were detected in GCF samples, with 183 proteins detected in GCF for the first time. These proteins were involved in processes of immune response, ion transport, and signal transduction. The GCF concentration of vitamin D binding protein (DBP) and seroserotransferrin (Tf) was significantly higher in pubertal than that in post-pubertal subjects. DBP and Tf, therefore, were considered to be candidate biomarkers of pubertal growth. This result was validated using GCF samples from new subjects (P < 0.05).

Conclusion

Our results indicate that TMT labelling coupled with LC-MS/MS were proved to be a useful method for proteomic analysis of GCF with high accuracy. The expression of DBP and Tf was increased in children at circumpubertal stage and can be considered candidate biomarkers of pubertal growth.

Transverse relationship of permanent molars after crossbite correction in deciduous dentition

Objective

To evaluate the transverse relationships of the first permanent molars after the correction of posterior crossbite performed during the deciduous dentition with two different treatment protocols.

Materials/methods

Ninety patients (40 males and 50 females) with posterior crossbite were treated during the deciduous dentition with either a removable expansion plate (RP group, 60 patients) or rapid maxillary expander (RME group, 30 patients). The dental casts before treatment (T0, mean age 5.1 ± 0.7 years) and after treatment, when the first permanent molars were fully erupted, (T1, mean age 7.7 ± 1.0 years) were analysed. The prevalence rates for posterior crossbite on the first permanent molars in the two groups were compared by means of chi-squared test with Yates correction. A logistic regression was performed to evaluate the factors that could influence the presence/absence of posterior crossbite on the first permanent molars.

Results

Prevalence rate of posterior crossbite on the first permanent molars at T1 was 34.4 per cent in the total sample, 28.3 per cent for the RP group and 46.6 per cent for the RME group. No significant predictors for the 'presence/absence of posterior crossbite on the first permanent molars' at T1 were found.

Limitations

Retrospective study.

Conclusions

After treatment of posterior crossbite during the deciduous dentition phase, the first permanent molars erupted in crossbite in the 34.4 per cent of the cases. The type of treatment is not a significant predictor for the presence of posterior crossbite on the first permanent molars.

Morphometric covariation between palatal shape and skeletal pattern in Class II growing subjects

Objectives

To evaluate the patterns of covariation between palatal and craniofacial morphology in Class II subjects in the early mixed dentition by means of geometric morphometrics.

Methods

A cross-sectional sample of 85 Class II subjects (44 females, 41 males; mean age 8.7 years ± 0.8) was collected retrospectively according to the following inclusion criteria: European ancestry (white), Class II skeletal relationship, Class II division 1 dental relationship, early mixed dentition, and prepubertal skeletal maturation. Pre-treatment digital 3D maxillary dental casts and lateral cephalograms were available. Landmarks and semilandmarks were digitized (239 on the palate and 121 on the cephalogram) and geometric morphometric methods (GMM) were applied. Procrustes analysis and principal component analysis (PCA) were performed to reveal the main patterns of palatal shape and craniofacial skeletal shape variation. Two-block partial least squares analysis (PLS) assessed patterns of covariation between palatal morphology and craniofacial morphology.

Results

For the morphology of the palate, the first principal component (PC1) described variation in all three dimensions. For the morphology of the craniofacial complex, PC1 showed shape variation mainly in the vertical direction. Palatal shape and craniofacial shape covaried significantly (RV coefficient: 0.199). PLS1 accounted for more than 64 per cent of total covariation and related divergence of the craniofacial complex to palatal height and width. The more a Class II subject tended towards high-angle divergence, the narrower and higher was the palate.

Conclusions

Class II high-angle patients tended to have narrower and higher palates, while Class II low-angle patients were related to wider and more shallow palates.

Three-dimensional assessment of the middle cranial fossa and central skull base following Herbst appliance treatment

OBJECTIVES:

The purpose of this three-dimensional (3D) study was to assess retrospectively the middle cranial fossa and central skull base of patients treated with the Herbst appliance (HA).

MATERIALS AND METHODS:

3D surface virtual models of 40 Class II, division 1 malocclusion patients were generated from cone-beam computed tomography (CBCT) acquired before treatment (T0) and after 8 months of HA treatment (T1). T0 and T1 3D models were superimposed volumetrically at the anterior cranial fossa. Twenty subjects who had been treated with the Herbst appliance (HAG) were compared to 20 subjects who were not treated orthopedically. The latter group served as a comparison control group (CG). Quantitative assessments of the location and directional changes were made with linear and angular measurements between anatomical landmarks. Qualitative assessments of the spatial behavior of the middle cranial fossa and central skull base relative to the anterior cranial fossa were displayed graphically for visualization with color maps and semitransparent overlays. Non-parametric tests were performed to compare the between the HAG and CG.

RESULTS:

Point-to-point linear measurements and skeletal rotation (pitch, roll, and yaw) changes were very small along the observational period and were not significantly different between HAG and CG. Visual analysis of color maps and overlays confirmed that no changes in the cranial base were associated with HA.

CONCLUSIONS:

HA therapy did not produce clinically significant changes in the middle cranial fossa and central skull base.

