New formula to objectively evaluate skeletal maturation using lateral cephalometric radiographs

The aim of this study was to establish two new formulas for objectively evaluating skeletal maturation of cervical vertebrae in female and male Brazilian subjects using lateral cephalometric radiographs. The sample included 128 girls and 110 boys, aged 7.0 to 15.9 years, from the files of the Oral Radiology Clinic, Piracicaba Dental School, University of Campinas (Unicamp), SP, Brazil. The cervical vertebral bodies of C3 and C4 were traced and measured and regression formulas were developed in order to determine cervical vertebral bone age. Another sample of lateral teleradiographs and hand-wrist radiographs of 55 girls and 54 boys (aged 7.0 to 15.9 years) was used to verify the reliability of the developed regression formulas, as compared with bone age assessed using the Tanner et al.15 (2001) Method (TW3) in hand-wrist radiographs. The analysis of both the boys’ and girls’ data (ANOVA) showed no statistical difference between cervical vertebral bone age, bone age, and chronological age, indicating that these formulas can be used in this population (p = 0.5721 and p = 0.6007 for girls and boys, respectively). Female cervical vertebral bodies of C3 and C4 increased in an accelerated manner from 10 to 13 years. Analysis of the male sample showed that C3 measurements increased in an accelerated manner from 12 to 15 years. The C4 measurements, however, did not increase at all. Using cervical vertebral bone age it is possible to evaluate skeletal maturation objectively in cephalometric radiographs.

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Objective Evaluation of Cervical Vertebral Bone Age— Its Reliability in Comparison with Hand-Wrist Bone Age: By TW3 Method

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-1407 ◽

2013 ◽

Vol 14 (5) ◽

pp. 806-813

Author(s):

Vamsi Nilay Reddy ◽

Gojja Sreedevi ◽

CMS Krishna Prasad ◽

Swaroopa Rani Ponnada ◽

K Padma Priya ◽

...

Keyword(s):

Skeletal Maturity ◽

Cervical Vertebrae ◽

Bone Age ◽

Objective Evaluation ◽

Ease Of Use ◽

Skeletal Maturation ◽

Potential Growth ◽

Vertebral Bone ◽

Therapeutic Decisions ◽

Lateral Cephalograms

ABSTRACT Aim The aim of this study was to establish the validity of a new method for evaluating skeletal maturation by assessing the 3rd and 4th cervical vertebrae seen in the cephalometric radiograph. Materials and methods This study consisted of a sample of 50 patients in the age group of 8 to 14 years of age. Chronologically, they were divided into six groups, based on the age consisting of a minimum of six to a maximum of 10 subjects. All the patients included in the study were females. The selected subjects were clinically examined and then age and date of birth of the patient in years and months was noted. Then lateral cephalograms and hand-wrist radiographs of the patient were taken on the same day with good clarity and contrast. Results The results suggested that cervical vertebral bone age on cephalometric radiographs calculated with this method is as reliable at estimating bone age as is the Tanner-Whitehouse 3 (TW3) method on hand-wrist radiographs. By determining the cervical vertebral bone age, skeletal maturity can be evaluated in a detailed and objective manner with cephalometric radiographs. Conclusion The ability to accurately appraise skeletal maturity from cervical vertebral maturation, without the need for additional radiographs, has the potential to improve orthodontic diagnostic and therapeutic decisions. The technique's simplicity and ease of use should encourage this method as a first level diagnostic tool to assess skeletal maturation. Clinical significance This study revealed that the timing and sequence of ossification of the bones in hand and wrist and cervical vertebrae were able to relate the skeletal development of the various skeletal maturity indicators to a child's development. This method provided a mean with which one can determine the skeletal maturity of a person and thereby determine whether the possibility of potential growth existed. How to cite this article Prasad CMSK, Reddy VN, Sreedevi G, Ponnada SR, Priya KP, Naik BR. Objective Evaluation of Cervical Vertebral Bone Age—Its Reliability in Comparison with Hand-Wrist Bone Age: By TW3 Method. J Contemp Dent Pract 2013;14(5):806-813.

