405912
11
Research Article Quantitative Assessment of Cervical Vertebral Maturation Using Cone Beam Computed Tomography in Korean Girls Bo-Ram Byun, 1,2 Yong-Il Kim, 1,2,3 Tetsuta ro Yamagu chi, 4 Koutar o Maki, 4 and Woo- Sung Son 1,2 Department of Orthodont ics, Dental Researc h Institute, Pusan National University Dental Hospital, Geumoro , Yangsan , Republic of Korea Department of Orthodontics, School of Dentistry, Pusan National University, Yangsan , Republic of Korea Department of Orthodonti cs, Biomedical Research Institut e, Pusan National University Hospital, Gudeokro , Busan , Republic of Korea Department of Orthodontics, School of Dentistry, Showa University, okyo , Japan Correspondence should be addressed to Y ong-Il Kim; kimyongil@p usan.ac.kr and Woo-Sung Son; [email protected] Received January ; Accepted March Academic Editor: Chuangyin Dang Copyright © Bo-Ram Byun et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproductio n in any medium, provided the original work is properly cited. Tis stud y was aimedto examine the corr elat ion betwee n skel etal mat urat ionstatus and para mete rs romthe odontoidprocess/body o the second vertebra and the bodies o third and ourth cervical vertebrae and simultaneously build multiple regression models to be able to estimate skeletal maturation status in Korean girls. Hand-wrist radiographs and cone beam computed tomo grap hy (CBC) image s were obta ined rom Korean girls(– years o age). CBC -gene rate d cervica l verte bral mat urat ion (CVM) was used to demarcate the odontoid process and the body o the second cervical vertebra, based on the dentocentral synchondrosis . Correlation coefficient analysis and multiple linear regression analysis were used or each parameter o the cervical vertebrae ( < 0. 05). Forty-seven o parameters rom CBC-generated CVM (independent variables) exhibited statistically signicant correlations ( < 0.05 ). Te multiple regression model with the greatest 2 had six parameters (PH/W, UW/W, (OH+AH)/LW, UW/LW, D, and H/W) as independent variables with a variance ination actor (VIF) o <. CBC- generated CVM was able to include parameters rom the second cervical vertebral body and odontoid process, respectively, or the multiple regression models. Tis suggests that quantitative analysis might be used to estimate skeletal maturation status. 1. Introduction Knowledge o bone age is necessary in order to determine treatment timing in orthodontic and orthognathic surgery patie nts. Many resea rche rs have introdu ced a varie ty o biological indicators [–] including chronologic age, dental deve lopme nt, sexual maturat ion, voice change, and body height [–]. Unortunately, chronologic age alone is not a reliable indicator or the evaluation o skeletal maturation. Among biological skel etal matu ration indic es, skel etal maturation indicators that use hand-wrist radiographs are pop ula r and rel iab le appr oac hes in ort hodontia cli nic s. However, this method requires a hand-wrist radiographic lm. Tere has been increased interest in the use o cer- vical vertebral maturation (CVM) as a replacement or the hand-wrist assessment [ –]. Franchi et al. [ ] used lateral cephalometric analysis to conrm the validity o six CVM stages as biological indicators o both somatic and mandibular skeletal maturity. Baccetti et al. [ ] introduced an improved version o the CVM method or the assessment o mandibular growth. Te CVM method has proven to be effective in assessing adolescent growth peaks regarding both body height and mandibular size [ –]. However , Gabriel et al. [ ] have raised issues regarding the po or inter- and intraobserver reliability o CVM, which are below % and %, respectively. Tey insisted that there is inherent bias in staging and that it would be necessary to use ewer vertebral bodies, employ more sensitive parameters, and avoid estimating stage based on a comparative assessment o changes between stages, in order to make the CVM analysis Hindawi Publishing Corporation Computational and Mathematical Methods in Medicine Volume 2015, Article ID 405912, 9 pages http://dx.doi.org/10.1155/2015/405912
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Research ArticleQuantitative Assessment of Cervical Vertebral MaturationUsing Cone Beam Computed Tomography in Korean Girls
Bo-Ram Byun12 Yong-Il Kim123 Tetsutaro Yamaguchi4
Koutaro Maki4 and Woo-Sung Son12
983089 Department of Orthodontics Dental Research Institute Pusan National University Dental Hospital Geumoro 983090983088Yangsan 983094983090983094983095983096983095 Republic of Korea
983090
Department of Orthodontics School of Dentistry Pusan National University Yangsan 983094983090983094983096983095983088 Republic of Korea983091Department of Orthodontics Biomedical Research Institute Pusan National University Hospital Gudeokro 983089983095983097Busan 983094983088983090983095983091983097 Republic of Korea
983092Department of Orthodontics School of Dentistry Showa University okyo 983089983092983090983096983093983093983093 Japan
Correspondence should be addressed to Yong-Il Kim kimyongilpusanackr and Woo-Sung Son wssonpusanackr
Received 983089983091 January 983090983088983089983093 Accepted 983089983091 March 983090983088983089983093
Academic Editor Chuangyin Dang
Copyright copy 983090983088983089983093 Bo-Ram Byun et al Tis is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited
Tis study was aimedto examine the correlation between skeletal maturation status and parameters romthe odontoidprocessbody
o the second vertebra and the bodies o third and ourth cervical vertebrae and simultaneously build multiple regressionmodels to be able to estimate skeletal maturation status in Korean girls Hand-wrist radiographs and cone beam computedtomography (CBC) images were obtained rom 983095983092 Korean girls (983094ndash983089983096 years o age) CBC-generated cervical vertebral maturation(CVM) was used to demarcate the odontoid process and the body o the second cervical vertebra based on the dentocentralsynchondrosis Correlation coefficient analysis and multiple linear regression analysis were used or each parameter o the cervical vertebrae ( lt 005) Forty-seven o 983094983092 parameters rom CBC-generated CVM (independent variables) exhibited statistically signi1047297cant correlations ( lt 005) Te multiple regression model with the greatest 1038389
2 had six parameters (PH983090W983090 UW983090W983090(OH+AH983090)LW983090 UW983091LW983091 D983091 and H983092W983092) as independent variables with a variance in1047298ation actor (VIF) o lt983090 CBC-generated CVM was able to include parameters rom the second cervical vertebral body and odontoid process respectively orthe multiple regression models Tis suggests that quantitative analysis might be used to estimate skeletal maturation status
1 Introduction
Knowledge o bone age is necessary in order to determinetreatment timing in orthodontic and orthognathic surgery patients Many researchers have introduced a variety o biological indicators [983089ndash983092] including chronologic age dentaldevelopment sexual maturation voice change and body height [983093ndash983097] Unortunately chronologic age alone is not areliable indicator or the evaluation o skeletal maturation
Among biological skeletal maturation indices skeletalmaturation indicators that use hand-wrist radiographs arepopular and reliable approaches in orthodontia clinicsHowever this method requires a hand-wrist radiographic1047297lm Tere has been increased interest in the use o cer-
vical vertebral maturation (CVM) as a replacement or
the hand-wrist assessment [983089983088ndash983089983090] Franchi et al [983089983089] usedlateral cephalometric analysis to con1047297rm the validity o six
CVM stages as biological indicators o both somatic andmandibular skeletal maturity Baccetti et al [983089983090] introducedan improved version o the CVM method or the assessmento mandibular growth Te CVM method has proven tobe effective in assessing adolescent growth peaks regardingboth body height and mandibular size [983089983088ndash983089983090] HoweverGabriel et al [983089983091] have raised issues regarding the poor inter-and intraobserver reliability o CVM which are below 983093983088and 983094983090 respectively Tey insisted that there is inherentbias in staging and that it would be necessary to use ewer
vertebral bodies employ more sensitive parameters andavoid estimating stage based on a comparative assessment o changes between stages in order to make the CVM analysis
Hindawi Publishing CorporationComputational and Mathematical Methods in MedicineVolume 2015 Article ID 405912 9 pageshttpdxdoiorg1011552015405912
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983090 Computational and Mathematical Methods in Medicine
clearer easier andmore applicable to the majority o patientso achieve these conditions Chen et al [983089983092] suggested aquantitative CVM (QCVM) method that used parametersrom the second third and ourth cervical vertebrae
Among the cervical vertebrae subjected to CVM analysisthe 1047297rst (atlas) and second (axis) cervical vertebrae are
atypically shaped In particular the second cervical vertebracontains the odontoid process which projects upward romthe body o test the more quantitative aspects o the CVMmethod Chatzigianni and Halazonetis [983089983093] applied statisticalshape analysis or the evaluation o cervical vertebral shapeIn their study morphological variations o the axis retainedthe same ratio o height to width as that o other vertebraeCokluk et al [983089983094] used magnetic resonance imaging (MRI)to examine the region including the occiput and the 1047297rstsecond and third cervical vertebrae Tey reported that theaverage ratio o the odontoid process to the body o thesecond cervical vertebra was 983090 in pediatric cases and 983089983096 inadult cases In the MRI study the remnant o dentocentral
synchondrosis was used as the border between the secondcervical vertebral body and its odontoid process Cokluk et al [983089983094] de1047297ned the borders o the body and odontoidprocess o the second cervical vertebra However a ew studies still consider the second cervical vertebral body andodontoid process to be parameters or the assessment o skeletal maturation because a lateral cephalogram is unableto demarcate the secondcervical vertebral body andodontoidprocess separately
Cone beam computed tomography (CBC) could be auseul tool or the three-dimensional approach to the secondcervical vertebral structure Like MRI CBC is able to show the remnant o dentocentral synchondrosis in the second
cervical vertebra Te images obtained rom CBC couldprovide another approach to the CVM method by de1047297ningthe second vertebral body and odontoid process ollowed by the remnant o dentocentral synchondrosis Joshi et al [983089983095]have already used CBC to assess skeletal maturation andprove the reliability o CBC when employed with CVM Inaddition CBC is available at a lower cost and yields high-quality data at relatively low radiation dosages thereore ithas become used more commonly in dental practice [983089983096]
Tis study aims to examine the correlation between skele-tal maturation stage and parameters rom CBC-generatedCVM (the odontoid process and the body o the second cer-
vical vertebra and the bodies o the third and ourth cervical
vertebrae) while simultaneouslybuilding multiple regressionmodels that are able to estimate skeletal maturation status inKorean girls
2 Material and Methods
983090983089 Study Population Te study population included 983095983094patients (983095983094 girls between 983094 and 983089983096 years o age) enrolled romJuly 983090983088983088983095 to December 983090983088983089983092 We examined the upper cervicalspine o each patient using CBC imaging (Pax-Zenith983091DVatech Seoul Korea) Hand-wrist radiographs (PM983090983088983088983090CCPlanmeca Helsinki Finland) were used to determine skeletalmaturation [983089983097 983090983088] Individuals with clef lip andor palate
983137983138983148983141 983089 Descriptive statistics o study participants
Sample size (1103925 = 76) Chronologic age
(years)Sempe maturation
level (SML )
Mean age 983089983092983094 983096983091983089
Maximum 983089983096983088 983097983092983096
983095983093 quartile 983089983094983094 983097983088983097Median 983089983093983091 983096983095983097
983090983093 quartile 983089983091983094 983096983090983095
Minimum 983094 983089983091983094
A-P axis
F983145983143983157983154983141 983089 Anteroposterior (A-P) axis
trauma or syndromeswere excluded rom the study(able 983089)Te Institutional Review Board o Pusan National University
Dental Hospital reviewed and approved this study (PNUDH-983090983088983089983088983092-983088983089983089)
983090983090 Skeletal Assessments As a measure o participantsrsquo skele-tal status two investigators assessed the hand-wrist radio-graphs Te assessments were based on the Sempe maturationlevel (SML) and Fishmanrsquos skeletal maturation index (SMI)CBC scans (1047297eld o view (FOV) 983090983088 times 983089983097 cm tube voltage983097983088 kVp tube current 983092983088 mA and scan time 983090983092s) wereobtained in an upright position with maximum intercus-pation Each patientrsquos Frankurt-horizontal (FH) plane wasset parallel to the 1047298oor Te CBC data were reconstructedusing 983091D imaging sofware (OnDemand983091D Cybermed Co
Seoul Korea) o obtain images o the cervical vertebrae983091D imaging sofware was used under the same condition(window width at 983092983088983088983088 window level at 983089983088983088983088)
983090983091 Data Acquisition o acquire each image 1047297rst the deep-est posterior point o the second cervical vertebral oramenand the midpoint o the second cervical vertebral body wereused to generate the anterior-posterior axis in the axial view (Figure 983089) Afer the anterior-posterior axis had been set weadjusted the vertical axis to pass through the midpoint o theodontoid process in the coronal view Te lateral image o thecervical vertebra was obtained rom the plane ormed by the
vertical axis and the anterior-posterior axis (Figure 983090)
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Computational and Mathematical Methods in Medicine 983091
D
O H
C 2 u a C 2 u m C 2 u p
C 2 l a
C 3 l p
C 3 l a C 3 l m C 4 u
p
U W
L W W C 4 l p C 4 u
a
C 4 a m
C 4 l a
H P H
A H C 3 a
m
C 3 u p C 3 u m
C 3 u a
C 2 a m C 2 l p
C2o
F983145983143983157983154983141 983090 Parameters (distances) used in the analysis OH verticaldistance o C983090o to the line o C983090ua and C983090up AH983090ndash983092 verticaldistance o C983090ndash983092ua to the line o C983090ndash983092lp and C983090ndash983092la H983090ndash983092 verticaldistance o C983090ndash983092um to the line o C983090ndash983092lp and C983090ndash983092la PH983090ndash983092
vertical distance o C983090ndash983092up to the line o C983090ndash983092lp and C983090ndash983092la UW983090ndash983092 vertical distance o C983090ndash983092ua to the line o C983090ndash983092up and C983090ndash983092lpW983090ndash983092 vertical distance o C983090ndash983092am to the line o C983090ndash983092up and C983090ndash983092lp LW983090ndash983092 vertical distance o C983090ndash983092la to the line o C983090ndash983092up andC983090ndash983092lp D983090ndash983092 vertical distance o C983090lm to the line o C983090la andC983090lp
In this study we adopted and modi1047297ed landmarks andmeasurements rom those described in the QCVM study by Chen et al [983089983092] these parameters are de1047297ned in Figure 983089and able 983090 Te border o the body o the second cervical
vertebra (C983090) was de1047297ned by the remnant o the dentocentralsynchondrosis as visualized in the lateral image o the second
cervical vertebra For every study participant each parameterwas measured and calculated using 983091D imaging sofware
983090983092 Statistical Analysis Te data were analyzed using sta-tistical sofware (SPSS version 983090983089983088 or Windows ChicagoIl USA) Te statistical analyses included correlation coeffi-cient analysis and multiple regression analysis with stepwiseelimination Multiple linear regression analysis was usedto determine the SML or Korean girls as the dependent
variable and parameters rom CBC-generated CVM as theindependent variables Te intraexaminer and interexaminerreliability o the linear measurements were each checkedby remeasurement o 983090983088 randomly selected lateral images 983090
weeks later the intraclass correlation coefficients were very high (means o 983088983097983097983091 and 983088983097983097983088 resp) Te intraobserverand interobserver errors or the SML and SMI were evaluatedusing Cohenrsquos kappa index Te intraobserver and interob-server reliability or Cohenrsquos kappa index each demonstratedsubstantial agreement (means o 983088983096983088983093 and 983088983095983095983097 resp)
3 Results
o prove that the SMI and SML are comparable we usedPearsonrsquos correlation coefficient analysis to determine thecorrelation between the SMI andSML which we then de1047297nedas the skeletal maturation status index Tis value exhibited
983137983138983148983141 983090 Landmarks and measurements
Parameter Description
Landmarks
C983090o Te most superior point o the odontoid
process
C983090ndash983092lm Te most superior points o the lower
border o the bodies o C983090ndash983092
C983090ndash983092la C983090ndash983092lpTe most anterior (a) and posterior (p)points on the lower border o the bodieso C983090ndash983092
C983090ndash983092ua C983090ndash983092upTe most superior points o the anterior(a) and posterior (p) borders o thebodies o C983090ndash983092
C983090ndash983092um Te middle o the upper border o the
bodies o C983090ndash983092
C983090ndash983092am Te middle o the anterior border o the
bodies o C983090ndash983092
Ratios
AH983090ndash983092H983090ndash983092 Ratio o AH983090ndash983092H983090ndash983092
H983090ndash983092PH983090ndash983092 Ratio o H983090ndash983092PH983090ndash983092
AH983090ndash983092PH983090ndash983092 Ratio o AH983090ndash983092PH983090ndash983092
UW983090ndash983092W983090ndash983092 Ratio o UW983090ndash983092W983090ndash983092
W983090ndash983092LW983090ndash983092 Ratio o W983090ndash983092LW983090ndash983092
UW983090ndash983092LW983090ndash983092 Ratio o UW983090ndash983092LW983090ndash983092
AH983090ndash983092UW983090ndash983092 Ratio o AH983090ndash983092UW983090ndash983092
H983090ndash983092UW983090ndash983092 Ratio o H983090ndash983092UW983090ndash983092
PH983090ndash983092UW983090ndash983092 Ratio o PH983090ndash983092UW983090ndash983092
AH983090ndash983092W983090ndash983092 Ratio o AH983090ndash983092W983090ndash983092
H983090ndash983092W983090ndash983092 Ratio o H983090ndash983092W983090ndash983092
PH983090ndash983092W983090ndash983092 Ratio o PH983090ndash983092W983090ndash983092
AH983090ndash983092LW983090ndash983092 Ratio o AH983090ndash983092LW983090ndash983092
H983090ndash983092LW983090ndash983092 Ratio o H983090ndash983092LW983090ndash983092
PH983090ndash983092LW983090ndash983092 Ratio o PH983090ndash983092LW983090ndash983092
OHUW983090 Ratio o OHUW983090
OHAH983090 Ratio o OHAH983090
OHH983090 Ratio o OHH983090
OHPH983090 Ratio o OHPH983090
OHUW983090 Ratio o OHUW983090
OHW983090 Ratio o OHW983090
OHLW983090 Ratio o OHLW983090
OHPH983090 Ratio o OHPH983090
(OH + AH983090)UW983090 Ratio o (OH + AH983090)UW983090
(OH + AH983090)W983090 Ratio o (OH + AH983090)W983090(OH + AH983090)LW983090 Ratio o (OH + AH983090)LW983090
(OH + H983090)UW983090 Ratio o (OH + H983090)UW983090
(OH + H983090)W983090 Ratio o (OH + H983090)W983090
(OH + H983090)LW983090 Ratio o (OH + H983090)LW983090
(OH + PH983090)UW983090 Ratio o (OH + PH983090)UW983090
(OH + PH983090)W983090 Ratio o (OH + PH983090)W983090
(OH + PH983090)LW983090 Ratio o (OH + PH983090)LW983090
a very high coefficient 983088983097983093983088 when the SML was substitutedor the SMI As a parametric method to present the degree o
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983092 Computational and Mathematical Methods in Medicine
983137983138983148983141 983091 Descriptive statistics or parameters in the C983090 C983091 and C983092 vertebral bodies
Parameter C983090 vertebra C983091 vertebra C983092 vertebra
Mean SD Min Max Mean SD Min Max Mean SD Min Max
AHH 983089983088983095 983088983088983093 983088983097983094 983089983090983088 983088983097983097 983088983088983094 983088983096983091 983089983089983091 983088983097983096 983088983088983095 983088983096983088 983089983089983093
HPH 983089983089983093 983088983088983093 983089983088983089 983089983090983097 983088983097983097 983088983088983093 983088983097983088 983089983089983095 983088983097983095 983088983088983093 983088983096983094 983089983088983095
AHPH 983089983090983091 983088983088983097 983088983097983095 983089983092983089 983088983097983097 983088983088983095 983088983095983097 983089983089983093 983088983097983093 983088983088983095 983088983095983092 983089983088983096UWW 983088983096983090 983088983088983094 983088983095983088 983088983097983091 983088983096983096 983088983088983093 983088983095983095 983088983097983095 983088983097983088 983088983088983093 983088983095983095 983089983088983094
WLW 983089983089983088 983088983088983096 983088983096983091 983089983090983094 983089983088983096 983088983088983092 983088983097983096 983089983089983095 983089983088983094 983088983088983093 983088983097983094 983089983089983096
UWLW 983088983097983088 983088983088983096 983088983095983092 983089983089983088 983088983097983093 983088983088983095 983088983096983091 983089983089983090 983088983097983093 983088983088983095 983088983095983095 983089983089983096
AHUW 983089983090983095 983088983089983089 983088983097983097 983089983093983093 983089983088983093 983088983090983088 983088983093983093 983089983092983089 983089983088983088 983088983090983088 983088983093983089 983089983091983095
HUW 983089983089983096 983088983089983089 983088983097983092 983089983092983093 983089983088983093 983088983089983095 983088983094983089 983089983091983094 983089983088983089 983088983089983094 983088983093983097 983089983091983094
PHUW 983089983088983091 983088983089983089 983088983096983089 983089983090983095 983089983088983094 983088983089983096 983088983093983095 983089983092983094 983089983088983093 983088983089983096 983088983094983089 983089983093983088
AHW 983089983088983092 983088983088983096 983088983096983094 983089983090983094 983088983097983089 983088983089983093 983088983093983089 983089983090983088 983088983096983097 983088983089983093 983088983092983096 983089983089983095
HW 983088983097983095 983088983088983096 983088983095983096 983089983089983093 983088983097983090 983088983089983090 983088983093983094 983089983089983093 983088983097983088 983088983089983090 983088983093983094 983089983089983094
PHW 983088983096983093 983088983088983097 983088983094983095 983089983089983088 983088983097983091 983088983089983091 983088983093983091 983089983089983093 983088983097983091 983088983089983092 983088983093983095 983089983090983092
AHLW 983089983089983092 983088983089983091 983088983096983095 983089983093983091 983088983097983097 983088983089983095 983088983093983092 983089983091983090 983088983097983092 983088983089983094 983088983093983089 983089983090983093
HLW 983089983088983094 983088983089983089 983088983096983093 983089983091983095 983088983097983097 983088983089983092 983088983093983095 983089983090983095 983088983097983094 983088983089983091 983088983093983097 983089983090983092
PHLW 983088983097983091 983088983089983089 983088983095983092 983089983090983089 983089983088983088 983088983089983093 983088983093983092 983089983090983095 983088983097983097 983088983089983093 983088983093983097 983089983091983091D 983089983095983093 983088983094983090 983088983088983094 983091983089983089 983089983095983091 983088983094983092 983088983088983089 983091983089983089 983089983093983089 983088983094983088 983088983089983090 983090983095983093
C983090 second cervical C983091 third cervical C983092 ourth cervical Min minimum Max maximum SD standard deviation
983137983138983148983141 983092 Descriptive statistics or SML and parameters in the C983090 vertebral body and odontoid process
Parameters Mean SD Min Max
SML 983096983090983088983090 983089983094983090983088 983089983096983091983088 983097983094983093983088
OHUW983090 983089983097983094 983088983089983097 983089983093983095 983090983092983092
OHAH983090 983089983093983093 983088983089983093 983089983089983092 983090983088983092
OHH983090 983089983094983095 983088983089983094 983089983090983096 983090983089983088
OHPH983090 983089983097983089 983088983090983088 983089983092983093 983090983091983097OUW983090 983089983097983094 983088983089983097 983089983093983095 983090983092983092
OHW983090 983089983094983089 983088983089983094 983089983091983094 983090983089983092
OHLW983090 983089983095983094 983088983089983093 983089983091983094 983090983089983092
(OH + AH983090)UW983090 983091983090983091 983088983090983094 983090983093983094 983091983095983096
(OH + AH983090)W983090 983090983094983094 983088983090983089 983090983090983095 983091983090983093
(OH + AH983090)LW983090 983090983097983088 983088983090983092 983090983090983091 983091983093983088
(OH + H983090)UW983090 983091983089983093 983088983090983094 983090983093983094 983091983095983092
(OH + H983090)W983090 983090983093983097 983088983090983089 983090983090983088 983091983090983090
(OH + H983090)LW983090 983090983096983090 983088983090983091 983090983090983090 983091983092983090
(OH + PH983090)UW983090 983091983088983088 983088983090983094 983090983092983095 983091983093983097
(OH + PH983090)W983090 983090983092983094 983088983090983090 983090983089983088 983091983090983088
(OH + PH983090)LW983090 983090983094983097 983088983090983090 983090983089983093 983091983090983096C983090 second cervical Min minimum Max maximum SD standard devia-tion
correlation between two variables we used the Shapiro-Wilk test ( lt 005) to con1047297rm the normality test in the sampledistribution
Te descriptive statistics o each parameter (obtainedrom CBC-generated CVM) are reported in ables 983091 and983092 We calculated the correlation coefficient rom these datain order to 1047297nd the correlation between the SML and theparameters rom CBC-generated CVM (able 983093) Out o atotal o 983094983092 parameters 983092983095 exhibited statistically signi1047297cant
correlations ( lt 005) Regression analysis with the SML(a dependent variable) and 983094983092 parameters rom CBC-generated CVM (independent variables) were employed tobuild eight multiple regression models (able 983094) Amongthese models the eighth multiple regression model (able 983094)
eatured the highest 10383892 and adjusted 1038389
2 Te model withPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 as independent variables exhibited the highest
coefficient o determination 983088983095983096983094 indicating that approxi-mately 983095983096983094 o the variation in the SML could be explainedby these independent variables Aside rom the signi1047297cant
enhancement o 10383892 there was no signi1047297cant multicollinearity between variables derived rom regression models or theSML We perormed multicollinearity tests based on the vari-ance in1047298ation actor (VIF) lt983090 which indicated the absenceo multicollinearity problems Te parameters AH983091W983091 andH983092W983092 had high VIF values (gt983090983088) in the ourth 1047297fh andsixth regression models Te models with these VIFs couldhave signi1047297cant multicollinearity problems [983090983089] (able 983094)
4 Discussion
Several methods or assessing skeletal maturation status havebeen introduced [983089ndash983092] Te CVM method has proven tobe especially useul Mito et al [983090983090] and Chen et al [983090983091]introduced multiple regression models in order to employ CVM to determine skeletal maturation stage Mito et al [983090983090]created a regression ormula to obtain cervical vertebral boneage they reported that the ormula was determined rom theratios o measurements in the third cervical vertebral (C983091)and ourth cervical (C983092) vertebral bodies Chen et al [983090983091]also developed ormulas that employed regression analysis topredict mandibularlength incrementusingcervical vertebraeand used the ratios o C983091 and C983092 vertebral bodies and
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Computational and Mathematical Methods in Medicine 983093
T 983137 983138 983148 983141 983093 C o r r e l a t i o n c o e ffi c i e n t b e t w e e n S e m p acute e m a t u r a
t i o n l e v e l a n d p a r a m e t e r s f r o m C B C T - g e n
e r a t e d c e r v i c a l v e r t e b r a l m a t u r a t i o n
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o
n
c o e ffi c i e n
t
P a r a m e t e r
C
o r r e l a t i o n
c
o e ffi c i e n t
A H 983091 L W 983091
983088 983096 983090 983095
983088 983088 983088 983088
D 983092
983088 983095 983091 983092
983088
983088 983088 983088
W 983091 L W 983091
983088 983093 983088 983095
983088 983088 983088 983089
H 983090 W 983090
minus 983088 983090 983095 983095
983088 983088 983093 983097
A H 983091 W 983091
983088 983096 983089 983096
983088 983088 983088 983088
A H 983091 H 983091
983088 983095 983091 983090
983088
983088 983088 983088
U W 983091 W 983091
minus 983088 983093 983088 983090
983088 983088 983088 983089
P H 983090 L W 983090
983088 983090 983095 983093
983088 983088 983094 983089
D 983091
983088 983096 983088 983094
983088 983088 983088 983088
P H 983091 U W 983091
983088 983095 983090 983090
983088
983088 983088 983088
H 983090 L W 983090
983088 983092 983097 983096
983088 983088 983088 983090
O H L W 983090
983088 983090 983091 983091
983088 983088 983097 983094
W 983090 L W 983090
983088 983096 983088 983091
983088 983088 983088 983088
H 983092 L W 983092
983088 983095 983089 983094
983088
983088 983088 983088
( O H + H 983090 ) W 983090
minus 983088 983092 983097 983094
983088 983088 983088 983090
H 983090 U W 983090
983088 983090 983089 983095
983088 983089 983089 983090
A H 983091 U W 983091
983088 983096 983088 983089
983088 983088 983088 983088
P H 983091 W 983091
983088 983095 983089 983091
983088
983088 983088 983088
H 983090 P H 983090
983088 983092 983095 983092
983088 983088 983088 983091
H 983091 P H 983091
minus 983088 983090 983088 983094
983088 983089 983090 983093
A H 983092 W 983092
983088 983095 983097 983091
983088 983088 983088 983088
D 983090
983088 983095 983088 983097
983088
983088 983088 983088
A H 983091 P H 983091
983088 983092 983095 983089
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
A H 983092 U W 983092
983088 983095 983096 983092
983088 983088 983088 983088
P H 983092 L W 983092
983088 983095 983088 983093
983088
983088 983088 983088
A H 983090 U W 983090
983088 983092 983095
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
H 983092 U W 983092
983088 983095 983096 983089
983088 983088 983088 983088
A H 983092 H 983092
983088 983094 983097 983090
983088
983088 983088 983088
( O H + A H 983090 ) L W 983090
983088 983092 983095
983088 983088 983088 983091
( O H + P H 983090 ) U W 983090
minus 983088 983089 983094 983089
983088 983089 983096 983093
H 983091 L W 983091
983088 983095 983095 983095
983088 983088 983088 983088
A H 983090 L W 983090
983088 983094 983093 983090
983088
983088 983088 983088
U W 983092 W 983092
minus 983088 983092 983094 983095
983088 983088 983088 983091
H 983092 P H 983092
minus 983088 983089 983091 983096
983088 983090 983090 983090
A H 983092 L W 983092
983088 983095 983095 983094
983088 983088 983088 983088
U W 983090 W 983090
minus 983088 983094 983091
983088
983088 983088 983088
P H 983090 W 983090
minus 983088 983092 983091 983094
983088 983088 983088 983094
U W 983091 L W 983091
minus 983088 983089 983090 983096
983088 983090 983091 983096
H 983092 W 983092
983088 983095 983095 983092
983088 983088 983088 983088
O H A H 983090
minus 983088 983094 983089 983092
983088
983088 983088 983088
U W 983090 L W 983090
983088 983092 983091
983088 983088 983088 983094
O H P H 983090
minus 983088 983089 983090
983088 983090 983093 983091
H 983091 W 983091
983088 983095 983094 983093
983088 983088 983088 983088
A H 983090 H 983090
983088 983094 983088 983092
983088
983088 983088 983088
( O H + A H 983090 ) W 983090
minus 983088 983091 983097 983096
983088 983088 983089 983089
