Comparative Diagnostic Accuracy of Spheno-Occipital Synchondrosis and Cervical Vertebral Maturation Index in Predicting Mandibular Growth Parameters in Adolescents: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated and compared the diagnostic utility of spheno-occipital synchondrosis maturation and the cervical vertebral maturation index for identifying mandibular growth parameters in adolescents. Longitudinal and mixed-longitudinal human studies that assessed spheno-occipital synchondrosis maturation and/or the cervical vertebral maturation index as index tests against mandibular growth parameters as the reference standard were considered eligible. Cross-sectional studies without a longitudinal growth reference and studies lacking extractable diagnostic accuracy data were excluded. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was performed from database inception to the final search date, and grey literature was additionally screened through ProQuest Dissertations & Theses, selected university repositories, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. Risk of bias and applicability concerns were independently assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Sensitivity estimates were derived from 2 × 2 contingency tables and pooled using a random-effects model, while the association between spheno-occipital synchondrosis maturation and cervical vertebral maturation index stages was synthesized through correlation meta-analysis. Six studies involving adolescents approximately 10 to 19 years of age met the inclusion criteria. Three longitudinal studies were included in the diagnostic accuracy meta-analysis for the cervical vertebral maturation index, and three cross-sectional studies contributed four datasets to the correlation meta-analysis examining the relationship between spheno-occipital synchondrosis maturation and the cervical vertebral maturation index. The cervical vertebral maturation index demonstrated moderate diagnostic performance for identifying mandibular growth phases, although sensitivity estimates varied notably across studies. Spheno-occipital synchondrosis maturation showed a strong pooled association with mandibular growth and skeletal maturation, with a random-effects correlation of approximately 0.8, although heterogeneity was considerable. Overall, both measures appear clinically informative for estimating mandibular growth timing in adolescents, with spheno-occipital synchondrosis maturation showing a strong relationship with skeletal maturation and the cervical vertebral maturation index demonstrating moderate diagnostic value for identifying phases of mandibular growth. No external funding was received. This review was registered in PROSPERO (CRD420251175309).