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Editor's Summary and Q&A: Cervical vertebrae maturation method: Poor reproducibility

https://doi.org/10.1016/j.ajodo.2009.04.011Get rights and content

Introduction

The cervical vertebrae maturation (CVM) method has been advocated as a predictor of peak mandibular growth. This method relies on the clinician's ability to determine the stage of maturation of the vertebrae. Careful examination of reports of this technique shows methodologic flaws that can lead to inflated levels of reproducibility. The purpose of this study was to evaluate the reproducibility of CVM stage determination by using a more stringent methodology.

Methods

Ten practicing orthodontists, trained in the CVM method, evaluated 30 individual and 30 pairs of cephalometric radiographs in 2 sessions to determine the CVM stage. Interobserver and intraobserver reliability was determined by using the Kendall coefficient of concordance and the weighted kappa statistic.

Results

All degrees of interobserver and intraobserver agreement were moderate (Kendall's W, 0.4-0.8). Interobserver agreement levels for CVM staging of the 10 orthodontists at both times were below 50%. Agreement improved marginally with the use of 2 longitudinal radiographs. Intraobserver agreement was only slightly better; on average, clinicians agreed with their own staging only 62% of the time.

Conclusions

Based on these results, we cannot recommend the CVM method as a strict clinical guideline for the timing of orthodontic treatment.

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Editor's summary

You have been following a patient's growth to determine when to start treatment for a Class II problem. The remaining permanent teeth are expected to erupt within the next 6 to 12 months, and you want to start treatment just before the period of peak mandibular growth. But how accurately can you predict when the peak mandibular growth will occur? All you have to go on is a full set of records, including a recent headfilm.

When I practiced with Dr Bob Little a few years back, he periodically

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Read the full text online at: www.ajodo.org, pages 478.e1-478.e7.

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