The document discusses methods for estimating physical maturity and skeletal age using dental development and radiographs of the hand, wrist, and cervical vertebrae. Specifically: - Dental development correlates reasonably well with chronological age but less so with physical maturity. - The greatest increase in cervical vertebral body height, indicating a peak in growth, occurs between stages 3 and 4 of cervical vertebral maturation (CVM), corresponding to peak mandibular growth. - CVM staging of the cervical vertebrae provides a reliable biological indicator of skeletal maturity and is useful for anticipating an individual's peak pubertal growth spurt.

1. Croissance et
Développement
MDD 20049
4-0 Estimation de la maturité physique

2. • Le développement dentaire est assez bien corrélé avec
l’âge chronologique bien que survenant
indépendamment
• Le développement dentaire est moins bien corrélé avec
le maturation physique
• Estimation de l’âge squelettique
✦ Rx main-poignet
✦ Rx vertèbre cervicale
©Dr Sylvain Chamberland;
sylvainchamberland.com
2

3. • Développement dentaire
✦ Indépendant de la maturité somatique ou sexuelle
✦ Faible association avec la maturité physique
• Corrélation âge chronologique et développement
physique: r = 0,8.
✦ Valeur explicative: 64%
• Corrélation entre âge dentaire et chronologique: r =0,7
✦ Valeur explicative: ~ 50%
©Dr Sylvain Chamberland;
sylvainchamberland.com
3

4. Estimation de la maturité
physique chez la fille
Semin. Orthod. 1997; 3: 212-221
©Dr Sylvain Chamberland
4

5. Estimation de la maturité
physique chez le garçon
Semin. Orthod. 1997; 3: 212-221
©Dr Sylvain Chamberland
5

6. Rx main-poignet
• Identification du sésamoïde
✦ Apparaît avant le pic de croissance
• Si absence de cartilage entre épiphyse et diaphyse:
Val, Pou 15a 5 m
✦ Croissance terminée
©Dr Sylvain Chamberland
6

7. • 2e phalange: capping de la diaphyse
• Fusion de la phalange distale
• Présence de cartilage entre épiphyse et diaphyse
Shad, Labr 12a 5 m
✦ Croissance disponible
©Dr Sylvain Chamberland;
sylvainchamberland.com
7

8. • Toutefois
• Le pic de croissance à l’adolescence des dimensions
faciales n’est pas corrélé de façon consistante avec la
croissance de la stature et la maturité physique tel que
déterminé par les rx de poignet
✦ Moore et al, Skeletal maturation and craniofacial growth,
AJODO 1990; 98: 33-40
©Dr Sylvain Chamberland;
sylvainchamberland.com
8

9. •
Le timing de certains types de traitement orthodontique à forte
composante orthopédique (correction cl II ou cl III, expansion
palatine) est intimement lié à l’identification d’accélération ou
d’intensification de la croissance pouvant contribuer à la
correction du débalancement squelettique
•
L’efficacité des thérapies fonctionnelles dépends de la réponse du
cartilage condylien qui, à son tour, dépends du taux de croissance
mandibulaire
•
L’évaluation de la maturation squelettique mandibulaire et du
potentiel de croissance de l’individu fournit des informations
essentielles sur l’anticipation du résultat du traitement
©Dr Sylvain Chamberland;
sylvainchamberland.com
9

10. • Indicateur biologique de maturité squelettique
✦ Augmentation en hauteur (grandeur) du corps (stature)
✓
Présente le moins de variabilité dans l’estimation de l’âge squelettique
✦ Développement et éruption dentaire
✦ Caractères sexuels secondaires (menstruations, poitrine, mue
de la voie)
✦ Maturation des vertèbres cervicaux
✓
©Dr Sylvain Chamberland;
sylvainchamberland.com
Efficace pour démontrer le pic de croissance de l’adolescence tant pour le garçon
que pour la fille
10

