Med. Surg. J. – Rev. Med. Chir. Soc. Med. Nat., Iaşi – 2019 – vol. 123, no.

DENTAL MEDICINE ORIGINAL PAPERS

STUDY ON CORRELATION BETWEEN CERVICAL VERTEBRAE

MATURATION, DENTAL AGE AND ACTUAL AGE OF CHILDREN

Liliana-Gabriela Halitchi 1, Vasilica Toma 2*, Mariana Pacurar 4,

Raluca Georgescu 1, Codruta Iliescu 3
University Apollonia Iaşi
Faculty of Dental Medicine
1. Department of Orthodontics
“Grigore T. Popa” University of Medicine and Pharmacy Iasi
Faculty of Dental Medicine
2. Department of Surgery
Faculty of Medicine
3. Department of Mother and Child Medicine
University of Medicine, Pharmacy, Sciences and Technology of Tg. Mures
Faculty of Dental Medicine
4. Department of Orthodontics
*
Corresponding author. E-mail: vasilicatoma40@yahoo.com

STUDY ON CORRELATION BETWEEN CERVICAL VERTEBRAE MATURATION,

DENTAL AGE AND ACTUAL AGE OF CHILDREN (Abstract): The study aim was to
provide a version of the cervical vertebral maturation index (CVM) method for evaluating
maxillary and mandibular skeletal maturation for each patient in the study group. Material
and methods: The morphology of the three cervical vertebrae, the presence of concavities
on the lower vertebral border and the form of the vertebral body at CS 2, CS 3 and CS 4 was
evaluated by visual inspection of lateral cephalograms by two eval uators. The percentage of
concordance among examiners was 96.7% For the study of the correlation the 2 evaluators
examined 60 panoramic radiographies and analyzed the dental age using the Demirjian I n-
dex. Results: The descriptive indicators of the study group show an average age of 12.65
years. The average CVM score awarded in the study group is 3.133. The most frequently
score is CVSM 2 ,anatomical feature that identifies the stage immediately ahead of the ma n-
dibular growth peak. For the correlation the dental age was determined with the better
known Demirjian Index using scores calculated on the reference teeth 33, 34, 37 on the pa n-
oramic radiographies in the study group. Conclusions: The results of visual cephalometric
analysis required a relatively short time and are consistent with the CVM method in pub-
lished studies, the reproducibility of CVM steps being equally high. Keywords: VERTE-
BRAE, FORM, CEPHALOGRAMS, CVM SCORE, DEMIRJIAN INDEX, DENTAL AGE.

The fundamental concept of dento- rately before puberty gives the impression
facial orthopedics is to achieve maximum, that functional appliances do not work
three-dimensional effects in the optimum although they are only used in a biological-
mandibular growth period. Treating inaccu- ly unfavorable moment .

531
 Liliana-Gabriela Halitchi et al.
There are few studies in our country
that include information on skeletal maturi-
ty in patients treated with functional appli-
ances, and for the most part, the biological
growth indicator is the supplementary
analysis of hand-wrist X-ray or Demirjian
analysis on panoramic radiographs (1, 2).
The Baccetti CVM method considers
that maximal mandibular growth time is
associated with CVM 3 - CVM 4 stage not
in temporary or mixed dentition but prepu-
berty (3, 4, 5, 6, 7) Recently, cervical ver-
tebral maturation index CVM has gained
maximum attention in the literature as an
alternative to evaluate skeletal maturity in
the office, replacing an additional radiolog-
ical exam (hand-wrist radiograph) in the
conditions where conventional cephalo-
gram is recommended for diagnosis, and
the majority of orthodontists are trained
and familiar with its interpretation.
AIM
In this study we intended to provide a
version of the cervical vertebral maturation
index CVM method for evaluating maxil-
lary and mandibular skeletal maturation for
each patient, we made the analysis of the
TABLE I
Distribution of the study group by age
Frequency Percentage
10.00 8 13.1
11.00 11 18.0
12.00 16 26.2
13.00 10 16.4
14.00 3 4.9
15.00 2 3.3
16.00 10 16.4
TOTAL 60 100.0
The statistical descriptive parameters of
the study group show an average age of
12.65 years, average Demirjian Index of
532
morphological characteristics of C2, C3
and C4 cervical vertebrae on lateral cepha-
lograms and determined the correlation
with the values of the Demirjian Index
evaluated on panoramic radiographs.
MATERIAL AND METHOD
Visual analysis - 2 evaluators examined
the morphology of the three cervical verte-
brae by visual inspection on lateral cepha-
lograms. The proportion of concordance
among examiners was 96.7%.
Visual analysis - 2 evaluators examined
the panoramic radiographs and the Demi-
rjian Index was determined. The percentage
of concordance among examiners was
96.7%;
60 lateral cephalograms and panoramic
radiographs were realized with the same
FONA radiological equipment was selected
for the study: 29 girls and 31 boys were
selected for the study. The distribution was
almost equal - 47.5% girls and 50.8% boys.
The age distribution of the study group is
heterogeneous: 12-year-old children pre-
dominate 26.2%, followed by 11-year-olds
and 13-year-olds, the smallest 15-year-old
(3.3%) (tab. I).
Cumulative
Valid percentage
percentage
13.3 13.3
18.3 31.7
26.7 58.3
16.7 75.0
5.0 80.0
3.3 83.3
16.4 75.0
7.43 for the lower canine, 7.35 for the low-
er first premolar, 6.88 for the lower second
premolar, 9 for the lower second molar.
Study on correlation between cervical vertebrae maturation, dental age and actual age of children

