Pubertal Growth Spurt Peak in Angle Class I and II Malocclusions Using Cervical Vertebrae Maturation Analysis in Deutero-Malay Children

  • Putry Mahendra Universitas Airlangga
  • Seno Pradopo
  • Mega Moeharyono Puteri
Keywords: Puberty, Malocclusion, Angle Class I, Angle Class II, Cervical Vertebrae, Skeletal Age Measurement, Cephalometry, Asiatic Race, Age of Onset


Background. The incidence rate of Angle Class I and Class II malocclusions in mixed dentition is higher than Class III. In orthodontic interceptive treatment, it is necessary to identify pubertal growth spurt peak individually because the best growth modification could be obtained during this period. One of the methods in assessing the pubertal growth spurt peak is cervical vertebrae maturation (CVM), which is done using a lateral cephalometric radiograph. CVM evaluates potential growth and skeletal maturity by assessing cervical vertebrae anatomy. Identifying the duration of growth spurt peak on both malocclusion classes is the most pivotal aspect of optimizing remodeling and correction of children’s malocclusion.

Objective. Distinguishing the duration of pubertal growth spurt peak of children with Angle Class I and II malocclusions based on CVM analysis in Deutero-Malay children so that it can be used in determining optimal orthodontic treatment plan and timing in children with Class I and Angle II malocclusion for Deutero-Malay children.

Methods. Analytical observational with cross-sectional approach was applied using lateral cephalometric radiographic images from patients’ medical records attending or had attended orthodontic treatment in the Pediatric Dentistry Clinic, Airlangga University Dental Hospital, Surabaya, Indonesia, in 2014-2019 that met the inclusion criteria and were analyzed with Baccetti’s method of CVM analysis. This study involved 66 conventional lateral cephalometric photographs that were selected using total sampling. The data were analyzed using Independent T-Test and Mann Whitney U Test.

Result. The duration of pubertal growth spurt peak in Angle Class I and II malocclusions was 11 and 7 months, respectively. The age of onset for Class I with CS3 was 9 years and 5 months, while for Angle Class II malocclusion starts entering the stage at 10 years 3 months of age, while for CS4 skeletal maturity we found that the age of onset for subjects with Angle Class I and II were 11 years 2 months and 12 years 4 months, respectively. The average duration of the pubertal growth spurt peak in female and male patients was 11.3 months and 18.2 months, respectively. All of these results were statistically significant (p ≤ 0.001) and representative of the population, in this case, Deutero-Malays.

Conclusion. Four-month differences in the duration of pubertal growth spurt peak of children with Angle Class I and II were found. This may lead to a shorter treatment duration of 4 months in children with Angle Class II malocclusion when compared to children with Angle Class I malocclusion. Angle Class II malocclusion exhibit shorter pubertal growth spurt peak duration, which may account for the difference in mandibular growth on the two malocclusion classes.