11. 338 Franchi, Baccetti, and McNamara
American Journal of
Maturation des vertèbres cervicales
A
Fig 4. Distribution o
stage 3 in cervica
females (Cvs3 fema
croissance
• Pic de du temps) en hauteur ➙ CVS3-CVS4
(93,5%
significant decelerat
Cvs4 to Cvs5 when
DISCUSSION
B
✦ A: groupe complet(n= 24)
✦ B: sous-groupe de 15 filles (~ 11 ans)
✦ C: sous-groupe de 9 garçons (~ 12-13 ans)
•
Pic de croissance mandibulaire ➙ CVS3-CVS4
C
Fig 3. Individual changes in body height at intervals
between stages in cervical vertebral maturation (A) in
24 subjects examined, (B) in subgroup of 15 females,
and (C) in subgroup of 9 males.
Cvs4 when compared with the growth interval Cvs2 to
Cvs3, and significant growth deceleration during the
interval Cvs4 to Cvs5 when compared with Cvs3 to
Cvs4. Ramus height (Co-Goi) and S-Gn also showed
The issue of
mandibular deficien
contemporary ortho
ment timing in Class
misleading variabl
some kind of categ
rather than individ
demonstrated clearl
skeletal maturity is
pedics, as the greate
appliances occur wh
is included in the tr
A few biologic
appraisal of individ
quently, for the detec
the mandible.2,4,6,11
statural height prese
assessment of skelet
of growth, thus show
logic indicator of sk
tation of this method
measurements repea
months) to construc
velocity. Radiograph
overcome this limita
skeletal maturation o
The features of an i
✦ G:12 a 8 m à 14a 2 m
✦ F: 11 a 4 m à 12 a 10 m
©Dr Sylvain Chamberland
11

12. •
Distribution de l’âge chronologique au stade 3
338 Franchi, Baccetti, and McNamara
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
✦ Filles: 8a 6 m à 11a 5 m
✦ Garçons: 10a à 14 a
A
• Donc, l’âge chronologique n’est pas un bon indicateur
Fig 4. Distribution of individual chronological age at
stage 3 in cervical vertebral maturation (Cvs3) in
females (Cvs3 females) and males (Cvs3 males).
de la maturation squelettique et ainsi de l’estimation du
timing du traitement orthodontique
significant deceleration of growth during the interval
Cvs4 to Cvs5 when compared with Cvs3 to Cvs4.
DISCUSSION
B
©Dr Sylvain Chamberland;
sylvainchamberland.com
C
Fig 3. Individual changes in body height at intervals
between stages in cervical vertebral maturation (A) in
24 subjects examined, (B) in subgroup of 15 females,
and (C) in subgroup of 9 males.
Cvs4 when compared with the growth interval Cvs2 to
Cvs3, and significant growth deceleration during the
The issue of optimal treatment timing for
mandibular deficiencies is a widely debated topic in
contemporary orthodontics. The definition of treatment timing in Class II disharmony too often relies on
misleading variables such as chronological age or
some kind of categorization of dentitional phases
rather than individual biologic factors. It has been
demonstrated clearly that the evaluation of individual
skeletal maturity is fundamental in dentofacial orthopedics, as the greatest effects of functional/orthopedic
appliances occur when the peak in mandibular growth
is included in the treatment period.1,8-10
A few biologic indicators are available for the
appraisal of individual skeletal maturity and, consequently, for the detection of the pubertal growth spurt in
the mandible.2,4,6,11-17 Among these, the changes in
statural height present with the least variability for the
assessment of skeletal age throughout the progression
of growth, thus showing the highest reliability as biologic indicator of skeletal maturity. The practical limitation of this method, however, is that it requires several
measurements repeated at regular intervals (eg, every 3
months) to construct an individual curve of growth
velocity. Radiographic methods have been proposed to
overcome this limitation that allow for an appraisal of
12

