Skeletal and Vertebral Age - A Literature Review

1

Skeletal and vertebral age – a literature review

Sergio Polizio Terçarolli Jaw Functional Orthopedics Specialist

ABSTRACT

The determination of the best moment to intervene is a constant pursuit in

orthodontic treatments. The evaluation of the skeletal age can provide additional

information that can contribute for this decision. Hand-wrist radiography is

recognized as a reliable parameter to evaluate the skeletal age of a patient. In

1972, Lamparski proposed the use of lateral cephalometric radiography and the

observation of cervical vertebrae as a new parameter to evaluate the patient’s

skeletal age. Several studies were and are being carried out to confirm the

efficiency of this evaluation. A review of the literature, and whether the reliability

of this type of interpretation is safe, are the objectives of this work.

Key words: jaw functional orthopedics, cervical vertebrae, vertebral age,

cephalometry, maturity.

=======================================================

Understanding the development pattern of growing patients is one of the

greatest responsibilities of Jaw Functional Orthopedists and/or Orthodontists.

It is of fundamental importance for the functional orthopedic or orthodontic

treatment to know if the growth surge will happen, is happening or has

happened1. Based on this information, it is possible to intervene at the most

appropriate moment, obtaining faster and more efficient results.

Manifestations of secondary sexual characteristics2,3, height and weight

variations4, chronological age5, dental age6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24

2

and skeletal age7,25,26,27,28,29,30,31,32,33 are part of the enormous arsenal referenced

in literature, and serve as criteria for the evaluation of the physiological age of

an individual. These criteria are based on the degree of maturity of different

tissues of the system and can be applied together or separately21.

Several body locations were studied to determine skeletal maturity or skeletal

age.: ulnar sesamoid of the thumb34,35,36, wrist and hand27,28,31,

teeth9,10,11,12,14,15,16,17,18,20,21,22,23, calcification of the hook of the hamate bone37,

development of the epiphysis of the middle phalanx of the 3rd finger28,36,37.

Based on Lamparski’s works38, another source of inquiry and reference in the

study of skeletal maturity of individuals can be evaluated: the vertebral skeletal

age.

“The process of skeletal maturation consists of differentiation, growth and

change of shape. These alterations start at the ossification centers and end with

the complete development of the bone. The entire process can be accompanied

or investigated by radiographic exams”39.

As the concern with the quality of life of patients is ever more present, one of the

alternatives to reduce the amount of ionizing radiation40 (elimination of hand-

wrist radiograph), is the use of lateral cephalometric radiography, which is

present in any routine orthodontic exam, to evaluate the skeletal maturity of an

individual.

Thus, structures not observed before, such as the frontal sinus41 and cervical

vertebrae1,25,38,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57 became the objective of

investigations. Other alternatives, such as the inclusion of the first three fingers

of the right hand in a cephalometric radiograph58,59 and the periapical x-ray of

the middle finger to evaluate the middle phalanx, were also investigated58.

A review of the literature about the reliability of evaluating the maturation of

cervical vertebrae (vertebral skeletal age) is the subject of this article.

3

LITERATURE REVIEW

The vertebral column is formed by cervical, thoracic and lumbar vertebrae and

by the sacrum60. The first seven vertebrae form the cervical column, with great

similarity between the four last ones61. Maturational alterations can be seen from

birth till maturity60,62.

Lamparski38 proposed in his study to examine growth (increase in size with age)

and development (maturation) of cervical vertebrae to determine if alterations

found in this area could be used to evaluate skeletal age in lieu of hand-wrist

radiographs. His method was based on the works by Bick and Copel62, Todd

and Pyle63, Eslberg and Duke64, Lanier65 e Hinck, Hopkins, Savara66.

Lamparski38 then established a maturational pattern for cervical vertebrae using

vertebrae C2, C3, C4, C5 and C6. This standardization consisted of 6 stages.

