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Objective: This study was conducted to investigate the relationship between dental development and cervical vertebral maturation stages in a group of Yemeni children and adolescents. Materials an Methods: The study included digital panoramic radiographs and lateral skull cephalograms obtained from 207 Yemeni subjects­122 females and 85 males aged between 8 to 18 years. Dental maturity was evaluated according to the method of Demirijian et al., calcification stages of the left mandibular canines, first and second premolars and second molars were assessed. Skeletal maturity was assessed by the cervical vertebral maturation (CVM) stages according to the method of Baccetti et al. Correlation between CVM and dental maturation was evaluated by Spearman rank-order correlation coefficient (SROCC). Results: CVM and dental calcification stages were highly correlated (p<0.001) in both genders, ranging from 0.686 to 0.873 for females and 0.787 to 0.871 for males. Calcification stages of the second molars showed the strongest correlation with CVM. Conclusion: Calcification stages of the second molar may be used as a reliable maturation indicator. Dental maturation may be applied to determine the skeletal maturity status of Yemeni children and adolescents.

Objetivo: Este estudio se realizó para investigar la relación entre el desarrollo dental y las etapas de maduración vertebral cervical en un grupo de niños y adolescentes yemeníes. Material y Métodos: El estudio incluyó radiografías panorámicas digitales y cefalogramas laterales del cráneo obtenidos de 207 sujetos yemeníes: 122 mujeres y 85 hombres de entre 8 y 18 años. La madurez dental se evaluó de acuerdo con el método de Demirijian et al. Se evaluaron las etapas de calcificación de los caninos mandibulares izquierdos, primer y segundo premolares y segundos molares. La madurez esquelética se evaluó mediante las etapas de maduración vertebral cervical (CVM) de acuerdo con el método de Baccetti et al. La correlación entre la CVM y la maduración dental se evaluó mediante el coeficiente de correlación de orden de rango de Spearman (SROCC). Resultado: Las etapas de CVM y calcificación dental estuvieron altamente correlacionadas (p<0.001) en ambos sexos, con un rango de 0.686 a 0.873 para las mujeres y 0.787 a 0.871 para los hombres. Las etapas de calcificación de los segundos molares mostraron la correlación más fuerte con CVM. Conclusión: las etapas de calcificación del segundo molar pueden usarse como un indicador de maduración confiable. La maduración dental puede aplicarse para determinar el estado de madurez esquelética de los niños y adolescentes yemeníes.

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El uso de un método rápido y efectivo para la estimación de la maduración esquelética de los pacientes pediátricos es fundamental para la aplicación oportuna de tratamientos ortopédicos/ortodónticos. En Odontología Pediátrica, la toma de una radiografía panorámica, como método diagnóstico de rutina, puede servir para estimar con precisión el estadio de maduración en estos pacientes, mediante el cálculo de la edad dental. El objetivo del presente trabajo fue determinar la correlación entre las edades cronológica y dental con los estadios de maduración esquelética de las vértebras cervicales, a través del método estadístico no paramétrico con Rho de Spearman. Se utilizó un diseño observacional, transversal y analítico. La muestra consistió en 516 expedientes de pacientes entre los 5 y 15 años de edad, sistémicamente sanos, con radiografías panorámica y lateral de cráneo, tomadas en la misma fecha. Se determinó la edad cronológica de cada paciente según su historia clínica. Se realizó el cálculo de la edad dental de cada paciente con el método de Demirjian, y se determinó el estadio de maduración de vértebras cervicales con el método de Lamparski. Se determinó una correlación de 72 % entre la edad cronológica y la maduración ósea vertebral; una correlación del 66 % entre la edad dental y la maduración ósea, y una correlación del 86 % entre la edad cronológica y la dental. De acuerdo con estos resultados, tanto la edad cronológica y dental presentan una alta correlación con la edad de maduración vertebral. Se concluye así que la edad dental y cronológica son indicadores apropiados para estimar el estadio de maduración esquelética de los pacientes pediátricos.

The use of fast and effective methods for estimating the skeletal maturity for pediatric patients, is fundamental for the opportune application of orthopedic/orthodontic treatments. In pediatric dentistry, the panoramic radiography as a routine diagnostic method, can be used to estimate the stage of maturation in these patients, through the calculation of dental age. The aim of the present study is to determine the correlation between the chronological and dental ages, with the cervical vertebrae stages of skeletal maturity, through the non-parametric Spearman statistical method. An observational, transversal, and analytical design was employed. The sample consisted of 516 records from patients between 5 and 15 years of age, systemically healthy, with panoramic and lateral skull radiographs taken on the same date. The chronological age of each patient was determined according to the clinical history. Dental age of each patient was calculated with the Demirjian approach, and the stage of maturation of cervical vertebrae was determined by means of the Lamparski method. The results showed a correlation of 72 % between chronological age and bone maturation, a correlation of 66 % between dental age and bone maturation, and a correlation of 86 % between chronological and dental age. It is concluded that both chronological and dental age exhibit a high correlation with the correspondent stage of vertebral maturity. Thus, dental and chronological age are appropriate indicators to estimate, with high precision the stage of skeletal maturation in pediatric patients.