13. 317
IMPROVED CVM METHOD
• Méthode initiale
✓
✓
changes can be observed in the vertebrae during this entire
interval, which covers the period when orthodontic/orthopedic treatment is typically performed in the growing patient.
Based on the findings of earlier investigations22,23,27,28 in
1972, Lamparski29 created separate standards of cervical
vertebral maturation for female and male subjects as related
to both chronological age and skeletal maturation height,
Franchi et al, Mandibular growth as related to cervical vertebra maturation and body observed
in the hand-wrist radiograph. The method analyzed size and
AJODO 2000; 118: 335-40
shape changes in the bodies of five cervical vertebrae (from
the second one through the sixth). Hassel and Farman30 reviewed lateral cephalometric and left hand-wrist radiographs from the Bolton-Brush Growth Study at Case Western Reserve University to develop an index based on the
Bacetti T. et al, The cervical vertebra maturation (CVM) method for the assessment of optimal
lateral profiles of the second, third, and fourth cervical vertreatment timing in dentofacial orthopedics, Semin. Orthod. 2005; 11: 119-129
tebrae. These researchers, as well as Pancherz and Szyska31
who further evaluated Hassel and Farman’s index in relation to increases in body height, stated that the cervical
vertebral analysis had a comparable high reliability and validity as the hand-wrist bone analysis in the assessment of
individual skeletal maturity.
As for the relationship of cervical vertebral maturation
and mandibular growth changes, O’Reilly and Yanniello32
evaluated annual lateral cephalometric radiographs of 13
Caucasian girls from 9 to 15 years of age and found statistically significant increases in mandibular length, corpus
length, and ramus height in association with specific maturation stages in the cervical vertebrae according to the
method of Lamparski.29 More recently, Franchi and coworkers12,13 confirmed the validity of six CVM stages as a
biologic indicator for both mandibular and somatic skeletal
maturity in 24 growing untreated subjects. The original
method by Lamparski29 was adopted with a modification
allowing for the appraisal of skeletal age in both boys and
girls, regardless of chronological age (Figure 1).
The main features of the CVM method as described by
Franchi and coworkers12,13 included:
✦ 6 stades de formations
FIGURE 1. Developmental stages of cervical vertebrae. Stage 1
(Cvs 1): the inferior borders of the bodies of all cervical vertebrae
are flat. The superior borders are tapered from posterior to anterior.
Stage 2 (Cvs 2): a concavity develops in the inferior border of the
second vertebra. The anterior vertical height of the bodies increases.
Stage 3 (Cvs 3): a concavity develops in the inferior border of the
third vertebra. Stage 4 (Cvs 4): a concavity develops in the inferior
border of the fourth vertebra. Concavities in the lower borders of the
fifth and of the sixth vertebrae are beginning to form. The bodies of
all cervical vertebrae are rectangular in shape. Stage 5 (Cvs 5):
concavities are well defined in the lower borders of the bodies of all
6 cervical vertebrae. The bodies are nearly square in shape and the
spaces between the bodies are reduced. Stage 6 (Cvs 6): all concavities have deepened. The bodies are now higher than they are
wide. (Modified from O’Reilly and Yanniello.31)
✦ La plus grande augmentation du corps en hauteur survient
a protective radiation collar. (2) To avoid definitions of stages based on a comparative assessment of between-stage
changes, so that stages can be identified easily in a single
cephalogram.
The aim of the present work, therefore, is to present an
improved version of the CVM method and its validity for
the appraisal of mandibular skeletal maturity in the individual patient.
entre le stade 3 (quand une concavité se développe sous le
bord inférieur de C3) et le stade 4 (quand une concavité se
développe sur le bord inférieure de C4) chez le garçon et
la fille
a. In nearly 95% of North-American subjects, the growth
interval between stage 3 and stage 4 in CVM coincides
with the pubertal peak in both mandibular growth and
body height.
b. Reproducibility of recorded data (identification of CVM
stages) is as high as 98.6%.
c. The method is useful for the anticipation of the pubertal
peak in mandibular growth. The peak has not been
reached if either stage 1 or stage 2 in CVM is recorded
in the individual patient.
SUBJECTS AND METHODS
The total sample (706 subjects) that comprises the cephalometric files of the University of Michigan Elementary
and Secondary School Growth Study33 was evaluated. Due
to the longitudinal nature and to the aim of the present
investigation, subjects with less than six consecutive cephalometric observations (n 5 492) were excluded from the
study. Total mandibular length (Co-Gn) was measured on
the longitudinal sets of annual lateral cephalograms for each
of the 214 remaining subjects. The lateral cephalograms
were analyzed by means of a digitizing tablet (Numonics,
Lansdale, Penn) and digitizing software (Viewbox, ver 2.6
Kafissa, Greece). The maximum increase in Co-Gn between
13
two consecutive cephalograms was used to define the peak
in mandibular growth at puberty in the individual subjects.
Two consecutive cephalograms comprising the interval of
maximum mandibular growth, together with two earlier
consecutive cephalograms and two later consecutive cephalograms had to be available for each subject and were
✦ Le pic de croissance de la stature entre cvs3 et cvs4
©Dr Sylvain Chamberland;
sylvainchamberland.com
correspond à la plus grande augmentation de mesures
mandibulaires
However, a few improvements of the original CVM analysis were still needed to make the method easier and applicable to the vast majority of patients: (1) To use a more
limited number of vertebral bodies to perform the staging
(as suggested by Hassel and Farman30). In particular, the
method should include only those cervical vertebrae (C2,
C3, and C4) that can be visualized when the patient wears
Angle Orthodontist, Vol 72, No 4, 2002