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Development and validation of a formula for objective assessment of cervical vertebral bone age

Progress in Orthodontics ◽

10.1186/s40510-020-00338-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Raghavan Chandrasekar ◽

Shyamala Chandrasekhar ◽

K. K. Shantha Sundari ◽

Poornima Ravi

Keyword(s):

Cervical Vertebrae ◽

Objective Assessment ◽

Bone Age ◽

Chronological Age ◽

Strong Positive Correlation ◽

Vertebral Bone ◽

Indian Patients ◽

South Indian ◽

Lateral Cephalograms ◽

Significant Difference

Abstract Background and aim Determination of skeletal maturity and bone age from cervical vertebrae has been well documented. Most methods described use subjective evaluation of morphological characteristics of cervical vertebrae and may be prone to variability and error. A few objective methods have also been developed, specific for certain populations and genders. The aim of this study was to establish and validate an objective method to determine cervical vertebral bone age from lateral cephalometric radiographs, for Asian South Indian patients of both genders. Methods Ninety boys and 90 girls between 9 and 15 years of age were recruited, and their lateral cephalograms were taken. Using measurements made from the third and fourth cervical vertebrae, a formula to determine cervical vertebral bone age was derived using stepwise regression analysis. To validate the formula, a separate sample of 30 boys and 30 girls was chosen, and hand-wrist radiographs and lateral cephalograms were obtained. Cervical vertebral bone age (CVBA) was determined by applying the formula derived. Bone age was also calculated using the Tanner-Whitehouse 3 method. The bone ages determined by both methods were compared to each other and chronological age, using one-way ANOVA, Tukey’s post hoc analysis, and Pearson’s correlation coefficient. Results The formulae derived in the current study to determine CVBA differed for both genders. No statistically significant difference was found between CVBA, bone age derived by the Tanner-Whitehouse 3 method, and chronological age for both boys (p value = 0.425) and girls (p value = 0.995). A moderate to strong positive correlation was found between CVBA, bone age, and chronological age. Conclusion The formulae derived in this study were validated and are reliable for objectively determining cervical vertebral bone age and skeletal maturation from lateral cephalograms for Asian South Indian patients of both genders.

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Anatomical evaluation of the cervical vertebrae of Wistar rats by means of digital radiographs and its correlation with the maturation stages of human cervical vertebrae

Dental Press Journal of Orthodontics ◽

10.1590/s2176-94512013000400012 ◽

2013 ◽

Vol 18 (4) ◽

pp. 82-88

Author(s):

Roberto Hiroshi Matsui ◽

Julio Cezar de Melo Castilho ◽

Luiz César de Moraes ◽

Mônica Fernandes Gomes ◽

Kurt Faltin Júnior ◽

...

Keyword(s):

Cross Sections ◽

Wistar Rats ◽

Cervical Vertebrae ◽

Pearson Correlation ◽

Bone Age ◽

Skeletal Maturation ◽

Growth Spurt ◽

Digital Radiographs ◽

Maturation Stages ◽

Development Assessment

INTRODUCTION: Biological age is an important parameter for growth and development assessment. It can be evaluated through the observation of radiographic changes in skeletal maturation of cervical vertebrae. OBJECTIVE: This study aims to: a) verify if there is correlation between growth curve and the stages of bone age of animals used in laboratories, by evaluating radiographs of the cervical vertebrae; b) correlate these stages with their correspondents in humans. METHODS: 35 Wistar rats were evaluated for a period of 160 days, starting at day 22nd (weaning), with cross sections for periodic weighing, length measurement and digital radiography. Radiographs of the cervical vertebrae (C2 and C3) were measured by means of a computer program (Radio IMP). Data were submitted to statistical analysis (ANOVA) and Pearson correlation. RESULTS: Growth spurt was characterized by fast increasing in weight and length. Through ANOVA, differences were observed in the cervical measurements between days 22, 97, 127, 157, 187 and 217 (p <0.001). A high correlation was found between increasing in body length and weight, as well as in cervical vertebrae height (r = 0.86). Increments in concavities of vertebrae were also observed, similar to humans. CONCLUSIONS: There is correlation between body growth and maturation of cervical vertebrae in rats. Despite the continuous development of concavities, it was not possible to clearly identify the 5/6 stages as in studies of cervical vertebrae maturation in humans.

