ORIGINAL ARTICLE

Predicting mandibular
growth potential with
cervical vertebral bone
age
Toshinori Mito, DDS, PhD,' Koshi Sato, DDS, PhD," and
Hideo Mitani, DDS, MS, PhD' Sendai, Japan
This study assessed the possibility of using cervical vertebral
bone age determined from cephalometric radiographs to
predict mandibular growth potential. The subjects were 2
groups of 20 Japanese girls and young women: one group
to derive a formula for predicting mandibular growth potential, the other to compare predicted values with
actual values. Each group included subjects in the initial stage of the pubertal growth period and the final stage
of growth in early adulthood. formula for predicting mandibular growth potential that included cervical
vertebral bone age and the actual growth of the mandible !condyliongnathion" was determined with
regression analysis. #ervical vertebral bone age, bone age on hand$wrist radiographs, and chronological age
were inserted into the formula, and actual values and values predicted with these parameters of the formula
for mandibular growth potential were compared. The formula found
mandibular growth potential !in millimeters" % &2.'( )
cervical vertebral bone age * +,.(,. The average error between the value predicted by cervical
vertebral bone age and the actual value !-.'. mm" was significantly less (P < .00-" than that
between the actual value and the value predicted by chronological age !+./, mm" and appro)imately the same
as that between the actual value and the value predicted by bone age !2.0. mm". The formula derived from this
study might be useful for treating orthodontic patients in the growth stage. !m J 0rthod 1entofacial 0rthop
200+2-2/:-'+$'"
etreatment can be required after orthodontic
treatment in Class III patients if mandibular
growth causes the anterior crossbite relapse
Another ma!or clinical problem is determining when to
appl" functional appliance therap" in Class II patients
To resol#e these problems$ the clinician must be able to
accuratel" predict mandibular growth potential in the
growth stage
Currentl"$ the most popular and reliable method for
e#aluating mandibular growth is the use of hand%wrist
radiographs& 'ato et af
t
reported using bone age
determined b" hand%wrist radiographs$ as in the Tan%
ner%(hitehouse ) *T()+ method$
,
to predict mandib%
ular growth potential -owe#er$ a more reliable and
safer method that does not require radiographs is
needed to reduce .%ra" e.posure as much as possible
Cer#ical #ertebrae appear on the cephalometric
radiographs that orthodontists usuall" use to plan treat%
/rom the 0i#ision of Orthodontics$ 0epartment of Lifelong Oral -ealth
'cience$ Graduate 'chool of 0entistr"$ Toho1u 2ni#ersit"$ 'endai$ 3apan
45ostdoctoral fellow
b
Assistant professor
65rofessor and chairman
Reprint requests to7 0r Toshinori 8ito$ Toho1u 2ni#ersit"$ Graduate 'chool of
0entistr"$ 0epartment of Lifelong Oral -ealth 'cience$ 0i#ision of Orthodon%
tics$ 9%:$ 'eir"o%machi$ Aoba%1u$ 'endai ;<=%<,>,$ 3apan? e%mail$ mito@
mail cctoho1u ac !p
'ubmitted$ 'eptember )==)? re#ised and accepted$ 0ecember )==)
Cop"right A )==B b" the American Association of Orthodontists
R
=<<;%,9=CD)==BDEB=== F =
doi7 :=:=:CD' =<<;%,9=C *=B+==9=: %B
173
ment It is well 1nown that the morpholog" of the
cer#ical #ertebral bodies changes with growth$ as seen
in lateral cephalograms
C%<
Lampars1i
;
published an
atlas that simulated the morphologic changes in cer#i%
cal #ertebral bodies in pubert" and used the changes to
e#aluate s1eletal maturation 8an" in#estigators$
:=%:B
using this atlas to report morphologic changes in
cer#ical #ertebral bodies$ showed an association with
mandibular growth In addition$ 8ito et al& reported
that cer#ical #ertebral bone age can be easil" calculated
from cephalometric radiographs This technique can be
used to ob!ecti#el" e#aluate s1eletal maturation and
calculate s1eletal age$ as in the T() method
The purpose of this stud" was to assess the possi%
bilit" of using cer#ical #ertebral bone age$ assessed
from cephalometric radiographs$ to predict mandibular
growth potential
MATERIAL AND METHODS
Lateral cephalometric and hand%wrist radiographs
obtained from the 0epartment of Orthodontics$ Toho1u
2ni#ersit" 0ental -ospital$ 'endai$ 3apan$ were e.am%
ined The images are :=C), times the actual siGe
The sub!ects consisted of ) groups of )= 3apanese
girls and "oung women These groups were each
di#ided into initial and final stages of growth7 >=% to
:B;%"ear%old sub!ects were grouped as the initial stage$
and those older than :>= "ears were the final stage In
17 Mito, Sato, and Mitani American Journal of Orthodontics
and Dentofacial Orthopedics
August 2003
%)=
<=
)=
ANS -I ni ti al st age A - Fi nal stage
!i" 1# Cephalometric landmarks for determining man-
dibular total length. Cd, condylion; Gn, gnathion.
