Benny M. Soegiharto

Discriminatory ability of the skeletal maturation index and the cervical vertebrae maturation index in detecting peak pubertal growth in Indonesian and white subjects with receiver operating characteristics analysis

INTRODUCTION In this study, we aimed to determine the effectiveness of the skeletal maturation index (SMI) and the cervical vertebrae maturation (CVM) index in discriminating between patients who have yet to attain their peak pubertal growth, compared with those who have reached or passed it. An additional aim was to determine whether there was any significant difference in the ability of the 2 methods to predict peak pubertal growth. METHODS The study included 2167 patients with hand-wrist and lateral cephalometric radiographs. There were 648 Indonesian boys and 303 white boys (age range, 10-17 years), and 774 Indonesian girls and 442 white girls (age range, 8-15 years). The SMI was used to evaluate the stages of skeletal maturity from hand-wrist radiographs, and the CVM index was used to evaluate skeletal maturity from lateral cephalograms. Several commonly used cephalometric parameters representing maxillary and mandibular dimensions were also measured to construct growth curves and calculate peak velocity. RESULTS Receiver operating characteristic (ROC) analysis was performed for the craniofacial morphology parameters for both sex and ethnic groups. The percentages of correctly classified subjects into the appropriate maturational stages for the mandibular parameters, as well as the stages with high sensitivity values for the maxillary parameters, showed that both the CVM index and the SMI have good discriminatory ability. On average, the results of the area under curve (AUC) for the SMI (AUC >0.9) were greater than for the CVM (AUC >0.8), and the differences between them were also statistically significant (P <0.05 for all parameters investigated). However, the curves for both CVM and SMI approached the top left corner of the ROC graph, suggesting that both tests have good discriminatory ability, and the differences between the methods were only between 1% and 7%. CONCLUSIONS Both the CVM index and the SMI are valid methods to discriminate between patients who have not yet attained peak pubertal growth and those who have reached or passed it. The differences in discriminatory ability between the SMI and the CVM index in detecting peak pubertal growth were small. These results question the necessity of taking hand-wrist radiographs and exposing a child to additional radiation when the discriminatory ability is similar with the CVM index, which is readily derived from most lateral cephalograms.

Skeletal maturation in Indonesian and white children assessed with hand-wrist and cervical vertebrae methods

INTRODUCTION The purpose of this study was to describe the stages of skeletal maturity of Deutero-Malay Indonesian children according to the hand-wrist and cervical vertebrae methods and to compare them with white children. METHODS The study included 2167 patients with hand-wrist radiographs and lateral cephalometric radiographs. Of these, there were 648 Indonesian boys, 303 white boys (age range of boys, 10-17 years), 774 Indonesian girls, and 442 white girls (age range of girls, 8-15 years). The skeletal maturation index (SMI) was used to evaluate the stages of skeletal maturity from hand-wrist radiographs, and the cervical vertebrae maturation (CVM) index was used to evaluate the stages of skeletal maturity from lateral cephalometric radiographs. One observer made all observations, and a repeatability study was undertaken. RESULTS Box-and-whisker plots were used to show the age distribution on attainment of each maturation stage based on the SMI and CVM. On average, both the SMI and the CVM showed that white children attained each maturation stage about 0.5 to 1 year earlier than their Indonesian peers, although the differences were less obvious in girls than in boys. Multiple regression analysis was used to predict the SMI from the chronologic age. Both the Indonesian and the white boys groups showed a good relationship between predicted SMI and chronologic age (R(2) = 0.728 and 0.739, respectively), as did the Indonesian and white girls groups (R(2) = 0.755 and 0.748, respectively). Further multiple regression analyses used to investigate the differences in the ages of attainment of skeletal development between Indonesian and white subjects indicated that, across the age ranges investigated, on average for a particular age, the white boys were 1 SMI stage ahead of the Indonesian boys, and the white girls were about 0.5 SMI stage ahead of their Indonesian peers. Because the CVM has only 5 categories, it was not considered appropriate to use this form of multiple regression analysis. CONCLUSIONS The findings confirmed marked variations in the chronologic ages for each skeletal maturity stage and also showed differences between the timing of skeletal maturity with both the SMI and the CVM between the sexes and the ethnic groups. These differences should be considered during orthodontic diagnosis and treatment planning.

Management of skeletal Class III malocclusion with unilateral crossbite on a growing patient using facemask-bonded rapid palatal expander and fixed appliances

Facemask (FM) and bonded rapid palatal expander (RPE) are part of growth modification treatments for correcting skeletal Class III pattern with retrognathic maxilla. This orthopaedic treatment is usually preceded by fixed appliances to achieve aesthetic dental alignment and improve interdigitation. This case report reviews treatment of Class III malocclusion with unilateral crossbite in a 12-year-old boy using FM and bonded RPE, followed by fixed appliances. Choice of FM and bonded RPE was in line with indication which was mild Class III malocclusion with retrognathic maxilla. Execution of treatment was made considering treatment biomechanics and patient cooperation. This orthopaedic treatment was followed by orthodontic treatment specifically aimed to correct unilateral crossbite, canine relationship yet to reach Class I, lower midline shift, as well as unintended dental consequences of using bonded RPE, namely posterior open bite and deepening curve of spee. Posttreatment facial profile and smile are more esthetic. Occlusion is significantly improved both functionally and aesthetically.