A H 983090 W 983090
983088 983088 983094 983094
983088 983091 983093 983095
H 983091 U W 983091
983088 983095 983094 983090
983088 983088 983088 983088
A H 983090 P H 983090
983088 983094 983088 983089
983088
983088 983088 983088
( O H + H 983090 ) L W 983090
983088 983091 983096 983094
983088 983088 983089 983091
( O H + A H 983090 ) U W 983090
983088 983088 983094 983094
983088 983091 983093 983096
P H 983092 U W 983092
983088 983095 983093 983097
983088 983088 983088 983088
A H 983092 P H 983092
983088 983094 983088 983089
983088
983088 983088 983088
O H H 983090
minus 983088 983091 983094 983095
983088 983088 983089 983096
( O H + H 983090 ) U W 983090
minus 983088 983088 983093 983093
983088 983091 983096 983089
P H 983092 W 983092
983088 983095 983093 983092
983088 983088 983088 983088
( O H + P H 983090 ) W 983090
minus 983088 983093 983093
983088
983088 983088 983088
U W 983092 L W 983092
minus 983088 983091 983090
983088 983088 983091 983093
P H 983090 U W 983090
minus 983088 983088 983091 983097
983088 983092 983089 983093
P H 983091 L W 983091
983088 983095 983091 983096
983088 983088 983088 983088
O H W 983090
minus 983088 983093 983089 983091
983088
983088 983088 983089
( O H + P H 983090 ) L W 983090
983088 983090 983096 983094
983088 983088 983093 983091
W 983092 L W 983092
983088 983088 983090 983092
983088 983092 983092 983096
C B C T c o n e b e a m c o m p u t e d t o m o g r a p h y
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983094 Computational and Mathematical Methods in Medicine
983137983138983148983141 983094 Te results o multiple regression analysis using the stepwise elimination method
Multipleregressionmodels
Independent variables 907317 SE szlig 10383892 Adjusted 1038389
2 VIF 983089VIF
983089st Intercept 983093983095983093983088 983096983088983091983095 983088983095983089983093 983088983092983095983095 983088983093983094983090 983088983093983093983094
AH983091W983091 983096983091983093983090983089 983096983094983097983091 983088983095983093983088 983097983094983088983096 983088983088983088983088 983089983088983088983088 983089983088983088983088
983090nd
Intercept 983093983091983091983095983093 983089983091983093983097983089 983091983097983090983095 983088983088983088983088 983088983094983092983095 983088983094983091983095
AH983091W983091 983096983089983095983089983097 983095983096983094983095 983088983095983091983091 983089983088983091983096983096 983088983088983088983088 983089983088983088983091 983088983097983097983095
PH983090W983090 minus983093983092983090983090983096 983089983091983088983096983088 minus983088983090983097983091 minus983092983089983092983094 983088983088983088983088 983089983088983088983091 983088983097983097983095
983091rd
Intercept 983089983088983090983088983090983089 983089983097983097983097983091 983093983089983088983091 983088983088983088983088 983088983094983097983089 983088983094983095983096
AH983091W983091 983095983094983094983088983094 983095983093983096983092 983088983094983096983095 983089983088983089983088983090 983088983088983088983088 983089983088983093983089 983088983097983093983089
PH983090W983090 minus983092983089983092983095983096 983089983090983097983094983089 minus983088983090983090983092 minus983091983090983088983088 983088983088983088983090 983089983089983089983088 983088983097983088983089
UW983090W983090 minus983094983094983093983089983092 983090983088983097983097983097 minus983088983090983090983095 minus983091983089983094983095 983088983088983088983090 983089983089983094983091 983088983096983094983088
983092th
Intercept 983097983093983092983097983097 983089983097983089983094983090 983092983097983096983092 983088983088983088983088 983088983095983090983093 983088983095983088983097
AH983091W983091 983092983089983094983095983093 983089983092983089983089983096 983088983091983095983092 983090983097983093983090 983088983088983088983092 983092983088983090983088 983088983090983092983097
PH983090W983090 minus983092983096983092983088983094 983089983090983093983094983095 minus983088983090983094983089 minus983091983096983093983090 983088983088983088983088 983089983089983093983090 983088983096983094983096
UW983090W983090 minus983094983094983093983093983092 983089983097983097983096983093 minus983088983090983090983095 minus983091983091983091983088 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983092983097983088983090983092 983089983095983088983091983088 983088983091983094983091 983090983096983095983097 983088983088983088983093 983091983097983095983090 983088983090983093983090
983093th
Intercept 983095983094983096983092983093 983089983097983088983096983089 983092983088983090983095 983088983088983088983088 983088983095983093983096 983088983095983092983088
AH983091W983091 983090983096983094983095983089 983089983091983097983096983092 983088983090983093983095 983090983088983093983088 983088983088983092983092 983092983092983090983094 983088983090983090983094
PH983090W983090 minus983094983092983091983097983092 983089983090983097983093983094 minus983088983091983092983096 minus983092983097983095983088 983088983088983088983088 983089983091983095983092 983088983095983090983096
UW983090W983090 minus983094983096983089983092983096 983089983096983096983095983090 minus983088983090983091983090 minus983091983094983089983089 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983093983089983094983097983090 983089983094983088983097983097 983088983091983096983090 983091983090983089983089 983088983088983088983090 983091983097983096983092 983088983090983093983089
(OH + AH983090)LW983090 983089983092983096983089983089 983092983096983090983091 983088983090983090983091 983091983088983095983089 983088983088983088983091 983089983092983096983093 983088983094983095983091
983094th
Intercept 983094983093983093983088983088 983089983097983091983092983089 983091983091983096983095 983088983088983088983089 983088983095983095983092 983088983095983093983091
AH983091W983091 983089983093983090983095983097 983089983093983088983088983089 983088983089983091983095 983089983088983089983096 983088983091983089983090 983093983091983094983089 983088983089983096983095
PH983090W983090 minus983094983089983091983091983089 983089983090983095983088983097 minus983088983091983091983089 minus983092983096983090983094 983088983088983088983088 983089983091983097983090 983088983095983089983096
UW983090W983090 minus983093983095983090983095983092 983089983097983088983096983094 minus983088983089983097983093 minus983091983088983088983089 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983093983091983089983095983094 983089983093983095983088983096 983088983091983097983091 983091983091983096983093 983088983088983088983089 983091983097983097983090 983088983090983093983089
(OH + AH983090)LW983090 983089983093983096983091983094 983092983095983090983094 983088983090983091983097 983091983091983093983089 983088983088983088983089 983089983093983088983089 983088983094983094983094
D983091 983092983092983092983092 983090983088983095983097 983088983089983095983094 983090983089983091983096 983088983088983091983094 983089983097983097983097 983088983093983088983088
983095th
Intercept 983094983092983089983090983096 983089983097983091983088983088 983091983091983090983091 983088983088983088983089 983088983095983095983088 983088983095983093983091
PH983090W983090 minus983094983091983095983092983095 983089983090983092983097983088 minus983088983091983092983092 minus983093983089983088983092 983088983088983088983088 983089983091983092983092 983088983095983092983092
UW983090983090 minus983093983095983088983090983095 983089983097983088983097983088 minus983088983089983097983092 minus983090983097983096983095 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983094983093983093983096983095 983097983097983089983093 983088983092983096983093 983094983094983089983093 983088983088983088983088 983089983093983097983088 983088983094983090983097
(OH + AH983090)LW983090 983089983095983091983093983095 983092983092983096983093 983088983090983094983090 983091983096983095983088 983088983088983088983088 983089983091983093983089 983088983095983092983088
D983091 983093983091983090983096 983089983096983096983097 983088983090983089983089 983090983096983090983088 983088983088983088983094 983089983094983093983089 983088983094983088983094
983096th
Intercept 983097983094983088983093983090 983090983091983093983097983093 983092983088983095983089 983088983088983088983088 983088983095983096983094 983088983095983094983095
PH983090W983090 minus983094983090983092983092983097 983089983090983089983093983092 minus983088983091983091983095 minus983093983089983091983096 983088983088983088983088 983089983091983092983095 983088983095983092983090
UW983090W983090 minus983093983092983096983092983091 983089983096983093983096983089 minus983088983089983096983095 minus983090983097983093983090 983088983088983088983092 983089983090983093983094 983088983095983097983094
H983092W983092 983094983091983090983095983088 983097983094983097983091 983088983092983094983096 983094983093983090983095 983088983088983088983088 983089983094983088983096 983088983094983090983090
(OH + AH983090)LW983090 983089983094983088983095983094 983092983091983097983095 983088983090983092983090 983091983094983093983094 983088983088983088983089 983089983091983095983092 983088983095983090983096
D983091 983093983093983097983091 983089983096983092983088 983088983090983090983089 983091983088983091983097 983088983088983088983091 983089983094983093983096 983088983094983088983091
UW983091LW983091 minus983091983089983088983090983096 983089983091983097983089983088 minus983088983089983090983097 minus983090983090983091983089 983088983088983090983097 983089983088983092983095 983088983097983093983093
unstandardized regression coefficient SE standard error o szlig standardized regression coefficient VIF variance in1047298ation actor
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Computational and Mathematical Methods in Medicine 983095
the lower concavity angle o C983090 as independent variablesHowever in this study we de1047297ned the measurements o theC983090 vertebral bodyand the odontoidprocess Te dentocentralsynchondrosis was considered the border between the body and the odontoid process o C983090 Te results showed thatthe ratios o the C983090 body and the odontoid process were
correlated very highly with skeletal maturation status (as didthe bodies o the third and ourth cervical vertebrae whichwere used in the previous studies) (ables 983093 and 983094)
During embryonic development the second cervical vertebra arises rom 1047297ve primary bone growth centers (oneoccurs in the body two occur in bilateral neural archesand the other two occur in the odontoid process) separatedby synchondrotic articulations [983090983092 983090983093] Te two in theodontoid process are used at birth Te border betweenthe odontoid process and the body o the axis vertebra iswell demarcated by the dentocentral synchondrosis [983090983094] Tebilateral neurocentral synchondroses between the bilateralneural arch and the dentocentral synchondrosis use at 983091 to
983094 years o age Afer 983094 years o age the odontoid processuses with the vertebral body and the neural arches [983090983094]Te remnant o the dentocentral synchondrosis which isbelow the superior articulating acets appears on CBCand MRI images as a ring Cokluk et al [983089983094] compared theodontoid process-to-vertebral body ratios between childrenandadults based on MRIs o the dentocentral synchondrosisTereore we were able to use CBC images to de1047297ne the
vertebral body and its odontoid process and expected thatthe odontoid process and vertebral body might be importantindependent variables or the regression model derived romCBC-generated CVM
Several studies used the third and ourth vertebral bodies
and the concavity o their lower borders to assess skeletalmaturation [983089983088 983090983090 983090983091] Tey reported that many ratios o the width and height o the C983091 and C983092 were correlatedwith skeletal maturation status In the present study 983092983095 o 983094983092 parameters exhibited statistically signi1047297cant correlations( lt 005) similar to the 1047297ndings o other previous studies(able 983093) Te C983090 vertebral body and odontoid process weresigni1047297cant independent variables in all multiple regressionmodels In the multiple regression model with the highest
10383892 adjusted 1038389
2 and variance in1047298ation actors (VIF) lt983090which indicated the absence o multicollinearity problemsPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 were independent variables Tis model also
exhibited the highest coefficient o determination 983088983095983096983094indicating that these independent variables were able toexplain approximately 983095983096983094 o the SML variation
While the ratios o the third and ourth cervical vertebraehad strong correlation coefficients in previous CVM studiesthe present study added the ratio o the second cervical
vertebra which correlated strongly with CBC-generatedCVM as an indicator Altan et al [983090983095] investigated thelongitudinal growth o cervical vertebrae in girls rom 983096 to983089983095 years o age Te growth o the cervical vertebrae ollowsa somatic pattern and they reach their 1047297nal size at maturity [983090983096] C983089 and C983092 reached their peak size at approximately 983089983089983093 years o age and C983091 reached its maximal size at 983089983088983093
years o age However the growth curve or C983090 did nothave a distinct peak growth rate its growth rate curve wasmore linear [983090983097] Tereore in this study the parameterso the C983090 vertebral body and the odontoid process mightbe independent variables or the multiple linear regressionmodel because it has a more linear growth pattern Our
1047297ndings indicated that the growth o C983090 vertebral body andodontoid process might be a useul indicator or evaluatingthe stages o skeletal maturation Te multiple regressionmodels put orth by Chen et al [983090983091] and Mito et al [983090983090]included parameters such as the heightwidth ratios o thethird and ourth cervical vertebrae as independent variablesHowever regression models in our study with AH983091H983091 andH983092W983092 ratios had multicollinearity problems with high VIF
values (able 983094)Similarly the third and ourth cervical vertebrae arise
rom three primary ossi1047297cation centers (one in the body and two in the posterior arches) [983091983088 983091983089] Te shape o thebodies o third and ourth cervical vertebrae changes romwedge-shaped to rectangular and then becomes square Teirshapes grow vertically and then horizontally Te total lengthand height o the third and ourth cervical vertebrae have
very similar incremental curves Cervical vertebral growthoccurred in the order o the upper to the lower cervical ver-tebrae Tereore these parameters might induce statisticalmulticollinearity problems Many clinical studies regardingdental research have used multiple regression analysis to 1047297ndcorrelations between the predictorand the outcome variablesHowever collinearity in the statistic regression models is onepossible problem with the use o multiple regression analysisldquoMulticollinearityrdquo is the statistical term or the situation inwhich more than two covariates are highly correlated [983090983089]It can distort the interpretation o statistical results rommultiple regression models increasing both inaccuracy anduncertainty Multicollinearity should be considered in theregression model
We used the SML as a measure o the study participantsrsquoskeletal maturation status in order to build the multipleregression models in this study Te SML comprises 983089983088983088983088stages numbered rom 983088 to 983097983097983097 compared to 983089983089 stagesit provides a more re1047297ned skeletal maturation status as apercentage Te SML (with stages 983088 to 983097983097983097) was pertinentto statistical analysis as a parametric dependent variable ormultiple regression models Te present study has already con1047297rmed its high correlation to Fishmanrsquos SMI or buildingmultiple regression models ( lt 005 correlation coefficient
983088983097983093983088)Other CVM-based studies had large study popula-
tions that were heterogeneous regarding sex and ethnicityAlthough our study population was comparatively small andhomogeneous this study had the advantage o introducingthe modi1047297ed CBC-generated CVM with the de1047297ned body o the second cervical vertebra and the odontoid processrom the dentocentral synchondrosis Given this CBCapproach the study could not have a large study popula-tion Despite these difficulties this study demonstrated anew application o the second cervical vertebral body andodontoid to the CBC-generated CVM and resulted in thebuilding o multiple regression models We expect that sexual
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983096 Computational and Mathematical Methods in Medicine
dimorphism may imply divergence between boys and girlsduring the course o ossi1047297cation Ethnicity may explain therelatively high correspondence o ossi1047297cation level observedin the present study compared with other studies Tereoreadditional studies are needed to address questions regardingsexual dimorphism and ethnicity
5 Conclusions
CBC-generated CVM was able to include parameters romthe second cervical vertebral body and the odontoid processrespectively or multiple regression models Te derivedmultiple regression models demonstrated the potential o thenewly de1047297ned parameters o the second cervical vertebra
Conflict of Interests
All o the authors declare that there is no con1047298ict o interestsregarding the publication o this paper
Acknowledgment
Tis study was supported by two-year research grant romPusan National University (Woo-Sung Son)
References
[983089] U Hagg and J aranger ldquoMaturation indicators and the pub-ertal growth spurtrdquo American Journal of Orthodontics vol 983096983090no 983092 pp 983090983097983097ndash983091983088983097 983089983097983096983090
[983090] Uysal Z Sari S I Ramoglu and F A Bascifci ldquoRelation-ships between dental and skeletal maturity in urkish subjectsrdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983093983095ndash983094983094983092 983090983088983088983092
[983091] M OrsquoReilly and G J Yanniello ldquoMandibular growth changesand maturation o cervical vertebraemdasha longitudinal cephalo-metric studyrdquo Angle Orthodontist vol 983093983096 no 983090 pp 983089983095983097ndash983089983096983092983089983097983096983096
[983092] W W Greulich and S I Pyle Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanord University PressStanord Cali USA 983089983097983093983097
[983093] A BLewis and S M Garn ldquoTerelationshipbetween tooth or-mation and other maturation actorsrdquo Te Angle Orthodontist vol 983091983088 no 983090 pp 983095983088ndash983095983095 983089983097983094983088
[983094] C J Hunter ldquoTe correlation o acial growth with body heightand skeletal maturation at adolescencerdquo Te Angle Orthodontist vol 983091983094 no 983089 pp 983092983092ndash983093983092 983089983097983094983094
[983095] A Bjork and S Helm ldquoPrediction o the age o maximumpuberal growth in body heightrdquo Angle Orthodontist vol 983091983095 no983090 pp 983089983091983092ndash983089983092983091 983089983097983094983095
[983096] M I oani ldquoMandibular growth at pubertyrdquo Te American Journal of Orthodontics vol 983094983090 no 983090 pp 983089983095983094ndash983089983097983093 983089983097983095983090
[983097] U Hagg and J aranger ldquoMenarche and voice change asindicators o the pubertal growth spurtrdquo Acta OdontologicaScandinavica vol 983091983096 no 983091 pp 983089983095983097ndash983089983096983094 983089983097983096983088
[983089983088] P San Roman J C Palma M D Oteo and E Nevado ldquoSkeletalmaturation determined by cervical vertebrae developmentrdquoEuropean Journal of Orthodontics vol 983090983092 no 983091 pp 983091983088983091ndash983091983089983089983090983088983088983090
[983089983089] L Franchi Baccetti and J A McNamara Jr ldquoMandibulargrowth as related to cervical vertebral maturation and body
heightrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983089983096 no 983091 pp 983091983091983093ndash983091983092983088 983090983088983088983088
[983089983090] Baccetti L Franchi and J A McNamara Jr ldquoAn improved version o the cervical vertebral maturation (CVM) method orthe assessment o mandibular growthrdquo Te Angle Orthodontist vol 983095983090 no 983092 pp 983091983089983094ndash983091983090983091 983090983088983088983090
[983089983091] D B Gabriel K A Southard F Qian S D Marshall R GFranciscus and E Southard ldquoCervical vertebrae matura-tion method poor reproducibilityrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp983092983095983096e983089ndash983092983095983096e983095 983090983088983088983097
[983089983092] L-L Chen -M Xu J-H Jiang X-Z Zhang and J-XLin ldquoQuantitative cervical vertebral maturation assessment inadolescents with normal occlusion a mixed longitudinal studyrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983092 no 983094 pp 983095983090983088e983089ndash983095983090983088e983095 983090983088983088983096
[983089983093] A Chatzigianni and D J Halazonetis ldquoGeometric morphome-tric evaluation o cervical vertebrae shape and its relationshipto skeletal maturationrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp 983092983096983089e983089ndash983092983096983089e983097 983090983088983088983097
[983089983094] C Cokluk K Aydm C Rakunt O Iyigun and A Onder ldquoTeborders o the odontoid process o c983090 in adults and in childrenincluding the estimation o odontoidbody ratiordquo EuropeanSpine Journal vol 983089983093 no 983091 pp 983090983095983096ndash983090983096983090 983090983088983088983094
[983089983095] V Joshi Yamaguchi Y Matsuda N Kaneko K Maki and Okano ldquoSkeletal maturity assessment with the use o cone-beam computerized tomographyrdquo Oral Surgery Oral MedicineOral Pathology and Oral Radiology vol 983089983089983091 no 983094 pp 983096983092983089ndash983096983092983097983090983088983089983090
[983089983096] J B Ludlow L E Davies-Ludlow S L Brooks and WB Howerton ldquoDosimetry o 983091 CBC devices or oral andmaxilloacial radiology CB Mercuray Newom 983091G and i-CArdquoDentomaxillofacial Radiology vol 983091983093 no 983092 pp 983090983089983097ndash983090983090983094 983090983088983088983094
[983089983097] M Sempe La P acuteediatrie au Quotidian Analyse de la MaturationSequelettique Les Editions INSERM Paris France 983089983097983096983095
[983090983088] L S Fishman ldquoRadiographic evaluation o skeletal maturationA clinically oriented method based on hand-wirst 1047297lmsrdquo AngleOrthodontist vol 983093983090 no 983090 pp 983096983096ndash983089983089983090 983089983097983096983090
[983090983089] J Miles and M Shelvin Applying Regression and CorrelationSage Publication London UK 983090983088983088983089
[983090983090] Mito K Sato and H Mitani ldquoCervical vertebral bone agein girlsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983090 no 983092 pp 983091983096983088ndash983091983096983093 983090983088983088983090
[983090983091] F Chen K eradaand K Hanada ldquoA newmethod opredictingmandibular length incrementon the basis o cervical vertebraerdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983091983088ndash983094983091983092 983090983088983088983092
[983090983092] H Herkowitz S Gar1047297n F Eismont G Bell and R BalderstonRothman-Simeone Te Spine WB Saunders Philadelphia PaUSA 983090983088983089983089
[983090983093] A Verbout ldquoTe development o the vertebral columnrdquo Advances in Anatomy Embryology and Cell Biology vol 983097983088 no983089 pp 983089ndash983089983090983090 983089983097983096983093
[983090983094] K B Arbogast P A Gholve J E Friedman M R Maltese MF omasello and J P Dormans ldquoNormal cervical spine rangeo motion in children 983091ndash983089983090 years oldrdquo Spine vol 983091983090 no 983089983088 ppE983091983088983097ndashE983091983089983093 983090983088983088983095
[983090983095] M Altan O Nebioglu Dalc and H Iseri ldquoGrowth o thecervical vertebrae in girls rom 983096 to 983089983095 years A longitudinalstudyrdquo European Journal of Orthodontics vol 983091983092 no 983091 pp 983091983090983095ndash983091983091983092 983090983088983089983090
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 210
983090 Computational and Mathematical Methods in Medicine
clearer easier andmore applicable to the majority o patientso achieve these conditions Chen et al [983089983092] suggested aquantitative CVM (QCVM) method that used parametersrom the second third and ourth cervical vertebrae
Among the cervical vertebrae subjected to CVM analysisthe 1047297rst (atlas) and second (axis) cervical vertebrae are
atypically shaped In particular the second cervical vertebracontains the odontoid process which projects upward romthe body o test the more quantitative aspects o the CVMmethod Chatzigianni and Halazonetis [983089983093] applied statisticalshape analysis or the evaluation o cervical vertebral shapeIn their study morphological variations o the axis retainedthe same ratio o height to width as that o other vertebraeCokluk et al [983089983094] used magnetic resonance imaging (MRI)to examine the region including the occiput and the 1047297rstsecond and third cervical vertebrae Tey reported that theaverage ratio o the odontoid process to the body o thesecond cervical vertebra was 983090 in pediatric cases and 983089983096 inadult cases In the MRI study the remnant o dentocentral
synchondrosis was used as the border between the secondcervical vertebral body and its odontoid process Cokluk et al [983089983094] de1047297ned the borders o the body and odontoidprocess o the second cervical vertebra However a ew studies still consider the second cervical vertebral body andodontoid process to be parameters or the assessment o skeletal maturation because a lateral cephalogram is unableto demarcate the secondcervical vertebral body andodontoidprocess separately
Cone beam computed tomography (CBC) could be auseul tool or the three-dimensional approach to the secondcervical vertebral structure Like MRI CBC is able to show the remnant o dentocentral synchondrosis in the second
cervical vertebra Te images obtained rom CBC couldprovide another approach to the CVM method by de1047297ningthe second vertebral body and odontoid process ollowed by the remnant o dentocentral synchondrosis Joshi et al [983089983095]have already used CBC to assess skeletal maturation andprove the reliability o CBC when employed with CVM Inaddition CBC is available at a lower cost and yields high-quality data at relatively low radiation dosages thereore ithas become used more commonly in dental practice [983089983096]
Tis study aims to examine the correlation between skele-tal maturation stage and parameters rom CBC-generatedCVM (the odontoid process and the body o the second cer-
vical vertebra and the bodies o the third and ourth cervical
vertebrae) while simultaneouslybuilding multiple regressionmodels that are able to estimate skeletal maturation status inKorean girls
2 Material and Methods
983090983089 Study Population Te study population included 983095983094patients (983095983094 girls between 983094 and 983089983096 years o age) enrolled romJuly 983090983088983088983095 to December 983090983088983089983092 We examined the upper cervicalspine o each patient using CBC imaging (Pax-Zenith983091DVatech Seoul Korea) Hand-wrist radiographs (PM983090983088983088983090CCPlanmeca Helsinki Finland) were used to determine skeletalmaturation [983089983097 983090983088] Individuals with clef lip andor palate
983137983138983148983141 983089 Descriptive statistics o study participants
Sample size (1103925 = 76) Chronologic age
(years)Sempe maturation
level (SML )
Mean age 983089983092983094 983096983091983089
Maximum 983089983096983088 983097983092983096
983095983093 quartile 983089983094983094 983097983088983097Median 983089983093983091 983096983095983097
983090983093 quartile 983089983091983094 983096983090983095
Minimum 983094 983089983091983094
A-P axis
F983145983143983157983154983141 983089 Anteroposterior (A-P) axis
trauma or syndromeswere excluded rom the study(able 983089)Te Institutional Review Board o Pusan National University
Dental Hospital reviewed and approved this study (PNUDH-983090983088983089983088983092-983088983089983089)
983090983090 Skeletal Assessments As a measure o participantsrsquo skele-tal status two investigators assessed the hand-wrist radio-graphs Te assessments were based on the Sempe maturationlevel (SML) and Fishmanrsquos skeletal maturation index (SMI)CBC scans (1047297eld o view (FOV) 983090983088 times 983089983097 cm tube voltage983097983088 kVp tube current 983092983088 mA and scan time 983090983092s) wereobtained in an upright position with maximum intercus-pation Each patientrsquos Frankurt-horizontal (FH) plane wasset parallel to the 1047298oor Te CBC data were reconstructedusing 983091D imaging sofware (OnDemand983091D Cybermed Co
Seoul Korea) o obtain images o the cervical vertebrae983091D imaging sofware was used under the same condition(window width at 983092983088983088983088 window level at 983089983088983088983088)
983090983091 Data Acquisition o acquire each image 1047297rst the deep-est posterior point o the second cervical vertebral oramenand the midpoint o the second cervical vertebral body wereused to generate the anterior-posterior axis in the axial view (Figure 983089) Afer the anterior-posterior axis had been set weadjusted the vertical axis to pass through the midpoint o theodontoid process in the coronal view Te lateral image o thecervical vertebra was obtained rom the plane ormed by the
vertical axis and the anterior-posterior axis (Figure 983090)
7172019 405912
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Computational and Mathematical Methods in Medicine 983091
D
O H
C 2 u a C 2 u m C 2 u p
C 2 l a
C 3 l p
C 3 l a C 3 l m C 4 u
p
U W
L W W C 4 l p C 4 u
a
C 4 a m
C 4 l a
H P H
A H C 3 a
m
C 3 u p C 3 u m
C 3 u a
C 2 a m C 2 l p
C2o
F983145983143983157983154983141 983090 Parameters (distances) used in the analysis OH verticaldistance o C983090o to the line o C983090ua and C983090up AH983090ndash983092 verticaldistance o C983090ndash983092ua to the line o C983090ndash983092lp and C983090ndash983092la H983090ndash983092 verticaldistance o C983090ndash983092um to the line o C983090ndash983092lp and C983090ndash983092la PH983090ndash983092
vertical distance o C983090ndash983092up to the line o C983090ndash983092lp and C983090ndash983092la UW983090ndash983092 vertical distance o C983090ndash983092ua to the line o C983090ndash983092up and C983090ndash983092lpW983090ndash983092 vertical distance o C983090ndash983092am to the line o C983090ndash983092up and C983090ndash983092lp LW983090ndash983092 vertical distance o C983090ndash983092la to the line o C983090ndash983092up andC983090ndash983092lp D983090ndash983092 vertical distance o C983090lm to the line o C983090la andC983090lp
In this study we adopted and modi1047297ed landmarks andmeasurements rom those described in the QCVM study by Chen et al [983089983092] these parameters are de1047297ned in Figure 983089and able 983090 Te border o the body o the second cervical
vertebra (C983090) was de1047297ned by the remnant o the dentocentralsynchondrosis as visualized in the lateral image o the second
cervical vertebra For every study participant each parameterwas measured and calculated using 983091D imaging sofware
983090983092 Statistical Analysis Te data were analyzed using sta-tistical sofware (SPSS version 983090983089983088 or Windows ChicagoIl USA) Te statistical analyses included correlation coeffi-cient analysis and multiple regression analysis with stepwiseelimination Multiple linear regression analysis was usedto determine the SML or Korean girls as the dependent
variable and parameters rom CBC-generated CVM as theindependent variables Te intraexaminer and interexaminerreliability o the linear measurements were each checkedby remeasurement o 983090983088 randomly selected lateral images 983090
weeks later the intraclass correlation coefficients were very high (means o 983088983097983097983091 and 983088983097983097983088 resp) Te intraobserverand interobserver errors or the SML and SMI were evaluatedusing Cohenrsquos kappa index Te intraobserver and interob-server reliability or Cohenrsquos kappa index each demonstratedsubstantial agreement (means o 983088983096983088983093 and 983088983095983095983097 resp)