!i" $# Profilogram of initial and final stages for groups A
and %# S, sella; N, nasion; Or, orbitale; ANS, anterior
nasal spine; A, point A; B, point ; Pog, pogonion; !e"
menton; Go, gonion; Ar, articulare; Mo, midpoint of
ma#illary first molar; U/, top point of ma#illary central
incisor; Li, top point of mandibular central incisor.
Ta&'e I# Age and mandibular total length *Cd%Gn+ of
groups A and H
Group A (n = 20 Group
! (n = 20
"nitial stage #inal stage
Age *"+ :=:< I :,C :<B9 I =>,
ANH *6+ 9>: I :>B 9=< I :;C
Cd%Gn *mm+ :=CC> I >=) ::>;) I ,,<
0ata are presented as a#erage I standard de#iation
group A$ sub!ects in the
initial stage a#eraged
:=:< I :,C "ears *range$
>:>%:)C>+$ and those in
the final stage a#eraged
:<B9 I =>, "ears
*range$ :>BB%:;<:+? this
group was used to deri#e
a formula for predicting
mandibular growth
potential In group H$
sub!ects in the initial stage
a#eraged :=B: I :C,
"ears *range$ >=<%
:B<B+$ and those in the
final stage a#eraged :<BC
I =;, "ears *range$
:>=<%)=,,+? this group
was used to compare
predicted #alues with
actual #alues Group H$
in particular$ included
earl"% and late%maturing
patients$ and the
differences between their
cer#ical #ertebral bone
ages and chronological
ages were more than =,
"ears in the initial stage
/urthermore$ neither
group was treated with
orthopedic forces *eg$
headgear$ chincap$
protractor$ functional
appliance+$ to enable a
prediction of natural
mandibular growth
potential
The cephalometric
landmar1s for
mandibular total length
*cond"lion%gnathion+
used in this stud" are
shown in /igure :
A#erage age$ ANH
angle$ and mandibular
total length in the initial
and final stages for
groups A and H are
listed in Table : A
profilogram of the
initial and final stages
for groups A and H is
shown in /igure )
8andibular growth
potential in groups A and
H was calculated from
the difference in the
mandibular total length
between the initial and
final stages Regression
anal"sis was used to
determine a formula for
predicting mandibular
growth potential in
group A with cer#ical
#ertebral bone age in the
initial stage and
mandibular growth
potential7 growth
potential J a K
cer#ical #ertebral bone
age F b$ where a is a
coefficient and $ is a
constant Cer#ical
#ertebral bone age was
calculated b" the
method of 8ito et al
m
7
%=)= F C)= K
A-BDA5B F ,;= K
A-9DA59 F 9>9 K
A-9D5-9 */ig B+
American Journal of Orthodontics and Dentofacial Orthopedics Mito, Sato, and Mitani $%&
%olume :)9$ &um$er )
Fig '. Areas of cer(ical (ertebral bodies measured on cephalometric radiographs used to calculate
cer(ical (ertebral bone age. Lower lines are tangent to front and back of lo)er parts of cer(ical
(ertebral bodies. AH3,4, *istance from top of front part to tangent of lo)er part; H3,4, distance from
top of middle part to tangent of lo)er part; PH3,4, distance from top of back part to tangent of lo)er
part; AP3,4, anteroposterior distance at middle of cer(ical (ertebral body.
To e#aluate the accurac" of this formula in predicting
mandibular growth potential$ cer#ical #ertebral bone
age$ bone age calculated with the T() method and
3apanese standards *R2'7 radius$ ulna$ and short
bones+$
:,
and chronological age in the initial stage in
group H were applied to the formula Then actual
#alues of mandibular growth and the #alues predicted
with these parameters were compared
All cephalometric radiographs were measured b" :
operator *T8+ Intraoperator error for cephalometric
measurement to calculate mandibular length was deter%
mined with := cephalometric radiographs selected ran%
doml"7 we measured twice$ and the second measure%
ment was ta1en := da"s after the first The method error
for cephalometric measurement to calculate cer#ical
#ertebral bone age is reported elsewhere
:9
A paired t test was used to determine whether there
was a significant difference in the a#erage prediction
error for mandibular growth potential between cer#ical
#ertebral bone age$ bone age$ and chronological age
All anal"ses were performed with '5'' for (indows
:==>3 *'5''$ Chicago$ Ill+
+,S-./S
The a#erage error between the first and second
measurements for total mandibular length was =,B I
=B: mm (r = ;;>$ ' L ==:+
0mm1 23 r
$& - $3
&
y4-
2.%5#6'7.57
3
The formula for predicting mandibular growth
potential was determined b" regression anal"sis7 3
3 8888888888888888888888888
% 7 9 $3 $$ $2 $' 0years1
Cer(ical (ertebral bone age
Fig :. Scattergram bet)een cer(ical (ertebral bone
age and mandibular gro)th potential in group A. ;;; P < .
