• Hafiz Taha Mahmood BDS Resident Orthodontics, Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, Karachi 74800, Pakistan
  • Attiya Shaikh BDS, M. Orth & FCPS (Orthodontics) Consultant Orthodontist/ Assistant Professor Liaquat College of Medicine and Dentistry
  • Mubassar Fida


Background: The present study aimed at assessing the relationship between growth changes in maxillary (MS) and sphenoid sinus (SS) and cervical vertebral maturation (CVM) and to evaluate their reliability and validity in assessing the skeletal maturity of an individual. Methods: A cross-sectional study was conducted on the pretreatment lateral cephalograms of 224 patients (males=116, females=108) aged 8–17 years. MS and SS heights, widths and indices were evaluated. The subjects were classified according to six stages based on CVM using Baccetti’s method. Kruskal-Wallis test was applied to compare MS and SS measurements at different cervical stages for each gender. Kappa statistics, positive predictive value, negative predictive value, sensitivity and specificity were calculated to test the diagnostic accuracy of MS and SS indices. Results: The MS and SS indices varied significantly (p<0.001) at different cervical stages for both gender. Kappa statistics showed significant agreement using MS (p<0.001) and SS indices (p<0.05). The diagnostic performance of MS index (Sensitivity ≥71%) was found to be better than SS index (Sensitivity ≥65%). Conclusions: The MS height, width and index in both genders and SS height, width and index in males and only SS width and index in females were significantly associated with the CVM stages. The validity of MS and SS indices were comparable for females; whereas, the MS index offers significant advantage over SS index for the assessment of growth status of males.Keywords: Maxillary Sinus; Sphenoid Sinus; Cervical Vertebral Maturation

Author Biographies

Attiya Shaikh, BDS, M. Orth & FCPS (Orthodontics) Consultant Orthodontist/ Assistant Professor Liaquat College of Medicine and Dentistry

Consultant Orthodontist/ Assistant ProfessorLiaquat College of Medicine and Dentistry

Mubassar Fida

BDS, MCPS & FCPS (Orthodontics), MCPS (Periodontology),MCPS (Community Dentistry), PGD HIMSConsultant Orthodontist/Associate Professor,Section of Dentistry, Department of Surgery,The Aga Khan University Hospital, P.O Box 3500, Stadium Road, Karachi 74800, Pakistan


Proffit WR, Jackson TH, Turvey TA. Changes in the pattern of patients receiving surgical-orthodontic treatment. Am J Orthod Dentofacial Orthop 2013;143(6):793–8.

Broadbent JM. Crossroads: acceptance or rejection of functional jaw orthopedics. Am J Orthod Dentofacial Orthop 1987;92(1):75–8.

DiBiase AT, Cobourne MT, Lee RT. The use of functional appliances in contemporary orthodontic practice. Br Dent J 2015;218(3):123–8.

Singer J. Physiologic timing of orthodontic treatment. Angle Orthod 1980;50(4):322–33.

Hunter WS. The correlation of facial growth with body height and skeletal maturation at adolescence. Angle Orthod 1966;36(1):44–54.

Green LJ. The interrelationships among height, weight, and chronological, dental, and skeletal ages. Angle Orthod 1961;31(3):189–93.

Hagg U, Taranger J. Menarche and voice changes as indicators of the pubertal growth spurt. Acta Odontol Scand 1980;38(3):179–86.

Coutinho S, Buschang PH, Miranda F. Relationships between mandibular canine calcification stages and skeletal maturity. Am J Orthod Dentofacial Orthop 1993;104(3):262–8.

Kumar S, Singla A, Sharma R, Virdi MS, Anupam A, Mittal B. Skeletal maturation evaluation using mandibular second molar calcification stages. Angle Orthod 2011;82(3):501–6.

Grave KC, Brown T. Skeletal ossification and the adolescent growth spurt. Am J Orthod 1976;69(6):611–9.

Fishman LS. Radiographic evaluation of skeletal maturation: a clinically oriented method based on hand-wrist films. Angle Orthod 1982;52(2):88–112.

Houston WJ. Relationships between skeletal maturity estimated from hand-wrist radiographs and the timing of the adolescent growth spurt. Euro J Orthod 1980;2(2):81–93.

Cavanese F, Charles YP, Dimeglio A. Skeletal age assessment from elbow radiographs. Review of the literature. Chir Organi Mov 2008;92(1):1–6.

Lamparski DG. Skeletal age assessment utilizing cervical vertebrae [master's thesis]. Pittsburgh, Penn: Department of Orthodontics, The University of Pittsburgh; 1972.

Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 1995;107(1):58–66.

Baccetti T, Franchi L, McNamara Jr JA. The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in Dentofacial orthopedics. Semin Orthod 2005;11(3):119–29.

Nestman TS, Marshall SD, Qian F, Holton N, Franciscus RG, Southard TE. Cervical vertebrae maturation method morphologic criteria: poor reproducibility. Am J Orthod Dentofacial Orthop 2011;140(2):182–8.

Kumar S, Tripathi T, Sindhu MS, Grover S, Diwaker R. Sphenoid sinus as a mandibular growth prediction - Is it valid? Indian J Dent Sci 2015;7(1):54–5.

Mahmood HT, Shaikh A, Fida M. Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity. Am J Orthod Dentofacial Orthop 2016;150(4):637–42.

Patil AA, Revankar AV. Reliability of the frontal sinus index as a maturity indicator. Indian J Dent Res 2013;24(4):523–3.

Ertuk N. Teleroentgen studies on the development of the frontal sinus. Fortschr Kieferothop 1968;29(2):245–8.

Endo T, Abe R, Kuroki H, Kojima K, Oka K, Shimooka S. Cephalometric evaluation of maxillary sinus sizes in different malocclusion classes. Odontology 2010;98(1):65–72.

Dahlberg, G. Statistical Methods for Medical and Biological Students. New York, NY: Interscience, 1940; p.122–32.

Houston WJ. The analysis of errors in orthodontic measurements. Am J Orthod 1983;83(5):382–90.

Graney DO, Rice DH. Anatomy. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE, editors. Otolaryngology: head and neck surgery, 2nd ed. St. Louis: Mosby Year Book, 1993; p.901–6.

Sharan A, Madjar D. Maxillary sinus pneumatization following extractions: A radiographic study. Int J Oral Maxillofac Implants 2008;23(1):48–56.

Scuderi AJ, Harnsberger HR, Boyer RS. Pneumatization of the paranasal sinuses: normal features of importance to the accurate interpretation of CT scans and MR images. AJR Am J Roentgenol 1993;160(5):1101–4.

Arat M, Köklü A, Ozdiler E, Rübendüz M, Erdoğan B. Craniofacial growth and skeletal maturation: a mixed longitudinal study. Eur J Orthod 2001;23(4):355–63.

Arat ZM, Rübendüz M, Arman Akgül AA. The displacement of craniofacial reference landmarks during puberty: a comparison of three superimposition methods. Angle Orthod 2003;73(4):374–80.

Shapiro R, Schorr S. A consideration of the systemic factors that influence frontal sinus pneumatization. Invest Radiol 1980;15(3):191–202.

Grummons DC, Kappeyne van de Coppello MA. A frontal asymmetry analysis. J Clin Orthod 1987;21(7):448–65.

Santiago RC, de Miranda Costa LF, Vitral RW, Fraga MR, Bolognese AM, Maia LC. Cervical vertebral maturation as a biologic indicator of skeletal maturity: a systematic review. Angle Orthod 2012;82(6):1123–31.



Most read articles by the same author(s)

1 2 > >>