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Growth and Pubertal Development in Elite Female Rhythmic Gymnasts

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.84.12.6177 ◽

1999 ◽

Vol 84 (12) ◽

pp. 4525-4530 ◽

Cited By ~ 39

Author(s):

N. Georgopoulos ◽

K. Markou ◽

A. Theodoropoulou ◽

P. Paraskevopoulou ◽

L. Varaki ◽

...

Keyword(s):

Body Fat ◽

Adult Height ◽

Pubertal Development ◽

Optimal Growth ◽

Bone Age ◽

Skeletal Maturation ◽

Chronological Age ◽

Average Height ◽

Limited Information ◽

Rhythmic Gymnasts

Optimal growth depends upon both environmental and genetic factors. Among environmental factors that could alter growth and sexual maturation are stress and intensive physical training. The influence of these factors has been documented in a variety of sports, but there is limited information on rhythmic gymnasts, who have entirely different training and performance requirements. The study was conducted during the 13th European Championships in Patras, Greece, and included 255 female rhythmic gymnasts, aged 11–23 yr. The study included measurement of height and weight, assessment of breast and pubic hair development, estimation of body fat and skeletal maturation, and registration of menarcheal age and parental height. Gymnasts were taller than average height for age, with mean height above and mean weight below the 50th percentile. Actual height sd score was positively correlated to weight sd score (P < 0.001), number of competitions (P = 0.01), and body mass index (BMI; P < 0.001). Predicted adult height sd score was positively correlated to weight sd score (P < 0.001) and negatively to body fat (P = 0.004). There was a delay in skeletal maturation of 1.3 yr (P < 0.001). Pubertal development was following bone age rather than chronological age. The mean age of menarche was significantly delayed from that of their mothers and sisters (P = 0.008 and P = 0.05, respectively), was positively correlated to the intensity of training and to the difference between chronological age and bone age (P < 0.001 and P = 0.002, respectively), and was negatively correlated to body fat (P < 0.001). In the elite female rhythmic gymnasts, psychological and somatic efforts have profound effects on growth and sexual development. Despite these aberrations, adult height is not expected to be affected.

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SKELETAL MATURATION IN THE CURRENT PEDIATRIC MEXICAN POPULATION

Endocrine Practice ◽

10.4158/ep-2020-0047 ◽

2020 ◽

Vol 26 (10) ◽

pp. 1053-1061

Author(s):

Miguel Klünder-Klünder ◽

Montserrat Espinosa-Espindola ◽

Desiree Lopez-Gonzalez ◽

Mariana Sánchez-Curiel Loyo ◽

Pilar Dies Suárez ◽

...

Keyword(s):

Middle Childhood ◽

Skeletal Maturity ◽

Bone Age ◽

Mexican Population ◽

Growth Potential ◽

Skeletal Maturation ◽

Chronological Age ◽

Greulich And Pyle ◽

Reference Curves ◽

End Of Puberty

Objective: The most commonly used methods for bone age (BA) reading were described in the Caucasian population decades ago. However, there are secular trends in skeletal maturation and different BA patterns between ethnic groups. Automated BA reading makes updating references easier and more precise than human reading. The objective of the present study was to present automated BA reference curves according to chronological age and gender in the Mexican population and compare the maturation tempo with that of other populations. Methods: The study included 923 healthy participants aged 5 to 18 years between 2017 and 2018. A hand radio-graph was analyzed using BoneXpert software to obtain the automated BA reading according to Greulich and Pyle (G&P) and Tanner-Whitehouse 2 (TW2) references. We constructed reference curves using the average difference between the BA and chronological age according to sex and age. Results: The G&P and TW2 automated reference curves showed that Mexican boys exhibit delays in BA during middle childhood by 0.5 to 0.7 (95% confidence interval [CI], −0.9 to −0.2) years; however, they demonstrate an advanced BA of up to 1.1 (95% CI, 0.8 to 1.4) years at the end of puberty. Mexican girls exhibited a delay in BA by 0.3 to 0.6 (95% CI, −0.9 to −0.1) years before puberty and an advanced BA of up to 0.9 (95% CI, 0.7 to 1.2) years at the end of puberty. Conclusion: Mexican children aged <10 years exhibited a delay in skeletal maturity, followed by an advanced BA by approximately 1 year at the end of puberty. This may affect the estimation of growth potential in this population. Abbreviations: BA = bone age; CA = chronological age; G&P = Greulich and Pyle; TW2 = Tanner-Whitehouse 2

