CONTENTS

Editor’s choice

David L. Turpin, Editor-in-Chief

Cervical vertebrae maturation method:Poor reproducibility

Daniel B. Gabriel, Karin A. Southard, Fang Qian, Steven D.

Marshall, Robert G. Franciscus, and Thomas E. Southard

The prediction of facial growth is an issue thatcomes and goes in every decade. Each new methodseems to have its proponents but then loses followersas classic studies resurface. Moyers noted that,‘‘Somatic growth and craniofacial growth are generallyrelated, but the relationship is difficult to utilize as a pre-cise, practical prediction of facial dimensional change.’’His claims have long been supported by the work ofBjork, Bambha and Van Natta, Bishara et al, Jamisonet al, and Lewis et al.

With continued use of the cervical vertebrae matu-ration (CVM) method, the authors of this study saw theneed to evaluate the reproducibility of the CVM stages.They used a sample of 30 individual lateral cephalo-grams and 30 longitudinal pairs of cephalograms ran-domly selected from longitudinal growth records ofuntreated subjects. Ten private-practice orthodontistswith an average 19.2 years of experience were trainedin the CVM method according to Baccetti et al. Theywere given instructions to stage the individual cephalo-grams first and then the pairs, using the reference mate-rials provided. They were told that the pairs ofheadfilms were taken longitudinally within 2 yearsand that they could be at the same or different cervicalstage. Three weeks after the first observation, the sameorthodontists were retrained in the CVM method andgiven the same materials as the first observation, exceptthat the 30 pairs of headfilms were placed in randomorder.

What does this study mean to the practicing ortho-dontist? To be of clinical value, this technique shouldbe robust enough to allow clinicians to correctly identifythe cervical stage of maturation. However, these find-ings did not accomplish this; interobserver agreementfor CVM staging was below 50%. Agreement improvedmarginally for the 2 longitudinal radiographs. It appears

Am J Orthod Dentofacial Orthop 2009;136:13A-14A

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Copyright � 2009 by the American Association of Orthodontists.

doi:10.1016/j.ajodo.2009.08.010

that, at the clinical level, CVM indicators should beused only to augment the orthodontist’s other observa-tions in making clinical decisions related to the timingof growth.

Informed consent recall andcomprehension in orthodontics:Traditional vs improved readability andprocessability methods

Edith Y. Kang, Henry W. Fields, Asuman Kiyak, F. Michael

Beck, and Allen R. Firestone

When was the last time you completed a treatmentdiscussion only to have the patient not schedule thestarting appointment? I remember more than 1 parentwho seemed to agree with everything I said but still de-clined treatment, giving no plausible reasons. Is theproblem more complex than a lack of language skillsor a shortage of funds? The purpose of this study wasto determine how informed consent materials can beused more effectively to improve patients’ and parents’understanding of critical issues. Signing informedconsent documents can become another routine event,proving only that they were given to the patient butnot that the patient truly understood them. However,bioethics experts and the courts have clearly statedthat the responsibility of obtaining true informed con-sent lies with the health care provider. The purposesof this study were to investigate (1) the recall andcomprehension of orthodontic informed consent amongpatients and their parents with the traditional AAOinformed consent form and other methods withimproved readability and processability, and (2) theassociation between reading ability, anxiety, andsocio-demographic variables.

This is a lengthy study, with a detailed discussionyou will want to read online. One positive finding indi-cated that combining audio and visual information fororthodontic informed consent in addition to simplifyingthe written materials is effective in significantly improv-ing patient and parental recall and comprehension.Overall, we cannot overlook that most patients’ abilitiesto self-assess their understanding of informed consentissues are poor.

13A

14A Editor’s choice American Journal of Orthodontics and Dentofacial Orthopedics

October 2009

Long-term effects of orthodontictherapy on the maxillary dental arch andnasal cavity

Nanci L. O. De Felippe, Neeta Bhushan, Adriana C. Da

Silveira, Grace Viana, and Bonnie Smith

It has been known for some time that the minimal cross-sectional area of the nasal cavity is an important structurebetween the nasal cartilages and the pyriform aperture.This is often referred to as the narrowest point of the entirecross-sectional area of the nasal cavity, acting like a nozzlein controlling airflow. The aims of this study were to assessmorphometric changes in the maxillary dental arch, look atpostorthodontic changes in nasal cavity geometry andfunction, assess long-term stability after rapid maxillaryexpansion (RME), and compare these findings witha matched control sample. Twenty-five patients returnedseveral months after treatment, which included RME.

This is an interesting article, and it is nice to see thatwhat we are doing actually lasts, although one wonderswhether it lasts only as long as the retainer is worn. Thepatients who returned might also be those who are re-sponsible and still doing what they were told to do.The authors noted other limitations of this study: theuse of only acoustic rhinometry to assess the nasal cav-ity geometry and function, and the nasal cavity’s evalu-ation under basal conditions. On the other hand, the3-dimensional morphometric analysis showed that thetotal palatal surface area and volume increased afterRME and seemed to be stable several months later.Nasal airway resistance decreased significantly due toRME and stabilized until it was measured after treat-ment. Although these findings suggest that RME isa powerful tool to normalize most of the variables inves-tigated, advances in cone-beam technology will aid inthe future evaluation of the effects of growth and remod-eling in this area.