COMPARISON OF HAND-WRIST AND CVMS METHODS FOR CRANIOFACIAL GROWTH SPURT ASSESSMENT

Objective: Hand-wrist (HW) radiographs are considered the most accurate method for assessing pubertal growth spurts in orthodontics but have declined in use due to added radiation exposure and the expertise required. Cervical vertebral maturation staging (CVMS) is now commonly used, given the routine availability of lateral cephalograms. However, the validity of CVMS remains uncertain. A recent study reported only 66% inter-observer reliability across time periods (Ingersoll, 2024). This follow-up study aims to evaluate CVMS as a predictor of growth to guide clinical decision-making. Methods: With protocol approval (MU HR-4695), this retrospective study followed a design modeled after a prior study to reduce bias. Two trained observers assessed 129 HW radiographs from the Burlington Growth sample. These radiographs were matched to lateral cephalograms used in the earlier CVMS study. All images were randomly sorted, renamed, and anonymized. Observers used the Bjork system (Hashim et al., 2018) to classify HW radiographs into pre-, peak-, or post-pubertal growth phases. These classifications were compared with the original CVMS-based classifications to evaluate validity. Results: Statistical analysis showed high inter- and intra-observer reliability (p < 0.0001). However, the percent agreement between HW and CVMS classifications was relatively low. Conclusion: While observer consistency was high, agreement between HW and CVMS methods was limited. Clinicians should exercise caution when relying solely on CVMS and consider supplementing assessments with HW radiographs or additional indicators like secondary sexual characteristics.