3 Results
o prove that the SMI and SML are comparable we usedPearsonrsquos correlation coefficient analysis to determine thecorrelation between the SMI andSML which we then de1047297nedas the skeletal maturation status index Tis value exhibited
983137983138983148983141 983090 Landmarks and measurements
Parameter Description
Landmarks
C983090o Te most superior point o the odontoid
process
C983090ndash983092lm Te most superior points o the lower
border o the bodies o C983090ndash983092
C983090ndash983092la C983090ndash983092lpTe most anterior (a) and posterior (p)points on the lower border o the bodieso C983090ndash983092
C983090ndash983092ua C983090ndash983092upTe most superior points o the anterior(a) and posterior (p) borders o thebodies o C983090ndash983092
C983090ndash983092um Te middle o the upper border o the
bodies o C983090ndash983092
C983090ndash983092am Te middle o the anterior border o the
bodies o C983090ndash983092
Ratios
AH983090ndash983092H983090ndash983092 Ratio o AH983090ndash983092H983090ndash983092
H983090ndash983092PH983090ndash983092 Ratio o H983090ndash983092PH983090ndash983092
AH983090ndash983092PH983090ndash983092 Ratio o AH983090ndash983092PH983090ndash983092
UW983090ndash983092W983090ndash983092 Ratio o UW983090ndash983092W983090ndash983092
W983090ndash983092LW983090ndash983092 Ratio o W983090ndash983092LW983090ndash983092
UW983090ndash983092LW983090ndash983092 Ratio o UW983090ndash983092LW983090ndash983092
AH983090ndash983092UW983090ndash983092 Ratio o AH983090ndash983092UW983090ndash983092
H983090ndash983092UW983090ndash983092 Ratio o H983090ndash983092UW983090ndash983092
PH983090ndash983092UW983090ndash983092 Ratio o PH983090ndash983092UW983090ndash983092
AH983090ndash983092W983090ndash983092 Ratio o AH983090ndash983092W983090ndash983092
H983090ndash983092W983090ndash983092 Ratio o H983090ndash983092W983090ndash983092
PH983090ndash983092W983090ndash983092 Ratio o PH983090ndash983092W983090ndash983092
AH983090ndash983092LW983090ndash983092 Ratio o AH983090ndash983092LW983090ndash983092
H983090ndash983092LW983090ndash983092 Ratio o H983090ndash983092LW983090ndash983092
PH983090ndash983092LW983090ndash983092 Ratio o PH983090ndash983092LW983090ndash983092
OHUW983090 Ratio o OHUW983090
OHAH983090 Ratio o OHAH983090
OHH983090 Ratio o OHH983090
OHPH983090 Ratio o OHPH983090
OHUW983090 Ratio o OHUW983090
OHW983090 Ratio o OHW983090
OHLW983090 Ratio o OHLW983090
OHPH983090 Ratio o OHPH983090
(OH + AH983090)UW983090 Ratio o (OH + AH983090)UW983090
(OH + AH983090)W983090 Ratio o (OH + AH983090)W983090(OH + AH983090)LW983090 Ratio o (OH + AH983090)LW983090
(OH + H983090)UW983090 Ratio o (OH + H983090)UW983090
(OH + H983090)W983090 Ratio o (OH + H983090)W983090
(OH + H983090)LW983090 Ratio o (OH + H983090)LW983090
(OH + PH983090)UW983090 Ratio o (OH + PH983090)UW983090
(OH + PH983090)W983090 Ratio o (OH + PH983090)W983090
(OH + PH983090)LW983090 Ratio o (OH + PH983090)LW983090
a very high coefficient 983088983097983093983088 when the SML was substitutedor the SMI As a parametric method to present the degree o
7172019 405912
httpslidepdfcomreaderfull405912 410
983092 Computational and Mathematical Methods in Medicine
983137983138983148983141 983091 Descriptive statistics or parameters in the C983090 C983091 and C983092 vertebral bodies
Parameter C983090 vertebra C983091 vertebra C983092 vertebra
Mean SD Min Max Mean SD Min Max Mean SD Min Max
AHH 983089983088983095 983088983088983093 983088983097983094 983089983090983088 983088983097983097 983088983088983094 983088983096983091 983089983089983091 983088983097983096 983088983088983095 983088983096983088 983089983089983093
HPH 983089983089983093 983088983088983093 983089983088983089 983089983090983097 983088983097983097 983088983088983093 983088983097983088 983089983089983095 983088983097983095 983088983088983093 983088983096983094 983089983088983095
AHPH 983089983090983091 983088983088983097 983088983097983095 983089983092983089 983088983097983097 983088983088983095 983088983095983097 983089983089983093 983088983097983093 983088983088983095 983088983095983092 983089983088983096UWW 983088983096983090 983088983088983094 983088983095983088 983088983097983091 983088983096983096 983088983088983093 983088983095983095 983088983097983095 983088983097983088 983088983088983093 983088983095983095 983089983088983094
WLW 983089983089983088 983088983088983096 983088983096983091 983089983090983094 983089983088983096 983088983088983092 983088983097983096 983089983089983095 983089983088983094 983088983088983093 983088983097983094 983089983089983096
UWLW 983088983097983088 983088983088983096 983088983095983092 983089983089983088 983088983097983093 983088983088983095 983088983096983091 983089983089983090 983088983097983093 983088983088983095 983088983095983095 983089983089983096
AHUW 983089983090983095 983088983089983089 983088983097983097 983089983093983093 983089983088983093 983088983090983088 983088983093983093 983089983092983089 983089983088983088 983088983090983088 983088983093983089 983089983091983095
HUW 983089983089983096 983088983089983089 983088983097983092 983089983092983093 983089983088983093 983088983089983095 983088983094983089 983089983091983094 983089983088983089 983088983089983094 983088983093983097 983089983091983094
PHUW 983089983088983091 983088983089983089 983088983096983089 983089983090983095 983089983088983094 983088983089983096 983088983093983095 983089983092983094 983089983088983093 983088983089983096 983088983094983089 983089983093983088
AHW 983089983088983092 983088983088983096 983088983096983094 983089983090983094 983088983097983089 983088983089983093 983088983093983089 983089983090983088 983088983096983097 983088983089983093 983088983092983096 983089983089983095
HW 983088983097983095 983088983088983096 983088983095983096 983089983089983093 983088983097983090 983088983089983090 983088983093983094 983089983089983093 983088983097983088 983088983089983090 983088983093983094 983089983089983094
PHW 983088983096983093 983088983088983097 983088983094983095 983089983089983088 983088983097983091 983088983089983091 983088983093983091 983089983089983093 983088983097983091 983088983089983092 983088983093983095 983089983090983092
AHLW 983089983089983092 983088983089983091 983088983096983095 983089983093983091 983088983097983097 983088983089983095 983088983093983092 983089983091983090 983088983097983092 983088983089983094 983088983093983089 983089983090983093
HLW 983089983088983094 983088983089983089 983088983096983093 983089983091983095 983088983097983097 983088983089983092 983088983093983095 983089983090983095 983088983097983094 983088983089983091 983088983093983097 983089983090983092
PHLW 983088983097983091 983088983089983089 983088983095983092 983089983090983089 983089983088983088 983088983089983093 983088983093983092 983089983090983095 983088983097983097 983088983089983093 983088983093983097 983089983091983091D 983089983095983093 983088983094983090 983088983088983094 983091983089983089 983089983095983091 983088983094983092 983088983088983089 983091983089983089 983089983093983089 983088983094983088 983088983089983090 983090983095983093
C983090 second cervical C983091 third cervical C983092 ourth cervical Min minimum Max maximum SD standard deviation
983137983138983148983141 983092 Descriptive statistics or SML and parameters in the C983090 vertebral body and odontoid process
Parameters Mean SD Min Max
SML 983096983090983088983090 983089983094983090983088 983089983096983091983088 983097983094983093983088
OHUW983090 983089983097983094 983088983089983097 983089983093983095 983090983092983092
OHAH983090 983089983093983093 983088983089983093 983089983089983092 983090983088983092
OHH983090 983089983094983095 983088983089983094 983089983090983096 983090983089983088
OHPH983090 983089983097983089 983088983090983088 983089983092983093 983090983091983097OUW983090 983089983097983094 983088983089983097 983089983093983095 983090983092983092
OHW983090 983089983094983089 983088983089983094 983089983091983094 983090983089983092
OHLW983090 983089983095983094 983088983089983093 983089983091983094 983090983089983092
(OH + AH983090)UW983090 983091983090983091 983088983090983094 983090983093983094 983091983095983096
(OH + AH983090)W983090 983090983094983094 983088983090983089 983090983090983095 983091983090983093
(OH + AH983090)LW983090 983090983097983088 983088983090983092 983090983090983091 983091983093983088
(OH + H983090)UW983090 983091983089983093 983088983090983094 983090983093983094 983091983095983092
(OH + H983090)W983090 983090983093983097 983088983090983089 983090983090983088 983091983090983090
(OH + H983090)LW983090 983090983096983090 983088983090983091 983090983090983090 983091983092983090
(OH + PH983090)UW983090 983091983088983088 983088983090983094 983090983092983095 983091983093983097
(OH + PH983090)W983090 983090983092983094 983088983090983090 983090983089983088 983091983090983088
(OH + PH983090)LW983090 983090983094983097 983088983090983090 983090983089983093 983091983090983096C983090 second cervical Min minimum Max maximum SD standard devia-tion
correlation between two variables we used the Shapiro-Wilk test ( lt 005) to con1047297rm the normality test in the sampledistribution
Te descriptive statistics o each parameter (obtainedrom CBC-generated CVM) are reported in ables 983091 and983092 We calculated the correlation coefficient rom these datain order to 1047297nd the correlation between the SML and theparameters rom CBC-generated CVM (able 983093) Out o atotal o 983094983092 parameters 983092983095 exhibited statistically signi1047297cant
correlations ( lt 005) Regression analysis with the SML(a dependent variable) and 983094983092 parameters rom CBC-generated CVM (independent variables) were employed tobuild eight multiple regression models (able 983094) Amongthese models the eighth multiple regression model (able 983094)
eatured the highest 10383892 and adjusted 1038389
2 Te model withPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 as independent variables exhibited the highest
coefficient o determination 983088983095983096983094 indicating that approxi-mately 983095983096983094 o the variation in the SML could be explainedby these independent variables Aside rom the signi1047297cant
enhancement o 10383892 there was no signi1047297cant multicollinearity between variables derived rom regression models or theSML We perormed multicollinearity tests based on the vari-ance in1047298ation actor (VIF) lt983090 which indicated the absenceo multicollinearity problems Te parameters AH983091W983091 andH983092W983092 had high VIF values (gt983090983088) in the ourth 1047297fh andsixth regression models Te models with these VIFs couldhave signi1047297cant multicollinearity problems [983090983089] (able 983094)
4 Discussion
Several methods or assessing skeletal maturation status havebeen introduced [983089ndash983092] Te CVM method has proven tobe especially useul Mito et al [983090983090] and Chen et al [983090983091]introduced multiple regression models in order to employ CVM to determine skeletal maturation stage Mito et al [983090983090]created a regression ormula to obtain cervical vertebral boneage they reported that the ormula was determined rom theratios o measurements in the third cervical vertebral (C983091)and ourth cervical (C983092) vertebral bodies Chen et al [983090983091]also developed ormulas that employed regression analysis topredict mandibularlength incrementusingcervical vertebraeand used the ratios o C983091 and C983092 vertebral bodies and
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Computational and Mathematical Methods in Medicine 983093
T 983137 983138 983148 983141 983093 C o r r e l a t i o n c o e ffi c i e n t b e t w e e n S e m p acute e m a t u r a
t i o n l e v e l a n d p a r a m e t e r s f r o m C B C T - g e n
e r a t e d c e r v i c a l v e r t e b r a l m a t u r a t i o n
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o
n
c o e ffi c i e n
t
P a r a m e t e r
C
o r r e l a t i o n
c
o e ffi c i e n t
A H 983091 L W 983091
983088 983096 983090 983095
983088 983088 983088 983088
D 983092
983088 983095 983091 983092
983088
983088 983088 983088
W 983091 L W 983091
983088 983093 983088 983095
983088 983088 983088 983089
H 983090 W 983090
minus 983088 983090 983095 983095
983088 983088 983093 983097
A H 983091 W 983091
983088 983096 983089 983096
983088 983088 983088 983088
A H 983091 H 983091
983088 983095 983091 983090
983088
983088 983088 983088
U W 983091 W 983091
minus 983088 983093 983088 983090
983088 983088 983088 983089
P H 983090 L W 983090
983088 983090 983095 983093
983088 983088 983094 983089
D 983091
983088 983096 983088 983094
983088 983088 983088 983088
P H 983091 U W 983091
983088 983095 983090 983090
983088
983088 983088 983088
H 983090 L W 983090
983088 983092 983097 983096
983088 983088 983088 983090
O H L W 983090
983088 983090 983091 983091
983088 983088 983097 983094
W 983090 L W 983090
983088 983096 983088 983091
983088 983088 983088 983088
H 983092 L W 983092
983088 983095 983089 983094
983088
983088 983088 983088
( O H + H 983090 ) W 983090
minus 983088 983092 983097 983094
983088 983088 983088 983090
H 983090 U W 983090
983088 983090 983089 983095
983088 983089 983089 983090
A H 983091 U W 983091
983088 983096 983088 983089
983088 983088 983088 983088
P H 983091 W 983091
983088 983095 983089 983091
983088
983088 983088 983088
H 983090 P H 983090
983088 983092 983095 983092
983088 983088 983088 983091
H 983091 P H 983091
minus 983088 983090 983088 983094
983088 983089 983090 983093
A H 983092 W 983092
983088 983095 983097 983091
983088 983088 983088 983088
D 983090
983088 983095 983088 983097
983088
983088 983088 983088
A H 983091 P H 983091
983088 983092 983095 983089
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
A H 983092 U W 983092
983088 983095 983096 983092
983088 983088 983088 983088
P H 983092 L W 983092
983088 983095 983088 983093
983088
983088 983088 983088
A H 983090 U W 983090
983088 983092 983095
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
H 983092 U W 983092
983088 983095 983096 983089
983088 983088 983088 983088
A H 983092 H 983092
983088 983094 983097 983090
983088
983088 983088 983088
( O H + A H 983090 ) L W 983090
983088 983092 983095
983088 983088 983088 983091
( O H + P H 983090 ) U W 983090
minus 983088 983089 983094 983089
983088 983089 983096 983093
H 983091 L W 983091
983088 983095 983095 983095
983088 983088 983088 983088
A H 983090 L W 983090
983088 983094 983093 983090
983088
983088 983088 983088
U W 983092 W 983092
minus 983088 983092 983094 983095
983088 983088 983088 983091
H 983092 P H 983092
minus 983088 983089 983091 983096
983088 983090 983090 983090
A H 983092 L W 983092
983088 983095 983095 983094
983088 983088 983088 983088
U W 983090 W 983090
minus 983088 983094 983091
983088
983088 983088 983088
P H 983090 W 983090
minus 983088 983092 983091 983094
983088 983088 983088 983094
U W 983091 L W 983091
minus 983088 983089 983090 983096
983088 983090 983091 983096
H 983092 W 983092
983088 983095 983095 983092
983088 983088 983088 983088
O H A H 983090
minus 983088 983094 983089 983092
983088
983088 983088 983088
U W 983090 L W 983090
983088 983092 983091
983088 983088 983088 983094
O H P H 983090
minus 983088 983089 983090
983088 983090 983093 983091
H 983091 W 983091
983088 983095 983094 983093
983088 983088 983088 983088
A H 983090 H 983090
983088 983094 983088 983092
983088
983088 983088 983088
( O H + A H 983090 ) W 983090
minus 983088 983091 983097 983096
983088 983088 983089 983089
A H 983090 W 983090
983088 983088 983094 983094
983088 983091 983093 983095
H 983091 U W 983091
983088 983095 983094 983090
983088 983088 983088 983088
A H 983090 P H 983090
983088 983094 983088 983089
983088
983088 983088 983088
( O H + H 983090 ) L W 983090
983088 983091 983096 983094
983088 983088 983089 983091
( O H + A H 983090 ) U W 983090
983088 983088 983094 983094
983088 983091 983093 983096
P H 983092 U W 983092
983088 983095 983093 983097
983088 983088 983088 983088
A H 983092 P H 983092
983088 983094 983088 983089
983088
983088 983088 983088
O H H 983090
minus 983088 983091 983094 983095
983088 983088 983089 983096
( O H + H 983090 ) U W 983090
minus 983088 983088 983093 983093
983088 983091 983096 983089
P H 983092 W 983092
983088 983095 983093 983092
983088 983088 983088 983088
( O H + P H 983090 ) W 983090
minus 983088 983093 983093
983088
983088 983088 983088
U W 983092 L W 983092
minus 983088 983091 983090
983088 983088 983091 983093
P H 983090 U W 983090
minus 983088 983088 983091 983097
983088 983092 983089 983093
P H 983091 L W 983091
983088 983095 983091 983096
983088 983088 983088 983088
O H W 983090
minus 983088 983093 983089 983091
983088
983088 983088 983089
( O H + P H 983090 ) L W 983090
983088 983090 983096 983094
983088 983088 983093 983091
W 983092 L W 983092
983088 983088 983090 983092
983088 983092 983092 983096
C B C T c o n e b e a m c o m p u t e d t o m o g r a p h y
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983094 Computational and Mathematical Methods in Medicine
983137983138983148983141 983094 Te results o multiple regression analysis using the stepwise elimination method
Multipleregressionmodels
Independent variables 907317 SE szlig 10383892 Adjusted 1038389
2 VIF 983089VIF
983089st Intercept 983093983095983093983088 983096983088983091983095 983088983095983089983093 983088983092983095983095 983088983093983094983090 983088983093983093983094
AH983091W983091 983096983091983093983090983089 983096983094983097983091 983088983095983093983088 983097983094983088983096 983088983088983088983088 983089983088983088983088 983089983088983088983088
983090nd
Intercept 983093983091983091983095983093 983089983091983093983097983089 983091983097983090983095 983088983088983088983088 983088983094983092983095 983088983094983091983095
AH983091W983091 983096983089983095983089983097 983095983096983094983095 983088983095983091983091 983089983088983091983096983096 983088983088983088983088 983089983088983088983091 983088983097983097983095
PH983090W983090 minus983093983092983090983090983096 983089983091983088983096983088 minus983088983090983097983091 minus983092983089983092983094 983088983088983088983088 983089983088983088983091 983088983097983097983095
983091rd
Intercept 983089983088983090983088983090983089 983089983097983097983097983091 983093983089983088983091 983088983088983088983088 983088983094983097983089 983088983094983095983096
AH983091W983091 983095983094983094983088983094 983095983093983096983092 983088983094983096983095 983089983088983089983088983090 983088983088983088983088 983089983088983093983089 983088983097983093983089
PH983090W983090 minus983092983089983092983095983096 983089983090983097983094983089 minus983088983090983090983092 minus983091983090983088983088 983088983088983088983090 983089983089983089983088 983088983097983088983089
UW983090W983090 minus983094983094983093983089983092 983090983088983097983097983097 minus983088983090983090983095 minus983091983089983094983095 983088983088983088983090 983089983089983094983091 983088983096983094983088
983092th
Intercept 983097983093983092983097983097 983089983097983089983094983090 983092983097983096983092 983088983088983088983088 983088983095983090983093 983088983095983088983097
AH983091W983091 983092983089983094983095983093 983089983092983089983089983096 983088983091983095983092 983090983097983093983090 983088983088983088983092 983092983088983090983088 983088983090983092983097
PH983090W983090 minus983092983096983092983088983094 983089983090983093983094983095 minus983088983090983094983089 minus983091983096983093983090 983088983088983088983088 983089983089983093983090 983088983096983094983096
UW983090W983090 minus983094983094983093983093983092 983089983097983097983096983093 minus983088983090983090983095 minus983091983091983091983088 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983092983097983088983090983092 983089983095983088983091983088 983088983091983094983091 983090983096983095983097 983088983088983088983093 983091983097983095983090 983088983090983093983090
983093th
Intercept 983095983094983096983092983093 983089983097983088983096983089 983092983088983090983095 983088983088983088983088 983088983095983093983096 983088983095983092983088
AH983091W983091 983090983096983094983095983089 983089983091983097983096983092 983088983090983093983095 983090983088983093983088 983088983088983092983092 983092983092983090983094 983088983090983090983094
PH983090W983090 minus983094983092983091983097983092 983089983090983097983093983094 minus983088983091983092983096 minus983092983097983095983088 983088983088983088983088 983089983091983095983092 983088983095983090983096
UW983090W983090 minus983094983096983089983092983096 983089983096983096983095983090 minus983088983090983091983090 minus983091983094983089983089 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983093983089983094983097983090 983089983094983088983097983097 983088983091983096983090 983091983090983089983089 983088983088983088983090 983091983097983096983092 983088983090983093983089
(OH + AH983090)LW983090 983089983092983096983089983089 983092983096983090983091 983088983090983090983091 983091983088983095983089 983088983088983088983091 983089983092983096983093 983088983094983095983091
983094th
Intercept 983094983093983093983088983088 983089983097983091983092983089 983091983091983096983095 983088983088983088983089 983088983095983095983092 983088983095983093983091
AH983091W983091 983089983093983090983095983097 983089983093983088983088983089 983088983089983091983095 983089983088983089983096 983088983091983089983090 983093983091983094983089 983088983089983096983095
PH983090W983090 minus983094983089983091983091983089 983089983090983095983088983097 minus983088983091983091983089 minus983092983096983090983094 983088983088983088983088 983089983091983097983090 983088983095983089983096
UW983090W983090 minus983093983095983090983095983092 983089983097983088983096983094 minus983088983089983097983093 minus983091983088983088983089 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983093983091983089983095983094 983089983093983095983088983096 983088983091983097983091 983091983091983096983093 983088983088983088983089 983091983097983097983090 983088983090983093983089
(OH + AH983090)LW983090 983089983093983096983091983094 983092983095983090983094 983088983090983091983097 983091983091983093983089 983088983088983088983089 983089983093983088983089 983088983094983094983094
D983091 983092983092983092983092 983090983088983095983097 983088983089983095983094 983090983089983091983096 983088983088983091983094 983089983097983097983097 983088983093983088983088
983095th
Intercept 983094983092983089983090983096 983089983097983091983088983088 983091983091983090983091 983088983088983088983089 983088983095983095983088 983088983095983093983091
PH983090W983090 minus983094983091983095983092983095 983089983090983092983097983088 minus983088983091983092983092 minus983093983089983088983092 983088983088983088983088 983089983091983092983092 983088983095983092983092
UW983090983090 minus983093983095983088983090983095 983089983097983088983097983088 minus983088983089983097983092 minus983090983097983096983095 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983094983093983093983096983095 983097983097983089983093 983088983092983096983093 983094983094983089983093 983088983088983088983088 983089983093983097983088 983088983094983090983097
(OH + AH983090)LW983090 983089983095983091983093983095 983092983092983096983093 983088983090983094983090 983091983096983095983088 983088983088983088983088 983089983091983093983089 983088983095983092983088
D983091 983093983091983090983096 983089983096983096983097 983088983090983089983089 983090983096983090983088 983088983088983088983094 983089983094983093983089 983088983094983088983094
983096th
Intercept 983097983094983088983093983090 983090983091983093983097983093 983092983088983095983089 983088983088983088983088 983088983095983096983094 983088983095983094983095
PH983090W983090 minus983094983090983092983092983097 983089983090983089983093983092 minus983088983091983091983095 minus983093983089983091983096 983088983088983088983088 983089983091983092983095 983088983095983092983090
UW983090W983090 minus983093983092983096983092983091 983089983096983093983096983089 minus983088983089983096983095 minus983090983097983093983090 983088983088983088983092 983089983090983093983094 983088983095983097983094
H983092W983092 983094983091983090983095983088 983097983094983097983091 983088983092983094983096 983094983093983090983095 983088983088983088983088 983089983094983088983096 983088983094983090983090
(OH + AH983090)LW983090 983089983094983088983095983094 983092983091983097983095 983088983090983092983090 983091983094983093983094 983088983088983088983089 983089983091983095983092 983088983095983090983096
D983091 983093983093983097983091 983089983096983092983088 983088983090983090983089 983091983088983091983097 983088983088983088983091 983089983094983093983096 983088983094983088983091
UW983091LW983091 minus983091983089983088983090983096 983089983091983097983089983088 minus983088983089983090983097 minus983090983090983091983089 983088983088983090983097 983089983088983092983095 983088983097983093983093
unstandardized regression coefficient SE standard error o szlig standardized regression coefficient VIF variance in1047298ation actor
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Computational and Mathematical Methods in Medicine 983095
the lower concavity angle o C983090 as independent variablesHowever in this study we de1047297ned the measurements o theC983090 vertebral bodyand the odontoidprocess Te dentocentralsynchondrosis was considered the border between the body and the odontoid process o C983090 Te results showed thatthe ratios o the C983090 body and the odontoid process were
correlated very highly with skeletal maturation status (as didthe bodies o the third and ourth cervical vertebrae whichwere used in the previous studies) (ables 983093 and 983094)
During embryonic development the second cervical vertebra arises rom 1047297ve primary bone growth centers (oneoccurs in the body two occur in bilateral neural archesand the other two occur in the odontoid process) separatedby synchondrotic articulations [983090983092 983090983093] Te two in theodontoid process are used at birth Te border betweenthe odontoid process and the body o the axis vertebra iswell demarcated by the dentocentral synchondrosis [983090983094] Tebilateral neurocentral synchondroses between the bilateralneural arch and the dentocentral synchondrosis use at 983091 to
983094 years o age Afer 983094 years o age the odontoid processuses with the vertebral body and the neural arches [983090983094]Te remnant o the dentocentral synchondrosis which isbelow the superior articulating acets appears on CBCand MRI images as a ring Cokluk et al [983089983094] compared theodontoid process-to-vertebral body ratios between childrenandadults based on MRIs o the dentocentral synchondrosisTereore we were able to use CBC images to de1047297ne the
vertebral body and its odontoid process and expected thatthe odontoid process and vertebral body might be importantindependent variables or the regression model derived romCBC-generated CVM
Several studies used the third and ourth vertebral bodies
and the concavity o their lower borders to assess skeletalmaturation [983089983088 983090983090 983090983091] Tey reported that many ratios o the width and height o the C983091 and C983092 were correlatedwith skeletal maturation status In the present study 983092983095 o 983094983092 parameters exhibited statistically signi1047297cant correlations( lt 005) similar to the 1047297ndings o other previous studies(able 983093) Te C983090 vertebral body and odontoid process weresigni1047297cant independent variables in all multiple regressionmodels In the multiple regression model with the highest
10383892 adjusted 1038389
2 and variance in1047298ation actors (VIF) lt983090which indicated the absence o multicollinearity problemsPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 were independent variables Tis model also
exhibited the highest coefficient o determination 983088983095983096983094indicating that these independent variables were able toexplain approximately 983095983096983094 o the SML variation
While the ratios o the third and ourth cervical vertebraehad strong correlation coefficients in previous CVM studiesthe present study added the ratio o the second cervical
vertebra which correlated strongly with CBC-generatedCVM as an indicator Altan et al [983090983095] investigated thelongitudinal growth o cervical vertebrae in girls rom 983096 to983089983095 years o age Te growth o the cervical vertebrae ollowsa somatic pattern and they reach their 1047297nal size at maturity [983090983096] C983089 and C983092 reached their peak size at approximately 983089983089983093 years o age and C983091 reached its maximal size at 983089983088983093
years o age However the growth curve or C983090 did nothave a distinct peak growth rate its growth rate curve wasmore linear [983090983097] Tereore in this study the parameterso the C983090 vertebral body and the odontoid process mightbe independent variables or the multiple linear regressionmodel because it has a more linear growth pattern Our
1047297ndings indicated that the growth o C983090 vertebral body andodontoid process might be a useul indicator or evaluatingthe stages o skeletal maturation Te multiple regressionmodels put orth by Chen et al [983090983091] and Mito et al [983090983090]included parameters such as the heightwidth ratios o thethird and ourth cervical vertebrae as independent variablesHowever regression models in our study with AH983091H983091 andH983092W983092 ratios had multicollinearity problems with high VIF
values (able 983094)Similarly the third and ourth cervical vertebrae arise
rom three primary ossi1047297cation centers (one in the body and two in the posterior arches) [983091983088 983091983089] Te shape o thebodies o third and ourth cervical vertebrae changes romwedge-shaped to rectangular and then becomes square Teirshapes grow vertically and then horizontally Te total lengthand height o the third and ourth cervical vertebrae have
very similar incremental curves Cervical vertebral growthoccurred in the order o the upper to the lower cervical ver-tebrae Tereore these parameters might induce statisticalmulticollinearity problems Many clinical studies regardingdental research have used multiple regression analysis to 1047297ndcorrelations between the predictorand the outcome variablesHowever collinearity in the statistic regression models is onepossible problem with the use o multiple regression analysisldquoMulticollinearityrdquo is the statistical term or the situation inwhich more than two covariates are highly correlated [983090983089]It can distort the interpretation o statistical results rommultiple regression models increasing both inaccuracy anduncertainty Multicollinearity should be considered in theregression model
We used the SML as a measure o the study participantsrsquoskeletal maturation status in order to build the multipleregression models in this study Te SML comprises 983089983088983088983088stages numbered rom 983088 to 983097983097983097 compared to 983089983089 stagesit provides a more re1047297ned skeletal maturation status as apercentage Te SML (with stages 983088 to 983097983097983097) was pertinentto statistical analysis as a parametric dependent variable ormultiple regression models Te present study has already con1047297rmed its high correlation to Fishmanrsquos SMI or buildingmultiple regression models ( lt 005 correlation coefficient
983088983097983093983088)Other CVM-based studies had large study popula-
tions that were heterogeneous regarding sex and ethnicityAlthough our study population was comparatively small andhomogeneous this study had the advantage o introducingthe modi1047297ed CBC-generated CVM with the de1047297ned body o the second cervical vertebra and the odontoid processrom the dentocentral synchondrosis Given this CBCapproach the study could not have a large study popula-tion Despite these difficulties this study demonstrated anew application o the second cervical vertebral body andodontoid to the CBC-generated CVM and resulted in thebuilding o multiple regression models We expect that sexual
