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Hand Wrist Vs Cervical Vertebra
Hand Wrist Vs Cervical Vertebra
Hand Wrist Vs Cervical Vertebra
ABSTRACT
Objective: To compare skeletal maturation as measured by hand-wrist bone analysis and by
cervical vertebral analysis.
Materials and Methods: A radiographic hand-wrist bone analysis and cephalometric cervical
vertebral analysis of 30 patients (14 males and 16 females; 7–18 years of age) were examined.
The hand-wrist bone analysis was evaluated by the Bjork index, whereas the cervical vertebral
the final stages of skeletal maturity, mandibular growth vical vertebral analysis measured on lateral skull ceph-
exceeds that of the maxilla. alograms.
In 1980, Smith8 reviewed the literature and con-
firmed the efficacy and diagnostic validity of the hand- MATERIALS AND METHODS
wrist bone analysis. Regarding the possible relation-
The present study involved 30 patients (14 males
ship between skeletal and chronological age, Fish-
and 16 females, 7–18 years of age) undergoing ortho-
man9 found no close relationship and concluded that dontic treatment. A hand-wrist bone analysis and a
there was no specific relation between the variables. cervical vertebral analysis were available for all pa-
The assessment of the degree of cervical vertebral tients and determined their skeletal age.
maturation (CVM)10–15 is another method of assessing This same determination was performed on the
skeletal maturation. This method has not been studied same radiographs after 6 months by the same oper-
closely but does show a great potential to determine ator to confirm the repeatability of the obtained results.
the skeletal age of the patient. In fact, the maturation The hand-wrist bone analysis was evaluated accord-
of the cervical vertebrae follows given stages of ossi- ing to the Bjork index.2,3 Hand-wrist bone mineraliza-
fication from which the skeletal maturity of the patient tion was evaluated up to the age of 9 years; thereafter,
can be deduced. the mineralization of the metacarpal and phalanx
of the patients will reach the peak of mandibular beginning of the adult age and corresponds to Bjork
growth within 1 year. stages 8 and 9.
• CVMS III: Marked by concavities under C4. C2, C3,
and C4 bodies are on the lower edge. C3 and C4 RESULTS
bodies are horizontal rectangles. This stage is the
The results of the cervical vertebral analysis and the
simplest to be checked and marks the end of the
hand-wrist bone analysis for the 30 patients are shown
maximum growth-spurt year. Therefore, the peak of
in Tables 1 and 2. Table 1 illustrates the data of the
maximum acceleration has just passed.
first evaluation, and Table 2 summarizes the data ob-
• CVMS IV: At least one of the two cervical vertebrae
tained on the same radiographs after 6 months.
(C3 and C4) or even both have a square feature.
The Cohen index was calculated by considering
The concavity on the inferior edge of C2, C3, and the most unfavorable conditions ranging between the
C4 is always present. The mandibular acceleration uncategorized cases of hand-wrist bone analysis and
peak ended at least 1 year earlier. those of the vertebral analysis (ie, when the stage of
• CVMS V: At least one vertebra (C3 and C4) or even growth is midway between two adjacent stages). For
both have a vertical rectangular form (the larger example, patient T.M. ⫽ CVMS IV–V or patient M.A.
base of the rectangle is vertical). The inferior edge ⫽ Bjork 3–4 and those in which the CVMS evaluation
TABLE 1. Cervical Vertebrae Measurements, Cervical Vertebral Maturation Stage (CVMS) Stages, and Hand-Wrist Bone Bjork Stages With
Related Intervals* (conc ⫽ concavity)
C2 C3 C4
conc conc conc
Patient (mm) (mm) (mm) P3 B3 A3 P4 B4 A4 C3 BAR C3 PAR C4 BAR C4 PAR CVMS Bjork
N.A. 0 0 0 11-16-7 12-16-9 2.28 1.57 1.77 1.33 I 1A
S.M. 1 0 0 8-12.5-6 9.5-13-7 2.08 1.33 1.85 1.35 I 1A
V.F. 0 0 0 11-13-8 10-13-8 1.62 1.37 1.62 1.25 I 1A
V.O. 1 0 0 12-14-8 11-14-8 1.75 1.5 1.75 1.37 I 1A
B.A. 0 0 0 9-15-8 10-15-7 1.87 1.12 2.14 1.42 I 2A
M.M. 1.5 0 0 11-14-8 12-14-7 1.75 1.37 2 1.71 I 2–3 A
M.C. 1 0 0 11.5-16-8 12-15-9 2 1.43 1.66 1.33 I 3A
G.M. 0 0 0 12-15-9 12-15-9 1.66 1.33 1.66 1.33 I 3A
B.G. 1 0.3 0 11-14-10 12-15-9 1.4 1.1 1.66 1.33 I–II 4B
M.A. 1 1 0 10-14-7 9-15-7 2 1.42 2.14 1.28 II 3–4 A–B
G.A. 1.5 1 0 12-15-9 12-16-9 1.66 1.33 1.77 1.33 II 4B
M.S. 2 1 0 12-16-9 10-14-9 1.77 1.33 1.55 1.11 II 4B
D.N. 1 1 0 10-13.5-8.5 10-13-10 1.58 1.17 1.3 1 II 4B
not a valid instrument to calculate the speed of growth (0.783). These same values were then confirmed in a
and skeletal maturation.5,9 However, both sexual dif- second assessment on the same radiographs after 6
ferences5 and the great variation among subjects can months. Given that in a Cohen statistical analysis
be ascertained by a radiographic hand-wrist bone even the unclassified cases are considered discor-
analysis with the Greulich and Pyle1 atlas. dant, the differences between the first and the second
Moore19 has pointed out that the facial bones differ evaluations do not change the results. Patient B.G.