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Objective: to determine the relationship between chronological age and dental age using Demirjian's method and Baccetti's method of cervical vertebral maturation in radiographs of children and adolescents aged 5 to 16 years in the city of Bucaramanga, Colombia. methods: an analytical observational cross-sectional study was performed in 1385 cephalometric and panoramic radiographs of 775 females and 610 males. sex, dental age according to the Demirjian's method, chronological age and degree of maturation of the cervical vertebrae according to Baccetti's method were analyzed. the univariate analysis included the calculation of measures of central tendency for quantitative variables, and frequencies and proportions for qualitative variables. spearman correlation coefficients were calculated in the bivariate analysis. in the multivariate analysis a multiple linear regression was performed. a value of p<0.05 was considered statistically significant. results: the mean chronological age was 10.8±3.3 years [Median: 11; 95 percent CI:10.6-10.6]. there was no statistically significant difference according to sex (p=0.3409). the mean of the differences between dental age and chronological age was 0.60±1.44 years. there was a strong and positive correlation between dental age and chronological age with each stage of maturation. females reached skeletal maturity at an earlier age. conclusions: chronological age shows a direct and positive relationship with dental age and stages of skeletal maturation in a colombian population.

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In maxillary orthopedics and related areas, it is essential to determine patient growth peak in order to provide timely diagnosis and treatments. This requires the use of biological indicators that enable children and adolescents to be assigned to maturation stages. The aim of this study was to determine the correlation between cervical vertebrae maturation stages and chronological age in children and adolescents. In this study were evaluated 93 lateral cranium radiographs of 6- to 17-year-old patients who visited the Postgraduate Maxillary Orthopedics Clinic at the School of Dentistry at Universidad del Zulia. Two examiners made independent assessments of cervical vertebrae maturation stage using the method described by Baccetti et al. For each stage, descriptive statistics for chronological age were evaluated, classified according to sex. In addition, parametric and non-parametric tests were performed in which p <0.05 was considered significant. Mean age of the children and adolescents studied was 9.6 years, with standard deviation 2.5 years. The correlation coefficient (r= 0.771) certified a high positive correlation between bone maturation and chronological age. This correlation coefficient was highly positive for girls (r=0.858) and moderately positive for boys (r=0.688). The model obtained explains 59.4 % of the variation between bone maturation and chronological age, evidencing an average age increase of three years when maturation stage increases by approximately 1 year. The results suggest that although the degree of covariance between chronological age and maturation stages was highly positive in this study, chronological age does not allow bone maturation to be determined precisely, since it may be influenced by genetic and/or environmental factors.

En ortopedia maxilar y áreas afines resulta esencial determinar el pico de crecimiento de los pacientes para establecer diagnósticos y tratamientos oportunos para lo cual es necesario utilizar indicadores biológicos, que permiten ubicar a los niños y adolescentes en estadios de maduración. El objetivo de este estudio fue determinar la correlación de los estadios de maduración de las vértebras cervicales según la edad cronológica en niños y adolescentes. Se evaluaron 93 imágenes de radiografías lateral de cráneo, de pacientes entre 6 y 17 años de edad que asistieron a la clínica del Posgrado de Ortopedia Maxilar de la Facultad de Odontología de La Universidad del Zulia, dos examinadores estimaron de forma independiente el estadio de maduración de las vértebras cervicales, utilizando el método descrito por Baccetti et al. y para cada estadio se evaluaron los estadísticos descriptivos de la edad cronológica categorizando según sexo, además se realizaron pruebas paramétricas y no paramétricas donde un p <0,05 fue considerado como significativo. La edad media de los niños y adolescentes estudiados resultó de 9,6 años y una desviación típica de 2,5 años. El coeficiente de correlación (r=0,771) certificó una correlación positiva alta entre maduración ósea y edad cronológica, igual producto se obtuvo en el caso de las niños y adolescentes del sexo femenino (r=0,858), mientras los del sexo masculino obtuvieron una correlación positiva moderada (r= 0,688). El modelo obtenido explica el 59,4 % de la variación entre maduración ósea y edad cronológica, lo cual evidencia el aumento de la edad promedio en tres años, cuando el estadio de maduración aumenta 1 año aproximadamente. Los resultados registrados sugieren que, aunque el grado de covarianza entre edad cronológica y estadios de maduración en esta investigación fue positiva alta, la edad cronológica no permite determinar con exactitud la maduración ósea, pudiendo estar influenciada por factores genéticos y/o ambientales.

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A utilização do método de maturação das vértebras cervicais (CVM) vem sendo controversa na literatura devido a sua baixa reprodutibilidade. O objetivo deste estudo prospectivo observacional foi avaliar as vértebras cervicais, por meio de imagens de tomografia computadorizada de feixe cônico (TCFC), verificando-se o grau de reprodutibilidade das características morfológicas e dos estágios de maturação das vértebras cervicais segundo o método proposto por Baccetti et al. (2005), incluindo-se o agrupamento dos estágios de pós-surto de crescimento. Para essa finalidade, 75 participantes examinaram 12 projeções cefalométricas laterais (Cef2D) extraídas de imagem de TCFC e 12 reconstruções tomográficas sagitais (Rec2D), para analisar as características morfológicas das vértebras cervicais (borda inferior de C2, C3 e C4 e forma de C3 e C4) e classificar seus estágios de maturação em cada imagem de acordo com o método CVM referenciado. O grau de reprodutibilidade das variáveis analisadas foi verificado por meio do índice kappa. A análise da reprodutibilidade intra-examinador e inter-examinador relacionada à borda inferior de C2, C3 e C4 mostrou, respectivamente, níveis de concordância quase perfeito e substancial; enquanto nível de concordância moderado foi evidenciado para a forma de C3 e C4 em ambas as análises. Esses resultados foram similares em Cef2D e Rec2D. Considerando-se a classificação dos estágios de maturação das vértebras cervicais, observaram-se graus de reprodutibilidade inter-examinador e intraexaminador substanciais em ambas as imagens geradas da TCFC. Ao eliminar as 24,5% de incoerências encontradas, o grau de reprodutibilidade melhorou para ambas as análises e imagens, principalmente na concordância interexaminador em Rec2D, onde o grau de concordância foi quase perfeito. Quando os estágios de pós-surto de crescimento foram reunidos, a reprodutibilidade do método CVM alcançou nível de concordância quase perfeito para Cef2D e Rec2D. Conclui-se que a forma das vértebras cervicais foi o parâmetro de maior dificuldade nas análises de reprodutibilidade realizadas neste estudo; ao passo que os estágios CVM de pós-surto de crescimento foram agrupados, melhores níveis de concordância no grau de reprodutibilidade foram constatados. Com isso, sugere-se uma nova abordagem do método CVM descrito por Baccetti et al (2005), onde somente a borda inferior das vértebras C2, C3 e C4 é considerada e agrupam-se os estágios de pós pico de crescimento mandibular. (AU)