The following conclusions were taken from his work: the maturational changes

that occur between the second and sixth cervical vertebrae can be used to

evaluate the skeletal age of an individual; the evaluation of vertebral age is

statistically valid and reliable, and has the same clinical value of hand-wrist

evaluations, thus, an additional radiograph is not needed to evaluate growth

potential; the cervical vertebrae maturation indicators (CVMI’s) are: initiation and

development of concavities on the lower borders of the vertebral bodies, and

increase of the anterior portion and of the total height of these vertical bodies,

causing changes in their shape, changing from a wedge shape to a rectangular

shape and later, to a square, and at the end of development presenting a

predominance of height over width; the vertebral maturity indicators are the

same for males and females. The difference lies in the fact that each stage of

vertebral development occurred earlier in females than in males.

Biological, osseous or skeletal age and skeletal maturation are synonyms used

to describe maturation stages in humans, i.e., the degree of development of

ossification on the bone. All changes in bones during growth can be observed

4

by radiographs. These changes are relatively constant for a given bone in a

person. Size and maturity can vary independently of each other. Modifying the

method proposed by Lamparski38, Hassel and Farman1 observed the vertebral

bodies of C2 (odontoid process), C3 and C4 vertebrae in a lateral cephalometric

radiograph, and evaluated their skeletal maturity through a correlation with the

Fishman method26 which, in turn, evaluates skeletal hand-wrist maturation with

a Skeletal Maturity Indicator (SMI) system developed by him. The main objective

of the study was to create an evaluation method of skeletal maturity using a

routine radiograph in orthodontic treatments. For this purpose were used 220

male and female individuals aged 8 to 18 years, from whom were taken, on the

same day, left hand-wrist radiographs and lateral cephalometric radiographs.

They then determined 6 separate phases for the maturation stages of cervical

vertebrae: initiation, acceleration, maturation, transition, deceleration and

finalization. Each has specific characteristics related to vertebra shape, which

determines skeletal maturity and whether there is a potential for growth.

1- INITIATION

Corresponds to the combination of Fishman’s stages 1 and 226;

Great amount of pubertal growth expected (80 a 100%);

Upper C3 and C4 edges are funneled from the posterior to the anterior region;

Lower borders of C2, C3 and C4 are plane or flat;

The vertebrae are wedge-shaped, with upper border inclined from posterior to

anterior region (figure 1).

2- ACCELERATION


Significant pubertal growth expected (65 a 85%);

5

Start of development of concavities on the lower borders of C2 and C3 (figure

1);

Lower border of C4 plane or flat;

The vertebral bodies of C3 and C4 tend towards a rectangular shape.

3- TRANSITION


Moderate pubertal growth expected (25 a 65%);

Presence of noticeable concavities on the lower borders of C2 and C3;

Start of development of a concavity on the lower border of C4 (figure 1);

C3 and C4 have a rectangular shape.

4- DECELERATION


Reduced expectation of pubertal growth (10 a 25%);

Presence of noticeable concavities on the lower borders of C2, C3 and C4

(figure1);

Shape of C3 and C4 nearing that of a square.

5- MATURATION


Insignificant puberal growth expected (5 a 10%);

Presence of prominent concavities on the lower borders of C2, C3 and C4;

Square shape of vertebrae C3 and C4 (figure 1).

6- FINALIZATION

Corresponds to Fishman’s stage 1126;

Pubertal growth completed at this stage (little or no growth expected);

6

Presence of deep concavities on the lower borders of C2, C3 and C4;

In the vertebral bodies of C3 and C4, there is a predominance of height over

width (figure 1).

Fig. 1 – The 6 stages of vertebral maturity described by Lamparski38 and modified by Hassel and Farman1. In their conclusions, the authors admit the reliability of lateral cephalometric

radiography to evaluate growth potential through skeletal maturity of cervical

vertebrae, thus making it easier to plan for the orthodontic or functional

orthopedic treatment.

