Brief communication: a proposed method for the assessment of pubertal stage in human skeletal remains using cervical vertebrae maturation.

The assessment of age-at-death in non-adult skeletal remains is under constant review. However, in many past societies an individual's physical maturation may have been more important in social terms than their exact age, particularly during the period of adolescence. In a recent article (Shapland and Lewis: Am J Phys Anthropol 151 (2013) 302–310) highlighted a set of dental and skeletal indicators that may be useful in mapping the progress of the pubertal growth spurt. This article presents a further skeletal indicator of adolescent development commonly used by modern clinicians: cervical vertebrae maturation (CVM). This method is applied to a collection of 594 adolescents from the medieval cemetery of St. Mary Spital, London. Analysis reveals a potential delay in ages of attainment of the later CVM stages compared with modern adolescents, presumably reflecting negative environmental conditions for growth and development. The data gathered on CVM is compared to other skeletal indicators of pubertal maturity and long bone growth from this site to ascertain the usefulness of this method on archaeological collections.

Estudo prospectivo da correção da má-oclusão de Classe II, divisão 1ª com forças ortopédicas por meio de aparelho extrabucal de tração cervical e expansão rápida da maxila

Pós-graduação em Odontologia - FOA

Evaluation of the cervical vertebrae maturation index in lateral cephalograms taken in different head positions

The aim of this study was to evaluate if upward or downward head inclination might interfere with determination of the growth stage, using cervical vertebrae maturation index (CVMI), in order to verify the accuracy of such diagnosis when radiographs are taken with errors. Forty-nine patients, 26 females and 23 males, aged 9 to 15 years, were submitted to 3 lateral cephalograms: normal (NHP), with 15° upward head inclination (NHP-Up), and with 15° downward head inclination (NHP-Down). Three examiners evaluated the CVMI on the 147 cephalograms. The agreement among examiners was higher in the evaluation of cephalograms taken in NHP. The weighted Kappa test revealed moderate to substantial agreement between NHP and NHP-Up and between NHP and NHP-Down. There was greater agreement between NHP-Up and NHP-Down. It may be concluded that the evaluation of the CVMI on cephalograms in NHP is different as compared with radiographs taken with inclinations. Both NHP-Up and NHP-Down exhibited greater disagreement in the interpretation among examiners, since the evaluation method was not designed for cephalograms with positioning errors.

Illusions of fusions: assessing cervical vertebral fusion on lateral cephalograms, multidetector computed tomographs, and cone-beam computed tomographs

INTRODUCTION The aims of this study were to compare lateral cephalograms with other radiologic methods for diagnosing suspected fusions of the cervical spine and to validate the assessment of congenital fusions and osteoarthritic changes against the anatomic truth. METHODS Four cadaver heads were selected with fusion of vertebrae C2 and C3 seen on a lateral cephalogram. Multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) were performed and assessed by 5 general radiologists and 5 oral radiologists, respectively. Vertebrae C2 and C3 were examined for osseous fusions, and the left and right facet joints were diagnosed for osteoarthritis. Subsequently, the C2 and C3 were macerated and appraised by a pathologist. Descriptive analysis was performed, and interrater agreements between and within the groups were computed. RESULTS All macerated specimens showed osteoarthritic findings of varying degrees, but no congenital bony fusion. All observers agreed that no fusion was found on MDCT or CBCT. They disagreed on the prevalence of osteoarthritic deformities (general radiologists/MDCT, 100%; oral radiologists/CBCT, 93.3%) and joint space assessment in the facet joints (kappa = 0.452). The agreement within the rater groups differed considerably (general radiologists/MDCT, kappa = 0.612; oral radiologists/CBCT, kappa = 0.240). CONCLUSIONS Lateral cephalograms do not provide dependable data to assess the cervical spine for fusions and cause false-positive detections. Both MDCT interpreted by general radiologists and CBCT interpreted by oral radiologists are reliable methods to exclude potential fusions. Degenerative osteoarthritic changes are diagnosed more accurately and consistently by general radiologists evaluating MDCT.