The use of the cervical vertebrae maturation method (CVM) has been controversial in the literature due to its low reproducibility. The objective of this prospective observational study was to evaluate the cervical vertebrae using cone-beam computed tomography (CBCT) images, verifying the degree of reproducibility of the morphological characteristics and maturation stages of the cervical vertebrae according to the method proposed by Baccetti et al. (2005), including the clustering of post-peak growth stages. For this, 75 participants examined 12 lateral cephalometric projections (Cef2D) extracted from CBCT images and 12 sagittal tomographic reconstructions (Rec2D), to analyze the morphological characteristics of the cervical vertebrae (lower border of C2, C3 and C4 and shape of C3 and C4) and classify their stages of maturation in each image according to the CVM method referenced. The degree of reproducibility of the analyzed variables was verified using the kappa index. The analysis of the intra-examiner and inter-examiner reproducibility related to the lower border of C2, C3 and C4 showed, respectively, levels of almost perfect and substantial agreement; while moderate agreement level was evidenced for the shape of C3 and C4 in both analyzes. These results were similar in Cef2D and Rec2D. Considering the classification of the maturation stages of the cervical vertebrae, substantial inter-examiner and intra-examiner reproducibility levels were observed in both generated images of the CBCT. By eliminating the 24.5% of inconsistencies found, the levels of reproducibility improved for both analyzes and images, especially in the inter-examiner agreement in Rec2D, where the level of agreement was almost perfect. When the post peak mandibular growth CVM stages were grouped, the reproducibility of the CVM method reached almost perfect agreement level for Cef2D and Rec2D. It was concluded that the shape of the cervical vertebrae was the parameter of greatest difficulty in the reproducibility analyzes performed in this study; when the post peak mandibular growth CVM stages were grouped, better levels of agreement on the degree of reproducibility were found. Therefore, we suggest a new approach to the CVM method described by Baccetti et al (2005), where only the lower border of the C2, C3 and C4 vertebrae is considered and the post peak mandibular growth stages are grouped. (AU)

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In maxillary orthopedics and related areas, it is essential to determine patient growth peak in order to provide timely diagnosis and treatments. This requires the use of biological indicators that enable children and adolescents to be assigned to maturation stages. The aim of this study was to determine the correlation between cervical vertebrae maturation stages and chronological age in children and adolescents. In this study were evaluated 93 lateral cranium radiographs of 6to 17yearold patients who visited the Postgraduate Maxillary Orthopedics Clinic at the School of Dentistry at Universidad del Zulia. Two examiners made independent assessments of cervical vertebrae maturation stage using the method described by Baccetti et al. For each stage, descriptive statistics for chronological age were evaluated, classified according to sex. In addition, parametric and nonparametric tests were performed in which p <0.05 was considered significant. Mean age of the children and adolescents studied was 9.6 years, with standard deviation 2.5 years. The correlation coefficient (r=0.771) certified a high positive correlation between bone maturation and chronological age. This correlation coefficient was highly positive for girls (r=0.858) and moderately positive for boys (r=0.688). The model obtained explains 59.4 % of the variation between bone maturation and chronological age, evidencing an average age increase of three years when maturation stage increases by approximately 1 year. The results suggest that although the degree of covariance between chronological age and matu ration stages was highly positive in this study, chronological age does not allow bone maturation to be determined precisely, since it may be influenced by genetic and/or environmental factors (AU)

En ortopedia maxilar y áreas afines resulta esencial determinar el pico de crecimiento de los pacientes para establecer diagnósticos y tratamientos oportunos para lo cual es necesario utilizar indicadores biológicos, que permiten ubicar a los niños y adolescentes en estadios de maduración. El objetivo de este estudio fue determinar la correlación de los estadios de maduración de las vértebras cervicales según la edad cronológica en niños y adolescentes. Se evaluaron 93 imágenes de radiografías lateral de cráneo, de pacientes entre 6 y 17 años de edad que asistieron a la clínica del Posgrado de Ortopedia Maxilar de la Facultad de Odontología de La Universidad del Zulia, dos examinadores estimaron de forma independiente el estadio de maduración de las vértebras cervicales, utilizando el método descrito por Baccetti et al. y para cada estadio se evaluaron los estadísticos descriptivos de la edad cronológica categorizando según sexo, además se realizaron pruebas paramétricas y no paramétricas donde un p <0,05 fue considerado como significativo. La edad media de los niños y adolescentes estudiados resultó de 9,6 años y una desviación típica de 2,5 años. El coeficiente de correlación (r=0,771) certificó una correlación positiva alta entre maduración ósea y edad cronológica, igual producto se obtuvo en el caso de las niños y adolescentes del sexo femenino (r=0,858), mientras los del sexo masculino obtuvieron una correlación positiva moderada (r= 0,688). El modelo obtenido explica el 59,4 % de la variación entre maduración ósea y edad cronológica, lo cual evidencia el aumento de la edad promedio en tres años, cuando el estadio de maduración aumenta 1 año aproximadamente. Los resultados registrados sugieren que, aunque el grado de covarianza entre edad cronológica y estadios de maduración en esta investigación fue positiva alta, la edad cronológica no permite determinar con exactitud la maduración ósea, pudiendo estar influenciada por factores genéticos y/o ambientales (AU)