In their work, Rajagopal and Kansal58 compared the six stages of skeletal

maturity observed on the middle phalanx of the middle finger (MP3) and

reported by Hagg and Taranger67, with the six maturation indicators of cervical

vertebrae (MICV) proposed by Hassel and Farman1. However, the technique

CC22

CC33

CC44

CC22

CC33

CC44

CC22

CC33

CC44

CC22

CC33

CC44

CC22

CC33

CC44

CC22

CC33

CC44

INITIATION ACCELERATION TRANSITION

MATURATION FINALIZATION DECELERATION

7

was modified by the use of a radiographic film appropriate for periapical to

radiograph the middle finger, instead of a hand-wrist radiograph. Of the 150

individuals analyzed, 75 were male and 75 females, with ages varying from 9 to

17. In their conclusion, the authors affirm that the modification of technique is

accurate, simple, practical and economical, in addition to showing an intimate

correlation with the MICV’s.

Garcia-Fernandez, Torres, Flores, Rea43 investigated the correlation between

cervical vertebrae and hand-wrist maturational indicators in a group of 113

Mexicans (50 men and 63 women) with ages ranging from 9 to 18 years. The

lateral cephalometric and hand-wrist radiographies were taken on the same day,

similarly to the work by Hassel and Farman1.

In the authors’ opinion, the orthodontist and/or jaw functional orthopedist do not

need to know accurately the skeletal age; how much will the bones grow during

treatment, or exactly when growth will take place. They need to know whether

the patient will grow during treatment and what percentage of growth can be

expected during that period.

The results of this investigation showed that there is no significant difference

between the two techniques of skeletal maturity evaluation in the Mexican

populational group. For this reason, cervical vertebrae could be used for this

type of evaluation.

O’Reilly and Yanniello45 report that a series of studies about mandibular growth

during adolescence have direct relationship with the ossification events

observed in hand-wrist radiographs68,69,70. The authors investigated the

maturation stages of cervical vertebrae determined by Lamparski38 and the

changes in the measurements of corpus length and height of ramus of the

mandible. Annual lateral cephalometric radiographies were taken of 13 girls

varying between 9 and 15 years of age. The analysis of the results showed a

8

significant increase in corpus length and height of the mandibular ramus during

the stages of vertebral maturation.

It was clear from the study that the stages of cervical vertebrae maturation have

a relationship with mandibular growth, and serve as an tool to evaluate when

mandibular changes take place during adolescence.

Research by Santos and Almeida71) compared changes in cervical vertebrae

with the ossification events in the hand-wrist region, with the objective of

showing the reliability of cervical vertebrae evaluation. Lateral cephalometric

radiographs and hand-wrist radiographs of individuals between 8-years-and-5-

months and 16-years-and-5-months of age, male and female, were used. In

their conclusion, the authors reported that both methods were of easy to apply

and that the correlation between them was statistically significant. Additionally,

the morphological changes of cervical vertebrae observed in lateral

cephalometric radiographs were a useful additional method to determine

skeletal age. Should there be a need for a more precise diagnosis, this type of

exam should not be used alone.

Nanda72, carried out a longitudinal study with 19 female patients,

leukodermatous, healthy, of medium-high social-economical level, in the city of

Denver, Colorado. Annual lateral cephalometric radiographies of these patients

were taken between the ages of 3 and 19 years, with a minimum of 10 and a

maximum of 15 radiographies evaluated for each patient. The Sella-Gnathion

linear distance was used to determine the maximum moment of facial growth

during adolescence, expressed by the increase of vertical and horizontal face

dimensions. Other aspects observed were the variations of stature in

centimeters, skeletal age by carpal radiography, according to Greulich and

Pyle27,28, dental age by the observation of Nolla’s stages8 of the first, second and

third molars, in addition to the vertebral age based in Lamparski’s work38. After

the evaluation of results, the author concluded that skeletal age, evaluation of

9

stature and vertebral age can be used to determine facial development pattern

determined by the measurement Sella-Gnathion. However, dental age showed

ample variations, especially above the age of 13.

