Cervical Vertebral Maturation Method: Reproducibility and Efficiency of Chronological Age Estimation

The aim of this study was to investigate the reproducibility of the Cervical Vertebral Maturation (CVM) method and the potential for chronological age estimation using this method. The sample consisted of 474 lateral cephalometric radiographs, from orthodontic patients aged 6.4-22.4 years. Six raters were trained to the CVM method (Baccetti). All images were assessed twice. Intra- and inter-rater agreements were assessed by Cohen's weighted kappa and intraclass correlation coefficient, respectively. Analysis of variance was performed to investigate the correlation between cervical maturation stages and chronological age. The age prediction potential of the method was tested by general linear model regression analysis. Intra-rater reliability ranged from 0.857 to 0.931. Intra-rater absolute agreement ranged from 77% to 87% however inter-rater absolute agreement was lower than 50%. Inter-rater reliability was higher than 0.9. The 3rd Cervical Maturation Stage (CS3) showed the lowest reproducibility. The mean age differences among the 6 CS stages were statistically significant and increased as the CS increased. CS and gender could roughly explain the 60% (adjusted R-2 = 0.61) of the age variance of the sample. This CVM method proved able to show high reliability; however, it cannot predict accurately the pubertal growth spurt. A direct correlation was found between cervical stages and chronological age. This method provides a broad estimation of chronological age.