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INTRODUCTION:: Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability. OBJECTIVE:: The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes. METHODS:: A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. The cervical vertebral maturation stage was recorded by means of Baccetti's method. The mean ages at CS3 and CS4 and the CS3-CS4 age interval were compared between boys and girls and among three skeletal classes. RESULTS:: Pubertal growth peak occurred on average four months earlier in girls than boys (p = 0.050). The average duration of pubertal growth peak was 11 months in Class I, seven months in Class II and 17 months in Class III subjects. Interclass differences were highly significant (Cohen's d > 0.08). However, no significant difference was found in the timing of pubertal growth peak onset among three skeletal classes (p = 0.126 in boys, p = 0.262 in girls). CONCLUSIONS:: Girls enter pubertal growth peak on average four months earlier than boys. Moreover, the duration of pubertal growth peak is on average four months shorter in Class II and six months longer in Class III subjects as compared to Class I subjects.

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ABSTRACT Introduction: Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability. Objective: The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes. Methods: A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. The cervical vertebral maturation stage was recorded by means of Baccetti's method. The mean ages at CS3 and CS4 and the CS3-CS4 age interval were compared between boys and girls and among three skeletal classes. Results: Pubertal growth peak occurred on average four months earlier in girls than boys (p = 0.050). The average duration of pubertal growth peak was 11 months in Class I, seven months in Class II and 17 months in Class III subjects. Interclass differences were highly significant (Cohen's d > 0.08). However, no significant difference was found in the timing of pubertal growth peak onset among three skeletal classes (p = 0.126 in boys, p = 0.262 in girls). Conclusions: Girls enter pubertal growth peak on average four months earlier than boys. Moreover, the duration of pubertal growth peak is on average four months shorter in Class II and six months longer in Class III subjects as compared to Class I subjects.

RESUMO Introdução: o pico de crescimento puberal está intimamente relacionado a um rápido aumento no comprimento da mandíbula e propicia uma larga gama de abordagens terapêuticas. Objetivos: o objetivo do presente estudo foi determinar e comparar as idades médias ao começo do pico de crescimento puberal, bem como sua duração, nas três diferentes classes esqueléticas. Métodos: esse estudo retrospectivo transversal foi conduzido usando radiografias celafométricas laterais de 230 indivíduos com potencial de crescimento (110 homens, 120 mulheres). Os indivíduos foram categorizados em 3 classes (Classe I = 81, Classe II = 82, Classe III = 67), conforme a relação sagital presente entre a maxila e a mandíbula. O estágio de maturação cervical foi registrado por meio do método de Baccetti. As idades médias em EMVC3 e EMVC4, bem como o intervalo de idade EMVC3-EMVC4 foram comparados entre meninos e meninas e entre as três classes esqueléticas. Resultados: o pico de crescimento puberal ocorreu, em média, quatro meses mais cedo nas meninas do que nos meninos (p = 0,050). A duração média do pico de crescimento puberal foi de 11 meses nos indivíduos Classe I, 7 meses nos indivíduos Classe II e de 17 meses nos indivíduos Classe III. As diferenças interclasses foram altamente significativas (d de Cohen > 0,08). Porém, não foram identificadas diferenças significativas quanto à época de início do pico de crescimento puberal entre as três classes esqueléticas (p = 0,126 nos garotos, p = 0,262 nas garotas). Conclusões: as meninas entram no pico de crescimento puberal, em média, quatro meses antes dos meninos. Além disso, a duração do pico de crescimento puberal é, em média, quatro meses menor em indivíduos Classe II e seis meses maior nos indivíduos Classe III, em comparação aos indivíduos Classe I.

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OBJECTIVES: To evaluate the cephalometric changes in skeletal, dentoalveolar and soft tissue variables induced by Clark's Twin Block (CTB) in Class II, Division 1 malocclusion patients and to compare these changes in different cervical vertebral maturation stages. METHODS: Pre- and post-treatment/observation lateral cephalograms of 53 Class II, Division 1 malocclusion patients and 60 controls were compared to evaluate skeletal, dentoalveolar and soft tissue changes. Skeletal maturity was assessed according to cervical vertebral maturation stages. Pre- and post-treatment/observation mean changes and differences (T2-T1) were compared by means of Wilcoxon sign rank and Mann-Whitney U-tests, respectively. Intergroup comparisons between different cervical stages were performed by means of Kruskal-Wallis test and Mann-Whitney U-test (p ≤ 0.05) . RESULTS: When compared with controls, there was a significant reduction in ANB angle (p < 0.001), which was due to a change in SNB angle in CS-2 and CS-3 (p < 0.001), and in SNA (p < 0.001) and SNB (p = 0.016) angles in the CS-4 group. There was significant increase in the GoGn-SN angle in CS-2 (p = 0.007) and CS-4 (p = 0.024), and increase in Co-Gn and Go-Gn amongst all cervical stages (p < 0.05). There was significant decrease in U1-SN and increase in IMPA amongst all cervical stages (p < 0.05). There was significant retraction of the upper lip in CS-3 (p = 0.001), protrusion of the lower lip in CS-2 (p = 0.005), increase in nasolabial angle in CS-4 (p = 0.006) and Z-angle in CS-3 (p = 0.016), reduction in H-angle in CS-2 (p = 0.013) and CS-3 (p = 0.002) groups. When pre- and post-treatment mean differences were compared between different cervical stages, significant differences were found for SNA, SNB and UI-SN angles and overjet. . CONCLUSIONS: The Twin-Block along with the normal craniofacial growth improves facial esthetics in Class II, Division 1 malocclusion by changes in underlying skeletal and dentoalveolar structures. The favorable mandibular growth occurs during any of the cervical vertebral maturation stages, with more pronounced effect during CS-3 stage.