Reliability of the cervical vertebrae maturation (CVM) method

OBJECTIVE To assess the reliability of the cervical vertebrae maturation method (CVM). BACKGROUND Skeletal maturity estimation can influence the manner and time of orthodontic treatment. The CVM method evaluates skeletal growth on the basis of the changes in the morphology of cervical vertebrae C2, C3, C4 during growth. These vertebrae are visible on a lateral cephalogram, so the method does not require an additional radiograph. METHODS In this website based study, 10 orthodontists with a long clinical practice (3 routinely using the method - "Routine user - RU" and 7 with less experience in the CVM method - "Non-Routine user - nonRU") rated twice cervical vertebrae maturation with the CVM method on 50 cropped scans of lateral cephalograms of children in circumpubertal age (for boys: 11.5 to 15.5 years; for girls: 10 to 14 years). Kappa statistics (with lower limits of 95% confidence intervals (CI)) and proportion of complete agreement on staging was used to evaluate intra- and inter-assessor agreement. RESULTS The mean weighted kappa for intra-assessor agreement was 0.44 (range: 0.30-0.64; range of lower limits of 95% CI: 0.12-0.48) and for inter-assessor agreement was 0.28 (range: -0.01-0.58; range of lower limits of 95% CI: -0.14-0.42). The mean proportion of identical scores assigned by the same assessor was 55.2 %(range: 44-74 %) and for different pairs of assessors was 42 % (range: 16-68 %). CONCLUSIONS The reliability of the CVM method is questionable and if orthodontic treatment should be initiated relative to the maximum growth, the use of additional biologic indicators should be considered (Tab. 4, Fig. 1, Ref. 24).

Effect of an intervertebral disk spacer on stiffness after monocortical screw/polymethylmethacrylate fixation in simulated and cadaveric canine cervical vertebral columns.

OBJECTIVE To determine the biomechanical effect of an intervertebral spacer on construct stiffness in a PVC model and cadaveric canine cervical vertebral columns stabilized with monocortical screws/polymethylmethacrylate (PMMA). STUDY DESIGN Biomechanical study. SAMPLE POPULATION PVC pipe; cadaveric canine vertebral columns. METHODS PVC model-PVC pipe was used to create a gap model mimicking vertebral endplate orientation and disk space width of large-breed canine cervical vertebrae; 6 models had a 4-mm gap with no spacer (PVC group 1); 6 had a PVC pipe ring spacer filling the gap (PCV group 2). Animals-large breed cadaveric canine cervical vertebral columns (C2-C7) from skeletally mature dogs without (cadaveric group 1, n = 6, historical data) and with an intervertebral disk spacer (cadaveric group 2, n = 6) were used. All PVC models and cadaver specimens were instrumented with monocortical titanium screws/PMMA. Stiffness of the 2 PVC groups was compared in extension, flexion, and lateral bending using non-destructive 4-point bend testing. Stiffness testing in all 3 directions was performed of the unaltered C4-C5 vertebral motion unit in cadaveric spines and repeated after placement of an intervertebral cortical allograft ring and instrumentation. Data were compared using a linear mixed model approach that also incorporated data from previously tested spines with the same screw/PMMA construct but without disk spacer (cadaveric group 1). RESULTS Addition of a spacer increased construct stiffness in both the PVC model (P < .001) and cadaveric vertebral columns (P < .001) compared to fixation without a spacer. CONCLUSIONS Addition of an intervertebral spacer significantly increased construct stiffness of monocortical screw/PMMA fixation.

Biomechanical comparison between bicortical pin and monocortical screw/polymethylmethacrylate constructs in the cadaveric canine cervical vertebral column.

