Human growth and development are not uniform
at various developing maturational stages.
Onset of puberty varies with sex, population and
Indicators to determine growth potential in adolescents:
sexual maturation charecteristics
Hand wrist radiographs have been used widely as a
reliable analysis to establish skeletal age.
Unfortunately, the hand-wrist method requires
additional radiation exposure when used in
orthodontic treatment planning.
In 1972 Lamparski created the first standards of
cervical vertebral maturation as related to
chronological age and to skeletal maturation as
observed on hand-wrist radiographs.
O’Reilly and Yanniell in 1988, Franchi et al in 2000,
and Baccetti et al in 2005 demonstrated that the
greatest increase in mandibular length occurred
during the pubertal growth spurt and that this could
be assessed during the interval between CS3 and CS4.
The literature provides indications about the duration
of the pubertal peak –
Class I occlusions,
Class III malocclusion.
This study evaluates the duration of the pubertal
growth spurt in subjects with Class III malocclusion vs
subjects with normal occlusion by using a reliable
indicator of skeletal maturity (CVM method).
Cephalograms of good quality.
No previous orthodontic treatment.
No congenitally missing or extracted teeth.
No systematic diseases that could have affected general
Skeletal Class I or III, with the diagnosis based on the
A-N-Pog angle by Bjork analysis (Class I= -0.50 < A-NPog < 40; Class III = A-N-Pog < -0.5)
Vertical skeletal relationship (NL/ML angle by Bjork
analysis) ranging from 190 to 330
Skeletal stages CS3 or CS4 based on the CVM method.
MATERIALS AND METHOD
The lateral cephalograms of 900 orthodontically
untreated subjects, ages 8 through 18 years, were
The CVM stage on each radiograph was assessed
according to the method of Baccetti et al, and skeletal
class was assessed according to Bjork’s cephalometric
The lateral cephalograms were analyzed on a
conventional viewing screen and traced on acetate by
the two observers.
The measurements were made with mutual agreement
between the two operators.
The final sample consisted of 218 subjects
125- male subjects
CS3 - 113 cephalograms:
67 Class I subjects : 28 –female
39 - male
46 Class III subjects : 27 - female
19 - male
CS4 - 105 cephalograms :
56 Class I subjects : 34 – female
22 – male
40 Class III subjects : 36 female
The variable ‘‘age’’ was tested with the Shapiro-Wilks
test to confirm normal distribution and Levene’s
analysis of variance exploratory test for confirmation
No statistical significance was assessed.
Student T-tests for independent samples (P < .05) were
used to compare the age intervals between CS3 and
CS4 in the Class I vs Class III subjects as
No statistically significant differences in the duration of
the CS3–CS4 interval were observed between genders.
Class III CS3
Average Duration of the Pubertal Peak Interval in the
The CS3–CS4 age interval was significantly longer
(P < .001) in Class III subjects than in Class I subjects
The effect size was larger than two, which means that
the average effect was much greater than the inter
individual variability expressed by the average
skeletal Class I and Class III
The significant difference in duration of the pubertal
peak between Class I and Class III groups is approximately 5 months
(P < .001).
This study obtains information about the duration of
the pubertal peak in untreated persons with Class III
skeletal relationships when compared to those with
normal skeletal relationships.
Reyes et al reported that, in those with a Class III
malocclusion, the largest ‘‘increase’’ in mandibular
length occurred - 1 year later in both sexes with Class III
skeletal relationships than it did in those with Class I
In the current investigation the average chronological
age at onset of the pubertal peak was similar for both
skeletal Class I and Class III subjects
Average chronological age was 11 years 5 months
However, the pubertal growth spurt interval ended
earlier for skeletal Class I subjects (average age of 12
years 3 months) than in skeletal Class III subjects
(average age of 12 years 9 months).
the pubertal peak for Class I subjects lasted 11 months
whereas in subjects with Class III malocclusion it
lasted for a longer period (16 months)
The increased mandibular length in Class III persons
at the pubertal growth spurt25 could be linked to the
longer duration of the pubertal peak in these subjects.
