title: Cervical vertebrae maturation method: poor reproducibility.
abstract: BACKGROUND
  The cervical vertebrae maturation (CVM) method has been advocated as a predictor of peak mandibular growth. This method relies on the clinician's ability to determine the stage of maturation of the vertebrae. Careful examination of reports of this technique shows methodologic flaws that can lead to inflated levels of reproducibility. The purpose of this study was to evaluate the reproducibility of CVM stage determination by using a more stringent methodology.
  
  
  METHODS
  Ten practicing orthodontists, trained in the CVM method, evaluated 30 individual and 30 pairs of cephalometric radiographs in 2 sessions to determine the CVM stage. Interobserver and intraobserver reliability was determined by using the Kendall coefficient of concordance and the weighted kappa statistic.
  
  
  RESULTS
  All degrees of interobserver and intraobserver agreement were moderate (Kendall's W, 0.4-0.8). Interobserver agreement levels for CVM staging of the 10 orthodontists at both times were below 50%. Agreement improved marginally with the use of 2 longitudinal radiographs. Intraobserver agreement was only slightly better; on average, clinicians agreed with their own staging only 62% of the time.
  
  
  CONCLUSIONS
  Based on these results, we cannot recommend the CVM method as a strict clinical guideline for the timing of orthodontic treatment.
authors.affiliation: United States Air Force, Okinawa, Japan.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Gabriel
authors.forename: Karin A
authors.initials: KA
authors.lastname: Southard
authors.forename: Fang
authors.initials: F
authors.lastname: Qian
authors.forename: Steven D
authors.initials: SD
authors.lastname: Marshall
authors.forename: Robert G
authors.initials: RG
authors.lastname: Franciscus
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Southard
mesh_terms: D000365:Age Determination by Skeleton / Q000379:methods / Q000706:statistics & numerical data*; D000886:Anthropometry; D001837:Body Weights and Measures; D002508:Cephalometry / Q000379:methods / Q000706:statistics & numerical data; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000254:growth & development*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008334:Mandible / Q000254:growth & development*; D015588:Observer Variation; D015203:Reproducibility of Results