OBJECTIVE To compare biomechanical stiffness of cadaveric canine cervical spine constructs stabilized with bicortical stainless steel pins and polymethylmethacrylate (PMMA), monocortical stainless steel screws with PMMA, or monocortical titanium screws with PMMA. STUDY DESIGN Biomechanical cadaver study. ANIMALS Eighteen canine cervical vertebral columns (C2-C7) were collected from skeletally mature dogs (weighing 22-32 kg). METHODS Specimens were radiographed and examined by dual energy X-ray absorptiometry. Stiffness of the unaltered C4-C5 intervertebral motion unit was measured in extension, flexion and lateral bending using non-destructive 4-point bend testing. Specimens were then stabilized by (1) bicortical stainless steel pins/PMMA, (2) monocortical stainless steel screws/PMMA, or (3) monocortical titanium screws/PMMA. Mechanical testing was repeated and stiffness data from unaltered specimens and the 3 treatment groups were compared. RESULTS All 3 surgical methods significantly increased stiffness of the C4-C5 motion unit compared with the unaltered specimen (P < .001 for all treatments), but stiffness was not significantly different among the 3 fixation groups (P = .578). CONCLUSIONS In this model, monocortical screw fixation (with stainless steel or titanium screws) was biomechanically equivalent to bicortical fixation.

Effets sur l'articulation temporo-mandibulaire du Twin-Block et d'un appareil myofonctionnel de classe II.

Introduction. Ce projet de recherche consiste en une étude cohorte prospective randomisée visant à évaluer les douleurs ressenties au niveau de l’articulation temporo-mandibulaire (ATM) lors d’une thérapie d’avancement mandibulaire grâce à un appareil fixe, le correcteur de classe II (CC) et d’un appareil amovible, le Twin-Block (TB). Matériels et méthodes. Cette étude comptait 26 patients (11 hommes et 15 femmes), âge moyen de 12ans 10mois (10ans 4mois à 15ans 10mois). Les sujets devaient avoir une malocclusion de classe II et être en croissance, CVM 2 ou 3 (Cervical Vertebral Maturation). Les patients étaient divisés en deux groupes : TB et CC. La douleur était évaluée selon l’axe I de l’examen du RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders) à 7 reprises (T0 à T6). De plus, le patient devait remplir un questionnaire, à la maison, sur la douleur ressentie et la médication prise lors des 30 premiers jours. La douleur était évaluée avant l’insertion des appareils (T0), à 1 semaine (T1) post-insertion, 4 semaines plus tard (T2), 8 semaines (T3) où une expansion de 20 tours (environs 5 mm) était débutée, ensuite (T4) (T5) et (T6) chacun à 8 semaines d’intervalles. Les tests statistiques utilisés dans cette étude : le test «Wilcoxon à un échantillon» ainsi que le test «Mann-Whitney à échantillons indépendants ». Résultats et Discussion. La douleur à l’examen clinique est variable mais tend à diminuer avec le temps. Aucune différence, statistiquement significative, ne fut observée entre les 2 groupes en ce qui à trait aux diverses palpations effectuées. Parmi les patients ayant rapporté de la douleur, 40% l’ont ressentie surtout le matin et 63,3% ont dit qu’elle durait de moins d’une heure jusqu’à quelques heures. Conclusion. D’après nos résultats, lors d’une thérapie myofonctionnnelle, il n’y a pas de différence statistiquement significative entre la douleur occasionnée par un Twin-Block et celle produite par un correcteur de classe II fixe au niveau de l’ATM et des muscles du complexe facial.

Long-term effectiveness and treatment timing for bionator therapy

The aim of the present investigation was to provide information about the long-term effects and optimal timing for class-II treatment with the Bionator appliance. Lateral cephalograms of 23 class-II patients treated with the Bionator were analyzed at three time periods: T1, start of treatment; T2, end of Bionator therapy; and T3, long-term observation (after completion of growth). T3 includes a phase with fixed appliances. The treated sample was divided into two groups according to their skeletal maturity as evaluated by the cervical vertebral maturation (CVM) method. The early-treated group (13 subjects) initiated treatment before the peak in mandibular growth, which occurred after completion of Bionator therapy. The late-treated group (10 subjects) received Bionator treatment during the peak. The T1-T2, T2-T3, and T1-T3 changes in the treated groups were compared with changes in control groups of untreated class-II subjects by nonparametric statistics (P < .05). The findings of the present study on Bionator therapy followed by fixed appliances indicate that this treatment protocol is more effective and stable when it is performed during the pubertal growth spurt. Optimal timing to start treatment with the Bionator is when a concavity appears at the lower borders of the second and the third cervical vertebrae (CVMS 11). In the long term, the amount of significant supplementary elongation of the mandible in subjects treated during the pubertal peak is 5.1 mm more than in the controls, and it is associated with a backward direction of condylar growth. Significant increments in mandibular ramus height also were recorded.