The average time of onset of pubertal peak in both
Class I and Class III subjects is similar: 11 years and 5
In Class I subjects, the interval between CS3 and CS4
(duration of pubertal peak) lasts 11 months, whereas it
lasts 16 months in skeletal Class III malocclusion.
The greater increase in mandibular length in Class III
subjects compared to that in Class I subjects during
puberty might be associated with the longer duration
of the pubertal peak in Class III subjects
This study deals with the growth changes of japanease
face associated with mandibular prognathism during
3yrs after the pubertal peak.
This investigation was based on serial lateral
Cephalometric roentgenograms of prognathic normal
Maturational stages of the pubertal growth were
determined individually by the ossification events
taken from hand-wrist radiographs.
Acc. To Grave and others, peak stages of pubertal
growth spurt was determined to occur shortly before
the appearance of the epiphyseal capping on its
diaphysis at the distal phalanges of fingers and radius.
3 groups were taken.each consisted of 3yr interval set
of lateral head films, which were taken at the ages of 15
and 18 for male and 14 &17 for female subjects.
Normal group exhibited excellent or mild class I
malocclusion. This was control group in the study.
Results indicate that the morphological characteristics
of the mandibular prognathism, which are established
before the pubertal growth peak, are strongly
maintained during the period studied.
Mandibular prognathism seems to show a manner of
growth change fairly similar to that of the normal after
the pubertal growth peak.
An Improved Version of the
Cervical Vertebral Maturation
(CVM) Method for the Assessment
of Mandibular Growth
Tiziano Baccetti, DDS, PhDa; Lorenzo Franchi,
DDS, PhDa; James A. McNamara Jr, DDS, PhDb
Angle Orthodontist, Vol 72, No 4, 2002
The morphology of the bodies of the second (odontoid
process, C2), third (C3), and fourth (C4) cervical
vertebrae were analyzed in six consecutive
cephalometric observations (T1 through T6) of 30
orthodontically untreated subjects.
Observations for each subject consisted of two
consecutive cephalograms comprising the interval of
maximum mandibular growth (as assessed by means
of the maximum increment in total mandibular
length, Co-Gn), together with two earlier consecutive
cephalograms and two later consecutive cephalograms.
The construction of the new version of the CVM
method was based on the results of both ANOVA for
repeated measures with post-hoc Scheffe´’s test (P<
.05) and discriminant analysis.
The new CVM method presents with five maturational
stages (Cervical Vertebral Maturation Stage [CVMS] I
through CVMS V, instead of Cvs 1 through Cvs 6 in the
former CVM method).
The peak in mandibular growth occurs between CVMS
II and CVMS III, and it has not been reached without
the attainment of both CVMS I and CVMS II. CVMS V
is recorded at least two years after the peak.
The advantages of the new version of the CVM method
are that mandibular skeletal maturity can be appraised
on a single cephalogram and through the analysis of
only the second, third, and fourth cervical vertebrae,
which usually are visible even when a protective
radiation collar is worn.
This study was to determine the validity of cervical
vertebrae radiographic assessment to predict skeletal
Left hand-wrist and lateral cephalometric radiographs
of 958 Spanish children from age of 5-18 yr were
Classification of Grave and Brown was used to assess
Lateral cephalograms were evaluated using the stages
described by Lamparski and Hassel and Farman.
A new method to evaluate the cervical maturation by
studying the changes in the concavity of the lower
border , height, and shape of vertebral body was
A good correlation was found between hand-wrist
skeletal maturation and vertebral maturation assess by
Hassel and Farmal classification.
Though it was significantly better for females.
Lower correlation was found when Lamparski
classification was compared with hand-wrist skeletal
Concavity tended to have a highest correlation with
Correlation coefficients were calculated to establish
the relationship between skeletal maturation values
obtained by the three classifications of vertebral,
skeletal maturation measured at the wrist.
All coefficient values obtained were statistically
Results suggest that new methodto determine skeletal
maturation was reliable.
The morphological vertebral parameter best able to
estimate the maturation is the concavity of the lower
border of the body.
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