Hellsing44, using lateral cephalometric radiographs of 107 patients of both

sexes, and correlating the changes in cervical vertebrae height and width with

pubertal stature growth (record of the patient’s height) concluded that the height

and width of the vertebrae can be used as indicators of skeletal growth.

Additionally, according to the author, the main advantage of using vertebral

development as an alternative for the evaluation of skeletal maturity, is the fact

that it does not require more than one radiographic technique, as the lateral

teleradiography commonly used for diagnosis can be used.

Mito, Sato, Hideo48 proposed in their work the establishment of vertebral skeletal

age as an objective index to evaluate skeletal maturation. Through the

observation of cephalometric radiographs enlarged 1.0625 times (and

evaluation of C3 and C4 vertebrae) in a group of 176 girls between 7 and 14.9

years of age, a formula was determined to obtain the vertebral skeletal age. In a

second group of 66 girls (between 8 and 13.9 years of age, thus with an

average age of 11 +/- 1.57 years) an evaluation was made of the reliability of

vertebral skeletal age in comparison to skeletal age obtained through the

Tanner-Whitehouse method (TW2)73 of hand-wrist radiographs . The authors 73

consider the TW2 method the most reliable one to evaluate skeletal age, and

the exams showed a high significance index between vertebral age and skeletal

age, even more than between vertebral age and chronological age. The results

suggested that vertebral age, evaluated in lateral cephalometric radiographs, is

as reliable as skeletal age obtained through hand-wrist radiographs by the TW2

method73. This method evolved to method TW3, more efficient and easier to

handle74.

10

Román, Palma, Oteo, Nevado57 developed a complex and rigorous investigation

with the objective of determining if morphological changes observed in cervical

vertebrae were as advantageous to determine growth stages as they were to

determine maturation stages, through the use of hand-wrist exams. The

research involved 958 individuals between 5 and 18 years of age (428 boys with

average age of 11.6 years and 530 girls with average age of 11.5 years). Lateral

cephalometric radiographs and hand-wrist radiographs were done during a

period of less than one month. To evaluate skeletal age, the Grave and Brown

method75 and the Björk and Helm growth curve4 were used. The method

developed by Lamparski38, and later by Hassel and Farman1, was used to

evaluate vertebral maturation. Using a system developed by the authors, they

analyzed: concavity of the lower borders of C2 to C6, height of vertebral bodies

of C3 and C4, and the shape of vertebral bodies of C3 and C4. Correlations

between skeletal age and different classifications of vertebral maturation

between skeletal age and anatomical parameters of the cervical vertebrae and

between skeletal age estimated by the concavity, height and shape of cervical

vertebrae were done. The results suggest that this method to evaluate skeletal

maturation, although very reliable, requires the development of a simpler

manner of investigation. According to the authors, the observation of the lower

border of the cervical vertebrae is the best parameter to evaluate vertebral

maturation.

Kucukkeles, Acar, Biren, Arun56 compared the cervical vertebrae and hand-wrist

skeletal maturity evaluation methods in a study with 180 individuals, male and

female, with ages varying between 8 and 18. The lateral cephalometric

radiographs and the hand-wrist radiographs of each individual were observed

according to the evaluation indices professed by Hassel/Farman1 and Fishman26

respectively.

11

The CVMI (cervical vertebrae maturation index) and the SMI (skeletal

maturation index) were divided into 3 pubertal growth periods: pre-peak, peak e

post-peak. The authors showed that the CVMI’s could be used to evaluate the

stages of pubertal growth periods.

DISCUSSION

The first maturational development pattern created in 1959 by Greulich and

Pyle28 Fishman26 demonstrated that the accelerations and decelerations of

craniofacial growth were associated with the concurrent changes of maturational

development revealed in hand-wrist radiographs. Like Fishman’s26, a series of

methods to evaluate skeletal maturity indicators can be found in literature, such

as Greulich and Pyle28, Tanner and Whitehouse76, Todd77 and Grave and

Brown78. Some of these methods are based on observations of a number of

maturational indicators that represent stages of skeletal development for each

age28. Others are based on skeletal stage and events at each age76,26. The

observation of the ossification of epiphysial cartilages in the hand79 can also

serve as an evaluation method.