Long-term skeletal and dental effects and treatment timing for functional appliances in Class II malocclusion

Objective: To analyze the long-term skeletal and dentoalveolar effects and to evaluate treatment timing of Class II treatment with functional appliances followed by fixed appliances.Materials and Methods: A group of 40 patients (22 females and 18 males) with Class II malocclusion consecutively treated either with a Bionator or an Activator followed by fixed appliances was compared with a control group of 20 subjects (9 females and 11 males) with untreated Class II malocclusion. Lateral cephalograms were available at the start of treatment (mean age 10 years), end of treatment with functional appliances (mean age 12 years), and long-term observation (mean age 18.6 years). The treated sample also was divided into two groups according to skeletal maturity. The early-treatment group was composed of 20 subjects (12 females and 8 males) treated before puberty, while the late-treatment group included 20 subjects (10 females and 10 males) treated at puberty. Statistical comparisons were performed with analysis of variance followed by Tukey's post hoc tests.Results: Significant long-term mandibular changes (Co-Gn) in the treated group (3.6 mm over the controls) were associated with improvements in the skeletal sagittal intermaxillary relationship, overjet, and molar relationship (similar to 3.0-3.5 mm). Treatment during the pubertal peak was able to produce significantly greater increases in total mandibular length (4.3 mm) and mandibular ramus height (3.1 mm) associated with a significant advancement of the bony chin (3.9 mm) when compared with treatment before puberty.Conclusion: Treatment of Class II malocclusion with functional appliances appears to be more effective at puberty. (Angle Orthod. 2013;83:334-340.)

Macro- and microstructure of the superior cervical ganglion in dogs, cats and horses during maturation

The superior cervical ganglion (SCG) provides sympathetic input to the head and neck, its relation with mandible, submandibular glands, eyes (second and third order control) and pineal gland being demonstrated in laboratory animals. In addition, the SCG's role in some neuropathies can be clearly seen in Horner's syndrome. In spite of several studies published involving rats and mice, there is little morphological descriptive and comparative data of SCG from large mammals. Thus, we investigated the SCG's macro- and microstructural organization in medium (dogs and cats) and large animals (horses) during a very specific period of the post-natal development, namely maturation (from young to adults). The SCG of dogs, cats and horses were spindle shaped and located deeply into the bifurcation of the common carotid artery, close to the distal vagus ganglion and more related to the internal carotid artery in dogs and horses, and to the occipital artery in cats. As to macromorphometrical data, that is ganglion length, there was a 23.6% increase from young to adult dogs, a 1.8% increase from young to adult cats and finally a 34% increase from young to adult horses. Histologically, the SCG's microstructure was quite similar between young and adult animals and among the 3 species. The SCG was divided into distinct compartments (ganglion units) by capsular septa of connective tissue. Inside each ganglion unit the most prominent cellular elements were ganglion neurons, glial cells and small intensely fluorescent cells, comprising the ganglion's morphological triad. Given this morphological arrangement, that is a summation of all ganglion units, SCG from dogs, cats and horses are better characterized as a ganglion complex rather than following the classical ganglion concept. During maturation (from young to adults) there was a 32.7% increase in the SCG's connective capsule in dogs, a 25.8% increase in cats and a 33.2% increase in horses. There was an age-related increase in the neuronal profile size in the SCG from young to adult animals, that is a 1.6-fold, 1.9-fold and 1.6-fold increase in dogs, cats and horses, respectively. on the other hand, there was an age-related decrease in the nuclear profile size of SCG neurons from young to adult animals (0.9-fold, 0.7-fold and 0.8-fold in dogs, cats and horses, respectively). Ganglion connective capsule is composed of 2 or 3 layers of collagen fibres in juxtaposition and, as observed in light microscopy and independently of the animal's age, ganglion neurons were organised in ganglionic units containing the same morphological triad seen in light microscopy. Copyright (c) 2007 S. Karger AG, Basel.