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983096 Computational and Mathematical Methods in Medicine
dimorphism may imply divergence between boys and girlsduring the course o ossi1047297cation Ethnicity may explain therelatively high correspondence o ossi1047297cation level observedin the present study compared with other studies Tereoreadditional studies are needed to address questions regardingsexual dimorphism and ethnicity
5 Conclusions
CBC-generated CVM was able to include parameters romthe second cervical vertebral body and the odontoid processrespectively or multiple regression models Te derivedmultiple regression models demonstrated the potential o thenewly de1047297ned parameters o the second cervical vertebra
Conflict of Interests
All o the authors declare that there is no con1047298ict o interestsregarding the publication o this paper
Acknowledgment
Tis study was supported by two-year research grant romPusan National University (Woo-Sung Son)
References
[983089] U Hagg and J aranger ldquoMaturation indicators and the pub-ertal growth spurtrdquo American Journal of Orthodontics vol 983096983090no 983092 pp 983090983097983097ndash983091983088983097 983089983097983096983090
[983090] Uysal Z Sari S I Ramoglu and F A Bascifci ldquoRelation-ships between dental and skeletal maturity in urkish subjectsrdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983093983095ndash983094983094983092 983090983088983088983092
[983091] M OrsquoReilly and G J Yanniello ldquoMandibular growth changesand maturation o cervical vertebraemdasha longitudinal cephalo-metric studyrdquo Angle Orthodontist vol 983093983096 no 983090 pp 983089983095983097ndash983089983096983092983089983097983096983096
[983092] W W Greulich and S I Pyle Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanord University PressStanord Cali USA 983089983097983093983097
[983093] A BLewis and S M Garn ldquoTerelationshipbetween tooth or-mation and other maturation actorsrdquo Te Angle Orthodontist vol 983091983088 no 983090 pp 983095983088ndash983095983095 983089983097983094983088
[983094] C J Hunter ldquoTe correlation o acial growth with body heightand skeletal maturation at adolescencerdquo Te Angle Orthodontist vol 983091983094 no 983089 pp 983092983092ndash983093983092 983089983097983094983094
[983095] A Bjork and S Helm ldquoPrediction o the age o maximumpuberal growth in body heightrdquo Angle Orthodontist vol 983091983095 no983090 pp 983089983091983092ndash983089983092983091 983089983097983094983095
[983096] M I oani ldquoMandibular growth at pubertyrdquo Te American Journal of Orthodontics vol 983094983090 no 983090 pp 983089983095983094ndash983089983097983093 983089983097983095983090
[983097] U Hagg and J aranger ldquoMenarche and voice change asindicators o the pubertal growth spurtrdquo Acta OdontologicaScandinavica vol 983091983096 no 983091 pp 983089983095983097ndash983089983096983094 983089983097983096983088
[983089983088] P San Roman J C Palma M D Oteo and E Nevado ldquoSkeletalmaturation determined by cervical vertebrae developmentrdquoEuropean Journal of Orthodontics vol 983090983092 no 983091 pp 983091983088983091ndash983091983089983089983090983088983088983090
[983089983089] L Franchi Baccetti and J A McNamara Jr ldquoMandibulargrowth as related to cervical vertebral maturation and body
heightrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983089983096 no 983091 pp 983091983091983093ndash983091983092983088 983090983088983088983088
[983089983090] Baccetti L Franchi and J A McNamara Jr ldquoAn improved version o the cervical vertebral maturation (CVM) method orthe assessment o mandibular growthrdquo Te Angle Orthodontist vol 983095983090 no 983092 pp 983091983089983094ndash983091983090983091 983090983088983088983090
[983089983091] D B Gabriel K A Southard F Qian S D Marshall R GFranciscus and E Southard ldquoCervical vertebrae matura-tion method poor reproducibilityrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp983092983095983096e983089ndash983092983095983096e983095 983090983088983088983097
[983089983092] L-L Chen -M Xu J-H Jiang X-Z Zhang and J-XLin ldquoQuantitative cervical vertebral maturation assessment inadolescents with normal occlusion a mixed longitudinal studyrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983092 no 983094 pp 983095983090983088e983089ndash983095983090983088e983095 983090983088983088983096
[983089983093] A Chatzigianni and D J Halazonetis ldquoGeometric morphome-tric evaluation o cervical vertebrae shape and its relationshipto skeletal maturationrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp 983092983096983089e983089ndash983092983096983089e983097 983090983088983088983097
[983089983094] C Cokluk K Aydm C Rakunt O Iyigun and A Onder ldquoTeborders o the odontoid process o c983090 in adults and in childrenincluding the estimation o odontoidbody ratiordquo EuropeanSpine Journal vol 983089983093 no 983091 pp 983090983095983096ndash983090983096983090 983090983088983088983094
[983089983095] V Joshi Yamaguchi Y Matsuda N Kaneko K Maki and Okano ldquoSkeletal maturity assessment with the use o cone-beam computerized tomographyrdquo Oral Surgery Oral MedicineOral Pathology and Oral Radiology vol 983089983089983091 no 983094 pp 983096983092983089ndash983096983092983097983090983088983089983090
[983089983096] J B Ludlow L E Davies-Ludlow S L Brooks and WB Howerton ldquoDosimetry o 983091 CBC devices or oral andmaxilloacial radiology CB Mercuray Newom 983091G and i-CArdquoDentomaxillofacial Radiology vol 983091983093 no 983092 pp 983090983089983097ndash983090983090983094 983090983088983088983094
[983089983097] M Sempe La P acuteediatrie au Quotidian Analyse de la MaturationSequelettique Les Editions INSERM Paris France 983089983097983096983095
[983090983088] L S Fishman ldquoRadiographic evaluation o skeletal maturationA clinically oriented method based on hand-wirst 1047297lmsrdquo AngleOrthodontist vol 983093983090 no 983090 pp 983096983096ndash983089983089983090 983089983097983096983090
[983090983089] J Miles and M Shelvin Applying Regression and CorrelationSage Publication London UK 983090983088983088983089
[983090983090] Mito K Sato and H Mitani ldquoCervical vertebral bone agein girlsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983090 no 983092 pp 983091983096983088ndash983091983096983093 983090983088983088983090
[983090983091] F Chen K eradaand K Hanada ldquoA newmethod opredictingmandibular length incrementon the basis o cervical vertebraerdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983091983088ndash983094983091983092 983090983088983088983092
[983090983092] H Herkowitz S Gar1047297n F Eismont G Bell and R BalderstonRothman-Simeone Te Spine WB Saunders Philadelphia PaUSA 983090983088983089983089
[983090983093] A Verbout ldquoTe development o the vertebral columnrdquo Advances in Anatomy Embryology and Cell Biology vol 983097983088 no983089 pp 983089ndash983089983090983090 983089983097983096983093
[983090983094] K B Arbogast P A Gholve J E Friedman M R Maltese MF omasello and J P Dormans ldquoNormal cervical spine rangeo motion in children 983091ndash983089983090 years oldrdquo Spine vol 983091983090 no 983089983088 ppE983091983088983097ndashE983091983089983093 983090983088983088983095
[983090983095] M Altan O Nebioglu Dalc and H Iseri ldquoGrowth o thecervical vertebrae in girls rom 983096 to 983089983095 years A longitudinalstudyrdquo European Journal of Orthodontics vol 983091983092 no 983091 pp 983091983090983095ndash983091983091983092 983090983088983089983090
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 310
Computational and Mathematical Methods in Medicine 983091
D
O H
C 2 u a C 2 u m C 2 u p
C 2 l a
C 3 l p
C 3 l a C 3 l m C 4 u
p
U W
L W W C 4 l p C 4 u
a
C 4 a m
C 4 l a
H P H
A H C 3 a
m
C 3 u p C 3 u m
C 3 u a
C 2 a m C 2 l p
C2o
F983145983143983157983154983141 983090 Parameters (distances) used in the analysis OH verticaldistance o C983090o to the line o C983090ua and C983090up AH983090ndash983092 verticaldistance o C983090ndash983092ua to the line o C983090ndash983092lp and C983090ndash983092la H983090ndash983092 verticaldistance o C983090ndash983092um to the line o C983090ndash983092lp and C983090ndash983092la PH983090ndash983092
vertical distance o C983090ndash983092up to the line o C983090ndash983092lp and C983090ndash983092la UW983090ndash983092 vertical distance o C983090ndash983092ua to the line o C983090ndash983092up and C983090ndash983092lpW983090ndash983092 vertical distance o C983090ndash983092am to the line o C983090ndash983092up and C983090ndash983092lp LW983090ndash983092 vertical distance o C983090ndash983092la to the line o C983090ndash983092up andC983090ndash983092lp D983090ndash983092 vertical distance o C983090lm to the line o C983090la andC983090lp
In this study we adopted and modi1047297ed landmarks andmeasurements rom those described in the QCVM study by Chen et al [983089983092] these parameters are de1047297ned in Figure 983089and able 983090 Te border o the body o the second cervical
vertebra (C983090) was de1047297ned by the remnant o the dentocentralsynchondrosis as visualized in the lateral image o the second
cervical vertebra For every study participant each parameterwas measured and calculated using 983091D imaging sofware
983090983092 Statistical Analysis Te data were analyzed using sta-tistical sofware (SPSS version 983090983089983088 or Windows ChicagoIl USA) Te statistical analyses included correlation coeffi-cient analysis and multiple regression analysis with stepwiseelimination Multiple linear regression analysis was usedto determine the SML or Korean girls as the dependent
variable and parameters rom CBC-generated CVM as theindependent variables Te intraexaminer and interexaminerreliability o the linear measurements were each checkedby remeasurement o 983090983088 randomly selected lateral images 983090
weeks later the intraclass correlation coefficients were very high (means o 983088983097983097983091 and 983088983097983097983088 resp) Te intraobserverand interobserver errors or the SML and SMI were evaluatedusing Cohenrsquos kappa index Te intraobserver and interob-server reliability or Cohenrsquos kappa index each demonstratedsubstantial agreement (means o 983088983096983088983093 and 983088983095983095983097 resp)
3 Results
o prove that the SMI and SML are comparable we usedPearsonrsquos correlation coefficient analysis to determine thecorrelation between the SMI andSML which we then de1047297nedas the skeletal maturation status index Tis value exhibited
983137983138983148983141 983090 Landmarks and measurements
Parameter Description
Landmarks
C983090o Te most superior point o the odontoid
process
C983090ndash983092lm Te most superior points o the lower
border o the bodies o C983090ndash983092
C983090ndash983092la C983090ndash983092lpTe most anterior (a) and posterior (p)points on the lower border o the bodieso C983090ndash983092
C983090ndash983092ua C983090ndash983092upTe most superior points o the anterior(a) and posterior (p) borders o thebodies o C983090ndash983092
C983090ndash983092um Te middle o the upper border o the
bodies o C983090ndash983092
C983090ndash983092am Te middle o the anterior border o the
bodies o C983090ndash983092
Ratios
AH983090ndash983092H983090ndash983092 Ratio o AH983090ndash983092H983090ndash983092
H983090ndash983092PH983090ndash983092 Ratio o H983090ndash983092PH983090ndash983092
AH983090ndash983092PH983090ndash983092 Ratio o AH983090ndash983092PH983090ndash983092
UW983090ndash983092W983090ndash983092 Ratio o UW983090ndash983092W983090ndash983092
W983090ndash983092LW983090ndash983092 Ratio o W983090ndash983092LW983090ndash983092
UW983090ndash983092LW983090ndash983092 Ratio o UW983090ndash983092LW983090ndash983092
AH983090ndash983092UW983090ndash983092 Ratio o AH983090ndash983092UW983090ndash983092
H983090ndash983092UW983090ndash983092 Ratio o H983090ndash983092UW983090ndash983092
PH983090ndash983092UW983090ndash983092 Ratio o PH983090ndash983092UW983090ndash983092
AH983090ndash983092W983090ndash983092 Ratio o AH983090ndash983092W983090ndash983092
H983090ndash983092W983090ndash983092 Ratio o H983090ndash983092W983090ndash983092
PH983090ndash983092W983090ndash983092 Ratio o PH983090ndash983092W983090ndash983092
AH983090ndash983092LW983090ndash983092 Ratio o AH983090ndash983092LW983090ndash983092
H983090ndash983092LW983090ndash983092 Ratio o H983090ndash983092LW983090ndash983092
PH983090ndash983092LW983090ndash983092 Ratio o PH983090ndash983092LW983090ndash983092
OHUW983090 Ratio o OHUW983090
OHAH983090 Ratio o OHAH983090
OHH983090 Ratio o OHH983090
OHPH983090 Ratio o OHPH983090
OHUW983090 Ratio o OHUW983090
OHW983090 Ratio o OHW983090
OHLW983090 Ratio o OHLW983090
OHPH983090 Ratio o OHPH983090
(OH + AH983090)UW983090 Ratio o (OH + AH983090)UW983090
(OH + AH983090)W983090 Ratio o (OH + AH983090)W983090(OH + AH983090)LW983090 Ratio o (OH + AH983090)LW983090
(OH + H983090)UW983090 Ratio o (OH + H983090)UW983090
(OH + H983090)W983090 Ratio o (OH + H983090)W983090
(OH + H983090)LW983090 Ratio o (OH + H983090)LW983090
(OH + PH983090)UW983090 Ratio o (OH + PH983090)UW983090
(OH + PH983090)W983090 Ratio o (OH + PH983090)W983090
(OH + PH983090)LW983090 Ratio o (OH + PH983090)LW983090
a very high coefficient 983088983097983093983088 when the SML was substitutedor the SMI As a parametric method to present the degree o
7172019 405912
httpslidepdfcomreaderfull405912 410
983092 Computational and Mathematical Methods in Medicine
983137983138983148983141 983091 Descriptive statistics or parameters in the C983090 C983091 and C983092 vertebral bodies
Parameter C983090 vertebra C983091 vertebra C983092 vertebra
Mean SD Min Max Mean SD Min Max Mean SD Min Max
AHH 983089983088983095 983088983088983093 983088983097983094 983089983090983088 983088983097983097 983088983088983094 983088983096983091 983089983089983091 983088983097983096 983088983088983095 983088983096983088 983089983089983093
HPH 983089983089983093 983088983088983093 983089983088983089 983089983090983097 983088983097983097 983088983088983093 983088983097983088 983089983089983095 983088983097983095 983088983088983093 983088983096983094 983089983088983095
AHPH 983089983090983091 983088983088983097 983088983097983095 983089983092983089 983088983097983097 983088983088983095 983088983095983097 983089983089983093 983088983097983093 983088983088983095 983088983095983092 983089983088983096UWW 983088983096983090 983088983088983094 983088983095983088 983088983097983091 983088983096983096 983088983088983093 983088983095983095 983088983097983095 983088983097983088 983088983088983093 983088983095983095 983089983088983094
WLW 983089983089983088 983088983088983096 983088983096983091 983089983090983094 983089983088983096 983088983088983092 983088983097983096 983089983089983095 983089983088983094 983088983088983093 983088983097983094 983089983089983096
UWLW 983088983097983088 983088983088983096 983088983095983092 983089983089983088 983088983097983093 983088983088983095 983088983096983091 983089983089983090 983088983097983093 983088983088983095 983088983095983095 983089983089983096
AHUW 983089983090983095 983088983089983089 983088983097983097 983089983093983093 983089983088983093 983088983090983088 983088983093983093 983089983092983089 983089983088983088 983088983090983088 983088983093983089 983089983091983095
HUW 983089983089983096 983088983089983089 983088983097983092 983089983092983093 983089983088983093 983088983089983095 983088983094983089 983089983091983094 983089983088983089 983088983089983094 983088983093983097 983089983091983094
PHUW 983089983088983091 983088983089983089 983088983096983089 983089983090983095 983089983088983094 983088983089983096 983088983093983095 983089983092983094 983089983088983093 983088983089983096 983088983094983089 983089983093983088
AHW 983089983088983092 983088983088983096 983088983096983094 983089983090983094 983088983097983089 983088983089983093 983088983093983089 983089983090983088 983088983096983097 983088983089983093 983088983092983096 983089983089983095
HW 983088983097983095 983088983088983096 983088983095983096 983089983089983093 983088983097983090 983088983089983090 983088983093983094 983089983089983093 983088983097983088 983088983089983090 983088983093983094 983089983089983094
PHW 983088983096983093 983088983088983097 983088983094983095 983089983089983088 983088983097983091 983088983089983091 983088983093983091 983089983089983093 983088983097983091 983088983089983092 983088983093983095 983089983090983092
AHLW 983089983089983092 983088983089983091 983088983096983095 983089983093983091 983088983097983097 983088983089983095 983088983093983092 983089983091983090 983088983097983092 983088983089983094 983088983093983089 983089983090983093
HLW 983089983088983094 983088983089983089 983088983096983093 983089983091983095 983088983097983097 983088983089983092 983088983093983095 983089983090983095 983088983097983094 983088983089983091 983088983093983097 983089983090983092
PHLW 983088983097983091 983088983089983089 983088983095983092 983089983090983089 983089983088983088 983088983089983093 983088983093983092 983089983090983095 983088983097983097 983088983089983093 983088983093983097 983089983091983091D 983089983095983093 983088983094983090 983088983088983094 983091983089983089 983089983095983091 983088983094983092 983088983088983089 983091983089983089 983089983093983089 983088983094983088 983088983089983090 983090983095983093
C983090 second cervical C983091 third cervical C983092 ourth cervical Min minimum Max maximum SD standard deviation
983137983138983148983141 983092 Descriptive statistics or SML and parameters in the C983090 vertebral body and odontoid process
Parameters Mean SD Min Max
SML 983096983090983088983090 983089983094983090983088 983089983096983091983088 983097983094983093983088
OHUW983090 983089983097983094 983088983089983097 983089983093983095 983090983092983092
OHAH983090 983089983093983093 983088983089983093 983089983089983092 983090983088983092
OHH983090 983089983094983095 983088983089983094 983089983090983096 983090983089983088
OHPH983090 983089983097983089 983088983090983088 983089983092983093 983090983091983097OUW983090 983089983097983094 983088983089983097 983089983093983095 983090983092983092
OHW983090 983089983094983089 983088983089983094 983089983091983094 983090983089983092
OHLW983090 983089983095983094 983088983089983093 983089983091983094 983090983089983092
(OH + AH983090)UW983090 983091983090983091 983088983090983094 983090983093983094 983091983095983096
(OH + AH983090)W983090 983090983094983094 983088983090983089 983090983090983095 983091983090983093
(OH + AH983090)LW983090 983090983097983088 983088983090983092 983090983090983091 983091983093983088
(OH + H983090)UW983090 983091983089983093 983088983090983094 983090983093983094 983091983095983092
(OH + H983090)W983090 983090983093983097 983088983090983089 983090983090983088 983091983090983090
(OH + H983090)LW983090 983090983096983090 983088983090983091 983090983090983090 983091983092983090
(OH + PH983090)UW983090 983091983088983088 983088983090983094 983090983092983095 983091983093983097
(OH + PH983090)W983090 983090983092983094 983088983090983090 983090983089983088 983091983090983088
(OH + PH983090)LW983090 983090983094983097 983088983090983090 983090983089983093 983091983090983096C983090 second cervical Min minimum Max maximum SD standard devia-tion
correlation between two variables we used the Shapiro-Wilk test ( lt 005) to con1047297rm the normality test in the sampledistribution
Te descriptive statistics o each parameter (obtainedrom CBC-generated CVM) are reported in ables 983091 and983092 We calculated the correlation coefficient rom these datain order to 1047297nd the correlation between the SML and theparameters rom CBC-generated CVM (able 983093) Out o atotal o 983094983092 parameters 983092983095 exhibited statistically signi1047297cant
correlations ( lt 005) Regression analysis with the SML(a dependent variable) and 983094983092 parameters rom CBC-generated CVM (independent variables) were employed tobuild eight multiple regression models (able 983094) Amongthese models the eighth multiple regression model (able 983094)
eatured the highest 10383892 and adjusted 1038389
2 Te model withPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 as independent variables exhibited the highest
coefficient o determination 983088983095983096983094 indicating that approxi-mately 983095983096983094 o the variation in the SML could be explainedby these independent variables Aside rom the signi1047297cant
enhancement o 10383892 there was no signi1047297cant multicollinearity between variables derived rom regression models or theSML We perormed multicollinearity tests based on the vari-ance in1047298ation actor (VIF) lt983090 which indicated the absenceo multicollinearity problems Te parameters AH983091W983091 andH983092W983092 had high VIF values (gt983090983088) in the ourth 1047297fh andsixth regression models Te models with these VIFs couldhave signi1047297cant multicollinearity problems [983090983089] (able 983094)
4 Discussion
Several methods or assessing skeletal maturation status havebeen introduced [983089ndash983092] Te CVM method has proven tobe especially useul Mito et al [983090983090] and Chen et al [983090983091]introduced multiple regression models in order to employ CVM to determine skeletal maturation stage Mito et al [983090983090]created a regression ormula to obtain cervical vertebral boneage they reported that the ormula was determined rom theratios o measurements in the third cervical vertebral (C983091)and ourth cervical (C983092) vertebral bodies Chen et al [983090983091]also developed ormulas that employed regression analysis topredict mandibularlength incrementusingcervical vertebraeand used the ratios o C983091 and C983092 vertebral bodies and
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Computational and Mathematical Methods in Medicine 983093
T 983137 983138 983148 983141 983093 C o r r e l a t i o n c o e ffi c i e n t b e t w e e n S e m p acute e m a t u r a
t i o n l e v e l a n d p a r a m e t e r s f r o m C B C T - g e n
e r a t e d c e r v i c a l v e r t e b r a l m a t u r a t i o n
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o
n
c o e ffi c i e n
t
P a r a m e t e r
C
o r r e l a t i o n
c
o e ffi c i e n t
A H 983091 L W 983091
983088 983096 983090 983095
983088 983088 983088 983088
D 983092
983088 983095 983091 983092
983088
983088 983088 983088
W 983091 L W 983091
983088 983093 983088 983095
983088 983088 983088 983089
H 983090 W 983090
minus 983088 983090 983095 983095
983088 983088 983093 983097
A H 983091 W 983091
983088 983096 983089 983096
983088 983088 983088 983088
A H 983091 H 983091
983088 983095 983091 983090
983088
983088 983088 983088
U W 983091 W 983091
minus 983088 983093 983088 983090
983088 983088 983088 983089
P H 983090 L W 983090
983088 983090 983095 983093
983088 983088 983094 983089
D 983091
983088 983096 983088 983094
983088 983088 983088 983088
P H 983091 U W 983091
983088 983095 983090 983090
983088
983088 983088 983088
H 983090 L W 983090
983088 983092 983097 983096
983088 983088 983088 983090
O H L W 983090
983088 983090 983091 983091
983088 983088 983097 983094
W 983090 L W 983090
983088 983096 983088 983091
983088 983088 983088 983088
H 983092 L W 983092
983088 983095 983089 983094
983088
983088 983088 983088
( O H + H 983090 ) W 983090
minus 983088 983092 983097 983094
983088 983088 983088 983090
H 983090 U W 983090
983088 983090 983089 983095
983088 983089 983089 983090
A H 983091 U W 983091
983088 983096 983088 983089
983088 983088 983088 983088
P H 983091 W 983091
983088 983095 983089 983091
983088
983088 983088 983088
H 983090 P H 983090
983088 983092 983095 983092
983088 983088 983088 983091
H 983091 P H 983091
minus 983088 983090 983088 983094
983088 983089 983090 983093
A H 983092 W 983092
983088 983095 983097 983091
983088 983088 983088 983088
D 983090
983088 983095 983088 983097
983088
983088 983088 983088
A H 983091 P H 983091
983088 983092 983095 983089
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
A H 983092 U W 983092
983088 983095 983096 983092
983088 983088 983088 983088
P H 983092 L W 983092
983088 983095 983088 983093
983088
983088 983088 983088
A H 983090 U W 983090
983088 983092 983095
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
H 983092 U W 983092
983088 983095 983096 983089
983088 983088 983088 983088
A H 983092 H 983092
983088 983094 983097 983090
983088
983088 983088 983088
( O H + A H 983090 ) L W 983090
983088 983092 983095
983088 983088 983088 983091
( O H + P H 983090 ) U W 983090
minus 983088 983089 983094 983089
983088 983089 983096 983093
H 983091 L W 983091
983088 983095 983095 983095
983088 983088 983088 983088
A H 983090 L W 983090
983088 983094 983093 983090
983088
983088 983088 983088
U W 983092 W 983092
minus 983088 983092 983094 983095
983088 983088 983088 983091
H 983092 P H 983092
minus 983088 983089 983091 983096
983088 983090 983090 983090
A H 983092 L W 983092
983088 983095 983095 983094
983088 983088 983088 983088
U W 983090 W 983090
minus 983088 983094 983091
983088
983088 983088 983088
P H 983090 W 983090
minus 983088 983092 983091 983094
983088 983088 983088 983094
U W 983091 L W 983091
minus 983088 983089 983090 983096
983088 983090 983091 983096
H 983092 W 983092
983088 983095 983095 983092
983088 983088 983088 983088
O H A H 983090
minus 983088 983094 983089 983092
983088
983088 983088 983088
U W 983090 L W 983090
983088 983092 983091
983088 983088 983088 983094
O H P H 983090
minus 983088 983089 983090
983088 983090 983093 983091
H 983091 W 983091
983088 983095 983094 983093
983088 983088 983088 983088
A H 983090 H 983090
983088 983094 983088 983092
983088
983088 983088 983088
( O H + A H 983090 ) W 983090
minus 983088 983091 983097 983096
983088 983088 983089 983089
A H 983090 W 983090
983088 983088 983094 983094
983088 983091 983093 983095
H 983091 U W 983091
983088 983095 983094 983090
983088 983088 983088 983088
A H 983090 P H 983090
983088 983094 983088 983089
983088
983088 983088 983088
( O H + H 983090 ) L W 983090
983088 983091 983096 983094
983088 983088 983089 983091
( O H + A H 983090 ) U W 983090
983088 983088 983094 983094
983088 983091 983093 983096
P H 983092 U W 983092
983088 983095 983093 983097
983088 983088 983088 983088
A H 983092 P H 983092
983088 983094 983088 983089
983088
983088 983088 983088
O H H 983090
minus 983088 983091 983094 983095
983088 983088 983089 983096
( O H + H 983090 ) U W 983090
minus 983088 983088 983093 983093
983088 983091 983096 983089
P H 983092 W 983092
983088 983095 983093 983092
983088 983088 983088 983088
( O H + P H 983090 ) W 983090
minus 983088 983093 983093
983088
983088 983088 983088
U W 983092 L W 983092
minus 983088 983091 983090
983088 983088 983091 983093
P H 983090 U W 983090
minus 983088 983088 983091 983097
983088 983092 983089 983093
P H 983091 L W 983091
983088 983095 983091 983096
983088 983088 983088 983088
O H W 983090
minus 983088 983093 983089 983091
983088
983088 983088 983089
( O H + P H 983090 ) L W 983090
983088 983090 983096 983094
983088 983088 983093 983091
W 983092 L W 983092
983088 983088 983090 983092
983088 983092 983092 983096
C B C T c o n e b e a m c o m p u t e d t o m o g r a p h y
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983094 Computational and Mathematical Methods in Medicine
983137983138983148983141 983094 Te results o multiple regression analysis using the stepwise elimination method
Multipleregressionmodels
Independent variables 907317 SE szlig 10383892 Adjusted 1038389
2 VIF 983089VIF
983089st Intercept 983093983095983093983088 983096983088983091983095 983088983095983089983093 983088983092983095983095 983088983093983094983090 983088983093983093983094
AH983091W983091 983096983091983093983090983089 983096983094983097983091 983088983095983093983088 983097983094983088983096 983088983088983088983088 983089983088983088983088 983089983088983088983088
983090nd
Intercept 983093983091983091983095983093 983089983091983093983097983089 983091983097983090983095 983088983088983088983088 983088983094983092983095 983088983094983091983095
AH983091W983091 983096983089983095983089983097 983095983096983094983095 983088983095983091983091 983089983088983091983096983096 983088983088983088983088 983089983088983088983091 983088983097983097983095
PH983090W983090 minus983093983092983090983090983096 983089983091983088983096983088 minus983088983090983097983091 minus983092983089983092983094 983088983088983088983088 983089983088983088983091 983088983097983097983095
983091rd
Intercept 983089983088983090983088983090983089 983089983097983097983097983091 983093983089983088983091 983088983088983088983088 983088983094983097983089 983088983094983095983096
AH983091W983091 983095983094983094983088983094 983095983093983096983092 983088983094983096983095 983089983088983089983088983090 983088983088983088983088 983089983088983093983089 983088983097983093983089
PH983090W983090 minus983092983089983092983095983096 983089983090983097983094983089 minus983088983090983090983092 minus983091983090983088983088 983088983088983088983090 983089983089983089983088 983088983097983088983089
UW983090W983090 minus983094983094983093983089983092 983090983088983097983097983097 minus983088983090983090983095 minus983091983089983094983095 983088983088983088983090 983089983089983094983091 983088983096983094983088
983092th
Intercept 983097983093983092983097983097 983089983097983089983094983090 983092983097983096983092 983088983088983088983088 983088983095983090983093 983088983095983088983097
AH983091W983091 983092983089983094983095983093 983089983092983089983089983096 983088983091983095983092 983090983097983093983090 983088983088983088983092 983092983088983090983088 983088983090983092983097
PH983090W983090 minus983092983096983092983088983094 983089983090983093983094983095 minus983088983090983094983089 minus983091983096983093983090 983088983088983088983088 983089983089983093983090 983088983096983094983096
UW983090W983090 minus983094983094983093983093983092 983089983097983097983096983093 minus983088983090983090983095 minus983091983091983091983088 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983092983097983088983090983092 983089983095983088983091983088 983088983091983094983091 983090983096983095983097 983088983088983088983093 983091983097983095983090 983088983090983093983090
983093th
Intercept 983095983094983096983092983093 983089983097983088983096983089 983092983088983090983095 983088983088983088983088 983088983095983093983096 983088983095983092983088
AH983091W983091 983090983096983094983095983089 983089983091983097983096983092 983088983090983093983095 983090983088983093983088 983088983088983092983092 983092983092983090983094 983088983090983090983094
PH983090W983090 minus983094983092983091983097983092 983089983090983097983093983094 minus983088983091983092983096 minus983092983097983095983088 983088983088983088983088 983089983091983095983092 983088983095983090983096
UW983090W983090 minus983094983096983089983092983096 983089983096983096983095983090 minus983088983090983091983090 minus983091983094983089983089 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983093983089983094983097983090 983089983094983088983097983097 983088983091983096983090 983091983090983089983089 983088983088983088983090 983091983097983096983092 983088983090983093983089
(OH + AH983090)LW983090 983089983092983096983089983089 983092983096983090983091 983088983090983090983091 983091983088983095983089 983088983088983088983091 983089983092983096983093 983088983094983095983091
983094th
Intercept 983094983093983093983088983088 983089983097983091983092983089 983091983091983096983095 983088983088983088983089 983088983095983095983092 983088983095983093983091
AH983091W983091 983089983093983090983095983097 983089983093983088983088983089 983088983089983091983095 983089983088983089983096 983088983091983089983090 983093983091983094983089 983088983089983096983095
PH983090W983090 minus983094983089983091983091983089 983089983090983095983088983097 minus983088983091983091983089 minus983092983096983090983094 983088983088983088983088 983089983091983097983090 983088983095983089983096