Post-orthodontic lower incisor inclination and gingival recession-a systematic review

BACKGROUND

The present systematic review was carried out to determine the correlation between gingival recession/bone height and incisor inclination in non-growing post-orthodontic patients compared to adult untreated subjects or patients treated with different methodologies.

MATERIALS AND METHODS

PubMed, EMBASE, Web of Science, Scopus, Cochrane, and OpenGrey databases were searched without time and language restriction. Search terms included orthodontic, incisor, inclination, angulation, proclination, and gingival. Articles involving human participants and adult subjects receiving orthodontic treatment with fixed appliance, having incisors position, bone height and/or gingival recessions evaluated pre- and post-treatment were included. Two authors independently extracted data using predefined forms. Risk of bias in individual studies was assessed with the Newcastle-Ottawa Scale.

RESULTS

Two observational studies were included in the qualitative analysis. The heterogeneity in outcome assessment among the studies did not allow performing a meta-analysis. The two studies, while observing some effects of orthodontic treatment on the development of gingival recession, reported that these effects were not statistically or clinically significant.

CONCLUSIONS

There is no strong scientific evidence concluding that proclination of incisors by means of fixed orthodontic appliances can affect periodontal health. Further prospective studies are required to elucidate this statement.

PROTOCOL

PROSPERO database registration number CRD42016042369 .

Long-term evaluation of rapid maxillary expansion and bite-block therapy in open bite growing subjects: A controlled clinical study

OBJECTIVE

To evaluate the long-term effects of rapid maxillary expansion (RME) and posterior bite block (BB) in prepubertal subjects with dentoskeletal open bite.

MATERIALS AND METHODS

The treatment group (TG) comprised 16 subjects (14 girls, 2 boys) with dentoskeletal open bite with a mean age of 8.1 ± 1.1 years treated with RME and BB. Three consecutive lateral cephalograms were available before treatment (T1), at the end of the active treatment with the RME and BB (T2), and at a follow-up observation at least 4 years after the completion of treatment (T3). The TG was compared with a control group (CG) of 16 subjects (14 girls, 2 boys) matched for sex, age, and vertical skeletal pattern. An independent sample t-test was used to compare the T1 to T3, T1 to T2, and T2 to T3 cephalometric changes between the TG and the CG.

RESULTS

In the long term, the TG showed a significantly greater increase in overbite (+1.8 mm), reduced extrusion of maxillary and mandibular molars (-3.3 mm), and, consequently, a significant decrease in facial divergence (-2.8°) when compared with untreated subjects.

CONCLUSIONS

The RME and BB protocol led to successful and stable recovery of positive overbite in 100% of the patients considered. Correction of open bite was associated with reduced extrusion of maxillary and mandibular molars with a significant improvement in vertical skeletal relationships when compared with the CG.

A cephalometric study of the skeletal and dento-alveolar effects of the modified Louisiana State University activator in Class II malocclusion

Objectives

To analyse the skeletal and dento-alveolar effects of the modified Louisiana State University activator (MLSUA) in Class II treatment.

Materials and methods

A test group of 46 participants (25 females, 21 males) with Class II malocclusion treated with MLSUA followed by fixed appliances was compared with a matched Class II control group. Lateral cephalograms were taken at T1 (initial records), T2 (completion of MLSUA treatment), and T3 (before deband). The participants were also divided into two groups: pre-pubertal and pubertal according to skeletal maturity and three groups of different vertical facial patterns at the start of the treatment: brachyfacial, mesofacial, and dolichofacial. Statistical comparisons were performed with t-tests and analysis of variance (ANOVA).

Results

Statistically significant supplementary mandibular growth (Co-Gn) in the test group (2.6 mm) was associated with improvement of overjet (OJ), overbite (OB), and molar relationship. Short-term mandibular growth was greater in pubertal than pre-pubertal groups (2.4 mm, P < 0.05). Mandibular incisors retroclined by 2.1 degrees after MLSUA treatment. The brachyfacial group showed greater reduction in the ANB angle and forward movement of pogonion. Mandibular, palatal, and occlusal plane angles showed insignificant change regardless of the facial type.

Conclusions

MLSUA treatment corrected the Class II malocclusion by accelerating mandibular growth in the short-term with minimal dento-alveolar compensation, and the correction was maintained before deband. The treatment may be more effective if started at puberty. The mandibular, palatal, and occlusal planes remained stable throughout the treatment. Brachyfacial patients showed more favourable horizontal growth.

Three-dimensional skeletal mandibular changes associated with Herbst appliance treatment

OBJECTIVES

Three-dimensional evaluation of skeletal mandibular changes following Herbst appliance treatment.

SETTING AND SAMPLE POPULATION

Retrospective case-control study, based on a sample size calculation. Twenty-five pubertal patients treated with Herbst appliance (HAG), and 25 matched Class II patients who received other non-orthopaedic dental treatments (CG).