All of them have a sole objective, to evaluate a patient’s skeletal age and

establish if growth has happened, is happening or will happen. Although hand-

wrist radiographs are used by jaw functional orthopedists and orthodontists to

this end, the need of an additional radiographic technique has been

questioned40. Alternatives have been tried29,41,58,59.

Firstly Lamparski38, and later several other authors42,43,44,46,47,48,51,52,53,56,57

determined a new way to evaluate skeletal maturity using cervical vertebrae as

a reference. According to the majority of them, this method is simpler, more

economical, and avoids one additional exposure to ionizing radiation, since a

carpal radiograph is not needed. This method has shown to be more and more

reliable in view of the enormous amount of research on the subject. Based on

12

the work by Lamparski38, four other vertebral maturation evaluation criteria were

found in the literature: Hassel and Farman1, Baccetti, Franchi and McNamara

JR51, Mito, Sato and Hideo48 and Román, Palma and Oteo57. Variables like race

and sex1,38,42,43,45,46,47,48,52,57,80 were amply explored in these researches, and

none of the authors reported significance of these parameters. Townsend and

Grave52 suggest that the evaluation of vertebral maturation can be applied in a

general manner to orthodontic practice.

Mandibular growth can be forecast by observation of cervical

vertebrae45,50,51,55,81. According to Baccetti, Franchi and McNamara JR51 (using

their own evaluation criteria), the peak of mandibular growth happens between

CVMI 2 and 3.

The exactness and reliability of the use of cervical vertebrae to evaluate growth

potential were also researched54. There was little concern with chassis

position46,47 and with positioning of the individual38,46,57 in the literature reviewed.

CONCLUSION

Based on the literature reviewed, it was determined that the relationship

between skeletal age and vertebral age is very close and, for this reason, the

reliability of this type of interpretation is sufficiently safe.

It is suggested that the best vertebrae to be evaluated are C3 and C4.

The fact that only one radiograph is needed to evaluate skeletal discrepancies,

positional changes and growth potential of patients, solidly demonstrates the

validity, in clinical practice, of this type of evaluation for jaw functional

orthopedists and/or orthodontists.

======================================================

13

BIBLIOGRAPHY 1- Hassel B, Farman AG. Skeletal maturation evaluation using cervical

vertebrae. Am J Orthod 1995;107:58-66. 2- Hagg U, Taranger J. Menarche and voice change as indicators of pubertal

growth spurt. Acta Odont Scand 1980;38:179-186. 3- Hagg U, Taranger J. Maturation indicators and pubertal growth spurt. Am J

Orthod 1982;82:299-309. 4- Björk A, Helm S. Prediction of the age of maximum pubertal growth in body

height. Angle Orthod 1967;37:134-143. 5- Fishman LS. Chronological versus skeletal age, an evaluation of craniofacial

growth. Angle Orthod 1979;49(3):181-189 . 6- Coutinho S, Buschang PH, Miranda F. Relationship between mandibular

canine calcification stages and skeletal maturity. Am J Orthod 1993;104(3):262-268.

7- Moraes MEL et al. Surto de crescimento puberal. Relação entre mineralização dentária, idade cronológica, idade dentária e idade óssea–método radiográfico. R Odontol UNESP São Paulo 1998;27(1):111-129.

8- Nolla C. The development of the permanent teeth. J Dent Child Chicago 1960; 27:254-266.

9- Chertkow S. Tooth mineralization as an indicator of the puberal growth spurt. Am J Orthod 1980;77(1):79-91

10- Chertkow S, Fatti P. The Relationship Between Tooth Mineralization and Early Radiographic Evidence of the Ulnar Sesamoid. Angle Orthod 1979;49(4)282-288.

11- Bambha JK, Van Natta P. A Longitudinal Study of Occlusion and Tooth eruption in Relation to Skeletal Maturation. Am J Orthod 1959;45:847-855.