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In Boys with Abnormal Developmental Tempo, Maturation of the Skeleton and the Hypothalamic-Pituitary-Gonadal Axis Remains Synchronous

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2002-021954 ◽

2004 ◽

Vol 89 (1) ◽

pp. 236-241 ◽

Cited By ~ 17

Author(s):

Armando Flor-Cisneros ◽

Ellen W. Leschek ◽

Deborah P. Merke ◽

Kevin M. Barnes ◽

Marilena Coco ◽

...

Keyword(s):

Body Mass Index ◽

Congenital Adrenal Hyperplasia ◽

Short Stature ◽

Precocious Puberty ◽

Bone Age ◽

Skeletal Maturation ◽

Chronological Age ◽

Adrenal Hyperplasia ◽

Normal Bone ◽

Primary Mechanism

The primary mechanism that initiates puberty is unknown. One possible clue is that pubertal maturation often parallels skeletal maturation. Conditions that delay skeletal maturation also tend to delay the onset of puberty, whereas conditions that accelerate skeletal maturation tend to hasten the onset of puberty. To examine this relationship, we studied boys with congenital adrenal hyperplasia (n = 13) and familial male-limited precocious puberty (n = 22), two conditions that accelerate maturational tempo, and boys with idiopathic short stature (n = 18) in which maturational tempo is sometimes delayed. In all three conditions, the onset of central puberty generally occurred at an abnormal chronological age but a normal bone age. Boys with the greatest skeletal advancement began central puberty at the earliest age, whereas boys with the greatest skeletal delay began puberty at the latest age. Furthermore, the magnitude of the skeletal advancement or delay matched the magnitude of the pubertal advancement or delay. This synchrony between skeletal maturation and hypothalamic-pituitary-gonadal axis maturation was observed among patients within each condition and also between conditions. In contrast, the maturation of the hypothalamic-pituitary-gonadal axis did not remain synchronous with other maturational processes including weight, height, or body mass index. We conclude that in boys with abnormal developmental tempo, maturation of the skeleton and the hypothalamic-pituitary-gonadal axis remains synchronous. This synchrony is consistent with the hypothesis that in boys, skeletal maturation influences hypothalamic-pituitary-gonadal axis maturation.

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Association between a History of Inhibitors and Delays in Skeletal Maturation in Adolescents with Hemophilia.

Blood ◽

10.1182/blood.v108.11.1022.1022 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1022-1022 ◽

Cited By ~ 2

Author(s):

Sharyne M. Donfield ◽

Alice Lail ◽

Edward D. Gomperts ◽

W. Keith Hoots ◽

Erik Berntorp ◽

...

Keyword(s):