UW983090W983090 minus983093983095983090983095983092 983089983097983088983096983094 minus983088983089983097983093 minus983091983088983088983089 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983093983091983089983095983094 983089983093983095983088983096 983088983091983097983091 983091983091983096983093 983088983088983088983089 983091983097983097983090 983088983090983093983089
(OH + AH983090)LW983090 983089983093983096983091983094 983092983095983090983094 983088983090983091983097 983091983091983093983089 983088983088983088983089 983089983093983088983089 983088983094983094983094
D983091 983092983092983092983092 983090983088983095983097 983088983089983095983094 983090983089983091983096 983088983088983091983094 983089983097983097983097 983088983093983088983088
983095th
Intercept 983094983092983089983090983096 983089983097983091983088983088 983091983091983090983091 983088983088983088983089 983088983095983095983088 983088983095983093983091
PH983090W983090 minus983094983091983095983092983095 983089983090983092983097983088 minus983088983091983092983092 minus983093983089983088983092 983088983088983088983088 983089983091983092983092 983088983095983092983092
UW983090983090 minus983093983095983088983090983095 983089983097983088983097983088 minus983088983089983097983092 minus983090983097983096983095 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983094983093983093983096983095 983097983097983089983093 983088983092983096983093 983094983094983089983093 983088983088983088983088 983089983093983097983088 983088983094983090983097
(OH + AH983090)LW983090 983089983095983091983093983095 983092983092983096983093 983088983090983094983090 983091983096983095983088 983088983088983088983088 983089983091983093983089 983088983095983092983088
D983091 983093983091983090983096 983089983096983096983097 983088983090983089983089 983090983096983090983088 983088983088983088983094 983089983094983093983089 983088983094983088983094
983096th
Intercept 983097983094983088983093983090 983090983091983093983097983093 983092983088983095983089 983088983088983088983088 983088983095983096983094 983088983095983094983095
PH983090W983090 minus983094983090983092983092983097 983089983090983089983093983092 minus983088983091983091983095 minus983093983089983091983096 983088983088983088983088 983089983091983092983095 983088983095983092983090
UW983090W983090 minus983093983092983096983092983091 983089983096983093983096983089 minus983088983089983096983095 minus983090983097983093983090 983088983088983088983092 983089983090983093983094 983088983095983097983094
H983092W983092 983094983091983090983095983088 983097983094983097983091 983088983092983094983096 983094983093983090983095 983088983088983088983088 983089983094983088983096 983088983094983090983090
(OH + AH983090)LW983090 983089983094983088983095983094 983092983091983097983095 983088983090983092983090 983091983094983093983094 983088983088983088983089 983089983091983095983092 983088983095983090983096
D983091 983093983093983097983091 983089983096983092983088 983088983090983090983089 983091983088983091983097 983088983088983088983091 983089983094983093983096 983088983094983088983091
UW983091LW983091 minus983091983089983088983090983096 983089983091983097983089983088 minus983088983089983090983097 minus983090983090983091983089 983088983088983090983097 983089983088983092983095 983088983097983093983093
unstandardized regression coefficient SE standard error o szlig standardized regression coefficient VIF variance in1047298ation actor
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Computational and Mathematical Methods in Medicine 983095
the lower concavity angle o C983090 as independent variablesHowever in this study we de1047297ned the measurements o theC983090 vertebral bodyand the odontoidprocess Te dentocentralsynchondrosis was considered the border between the body and the odontoid process o C983090 Te results showed thatthe ratios o the C983090 body and the odontoid process were
correlated very highly with skeletal maturation status (as didthe bodies o the third and ourth cervical vertebrae whichwere used in the previous studies) (ables 983093 and 983094)
During embryonic development the second cervical vertebra arises rom 1047297ve primary bone growth centers (oneoccurs in the body two occur in bilateral neural archesand the other two occur in the odontoid process) separatedby synchondrotic articulations [983090983092 983090983093] Te two in theodontoid process are used at birth Te border betweenthe odontoid process and the body o the axis vertebra iswell demarcated by the dentocentral synchondrosis [983090983094] Tebilateral neurocentral synchondroses between the bilateralneural arch and the dentocentral synchondrosis use at 983091 to
983094 years o age Afer 983094 years o age the odontoid processuses with the vertebral body and the neural arches [983090983094]Te remnant o the dentocentral synchondrosis which isbelow the superior articulating acets appears on CBCand MRI images as a ring Cokluk et al [983089983094] compared theodontoid process-to-vertebral body ratios between childrenandadults based on MRIs o the dentocentral synchondrosisTereore we were able to use CBC images to de1047297ne the
vertebral body and its odontoid process and expected thatthe odontoid process and vertebral body might be importantindependent variables or the regression model derived romCBC-generated CVM
Several studies used the third and ourth vertebral bodies
and the concavity o their lower borders to assess skeletalmaturation [983089983088 983090983090 983090983091] Tey reported that many ratios o the width and height o the C983091 and C983092 were correlatedwith skeletal maturation status In the present study 983092983095 o 983094983092 parameters exhibited statistically signi1047297cant correlations( lt 005) similar to the 1047297ndings o other previous studies(able 983093) Te C983090 vertebral body and odontoid process weresigni1047297cant independent variables in all multiple regressionmodels In the multiple regression model with the highest
10383892 adjusted 1038389
2 and variance in1047298ation actors (VIF) lt983090which indicated the absence o multicollinearity problemsPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 were independent variables Tis model also
exhibited the highest coefficient o determination 983088983095983096983094indicating that these independent variables were able toexplain approximately 983095983096983094 o the SML variation
While the ratios o the third and ourth cervical vertebraehad strong correlation coefficients in previous CVM studiesthe present study added the ratio o the second cervical
vertebra which correlated strongly with CBC-generatedCVM as an indicator Altan et al [983090983095] investigated thelongitudinal growth o cervical vertebrae in girls rom 983096 to983089983095 years o age Te growth o the cervical vertebrae ollowsa somatic pattern and they reach their 1047297nal size at maturity [983090983096] C983089 and C983092 reached their peak size at approximately 983089983089983093 years o age and C983091 reached its maximal size at 983089983088983093
years o age However the growth curve or C983090 did nothave a distinct peak growth rate its growth rate curve wasmore linear [983090983097] Tereore in this study the parameterso the C983090 vertebral body and the odontoid process mightbe independent variables or the multiple linear regressionmodel because it has a more linear growth pattern Our
1047297ndings indicated that the growth o C983090 vertebral body andodontoid process might be a useul indicator or evaluatingthe stages o skeletal maturation Te multiple regressionmodels put orth by Chen et al [983090983091] and Mito et al [983090983090]included parameters such as the heightwidth ratios o thethird and ourth cervical vertebrae as independent variablesHowever regression models in our study with AH983091H983091 andH983092W983092 ratios had multicollinearity problems with high VIF
values (able 983094)Similarly the third and ourth cervical vertebrae arise
rom three primary ossi1047297cation centers (one in the body and two in the posterior arches) [983091983088 983091983089] Te shape o thebodies o third and ourth cervical vertebrae changes romwedge-shaped to rectangular and then becomes square Teirshapes grow vertically and then horizontally Te total lengthand height o the third and ourth cervical vertebrae have
very similar incremental curves Cervical vertebral growthoccurred in the order o the upper to the lower cervical ver-tebrae Tereore these parameters might induce statisticalmulticollinearity problems Many clinical studies regardingdental research have used multiple regression analysis to 1047297ndcorrelations between the predictorand the outcome variablesHowever collinearity in the statistic regression models is onepossible problem with the use o multiple regression analysisldquoMulticollinearityrdquo is the statistical term or the situation inwhich more than two covariates are highly correlated [983090983089]It can distort the interpretation o statistical results rommultiple regression models increasing both inaccuracy anduncertainty Multicollinearity should be considered in theregression model
We used the SML as a measure o the study participantsrsquoskeletal maturation status in order to build the multipleregression models in this study Te SML comprises 983089983088983088983088stages numbered rom 983088 to 983097983097983097 compared to 983089983089 stagesit provides a more re1047297ned skeletal maturation status as apercentage Te SML (with stages 983088 to 983097983097983097) was pertinentto statistical analysis as a parametric dependent variable ormultiple regression models Te present study has already con1047297rmed its high correlation to Fishmanrsquos SMI or buildingmultiple regression models ( lt 005 correlation coefficient
983088983097983093983088)Other CVM-based studies had large study popula-
tions that were heterogeneous regarding sex and ethnicityAlthough our study population was comparatively small andhomogeneous this study had the advantage o introducingthe modi1047297ed CBC-generated CVM with the de1047297ned body o the second cervical vertebra and the odontoid processrom the dentocentral synchondrosis Given this CBCapproach the study could not have a large study popula-tion Despite these difficulties this study demonstrated anew application o the second cervical vertebral body andodontoid to the CBC-generated CVM and resulted in thebuilding o multiple regression models We expect that sexual
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983096 Computational and Mathematical Methods in Medicine
dimorphism may imply divergence between boys and girlsduring the course o ossi1047297cation Ethnicity may explain therelatively high correspondence o ossi1047297cation level observedin the present study compared with other studies Tereoreadditional studies are needed to address questions regardingsexual dimorphism and ethnicity
5 Conclusions
CBC-generated CVM was able to include parameters romthe second cervical vertebral body and the odontoid processrespectively or multiple regression models Te derivedmultiple regression models demonstrated the potential o thenewly de1047297ned parameters o the second cervical vertebra
Conflict of Interests
All o the authors declare that there is no con1047298ict o interestsregarding the publication o this paper
Acknowledgment
Tis study was supported by two-year research grant romPusan National University (Woo-Sung Son)
References
[983089] U Hagg and J aranger ldquoMaturation indicators and the pub-ertal growth spurtrdquo American Journal of Orthodontics vol 983096983090no 983092 pp 983090983097983097ndash983091983088983097 983089983097983096983090
[983090] Uysal Z Sari S I Ramoglu and F A Bascifci ldquoRelation-ships between dental and skeletal maturity in urkish subjectsrdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983093983095ndash983094983094983092 983090983088983088983092
[983091] M OrsquoReilly and G J Yanniello ldquoMandibular growth changesand maturation o cervical vertebraemdasha longitudinal cephalo-metric studyrdquo Angle Orthodontist vol 983093983096 no 983090 pp 983089983095983097ndash983089983096983092983089983097983096983096
[983092] W W Greulich and S I Pyle Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanord University PressStanord Cali USA 983089983097983093983097
[983093] A BLewis and S M Garn ldquoTerelationshipbetween tooth or-mation and other maturation actorsrdquo Te Angle Orthodontist vol 983091983088 no 983090 pp 983095983088ndash983095983095 983089983097983094983088
[983094] C J Hunter ldquoTe correlation o acial growth with body heightand skeletal maturation at adolescencerdquo Te Angle Orthodontist vol 983091983094 no 983089 pp 983092983092ndash983093983092 983089983097983094983094
[983095] A Bjork and S Helm ldquoPrediction o the age o maximumpuberal growth in body heightrdquo Angle Orthodontist vol 983091983095 no983090 pp 983089983091983092ndash983089983092983091 983089983097983094983095
[983096] M I oani ldquoMandibular growth at pubertyrdquo Te American Journal of Orthodontics vol 983094983090 no 983090 pp 983089983095983094ndash983089983097983093 983089983097983095983090
[983097] U Hagg and J aranger ldquoMenarche and voice change asindicators o the pubertal growth spurtrdquo Acta OdontologicaScandinavica vol 983091983096 no 983091 pp 983089983095983097ndash983089983096983094 983089983097983096983088
[983089983088] P San Roman J C Palma M D Oteo and E Nevado ldquoSkeletalmaturation determined by cervical vertebrae developmentrdquoEuropean Journal of Orthodontics vol 983090983092 no 983091 pp 983091983088983091ndash983091983089983089983090983088983088983090
[983089983089] L Franchi Baccetti and J A McNamara Jr ldquoMandibulargrowth as related to cervical vertebral maturation and body
heightrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983089983096 no 983091 pp 983091983091983093ndash983091983092983088 983090983088983088983088
[983089983090] Baccetti L Franchi and J A McNamara Jr ldquoAn improved version o the cervical vertebral maturation (CVM) method orthe assessment o mandibular growthrdquo Te Angle Orthodontist vol 983095983090 no 983092 pp 983091983089983094ndash983091983090983091 983090983088983088983090
[983089983091] D B Gabriel K A Southard F Qian S D Marshall R GFranciscus and E Southard ldquoCervical vertebrae matura-tion method poor reproducibilityrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp983092983095983096e983089ndash983092983095983096e983095 983090983088983088983097
[983089983092] L-L Chen -M Xu J-H Jiang X-Z Zhang and J-XLin ldquoQuantitative cervical vertebral maturation assessment inadolescents with normal occlusion a mixed longitudinal studyrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983092 no 983094 pp 983095983090983088e983089ndash983095983090983088e983095 983090983088983088983096
[983089983093] A Chatzigianni and D J Halazonetis ldquoGeometric morphome-tric evaluation o cervical vertebrae shape and its relationshipto skeletal maturationrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp 983092983096983089e983089ndash983092983096983089e983097 983090983088983088983097
[983089983094] C Cokluk K Aydm C Rakunt O Iyigun and A Onder ldquoTeborders o the odontoid process o c983090 in adults and in childrenincluding the estimation o odontoidbody ratiordquo EuropeanSpine Journal vol 983089983093 no 983091 pp 983090983095983096ndash983090983096983090 983090983088983088983094
[983089983095] V Joshi Yamaguchi Y Matsuda N Kaneko K Maki and Okano ldquoSkeletal maturity assessment with the use o cone-beam computerized tomographyrdquo Oral Surgery Oral MedicineOral Pathology and Oral Radiology vol 983089983089983091 no 983094 pp 983096983092983089ndash983096983092983097983090983088983089983090
[983089983096] J B Ludlow L E Davies-Ludlow S L Brooks and WB Howerton ldquoDosimetry o 983091 CBC devices or oral andmaxilloacial radiology CB Mercuray Newom 983091G and i-CArdquoDentomaxillofacial Radiology vol 983091983093 no 983092 pp 983090983089983097ndash983090983090983094 983090983088983088983094
[983089983097] M Sempe La P acuteediatrie au Quotidian Analyse de la MaturationSequelettique Les Editions INSERM Paris France 983089983097983096983095
[983090983088] L S Fishman ldquoRadiographic evaluation o skeletal maturationA clinically oriented method based on hand-wirst 1047297lmsrdquo AngleOrthodontist vol 983093983090 no 983090 pp 983096983096ndash983089983089983090 983089983097983096983090
[983090983089] J Miles and M Shelvin Applying Regression and CorrelationSage Publication London UK 983090983088983088983089
[983090983090] Mito K Sato and H Mitani ldquoCervical vertebral bone agein girlsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983090 no 983092 pp 983091983096983088ndash983091983096983093 983090983088983088983090
[983090983091] F Chen K eradaand K Hanada ldquoA newmethod opredictingmandibular length incrementon the basis o cervical vertebraerdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983091983088ndash983094983091983092 983090983088983088983092
[983090983092] H Herkowitz S Gar1047297n F Eismont G Bell and R BalderstonRothman-Simeone Te Spine WB Saunders Philadelphia PaUSA 983090983088983089983089
[983090983093] A Verbout ldquoTe development o the vertebral columnrdquo Advances in Anatomy Embryology and Cell Biology vol 983097983088 no983089 pp 983089ndash983089983090983090 983089983097983096983093
[983090983094] K B Arbogast P A Gholve J E Friedman M R Maltese MF omasello and J P Dormans ldquoNormal cervical spine rangeo motion in children 983091ndash983089983090 years oldrdquo Spine vol 983091983090 no 983089983088 ppE983091983088983097ndashE983091983089983093 983090983088983088983095
[983090983095] M Altan O Nebioglu Dalc and H Iseri ldquoGrowth o thecervical vertebrae in girls rom 983096 to 983089983095 years A longitudinalstudyrdquo European Journal of Orthodontics vol 983091983092 no 983091 pp 983091983090983095ndash983091983091983092 983090983088983089983090
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 410
983092 Computational and Mathematical Methods in Medicine
983137983138983148983141 983091 Descriptive statistics or parameters in the C983090 C983091 and C983092 vertebral bodies
Parameter C983090 vertebra C983091 vertebra C983092 vertebra
Mean SD Min Max Mean SD Min Max Mean SD Min Max
AHH 983089983088983095 983088983088983093 983088983097983094 983089983090983088 983088983097983097 983088983088983094 983088983096983091 983089983089983091 983088983097983096 983088983088983095 983088983096983088 983089983089983093
HPH 983089983089983093 983088983088983093 983089983088983089 983089983090983097 983088983097983097 983088983088983093 983088983097983088 983089983089983095 983088983097983095 983088983088983093 983088983096983094 983089983088983095
AHPH 983089983090983091 983088983088983097 983088983097983095 983089983092983089 983088983097983097 983088983088983095 983088983095983097 983089983089983093 983088983097983093 983088983088983095 983088983095983092 983089983088983096UWW 983088983096983090 983088983088983094 983088983095983088 983088983097983091 983088983096983096 983088983088983093 983088983095983095 983088983097983095 983088983097983088 983088983088983093 983088983095983095 983089983088983094
WLW 983089983089983088 983088983088983096 983088983096983091 983089983090983094 983089983088983096 983088983088983092 983088983097983096 983089983089983095 983089983088983094 983088983088983093 983088983097983094 983089983089983096
UWLW 983088983097983088 983088983088983096 983088983095983092 983089983089983088 983088983097983093 983088983088983095 983088983096983091 983089983089983090 983088983097983093 983088983088983095 983088983095983095 983089983089983096
AHUW 983089983090983095 983088983089983089 983088983097983097 983089983093983093 983089983088983093 983088983090983088 983088983093983093 983089983092983089 983089983088983088 983088983090983088 983088983093983089 983089983091983095
HUW 983089983089983096 983088983089983089 983088983097983092 983089983092983093 983089983088983093 983088983089983095 983088983094983089 983089983091983094 983089983088983089 983088983089983094 983088983093983097 983089983091983094
PHUW 983089983088983091 983088983089983089 983088983096983089 983089983090983095 983089983088983094 983088983089983096 983088983093983095 983089983092983094 983089983088983093 983088983089983096 983088983094983089 983089983093983088
AHW 983089983088983092 983088983088983096 983088983096983094 983089983090983094 983088983097983089 983088983089983093 983088983093983089 983089983090983088 983088983096983097 983088983089983093 983088983092983096 983089983089983095
HW 983088983097983095 983088983088983096 983088983095983096 983089983089983093 983088983097983090 983088983089983090 983088983093983094 983089983089983093 983088983097983088 983088983089983090 983088983093983094 983089983089983094
PHW 983088983096983093 983088983088983097 983088983094983095 983089983089983088 983088983097983091 983088983089983091 983088983093983091 983089983089983093 983088983097983091 983088983089983092 983088983093983095 983089983090983092
AHLW 983089983089983092 983088983089983091 983088983096983095 983089983093983091 983088983097983097 983088983089983095 983088983093983092 983089983091983090 983088983097983092 983088983089983094 983088983093983089 983089983090983093
HLW 983089983088983094 983088983089983089 983088983096983093 983089983091983095 983088983097983097 983088983089983092 983088983093983095 983089983090983095 983088983097983094 983088983089983091 983088983093983097 983089983090983092
PHLW 983088983097983091 983088983089983089 983088983095983092 983089983090983089 983089983088983088 983088983089983093 983088983093983092 983089983090983095 983088983097983097 983088983089983093 983088983093983097 983089983091983091D 983089983095983093 983088983094983090 983088983088983094 983091983089983089 983089983095983091 983088983094983092 983088983088983089 983091983089983089 983089983093983089 983088983094983088 983088983089983090 983090983095983093
C983090 second cervical C983091 third cervical C983092 ourth cervical Min minimum Max maximum SD standard deviation
983137983138983148983141 983092 Descriptive statistics or SML and parameters in the C983090 vertebral body and odontoid process
Parameters Mean SD Min Max
SML 983096983090983088983090 983089983094983090983088 983089983096983091983088 983097983094983093983088
OHUW983090 983089983097983094 983088983089983097 983089983093983095 983090983092983092
OHAH983090 983089983093983093 983088983089983093 983089983089983092 983090983088983092
OHH983090 983089983094983095 983088983089983094 983089983090983096 983090983089983088
OHPH983090 983089983097983089 983088983090983088 983089983092983093 983090983091983097OUW983090 983089983097983094 983088983089983097 983089983093983095 983090983092983092
OHW983090 983089983094983089 983088983089983094 983089983091983094 983090983089983092
OHLW983090 983089983095983094 983088983089983093 983089983091983094 983090983089983092
(OH + AH983090)UW983090 983091983090983091 983088983090983094 983090983093983094 983091983095983096
(OH + AH983090)W983090 983090983094983094 983088983090983089 983090983090983095 983091983090983093
(OH + AH983090)LW983090 983090983097983088 983088983090983092 983090983090983091 983091983093983088
(OH + H983090)UW983090 983091983089983093 983088983090983094 983090983093983094 983091983095983092
(OH + H983090)W983090 983090983093983097 983088983090983089 983090983090983088 983091983090983090
(OH + H983090)LW983090 983090983096983090 983088983090983091 983090983090983090 983091983092983090
(OH + PH983090)UW983090 983091983088983088 983088983090983094 983090983092983095 983091983093983097
(OH + PH983090)W983090 983090983092983094 983088983090983090 983090983089983088 983091983090983088
(OH + PH983090)LW983090 983090983094983097 983088983090983090 983090983089983093 983091983090983096C983090 second cervical Min minimum Max maximum SD standard devia-tion
correlation between two variables we used the Shapiro-Wilk test ( lt 005) to con1047297rm the normality test in the sampledistribution
Te descriptive statistics o each parameter (obtainedrom CBC-generated CVM) are reported in ables 983091 and983092 We calculated the correlation coefficient rom these datain order to 1047297nd the correlation between the SML and theparameters rom CBC-generated CVM (able 983093) Out o atotal o 983094983092 parameters 983092983095 exhibited statistically signi1047297cant
correlations ( lt 005) Regression analysis with the SML(a dependent variable) and 983094983092 parameters rom CBC-generated CVM (independent variables) were employed tobuild eight multiple regression models (able 983094) Amongthese models the eighth multiple regression model (able 983094)
eatured the highest 10383892 and adjusted 1038389
2 Te model withPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 as independent variables exhibited the highest
coefficient o determination 983088983095983096983094 indicating that approxi-mately 983095983096983094 o the variation in the SML could be explainedby these independent variables Aside rom the signi1047297cant
enhancement o 10383892 there was no signi1047297cant multicollinearity between variables derived rom regression models or theSML We perormed multicollinearity tests based on the vari-ance in1047298ation actor (VIF) lt983090 which indicated the absenceo multicollinearity problems Te parameters AH983091W983091 andH983092W983092 had high VIF values (gt983090983088) in the ourth 1047297fh andsixth regression models Te models with these VIFs couldhave signi1047297cant multicollinearity problems [983090983089] (able 983094)
4 Discussion
Several methods or assessing skeletal maturation status havebeen introduced [983089ndash983092] Te CVM method has proven tobe especially useul Mito et al [983090983090] and Chen et al [983090983091]introduced multiple regression models in order to employ CVM to determine skeletal maturation stage Mito et al [983090983090]created a regression ormula to obtain cervical vertebral boneage they reported that the ormula was determined rom theratios o measurements in the third cervical vertebral (C983091)and ourth cervical (C983092) vertebral bodies Chen et al [983090983091]also developed ormulas that employed regression analysis topredict mandibularlength incrementusingcervical vertebraeand used the ratios o C983091 and C983092 vertebral bodies and
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Computational and Mathematical Methods in Medicine 983093
T 983137 983138 983148 983141 983093 C o r r e l a t i o n c o e ffi c i e n t b e t w e e n S e m p acute e m a t u r a
t i o n l e v e l a n d p a r a m e t e r s f r o m C B C T - g e n
e r a t e d c e r v i c a l v e r t e b r a l m a t u r a t i o n
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o
n
c o e ffi c i e n
t
P a r a m e t e r
C
o r r e l a t i o n
c
o e ffi c i e n t
A H 983091 L W 983091
983088 983096 983090 983095
983088 983088 983088 983088
D 983092
983088 983095 983091 983092
983088
983088 983088 983088
W 983091 L W 983091
983088 983093 983088 983095
983088 983088 983088 983089
H 983090 W 983090
minus 983088 983090 983095 983095
983088 983088 983093 983097
A H 983091 W 983091
983088 983096 983089 983096
983088 983088 983088 983088
A H 983091 H 983091
983088 983095 983091 983090
983088
983088 983088 983088
U W 983091 W 983091
minus 983088 983093 983088 983090
983088 983088 983088 983089
P H 983090 L W 983090
983088 983090 983095 983093
983088 983088 983094 983089
D 983091
983088 983096 983088 983094
983088 983088 983088 983088
P H 983091 U W 983091
983088 983095 983090 983090
983088
983088 983088 983088
H 983090 L W 983090
983088 983092 983097 983096
983088 983088 983088 983090
O H L W 983090
983088 983090 983091 983091
983088 983088 983097 983094
W 983090 L W 983090
983088 983096 983088 983091
983088 983088 983088 983088
H 983092 L W 983092
983088 983095 983089 983094
983088
983088 983088 983088
( O H + H 983090 ) W 983090
minus 983088 983092 983097 983094
983088 983088 983088 983090
H 983090 U W 983090
983088 983090 983089 983095
983088 983089 983089 983090
A H 983091 U W 983091
983088 983096 983088 983089
983088 983088 983088 983088
P H 983091 W 983091
983088 983095 983089 983091
983088
983088 983088 983088
H 983090 P H 983090
983088 983092 983095 983092
983088 983088 983088 983091
H 983091 P H 983091
minus 983088 983090 983088 983094
983088 983089 983090 983093
A H 983092 W 983092
983088 983095 983097 983091
983088 983088 983088 983088
D 983090
983088 983095 983088 983097
983088
983088 983088 983088
A H 983091 P H 983091
983088 983092 983095 983089
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
A H 983092 U W 983092
983088 983095 983096 983092
983088 983088 983088 983088
P H 983092 L W 983092
983088 983095 983088 983093
983088
983088 983088 983088
A H 983090 U W 983090
983088 983092 983095
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
H 983092 U W 983092
983088 983095 983096 983089
983088 983088 983088 983088
A H 983092 H 983092
983088 983094 983097 983090
983088
983088 983088 983088
( O H + A H 983090 ) L W 983090
983088 983092 983095
983088 983088 983088 983091
( O H + P H 983090 ) U W 983090
minus 983088 983089 983094 983089
983088 983089 983096 983093
H 983091 L W 983091
983088 983095 983095 983095
983088 983088 983088 983088
A H 983090 L W 983090
983088 983094 983093 983090
983088
983088 983088 983088
U W 983092 W 983092
minus 983088 983092 983094 983095
983088 983088 983088 983091
H 983092 P H 983092
minus 983088 983089 983091 983096
983088 983090 983090 983090
A H 983092 L W 983092
983088 983095 983095 983094
983088 983088 983088 983088
U W 983090 W 983090
minus 983088 983094 983091
983088
983088 983088 983088
P H 983090 W 983090
minus 983088 983092 983091 983094
983088 983088 983088 983094
U W 983091 L W 983091
minus 983088 983089 983090 983096
983088 983090 983091 983096
H 983092 W 983092
983088 983095 983095 983092
983088 983088 983088 983088
O H A H 983090
minus 983088 983094 983089 983092
983088
983088 983088 983088
U W 983090 L W 983090
983088 983092 983091
983088 983088 983088 983094
O H P H 983090
minus 983088 983089 983090
983088 983090 983093 983091
H 983091 W 983091
983088 983095 983094 983093
983088 983088 983088 983088
A H 983090 H 983090
983088 983094 983088 983092
983088
983088 983088 983088
( O H + A H 983090 ) W 983090
minus 983088 983091 983097 983096
983088 983088 983089 983089
A H 983090 W 983090
983088 983088 983094 983094
983088 983091 983093 983095
H 983091 U W 983091
983088 983095 983094 983090
983088 983088 983088 983088
A H 983090 P H 983090
983088 983094 983088 983089
983088
983088 983088 983088
( O H + H 983090 ) L W 983090
983088 983091 983096 983094
983088 983088 983089 983091
( O H + A H 983090 ) U W 983090
983088 983088 983094 983094
983088 983091 983093 983096
P H 983092 U W 983092
983088 983095 983093 983097
983088 983088 983088 983088
A H 983092 P H 983092
983088 983094 983088 983089
983088
983088 983088 983088
O H H 983090
minus 983088 983091 983094 983095
983088 983088 983089 983096
( O H + H 983090 ) U W 983090
minus 983088 983088 983093 983093
983088 983091 983096 983089
P H 983092 W 983092
983088 983095 983093 983092
983088 983088 983088 983088
( O H + P H 983090 ) W 983090
minus 983088 983093 983093
983088
983088 983088 983088
U W 983092 L W 983092
minus 983088 983091 983090
983088 983088 983091 983093
P H 983090 U W 983090
minus 983088 983088 983091 983097
983088 983092 983089 983093
P H 983091 L W 983091
983088 983095 983091 983096
983088 983088 983088 983088
O H W 983090
minus 983088 983093 983089 983091
983088
983088 983088 983089
( O H + P H 983090 ) L W 983090
983088 983090 983096 983094
983088 983088 983093 983091
W 983092 L W 983092
983088 983088 983090 983092
983088 983092 983092 983096
C B C T c o n e b e a m c o m p u t e d t o m o g r a p h y
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983094 Computational and Mathematical Methods in Medicine
983137983138983148983141 983094 Te results o multiple regression analysis using the stepwise elimination method
Multipleregressionmodels
Independent variables 907317 SE szlig 10383892 Adjusted 1038389
2 VIF 983089VIF
983089st Intercept 983093983095983093983088 983096983088983091983095 983088983095983089983093 983088983092983095983095 983088983093983094983090 983088983093983093983094
AH983091W983091 983096983091983093983090983089 983096983094983097983091 983088983095983093983088 983097983094983088983096 983088983088983088983088 983089983088983088983088 983089983088983088983088
