Evidence map›Paper›PMID 41917479›Full record

SynthesisOral radiology2026

Radiographic choice for skeletal maturation assessment: a systematic review of Cervical Vertebrae Method and Middle Phalanx Method.

Angelo Michele Inchingolo, Grazia Marinelli, Francesca Calò, Claudia Ciocia, Antonio Rizzo, Francesco Inchingolo, Gianluca Martino Tartaglia, Massimo Del Fabbro, Andrea Palermo, Daniela Di Venere and 3 more

Abstract readSystematic Review
In one paragraph

Synthesis in Oral radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Angelo Michele Inchingolo *Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.
Grazia Marinelli *Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.
Francesca CalòInterdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.
Claudia CiociaInterdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.
Antonio RizzoInterdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.
Francesco InchingoloInterdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.
Gianluca Martino TartagliaDepartment of Biomedical, Surgical and Dental Sciences, Milan University, 20122, Milan, Italy.
Massimo Del FabbroDepartment of Biomedical, Surgical and Dental Sciences, Milan University, 20122, Milan, Italy.
Andrea PalermoDepartment of Experimental Medicine, University of Salento, 73100, Lecce, Italy. andrea.palermo@unisalento.it.
Daniela Di VenereInterdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.
Vito CrincoliInterdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy. vito.crincoli@uniba.it.
Alessio Danilo Inchingolo *Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.
Gianna Dipalma *Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe aim of the present study was to conduct a systematic review of the literature to provide an updated guide for clinicians in choosing the most appropriate radiographic method for skeletal age assessment and timing the pubertal growth spurt (PGS).

methodsThe review followed the PRISMA guidelines and used the PICOS strategy. Eligibility criteria focused on studies published in the last decade, directly comparing the Cervical Vertebrae Method (CVM) and the Middle Phalanx Method (MPM). Two reviewers performed the selection and a third reviewer intervened in cases of disagreement.

resultsAfter screening, thirteen studies were included. The analysis revealed that CVM and MPM are highly correlated and equivalent biological indicators. From the perspective of precision and reliability, the MPM method demonstrated excellent intra-observer reliability and clearly revealed the PGS. Conversely, CVM method showed reproducibility that is not improved by increasing clinical experience, but it achieved excellent accuracy when supported by Deep Learning (DL) and Artificial Intelligence (AI) systems.

conclusionThis review revealed that although MPM remains an excellent biological indicator, the equivalence of results, combined with the routine adoption of cephalometric radiography and the increasing implementation of AI, solidifies CVM as the preferred radiographic method. Consequently, subjecting the patient to an additional hand-wrist radiograph is unwarranted, relegating MPM to the role of a reserve indicator. CLINICAL RELEVANCE: AI and DL technologies are expected to standardize and drastically improve the objectivity and accuracy of CVM assessments, representing a crucial shift toward objective clinical diagnostics to eliminate the acknowledged inter- and intra-observer variability and optimize radiation dose management. The protocol was registered with the Prospective International Register of Systematic Reviews under number ID 1,110,124.

Indexed as

Age Determination by SkeletonCervical VertebraeFinger PhalangesHumansReproducibility of ResultsArtificial IntelligenceCervical vertebral maturationDeep learningPubertal growth spurtSkeletal age

Identifiers

PMID41917479
PMCPMC13290916

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.