| Summary: | Background: Knowledge of craniofacial growth and development is a prerequisite for the comprehensive and successful management of orthodontic patients. In orthodontic treatment during adolescence, craniofacial growth is often paramount to its success of treatment, especially in patients with skeletal discrepancies. The ultimate goal, in orthodontics, would be the ability to predict accurately the onset, duration and magnitude of the peak pubertal growth spurt, particularly in relation to the mandible. The radiographic assessment of features of skeletal maturation has been extensively researched, as a means of determining an individual’s growth potential. Historically, assessments of the ossification of the bones on the hand-wrist radiograph were evaluated. However for orthodontics, in the UK and some other parts of the world, this method has been superseded by assessment of morphological features of the cervical vertebrae, on the lateral cephalogram. This increase in popularity is because the cervical vertebrae assessment prevents additional radiation to the patient. It is, therefore, safer for the patient. Aim: This study aimed to: 1. Determine the reliability and reproducibility of Cervical Vertebrae Maturation (CVM) stage assessment amongst orthodontists in training and specialist orthodontists, looking at a sample of consecutive lateral cephalograms taken at Liverpool University Dental Hospital. 2. Determine the reliability and reproducibility of CVM stage assessment amongst orthodontists in training and specialist orthodontists, looking at a sample of ideal images provided by co-author of the index, Dr J McNamara. 3. Compare the agreement of specialist orthodontists with orthodontists in training. 4. Determine whether increased experience with the index improved the agreement between observers. 5. Determine if the principal investigator (BJR) and research supervisor (JEH) agree with the experts and developers of the index (JMN/LF) and determine if they could be classified as experts. Design: This was a two phase reliability study. A group of 20 orthodontic clinicians, none of whom had used a CVM staging method previously, were trained in the use of the improved version of the CVM method for the assessment of mandibular growth using McNamara’s teaching programme. They independently assessed a sample of 72 consecutive lateral cephalograms, taken at Liverpool University Dental Hospital, on two separate occasions. The cephalograms were presented in a random order and interspersed with 11 ideal images from McNamara for standardisation. The intra- and inter-observer agreements were evaluated, for both image samples, using the weighted kappa statistic. The principal researchers also completed the two phase reliability study. Their results were analysed separately and compared to the findings for observers with no previous experience. The principal investigators then mutually agreed on staging of each radiographs and compared these to the staging given by the developers of the index, to determine if the principal investigator and research supervisor could be classified as experts. Results: The intra-observer and inter-observer agreements were substantial, (weighted kappa 0.6-0.8). The overall intra-observer agreement was 0.70 (SE 0.01) with average agreement 89%. The inter-observer agreement on the first occasion was 0.68 (SE 0.03) and 0.66 (SE 0.03) on the second occasion, with an average inter-observer agreement of 88%. Conclusions: The intra-observer and inter-observer agreement of classifying CVM stages, using the improved version of the CVM method for the assessment of mandibular growth, were substantial.
|
|---|
