Research Article|Articles in Press

Automatic determination of pubertal growth spurts based on the cervical vertebral maturation staging using deep convolutional neural networks

Published:March 06, 2023DOI:


      • This study aimed to develop a deep convolutional neural network (CNN) for automatic classification of pubertal growth spurts using cervical vertebral maturation staging based on the lateral cephalograms of Iranian subpopulation.
      • The study findings confirm the potential of convolutional neural networks as a diagnostic tool for intelligent evaluation of skeletal maturation with high accuracy even with a relatively small number of images.



      This study aimed to develop a deep convolutional neural network (CNN) for automatic classification of pubertal growth spurts using cervical vertebral maturation (CVM) staging based on the lateral cephalograms of an Iranian subpopulation.

      Material and Methods

      Cephalometric radiographs were collected from 1846 eligible patients (aged 5–18 years) referred to the orthodontic department of Hamadan University of Medical Sciences. These images were labeled by two experienced orthodontists. Two scenarios, including two- and three-class (pubertal growth spurts using CVM), were considered as the output for the classification task. The cropped image of the second to fourth cervical vertebrae was used as input to the network. After the preprocessing, the augmentation step, and hyperparameter tuning, the networks were trained with initial random weighting and transfer learning. Finally, the best architecture among the different architectures was determined based on the accuracy and F-score criteria.


      The CNN based on the ConvNeXtBase-296 architecture had the highest accuracy for automatically assessing pubertal growth spurts based on CVM staging in both three-class (82% accuracy) and two-class (93% accuracy) scenarios. Given the limited amount of data available for training the target networks for most of the architectures in use, transfer learning improves predictive performance.


      The results of this study confirm the potential of CNNs as an auxiliary diagnostic tool for intelligent assessment of skeletal maturation staging with high accuracy even with a relatively small number of images. Considering the development of orthodontic science toward digitalization, the development of such intelligent decision systems is proposed.


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