12- Hess AF, Lewis JM, Roman B. A Radiographic Study of Calcification of the Teeth from Birth to Adolescence. Dental Cosmos 1932;74:1053-1061.

13- Garn SM, Lewis AB, Polacheck DL. Variability of Tooth Formation. J Dent Res 1959;28(1):135-148.

14- Garn SM, Lewis AB, Koski K, Polacheck DL. The Sex Difference in Tooth Calcification. J Dent Res 1958;37:561-567.

15- Lewis AB, Garn SM. The Relationship Between Tooth Formation and Other Maturational Factors. Angle Orthod 1960;30(2):70-77.

16- Lee MCM, Chan ST, Low WD, Chang KSF. The Relationship Between Dental and Skeletal Maturation in Chinese Children. Arch Oral Biol 1965;10(6):883-891.

17- Green LJ. The Interrelationship Among Height, Weight And Chronological, Dental And Skeletal Ages. Angle Orthod 1961;31:189-193.

18- Hagg U, Taranger J. Dental development assessed by tooth counts and its correlation to somatic development during puberty. Europ J Orthod 1984;6(1):56-64.

14

19- Hagg U, Taranger J. Dental Development Dental Age and Tooth Counts. Angle Orthod 1985;55(2):93-107.

20- Hagg U, Matsson L. Dental maturity as an indicator of chronological age: the accuracy and precision of three methods. Europ J Orthod 1985;7:25-34.

21- Demirjian A, Goldstein H, Tanner JM. A New System of Dental Age Assessment. Human Biol 1973;45:210-227.

22- Demirjian A, Buschang PH, Tanguay R, Patterson DK. Interrelationship among measures of somatic, skeletal, dental, and sexual maturity. Am J Orthod 1985;88(5):433-438.

23- Sierra AM. Assessment of Dental and Skeletal Maturity A New Approach. Angle Orthod 1987;57(3):194-208.

24- Nanda RS. Eruption of human teeth. Am J Orthod 1960;46:363-378. 25- Farman AG, Escobar V. Radiographic appearance of the cervical

vertebrae in normal and abnormal development. Br J Oral Surg 1982;20:264-274.

26- Fishman LS. Radiographic evaluation of skeletal maturation, a clinically oriented study based on hand-wrist film. Angle Orthod 1982;52:88-112.

27- Greulich WW, Pyle SI. Radiograph atlas as skeletal development of the hand and wrist .1st ed Stanford University Press;1949.

28- Greulich WW, Pyle SI. Radiograph atlas as skeletal development of the hand and wrist. 2nd ed Stanford University Press;1959.

29- Leite HR, O’Reilly MT. Skeletal age assessment using the first, second and third fingers of the hand. Am J Orthod Dentofacial Orthop 1987;92(6):492-98.

30- Tanner JM, Whitehouse RH. Standards for skeletal maturity. Paris: International Children’s Center;1959.

31- Tanner JM, Whitehouse RH, Healy MJR. A new system for estimating skeletal maturity from the hand and wirst, with standards derived from a study of 2600 healthy British children. Part II: The scoring system. Paris: International Children’s Center;1962.

32- Tavano O, et al, Greulich & Pyle e Tanner & Whitehouse. Comparação entre duas tabelas de avaliação de idade biológica através do desenvolvimento ósseo. Pediatria Clínica 1982;6:7-21.

33- Ursi WJS. Determinação da maturidade esquelética através das radiografias carpais: sua importância no tratamento ortodôntico ortopédico. In: Interlandi S. Ortodontia: bases para a iniciação. 4ª ed; Artes Médicas 1999;p. 337-392.

34- Chapman SM. Ossification of the adductor sesamoid and the adolescent growth spurt. Angle Orthod 1972;42:236-244.

35- Helm S, Siersback-Nielsen S, Skieler V, Björk A. Skeletal maturation of the hand in relation to maximum pubertal growth in body height. Danish Dental Journal 1971; 75:1223-1224.