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ABSTRACT Objectives: To evaluate the cephalometric changes in skeletal, dentoalveolar and soft tissue variables induced by Clark's Twin Block (CTB) in Class II, Division 1 malocclusion patients and to compare these changes in different cervical vertebral maturation stages. Methods: Pre- and post-treatment/observation lateral cephalograms of 53 Class II, Division 1 malocclusion patients and 60 controls were compared to evaluate skeletal, dentoalveolar and soft tissue changes. Skeletal maturity was assessed according to cervical vertebral maturation stages. Pre- and post-treatment/observation mean changes and differences (T2-T1) were compared by means of Wilcoxon sign rank and Mann-Whitney U-tests, respectively. Intergroup comparisons between different cervical stages were performed by means of Kruskal-Wallis test and Mann-Whitney U-test (p ≤ 0.05) . Results: When compared with controls, there was a significant reduction in ANB angle (p < 0.001), which was due to a change in SNB angle in CS-2 and CS-3 (p < 0.001), and in SNA (p < 0.001) and SNB (p = 0.016) angles in the CS-4 group. There was significant increase in the GoGn-SN angle in CS-2 (p = 0.007) and CS-4 (p = 0.024), and increase in Co-Gn and Go-Gn amongst all cervical stages (p < 0.05). There was significant decrease in U1-SN and increase in IMPA amongst all cervical stages (p < 0.05). There was significant retraction of the upper lip in CS-3 (p = 0.001), protrusion of the lower lip in CS-2 (p = 0.005), increase in nasolabial angle in CS-4 (p = 0.006) and Z-angle in CS-3 (p = 0.016), reduction in H-angle in CS-2 (p = 0.013) and CS-3 (p = 0.002) groups. When pre- and post-treatment mean differences were compared between different cervical stages, significant differences were found for SNA, SNB and UI-SN angles and overjet. . Conclusions: The Twin-Block along with the normal craniofacial growth improves facial esthetics in Class II, Division 1 malocclusion by changes in underlying skeletal and dentoalveolar structures. The favorable mandibular growth occurs during any of the cervical vertebral maturation stages, with more pronounced effect during CS-3 stage.

RESUMO Objetivo: avaliar as alterações em variáveis cefalométricas esqueléticas, dentoalveolares e do perfil tegumentar, induzidas pelo aparelho Twin Block de Clark (TBC), em pacientes com má oclusão de Classe II, divisão 1, e comparar as alterações nos diferentes estágios de maturação das vértebras cervicais. Métodos: telerradiografias laterais pré- e pós-tratamento de 53 pacientes com má oclusão de Classe II, divisão 1, foram comparadas às telerradiografias de 60 pacientes controle, para avaliar as alterações esqueléticas, dentoalveolares e no perfil tegumentar. A maturação esquelética foi avaliada de acordo com os estágios de maturação das vértebras cervicais. As alterações médias e as diferenças entre o pré- e o pós-tratamento (T2 - T1) foram comparadas por meio do teste de postos sinalizados de Wilcoxon e do teste U de Mann-Whitney, respectivamente. Foram realizadas comparações intergrupos para os diferentes estágios de maturação das vértebras cervicais, por meio do teste de Kruskal-Wallis e teste U de Mann-Whitney (p ≤ 0,05). Resultados: em comparação aos pacientes do grupo controle, constatou-se que houve uma redução significativa do ângulo ANB (p < 0,001), em virtude de alterações no ângulo SNB nos estágios CS2 e CS3 (p < 0,001), e nos ângulos SNA (p < 0,001) e SNB (p = 0,016) no estágio CS4. Houve um aumento significativo do ângulo GoGn-SN nos estágios CS2 (p = 0,007) e CS4 (p = 0,024), e um aumento em Co-Gn e Go-Gn em todos os estágios de maturação das vértebras cervicais (p < 0,05). Houve redução significativa em U1-SN e um aumento do IMPA em todos os estágios de maturação das vértebras cervicais (p < 0,05). Houve retração significativa do lábio superior em CS3 (p = 0,001), protrusão do lábio inferior em CS2 (p = 0,005), aumento do ângulo nasolabial em CS4 (p = 0,006) e do ângulo Z em CS3 (p = 0,016), além de redução do ângulo H em CS2 (p = 0,013) e CS3 (p = 0,002). Quando as diferenças médias entre pré- e pós-tratamento foram comparadas entre os diferentes estágios de maturação das vértebras cervicais, foram identificadas diferenças significativas para os ângulos SNA, SNB e UI-SN, assim como para o overjet. Conclusões: o uso do aparelho Twin-Block, associado ao crescimento craniofacial normal, melhora a estética facial em pacientes com má oclusão de Classe II, divisão 1, por meio de alterações nas estruturas esqueléticas e dentoalveolares subjacentes. Esse crescimento mandibular mais favorável pode ocorrer durante qualquer um dos estágios de maturação das vértebras cervicais, com um efeito mais acentuado durante o estágio CS3.