Children And Adolescents ◽

Bone Age ◽

Physical Growth ◽

Skeletal Maturation ◽

Chronological Age ◽

Growth Delay ◽

Hiv Positive ◽

P Values ◽

History Of ◽

Hiv Negative

Abstract The development of inhibitory antibodies to factor VIII or factor IX is the most serious complication of replacement therapy for people with hemophilia. Inhibitors decrease effectiveness of treatment, increasing risk of morbidity including bleeding frequency and arthropathy, and mortality. The current study examined the association between history of inhibitors and physical growth measured by skeletal maturation (bone age, BA) in participants enrolled in the longitudinal Hemophilia Growth and Development Study (HGDS). The HGDS is a population-based multicenter study of children and adolescents enrolled between 1989 and 1990. Participants not skeletally mature (n=306) were included in this investigation. Their mean age was 12, range 7–18 years. Seventy-five percent had severe hemophilia, 19% moderate, and 6% mild. Eighteen percent (n=54) had a history of inhibitors, with maximum lifetime Bethesda titers ranging from 1 to 2048. In general, HGDS participants received on-demand therapy prior to and during study follow-up. Skeletal maturation was determined centrally from x-rays of the hand-wrist according to the Fels method. Readers were masked to the clinical status of participants. Growth delay was defined as chronological age (age) minus BA and modelled using a longitudinal mixed effects polynomial model including age, race, HIV and inhibitor status, and their interactions. P-values were adjusted for multiple comparisons using Scheffe’s method. At every year evaluated (10 through 16), growth delay was greater among HIV-negative subjects with a history of inhibitors compared to HIV-negative subjects without inhibitors (p-values ranged from 0.042 to 0.12). The greatest differences, 9 to 10 months, were observed during the period of expected maximum growth velocity, 12 through 14 years of age (all p<0.05). At ages 15 and 16, subjects with inhibitors lagged approximately 9 months behind those without inhibitors in their skeletal maturation (p=0.067 and 0.12). The predicted BA of HIV-negative adolescents without inhibitors was quite similar to age during this period. At 12, 13, 14, 15 and 16 years, they were 11.9, 13.1, 14.3, 15.4, and 16.4 respectively. Previous investigations from the HGDS have reported delays in skeletal maturation associated with HIV. In this study, delays were greater among HIV-positive subjects with an inhibitor compared to HIV-positive subjects without an inhibitor at every age, but perhaps due to intervening effects of HIV, the differences were generally small (1 to 2 months) and not statistically significant. In conclusion, the differences in bone age relative to chronological age between the HIV-negative groups suggest that a history of inhibitors is associated with delays in onset of puberty. Further investigation of this association and other growth parameters is a priority. If confirmed, the observation has important clinical, epidemiologic and therapeutic implications for the children and adolescents most severely impacted by hemophilia.

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Correlation between different methods of assessing bone maturation

Revista de Ciências Médicas e Biológicas ◽

10.9771/cmbio.v20i1.38643 ◽

2021 ◽

Vol 20 (1) ◽

pp. 75

Author(s):

Daniela Correia Cavalcante Souza ◽

Marina Tavares Costa Nóbrega ◽

Andressa Cavalcanti Pires ◽

Rosa Helena Wanderley Lacerda

Keyword(s):

Skeletal Maturity ◽

Cervical Vertebrae ◽

Assessment Methods ◽

Skeletal Maturation ◽

Chronological Age ◽

Bone Maturation ◽

Matlab Program ◽

Maturation Stages ◽

Maturation Index ◽

Dental Mineralization

Introduction: the skeletal maturity of na individual can be evaluated through different methods and it is an important tool to the diagnostic and treatment in othodontics. Objective: to verify the correlation between different methods of assessing bone maturation: Carpal Maturation Index (CMI), Cervical Vertebrae Maturation Stages (CVM) and Dental Mineralization Stages (DM). Methodology: the sample consisted of digitalized images of cephalometric, panoramic and hand and wrist radiographs of 73 patients. 50 were selected for analysis. Two examiners were properly calibrated, through images analysis from another database. Inter and intraexaminer reliability was measured by Kappa coefficient. The images were assessed according to Fishman (1982), Baccetti, Franchi and McNamara Junior (2002) and Nolla (1960) methods. All images were coded and data of all analyzes was transferred to spreadsheets. The data was processed in Matlab program for Windows, version 7.10.0, and analyzed using descriptive and inferential statistics. Results: the results demonstrated a positive correlation among bone maturity methods (CMI, CVM and DM), as well as between those methods and chronological age. Females showed precocity in reaching the stages of skeletal maturation indicators and CVM compared to males. It was observed that there was a correspondence between maturation methods for both genders. Conclusion: there was a correlation between skeletal maturation assessment methods and dental mineralization in patients. Significant differences were observed between genders for skeletal maturity assessment methods. There was a relation between the methods used for skeletal maturation and dental mineralization, as well as chronological age.

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