Comparative effectiveness of cervical vertebral maturation and hand-wrist radiography in assessing bone age in patients with amelogenesis imperfecta: a retrospective analysis

Objective: Amelogenesis imperfecta (AI) is a hereditary enamel disorder whose potential impact on skeletal development remains unclear. Accurate assessment of skeletal maturation is essential for optimizing treatment timing in these individuals. This study aimed to investigate the agreement between cervical vertebral maturation (CVM) and hand-wrist radiography (HWR) in determining skeletal age in patients with AI. Methods: This retrospective study included 28 AI patients (16 females, 12 males; mean age: 9.65 ± 2.92 years) and 30 age- and sex-matched healthy controls. This retrospective study analyzed 58 participants: 28 patients with AI (16 females, 12 males; mean age 9.65 ± 2.92 years) and 30 healthy controls matched for age and sex (15 females, mean age 10.4 ± 2.09 years and 15 males, mean age 10.93 ± 2.4 years). Skeletal maturation was assessed via CVM stages from lateral cephalometric radiographs and Björk’s hand-wrist maturation stages. For comparative analysis, Björk’s nine stages were condensed into five developmental categories. Agreement between methods was evaluated via weighted kappa statistics. Gender-based subgroup analyses and intermethod correlations were also performed. Statistical significance was set at p < 0.05. Results: Moderate agreement was observed between the CVM and HWM stages in both groups (AI group: κ = 0.440; control group: κ = 0.556; total: κ = 0.525;p < 0.05). The lowest agreement was found among males with AI (κ = 0.221; p < 0.05), whereas the highest agreement occurred among control group males (κ = 0.623; p < 0.05). Despite moderate overall agreement, the findings suggest possible discrepancies in skeletal maturation assessment among AI patients, particularly in male subgroups. Conclusion: The CVM and HWM methods demonstrated moderate overall agreement in assessing skeletal age. However, the reduced agreement in male AI patients indicates the need for careful interpretation of skeletal maturation in this subgroup. The results highlight the importance of using both methods complementarily to optimize growth assessment and treatment planning in AI patients.