14. Méthode simplifiée CVM
• Bacetti T. et al, An improved version of the cervical
vertebra maturation (CVM) method for the assessment
of mandibular growth, A.O. 2002; 72: 295-301
338 Franchi, Baccetti, and McNamara
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
A
Bacetti T. et al, Growth in the untreated cl III subjects, Semin. Orthod. 2007;13: 130-142
Fig 4. Distribution of individual chronological age at
stage 3 in cervical vertebral maturation (Cvs3) in
females (Cvs3 females) and males (Cvs3 males).
©Dr Sylvain Chamberland
significant deceleration of growth during the interval
Cvs4 to Cvs5 when compared with Cvs3 to Cvs4.
DISCUSSION
B
The issue of optimal treatment timing for
mandibular deficiencies is a widely debated topic in
contemporary orthodontics. The definition of treatment timing in Class II disharmony too often relies on
misleading variables such as chronological age or
14

15. 338 Franchi, Baccetti, and McNamara
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
A
• CVMS 1
Fig 4. Distribution of individual chronological age at
stage 3 in cervical vertebral maturation (Cvs3) in
females (Cvs3 females) and males (Cvs3 males).
significant deceleration of growth during the interval
Cvs4 to Cvs5 when compared with Cvs3 to Cvs4.
DISCUSSION
B
C
The issue of optimal treatment timing for
mandibular deficiencies is a widely debated topic in
contemporary orthodontics. The definition of treatment timing in Class II disharmony too often relies on
misleading variables such as chronological age or
some kind of categorization of dentitional phases
rather than individual biologic factors. It has been
demonstrated clearly that the evaluation of individual
skeletal maturity is fundamental in dentofacial orthopedics, as the greatest effects of functional/orthopedic
appliances occur when the peak in mandibular growth
is included in the treatment period.1,8-10
A few biologic indicators are available for the
appraisal of individual skeletal maturity and, consequently, for the detection of the pubertal growth spurt in
the mandible.2,4,6,11-17 Among these, the changes in
statural height present with the least variability for the
assessment of skeletal age throughout the progression
of growth, thus showing the highest reliability as biologic indicator of skeletal maturity. The practical limitation of this method, however, is that it requires several
measurements repeated at regular intervals (eg, every 3
months) to construct an individual curve of growth
velocity. Radiographic methods have been proposed to
overcome this limitation that allow for an appraisal of
skeletal maturation on the basis of a single observation.
The features of an ideal radiographic indicator should
✦ Bord inférieur des 3 vert.cerv. = plat
✦ Possibilité de concavité du bord inférieure de C2 dans la moitié
Fig 3. Individual changes in body height at intervals
between stages in cervical vertebral maturation (A) in
24 subjects examined, (B) in subgroup of 15 females,
and (C) in subgroup of 9 males.
Cvs4 when compared with the growth interval Cvs2 to
Cvs3, and significant growth deceleration during the
interval Cvs4 to Cvs5 when compared with Cvs3 to
Cvs4. Ramus height (Co-Goi) and S-Gn also showed
des cas
✦ Le corps de C3 et C4 est trapézoïde (bord supérieur “taper”
postéro-antérieurment)
✦ Le pic de croissance mandibulaire surviendra dans plus d’un an
©Dr Sylvain Chamberland;
sylvainchamberland.com
15