983090nd
Intercept 983093983091983091983095983093 983089983091983093983097983089 983091983097983090983095 983088983088983088983088 983088983094983092983095 983088983094983091983095
AH983091W983091 983096983089983095983089983097 983095983096983094983095 983088983095983091983091 983089983088983091983096983096 983088983088983088983088 983089983088983088983091 983088983097983097983095
PH983090W983090 minus983093983092983090983090983096 983089983091983088983096983088 minus983088983090983097983091 minus983092983089983092983094 983088983088983088983088 983089983088983088983091 983088983097983097983095
983091rd
Intercept 983089983088983090983088983090983089 983089983097983097983097983091 983093983089983088983091 983088983088983088983088 983088983094983097983089 983088983094983095983096
AH983091W983091 983095983094983094983088983094 983095983093983096983092 983088983094983096983095 983089983088983089983088983090 983088983088983088983088 983089983088983093983089 983088983097983093983089
PH983090W983090 minus983092983089983092983095983096 983089983090983097983094983089 minus983088983090983090983092 minus983091983090983088983088 983088983088983088983090 983089983089983089983088 983088983097983088983089
UW983090W983090 minus983094983094983093983089983092 983090983088983097983097983097 minus983088983090983090983095 minus983091983089983094983095 983088983088983088983090 983089983089983094983091 983088983096983094983088
983092th
Intercept 983097983093983092983097983097 983089983097983089983094983090 983092983097983096983092 983088983088983088983088 983088983095983090983093 983088983095983088983097
AH983091W983091 983092983089983094983095983093 983089983092983089983089983096 983088983091983095983092 983090983097983093983090 983088983088983088983092 983092983088983090983088 983088983090983092983097
PH983090W983090 minus983092983096983092983088983094 983089983090983093983094983095 minus983088983090983094983089 minus983091983096983093983090 983088983088983088983088 983089983089983093983090 983088983096983094983096
UW983090W983090 minus983094983094983093983093983092 983089983097983097983096983093 minus983088983090983090983095 minus983091983091983091983088 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983092983097983088983090983092 983089983095983088983091983088 983088983091983094983091 983090983096983095983097 983088983088983088983093 983091983097983095983090 983088983090983093983090
983093th
Intercept 983095983094983096983092983093 983089983097983088983096983089 983092983088983090983095 983088983088983088983088 983088983095983093983096 983088983095983092983088
AH983091W983091 983090983096983094983095983089 983089983091983097983096983092 983088983090983093983095 983090983088983093983088 983088983088983092983092 983092983092983090983094 983088983090983090983094
PH983090W983090 minus983094983092983091983097983092 983089983090983097983093983094 minus983088983091983092983096 minus983092983097983095983088 983088983088983088983088 983089983091983095983092 983088983095983090983096
UW983090W983090 minus983094983096983089983092983096 983089983096983096983095983090 minus983088983090983091983090 minus983091983094983089983089 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983093983089983094983097983090 983089983094983088983097983097 983088983091983096983090 983091983090983089983089 983088983088983088983090 983091983097983096983092 983088983090983093983089
(OH + AH983090)LW983090 983089983092983096983089983089 983092983096983090983091 983088983090983090983091 983091983088983095983089 983088983088983088983091 983089983092983096983093 983088983094983095983091
983094th
Intercept 983094983093983093983088983088 983089983097983091983092983089 983091983091983096983095 983088983088983088983089 983088983095983095983092 983088983095983093983091
AH983091W983091 983089983093983090983095983097 983089983093983088983088983089 983088983089983091983095 983089983088983089983096 983088983091983089983090 983093983091983094983089 983088983089983096983095
PH983090W983090 minus983094983089983091983091983089 983089983090983095983088983097 minus983088983091983091983089 minus983092983096983090983094 983088983088983088983088 983089983091983097983090 983088983095983089983096
UW983090W983090 minus983093983095983090983095983092 983089983097983088983096983094 minus983088983089983097983093 minus983091983088983088983089 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983093983091983089983095983094 983089983093983095983088983096 983088983091983097983091 983091983091983096983093 983088983088983088983089 983091983097983097983090 983088983090983093983089
(OH + AH983090)LW983090 983089983093983096983091983094 983092983095983090983094 983088983090983091983097 983091983091983093983089 983088983088983088983089 983089983093983088983089 983088983094983094983094
D983091 983092983092983092983092 983090983088983095983097 983088983089983095983094 983090983089983091983096 983088983088983091983094 983089983097983097983097 983088983093983088983088
983095th
Intercept 983094983092983089983090983096 983089983097983091983088983088 983091983091983090983091 983088983088983088983089 983088983095983095983088 983088983095983093983091
PH983090W983090 minus983094983091983095983092983095 983089983090983092983097983088 minus983088983091983092983092 minus983093983089983088983092 983088983088983088983088 983089983091983092983092 983088983095983092983092
UW983090983090 minus983093983095983088983090983095 983089983097983088983097983088 minus983088983089983097983092 minus983090983097983096983095 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983094983093983093983096983095 983097983097983089983093 983088983092983096983093 983094983094983089983093 983088983088983088983088 983089983093983097983088 983088983094983090983097
(OH + AH983090)LW983090 983089983095983091983093983095 983092983092983096983093 983088983090983094983090 983091983096983095983088 983088983088983088983088 983089983091983093983089 983088983095983092983088
D983091 983093983091983090983096 983089983096983096983097 983088983090983089983089 983090983096983090983088 983088983088983088983094 983089983094983093983089 983088983094983088983094
983096th
Intercept 983097983094983088983093983090 983090983091983093983097983093 983092983088983095983089 983088983088983088983088 983088983095983096983094 983088983095983094983095
PH983090W983090 minus983094983090983092983092983097 983089983090983089983093983092 minus983088983091983091983095 minus983093983089983091983096 983088983088983088983088 983089983091983092983095 983088983095983092983090
UW983090W983090 minus983093983092983096983092983091 983089983096983093983096983089 minus983088983089983096983095 minus983090983097983093983090 983088983088983088983092 983089983090983093983094 983088983095983097983094
H983092W983092 983094983091983090983095983088 983097983094983097983091 983088983092983094983096 983094983093983090983095 983088983088983088983088 983089983094983088983096 983088983094983090983090
(OH + AH983090)LW983090 983089983094983088983095983094 983092983091983097983095 983088983090983092983090 983091983094983093983094 983088983088983088983089 983089983091983095983092 983088983095983090983096
D983091 983093983093983097983091 983089983096983092983088 983088983090983090983089 983091983088983091983097 983088983088983088983091 983089983094983093983096 983088983094983088983091
UW983091LW983091 minus983091983089983088983090983096 983089983091983097983089983088 minus983088983089983090983097 minus983090983090983091983089 983088983088983090983097 983089983088983092983095 983088983097983093983093
unstandardized regression coefficient SE standard error o szlig standardized regression coefficient VIF variance in1047298ation actor
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Computational and Mathematical Methods in Medicine 983095
the lower concavity angle o C983090 as independent variablesHowever in this study we de1047297ned the measurements o theC983090 vertebral bodyand the odontoidprocess Te dentocentralsynchondrosis was considered the border between the body and the odontoid process o C983090 Te results showed thatthe ratios o the C983090 body and the odontoid process were
correlated very highly with skeletal maturation status (as didthe bodies o the third and ourth cervical vertebrae whichwere used in the previous studies) (ables 983093 and 983094)
During embryonic development the second cervical vertebra arises rom 1047297ve primary bone growth centers (oneoccurs in the body two occur in bilateral neural archesand the other two occur in the odontoid process) separatedby synchondrotic articulations [983090983092 983090983093] Te two in theodontoid process are used at birth Te border betweenthe odontoid process and the body o the axis vertebra iswell demarcated by the dentocentral synchondrosis [983090983094] Tebilateral neurocentral synchondroses between the bilateralneural arch and the dentocentral synchondrosis use at 983091 to
983094 years o age Afer 983094 years o age the odontoid processuses with the vertebral body and the neural arches [983090983094]Te remnant o the dentocentral synchondrosis which isbelow the superior articulating acets appears on CBCand MRI images as a ring Cokluk et al [983089983094] compared theodontoid process-to-vertebral body ratios between childrenandadults based on MRIs o the dentocentral synchondrosisTereore we were able to use CBC images to de1047297ne the
vertebral body and its odontoid process and expected thatthe odontoid process and vertebral body might be importantindependent variables or the regression model derived romCBC-generated CVM
Several studies used the third and ourth vertebral bodies
and the concavity o their lower borders to assess skeletalmaturation [983089983088 983090983090 983090983091] Tey reported that many ratios o the width and height o the C983091 and C983092 were correlatedwith skeletal maturation status In the present study 983092983095 o 983094983092 parameters exhibited statistically signi1047297cant correlations( lt 005) similar to the 1047297ndings o other previous studies(able 983093) Te C983090 vertebral body and odontoid process weresigni1047297cant independent variables in all multiple regressionmodels In the multiple regression model with the highest
10383892 adjusted 1038389
2 and variance in1047298ation actors (VIF) lt983090which indicated the absence o multicollinearity problemsPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 were independent variables Tis model also
exhibited the highest coefficient o determination 983088983095983096983094indicating that these independent variables were able toexplain approximately 983095983096983094 o the SML variation
While the ratios o the third and ourth cervical vertebraehad strong correlation coefficients in previous CVM studiesthe present study added the ratio o the second cervical
vertebra which correlated strongly with CBC-generatedCVM as an indicator Altan et al [983090983095] investigated thelongitudinal growth o cervical vertebrae in girls rom 983096 to983089983095 years o age Te growth o the cervical vertebrae ollowsa somatic pattern and they reach their 1047297nal size at maturity [983090983096] C983089 and C983092 reached their peak size at approximately 983089983089983093 years o age and C983091 reached its maximal size at 983089983088983093
years o age However the growth curve or C983090 did nothave a distinct peak growth rate its growth rate curve wasmore linear [983090983097] Tereore in this study the parameterso the C983090 vertebral body and the odontoid process mightbe independent variables or the multiple linear regressionmodel because it has a more linear growth pattern Our
1047297ndings indicated that the growth o C983090 vertebral body andodontoid process might be a useul indicator or evaluatingthe stages o skeletal maturation Te multiple regressionmodels put orth by Chen et al [983090983091] and Mito et al [983090983090]included parameters such as the heightwidth ratios o thethird and ourth cervical vertebrae as independent variablesHowever regression models in our study with AH983091H983091 andH983092W983092 ratios had multicollinearity problems with high VIF
values (able 983094)Similarly the third and ourth cervical vertebrae arise
rom three primary ossi1047297cation centers (one in the body and two in the posterior arches) [983091983088 983091983089] Te shape o thebodies o third and ourth cervical vertebrae changes romwedge-shaped to rectangular and then becomes square Teirshapes grow vertically and then horizontally Te total lengthand height o the third and ourth cervical vertebrae have
very similar incremental curves Cervical vertebral growthoccurred in the order o the upper to the lower cervical ver-tebrae Tereore these parameters might induce statisticalmulticollinearity problems Many clinical studies regardingdental research have used multiple regression analysis to 1047297ndcorrelations between the predictorand the outcome variablesHowever collinearity in the statistic regression models is onepossible problem with the use o multiple regression analysisldquoMulticollinearityrdquo is the statistical term or the situation inwhich more than two covariates are highly correlated [983090983089]It can distort the interpretation o statistical results rommultiple regression models increasing both inaccuracy anduncertainty Multicollinearity should be considered in theregression model
We used the SML as a measure o the study participantsrsquoskeletal maturation status in order to build the multipleregression models in this study Te SML comprises 983089983088983088983088stages numbered rom 983088 to 983097983097983097 compared to 983089983089 stagesit provides a more re1047297ned skeletal maturation status as apercentage Te SML (with stages 983088 to 983097983097983097) was pertinentto statistical analysis as a parametric dependent variable ormultiple regression models Te present study has already con1047297rmed its high correlation to Fishmanrsquos SMI or buildingmultiple regression models ( lt 005 correlation coefficient
983088983097983093983088)Other CVM-based studies had large study popula-
tions that were heterogeneous regarding sex and ethnicityAlthough our study population was comparatively small andhomogeneous this study had the advantage o introducingthe modi1047297ed CBC-generated CVM with the de1047297ned body o the second cervical vertebra and the odontoid processrom the dentocentral synchondrosis Given this CBCapproach the study could not have a large study popula-tion Despite these difficulties this study demonstrated anew application o the second cervical vertebral body andodontoid to the CBC-generated CVM and resulted in thebuilding o multiple regression models We expect that sexual
7172019 405912
httpslidepdfcomreaderfull405912 810
983096 Computational and Mathematical Methods in Medicine
dimorphism may imply divergence between boys and girlsduring the course o ossi1047297cation Ethnicity may explain therelatively high correspondence o ossi1047297cation level observedin the present study compared with other studies Tereoreadditional studies are needed to address questions regardingsexual dimorphism and ethnicity
5 Conclusions
CBC-generated CVM was able to include parameters romthe second cervical vertebral body and the odontoid processrespectively or multiple regression models Te derivedmultiple regression models demonstrated the potential o thenewly de1047297ned parameters o the second cervical vertebra
Conflict of Interests
All o the authors declare that there is no con1047298ict o interestsregarding the publication o this paper
Acknowledgment
Tis study was supported by two-year research grant romPusan National University (Woo-Sung Son)
References
[983089] U Hagg and J aranger ldquoMaturation indicators and the pub-ertal growth spurtrdquo American Journal of Orthodontics vol 983096983090no 983092 pp 983090983097983097ndash983091983088983097 983089983097983096983090
[983090] Uysal Z Sari S I Ramoglu and F A Bascifci ldquoRelation-ships between dental and skeletal maturity in urkish subjectsrdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983093983095ndash983094983094983092 983090983088983088983092
[983091] M OrsquoReilly and G J Yanniello ldquoMandibular growth changesand maturation o cervical vertebraemdasha longitudinal cephalo-metric studyrdquo Angle Orthodontist vol 983093983096 no 983090 pp 983089983095983097ndash983089983096983092983089983097983096983096
[983092] W W Greulich and S I Pyle Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanord University PressStanord Cali USA 983089983097983093983097
[983093] A BLewis and S M Garn ldquoTerelationshipbetween tooth or-mation and other maturation actorsrdquo Te Angle Orthodontist vol 983091983088 no 983090 pp 983095983088ndash983095983095 983089983097983094983088
[983094] C J Hunter ldquoTe correlation o acial growth with body heightand skeletal maturation at adolescencerdquo Te Angle Orthodontist vol 983091983094 no 983089 pp 983092983092ndash983093983092 983089983097983094983094
[983095] A Bjork and S Helm ldquoPrediction o the age o maximumpuberal growth in body heightrdquo Angle Orthodontist vol 983091983095 no983090 pp 983089983091983092ndash983089983092983091 983089983097983094983095
[983096] M I oani ldquoMandibular growth at pubertyrdquo Te American Journal of Orthodontics vol 983094983090 no 983090 pp 983089983095983094ndash983089983097983093 983089983097983095983090
[983097] U Hagg and J aranger ldquoMenarche and voice change asindicators o the pubertal growth spurtrdquo Acta OdontologicaScandinavica vol 983091983096 no 983091 pp 983089983095983097ndash983089983096983094 983089983097983096983088
[983089983088] P San Roman J C Palma M D Oteo and E Nevado ldquoSkeletalmaturation determined by cervical vertebrae developmentrdquoEuropean Journal of Orthodontics vol 983090983092 no 983091 pp 983091983088983091ndash983091983089983089983090983088983088983090
[983089983089] L Franchi Baccetti and J A McNamara Jr ldquoMandibulargrowth as related to cervical vertebral maturation and body
heightrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983089983096 no 983091 pp 983091983091983093ndash983091983092983088 983090983088983088983088
[983089983090] Baccetti L Franchi and J A McNamara Jr ldquoAn improved version o the cervical vertebral maturation (CVM) method orthe assessment o mandibular growthrdquo Te Angle Orthodontist vol 983095983090 no 983092 pp 983091983089983094ndash983091983090983091 983090983088983088983090
[983089983091] D B Gabriel K A Southard F Qian S D Marshall R GFranciscus and E Southard ldquoCervical vertebrae matura-tion method poor reproducibilityrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp983092983095983096e983089ndash983092983095983096e983095 983090983088983088983097
[983089983092] L-L Chen -M Xu J-H Jiang X-Z Zhang and J-XLin ldquoQuantitative cervical vertebral maturation assessment inadolescents with normal occlusion a mixed longitudinal studyrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983092 no 983094 pp 983095983090983088e983089ndash983095983090983088e983095 983090983088983088983096
[983089983093] A Chatzigianni and D J Halazonetis ldquoGeometric morphome-tric evaluation o cervical vertebrae shape and its relationshipto skeletal maturationrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp 983092983096983089e983089ndash983092983096983089e983097 983090983088983088983097
[983089983094] C Cokluk K Aydm C Rakunt O Iyigun and A Onder ldquoTeborders o the odontoid process o c983090 in adults and in childrenincluding the estimation o odontoidbody ratiordquo EuropeanSpine Journal vol 983089983093 no 983091 pp 983090983095983096ndash983090983096983090 983090983088983088983094
[983089983095] V Joshi Yamaguchi Y Matsuda N Kaneko K Maki and Okano ldquoSkeletal maturity assessment with the use o cone-beam computerized tomographyrdquo Oral Surgery Oral MedicineOral Pathology and Oral Radiology vol 983089983089983091 no 983094 pp 983096983092983089ndash983096983092983097983090983088983089983090
[983089983096] J B Ludlow L E Davies-Ludlow S L Brooks and WB Howerton ldquoDosimetry o 983091 CBC devices or oral andmaxilloacial radiology CB Mercuray Newom 983091G and i-CArdquoDentomaxillofacial Radiology vol 983091983093 no 983092 pp 983090983089983097ndash983090983090983094 983090983088983088983094
[983089983097] M Sempe La P acuteediatrie au Quotidian Analyse de la MaturationSequelettique Les Editions INSERM Paris France 983089983097983096983095
[983090983088] L S Fishman ldquoRadiographic evaluation o skeletal maturationA clinically oriented method based on hand-wirst 1047297lmsrdquo AngleOrthodontist vol 983093983090 no 983090 pp 983096983096ndash983089983089983090 983089983097983096983090
[983090983089] J Miles and M Shelvin Applying Regression and CorrelationSage Publication London UK 983090983088983088983089
[983090983090] Mito K Sato and H Mitani ldquoCervical vertebral bone agein girlsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983090 no 983092 pp 983091983096983088ndash983091983096983093 983090983088983088983090
[983090983091] F Chen K eradaand K Hanada ldquoA newmethod opredictingmandibular length incrementon the basis o cervical vertebraerdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983091983088ndash983094983091983092 983090983088983088983092
[983090983092] H Herkowitz S Gar1047297n F Eismont G Bell and R BalderstonRothman-Simeone Te Spine WB Saunders Philadelphia PaUSA 983090983088983089983089
[983090983093] A Verbout ldquoTe development o the vertebral columnrdquo Advances in Anatomy Embryology and Cell Biology vol 983097983088 no983089 pp 983089ndash983089983090983090 983089983097983096983093
[983090983094] K B Arbogast P A Gholve J E Friedman M R Maltese MF omasello and J P Dormans ldquoNormal cervical spine rangeo motion in children 983091ndash983089983090 years oldrdquo Spine vol 983091983090 no 983089983088 ppE983091983088983097ndashE983091983089983093 983090983088983088983095
[983090983095] M Altan O Nebioglu Dalc and H Iseri ldquoGrowth o thecervical vertebrae in girls rom 983096 to 983089983095 years A longitudinalstudyrdquo European Journal of Orthodontics vol 983091983092 no 983091 pp 983091983090983095ndash983091983091983092 983090983088983089983090
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 510
Computational and Mathematical Methods in Medicine 983093
T 983137 983138 983148 983141 983093 C o r r e l a t i o n c o e ffi c i e n t b e t w e e n S e m p acute e m a t u r a
t i o n l e v e l a n d p a r a m e t e r s f r o m C B C T - g e n
e r a t e d c e r v i c a l v e r t e b r a l m a t u r a t i o n
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o n
c o e ffi c i e n t
P a r a m e t e r
C o r r e l a t i o
n
c o e ffi c i e n
t
P a r a m e t e r
C
o r r e l a t i o n
c
o e ffi c i e n t
A H 983091 L W 983091
983088 983096 983090 983095
983088 983088 983088 983088
D 983092
983088 983095 983091 983092
983088
983088 983088 983088
W 983091 L W 983091
983088 983093 983088 983095
983088 983088 983088 983089
H 983090 W 983090
minus 983088 983090 983095 983095
983088 983088 983093 983097
A H 983091 W 983091
983088 983096 983089 983096
983088 983088 983088 983088
A H 983091 H 983091
983088 983095 983091 983090
983088
983088 983088 983088
U W 983091 W 983091
minus 983088 983093 983088 983090
983088 983088 983088 983089
P H 983090 L W 983090
983088 983090 983095 983093
983088 983088 983094 983089
D 983091
983088 983096 983088 983094
983088 983088 983088 983088
P H 983091 U W 983091
983088 983095 983090 983090
983088
983088 983088 983088
H 983090 L W 983090
983088 983092 983097 983096
983088 983088 983088 983090
O H L W 983090
983088 983090 983091 983091
983088 983088 983097 983094
W 983090 L W 983090
983088 983096 983088 983091
983088 983088 983088 983088
H 983092 L W 983092
983088 983095 983089 983094
983088
983088 983088 983088
( O H + H 983090 ) W 983090
minus 983088 983092 983097 983094
983088 983088 983088 983090
H 983090 U W 983090
983088 983090 983089 983095
983088 983089 983089 983090
A H 983091 U W 983091
983088 983096 983088 983089
983088 983088 983088 983088
P H 983091 W 983091
983088 983095 983089 983091
983088
983088 983088 983088
H 983090 P H 983090
983088 983092 983095 983092
983088 983088 983088 983091
H 983091 P H 983091
minus 983088 983090 983088 983094
983088 983089 983090 983093
A H 983092 W 983092
983088 983095 983097 983091
983088 983088 983088 983088
D 983090
983088 983095 983088 983097
983088
983088 983088 983088
A H 983091 P H 983091
983088 983092 983095 983089
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
A H 983092 U W 983092
983088 983095 983096 983092
983088 983088 983088 983088
P H 983092 L W 983092
983088 983095 983088 983093
983088
983088 983088 983088
A H 983090 U W 983090
983088 983092 983095
983088 983088 983088 983091
O H U W 983090
minus 983088 983089 983097 983091
983088 983089 983092 983089
H 983092 U W 983092
983088 983095 983096 983089
983088 983088 983088 983088
A H 983092 H 983092
983088 983094 983097 983090
983088
983088 983088 983088
( O H + A H 983090 ) L W 983090
983088 983092 983095
983088 983088 983088 983091
( O H + P H 983090 ) U W 983090
minus 983088 983089 983094 983089
983088 983089 983096 983093
H 983091 L W 983091
983088 983095 983095 983095
983088 983088 983088 983088
A H 983090 L W 983090
983088 983094 983093 983090
983088
983088 983088 983088
U W 983092 W 983092
minus 983088 983092 983094 983095
983088 983088 983088 983091
H 983092 P H 983092
minus 983088 983089 983091 983096
983088 983090 983090 983090
A H 983092 L W 983092
983088 983095 983095 983094
983088 983088 983088 983088
U W 983090 W 983090
minus 983088 983094 983091
983088
983088 983088 983088
P H 983090 W 983090
minus 983088 983092 983091 983094
983088 983088 983088 983094
U W 983091 L W 983091
minus 983088 983089 983090 983096
983088 983090 983091 983096
H 983092 W 983092
983088 983095 983095 983092
983088 983088 983088 983088
O H A H 983090
minus 983088 983094 983089 983092
983088
983088 983088 983088
U W 983090 L W 983090
983088 983092 983091
983088 983088 983088 983094
O H P H 983090
minus 983088 983089 983090
983088 983090 983093 983091
H 983091 W 983091
983088 983095 983094 983093
983088 983088 983088 983088
A H 983090 H 983090
983088 983094 983088 983092
983088
983088 983088 983088
( O H + A H 983090 ) W 983090
minus 983088 983091 983097 983096
983088 983088 983089 983089
A H 983090 W 983090
983088 983088 983094 983094
983088 983091 983093 983095
H 983091 U W 983091
983088 983095 983094 983090
983088 983088 983088 983088
A H 983090 P H 983090
983088 983094 983088 983089
983088
983088 983088 983088
( O H + H 983090 ) L W 983090
983088 983091 983096 983094
983088 983088 983089 983091
( O H + A H 983090 ) U W 983090
983088 983088 983094 983094
983088 983091 983093 983096
P H 983092 U W 983092
983088 983095 983093 983097
983088 983088 983088 983088
A H 983092 P H 983092
983088 983094 983088 983089
983088
983088 983088 983088
O H H 983090
minus 983088 983091 983094 983095
983088 983088 983089 983096
( O H + H 983090 ) U W 983090
minus 983088 983088 983093 983093
983088 983091 983096 983089
P H 983092 W 983092
983088 983095 983093 983092
983088 983088 983088 983088
( O H + P H 983090 ) W 983090
minus 983088 983093 983093
983088
983088 983088 983088
U W 983092 L W 983092
minus 983088 983091 983090
983088 983088 983091 983093
P H 983090 U W 983090
minus 983088 983088 983091 983097
983088 983092 983089 983093
P H 983091 L W 983091
983088 983095 983091 983096
983088 983088 983088 983088
O H W 983090
minus 983088 983093 983089 983091
983088
983088 983088 983089
( O H + P H 983090 ) L W 983090
983088 983090 983096 983094
983088 983088 983093 983091
W 983092 L W 983092
983088 983088 983090 983092
983088 983092 983092 983096
C B C T c o n e b e a m c o m p u t e d t o m o g r a p h y
7172019 405912
httpslidepdfcomreaderfull405912 610
983094 Computational and Mathematical Methods in Medicine
983137983138983148983141 983094 Te results o multiple regression analysis using the stepwise elimination method
Multipleregressionmodels
Independent variables 907317 SE szlig 10383892 Adjusted 1038389
2 VIF 983089VIF
983089st Intercept 983093983095983093983088 983096983088983091983095 983088983095983089983093 983088983092983095983095 983088983093983094983090 983088983093983093983094
AH983091W983091 983096983091983093983090983089 983096983094983097983091 983088983095983093983088 983097983094983088983096 983088983088983088983088 983089983088983088983088 983089983088983088983088
983090nd
Intercept 983093983091983091983095983093 983089983091983093983097983089 983091983097983090983095 983088983088983088983088 983088983094983092983095 983088983094983091983095
AH983091W983091 983096983089983095983089983097 983095983096983094983095 983088983095983091983091 983089983088983091983096983096 983088983088983088983088 983089983088983088983091 983088983097983097983095
PH983090W983090 minus983093983092983090983090983096 983089983091983088983096983088 minus983088983090983097983091 minus983092983089983092983094 983088983088983088983088 983089983088983088983091 983088983097983097983095
983091rd
Intercept 983089983088983090983088983090983089 983089983097983097983097983091 983093983089983088983091 983088983088983088983088 983088983094983097983089 983088983094983095983096
AH983091W983091 983095983094983094983088983094 983095983093983096983092 983088983094983096983095 983089983088983089983088983090 983088983088983088983088 983089983088983093983089 983088983097983093983089
PH983090W983090 minus983092983089983092983095983096 983089983090983097983094983089 minus983088983090983090983092 minus983091983090983088983088 983088983088983088983090 983089983089983089983088 983088983097983088983089
UW983090W983090 minus983094983094983093983089983092 983090983088983097983097983097 minus983088983090983090983095 minus983091983089983094983095 983088983088983088983090 983089983089983094983091 983088983096983094983088
983092th
Intercept 983097983093983092983097983097 983089983097983089983094983090 983092983097983096983092 983088983088983088983088 983088983095983090983093 983088983095983088983097
AH983091W983091 983092983089983094983095983093 983089983092983089983089983096 983088983091983095983092 983090983097983093983090 983088983088983088983092 983092983088983090983088 983088983090983092983097
PH983090W983090 minus983092983096983092983088983094 983089983090983093983094983095 minus983088983090983094983089 minus983091983096983093983090 983088983088983088983088 983089983089983093983090 983088983096983094983096
UW983090W983090 minus983094983094983093983093983092 983089983097983097983096983093 minus983088983090983090983095 minus983091983091983091983088 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983092983097983088983090983092 983089983095983088983091983088 983088983091983094983091 983090983096983095983097 983088983088983088983093 983091983097983095983090 983088983090983093983090
983093th
Intercept 983095983094983096983092983093 983089983097983088983096983089 983092983088983090983095 983088983088983088983088 983088983095983093983096 983088983095983092983088
AH983091W983091 983090983096983094983095983089 983089983091983097983096983092 983088983090983093983095 983090983088983093983088 983088983088983092983092 983092983092983090983094 983088983090983090983094
PH983090W983090 minus983094983092983091983097983092 983089983090983097983093983094 minus983088983091983092983096 minus983092983097983095983088 983088983088983088983088 983089983091983095983092 983088983095983090983096
UW983090W983090 minus983094983096983089983092983096 983089983096983096983095983090 minus983088983090983091983090 minus983091983094983089983089 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983093983089983094983097983090 983089983094983088983097983097 983088983091983096983090 983091983090983089983089 983088983088983088983090 983091983097983096983092 983088983090983093983089
(OH + AH983090)LW983090 983089983092983096983089983089 983092983096983090983091 983088983090983090983091 983091983088983095983089 983088983088983088983091 983089983092983096983093 983088983094983095983091
983094th
Intercept 983094983093983093983088983088 983089983097983091983092983089 983091983091983096983095 983088983088983088983089 983088983095983095983092 983088983095983093983091
AH983091W983091 983089983093983090983095983097 983089983093983088983088983089 983088983089983091983095 983089983088983089983096 983088983091983089983090 983093983091983094983089 983088983089983096983095