MATERIAL AND METHODS

Three-dimensional models were generated from pre-treatment (T0) and post-treatment (T1) cone beam computed tomograms. Volumetric registration on the cranial base was used to assess mandibular displacement; volumetric regional registration was performed to evaluate mandibular growth. Quantitative measurements of X, Y, Z and 3D Euclidian changes, and also qualitative visualization by colour-mapping and semi-transparent overlays were obtained.

RESULTS

Downward displacement of the mandible was observed in both HAG and CG (2.4 mm and 1.5 mm, respectively). Significant forward displacement of the mandible was observed in the HAG (1.7 mm). HAG showed greater 3D superior and posterior condylar growth than the CG (3.5 mm and 2.0 mm, respectively). Greater posterior growth of the ramus was noted in the HAG than in CG.

CONCLUSIONS

Immediately after Herbst therapy, a significant mandibular forward displacement was achieved, due to increased bone remodelling of the condyles and rami compared to a comparison group. Three-dimensional changes in the direction and magnitude of condylar growth were observed in Herbst patients.

Zygomaticomaxillary suture maturation: A predictor of maxillary protraction? Part I - A classification method

OBJECTIVE

The aim of this study was to present a method of classifying the maturational level of the zygomaticomaxillary sutures (ZMSs).

METHODS

Cone-beam CT (CBCT) images from 74 subjects (5.6-58.4 years) were examined to define the radiographic stages of ZMS maturation. Five stages of maturation of the ZMS were identified and defined: Stage A-uniform high-density sutural line, with no or little interdigitation; Stage B-scalloped appearance of the high-density sutural line; Stage C-two parallel, scalloped, high-density lines, separated in some areas by small low-density spaces; Stage D-fusion in the inferior portion of the suture; and Stage E-complete fusion. Intra- and inter-examiner agreements were evaluated by weighted kappa tests.

RESULTS

The intra- and inter-examiners reproducibility values demonstrated substantial to almost perfect agreement. No fusion of ZMSs was observed in patients up to 10 years of age. From 10 to 15 years, all maturational stages were identified. After 15 years of age, the majority of patients showed fusion of ZMSs.

CONCLUSIONS

The classification of ZMS maturation using CBCT is a reliable method that allows the assessment of the morphology of the ZMSs in the individual patient.

Staging hand-wrist and cervical vertebrae images: a comparison of reproducibility

OBJECTIVES

The aim of this study was to compare the reproducibility of skeletal maturation assessments by raters with similar orthodontic experience using hand-wrist (HW) and cervical vertebral maturation (CVM) methods.

METHODS

HW and lateral cephalometric radiographs from 15 subjects (8 males and 7 females; ages, 9-16 years) were selected randomly. HW skeletal maturation was evaluated by the method of Greulich and Pyle, and CVM staging was evaluated by the method of Baccetti et al. Six orthodontic residents evaluated all images at three time periods: T₁, initial evaluation; T₂, re-evaluation after 7 days and T₃, final evaluation after 5 weeks. Intra- and interexaminer reproducibility was evaluated with the intraclass correlation coefficient; the limits of agreement (LoA) were determined by using the Bland-Altman method.

RESULTS

The intraexaminer reliability assessed by intraclass correlation coefficient was scored as good for both of methods (T₁-T₂-T₃ HW = 0.89 and CVM = 0.80; T₁-T₂ HW = 0.87 and CVM = 0.77; T₂-T₃ HW0 = 0.90 and CVM = 0.81), as well as the interexaminer evaluation, with the exception of HW-T₁, which scored excellent (0.92). The width of LoA from Bland-Altman plot of cervical vertebra method was narrower (CVM T₁-T₂: -2.3 and +1.8; CVM T₂-T₃: -2.0 and +2.0) than the HW method (HW T₁-T₂: -3.9 and +4.8; HW T₂-T₃: -4.0 and +3.5).

CONCLUSIONS

Both HW and CVM methods presented good reproducibility for intra- and interexaminer correlation assessments. The small LoA indicated that the CVM is a reproducible method.

The cervical vertebral maturation method: A user's guide

The cervical vertebral maturation (CVM) method is used to determine the craniofacial skeletal maturational stage of an individual at a specific time point during the growth process. This diagnostic approach uses data derived from the second (C2), third (C3), and fourth (C4) cervical vertebrae, as visualized in a two-dimensional lateral cephalogram. Six maturational stages of those three cervical vertebrae can be determined, based on the morphology of their bodies. The first step is to evaluate the inferior border of these vertebral bodies, determining whether they are flat or concave (ie, presence of a visible notch). The second step in the analysis is to evaluate the shape of C3 and C4. These vertebral bodies change in shape in a typical sequence, progressing from trapezoidal to rectangular horizontal, to square, and to rectangular vertical. Typically, cervical stages (CSs) 1 and CS 2 are considered prepubertal, CS 3 and CS 4 circumpubertal, and CS 5 and CS 6 postpubertal. Criticism has been rendered as to the reproducibility of the CVM method. Diminished reliability may be observed at least in part due to the lack of a definitive description of the staging procedure in the literature. Based on the now nearly 20 years of experience in staging cervical vertebrae, this article was prepared as a "user's guide" that describes the CVM stages in detail in attempt to help the reader use this approach in everyday clinical practice.