There are several reasons why it’s a good idea to understand growth potential in patients. It can affect the timing for certain orthodontic treatments, especially if you want to do the orthodontic treatment during periods of growth spurts.
Growth potential can also affect the timing for implant procedures if you want to time implant placement after the growth has stopped.
3 different ways to assess the growth stage for patients
You can use the cervical vertebral maturation or CVM analysis, which looks at the spine on the cephalometric x-ray. You can evaluate a hand wrist x-ray. You can also trace consecutive cephalometric x-rays and ensure there hasn’t been any additional growth during that time period.
1. Cervical vertebral maturation analysis
The cervical vertebral maturation method evaluates the shape and the morphology of the cervical vertebrae C – 2 to C – 6. The analysis corresponds to Growth Stages 1 – 6.
Those stages, one to six, show different shapes of the cervical bones.
You may see shapes that look initially more trapezoidal where the upper border runs obliquely from the back and downward forward.
Then you may start to see vertebral shapes that are more rectangular horizontal, where they’re wider than they are tall. Then you may see more square shapes. And then finally you’ll see more vertical rectangular shapes where the vertebra are taller, and that’s when the bone is more mature, and of course the patient is taller.
There’s certain key indicators for identifying which stage patients are in by looking at the cephalometric x-ray: and there’s also even software that help put points on the corners of the vertebrae to help identify is it square or is it rectangular, vertical or rectangular or horizontal.
2. Hand wrist radiograph
There are different ossification stages. There’s a width equalization when the epiphysis becomes as wide as the metaphysis. For example, the MP3F stage, there’s a capping stage where the epiphysis caps, the metaphysis MP3G stage. There’s a fusion stage where the epiphysis in the meta metaphysis begin to fuse at the MP3H stage.
And then there’s a complete fusion stage where full fusion indicates skeletal maturity. MP3 stage.
You can use different charts to help analyze x-rays to see which stages of growth are in place. And then once key indicators are determined, you can look at growth charts to see which age of maturity this patient’s in.
Pros and cons
When we look at the key indicators for the CVM method, we look at the vertebral shape and the concavity.
- For the hand wrist bones we look at the ossification infusion stages.
- For the growth spurt timing For the CVM, we look at CS3 to CS4.
- For the hand wrists, bones, we look at MP3G to MP3H.
- For CVM, we may say that the radiation exposure is less because we may already have a cephalometric x-ray for the ortho, and we can still look at that.
- For the hand wrist, we say that exposure’s higher because this is an additional x-ray we have to take just to look at the growth.
In addition to timing orthodontic treatments or evaluating timing for implants, it could also help predict final height and be used for diagnosing growth disorders like delayed puberty or advanced bone age.
3. Serial Cephalometric Tracing assessment
And then finally, another way to evaluate if there’s any remaining growth is to look at serial cephalometric tracing assessment.
Basically, we want to look at three views, for example of an overall super imposition of two X-rays at different point in time aligning at the base of the skull. We can , then also do a maxillary super imposition and a mandibular super imposition, and just look to make sure whether there are any changes in growth or not.
Using x-rays to estimate growth matters for treating the patient
So applications: let’s say you have a young orthodontic patient with congenitally missing lateral incisors, and you’re trying to determine when to place the implants. You probably have some cephalometric x-rays from the start and final for the ortho, which you could certainly look at the stages of the CVM along the way.
You could choose to take a hand wrist x-ray to evaluate. And if there’s any question, you could look at consecutive cephs from six to 12 months apart to make sure there’s no remaining growth.
Typically, females at 18 years old or males at 20 years old are probably towards the end of their growth. But the two consecutive cephalometric x-ray would help to confirm that on a more individual basis.