title: A comparison of hand-wrist bone and cervical vertebral analyses in measuring skeletal maturation.
abstract: OBJECTIVE
  To compare skeletal maturation as measured by hand-wrist bone analysis and by cervical vertebral analysis.
  
  
  METHODS
  A radiographic hand-wrist bone analysis and cephalometric cervical vertebral analysis of 30 patients (14 males and 16 females; 7-18 years of age) were examined. The hand-wrist bone analysis was evaluated by the Bjork index, whereas the cervical vertebral analysis was assessed by the cervical vertebral maturation stage (CVMS) method. To define vertebral stages, the analysis consisted of both cephalometric (13 points) and morphologic evaluation of three cervical vertebrae (concavity of second, third, and fourth vertebrae and shape of third and fourth vertebrae). These measurements were then compared with the hand-wrist bone analysis, and the results were statistically analyzed by the Cohen kappa concordance index. The same procedure was repeated after 6 months and showed identical results.
  
  
  RESULTS
  The Cohen kappa index obtained (mean +/- SD) was 0.783 +/- 0.098, which is in the significant range. The results show a concordance of 83.3%, considering that the estimated percentage for each case is 23.3%. The results also show a correlation of CVMS I with Bjork stages 1-3 (interval A), CVMS II with Bjork stage 4 (interval B), CVMS III with Bjork stage 5 (interval C), CVMS IV with Bjork stages 6 and 7 (interval D), and CVMS V with Bjork stages 8 and 9 (interval E).
  
  
  CONCLUSIONS
  Vertebral analysis on a lateral cephalogram is as valid as the hand-wrist bone analysis with the advantage of reducing the radiation exposure of growing subjects.
authors.affiliation: Department of Orthodontics, University of Pisa, Pisa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gandini
authors.forename: Marta
authors.initials: M
authors.lastname: Mancini
authors.forename: Federico
authors.initials: F
authors.lastname: Andreani
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton / Q000379:methods*; D001846:Bone Development; D002348:Carpal Bones / Q000000981:diagnostic imaging / Q000254:growth & development*; D002508:Cephalometry; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000254:growth & development*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000254:growth & development*; D012016:Reference Values