PH983090W983090 minus983094983089983091983091983089 983089983090983095983088983097 minus983088983091983091983089 minus983092983096983090983094 983088983088983088983088 983089983091983097983090 983088983095983089983096
UW983090W983090 minus983093983095983090983095983092 983089983097983088983096983094 minus983088983089983097983093 minus983091983088983088983089 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983093983091983089983095983094 983089983093983095983088983096 983088983091983097983091 983091983091983096983093 983088983088983088983089 983091983097983097983090 983088983090983093983089
(OH + AH983090)LW983090 983089983093983096983091983094 983092983095983090983094 983088983090983091983097 983091983091983093983089 983088983088983088983089 983089983093983088983089 983088983094983094983094
D983091 983092983092983092983092 983090983088983095983097 983088983089983095983094 983090983089983091983096 983088983088983091983094 983089983097983097983097 983088983093983088983088
983095th
Intercept 983094983092983089983090983096 983089983097983091983088983088 983091983091983090983091 983088983088983088983089 983088983095983095983088 983088983095983093983091
PH983090W983090 minus983094983091983095983092983095 983089983090983092983097983088 minus983088983091983092983092 minus983093983089983088983092 983088983088983088983088 983089983091983092983092 983088983095983092983092
UW983090983090 minus983093983095983088983090983095 983089983097983088983097983088 minus983088983089983097983092 minus983090983097983096983095 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983094983093983093983096983095 983097983097983089983093 983088983092983096983093 983094983094983089983093 983088983088983088983088 983089983093983097983088 983088983094983090983097
(OH + AH983090)LW983090 983089983095983091983093983095 983092983092983096983093 983088983090983094983090 983091983096983095983088 983088983088983088983088 983089983091983093983089 983088983095983092983088
D983091 983093983091983090983096 983089983096983096983097 983088983090983089983089 983090983096983090983088 983088983088983088983094 983089983094983093983089 983088983094983088983094
983096th
Intercept 983097983094983088983093983090 983090983091983093983097983093 983092983088983095983089 983088983088983088983088 983088983095983096983094 983088983095983094983095
PH983090W983090 minus983094983090983092983092983097 983089983090983089983093983092 minus983088983091983091983095 minus983093983089983091983096 983088983088983088983088 983089983091983092983095 983088983095983092983090
UW983090W983090 minus983093983092983096983092983091 983089983096983093983096983089 minus983088983089983096983095 minus983090983097983093983090 983088983088983088983092 983089983090983093983094 983088983095983097983094
H983092W983092 983094983091983090983095983088 983097983094983097983091 983088983092983094983096 983094983093983090983095 983088983088983088983088 983089983094983088983096 983088983094983090983090
(OH + AH983090)LW983090 983089983094983088983095983094 983092983091983097983095 983088983090983092983090 983091983094983093983094 983088983088983088983089 983089983091983095983092 983088983095983090983096
D983091 983093983093983097983091 983089983096983092983088 983088983090983090983089 983091983088983091983097 983088983088983088983091 983089983094983093983096 983088983094983088983091
UW983091LW983091 minus983091983089983088983090983096 983089983091983097983089983088 minus983088983089983090983097 minus983090983090983091983089 983088983088983090983097 983089983088983092983095 983088983097983093983093
unstandardized regression coefficient SE standard error o szlig standardized regression coefficient VIF variance in1047298ation actor
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Computational and Mathematical Methods in Medicine 983095
the lower concavity angle o C983090 as independent variablesHowever in this study we de1047297ned the measurements o theC983090 vertebral bodyand the odontoidprocess Te dentocentralsynchondrosis was considered the border between the body and the odontoid process o C983090 Te results showed thatthe ratios o the C983090 body and the odontoid process were
correlated very highly with skeletal maturation status (as didthe bodies o the third and ourth cervical vertebrae whichwere used in the previous studies) (ables 983093 and 983094)
During embryonic development the second cervical vertebra arises rom 1047297ve primary bone growth centers (oneoccurs in the body two occur in bilateral neural archesand the other two occur in the odontoid process) separatedby synchondrotic articulations [983090983092 983090983093] Te two in theodontoid process are used at birth Te border betweenthe odontoid process and the body o the axis vertebra iswell demarcated by the dentocentral synchondrosis [983090983094] Tebilateral neurocentral synchondroses between the bilateralneural arch and the dentocentral synchondrosis use at 983091 to
983094 years o age Afer 983094 years o age the odontoid processuses with the vertebral body and the neural arches [983090983094]Te remnant o the dentocentral synchondrosis which isbelow the superior articulating acets appears on CBCand MRI images as a ring Cokluk et al [983089983094] compared theodontoid process-to-vertebral body ratios between childrenandadults based on MRIs o the dentocentral synchondrosisTereore we were able to use CBC images to de1047297ne the
vertebral body and its odontoid process and expected thatthe odontoid process and vertebral body might be importantindependent variables or the regression model derived romCBC-generated CVM
Several studies used the third and ourth vertebral bodies
and the concavity o their lower borders to assess skeletalmaturation [983089983088 983090983090 983090983091] Tey reported that many ratios o the width and height o the C983091 and C983092 were correlatedwith skeletal maturation status In the present study 983092983095 o 983094983092 parameters exhibited statistically signi1047297cant correlations( lt 005) similar to the 1047297ndings o other previous studies(able 983093) Te C983090 vertebral body and odontoid process weresigni1047297cant independent variables in all multiple regressionmodels In the multiple regression model with the highest
10383892 adjusted 1038389
2 and variance in1047298ation actors (VIF) lt983090which indicated the absence o multicollinearity problemsPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 were independent variables Tis model also
exhibited the highest coefficient o determination 983088983095983096983094indicating that these independent variables were able toexplain approximately 983095983096983094 o the SML variation
While the ratios o the third and ourth cervical vertebraehad strong correlation coefficients in previous CVM studiesthe present study added the ratio o the second cervical
vertebra which correlated strongly with CBC-generatedCVM as an indicator Altan et al [983090983095] investigated thelongitudinal growth o cervical vertebrae in girls rom 983096 to983089983095 years o age Te growth o the cervical vertebrae ollowsa somatic pattern and they reach their 1047297nal size at maturity [983090983096] C983089 and C983092 reached their peak size at approximately 983089983089983093 years o age and C983091 reached its maximal size at 983089983088983093
years o age However the growth curve or C983090 did nothave a distinct peak growth rate its growth rate curve wasmore linear [983090983097] Tereore in this study the parameterso the C983090 vertebral body and the odontoid process mightbe independent variables or the multiple linear regressionmodel because it has a more linear growth pattern Our
1047297ndings indicated that the growth o C983090 vertebral body andodontoid process might be a useul indicator or evaluatingthe stages o skeletal maturation Te multiple regressionmodels put orth by Chen et al [983090983091] and Mito et al [983090983090]included parameters such as the heightwidth ratios o thethird and ourth cervical vertebrae as independent variablesHowever regression models in our study with AH983091H983091 andH983092W983092 ratios had multicollinearity problems with high VIF
values (able 983094)Similarly the third and ourth cervical vertebrae arise
rom three primary ossi1047297cation centers (one in the body and two in the posterior arches) [983091983088 983091983089] Te shape o thebodies o third and ourth cervical vertebrae changes romwedge-shaped to rectangular and then becomes square Teirshapes grow vertically and then horizontally Te total lengthand height o the third and ourth cervical vertebrae have
very similar incremental curves Cervical vertebral growthoccurred in the order o the upper to the lower cervical ver-tebrae Tereore these parameters might induce statisticalmulticollinearity problems Many clinical studies regardingdental research have used multiple regression analysis to 1047297ndcorrelations between the predictorand the outcome variablesHowever collinearity in the statistic regression models is onepossible problem with the use o multiple regression analysisldquoMulticollinearityrdquo is the statistical term or the situation inwhich more than two covariates are highly correlated [983090983089]It can distort the interpretation o statistical results rommultiple regression models increasing both inaccuracy anduncertainty Multicollinearity should be considered in theregression model
We used the SML as a measure o the study participantsrsquoskeletal maturation status in order to build the multipleregression models in this study Te SML comprises 983089983088983088983088stages numbered rom 983088 to 983097983097983097 compared to 983089983089 stagesit provides a more re1047297ned skeletal maturation status as apercentage Te SML (with stages 983088 to 983097983097983097) was pertinentto statistical analysis as a parametric dependent variable ormultiple regression models Te present study has already con1047297rmed its high correlation to Fishmanrsquos SMI or buildingmultiple regression models ( lt 005 correlation coefficient
983088983097983093983088)Other CVM-based studies had large study popula-
tions that were heterogeneous regarding sex and ethnicityAlthough our study population was comparatively small andhomogeneous this study had the advantage o introducingthe modi1047297ed CBC-generated CVM with the de1047297ned body o the second cervical vertebra and the odontoid processrom the dentocentral synchondrosis Given this CBCapproach the study could not have a large study popula-tion Despite these difficulties this study demonstrated anew application o the second cervical vertebral body andodontoid to the CBC-generated CVM and resulted in thebuilding o multiple regression models We expect that sexual
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983096 Computational and Mathematical Methods in Medicine
dimorphism may imply divergence between boys and girlsduring the course o ossi1047297cation Ethnicity may explain therelatively high correspondence o ossi1047297cation level observedin the present study compared with other studies Tereoreadditional studies are needed to address questions regardingsexual dimorphism and ethnicity
5 Conclusions
CBC-generated CVM was able to include parameters romthe second cervical vertebral body and the odontoid processrespectively or multiple regression models Te derivedmultiple regression models demonstrated the potential o thenewly de1047297ned parameters o the second cervical vertebra
Conflict of Interests
All o the authors declare that there is no con1047298ict o interestsregarding the publication o this paper
Acknowledgment
Tis study was supported by two-year research grant romPusan National University (Woo-Sung Son)
References
[983089] U Hagg and J aranger ldquoMaturation indicators and the pub-ertal growth spurtrdquo American Journal of Orthodontics vol 983096983090no 983092 pp 983090983097983097ndash983091983088983097 983089983097983096983090
[983090] Uysal Z Sari S I Ramoglu and F A Bascifci ldquoRelation-ships between dental and skeletal maturity in urkish subjectsrdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983093983095ndash983094983094983092 983090983088983088983092
[983091] M OrsquoReilly and G J Yanniello ldquoMandibular growth changesand maturation o cervical vertebraemdasha longitudinal cephalo-metric studyrdquo Angle Orthodontist vol 983093983096 no 983090 pp 983089983095983097ndash983089983096983092983089983097983096983096
[983092] W W Greulich and S I Pyle Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanord University PressStanord Cali USA 983089983097983093983097
[983093] A BLewis and S M Garn ldquoTerelationshipbetween tooth or-mation and other maturation actorsrdquo Te Angle Orthodontist vol 983091983088 no 983090 pp 983095983088ndash983095983095 983089983097983094983088
[983094] C J Hunter ldquoTe correlation o acial growth with body heightand skeletal maturation at adolescencerdquo Te Angle Orthodontist vol 983091983094 no 983089 pp 983092983092ndash983093983092 983089983097983094983094
[983095] A Bjork and S Helm ldquoPrediction o the age o maximumpuberal growth in body heightrdquo Angle Orthodontist vol 983091983095 no983090 pp 983089983091983092ndash983089983092983091 983089983097983094983095
[983096] M I oani ldquoMandibular growth at pubertyrdquo Te American Journal of Orthodontics vol 983094983090 no 983090 pp 983089983095983094ndash983089983097983093 983089983097983095983090
[983097] U Hagg and J aranger ldquoMenarche and voice change asindicators o the pubertal growth spurtrdquo Acta OdontologicaScandinavica vol 983091983096 no 983091 pp 983089983095983097ndash983089983096983094 983089983097983096983088
[983089983088] P San Roman J C Palma M D Oteo and E Nevado ldquoSkeletalmaturation determined by cervical vertebrae developmentrdquoEuropean Journal of Orthodontics vol 983090983092 no 983091 pp 983091983088983091ndash983091983089983089983090983088983088983090
[983089983089] L Franchi Baccetti and J A McNamara Jr ldquoMandibulargrowth as related to cervical vertebral maturation and body
heightrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983089983096 no 983091 pp 983091983091983093ndash983091983092983088 983090983088983088983088
[983089983090] Baccetti L Franchi and J A McNamara Jr ldquoAn improved version o the cervical vertebral maturation (CVM) method orthe assessment o mandibular growthrdquo Te Angle Orthodontist vol 983095983090 no 983092 pp 983091983089983094ndash983091983090983091 983090983088983088983090
[983089983091] D B Gabriel K A Southard F Qian S D Marshall R GFranciscus and E Southard ldquoCervical vertebrae matura-tion method poor reproducibilityrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp983092983095983096e983089ndash983092983095983096e983095 983090983088983088983097
[983089983092] L-L Chen -M Xu J-H Jiang X-Z Zhang and J-XLin ldquoQuantitative cervical vertebral maturation assessment inadolescents with normal occlusion a mixed longitudinal studyrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983092 no 983094 pp 983095983090983088e983089ndash983095983090983088e983095 983090983088983088983096
[983089983093] A Chatzigianni and D J Halazonetis ldquoGeometric morphome-tric evaluation o cervical vertebrae shape and its relationshipto skeletal maturationrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp 983092983096983089e983089ndash983092983096983089e983097 983090983088983088983097
[983089983094] C Cokluk K Aydm C Rakunt O Iyigun and A Onder ldquoTeborders o the odontoid process o c983090 in adults and in childrenincluding the estimation o odontoidbody ratiordquo EuropeanSpine Journal vol 983089983093 no 983091 pp 983090983095983096ndash983090983096983090 983090983088983088983094
[983089983095] V Joshi Yamaguchi Y Matsuda N Kaneko K Maki and Okano ldquoSkeletal maturity assessment with the use o cone-beam computerized tomographyrdquo Oral Surgery Oral MedicineOral Pathology and Oral Radiology vol 983089983089983091 no 983094 pp 983096983092983089ndash983096983092983097983090983088983089983090
[983089983096] J B Ludlow L E Davies-Ludlow S L Brooks and WB Howerton ldquoDosimetry o 983091 CBC devices or oral andmaxilloacial radiology CB Mercuray Newom 983091G and i-CArdquoDentomaxillofacial Radiology vol 983091983093 no 983092 pp 983090983089983097ndash983090983090983094 983090983088983088983094
[983089983097] M Sempe La P acuteediatrie au Quotidian Analyse de la MaturationSequelettique Les Editions INSERM Paris France 983089983097983096983095
[983090983088] L S Fishman ldquoRadiographic evaluation o skeletal maturationA clinically oriented method based on hand-wirst 1047297lmsrdquo AngleOrthodontist vol 983093983090 no 983090 pp 983096983096ndash983089983089983090 983089983097983096983090
[983090983089] J Miles and M Shelvin Applying Regression and CorrelationSage Publication London UK 983090983088983088983089
[983090983090] Mito K Sato and H Mitani ldquoCervical vertebral bone agein girlsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983090 no 983092 pp 983091983096983088ndash983091983096983093 983090983088983088983090
[983090983091] F Chen K eradaand K Hanada ldquoA newmethod opredictingmandibular length incrementon the basis o cervical vertebraerdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983091983088ndash983094983091983092 983090983088983088983092
[983090983092] H Herkowitz S Gar1047297n F Eismont G Bell and R BalderstonRothman-Simeone Te Spine WB Saunders Philadelphia PaUSA 983090983088983089983089
[983090983093] A Verbout ldquoTe development o the vertebral columnrdquo Advances in Anatomy Embryology and Cell Biology vol 983097983088 no983089 pp 983089ndash983089983090983090 983089983097983096983093
[983090983094] K B Arbogast P A Gholve J E Friedman M R Maltese MF omasello and J P Dormans ldquoNormal cervical spine rangeo motion in children 983091ndash983089983090 years oldrdquo Spine vol 983091983090 no 983089983088 ppE983091983088983097ndashE983091983089983093 983090983088983088983095
[983090983095] M Altan O Nebioglu Dalc and H Iseri ldquoGrowth o thecervical vertebrae in girls rom 983096 to 983089983095 years A longitudinalstudyrdquo European Journal of Orthodontics vol 983091983092 no 983091 pp 983091983090983095ndash983091983091983092 983090983088983089983090
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 610
983094 Computational and Mathematical Methods in Medicine
983137983138983148983141 983094 Te results o multiple regression analysis using the stepwise elimination method
Multipleregressionmodels
Independent variables 907317 SE szlig 10383892 Adjusted 1038389
2 VIF 983089VIF
983089st Intercept 983093983095983093983088 983096983088983091983095 983088983095983089983093 983088983092983095983095 983088983093983094983090 983088983093983093983094
AH983091W983091 983096983091983093983090983089 983096983094983097983091 983088983095983093983088 983097983094983088983096 983088983088983088983088 983089983088983088983088 983089983088983088983088
983090nd
Intercept 983093983091983091983095983093 983089983091983093983097983089 983091983097983090983095 983088983088983088983088 983088983094983092983095 983088983094983091983095
AH983091W983091 983096983089983095983089983097 983095983096983094983095 983088983095983091983091 983089983088983091983096983096 983088983088983088983088 983089983088983088983091 983088983097983097983095
PH983090W983090 minus983093983092983090983090983096 983089983091983088983096983088 minus983088983090983097983091 minus983092983089983092983094 983088983088983088983088 983089983088983088983091 983088983097983097983095
983091rd
Intercept 983089983088983090983088983090983089 983089983097983097983097983091 983093983089983088983091 983088983088983088983088 983088983094983097983089 983088983094983095983096
AH983091W983091 983095983094983094983088983094 983095983093983096983092 983088983094983096983095 983089983088983089983088983090 983088983088983088983088 983089983088983093983089 983088983097983093983089
PH983090W983090 minus983092983089983092983095983096 983089983090983097983094983089 minus983088983090983090983092 minus983091983090983088983088 983088983088983088983090 983089983089983089983088 983088983097983088983089
UW983090W983090 minus983094983094983093983089983092 983090983088983097983097983097 minus983088983090983090983095 minus983091983089983094983095 983088983088983088983090 983089983089983094983091 983088983096983094983088
983092th
Intercept 983097983093983092983097983097 983089983097983089983094983090 983092983097983096983092 983088983088983088983088 983088983095983090983093 983088983095983088983097
AH983091W983091 983092983089983094983095983093 983089983092983089983089983096 983088983091983095983092 983090983097983093983090 983088983088983088983092 983092983088983090983088 983088983090983092983097
PH983090W983090 minus983092983096983092983088983094 983089983090983093983094983095 minus983088983090983094983089 minus983091983096983093983090 983088983088983088983088 983089983089983093983090 983088983096983094983096
UW983090W983090 minus983094983094983093983093983092 983089983097983097983096983093 minus983088983090983090983095 minus983091983091983091983088 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983092983097983088983090983092 983089983095983088983091983088 983088983091983094983091 983090983096983095983097 983088983088983088983093 983091983097983095983090 983088983090983093983090
983093th
Intercept 983095983094983096983092983093 983089983097983088983096983089 983092983088983090983095 983088983088983088983088 983088983095983093983096 983088983095983092983088
AH983091W983091 983090983096983094983095983089 983089983091983097983096983092 983088983090983093983095 983090983088983093983088 983088983088983092983092 983092983092983090983094 983088983090983090983094
PH983090W983090 minus983094983092983091983097983092 983089983090983097983093983094 minus983088983091983092983096 minus983092983097983095983088 983088983088983088983088 983089983091983095983092 983088983095983090983096
UW983090W983090 minus983094983096983089983092983096 983089983096983096983095983090 minus983088983090983091983090 minus983091983094983089983089 983088983088983088983089 983089983089983094983091 983088983096983094983088
H983092W983092 983093983089983094983097983090 983089983094983088983097983097 983088983091983096983090 983091983090983089983089 983088983088983088983090 983091983097983096983092 983088983090983093983089
(OH + AH983090)LW983090 983089983092983096983089983089 983092983096983090983091 983088983090983090983091 983091983088983095983089 983088983088983088983091 983089983092983096983093 983088983094983095983091
983094th
Intercept 983094983093983093983088983088 983089983097983091983092983089 983091983091983096983095 983088983088983088983089 983088983095983095983092 983088983095983093983091
AH983091W983091 983089983093983090983095983097 983089983093983088983088983089 983088983089983091983095 983089983088983089983096 983088983091983089983090 983093983091983094983089 983088983089983096983095
PH983090W983090 minus983094983089983091983091983089 983089983090983095983088983097 minus983088983091983091983089 minus983092983096983090983094 983088983088983088983088 983089983091983097983090 983088983095983089983096
UW983090W983090 minus983093983095983090983095983092 983089983097983088983096983094 minus983088983089983097983093 minus983091983088983088983089 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983093983091983089983095983094 983089983093983095983088983096 983088983091983097983091 983091983091983096983093 983088983088983088983089 983091983097983097983090 983088983090983093983089
(OH + AH983090)LW983090 983089983093983096983091983094 983092983095983090983094 983088983090983091983097 983091983091983093983089 983088983088983088983089 983089983093983088983089 983088983094983094983094
D983091 983092983092983092983092 983090983088983095983097 983088983089983095983094 983090983089983091983096 983088983088983091983094 983089983097983097983097 983088983093983088983088
983095th
Intercept 983094983092983089983090983096 983089983097983091983088983088 983091983091983090983091 983088983088983088983089 983088983095983095983088 983088983095983093983091
PH983090W983090 minus983094983091983095983092983095 983089983090983092983097983088 minus983088983091983092983092 minus983093983089983088983092 983088983088983088983088 983089983091983092983092 983088983095983092983092
UW983090983090 minus983093983095983088983090983095 983089983097983088983097983088 minus983088983089983097983092 minus983090983097983096983095 983088983088983088983092 983089983090983093983090 983088983095983097983097
H983092W983092 983094983093983093983096983095 983097983097983089983093 983088983092983096983093 983094983094983089983093 983088983088983088983088 983089983093983097983088 983088983094983090983097
(OH + AH983090)LW983090 983089983095983091983093983095 983092983092983096983093 983088983090983094983090 983091983096983095983088 983088983088983088983088 983089983091983093983089 983088983095983092983088
D983091 983093983091983090983096 983089983096983096983097 983088983090983089983089 983090983096983090983088 983088983088983088983094 983089983094983093983089 983088983094983088983094
983096th
Intercept 983097983094983088983093983090 983090983091983093983097983093 983092983088983095983089 983088983088983088983088 983088983095983096983094 983088983095983094983095
PH983090W983090 minus983094983090983092983092983097 983089983090983089983093983092 minus983088983091983091983095 minus983093983089983091983096 983088983088983088983088 983089983091983092983095 983088983095983092983090
UW983090W983090 minus983093983092983096983092983091 983089983096983093983096983089 minus983088983089983096983095 minus983090983097983093983090 983088983088983088983092 983089983090983093983094 983088983095983097983094
H983092W983092 983094983091983090983095983088 983097983094983097983091 983088983092983094983096 983094983093983090983095 983088983088983088983088 983089983094983088983096 983088983094983090983090
(OH + AH983090)LW983090 983089983094983088983095983094 983092983091983097983095 983088983090983092983090 983091983094983093983094 983088983088983088983089 983089983091983095983092 983088983095983090983096
D983091 983093983093983097983091 983089983096983092983088 983088983090983090983089 983091983088983091983097 983088983088983088983091 983089983094983093983096 983088983094983088983091
UW983091LW983091 minus983091983089983088983090983096 983089983091983097983089983088 minus983088983089983090983097 minus983090983090983091983089 983088983088983090983097 983089983088983092983095 983088983097983093983093
unstandardized regression coefficient SE standard error o szlig standardized regression coefficient VIF variance in1047298ation actor
7172019 405912
httpslidepdfcomreaderfull405912 710
Computational and Mathematical Methods in Medicine 983095
the lower concavity angle o C983090 as independent variablesHowever in this study we de1047297ned the measurements o theC983090 vertebral bodyand the odontoidprocess Te dentocentralsynchondrosis was considered the border between the body and the odontoid process o C983090 Te results showed thatthe ratios o the C983090 body and the odontoid process were
correlated very highly with skeletal maturation status (as didthe bodies o the third and ourth cervical vertebrae whichwere used in the previous studies) (ables 983093 and 983094)
During embryonic development the second cervical vertebra arises rom 1047297ve primary bone growth centers (oneoccurs in the body two occur in bilateral neural archesand the other two occur in the odontoid process) separatedby synchondrotic articulations [983090983092 983090983093] Te two in theodontoid process are used at birth Te border betweenthe odontoid process and the body o the axis vertebra iswell demarcated by the dentocentral synchondrosis [983090983094] Tebilateral neurocentral synchondroses between the bilateralneural arch and the dentocentral synchondrosis use at 983091 to
983094 years o age Afer 983094 years o age the odontoid processuses with the vertebral body and the neural arches [983090983094]Te remnant o the dentocentral synchondrosis which isbelow the superior articulating acets appears on CBCand MRI images as a ring Cokluk et al [983089983094] compared theodontoid process-to-vertebral body ratios between childrenandadults based on MRIs o the dentocentral synchondrosisTereore we were able to use CBC images to de1047297ne the
vertebral body and its odontoid process and expected thatthe odontoid process and vertebral body might be importantindependent variables or the regression model derived romCBC-generated CVM
Several studies used the third and ourth vertebral bodies
and the concavity o their lower borders to assess skeletalmaturation [983089983088 983090983090 983090983091] Tey reported that many ratios o the width and height o the C983091 and C983092 were correlatedwith skeletal maturation status In the present study 983092983095 o 983094983092 parameters exhibited statistically signi1047297cant correlations( lt 005) similar to the 1047297ndings o other previous studies(able 983093) Te C983090 vertebral body and odontoid process weresigni1047297cant independent variables in all multiple regressionmodels In the multiple regression model with the highest
10383892 adjusted 1038389
2 and variance in1047298ation actors (VIF) lt983090which indicated the absence o multicollinearity problemsPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 were independent variables Tis model also
exhibited the highest coefficient o determination 983088983095983096983094indicating that these independent variables were able toexplain approximately 983095983096983094 o the SML variation
While the ratios o the third and ourth cervical vertebraehad strong correlation coefficients in previous CVM studiesthe present study added the ratio o the second cervical
vertebra which correlated strongly with CBC-generatedCVM as an indicator Altan et al [983090983095] investigated thelongitudinal growth o cervical vertebrae in girls rom 983096 to983089983095 years o age Te growth o the cervical vertebrae ollowsa somatic pattern and they reach their 1047297nal size at maturity [983090983096] C983089 and C983092 reached their peak size at approximately 983089983089983093 years o age and C983091 reached its maximal size at 983089983088983093
years o age However the growth curve or C983090 did nothave a distinct peak growth rate its growth rate curve wasmore linear [983090983097] Tereore in this study the parameterso the C983090 vertebral body and the odontoid process mightbe independent variables or the multiple linear regressionmodel because it has a more linear growth pattern Our
1047297ndings indicated that the growth o C983090 vertebral body andodontoid process might be a useul indicator or evaluatingthe stages o skeletal maturation Te multiple regressionmodels put orth by Chen et al [983090983091] and Mito et al [983090983090]included parameters such as the heightwidth ratios o thethird and ourth cervical vertebrae as independent variablesHowever regression models in our study with AH983091H983091 andH983092W983092 ratios had multicollinearity problems with high VIF
values (able 983094)Similarly the third and ourth cervical vertebrae arise
rom three primary ossi1047297cation centers (one in the body and two in the posterior arches) [983091983088 983091983089] Te shape o thebodies o third and ourth cervical vertebrae changes romwedge-shaped to rectangular and then becomes square Teirshapes grow vertically and then horizontally Te total lengthand height o the third and ourth cervical vertebrae have
very similar incremental curves Cervical vertebral growthoccurred in the order o the upper to the lower cervical ver-tebrae Tereore these parameters might induce statisticalmulticollinearity problems Many clinical studies regardingdental research have used multiple regression analysis to 1047297ndcorrelations between the predictorand the outcome variablesHowever collinearity in the statistic regression models is onepossible problem with the use o multiple regression analysisldquoMulticollinearityrdquo is the statistical term or the situation inwhich more than two covariates are highly correlated [983090983089]It can distort the interpretation o statistical results rommultiple regression models increasing both inaccuracy anduncertainty Multicollinearity should be considered in theregression model