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The demand for age estimation of living and deceased children considerably increased in the last years. It was mainly justified by the growing globalization trend and the enlarged amount of violent crimes involving young victims. The present research aims to correlate skeletal and dental developmental stages using radiographic parameters. Lateral cephalometric (n = 576) and panoramic (n = 576) radiographs taken in the same moment were used to asses skeletal and dental development according to the methods of Hassel and Farman (1995) and Bacetti et al. (2002), and Demirjian et al. (1973), respectively. Likelihood-ratio test was used to verify the positive prediction in correlations between developmental stages. Spearman's correlation coefficient was calculated between skeletal and dental developmental stages, as well between estimated and chronological ages. Higher prediction in correlation for the skeletal starting stage (stage 1) with stage E in mandibular canines, and with stage D in mandibular premolars and second molars was detected. Higher staging correlations were observed considering the mandibular left second premolar (0.652, p < 0.001 for the technique of Bacetti et al.; and 0.646, p < 0.001 for the technique of Hassel and Farman). Despite the correlations between skeletal and dental developmental stages, the results must be carefully interpreted once it reached moderate values (<0.652). Further researches must test different classifications of skeletal and dental development, in order to verify the possibility of replacing one technique for another with stronger correlation.

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La maduración se puede definir como un proceso gradual en el tiempo, presenta sucesivas modificaciones cualitativas en la organización anatómica y fisiológica durante la pubertad hasta el estado de madurez adulto. En el diagnóstico y tratamiento en ortodoncia es importante conocer los estadios de maduración ósea pues proporcionan información relevante que permite determinar ritmo y tiempo de maduración individual. El uso y la aplicación varían entre las técnicas y tienen un objetivo común, la clasificación de niños y adolescentes en estadios de maduración. El objetivo de este estudio fue comparar la maduración ósea de las vértebras cervicales utilizando los métodos de Baccetti y Lamparski en una población nayarita. La muestra fueron 298 radiografías laterales de cráneo de las edades de 8 a 15 años. Se compararon mediante t de Student los estadios de maduración de los grupos en el análisis CVM de Baccetti y el análisis de Lamparski; en hombres y mujeres. La población masculina de 8 y 10 años no presentaba diferencias significativas entre ambos análisis; la población femenina de 8 años y masculina de 9 años se encontraron diferencias, teniendo mayores valores el análisis CVM de Baccetti, en los demás grupos del estudio también se encontraron diferencias presentando mayores valores en el análisis Lamparski. Los estadios de maduración en los dos tipos de análisis mostraron una marcada diferencia en sus interpretaciones, siendo el análisis de Lamparski más confiable como método diagnóstico de la maduración ósea.

Maturation can be defined as a gradual process over time, presenting successive qualitative changes in the anatomical and physiological organization during puberty to the adult status maturity. In the diagnosis and treatment in orthodontics it is important to know the stages of bone maturation. This can provide us relevant information that allows us to determine pace and time of maturation individual. The use and application techniques vary between and have a common goal, the classification of children and adolescents in stages of maturation. The objective of the study was to compare bone maturation of the cervical vertebrae using the methods of Baccetti and Lamparski in a population of Nayarit. The sample consisted of 298 lateral radiographs of the skull between ages of 8­15 years old. The maturity stages of the groups of CVM and Lamparski method, in men and women, were compared using Student t test. In the masculine population between 8 and 10 years significant differences were not found between both analysis; in the 8-year-old female group and the 9-year-old males, differences were found, with the CVM Baccetti analysis having higher values. In the other study groups, differences were also found showing higher values in the Lamparski analysis. The stages of maturation in the two types of analysis showed a marked difference in their interpretations. Lamparski analysis being more reliable as a diagnostic method for bone maturation.

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Introducción: en las prácticas médicas, ortopédicas y odontológicas se ha reconocido la importancia de diferenciar la edad cronológica de la edad esquelética o maduración ósea. La estimación del desarrollo óseo a partir de las vértebras cervicales es un método que se ha comprobado como confiable. Objetivo: relacionar los estadios de maduración ósea desde las vértebras cervicales según lo describe Baccetti y la edad cronológica en niños y adolescentes entre 8 y 14 años que asistieron a una clínica odontológica. Métodos: la muestra seleccionada fue probabilística y estuvo conformada por un total de 130 niños de la ciudad de Cali, Colombia. Se tomó una radiografía lateral de cráneo y se evaluaron los estadios de maduración ósea vertebral cervical bajo los estándares del método descrito por Baccetti. Resultados: el coeficiente de correlación entre la edad cronológica y estadios de maduración cervical fue r= 0,69, lo que muestra una moderada relación entre estas dos variables para los niños estudiados. Los estadios de maduración y el sexo explicaron el 50,4 % de la variabilidad de la edad cronológica. Para todos los estadios de maduración se encontraron diferencias significativas (p< 0,001). Los niños varones presentaron mayores estadios iniciales de maduración, aunque no se encontró diferencias significativas en función del sexo (p> 0,05). Conclusiones: Se logra determinar un modelo para explicar la variación de la edad cronológica del niño en función del estadio de maduración ósea cervical y el sexo del niño basado en la relacion positiva moderada entre la edad cronologica y la maduración osea evidenciada hasta el estadio C3(AU)