The average cervical vertebral maturation 3.133 with a standard deviation of 1.52
index CVM score in the study group is (tab. II).

TABLE II
Statistical descriptive parameters in the study group
N Minimum Maximum Medium value Standard Deviation
Age 60 10.00 16.00 12.6500 2.08160
DI 33 60 6.00 8.00 7.4333 0.67313
DI 34 60 5.00 8.00 7.3500 0.75521
DI 35 60 6.00 8.00 6.8833 0.82527
DI 37 60 5.00 8.00 6.9000 0.72952
CVM 60 1.00 6.00 3.1333 1.52345

RESULTS AND DISCUSSION bral maturation index CVM 1 scores in 8%

The first examiner gave cervical vertebral
maturation index CVM scores between 1 and
6 with an average of 3. The second observer
gave cervical vertebral maturation index CVM
close but less expressive CVM with a mean
greater than 3.5, bringing the patients to the
maximum value of the CVM score (tab. III).
The first examiner gave cervical verte-
cases; CVM 2 in 40% cases; CVM 3 score
in 18%;CVM 4 score in 16% cases; CVM 5
score in 14% cases and CVM 6 score in 4%
of cases. The second examiner gave CVM
1 scores in 12% cases; CVM 2 in 28%
cases; CVM 3 score in 24% cases; CVM 4
score in 16% cases; CVM 5 score in 12%
cases and CVM score 6 in 4% cases.

TABLE III
The CVM scores calculated in the study group
N Medium value Standard Dev. Medium Error
Age
60 12.65 2.08160 0.84728
CVM scores Observer 1 60 3.0000 1.35526 0.19166
CVM scores Observer 2 60 3.5400 4.47765 0.63324

In the study group, cervical vertebral of skeletal development, vertebrae C2 and

maturation index CVM 1 scores were seen
in 13.1%. lateral cephalograms; CVM 2
scores were seen in 27% examinations.;
CVM 3 scores were seen in 19.7% exami-
nations; CVM 4 scores were seen in 18%
examinations and CVM scores 5 and 6
were seen in 10% examinations (tab. IV).
The cervical vertebral maturation index
CVM score most often accorded is CVM 2
which has the highest percentage distribu-
tion as in Howell’s studies (8). In this stage
C3 are trapezoidal or rectangular in shape
and have concavities on the lower edge of
the vertebral body.
General tendency is that the skeletal age
is lower than the chronological age, which
leads to the conclusion that these children
tend to late mature as the Arab children in
the study of Alhadlaq (9), the Turkish chil-
dren in the study of Uysal (10, 11) and
different from Thai children with early
maturation from Kumar's study (12).

