Date of Award
Summer 2024
Document Type
Thesis
Degree Name
Master of Science (MS)
Department
Dentistry
First Advisor
Marinho Del Santo
Second Advisor
Dawei Liu
Third Advisor
Shengtong Han
Abstract
Objective: Cervical vertebral maturation staging (CVMS) is a popular method to determine the growth potential of a child utilizing the changing shapes of C2, C3, and C4. Staging is separated into six stages where the first two stages are before the growth spurt, the second two stages are during the growth spurt, and the last two stages are after the growth spurt. This method is highly practical because it is read on a lateral cephalogram, a radiograph taken by the orthodontist for diagnostic records. However, many clinicians question its reliability and validity as a test. The objective of this study was to test the reliability of CVMS between observers and time periods. Methods: This retrospective study had two observers look at 925 lateral cephalograms from the Burlington Growth sample. Each lateral cephalogram chosen had a correlating hand wrist radiograph for a later study. The sample observed was randomly sorted, renamed, and cropped so only the cervical vertebrae could be visualized. Each observer read “The cervical vertebral maturation method: A user’s guide” before the staging process (McNamara & Franchi, 2018). The article was used as the only reference for analyzing radiographs. The two observers ranked each cephalogram in one of the six CVM stages. Working periods were limited to 20 minutes with at least a 30-minute break to ensure observer focus. All observations were done in a one-week period. Observations were repeated, at least one month apart. CVM staging trials conducted by each observer were reported on separate excel documents. Results: Cohen’s kappa was used to test inter-reliability between observers. Intra- reliability was assessed using ICC. Statistical agreement was high for inter-reliability and intra-reliability with a p-value of <0.0001. However, percent agreement for inter- reliability and intra-reliability was only moderate. Conclusion: The cervical vertebral maturation method was found to have a high agreement level between trained observers at various timepoints. Even so, percent agreement was only moderate. Orthodontists are advised to use CVMS in conjunction with other growth indicators, such as secondary sexual characteristics, when evaluating patients for orthodontic treatment.