Evaluating the effect of considering transitional stages on reproducibility of cervical vertebral maturation staging method in orthodontic treatments

Abstract

Time plays a crucial role in determining the final morphology and dimensions of a growing somatic structure. In orthodontics, timing of treatment could be as important as treatment plan. Cervical vertebrae morphology varies with growth. Since, the cervical vertebrae are visible in the lateral cephalograms which orthodontists typically use and does not need extra exposure to x-ray, assessment of skeletal age from cervical vertebrae maturation (CVM method), is a reliable method. The reproducibility of CVM method has been questioned recently. Some researchers believe that CVMS relies on clinician's ability in determining the morphological features of cervical vertebrae which can lead to low reproducibility of this method. One of the factors which should be considered is that morphological changes at different stages of growth occur gradually from one level to the next step rather than suddenly. In this study we're going to investigate the possible impact of considering intermediate stages on the reproducibility of the CVMS method. Materials & Methods: Seventy pretreatment lateral cephalograms of Iranian patients between 7 and 15 years of good-quality with four cervical vertebrae in full view were observed by five experienced orthodontists according to method of Baccetti et al and also according to a nine-stage method. Inter-observer reproducibility was calculated using weighted Kohen's kappa and intra-observer reproducibility was calculated using Fleiss kappa test. Results: Inter-observer reproducibility was between 0.48 and 0.61 in Baccettis standard method. Inter-observer reproducibility of intermediate method was between 0.36 and 0.57. Intra-observer reproducibility of both methods was between 0.70 and 0.75. Conclusions: Inter-observer reproducibility of CVMS is fair to moderate and considering intermediate stages does not increase the reproducibility of this method. Intra-observer reproducibility of CVMS method is substantial and it does not show significant change by considering intermediate stages. On the other hand, CVMS has an acceptable reproducibility in determining timming of functional treatment for Class II patients.