from most of the skeleton because they are formed by was CVMS I–II Bjork 4 (undefined) in the first evalu-
intramembranous ossification with no cartilaginous ation and CVMS I Bjork 4 (discordant) in the second
precursor. Therefore, in comparison with general de- evaluation. Regarding skeletal aging, this shows that
velopment, different factors are involved in each indi- the significance of the cervical vertebral analysis, in
vidual’s facial growth. particular CVMS and hand-wrist methods, is very
In recent years, the modification of the cervical ver- close.
tebrae in form and dimension has been reported, thus Our results confirm what was observed by San Ro-
enabling the assessment of an individual’s skeletal man et al,20 but we think it is worth adding a consid-
maturation rate.10–17,19 The orthodontic clinical implica- eration concerning both methods. Because growth is
tions are interesting, and many authors have support- a continuous phenomenon, either the hand-wrist or the
ed the efficacy of the cervical vertebral analysis to as- cervical vertebral indicators can present both non–
sess the skeletal age.12–15,17 well-defined patients and some whose growth is inter-
The comparison between the hand-wrist bone anal- mediate between two stages. As far as orthognathic
ysis and the cervical vertebral analysis in our sample purposes and from a clinical point of view, what mat-
revealed a concordance in 25 individuals (83.3%). The ters is not a rigid stage classification but the identifi-
Cohen index also revealed a good concordance cation of a growth interval.
TABLE 2. The Same Measurements and Intervals as in Table 1 After 6 Months (conc ⫽ concavity)
C2 C3 C4
conc conc conc
Patient (mm) (mm) (mm) P3 B3 A3 P4 B4 A4 C3 BAR C3 PAR C4 BAR C4 PAR CVMS Bjork
N.A. 1.5 0 0 11.5-15-7 11-15-8 2.14 1.64 1.87 1.37 I 1A
S.M. 1 0 0 8-12.5-6 9.5-13-7 2.08 1.33 1.85 1.35 I 1A
V.F. 0 0 0 10-12-8 10-13-8 1.5 1.25 1.62 1.25 I 1A
V.O. 2 0 0 12-14-8 11.5-14-7 1.75 1.5 2 1.64 I 1A
B.A. 0 0 0 10-14-6 10-15-7 2.33 1.66 2.14 1.42 I 2A
M.M. 1 0 0 11-13-8 11-14-8 1.62 1.37 1.75 1.37 I 2A
M.C. 1 0 0 11.5-16-8 12-15-9 2 1.43 1.66 1.33 I 3A
G.M. 0 0 0 11-14-9 10-14-8 1.55 1.22 1.75 1.25 I 3A
B.G. 0 0 0 13-14-10 13-14-10 1.4 1.3 1.4 1.3 I 4B
M.A. 1 1 0 10-14-7 9-15-7 2 1.42 2.14 1.28 II 3–4 A–B
G.A. 1 1 0 13-15-9 11-16-9 1.66 1.44 1.77 1.22 II 4B
M.S. 2 1 0 12-16-9 10-14-9 1.77 1.33 1.55 1.11 II 4B
D.N. 1 1 0 10-13.5-8.5 10-13-10 1.58 1.17 1.3 1 II 4B
T.T. 1 1 0 12-15-10 12-14-9 1.5 1.2 1.55 1.33 II 4B
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