Determinação da idade óssea através do método de avaliação vertebral cervical versus mão-punho: uma revisão sistemática

Abstract

The patient bone age determination is a preponderant factor in obtaining a favorable prognosis for the planned mechanotherapy in orthodontic treatment, so the hand-wrist radiographic evaluation is one of the most reliable and currently used methods. Although the assessment of changes in the radiographic appearance of the long bones epiphyses in this region, allows a strong correlation with general bone growth, a relevant factor for its contraindication is the guidelines published by the British Orthodontic Society, in addition to the concern regarding increased exposure to radiation. Therefore, the analysis of the cervical vertebrae, contained in the lateral cephalograms, has been getting more significance in the determination of bone age. The evaluation of these structures has been described by several authors, justifying the importance to elucidate this issue regarding the appropriate technique and clinical protocol. In this sense, the objective of this systematic review was to evaluate the use of the method that analyzes the morphological changes of the cervical vertebrae, using the lateral cephalometric radiographs, in comparison with the method of hand-wrist radiographs analysis, for determining bone age. A systematic search was performed in four electronic databases, including PubMed, Cochrane Library, Web of Science, Lilacs/BBO, also covering gray literature (OpenGrey). The articles were analyzed by two independent reviewers and the selected studies were evaluated following the guidelines of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. In this selection process, eighteen studies were included in this systematic review, which were ethodologically heterogeneous and with risk of bias classified as uncertain or high. The certainty of the evidence was considered very low, it can be concluded that, despite the different methodologies adopted, the method of analysis of cervical vertebrae is characterized by a high level of reliability, efficacy and correlation with the hand-wrist maturation method, when be used to determine the bone age of the individual. However, more studies are needed to increase the certainty of this evidence.