16. 338 Franchi, Baccetti, and McNamara
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
A
• CVMS II
Fig 4. Distribution of individual chronological age at
stage 3 in cervical vertebral maturation (Cvs3) in
females (Cvs3 females) and males (Cvs3 males).
significant deceleration of growth during the interval
Cvs4 to Cvs5 when compared with Cvs3 to Cvs4.
DISCUSSION
B
C
The issue of optimal treatment timing for
mandibular deficiencies is a widely debated topic in
contemporary orthodontics. The definition of treatment timing in Class II disharmony too often relies on
misleading variables such as chronological age or
some kind of categorization of dentitional phases
rather than individual biologic factors. It has been
demonstrated clearly that the evaluation of individual
skeletal maturity is fundamental in dentofacial orthopedics, as the greatest effects of functional/orthopedic
appliances occur when the peak in mandibular growth
is included in the treatment period.1,8-10
A few biologic indicators are available for the
appraisal of individual skeletal maturity and, consequently, for the detection of the pubertal growth spurt in
the mandible.2,4,6,11-17 Among these, the changes in
statural height present with the least variability for the
assessment of skeletal age throughout the progression
of growth, thus showing the highest reliability as biologic indicator of skeletal maturity. The practical limitation of this method, however, is that it requires several
measurements repeated at regular intervals (eg, every 3
months) to construct an individual curve of growth
velocity. Radiographic methods have been proposed to
overcome this limitation that allow for an appraisal of
skeletal maturation on the basis of a single observation.
The features of an ideal radiographic indicator should
✦ Concavité sur le bord inférieur de C2 et C3
✦ Corps de C3 et C4 sont soit trapézoïdes ou rectangulaires
Fig 3. Individual changes in body height at intervals
between stages in cervical vertebral maturation (A) in
24 subjects examined, (B) in subgroup of 15 females,
and (C) in subgroup of 9 males.
Cvs4 when compared with the growth interval Cvs2 to
Cvs3, and significant growth deceleration during the
interval Cvs4 to Cvs5 when compared with Cvs3 to
Cvs4. Ramus height (Co-Goi) and S-Gn also showed
horizontalement
✦ Le pic de croissance mandibulaire survient moins d’un an après
ce stade
©Dr Sylvain Chamberland;
sylvainchamberland.com
16

17. 338 Franchi, Baccetti, and McNamara
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
A
Fig 4. Distribution of individual chronological age at
stage 3 in cervical vertebral maturation (Cvs3) in
females (Cvs3 females) and males (Cvs3 males).
• CVMS III
significant deceleration of growth during the interval
Cvs4 to Cvs5 when compared with Cvs3 to Cvs4.
DISCUSSION
B
The issue of optimal treatment timing for
mandibular deficiencies is a widely debated topic in
contemporary orthodontics. The definition of treatment timing in Class II disharmony too often relies on
misleading variables such as chronological age or
some kind of categorization of dentitional phases
rather than individual biologic factors. It has been
demonstrated clearly that the evaluation of individual
skeletal maturity is fundamental in dentofacial orthopedics, as the greatest effects of functional/orthopedic
appliances occur when the peak in mandibular growth
is included in the treatment period.1,8-10
A few biologic indicators are available for the
appraisal of individual skeletal maturity and, consequently, for the detection of the pubertal growth spurt in
the mandible.2,4,6,11-17 Among these, the changes in
statural height present with the least variability for the
assessment of skeletal age throughout the progression
of growth, thus showing the highest reliability as biologic indicator of skeletal maturity. The practical limitation of this method, however, is that it requires several
measurements repeated at regular intervals (eg, every 3
months) to construct an individual curve of growth
velocity. Radiographic methods have been proposed to
overcome this limitation that allow for an appraisal of
skeletal maturation on the basis of a single observation.
The features of an ideal radiographic indicator should
✦ Concavité du bord inférieur de C2, C3 et C4
C
✦ Les corps de C3 et C4 sont rectangulaires horizontalement
Fig 3. Individual changes in body height at intervals
between stages in cervical vertebral maturation (A) in
24 subjects examined, (B) in subgroup of 15 females,
and (C) in subgroup of 9 males.
Cvs4 when compared with the growth interval Cvs2 to
Cvs3, and significant growth deceleration during the
interval Cvs4 to Cvs5 when compared with Cvs3 to
Cvs4. Ramus height (Co-Goi) and S-Gn also showed
✦ Le pic de croissance mandibulaire est survenu entre 1 et 2 ans
avant ce stade
©Dr Sylvain Chamberland;
sylvainchamberland.com
17