Introduction: the importance of distinguishing chronological from skeletal age or bone maturation has been recognized in medical, orthopedic and dental practice. Estimation of bone development on the basis of cervical vertebrae has proved to be a reliable method. Objective: relate the stages of bone maturation based on cervical vertebral development as described by Baccetti to the chronological age of children and adolescents aged 8-14 years attending a dental clinic. Methods: probabilistic sampling was used to select 130 children from the city of Cali, Colombia. Lateral skull radiography was performed to evaluate the stages of cervical vertebral bone maturation using the method described by Baccetti. Results: the correlation coefficient between chronological age and cervical maturation stage was r= 0.69, showing a moderate relationship between the two variables for the children studied. Maturation stages and gender accounted for 50.4 % of the variability in chronological age. Significant differences were found for all maturation stages (p< 0.001). Boys had higher initial maturation stages, though significant differences were not found between the genders (p> 0.05). Conclusions: It is possible to determine a model to explain the change in chronological age depending on the stage of cervical bone maturation and sex of the child, based on moderate positive relationship between chronological age and bone maturation evidenced through C3 stadium(AU)

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OBJECTIVES: The aim of this study was to evaluate the performance of CBCT three-dimensional (3D) reconstructions and sagittal sections for estimates of cervical vertebrae maturation index (CVMI). METHODS: The sample consisted of 72 CBCT examinations from patients aged 8-16 years (45 females and 27 males) selected from the archives of two private clinics. Two calibrated observers (kappa scores: ≥0.901) interpreted the CBCT settings twice. Intra- and interobserver agreement for both imaging exhibition modes was analyzed by kappa statistics, which was also used to analyze the agreement between 3D reconstructions and sagittal sections. Correlations between cervical vertebrae maturation estimates and chronological age, as well as between the assessments by 3D reconstructions and sagittal sections, were analyzed using gamma Goodman-Kruskal coefficients (α = 0.05). RESULTS: The kappa scores evidenced almost perfect agreement between the first and second assessments of the cervical vertebrae by 3D reconstructions (0.933-0.983) and sagittal sections (0.983-1.000). Similarly, the agreement between 3D reconstructions and sagittal sections was almost perfect (kappa index: 0.983). In most divergent cases, the difference between 3D reconstructions and sagittal sections was one stage of CVMI. Strongly positive correlations (>0.8, p < 0.001) were found not only between chronological age and CVMI but also between the estimates by 3D reconstructions and sagittal sections (p < 0.001). CONCLUSIONS: Although CBCT imaging must not be used exclusively for this purpose, it may be suitable for skeletal maturity assessments.

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OBJECTIVE: The aim of this cross sectional study was to assess serum insulin-like growth factor-1 (IGF-1) levels in female and male subjects at various cervical vertebral maturation (CVM) stages. MATERIAL AND METHODS: The study sample consisted of 60 subjects, 30 females and 30 males, in the age range of 8-23 years. For all subjects, serum IGF-1 level was estimated from blood samples by means of chemiluminescence immunoassay (CLIA). CVM was assessed on lateral cephalograms using the method described by Baccetti. Serum IGF-1 level and cervical staging data of 30 female subjects were included and taken from records of a previous study. Data were analyzed by Kruska-Wallis and Mann Whitney test. Bonferroni correction was carried out and alpha value was set at 0.003. RESULTS: Peak value of serum IGF-1 was observed in cervical stages CS3 in females and CS4 in males. Differences between males and females were observed in mean values of IGF-1 at stages CS3, 4 and 5. The highest mean IGF-1 levels in males was observed in CS4 followed by CS5 and third highest in CS3; whereas in females the highest mean IGF-1 levelswas observed in CS3 followed by CS4 and third highest in CS5. Trends of IGF-1 in relation to the cervical stages also differed between males and females. The greatest mean serum IGF-1 value for both sexes was comparable, for females (397 ng/ml) values were slightly higher than in males (394.8 ng/ml). CONCLUSIONS: Males and females showed differences in IGF-1 trends and levels at different cervical stages.

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OBJECTIVES: To perform a systematic review with meta-analysis to answer the question: is the cervical vertebrae maturation index (CVMI) effective to replace hand-wrist radiograph (gold standard) in determining the pubertal growth spurt in patients undergoing bone growth? METHODS: A search in three databases was performed, in which studies were selected that compared one of the two main assessment methods for cervical vertebrae (Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 1995; 107: 58-66, or Baccetti T, Franchi L, McNamara JA Jr. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod 2002; 72: 316-23) to a carpal assessment method. The main methodological data from each of the texts were collected and tabulated after. Later, the meta-analysis of the correlation coefficients obtained was performed. RESULTS: 19 articles were selected from an initial 206 articles collected. Regardless of the method used, the results of the meta-analysis showed that every article selected presented a positive correlation between skeletal maturation assessment performed by cervical vertebrae and carpal methods, with discrepancy of values between genders indicating higher correlation for the female gender (0.925; 0.878) than for the male (0.879; 0.842). When the assessment was performed without gender separation, correlation was significant (0.592; 0.688) but lower in the cases when genders were separated. CONCLUSIONS: With the results of this meta-analysis, it is safe to affirm that both CVMIs used in the present study are reliable to replace the hand-wrist radiograph in predicting the pubertal growth spurt, considering that the highest values were found in female samples, especially in the method by Hassel and Farman.

