Radiographic growth indicators: The issue of diagnostic reliability and clinical feasibility
Abstract
The use of radiographic growth indicators, such as the hand-and-wrist maturation (HWM) and cervical vertebral maturation (CVM) methods, has been recommended in previous clinical trials on the skeletal effects obtained by functional treatment in growing ClassII patients. The concept behind the use of indicators resides in the identification of the pubertal growth spurt in individual patients allowing the delivery of the treatment at this specific stage of skeletal maturation when the mandible response is expected to be maximum growth. Interestingly, while many of the former types of investigations reported a poor correlation between the stages of growth indicators (mainly the CVM) and mandibular growth spurt, most of the latter type of investigations reported clinically relevant favorable effects when the growth indicators are used. It is perhaps that investigations are still missing the relevant piece of evidence.The first critical issue relates to the correlation between two variables (i.e., stages of maturation and mandibular growth) that does not imply diagnostic accuracy, as it has been extensively reported for the case of dental maturation. The other relevant issue relates to the clinical feasibility of the repetition of the recording when dealing with invasive methods based on X-rays, irrespective of whether the methods are accurate. Meanwhile, more opportunity will be given by the use of non-invasive (serum or GCF) biomarkers. According to all these considerations, more reports will be necessary to elucidate the role of the growth indicators in orthodontics fully.
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