15

36- Brown T, Barret MJ, Grave KC. Facial growth and skeletal maturation at adolescent. Dan Den J 1971;75:1121-1222.

37- Björk A. Timing of interceptive orthodontic measures based on stages of maturation. Europ Orthod Soc 1972;48:61-74.

38- Lamparski DG. Skeletal age assessment utilizing cervical vertebrae. Master’s thesis, University of Pittsburgh 1972. 164p.

39- Liliequist B, Lundberg M. Skeletal and tooth development. Acta Radiologia Diagnosis 1971;11(2):97-112.

40- Smith R J. Misuse of hand-wrist radiographs. Am J Orthod 1980;77(1):75-78.

41- Ruf S, Pancherz H. Frontalsinus development as an indicator for somatic maturity at puberty ? Am J Orthod Dentofacial Orthop 1996;110(5):476-482.

42- Armond MC. Estimativa do surto de crescimento puberal pela avaliação das vértebras cervicais em radiografias cefalométricas laterais. Ortodontia 2001;34(1):51-60.

43- Garcia-Fernandez P, Torres H, Flores L, Rea J. The cervical vertebrae as maturational indicators. J Clin Orthod 1998;32(4):221-225.

44- Hellsing E. Cervical vertebral dimensions in 8-11 and 15 year old children. Acta Odontol Scan 1991;49:207-213.

45- O’Reilly MT, Yanniello GJ. Mandibular growth changes and maturation of cervical vertebrae. Angle Orthod 1988;58:179-184.

46- Schusterchitz T, Neto FH. Estudo comparativo entre a maturação óssea das vértebras cervicais e a região carpal. Ortodontia 2002;35(3):33-42.

47- Generoso R, Tavano O, Ribeiro A, Parreira MLJ. Estudo da Correlação entre a Idade Cronológica e a Maturação das Vértebras Cervicais em Pacientes em Fase de Crescimento Puberal. Dental Press Ortodon Ortop Facial 2003;8(4):19-36.

48- Mito T, Sato K, Hideo M. Cervical vertebral bone age in girl. Am J Orthod Dentofacial Orthop 2002;122:380-385.

49- Baccetti T, Franchi L, McNamara Jr JA. The cervical vertebral maturation method: some need clarification. Am J Ortod Dentofacial Orthop 2003;123:19A-20A.

50- Franchi L, Baccetti T, McNamara Jr JA. Mandibular growth as related to cervical vertebral maturation. Am J Orthod Dentofacial Orthop 2000;118(3):335-40.

51- BaccettiT, Franchi L, McNamara Jr JA. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod 2002;72: 316-323.

52- Townsend G, Grave K. Cervical vertebral maturation as a predictor of adolescent growth spurt. Aust Orthod J 2003;19:25-32.

16

53- Townsend G, Grave K. Hand-wrist and cervical vertebral maturation indicators: how can these events be used to time ClassII treatments? Aust Orthod J 2003;19(2):33-45.

54- Ballrick J W, Fields H W, Vig K W L, Beck F M, Germak J. The Accuracy and Reliability of Cervical Vertebral Maturation (CVM) versus Hand-Wrist Radiograph Methods for Evaluating Patient Growth Potential. [periódico on line], disponível em URL: http// www.google.com.br

55- Chen F, Terad K, Hanada K. A New Method of Predicting Mandibular Length Increment on the Basis of Cervical Vertebrae. Angle Orthod 2003;74;(5): 630-634.

56- Kucukkeles N, Acar A, Biren S, Arun T. Comparisson between cervical vertebrae and hand-wrist maturation for the assessment of skeletal maturity. J Clin Ped Dent 1999;Nov;24(1):47-52.

57- Román P, Palma JC, Oteo MD, Nevado E. Skeletal maturation determined by cervical vertebrae development. Europ Orthod Soc 2002;24:303-311.