33$.
mandibular growth potential *in millimeters+ J M
)>C K cer#ical #ertebral bone age F B<C< (r =
<,>+
A scattergram between cer#ical #ertebral bone age
and mandibular growth potential in group A is shown in
/igure :.
Table II shows the predicted mandibular growth
potential and the a#erage error between actual #alues
and #alues predicted with cer#ical #ertebral bone age$
chronological age$ and bone age in group H
$%5 Mito, Sato, and Mitani American Journal of Orthodontics and Dentofacial Orthopedics
August 2003
/able II. Comparison of predicted mandibular growth potential and a#erage error between actual #alue and #alue
predicted b" cer#ical #ertebral bone age *NA+$ chronological age *CA+$ and bone age *HA+ in group H
Actual (alue %alue predicted $) %A %alue predicted $) *A %alue predicted $) !A
n )= )= )= )=
8andibular growth potential ::,< I ,)B ::,= I 99) :=)B I 9,, :)B; I ,9:
A#erage error *absolute #alue+
:>; I ::9
B9< I :;>
)=; I :><
0ata are presetned as a#erage I standard de#iation *mm+ 'ignificant *5L==:+ differences were found between a#erage error *absolute #alue+
b" cer#ical #ertebral bone age and chronological age
The a#erage error between the #alue predicted b"
cer#ical #ertebral bone age and the actual #alue *:>;
mm+ was significantl" less (' + ==:+ than that
between actual #alue and the #alue predicted b" chro%
nological age *B9< mm+ and appro.imatel" the same as
that between actual #alue and the #alue predicted b"
bone age *)=; mm+
DIS()SSION
The purpose of this stud" was to assess the possi%
bilit" of predicting mandibular growth potential with
cer#ical #ertebral bone age$ which was assessed from
cephalometric radiographs In man" circumstances$ it is
important to be able to predict mandibular growth
potential *eg$ to determine when to appl" functional
appliances in Class II patients or when to perform
orthopedic surger" in cases of se#ere s1eletal deformit"+
'ato et af
t
attempted to predict mandibular growth
potential with bone age$ which is determined with
hand%wrist radiographs$ as in the T() method
,
The"
found that the growth potential method was the most
accurate means of predicting mandibular growth In
this method$ growth potential was determined b" a
linear equation7 growth potential J a K bone age F b$
where a is a coefficient and $ is a constant In the
present stud"$ we fried to predict mandibular growth
potential b" using a modified growth potential method7
growth potential J a K cer#ical #ertebral bone age F b
The a#erage error between the #alue predicted b"
cer#ical #ertebral bone age and the actual #alue was
significantl" less than that between the #alue predicted
b" chronological age and actual #alue$ and it was
appro.imatel" the same as that between the #alue
predicted b" bone age and actual #alue Thus$ our
prediction of mandibular growth potential using cer#i%
cal #ertebral bone age is accurate In addition$ group H
included earl"% and late%maturing patients$ whose dif%
ferences between cer#ical #ertebral bone age and chro%
nological age were more than =, "ears in the initial
stage It is more difficult to predict growth in earl"% or
late%maturing patients than in a#erage patients There%
fore$ our formula should be more accurate if we select
patients with a#erage growth$ because there is theoret
icall" no difference between a#erage cer#ical #ertebral
bone age and chronological age This method might be
clinicall" useful$ because it is accurate for predicting
growth in earl"% and late%maturing patients
Almost all the sub!ects of this stud" were classified
into s1eletal Class I$ as shown in /igure ) Therefore$
the formula for predicting mandibular growth potential
should be applied to s1eletal Class I patients -owe#er$
man" in#estigators
:C%:;
ha#e concluded that there are no
differences in mandibular growth rates in the #arious
s1eletal patterns (e intend to #erif" whether our
formula can be applied to other s1eletal patterns To be
more significant for clinical application$ it might be
necessar" in future studies to impro#e the predicti#e
precision b" increasing the number of sub!ects$ adding
those with #arious s1eletal patterns$ and ma1ing a
separate formula for each s1eletal pattern$ if necessar"
(ON(L)SIONS
This stud" has produced a method for predicting
mandibular growth potential with onl" cephalometric
radiographs This method might be useful in treating
orthodontic patients in the growth stage
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American Journal of Orthodontics and Dentofacial Orthopedics Mito, Sato, and Mitani 177
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