The Effect of Clinical Experience on Cervical Vertebral Maturation Assessment: Is a Hand-wrist Radiograph Necessary?

Abstract

Objective: To evaluate the role of hand-wrist radiographs (HWRs) in the assessment of growth and development based on the cervical vertebral maturation (CVM) method and to determine whether clinical experience levels would affect the decision-making process. Materials and Methods: The lateral cephalometric radiographs and HWRs of 48 patients aged 11 to 16 years were assessed in this study. The clinicians first determined the growth stage by the CVM method based on lateral cephalometric images (T1). Then, the clinicians filled out the same questionnaire with HWRs on each question (T2). Subsequently, the clinicians were divided into groups according to their experience levels. Intraclass correlation coefficients were calculated to evaluate intraobserver agreements. The data were analyzed with chi-square or Fisher-Freeman-Halton Exact tests for intergroup comparisons. Results: For all evaluators, the percentage of agreement changed minimally after T2. The most experienced clinicians demonstrated the most consistent decisions for overall CVM stages at both evaluations. Concerning each stage, the percentages of changed decisions showed no significant differences between the groups except for stages CS4 and CS5. There were significant differences between the rates of agreement for CS3 in each group from T1 to T2 (p<0.05). Conclusion: The level of orthodontic experience affects the decision-making process. The presence of HWRs provided no advantage in the assessment of CVM.