We used the SML as a measure o the study participantsrsquoskeletal maturation status in order to build the multipleregression models in this study Te SML comprises 983089983088983088983088stages numbered rom 983088 to 983097983097983097 compared to 983089983089 stagesit provides a more re1047297ned skeletal maturation status as apercentage Te SML (with stages 983088 to 983097983097983097) was pertinentto statistical analysis as a parametric dependent variable ormultiple regression models Te present study has already con1047297rmed its high correlation to Fishmanrsquos SMI or buildingmultiple regression models ( lt 005 correlation coefficient
983088983097983093983088)Other CVM-based studies had large study popula-
tions that were heterogeneous regarding sex and ethnicityAlthough our study population was comparatively small andhomogeneous this study had the advantage o introducingthe modi1047297ed CBC-generated CVM with the de1047297ned body o the second cervical vertebra and the odontoid processrom the dentocentral synchondrosis Given this CBCapproach the study could not have a large study popula-tion Despite these difficulties this study demonstrated anew application o the second cervical vertebral body andodontoid to the CBC-generated CVM and resulted in thebuilding o multiple regression models We expect that sexual
7172019 405912
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983096 Computational and Mathematical Methods in Medicine
dimorphism may imply divergence between boys and girlsduring the course o ossi1047297cation Ethnicity may explain therelatively high correspondence o ossi1047297cation level observedin the present study compared with other studies Tereoreadditional studies are needed to address questions regardingsexual dimorphism and ethnicity
5 Conclusions
CBC-generated CVM was able to include parameters romthe second cervical vertebral body and the odontoid processrespectively or multiple regression models Te derivedmultiple regression models demonstrated the potential o thenewly de1047297ned parameters o the second cervical vertebra
Conflict of Interests
All o the authors declare that there is no con1047298ict o interestsregarding the publication o this paper
Acknowledgment
Tis study was supported by two-year research grant romPusan National University (Woo-Sung Son)
References
[983089] U Hagg and J aranger ldquoMaturation indicators and the pub-ertal growth spurtrdquo American Journal of Orthodontics vol 983096983090no 983092 pp 983090983097983097ndash983091983088983097 983089983097983096983090
[983090] Uysal Z Sari S I Ramoglu and F A Bascifci ldquoRelation-ships between dental and skeletal maturity in urkish subjectsrdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983093983095ndash983094983094983092 983090983088983088983092
[983091] M OrsquoReilly and G J Yanniello ldquoMandibular growth changesand maturation o cervical vertebraemdasha longitudinal cephalo-metric studyrdquo Angle Orthodontist vol 983093983096 no 983090 pp 983089983095983097ndash983089983096983092983089983097983096983096
[983092] W W Greulich and S I Pyle Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanord University PressStanord Cali USA 983089983097983093983097
[983093] A BLewis and S M Garn ldquoTerelationshipbetween tooth or-mation and other maturation actorsrdquo Te Angle Orthodontist vol 983091983088 no 983090 pp 983095983088ndash983095983095 983089983097983094983088
[983094] C J Hunter ldquoTe correlation o acial growth with body heightand skeletal maturation at adolescencerdquo Te Angle Orthodontist vol 983091983094 no 983089 pp 983092983092ndash983093983092 983089983097983094983094
[983095] A Bjork and S Helm ldquoPrediction o the age o maximumpuberal growth in body heightrdquo Angle Orthodontist vol 983091983095 no983090 pp 983089983091983092ndash983089983092983091 983089983097983094983095
[983096] M I oani ldquoMandibular growth at pubertyrdquo Te American Journal of Orthodontics vol 983094983090 no 983090 pp 983089983095983094ndash983089983097983093 983089983097983095983090
[983097] U Hagg and J aranger ldquoMenarche and voice change asindicators o the pubertal growth spurtrdquo Acta OdontologicaScandinavica vol 983091983096 no 983091 pp 983089983095983097ndash983089983096983094 983089983097983096983088
[983089983088] P San Roman J C Palma M D Oteo and E Nevado ldquoSkeletalmaturation determined by cervical vertebrae developmentrdquoEuropean Journal of Orthodontics vol 983090983092 no 983091 pp 983091983088983091ndash983091983089983089983090983088983088983090
[983089983089] L Franchi Baccetti and J A McNamara Jr ldquoMandibulargrowth as related to cervical vertebral maturation and body
heightrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983089983096 no 983091 pp 983091983091983093ndash983091983092983088 983090983088983088983088
[983089983090] Baccetti L Franchi and J A McNamara Jr ldquoAn improved version o the cervical vertebral maturation (CVM) method orthe assessment o mandibular growthrdquo Te Angle Orthodontist vol 983095983090 no 983092 pp 983091983089983094ndash983091983090983091 983090983088983088983090
[983089983091] D B Gabriel K A Southard F Qian S D Marshall R GFranciscus and E Southard ldquoCervical vertebrae matura-tion method poor reproducibilityrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp983092983095983096e983089ndash983092983095983096e983095 983090983088983088983097
[983089983092] L-L Chen -M Xu J-H Jiang X-Z Zhang and J-XLin ldquoQuantitative cervical vertebral maturation assessment inadolescents with normal occlusion a mixed longitudinal studyrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983092 no 983094 pp 983095983090983088e983089ndash983095983090983088e983095 983090983088983088983096
[983089983093] A Chatzigianni and D J Halazonetis ldquoGeometric morphome-tric evaluation o cervical vertebrae shape and its relationshipto skeletal maturationrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp 983092983096983089e983089ndash983092983096983089e983097 983090983088983088983097
[983089983094] C Cokluk K Aydm C Rakunt O Iyigun and A Onder ldquoTeborders o the odontoid process o c983090 in adults and in childrenincluding the estimation o odontoidbody ratiordquo EuropeanSpine Journal vol 983089983093 no 983091 pp 983090983095983096ndash983090983096983090 983090983088983088983094
[983089983095] V Joshi Yamaguchi Y Matsuda N Kaneko K Maki and Okano ldquoSkeletal maturity assessment with the use o cone-beam computerized tomographyrdquo Oral Surgery Oral MedicineOral Pathology and Oral Radiology vol 983089983089983091 no 983094 pp 983096983092983089ndash983096983092983097983090983088983089983090
[983089983096] J B Ludlow L E Davies-Ludlow S L Brooks and WB Howerton ldquoDosimetry o 983091 CBC devices or oral andmaxilloacial radiology CB Mercuray Newom 983091G and i-CArdquoDentomaxillofacial Radiology vol 983091983093 no 983092 pp 983090983089983097ndash983090983090983094 983090983088983088983094
[983089983097] M Sempe La P acuteediatrie au Quotidian Analyse de la MaturationSequelettique Les Editions INSERM Paris France 983089983097983096983095
[983090983088] L S Fishman ldquoRadiographic evaluation o skeletal maturationA clinically oriented method based on hand-wirst 1047297lmsrdquo AngleOrthodontist vol 983093983090 no 983090 pp 983096983096ndash983089983089983090 983089983097983096983090
[983090983089] J Miles and M Shelvin Applying Regression and CorrelationSage Publication London UK 983090983088983088983089
[983090983090] Mito K Sato and H Mitani ldquoCervical vertebral bone agein girlsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983090 no 983092 pp 983091983096983088ndash983091983096983093 983090983088983088983090
[983090983091] F Chen K eradaand K Hanada ldquoA newmethod opredictingmandibular length incrementon the basis o cervical vertebraerdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983091983088ndash983094983091983092 983090983088983088983092
[983090983092] H Herkowitz S Gar1047297n F Eismont G Bell and R BalderstonRothman-Simeone Te Spine WB Saunders Philadelphia PaUSA 983090983088983089983089
[983090983093] A Verbout ldquoTe development o the vertebral columnrdquo Advances in Anatomy Embryology and Cell Biology vol 983097983088 no983089 pp 983089ndash983089983090983090 983089983097983096983093
[983090983094] K B Arbogast P A Gholve J E Friedman M R Maltese MF omasello and J P Dormans ldquoNormal cervical spine rangeo motion in children 983091ndash983089983090 years oldrdquo Spine vol 983091983090 no 983089983088 ppE983091983088983097ndashE983091983089983093 983090983088983088983095
[983090983095] M Altan O Nebioglu Dalc and H Iseri ldquoGrowth o thecervical vertebrae in girls rom 983096 to 983089983095 years A longitudinalstudyrdquo European Journal of Orthodontics vol 983091983092 no 983091 pp 983091983090983095ndash983091983091983092 983090983088983089983090
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 710
Computational and Mathematical Methods in Medicine 983095
the lower concavity angle o C983090 as independent variablesHowever in this study we de1047297ned the measurements o theC983090 vertebral bodyand the odontoidprocess Te dentocentralsynchondrosis was considered the border between the body and the odontoid process o C983090 Te results showed thatthe ratios o the C983090 body and the odontoid process were
correlated very highly with skeletal maturation status (as didthe bodies o the third and ourth cervical vertebrae whichwere used in the previous studies) (ables 983093 and 983094)
During embryonic development the second cervical vertebra arises rom 1047297ve primary bone growth centers (oneoccurs in the body two occur in bilateral neural archesand the other two occur in the odontoid process) separatedby synchondrotic articulations [983090983092 983090983093] Te two in theodontoid process are used at birth Te border betweenthe odontoid process and the body o the axis vertebra iswell demarcated by the dentocentral synchondrosis [983090983094] Tebilateral neurocentral synchondroses between the bilateralneural arch and the dentocentral synchondrosis use at 983091 to
983094 years o age Afer 983094 years o age the odontoid processuses with the vertebral body and the neural arches [983090983094]Te remnant o the dentocentral synchondrosis which isbelow the superior articulating acets appears on CBCand MRI images as a ring Cokluk et al [983089983094] compared theodontoid process-to-vertebral body ratios between childrenandadults based on MRIs o the dentocentral synchondrosisTereore we were able to use CBC images to de1047297ne the
vertebral body and its odontoid process and expected thatthe odontoid process and vertebral body might be importantindependent variables or the regression model derived romCBC-generated CVM
Several studies used the third and ourth vertebral bodies
and the concavity o their lower borders to assess skeletalmaturation [983089983088 983090983090 983090983091] Tey reported that many ratios o the width and height o the C983091 and C983092 were correlatedwith skeletal maturation status In the present study 983092983095 o 983094983092 parameters exhibited statistically signi1047297cant correlations( lt 005) similar to the 1047297ndings o other previous studies(able 983093) Te C983090 vertebral body and odontoid process weresigni1047297cant independent variables in all multiple regressionmodels In the multiple regression model with the highest
10383892 adjusted 1038389
2 and variance in1047298ation actors (VIF) lt983090which indicated the absence o multicollinearity problemsPH983090W983090 UW983090W983090 (OH + AH983090)LW983090 UW983091LW983091 D983091and H983092W983092 were independent variables Tis model also
exhibited the highest coefficient o determination 983088983095983096983094indicating that these independent variables were able toexplain approximately 983095983096983094 o the SML variation
While the ratios o the third and ourth cervical vertebraehad strong correlation coefficients in previous CVM studiesthe present study added the ratio o the second cervical
vertebra which correlated strongly with CBC-generatedCVM as an indicator Altan et al [983090983095] investigated thelongitudinal growth o cervical vertebrae in girls rom 983096 to983089983095 years o age Te growth o the cervical vertebrae ollowsa somatic pattern and they reach their 1047297nal size at maturity [983090983096] C983089 and C983092 reached their peak size at approximately 983089983089983093 years o age and C983091 reached its maximal size at 983089983088983093
years o age However the growth curve or C983090 did nothave a distinct peak growth rate its growth rate curve wasmore linear [983090983097] Tereore in this study the parameterso the C983090 vertebral body and the odontoid process mightbe independent variables or the multiple linear regressionmodel because it has a more linear growth pattern Our
1047297ndings indicated that the growth o C983090 vertebral body andodontoid process might be a useul indicator or evaluatingthe stages o skeletal maturation Te multiple regressionmodels put orth by Chen et al [983090983091] and Mito et al [983090983090]included parameters such as the heightwidth ratios o thethird and ourth cervical vertebrae as independent variablesHowever regression models in our study with AH983091H983091 andH983092W983092 ratios had multicollinearity problems with high VIF
values (able 983094)Similarly the third and ourth cervical vertebrae arise
rom three primary ossi1047297cation centers (one in the body and two in the posterior arches) [983091983088 983091983089] Te shape o thebodies o third and ourth cervical vertebrae changes romwedge-shaped to rectangular and then becomes square Teirshapes grow vertically and then horizontally Te total lengthand height o the third and ourth cervical vertebrae have
very similar incremental curves Cervical vertebral growthoccurred in the order o the upper to the lower cervical ver-tebrae Tereore these parameters might induce statisticalmulticollinearity problems Many clinical studies regardingdental research have used multiple regression analysis to 1047297ndcorrelations between the predictorand the outcome variablesHowever collinearity in the statistic regression models is onepossible problem with the use o multiple regression analysisldquoMulticollinearityrdquo is the statistical term or the situation inwhich more than two covariates are highly correlated [983090983089]It can distort the interpretation o statistical results rommultiple regression models increasing both inaccuracy anduncertainty Multicollinearity should be considered in theregression model
We used the SML as a measure o the study participantsrsquoskeletal maturation status in order to build the multipleregression models in this study Te SML comprises 983089983088983088983088stages numbered rom 983088 to 983097983097983097 compared to 983089983089 stagesit provides a more re1047297ned skeletal maturation status as apercentage Te SML (with stages 983088 to 983097983097983097) was pertinentto statistical analysis as a parametric dependent variable ormultiple regression models Te present study has already con1047297rmed its high correlation to Fishmanrsquos SMI or buildingmultiple regression models ( lt 005 correlation coefficient
983088983097983093983088)Other CVM-based studies had large study popula-
tions that were heterogeneous regarding sex and ethnicityAlthough our study population was comparatively small andhomogeneous this study had the advantage o introducingthe modi1047297ed CBC-generated CVM with the de1047297ned body o the second cervical vertebra and the odontoid processrom the dentocentral synchondrosis Given this CBCapproach the study could not have a large study popula-tion Despite these difficulties this study demonstrated anew application o the second cervical vertebral body andodontoid to the CBC-generated CVM and resulted in thebuilding o multiple regression models We expect that sexual
7172019 405912
httpslidepdfcomreaderfull405912 810
983096 Computational and Mathematical Methods in Medicine
dimorphism may imply divergence between boys and girlsduring the course o ossi1047297cation Ethnicity may explain therelatively high correspondence o ossi1047297cation level observedin the present study compared with other studies Tereoreadditional studies are needed to address questions regardingsexual dimorphism and ethnicity
5 Conclusions
CBC-generated CVM was able to include parameters romthe second cervical vertebral body and the odontoid processrespectively or multiple regression models Te derivedmultiple regression models demonstrated the potential o thenewly de1047297ned parameters o the second cervical vertebra
Conflict of Interests
All o the authors declare that there is no con1047298ict o interestsregarding the publication o this paper
Acknowledgment
Tis study was supported by two-year research grant romPusan National University (Woo-Sung Son)
References
[983089] U Hagg and J aranger ldquoMaturation indicators and the pub-ertal growth spurtrdquo American Journal of Orthodontics vol 983096983090no 983092 pp 983090983097983097ndash983091983088983097 983089983097983096983090
[983090] Uysal Z Sari S I Ramoglu and F A Bascifci ldquoRelation-ships between dental and skeletal maturity in urkish subjectsrdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983093983095ndash983094983094983092 983090983088983088983092
[983091] M OrsquoReilly and G J Yanniello ldquoMandibular growth changesand maturation o cervical vertebraemdasha longitudinal cephalo-metric studyrdquo Angle Orthodontist vol 983093983096 no 983090 pp 983089983095983097ndash983089983096983092983089983097983096983096
[983092] W W Greulich and S I Pyle Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanord University PressStanord Cali USA 983089983097983093983097
[983093] A BLewis and S M Garn ldquoTerelationshipbetween tooth or-mation and other maturation actorsrdquo Te Angle Orthodontist vol 983091983088 no 983090 pp 983095983088ndash983095983095 983089983097983094983088
[983094] C J Hunter ldquoTe correlation o acial growth with body heightand skeletal maturation at adolescencerdquo Te Angle Orthodontist vol 983091983094 no 983089 pp 983092983092ndash983093983092 983089983097983094983094
[983095] A Bjork and S Helm ldquoPrediction o the age o maximumpuberal growth in body heightrdquo Angle Orthodontist vol 983091983095 no983090 pp 983089983091983092ndash983089983092983091 983089983097983094983095
[983096] M I oani ldquoMandibular growth at pubertyrdquo Te American Journal of Orthodontics vol 983094983090 no 983090 pp 983089983095983094ndash983089983097983093 983089983097983095983090
[983097] U Hagg and J aranger ldquoMenarche and voice change asindicators o the pubertal growth spurtrdquo Acta OdontologicaScandinavica vol 983091983096 no 983091 pp 983089983095983097ndash983089983096983094 983089983097983096983088
[983089983088] P San Roman J C Palma M D Oteo and E Nevado ldquoSkeletalmaturation determined by cervical vertebrae developmentrdquoEuropean Journal of Orthodontics vol 983090983092 no 983091 pp 983091983088983091ndash983091983089983089983090983088983088983090
[983089983089] L Franchi Baccetti and J A McNamara Jr ldquoMandibulargrowth as related to cervical vertebral maturation and body
heightrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983089983096 no 983091 pp 983091983091983093ndash983091983092983088 983090983088983088983088
[983089983090] Baccetti L Franchi and J A McNamara Jr ldquoAn improved version o the cervical vertebral maturation (CVM) method orthe assessment o mandibular growthrdquo Te Angle Orthodontist vol 983095983090 no 983092 pp 983091983089983094ndash983091983090983091 983090983088983088983090
[983089983091] D B Gabriel K A Southard F Qian S D Marshall R GFranciscus and E Southard ldquoCervical vertebrae matura-tion method poor reproducibilityrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp983092983095983096e983089ndash983092983095983096e983095 983090983088983088983097
[983089983092] L-L Chen -M Xu J-H Jiang X-Z Zhang and J-XLin ldquoQuantitative cervical vertebral maturation assessment inadolescents with normal occlusion a mixed longitudinal studyrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983092 no 983094 pp 983095983090983088e983089ndash983095983090983088e983095 983090983088983088983096
[983089983093] A Chatzigianni and D J Halazonetis ldquoGeometric morphome-tric evaluation o cervical vertebrae shape and its relationshipto skeletal maturationrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp 983092983096983089e983089ndash983092983096983089e983097 983090983088983088983097
[983089983094] C Cokluk K Aydm C Rakunt O Iyigun and A Onder ldquoTeborders o the odontoid process o c983090 in adults and in childrenincluding the estimation o odontoidbody ratiordquo EuropeanSpine Journal vol 983089983093 no 983091 pp 983090983095983096ndash983090983096983090 983090983088983088983094
[983089983095] V Joshi Yamaguchi Y Matsuda N Kaneko K Maki and Okano ldquoSkeletal maturity assessment with the use o cone-beam computerized tomographyrdquo Oral Surgery Oral MedicineOral Pathology and Oral Radiology vol 983089983089983091 no 983094 pp 983096983092983089ndash983096983092983097983090983088983089983090
[983089983096] J B Ludlow L E Davies-Ludlow S L Brooks and WB Howerton ldquoDosimetry o 983091 CBC devices or oral andmaxilloacial radiology CB Mercuray Newom 983091G and i-CArdquoDentomaxillofacial Radiology vol 983091983093 no 983092 pp 983090983089983097ndash983090983090983094 983090983088983088983094
[983089983097] M Sempe La P acuteediatrie au Quotidian Analyse de la MaturationSequelettique Les Editions INSERM Paris France 983089983097983096983095
[983090983088] L S Fishman ldquoRadiographic evaluation o skeletal maturationA clinically oriented method based on hand-wirst 1047297lmsrdquo AngleOrthodontist vol 983093983090 no 983090 pp 983096983096ndash983089983089983090 983089983097983096983090
[983090983089] J Miles and M Shelvin Applying Regression and CorrelationSage Publication London UK 983090983088983088983089
[983090983090] Mito K Sato and H Mitani ldquoCervical vertebral bone agein girlsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983090 no 983092 pp 983091983096983088ndash983091983096983093 983090983088983088983090
[983090983091] F Chen K eradaand K Hanada ldquoA newmethod opredictingmandibular length incrementon the basis o cervical vertebraerdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983091983088ndash983094983091983092 983090983088983088983092
[983090983092] H Herkowitz S Gar1047297n F Eismont G Bell and R BalderstonRothman-Simeone Te Spine WB Saunders Philadelphia PaUSA 983090983088983089983089
[983090983093] A Verbout ldquoTe development o the vertebral columnrdquo Advances in Anatomy Embryology and Cell Biology vol 983097983088 no983089 pp 983089ndash983089983090983090 983089983097983096983093
[983090983094] K B Arbogast P A Gholve J E Friedman M R Maltese MF omasello and J P Dormans ldquoNormal cervical spine rangeo motion in children 983091ndash983089983090 years oldrdquo Spine vol 983091983090 no 983089983088 ppE983091983088983097ndashE983091983089983093 983090983088983088983095
[983090983095] M Altan O Nebioglu Dalc and H Iseri ldquoGrowth o thecervical vertebrae in girls rom 983096 to 983089983095 years A longitudinalstudyrdquo European Journal of Orthodontics vol 983091983092 no 983091 pp 983091983090983095ndash983091983091983092 983090983088983089983090
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 810
983096 Computational and Mathematical Methods in Medicine
dimorphism may imply divergence between boys and girlsduring the course o ossi1047297cation Ethnicity may explain therelatively high correspondence o ossi1047297cation level observedin the present study compared with other studies Tereoreadditional studies are needed to address questions regardingsexual dimorphism and ethnicity
5 Conclusions
CBC-generated CVM was able to include parameters romthe second cervical vertebral body and the odontoid processrespectively or multiple regression models Te derivedmultiple regression models demonstrated the potential o thenewly de1047297ned parameters o the second cervical vertebra
Conflict of Interests
All o the authors declare that there is no con1047298ict o interestsregarding the publication o this paper
Acknowledgment
Tis study was supported by two-year research grant romPusan National University (Woo-Sung Son)
References
[983089] U Hagg and J aranger ldquoMaturation indicators and the pub-ertal growth spurtrdquo American Journal of Orthodontics vol 983096983090no 983092 pp 983090983097983097ndash983091983088983097 983089983097983096983090
[983090] Uysal Z Sari S I Ramoglu and F A Bascifci ldquoRelation-ships between dental and skeletal maturity in urkish subjectsrdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983093983095ndash983094983094983092 983090983088983088983092
[983091] M OrsquoReilly and G J Yanniello ldquoMandibular growth changesand maturation o cervical vertebraemdasha longitudinal cephalo-metric studyrdquo Angle Orthodontist vol 983093983096 no 983090 pp 983089983095983097ndash983089983096983092983089983097983096983096
[983092] W W Greulich and S I Pyle Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanord University PressStanord Cali USA 983089983097983093983097
[983093] A BLewis and S M Garn ldquoTerelationshipbetween tooth or-mation and other maturation actorsrdquo Te Angle Orthodontist vol 983091983088 no 983090 pp 983095983088ndash983095983095 983089983097983094983088
[983094] C J Hunter ldquoTe correlation o acial growth with body heightand skeletal maturation at adolescencerdquo Te Angle Orthodontist vol 983091983094 no 983089 pp 983092983092ndash983093983092 983089983097983094983094
[983095] A Bjork and S Helm ldquoPrediction o the age o maximumpuberal growth in body heightrdquo Angle Orthodontist vol 983091983095 no983090 pp 983089983091983092ndash983089983092983091 983089983097983094983095
[983096] M I oani ldquoMandibular growth at pubertyrdquo Te American Journal of Orthodontics vol 983094983090 no 983090 pp 983089983095983094ndash983089983097983093 983089983097983095983090
[983097] U Hagg and J aranger ldquoMenarche and voice change asindicators o the pubertal growth spurtrdquo Acta OdontologicaScandinavica vol 983091983096 no 983091 pp 983089983095983097ndash983089983096983094 983089983097983096983088
[983089983088] P San Roman J C Palma M D Oteo and E Nevado ldquoSkeletalmaturation determined by cervical vertebrae developmentrdquoEuropean Journal of Orthodontics vol 983090983092 no 983091 pp 983091983088983091ndash983091983089983089983090983088983088983090
[983089983089] L Franchi Baccetti and J A McNamara Jr ldquoMandibulargrowth as related to cervical vertebral maturation and body
heightrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983089983096 no 983091 pp 983091983091983093ndash983091983092983088 983090983088983088983088
[983089983090] Baccetti L Franchi and J A McNamara Jr ldquoAn improved version o the cervical vertebral maturation (CVM) method orthe assessment o mandibular growthrdquo Te Angle Orthodontist vol 983095983090 no 983092 pp 983091983089983094ndash983091983090983091 983090983088983088983090
[983089983091] D B Gabriel K A Southard F Qian S D Marshall R GFranciscus and E Southard ldquoCervical vertebrae matura-tion method poor reproducibilityrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp983092983095983096e983089ndash983092983095983096e983095 983090983088983088983097
[983089983092] L-L Chen -M Xu J-H Jiang X-Z Zhang and J-XLin ldquoQuantitative cervical vertebral maturation assessment inadolescents with normal occlusion a mixed longitudinal studyrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983092 no 983094 pp 983095983090983088e983089ndash983095983090983088e983095 983090983088983088983096
[983089983093] A Chatzigianni and D J Halazonetis ldquoGeometric morphome-tric evaluation o cervical vertebrae shape and its relationshipto skeletal maturationrdquo American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983094 no 983092 pp 983092983096983089e983089ndash983092983096983089e983097 983090983088983088983097
[983089983094] C Cokluk K Aydm C Rakunt O Iyigun and A Onder ldquoTeborders o the odontoid process o c983090 in adults and in childrenincluding the estimation o odontoidbody ratiordquo EuropeanSpine Journal vol 983089983093 no 983091 pp 983090983095983096ndash983090983096983090 983090983088983088983094
[983089983095] V Joshi Yamaguchi Y Matsuda N Kaneko K Maki and Okano ldquoSkeletal maturity assessment with the use o cone-beam computerized tomographyrdquo Oral Surgery Oral MedicineOral Pathology and Oral Radiology vol 983089983089983091 no 983094 pp 983096983092983089ndash983096983092983097983090983088983089983090
[983089983096] J B Ludlow L E Davies-Ludlow S L Brooks and WB Howerton ldquoDosimetry o 983091 CBC devices or oral andmaxilloacial radiology CB Mercuray Newom 983091G and i-CArdquoDentomaxillofacial Radiology vol 983091983093 no 983092 pp 983090983089983097ndash983090983090983094 983090983088983088983094
[983089983097] M Sempe La P acuteediatrie au Quotidian Analyse de la MaturationSequelettique Les Editions INSERM Paris France 983089983097983096983095
[983090983088] L S Fishman ldquoRadiographic evaluation o skeletal maturationA clinically oriented method based on hand-wirst 1047297lmsrdquo AngleOrthodontist vol 983093983090 no 983090 pp 983096983096ndash983089983089983090 983089983097983096983090
[983090983089] J Miles and M Shelvin Applying Regression and CorrelationSage Publication London UK 983090983088983088983089
[983090983090] Mito K Sato and H Mitani ldquoCervical vertebral bone agein girlsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983090 no 983092 pp 983091983096983088ndash983091983096983093 983090983088983088983090
[983090983091] F Chen K eradaand K Hanada ldquoA newmethod opredictingmandibular length incrementon the basis o cervical vertebraerdquo Angle Orthodontist vol 983095983092 no 983093 pp 983094983091983088ndash983094983091983092 983090983088983088983092
[983090983092] H Herkowitz S Gar1047297n F Eismont G Bell and R BalderstonRothman-Simeone Te Spine WB Saunders Philadelphia PaUSA 983090983088983089983089
[983090983093] A Verbout ldquoTe development o the vertebral columnrdquo Advances in Anatomy Embryology and Cell Biology vol 983097983088 no983089 pp 983089ndash983089983090983090 983089983097983096983093
[983090983094] K B Arbogast P A Gholve J E Friedman M R Maltese MF omasello and J P Dormans ldquoNormal cervical spine rangeo motion in children 983091ndash983089983090 years oldrdquo Spine vol 983091983090 no 983089983088 ppE983091983088983097ndashE983091983089983093 983090983088983088983095
[983090983095] M Altan O Nebioglu Dalc and H Iseri ldquoGrowth o thecervical vertebrae in girls rom 983096 to 983089983095 years A longitudinalstudyrdquo European Journal of Orthodontics vol 983091983092 no 983091 pp 983091983090983095ndash983091983091983092 983090983088983089983090
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 910
Computational and Mathematical Methods in Medicine 983097
[983090983096] R S ulsi ldquoGrowth o the human vertebral column An osteo-logical studyrdquo Acta Anatomica vol 983095983097 no 983092 pp 983093983095983088ndash983093983096983088 983089983097983095983089
[983090983097] N Yoganandan F A Pintar S M Lew R D Rao and NRangarajan ldquoQuantitative analyses o pediatric cervical spineossi1047297cation patterns using computed tomographyrdquo Annals of Advances in Automotive Medicine vol 983093983093 no 983089 pp 983089983093983097ndash983089983094983096983090983088983089983089
[983091983088] S Chandraraj and C A Briggs ldquoMultiple growth cartilages inthe neural archrdquo Te Anatomical Record vol 983090983091983088 no 983089 pp 983089983089983092ndash983089983090983088 983089983097983097983089
[983091983089] D M Ford K D McFadden and K M Bagnall ldquoSequence o ossi1047297cation in human vertebral neural arch centersrdquo Anatomical Record vol 983090983088983091 no 983089 pp 983089983095983093ndash983089983095983096 983089983097983096983090
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
7172019 405912
httpslidepdfcomreaderfull405912 1010
Submit your manuscripts at
httpwwwhindawicom