533
 Liliana-Gabriela Halitchi et al.

TABLE IV
CVM scores in the study group
CVM
Valid Cumulative
Frequency Percentage
Percentage percentage
1.00 8 13.1 13.3 13.3
2.00 17 27.9 28.3 41.7
3.00 12 19.7 20.0 61.7
4.00 11 18.0 18.3 80.0
5.00 6 9.8 10.0 90.0
6.00 6 9.8 10.0 100.0
TOTAL 60 100.0

For the correlation of age identified us-
ing the cervical vertebral maturation index
CVM stages on the lateral cephalograms
Demirjian scores on the reference teeth 33,
34, 37 were calculated on panoramic radio-
graphs of the patients in the study group
(13, 14).
The score for the lower canine was 6 for
9.8% of patients; 7 for 36.1% and 8 for half
of the patients in the study group, the lower
canine being in stage G or H of dental de-
velopment after Demirjian. This stage is
reached 0.4 years before the pubertal growth
peak in girls, and in boys 1.3 years earlier.
The Demirjian score for the first lower
premolar was 5 for 3.3% of patients; 6 for
6.6%, 7 for 41%; and 8 for 41% of the
patients in the study group, the lower ca-
nine being in stage G or H of development
after Demirjian.
This stage is reached 0.4 years before
puberty growth peak in girls and in boys
with 1.3 years previously. The score for
the lower second molar was 5 for 3.3% of
patients, 6 for 21.3%, 7 for 55.7% and 8 for
18% of the patients in the study group, the
lower molar being in stage F, G or H dental
development after Demirjian Index. Stage
F marks the onset of pubertal growth peak
in girls (tab. V) (15).

TABLE V
Values of the Demirjian Index on panoramic radiographies at 33 , 34 and 37
in the study group. Imaging with the Demirjian Index by Maniar et al.
Demirjian Index Demirjian Index Demirjian Index
33 34 37
Frequency Frequency Frequency
F 5.00 6 2 2
G 6.00 22 4 4
G 7.00 32 25 25
H 8.00 61 29 29
TOTAL 60 60 60

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Study on correlation between cervical vertebrae maturation, dental age and actual age of children

For the 11-year-old CE diagnosed with old was identified and a functional appliance
Class II / 1 Angle Malocclusion, lateral ceph- treatment was initiated with a Klammt elastic
alogram and panoramic radiography were activator that corrected the overjet and class
analyzed, a maximum increase at 11 years II molar relation in 6 months (figs. 1, 2, 3).

Fig. 1. Initial intraoral aspects

Fig. 2. Intraoral image after 6 months treatment with Klammt elastic activator -
normal overjet and molar occlusion

535
 Liliana-Gabriela Halitchi et al.
Fig. 3. CVM score, Demirjian Index and the functional appliance for the patient CE
CONCLUSIONS
Changes in the size and shape of cervi-
cal vertebrae seen in growing children are
of major concern as individual skeletal
maturation indicators.
The results of visual cephalometric
analysis require a relatively short time and
are consistent with the CVM method in
published studies, the reproducibility of
CVM steps being equally large.
536
Stage CVM 2 Lower margins
of vertebrae C2, C3 have a
visible concavity on the lower
edge, vertebrae C3 and C4 are
rectangular in shape and the
mandible will have a maximum
increase in one year.
Stage G of the Demirjian
Index, in which the limiting
walls of the 33,34 apex are
parallel, and the distal roots of
the molars, especially the distal
one is open
The Klammt activator used for
patient CE in the optimal CVM
2 stage who corrected
the occlusion in 6 months
The appearance of a concavity on the
C3 cervical vertebrae represents the ana-
tomical characteristic that identifies the
stage immediately before the peak of man-
dibular growth.
Correspondence between the records of
the two examiners is maximum.
For correlation of age identified with
CVM stages on cephalograms Demirjian
scores on reference teeth 33, 34, 37 were
 Study on correlation between cervical vertebrae maturation, dental age and actual age of children

calculated on panoramic radiographies of CVM score more often granted is

patients in the study group. The score for the
lower canine was 6 for 9.8% of patients, 7
for 36.1% and 8 for half of the patients in
the study group, the lower canine being in
stage G or H of dental development after
Demirjian. This stage is reached 0.4 years
before the pubertal growth peak in girls, and
1.3 years earlier in boys .
CVSM 2 which has the highest percentage
distribution.
The general tendency is that the skeletal
age is lower than the chronological one,
which leads to the conclusion that these
children tend to late mature as the Arab
children, Turkish children and different
from Thai children with early maturation.

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