18. 338 Franchi, Baccetti, and McNamara
A
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
•
CVMS IV
Fig 4. Distribution of individual chronological age at
stage 3 in cervical vertebral maturation (Cvs3) in
females (Cvs3 females) and males (Cvs3 males).
significant deceleration of growth during the interval
Cvs4 to Cvs5 when compared with Cvs3 to Cvs4.
DISCUSSION
B
The issue of optimal treatment timing for
mandibular deficiencies is a widely debated topic in
contemporary orthodontics. The definition of treatment timing in Class II disharmony too often relies on
misleading variables such as chronological age or
some kind of categorization of dentitional phases
rather than individual biologic factors. It has been
demonstrated clearly that the evaluation of individual
skeletal maturity is fundamental in dentofacial orthopedics, as the greatest effects of functional/orthopedic
appliances occur when the peak in mandibular growth
is included in the treatment period.1,8-10
A few biologic indicators are available for the
appraisal of individual skeletal maturity and, consequently, for the detection of the pubertal growth spurt in
the mandible.2,4,6,11-17 Among these, the changes in
statural height present with the least variability for the
assessment of skeletal age throughout the progression
of growth, thus showing the highest reliability as biologic indicator of skeletal maturity. The practical limitation of this method, however, is that it requires several
measurements repeated at regular intervals (eg, every 3
months) to construct an individual curve of growth
velocity. Radiographic methods have been proposed to
overcome this limitation that allow for an appraisal of
skeletal maturation on the basis of a single observation.
The features of an ideal radiographic indicator should
✦ Concavité des bords inférieurs de C2, C3, C4 encore visible
✦ Au moins une des deux vertèbres C3 ou C4 a une forme carré
C
Fig 3. Individual changes in body height at intervals
between stages in cervical vertebral maturation (A) in
24 subjects examined, (B) in subgroup of 15 females,
and (C) in subgroup of 9 males.
✦ S’il n’est pas carré, le l’autre vertèbre est encore rectangulaire
Cvs4 when compared with the growth interval Cvs2 to
Cvs3, and significant growth deceleration during the
interval Cvs4 to Cvs5 when compared with Cvs3 to
Cvs4. Ramus height (Co-Goi) and S-Gn also showed
horizontale
✦ Le pic de croissance mandibulaire est terminé depuis moins de
1 an avant ce stade
©Dr Sylvain Chamberland;
sylvainchamberland.com
18

