{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:07:43Z","timestamp":1789016863893,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004054","name":"King Abdulaziz University","doi-asserted-by":"crossref","award":["IPP:1627-165-2026"],"award-info":[{"award-number":["IPP:1627-165-2026"]}],"id":[{"id":"10.13039\/501100004054","id-type":"DOI","asserted-by":"crossref"}]},{"award":["IPP:1627-165-2026"],"award-info":[{"award-number":["IPP:1627-165-2026"]}],"id":[{"id":"https:\/\/ror.org\/02ma4wv74","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Skeletal maturity assessment is essential for timing orthodontic growth-modification treatment. The cervical vertebral maturation (CVM) method is widely used, but manual staging is subjective and prone to inter-observer variability, and artificial intelligence (AI) may improve its consistency and accuracy. The aim of this study was to develop and externally validate a fully automated deep-learning pipeline for CVM assessment and to determine its diagnostic accuracy for three-phase and six-stage classification against calibrated expert staging. Methods: A cross-sectional three-stage deep-learning pipeline was trained and internally cross-validated on 523 cephalometric radiographs from King Abdulaziz University. Images were CLAHE-enhanced; YOLOv8 detected the C2\u2013C4 region; a ResNet-50 classifier assigned the growth phase (Early, Peak, Late); and phase-specific binary classifiers assigned CVM stages (CS1\u2013CS6). External validation used the independent \u2018Aariz dataset (n = 150). Results: The detector achieved mAP@0.5 = 0.9939 and mean IoU = 0.8884. On external validation, the three-phase classifier reached 96.0% accuracy, macro-F1 0.919, weighted \u03ba 0.951 and ROC-AUC 0.998, whereas the end-to-end six-stage cascade reached 79.3% accuracy, macro-F1 0.735, weighted \u03ba 0.910 and ROC-AUC 0.923. Most errors occurred between adjacent stages, with 98.7% of predictions within \u00b11 stage of the reference standard. Conclusions: The automated pipeline showed promising performance for three-phase CVM classification and moderate performance for six-stage classification on one independent external benchmark. Further multicenter prospective validation is required to establish its generalizability and clinical utility.<\/jats:p>","DOI":"10.3390\/diagnostics16182886","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:10:22Z","timestamp":1788855022000},"page":"2886","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Accuracy of a Machine Learning Model for Cervical Vertebra-Based Skeletal Maturity Assessment in Pediatric and Adolescent Patients Using Cephalometric Radiographs"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3194-7358","authenticated-orcid":false,"given":"Narmin","family":"Helal","sequence":"first","affiliation":[{"name":"Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7637-7772","authenticated-orcid":false,"given":"Faisal","family":"Al-Malki","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8868-314X","authenticated-orcid":false,"given":"Basil","family":"Saadi","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5372-2769","authenticated-orcid":false,"given":"Osama","family":"Basri","sequence":"additional","affiliation":[{"name":"King Faisal Specialist Hospital and Research Center, Jeddah 21499, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1053\/j.sodo.2005.04.005","article-title":"The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics","volume":"11","author":"Baccetti","year":"2005","journal-title":"Semin. 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