This document describes the Cervical Vertebral Maturation (CVM) method for assessing optimal treatment timing in dentofacial orthopedics. CVM stages growth based on the shape and morphology of cervical vertebrae C2-C4 visible on lateral cephalograms. A study evaluated 706 subjects and found that peak mandibular growth occurs between CVM stages 3 and 4. CVM is advantageous because it is easy, reliable, reproducible, and valid, and avoids additional radiation compared to alternative methods. The application of CVM in orthodontics suggests that class II treatment is most effective during CVM stages 3-4, while other treatments are more effective at prepubertal or pubertal stages

1. UNIVERSITY OF GLASGOW
The Cervical Vertebral Maturation (CVM) Method for the Assessment of
Optimal Treatment Timing in Dentofacial Orthopedics
Mohammed almuzian
Personal notes
1/1/2013

2. Mohammed Almuzian, University of Glasgow, 2013 Page 1
Table of Contents
Methods.............................................................................................................................................1
Results:..............................................................................................................................................2
Advantages of Cervical Vertebral Maturation (CVM) ...........................................................................2
The application of this method in orthodontics and dentofacial orthopedics ............................................3
Stages of growth proposed by Baccetti 2005 ........................................................................................3
The Cervical Vertebral Maturation (CVM) Method for the Assessment of
Optimal Treatment Timing in Dentofacial Orthopedics
 The use of cervical vertebral maturation was first described by Lamparskiin 1972.
 Franchi 2000 & Baccetti 2002 tried to improve the version of using the vertebrae
for assessing mandibular growth. The technique that will be described here is the
last modified version of using CVM as described by Baccetti in 2005.
Methods
 The total sample (n706) that comprises the cephalometric files of the University of
Michigan Elementary and SecondarySchoolGrowth Study was evaluated.
 Total mandibular length (Co-Gn) was measured on the longitudinal sets of lateral
cephalograms for each of the 214 remaining subjects at yearly intervals.
 The maximum increase in Co-Gn between two consecutive annual cephalograms
was used to define the peak in mandibular growth at puberty in the individual
subjects.
 The morphology of the bodies of the second (C2 – odontoid process), third (C3),
and fourth (C4) cervical vertebrae were analyzed in the six consecutive annual
observations (T1 through T6).

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Results:
 CS1 and CS2 are prepeak stages; total mandibular length exhibited an average
increase of about 2.5 mm from CS1 to CS2 and from CS2 to CS3 again about 2.5
mm.
 The peak in mandibular growth occurs between CS3 and CS4. total mandibular
length exhibited an average increase of 5.4 mm in the year following CS3
 CS4 to CS5 total mandibular length exhibited an average increase of about 1.6
mm
 CS5 to CS6 total mandibular length exhibited an average increase of about 2.1
mm.
 CS6 is recorded at least 2 years after the peak.
Advantages of CervicalVertebral Maturation (CVM)
1. Easy
2. Reliable.
3. The reproducibility
4. Valid
5. The cervical vertebrae are available on the lateral cephalogram that is used
routinely for orth By replacing the hand-wrist method
6. With the CVM method, an additional radiograph can be avoided, thus reducing the
patient’s total radiation
7. Orthodontic diagnosis and treatment planning.

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The application of this method in orthodontics and dentofacialorthopedics
1. Class II treatment is most effective when it includes the peak in mandibular
growth; CVM3 and 4
2. Class III treatment with maxillary expansion and protraction is effective in the
maxilla only when it is performed before the peak (CS1 or CS2), whereas it is
effective in the mandible during both prepubertal and pubertal stages;
3. Skeletal effects of rapid maxillary expansion for the correction of transverse
maxillary deficiency are greater at prepubertal stages, while pubertal or
postpubertaluse of the rapid maxillary expander entails more dentoalveolar
effects;
4. Deficiency of mandibular ramus height can be enhanced significantly in subjects
with increased vertical facial dimension when orthopedic treatment is performed at
the peak in mandibular growth (CS3).
 To summarize, effects of therapies aimed to enhance/restrict mandibular growth
appear to be of greater magnitude at the circumpubertal period during which the
growth spurt occurs in comparison to earlier intervention, while effects of therapies
aimed to alter the maxilla orthopedically (maxillary protraction/maxillary
expansion) are greater at prepubertal
Stages of growthproposedby Baccetti 2005
Cervicalstage 1 (CS1). The lower borders of all the
three vertebrae (C2-C4) are flat. The bodies of both C3
and C4 are trapezoid in shape (the superior borderof the
vertebral bodyis tapered from posterior to anterior). The
peak in mandibular growth will occuron average 2 years
after this stage.

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Cervicalstage 2 (CS2). A concavity is present at the
lower border of C2. The bodies of both C3 and C4 are
still trapezoid in shape. The peak in mandibular growth
will occuron average 1 year after this stage.
Cervicalstage 3 (CS3). Concavities at the lower borders
of both C2 and C3 are present. The bodies of C3 and C4
may be either trapezoid or rectangular horizontal in
shape. The peak in mandibular growth will occurduring
the year after this stage.
Cervicalstage 4 (CS4). Concavities at the lower borders
of C2, C3, and C4 now are present. The bodies of bothC3
and C4 are rectangular horizontal in shape. The peak in
mandibular growth has occurred within 1 or 2 years
before this stage.

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Cervicalstage 5 (CS5). The concavities at the lower
borders of C2, C3, and C4 still are present. At least one of
the bodies of C3 and C4 is squared in shape. If not
squared, the bodyof the other cervical vertebra still is
rectangular horizontal. The peak in mandibular growth
has ended at least 1 year before this stage.
Cervicalstage 6 (CS6). The concavities at the lower
borders of C2, C3, and C4 still are evident. At least one of
the bodies of C3 and C4 is rectangular vertical in shape. If
not rectangular vertical, the bodyof the other cervical
vertebra is squared. The peak in mandibular growth has
ended at least 2 years before this stage.