19. 338 Franchi, Baccetti, and McNamara
A
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
• CVMS V
Fig 4. Distribution of individual chronological age at
stage 3 in cervical vertebral maturation (Cvs3) in
females (Cvs3 females) and males (Cvs3 males).
significant deceleration of growth during the interval
Cvs4 to Cvs5 when compared with Cvs3 to Cvs4.
DISCUSSION
B
✦ La concavité des bords inférieurs de C2, C3, C4 est encore
The issue of optimal treatment timing for
mandibular deficiencies is a widely debated topic in
contemporary orthodontics. The definition of treatment timing in Class II disharmony too often relies on
misleading variables such as chronological age or
some kind of categorization of dentitional phases
rather than individual biologic factors. It has been
demonstrated clearly that the evaluation of individual
skeletal maturity is fundamental in dentofacial orthopedics, as the greatest effects of functional/orthopedic
appliances occur when the peak in mandibular growth
is included in the treatment period.1,8-10
A few biologic indicators are available for the
appraisal of individual skeletal maturity and, consequently, for the detection of the pubertal growth spurt in
the mandible.2,4,6,11-17 Among these, the changes in
statural height present with the least variability for the
assessment of skeletal age throughout the progression
of growth, thus showing the highest reliability as biologic indicator of skeletal maturity. The practical limitation of this method, however, is that it requires several
measurements repeated at regular intervals (eg, every 3
months) to construct an individual curve of growth
velocity. Radiographic methods have been proposed to
overcome this limitation that allow for an appraisal of
skeletal maturation on the basis of a single observation.
The features of an ideal radiographic indicator should
visible
C
✦ Au moins une vertèbre de C3 ou de C4 est rectangulaire
Fig 3. Individual changes in body height at intervals
between stages in cervical vertebral maturation (A) in
24 subjects examined, (B) in subgroup of 15 females,
and (C) in subgroup of 9 males.
Cvs4 when compared with the growth interval Cvs2 to
Cvs3, and significant growth deceleration during the
interval Cvs4 to Cvs5 when compared with Cvs3 to
Cvs4. Ramus height (Co-Goi) and S-Gn also showed
verticalement
✦ Si elle n’est pas rectangulaire, l’autre vertèbre est carrée
✦ Le pic de croissance mandibulaire est terminé environ 2 ans
avant ce stade
©Dr Sylvain Chamberland;
sylvainchamberland.com
19

20. • SI CVMS 1 est observé
✦ Attendre au moins 1 an avant de débuter un tx orthopédique
• CVMS II: Stade idéal pour débuté tx orthopédique
✦ Md augmente de ~5,4 mm dans l’année suivante (CVMS II ➙
CVMS III)
• Entre CVMS 1 et CVMS II ➙ Md augmente de ~2,4 mm
• Entre CVMS III et CVMS IV ➙ Md augmente de 1,6 mm
• Entre CVMS IV et CVMS V ➙ Md augmente de 2,1 mm
©Dr Sylvain Chamberland;
sylvainchamberland.com
20

21. • Les traitements des classes II seront le plus efficace si
fait durant le pic de croissance mandibulaire
• Les traitements de cl III avec expansion maxillaire et
protraction sont efficaces sur le maxillaire si c’est fait
avant le pic mandibulaire (CS 1 et CS 2)
• Les effets squelettiques de l’expansion palatine rapide
pour corriger une déficience transverse sont plus grand
si fait aux stades prépubertaires alors que si c’est fait
durant la puberté ou après, les effets seront plutôt
dento-alvéolaires
©Dr Sylvain Chamberland;
sylvainchamberland.com
21

22. • Concavité sur le bord inférieur
• C2, C3, C4: taper
• C3: carrée
Sha.La.12a5m
©Dr Sylvain Chamberland;
sylvainchamberland.com
22

23. • C2: bord inférieur concave
• C3, C4: bord inférieur plat
• C3 et C4: taper, trapézoïde
• C3 et C4: rectangulaire horizontal
©Dr Sylvain Chamberland;
sylvainchamberland.com
Gu.Ma.12a4m
23

24. • Concavité du bord inférieur
• C3: forme rectangulaire horizontale
• C4: forme carré
Va.Po.15a5m
©Dr Sylvain Chamberland;
sylvainchamberland.com
24

25. • C2, C3, C4: bord inférieur plat
• C3 et C4: taper, trapézoïde
Ly.Tr. 10a10m
©Dr Sylvain Chamberland;
sylvainchamberland.com
25

26. • C3: concavité bord inférieur
• C3: carré horizontal, taper antérieurement
Ch.Cô. 13a8m
©Dr Sylvain Chamberland;
sylvainchamberland.com
26

27. • C2, C3, C4: rectangulaire vertical
• Concavité du bord inférieur
Fr.Fe.18a4m
©Dr Sylvain Chamberland;
sylvainchamberland.com
27