Cranial base

Cervical vertebral maturation (CVM) : 

Cervical vertebral maturation (CVM) Syrina & Varissara

Outline : 

Outline Mandibular growth as related to CVM and body height An improved of CVM method for the assessment of mandibular growth The assessment of optimal treatment timing in dentofacial orthopedics

Objective : 

Objective To understand the association of CVM and mandibular growth To recognize the CVM method for mandibular growth To detect the optimal treatment timing by appraisal of CVM

I. Mandibular growth as related to cervical vertebral maturation and body height : 

I. Mandibular growth as related to cervical vertebral maturation and body height L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340

Slide 5: 

Mand. growth -- > importance in dentofacial orthopedics Tx. -- > esp. use of functional app. in Class II skeletal INTRODUCTION Main goal -- > supplementary lengthening of the mandible -- > increased growth at the condylar cartilage Effectiveness of functional app. -- > responsive of the condylar cartilage -- > growth rate of the mandible L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340

Slide 6: 

Mand. skeletal maturity can be assessed -- > body height -- > hand and wrist -- > dental development and eruption -- > menarche -- > breast -- > voice changes -- > cervical vertebral maturation CV. maturation related to -- > the mand. growth during puberty L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340 BIOLOGIC INDICATORS

Slide 7: 

Hellsing, 1991 -- > sig. correlation b/w height and length of CV bodies and statural height -- > similar results ~ Mitani and Sato, 1992 Hassel and Farman, 1995 Garcia-Fernandez et al, 1998 -- > high correlation between cervical vertebral maturation and the hand-wrist. L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340 BODY HEIGHT AND HAND-WRIST

Slide 8: 

To assess the validity of the cervical vertebrae method for the evaluation of mandibular skeletal maturity by analyzing concomitant variations in an efficient growth indicator such as statural height L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340 PURPOSE

Slide 9: 

24 subjects (15 females and 9 males) age 3 - 18 yrs. untreated children annual cephalograms and dental casts at same time annual measurements of body height and weight SUBJECTS AND METHODS L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340

Slide 10: 

LAMPARSKI’S STANDARD 1972 (Original method) Lat. ceph. for each of the 24 subjects -- > classified stages CV maturation ( Cvs1- Cvs 6)

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Co-Gn Co-Goi Goi-Gn S-Gn S-Goi N-Me ANS-Me

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Individual changes in body height at intervals Cvs 9 ♂ 15 ♀ 24 All RESULTS

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Greatest increment for all ceph. variables ~ interval Cvs3 to Cvs4

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Statural height -- > highest reliability but practical limitation -- > requires several measurements -- > repeated at regular intervals ( eg. every 3 months ) -- > to construct an individual growth curve Lat. Radiographic ( CV maturation ) -- > biologic validity in describing individual skeletal maturity -- > reliable indicator such as body height -- > efficient in detecting the peak in mandibular growth -- > not require supplementary radiographic – single observation DISCUSSION Few biologic indicators “ individual skeletal maturity” L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340

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CONCLUSIONS CV maturation -- > validity for the evaluation of skeletal maturity -- > identified pubertal peak in growth rate in individual subjects The peak in statural height -- > Cvs3 - Cvs4 -- > the greatest increments L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(18), 335-340

II. An Improved Version of the Cervical Vertebral Maturation(CVM) Method for the Assessment of Mandibular Growth : 

II. An Improved Version of the Cervical Vertebral Maturation(CVM) Method for the Assessment of Mandibular Growth T. Baccetti, L. Franchi, J A. McNamara Angle Orthodontist 2002 (72), 316-323

INTRODUCTION : 

INTRODUCTION An “ideal” biologic indicator of mandibular skeletal maturity should be characterized by at least five features. Detect the peak in mandibular growth No need for additional x-ray exposure. Ease in recording Consistency in the interpretation Before the peak in mandibular growth

INTRODUCTION : 

INTRODUCTION The main features of the CVM method as described by Franchi and coworkers included: CVM  pubertal peak : Mandibular growth + Body height. Cervical vertebral in lateral cephalogram : Used routinely for orthodontic diagnosis and Tx planning. The appraisal of the shape of the cervical vertebrae is straightforward. The reproducibility of classifying CVM stages is high (98% by trained examiners). The anticipation of the pubertal peak in mandibular growth The original method by Lamparski

Slide 19: 

LAMPARSKI’S STANDARD 1972 (Original method) Lat. ceph. for each of the 24 subjects -- > classified stages CV maturation ( Cvs1- Cvs 6)

PURPOSE : 

PURPOSE Baccetti 2002 : easier and applicable 1. More limited number of vertebral C2, C3, and C4 that can be visualized when a protective radiation collar is worn 2. Definitions of stages were not based on a comparative assessment of between-stage changes, so that stages can be identified easily on a single cephalogram.

