Morphometric Evaluation of Cervical Vertebral Age and Mandibular Growth in Skeletal Class II Individuals Using Digital Cephalometry: A Cross-sectional Study.

Abstract

Aims: This study examined the association between morphometric cervical vertebral bone (CVB) age and mandibular growth in Saudi individuals with skeletal class II malocclusion.

Materials and methods: A retrospective cross-sectional analysis was performed using archived digital lateral cephalograms of 56 Saudi patients with skeletal class II malocclusion. Radiographs were categorized into a pubertal group (8-13 years; n = 28) and a postpubertal group (17-21 years; n = 28), with each group equally stratified by gender (14 males and 14 females). Mandibular length estimates calculated during the pubertal phase were compared with measured mandibular dimensions in postpubertal subjects, and sex-related growth differences were evaluated. Cervical vertebral bone age was calculated using vertebral morphometric measurements, and mandibular length (Condylion-Gnathion) was digitally assessed. Predicted mandibular lengths derived from CVB age were statistically compared with observed postpubertal values using independent t-tests, Cohen's d, and descriptive Bland-Altman analysis.

Results: Chronological age (CA) demonstrated no significant discrepancy from CVB age in either males (p = 0.28) or females (p = 0.63). Mandibular lengths predicted during the pubertal phase did not differ significantly from observed mandibular dimensions in the postpubertal group, for both sexes (p > 0.05). Bland-Altman analysis demonstrated minimal bias and acceptable group-level agreement, with higher precision in females. Males exhibited greater but more variable estimated growth potential than females.

Conclusion: Morphometric CVB age showed good group-level agreement between mandibular length predicted during the pubertal phase (8-13 years) and measured postpubertal values (17-21 years) in Saudi skeletal class II subjects.

Clinical significance: Accurate assessment of mandibular growth timing remains essential for optimizing orthopedic intervention in skeletal class II malocclusion. This study highlights the clinical applicability of CVB morphometric assessment as a practical, radiation-free approach using routine cephalograms to estimate mandibular growth potential and support informed treatment timing decisions.