Radiographic growth indicators: The issue of diagnostic reliability and clinical feasibility

Abstract

The use of radiographic growth indicators, such as the hand-and-wrist maturation (HWM) and cervical vertebral maturation (CVM) methods, has been recommended in previous clinical trials on the skeletal effects obtained by functional treatment in growing Class II patients. The concept behind the use of indicators resides in the identification of the pubertal growth spurt in individual patients allowing the delivery of the treatment at this specific stage of skeletal maturation when the mandible response is expected to be maximum growth. Interestingly, while many of the former types of investigations reported a poor correlation between the stages of growth indicators (mainly the CVM) and mandibular growth spurt, most of the latter type of investigations reported clinically relevant favorable effects when the growth indicators are used. It is perhaps that investigations are still missing the relevant piece of evidence. The first critical issue relates to the correlation between two variables (i.e., stages of maturation and mandibular growth) that does not imply diagnostic accuracy, as it has been extensively reported for the case of dental maturation. The other relevant issue relates to the clinical feasibility of the repetition of the recording when dealing with invasive methods based on X-rays, irrespective of whether the methods are accurate. Meanwhile, more opportunity will be given by the use of non-invasive (serum or GCF) biomarkers. According to all these considerations, more reports will be necessary to elucidate the role of the growth indicators in orthodontics fully.

Craniofacial growth spurt in Class I subjects: Data vs conclusions

“…The present study shows only a correlation between the CVM and growth, which cannot be confused with diagnostic accuracy of a given CVM stage in the identification of an imminent growth peak. 4 Therefore, the data reported in the article support only the poor validity of the CVM method in predicting the pubertal growth spurt.…”

The Third Finger Middle Phalanx Maturation (MPM) Method to Assess Timing of Functional Treatment for Skeletal Class II Malocclusion: Report of Three Cases

“…Therefore, patients should ideally be followed from a prepubertal stage of development to the pubertal one. In this context, a crucial issue relates to the clinical feasibility of the repetition of the recording by invasive X-ray procedures [13, 14], irrespective of whether the used growth indicator is accurate, thus limiting the use of indicators such as the HWM and CVM methods.…”