58- Rajagopal R, Kansal S. A Comparison of Modified MP3 Stages and the Cervical Vertebrae as Growth Indicators. J Clin Orthod 2002;36(7):398-406.

59- Thurow RC. Atlas of orthodontic principles. 1st ed.St. Louis C V Mosby 1970; p.26,30,33.

60- Gray Anatomia. editoria: Charles MG; 29a ed Rio de Janeiro: Guanabara Koogan,1977.

61- Epstein BA. Radiological Text and Atlas. Philadelphia Lea & Febiger 1976 appud Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod 1995;107:58-66.

62- Bick E, Copel J. Longitudinal growth of the human vertebrae. J Bone Joint Surg 1950; 32:803-813. 63- Todd T, Pyle SI. Quantitative study of the vertebral column. Am J Phys

Anthropol 1928;12:321. 64- Elsberg C A, Duke C G. The diagnosis and localization of tumors of the

spinal cord by means of measurements made of x-ray film of the vertebrae and correlation of clinical and x-ray findings. Bull Neuro Inst 1934;3:359

65- Lanier R. Presacral vertebrae of white and negro males. Am J Phys Anthropol 1939;25:341-417.

66- Hinck V, Hopkins C, Savara B. Sagittal diameter of the cervical spine in children. Radiology 1962;70-97.

67- Hagg U, Taranger J. Skeletal of the hand and wrist as of the pubertal growth spurt. Acta Odontol Scand 1980;38:187-200.

68- Hunter CJ. The correlation of facial growth with body height and skeletal maturation at adolescence. Angle Orthod 1966;36:44-54.

69- Tofani M. Mandibular growth at puberty. Am J Orthod 1972;62:176-195.

17

70- Bamba JK, VanNattan P. Longitudinal study of facial growth in relation to maturation during adolescence. Am J Orthod 1963;49:481-493.

71- Santos SC, Almeida RR. Estudo comparativo de dois métodos de avaliação da idade esquelética utilizando telerradiografias em norma lateral e radiografias carpais. Ortodontia 1999;32(2):33-45.

72- Nanda SK. Prediction of facial growth using different biologic criteria in females. In: Carlson D, Ribbens KA. Cranofacial growth during adolescence. Center for human growth and development. Monograph 20, CFG Series. Ann Arbor; University of Michigan 1987;135-205.

73- Tanner JM, Whitehouse RH, Marshall W, Healy MJR, Goldstein H. Assessment of skeletal Maturity and Prediction of Adult Height. (TW2 Method), Academic Press, London 1975.

74- Tanner JM, Healy, MJR, Goldstein H, Cameron, N – Assessment of Skeletal maturity and Prediction of Adult Height (TW3 Method). 3ª ed. Londres: Saunders, 2001; 110p.

75- Grave KC, Brown T. Skeletal ossification and the adolescent growth spurt. Am J Orthod 1976;69:611-619.

76- Tanner JM, Whitehouse RH. Atlas of children’s growth; normal variation and growth disorders 1st ed. London Academic Press 1982.

77- Tood TW. Atlas of skeletal maturation, part 1, (hand) 1937. 78- Grave KC, Brown T. Carpal radiographs in orthodontic treatment. Am J

Orthod 1979;75:27-45. 79- Hellman M. Ossification of epiphysial cartilages in the hand. Am Phys

Anthropol 1928;11:22-43. 80- Faulkner CT, Harris EF. 1259 Race and Sex Differences in Tempos of

Cervical Vertebral Maturation. Am J Orthod Dentofacial Orthop 200;119(5):13A.

81- Mito T, Sato K, Mitani H. Predicting mandibular growth potential with cervical vertebral bone age. Am J Orthod Dentofacial Orthop 2003;124(2):173-177. =========================================================

Sergio Polizio Terçarolli

Rua Prof. Vahia de Abreu, 733 04549-003 - Vila Olimpia – SP Tel/Fax: 3842.1093 / 3845.8452 E-mail: [email protected]

=========================================================

Documents

Skeletal and Vertebral Age - A Literature Review