SUBJECTS AND METHODS : 

SUBJECTS AND METHODS 6 consecutive cephalograms (T1-T6) 2 the interval of maximum growth 2 earlier & 2 later Analyzed C2 C3 C4 Morphology Visual analysis Cephalometric analysis

VISUAL ANALYSIS : 

VISUAL ANALYSIS Presence of a concavity at the lower border of the body of C2, C3, and C4 Shape of the body of C3 and C4 Trapezoid Rectangular Squared rectangular vertical

CEPHALOMETRIC ANALYSIS : 

CEPHALOMETRIC ANALYSIS C2 C3 C4 Conc The depth at the lower border of the vertebra C3 C4 BAR Ratio bet the length of the base and the anterior height of the body C3 C4 PAR Ratio bet the posterior and the anterior height of the body C2 C3 C4

CONCLUSION : 

CONCLUSION New CVM method

ADVANTAGES : 

ADVANTAGES

The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics : 

The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics T. Baccetti, L. Franchi, J A. McNamara Seminars in Orthodontics 2005 (11), 119-129

Modifeid version CS1-6 : 

Modifeid version CS1-6

CS1 : 

CS1 C2-C4 Flat lower border C3 & C4 Trapezoid Peak in mandibular growth : 2 yrs after

CS2 : 

CS2 C2 Concavity at lower border C3 & C4 Trapezoid Peak in mandibular growth : 1 yrs after

CS3 : 

CS3 C2 & C3 Concavity at lower border C3 & C4 Trapezoid or rectangular horizontal Peak in mandibular growth : during the year after

CS4 : 

CS4 C2 C3 C4 Concavity at lower border C3 & C4 Rectangular horizontal Peak in mandibular growth : Within 1 or 2 year before

CS5 : 

CS5 C2 C3 C4 Concavity at lower border C3 & C4 Squared or rectangular horizontal Peak in mandibular growth : End at least 1 yr before

CS6 : 

CS6 C2 C3 C4 Concavity at lower border C3 & C4 Rectangular vertical or square Peak in mandibular growth : End at least 2 yr before

CONCLUSION : 

CONCLUSION Peak in mandibular growth: between CS3 and CS4 CS2 indicates that the growth spurt is approaching, and it will start at CS3, which is approximately 1 year after CS2 Active growth completed : CS6

CONCLUSION : 

CONCLUSION A single cephalogram Only the cervical vertebrae from the 2th – 6th The lateral cephalogram is the radiographic record used routinely for orthodontic diagnosis and treatment planning

APPLICATION TO DENTOFACIAL ORTHOPEDICS : 

APPLICATION TO DENTOFACIAL ORTHOPEDICS

APPLICATION TO DENTOFACIAL ORTHOPEDICS : 

The CVM method To assess completion of active growth in studies dealing with the long term effects of orthodontic/orthopedic treatment strategies. To identify the adequate time for intervention in subjects who need surgery for the late correction of facial disharmonies. Optimal treatment timing APPLICATION TO DENTOFACIAL ORTHOPEDICS

QUIZ : 

QUIZ

QUIZ : 

QUIZ C2 Concavity at lower border C3 & C4 Trapezoid Peak in mandibular growth : 1 yrs after

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To be continued..

elements : 

elements www.animationfactory.com

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Dahlberg’s formula -- > to assess error for repeated measure Error ranged from 0.15- 0.81 mm. % of interoperator agreement ~ 98.6% ( 2 operators ) Intraoperator agreement -- > assessed by re-evaluation 2 weeks later -- > same operator 100 % agreement L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340

Slide 43: 

Descriptive statistics -- > statural height and ceph. measurement -- > at each developmental stage ( Cvs1 - Cvs6 ) Changes -- > observation intervals Cvs1 - Cvs2 Cvs2 - Cvs3 Cvs3 - Cvs4 Cvs4 - Cvs5 Cvs5 – Cvs6 L. Franchi, T. Baccetti, J A. McNamara AJODO 2000(118), 335-340

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RESULTS

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RESULTS

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chronological age can not -- > used or the appraisal of individual skeletal maturation girls 8.6 – 11. 5 yrs. boys 10 - 14 yrs.

Slide 47: 

Present with biologic validity in describing individual skeletal maturity. Efficient in detecting the peak in mandibular growth Should not require supplementary radiographic exposure in addition to the lateral cephalogram that is needed for orthodontic diagnosis and treatment planning. An ideal radiographic indicator