title: Radiographic assessment of skeletal maturation stages for orthodontic patients: hand-wrist bones or cervical vertebrae?
abstract: OBJECTIVE
  The skeletal maturation status of a growing patient can influence the selection of orthodontic treatment procedures. Either lateral cephalometric or hand-wrist radiography can be used to assess skeletal development. In this study, we examined the correlation between the maturation stages of cervical vertebrae and hand-wrist bones in Taiwanese individuals.
  
  
  METHODS
  The study group consisted of 330 male and 379 female subjects ranging in age from 8 to 18 years. A total of 709 hand-wrist and 709 lateral cephalometric radiographs were analyzed. Hand-wrist maturation stages were assessed using National Taiwan University Hospital Skeletal Maturation Index (NTUH-SMI). Cervical vertebral maturation stages were determined by the latest Cervical Vertebral Maturation Stage (CVMS) Index. Spearman's rank correlation was used to correlate the respective maturation stages assessed from the hand-wrist bones and the cervical vertebrae.
  
  
  RESULTS
  The values of Spearman's rank correlation were 0.910 for males and 0.937 for females, respectively. These data confirmed a strong and significant correlation between CVMS and NTUH-SMI systems (p less than 0.001). After comparison of the mean ages of subjects in different stages of CVMS and NTU-SMI systems, we found that CVMS I corresponded to NTUH-SMI stages 1 and 2, CVMS II to NTUH-SMI stage 3, CVMS III to NTUHSMI stage 4, CVMS IV to NTUH-SMI stage 5, CVMS V to NTUH-SMI stages 6, 7 and 8, and CVMS VI to NTUH-SMI stage 9.
  
  
  CONCLUSIONS
  Our results indicate that cervical vertebral maturation stages can be used to replace hand-wrist bone maturation stages for evaluation of skeletal maturity in Taiwanese individuals.
authors.affiliation: Department of Orthodontics, School of Dentistry, and Dental Department, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Eddie Hsiang-Hua
authors.initials: EH
authors.lastname: Lai
authors.forename: Jen-Pei
authors.initials: JP
authors.lastname: Liu
authors.forename: Jenny Zwei-Chieng
authors.initials: JZ
authors.lastname: Chang
authors.forename: Shih-Jaw
authors.initials: SJ
authors.lastname: Tsai
authors.forename: Chung-Chen Jane
authors.initials: CC
authors.lastname: Yao
authors.forename: Mu-Hsiung
authors.initials: MH
authors.lastname: Chen
authors.forename: Yi-Jane
authors.initials: YJ
authors.lastname: Chen
authors.forename: Chun-Pin
authors.initials: CP
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D001846:Bone Development; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D009970:Orthodontics; D011859:Radiography; D014953:Wrist / Q000000981:diagnostic imaging*