Comparison of three methods to assess individual skeletal maturity

  • E. Pasciuti
  • L. FranchiEmail author
  • T. Baccetti
  • S. Milani
  • G. Farronato
Original article



The knowledge of facial growth and development is fundamental to determine the optimal timing for different treatment procedures in the growing patient.


To analyze the reproducibility of three methods in assessing individual skeletal maturity, and to evaluate any degree of concordance among them.


In all, 100 growing subjects were enrolled to test three methods: the hand-wrist, cervical vertebral maturation (CVM), and medial phalanges of the third finger method (MP3). Four operators determined the skeletal maturity of the subjects to evaluate the reproducibility of each method. After 30 days the operators repeated the analysis to assess the repeatability of each method. Finally, one operator examined all subjects’ radiographs to detect any concordance among the three methods.


The weighted kappa values for inter-operator variability were 0.94, 0.91, and 0.90, for the WRI, CVM, and MP3 methods, respectively. The weighted kappa values for intra-operator variability were 0.92, 0.91, and 0.92, for the WRI, CVM, and MP3 methods, respectively.


The three methods revealed a high degree of repeatability and reproducibility. Complete agreement among the three methods was observed in 70% of the analyzed samples. The CVM method has the advantage of not necessitating an additional radiograph. The MP3 method is a simple and practical alternative as it requires only a standard dental x-ray device.


Interceptive orthodontics Skeletal maturity Growth and development 

Vergleich dreier Methoden zur Beurteilung der individuellen Skelettreife



Bestimmung der Reproduzierbarkeit von drei Methoden zur Bestimmung der individuellen skeletalen Reife und möglicher Übereinstimmungen.

Material und Methoden

Das Studienkollektiv bestand aus 100 Probanden. Die verwendeten Methoden waren die Handröntgenaufnahme, die Methode zur Bestimmung der skeletalen Reife der Halswirbel (CVM-Methode) und die Methode zur Bestimmung der medialen Phalanx des Mittelfingers (MP3). Vier Untersucher bestimmten die skeletale Reife, um die Reproduzierbarkeit jeder Methode zu evaluieren. Nach 30 Tagen wiederholten die Untersucher die Analyse, um die Reproduzierbarkeit jeder Methode festzustellen. Schließlich analysierte ein Untersucher die Röntgenaufnahmen aller Probanden, um mögliche Übereinstimmungen zwischen den drei Methoden festzustellen.


Alle Methoden zeigten eine hohen Grad an Reproduzierbarkeit. Eine vollständige Übereinstimmung zwischen den drei Methoden wurde bei einer hohen Prozentzahl des Untersuchungsgutes (ungefähr 70%) gefunden.


Die CVM-Methode hat den Vorteil, dass sie eine zusätzliche Röntgenaufnahme vermeidet. Die MP3-Methode ist eine einfache und praktische Alternative, da sie nur ein Dentalröntgengerät erfordert, das in jeder Zahnarztpraxis vorhanden ist.


Interzeptive Kieferorthopädie Skelettreife Wachstum und Entwicklung 


Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.


Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • E. Pasciuti
    • 1
  • L. Franchi
    • 2
    Email author
  • T. Baccetti
    • 3
  • S. Milani
    • 4
  • G. Farronato
    • 5
  1. 1.Private practiceMilanItaly
  2. 2.Department of OrthodonticsUniversity of FlorenceFlorenceItaly
  3. 3.Department of Orthodontics and Pediatric Dentistry, School of DentistryUniversity of MichiganAnn ArborUSA
  4. 4.Department of StatisticsUniversity of MilanMilanItaly
  5. 5.Department of OrthodonticsUniversity of MilanMilanItaly

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