Imagine a dentist trying to determine the exact right time to place orthodontic appliances on a nine-year-old child. Too early, and the results may not be optimal. Too late, and a critical growth opportunity may be missed. Traditionally, many clinicians have relied on chronological age as a reference. However, research from the Faculty of Dentistry at Universitas Gadjah Mada suggests that the answer may be hidden in the upper cervical vertebrae rather than in the child’s age.
Published in the Padjadjaran Journal of Dentistry (2021), the study revealed different patterns of facial growth between boys and girls, measured using the Cervical Vertebrae Maturation Index (CVMI). The findings offer a new perspective on how clinicians should determine the optimal time to initiate early orthodontic treatment.
The Cervical Vertebrae as a Window into Facial Growth
The cervical vertebrae—specifically the second, third, and fourth vertebrae—contain valuable information about overall craniofacial skeletal maturity. The CVMI method assesses morphological changes in these three vertebrae on a lateral cephalometric radiograph, a diagnostic image routinely used in orthodontic treatment planning.
The practical advantage is clear: no additional X-ray is required. From a single lateral cephalometric image, a dentist can simultaneously assess facial dimensions and skeletal maturity. The six CVMI stages reflect the progression from an early phase of relatively limited growth through the pubertal growth peak and eventually into a period of declining growth.
The study, conducted by Ica Listania, drg. Sri Kuswandari, and drg. Putri Kusuma Wardani Mahendra, M.Kes., Sp.KGA., from the Department of Pediatric Dentistry at FKG UGM, involved 44 children aged 8 to 11 years from Madrasah Ibtidaiyah schools in Depok District, Sleman, Yogyakarta. Data were collected from July 2019 to January 2020 using digital cephalometric radiographs at the Radiology Installation of Prof. Soedomo Dental Hospital, UGM.
The Maxilla and Mandible Move, While the Cranial Base Remains Stable
Of the four anteroposterior dimensions measured—S-N (anterior cranial base), PNS-ANS (maxilla), Go-Me, and Co-Gn (mandible)—the most striking results were observed in the jaws.
The dimensions of both the maxilla and mandible showed significant differences as CVMI maturity stages increased in both boys and girls. The mandible, measured using two different parameters, demonstrated the most consistent and dramatic growth across all CVMI intervals examined.
In contrast, the anterior cranial base (the distance from the sella turcica to the nasion, or S-N) showed no significant differences. This finding is consistent with the theory that growth of the anterior cranial base is largely complete by approximately eight years of age and therefore remains relatively stable as children enter the middle mixed-dentition and early permanent-dentition stages.
The timing pattern was particularly interesting. In boys, acceleration in maxillary growth was more evident between CVMI stages 2 and 3, whereas in girls, the significant growth spurt occurred between stages 3 and 4. This confirms that girls experience their peak growth approximately two years earlier than boys, a biological fact that has long been recognized but is now documented using measurable cephalometric data.
The Golden Window That Should Not Be Missed
The clinical implications of these findings are quite concrete. Functional orthodontic treatment aimed at modifying jaw growth can be approximately twice as effective when performed at the pubertal growth peak compared with three years before or after that period.
“Early orthodontic treatment, if started at the optimal maturation stage, can give the best results with the lowest predictable probability of treatment failure.”
This is not merely theoretical. The study demonstrated that during CVMI stages 3 and 4, the mandible continued to grow significantly in both sexes. This means there is a window of opportunity that orthodontists and pediatric dentists can use to initiate the most effective intervention.
CVMI provides a degree of precision that chronological age alone cannot offer. Two children who are both ten years old may be at very different stages of biological maturation. One may already have passed the growth peak, while the other may only be approaching it.
Reading the Bones, Designing the Future of a Smile
This study strengthens the argument that biological maturity, rather than simply the number on a child’s identification card, should be an important consideration when planning orthodontic treatment. An X-ray traditionally viewed simply as a dental diagnostic tool can actually contain information about the entire course of a child’s facial skeletal growth.
For clinicians, the message is simple but requires careful attention: identify the child’s CVMI stage before deciding when to initiate orthodontic treatment. Because when it comes to growth, as with many other things in life, timing can make all the difference.
Source DOI: http://10.24198/pjd.vol33no2.30947
Authors: Nanda Ayu, drg. Achmad Zam Zam Aghasy, M.Kes.
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