Anatomical evaluation of the cervical vertebrae of Wistar rats by means of digital radiographs and its correlation with the maturation stages of human cervical vertebrae

INTRODUCTION: Biological age is an important parameter for growth and development assessment. It can be evaluated through the observation of radiographic changes in skeletal maturation of cervical vertebrae. OBJECTIVE: This study aims to: a) verify if there is correlation between growth curve and the stages of bone age of animals used in laboratories, by evaluating radiographs of the cervical vertebrae; b) correlate these stages with their correspondents in humans. METHODS: 35 Wistar rats were evaluated for a period of 160 days, starting at day 22nd (weaning), with cross sections for periodic weighing, length measurement and digital radiography. Radiographs of the cervical vertebrae (C2 and C3) were measured by means of a computer program (Radio IMP). Data were submitted to statistical analysis (ANOVA) and Pearson correlation. RESULTS: Growth spurt was characterized by fast increasing in weight and length. Through ANOVA, differences were observed in the cervical measurements between days 22, 97, 127, 157, 187 and 217 (p <0.001). A high correlation was found between increasing in body length and weight, as well as in cervical vertebrae height (r = 0.86). Increments in concavities of vertebrae were also observed, similar to humans. CONCLUSIONS: There is correlation between body growth and maturation of cervical vertebrae in rats. Despite the continuous development of concavities, it was not possible to clearly identify the 5/6 stages as in studies of cervical vertebrae maturation in humans.

Avaliação da reprodutibilidade do método de determinação da maturação esquelética por meio das vértebras cervicais

Dentre os diversos meios de se determinar o grau de maturação esquelética do paciente destaca-se o Método de Lamparski modificado por Hassel e Farman, em 1995, que propuseram a identificação do estágio da maturação por meio das modificações anatômicas das 2ª, 3ª e 4ª vértebras cervicais. Cientes das qualidades advogadas ao método citado surgiu o interesse em avaliar sua reprodutibilidade com o intuito de divulgá-lo e incorporá-lo como um elemento no diagnóstico e auxiliar no prognóstico dos tratamentos das más oclusões. A amostra constou de 100 telerradiografias em norma lateral de pacientes triados para tratamento ortodôntico na Faculdade de Odontologia de Araçatuba - UNESP nos períodos de 2000 e 2001. Foram incluídos pacientes de ambos os gêneros na faixa etária de 6 a 16 anos e a média de 9 anos e 7 meses. Três examinadores devidamente calibrados realizaram a avaliação das radiografias classificando-as em escores de 1 a 6. Após a análise dos resultados, os mesmos foram tabulados e submetidos ao coeficiente Kappa de concordância para avaliação inter e intra-examinador concluindo, dessa forma, a reprodutibilidade do referido método. O método de determinação da maturação esquelética por meio das vértebras cervicais mostrou-se reproduzível na avaliação do estágio em que o indivíduo se encontra na curva de crescimento.

Avaliação longitudinal do crescimento craniofacial de indivíduos classe II tratados e não tratados

Pós-graduação em Ciências Odontológicas - FOAR

Comparative study of vertebral fractures and luxations in dogs and cats

The purpose of this retrospective study was to compare patterns of vertebral fractures and luxations in 42 cats and 47 dogs, and to evaluate the impact of species-related differences on clinical outcome. Data regarding aetiology, neurological status, radiographic appearance and follow-up were compared between the groups. The thoracolumbar (Th3-L3) area was the most commonly affected location in both cats (49%) and dogs (58%). No lesions were observed in the cervical vertebral segments in cats, and none of the cats showed any signs of a Schiff-Sherrington syndrome. Vertebral luxations were significantly more frequent in dogs (20%) than in cats (6%), whereas combined fracture-luxations occurred significantly more often in cats (65%) than in dogs (37%). Caudal vertebral segment displacement was mostly dorsal in cats and ventral in dogs, with a significant difference in direction between cats and large dogs. The clinical outcome did not differ significantly between the two populations, and was poor in most cases (cats: 61%; dogs: 56%). The degree of dislocation and axis deviation were both significantly associated with a worse outcome in dogs, but not in cats. Although several differences in vertebral fractures and luxation patterns exist between cats and dogs, these generally do not seem to affect outcome.