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El objetivo del estudio fue comparar los valores del triángulo cefalométrico de McNamara en sujetos normodivergentes no tratados con maloclusión de Clase II y Clase III, de origen latinoamericano, agrupados por estadío de maduración devértebras cervicales, en comparación con un grupo control sin tratamiento, normodivergentes y con maloclusión de Clase I. El estudio se realizó sobre una muestra de seiscientos diez cefalogramas laterales de cabeza pretratamiento (250 hombres, 360 mujeres) que fueron agrupados de acuerdo a su relación esquelética sagital (Clase I, II ó III), estadío de maduración vértebras cervicales (pre pico puberal P1 = CS1 y CS2, pico puberal P2 = CS3 y CS4, y post pico puberal P3 = CS5 y CS6) y sexo. Se midió en cada cefalograma el triángulocefalométrico de McNamara Co-A, Co-Gn y ENA-Me. Se realizaron las pruebas de ANOVA y post-hoc Tukey HSD paradeterminar las diferencias entre grupos. Los resultados en hombres muestran que los mayores aumentos maxilares ymandibulares se produjeron durante la etapa P3 (CS5 para CS6), mientras que en las mujeres se produjeron en la etapaP2 (CS3 para CS4). Las distancias Co-A y Co-Gn muestran diferencias significativas entre las diferentes clases (p <0,05). La longitud maxilar de los sujetos de Clase II y la longitudmandibular de los sujetos de Clase III estuvieron aumentadas al inicio del período evaluado (P1). Se identificó una tendencia al empeoramiento de las maloclusiones de Clase II y III durante el período evaluado. Finalmente los cambios en los valores del triángulo cefalométrico de McNamara fueron marcadamente diferentes en las tres clases de maloclusión en sujetos normodivergentes. En estos sujetos latinoamericanos el estirón puberal se produjo en momentos diferentes con respecto a la raza caucásica y lasnormas asiáticas...

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The aim of the present work was to determine the duration of the adolescent peak growth spurt using cervical vertebral maturation analysis in class I and II malocclusion subjects. The study was conducted on a sample which consisted of 154 lateral cephalograms of children and adolescents aged 9-15 years (84 females and 70 males). The evaluation of skeletal maturation stage was performed using a visual morphological analysis of CS3 and CS4 cervical vertebrae. The sagittal skeletal relation was evaluated according to Steiner analysis. Descriptive statistics were used to summarize chronological age in each malocclusion group and for each CS3 and CS4 skeletal maturation stage. Due to a lack of normal distribution, comparisons of CS3 and CS4 age intervals on class I and II subjects were compared using the Mann-Whitney U test for independent samples. The results show that the mean duration of the adolescent peak growth spurt was 10 months between CS3 and CS4 stages in class I malocclusion subjects, whereas in class II malocclusion patients the duration was 6 months. This difference of 4 months was statistically significant (p<0.001). Finally, a clinically significant difference of 4 months in the duration of the adolescent peak growth spurt for class I and II malocclusion subjects was identified.

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Este estudo analisou a aplicabilidade da Fórmula de Regressão Múltipla de Mito, Sato e Mitani (2002) na avaliação da maturidade esquelética em 289 crianças brasileiras, naturais da cidade de Ourinhos, com a idade cronológica variando entre sete e 15 anos, sendo 153 do sexo feminino e 136 do sexo masculino. Na sequência, comparou-se a idade esquelética verificada na vértebra cervical com a identificada na radiografia carpal, empregando-se o método computadorizado de Eklõf e Ringertz (1967), e o método comparativo de Greulich e Pyle (1959). Com a aplicação do teste t e da análise de correlação, e considerando a metodologia adotada, concluiu-se que: 1) para o sexo feminino, observou-se uma maior correlação entre a idade ER e a idade GP; com relação à idade das vértebras, a correlação foi significante com a idade GP, ao passo que, no sexo masculino, verificou-se a diferença entre a idade vertebral e as demais; 2) o resultado das proporções mostrou-se semelhante ao de Mito, Sato e Mitani, para o sexo feminino; 3) a morfologia das vértebras apresentou maior correlação com o metacarpo do segundo dedo; 4) a fórmula de regressão não foi aplicável à amostra avaliada, devendo ser individualizada segundo a composição racial.

This study verified the applicability of the Multiple Regression Formula of Mito, Sato and Mitani (2002) in the assessment of skeletal maturity in 289 Brazilian children that were born in Ourinhos, with chronological ages ranging from 7-15 years, of which 153 were of the female gender and 136 of the male gender. Next, we compared the skeletal age checking the cervical vertebrae with the carpal index on radiographs, using the computerized method of the Eklõf Ringertz (1967), and the comparative method of Greulich and Pyle (1959). The application of the test t and correlation analysis, considering the methodology, it can be concluded that: 1) children of the female gender, showed a higher correlation between ER and GP age; with the vertebrae age, the correlation was significant, with the GP age; however in children of the male gender, it was verified a difference between the vertebral age with the others; 2) the result of the proportions was similar to the Mito, Sato and Mitani, for females; 3) the morphology of the vertebrae showed a higher correlation with the second finger metacarpal; 4) the regression formula was not applicable to the assessed sample and should be individualized according to racial composition.

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INTRODUCTION: This study was conducted with the aim of adapting the methods developed by Martins and Sakima to assess skeletal maturation by cervical vertebrae in the pubertal growth spurt (PGS) curve. It also aimed to test the reliability and agreement between those methods and the method of hand and wrist radiograph when compared two by two and all together.  METHODS: The sample comprised 72 radiographs, with 36 lateral radiographs of the head and 36 hand-wrist radiographs of 36 subjects with Down's syndrome (DS), 13 female and 23 male, aged between 8 years and 6 months and 18 years and 7 months, with an average age of 13 years and 10 months.  RESULTS AND CONCLUSIONS: Results revealed that adapting the methods developed by Martins and Sakima to assess skeletal maturation by cervical vertebrae in the PGS curve is practical and useful in determining the stage of growth and development of individuals. The stages of maturation evaluated by cervical vertebrae and ossification centers observed in radiographs of the hand and wrist were considered reliable, with excellent level of agreement between the methods by Hassel and Farman as well as Baccetti, Franchi and McNamara Jr and Martins and Sakima. Additionally, results revealed an agreement that ranged between reasonable to good for the three methods used to assess the skeletal maturation, showing statistical significance.

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