Cervical vertebral and dental maturity in Turkish subjects

Is there a correlation between dental and cervical vertebrae maturation stages in growing subjects? A systematic review with meta-analysis

OBJECTIVE

To assess the evidence on the relationship between dental and cervical vertebrae maturation.

MATERIALS AND METHODS

Searches were performed (up to December 2021) in seven databases, as well as in gray literature. Studies that included growing subjects, which evaluated the correlation between the stages of tooth formation and the maturation of cervical vertebrae, were eligible. The methodological quality of the selected reports was assessed using the JBI checklist for cross-sectional studies. Random-effects meta-analyses were implemented to calculate the pooled correlation coefficients between the maturation stages of cervical vertebrae and each tooth type. The GRADE approach was followed to assess the certainty of evidence.

RESULTS

Seventy-seven studies were selected. Most of them had limitations related to sampling and reliability of the methods to evaluate maturation. The syntheses evidenced positive correlations between the maturation of cervical vertebrae and the formation/calcification stages of the following lower teeth: canine (n = 7318; r = 0.692; 95% CI: 0.656-0.724), first premolar (n = 6194; r = 0.689; 95% CI: 0.649-0.725), second premolar (n = 6194; r = 0.695; 95% CI: 0.659-0.729), and second molar (n = 7905; r = 0.698; 95% CI: 0.652-0.739). All estimates were affected by the risk of bias and the presence of unexplained statistical heterogeneity.

CONCLUSIONS

The evidence points to an apparent positive correlation between dental and cervical vertebrae maturation. These results need to be carefully evaluated as the body of evidence is of very low quality.

CLINICAL RELEVANCE

Dental maturation might be a potential indicator of skeletal craniofacial growth status. A routine dental x-ray could be sufficient, reducing radiation exposure by requesting additional radiographs.

Concordances and correlations between chronological, dental and bone ages: A retrospective study in French individuals

Bone and dental maturations are subject to physiological, environmental and pathological variables and are unique to each individual. Numerous methods for age estimation appeared to answer a new demand explained by the contemporary migratory movements and the increase of the crime rates. The objective of this study was to observe the relationships between skeletal and dental maturation stages to estimate which methods can be applied to a French population. This retrospective study was based on panoramic and cephalometric radiographs belonging to 192 (101 females and 91 males) orthodontic patients aged between 9 and 19 years, inhabitants of the Provence-Alpes-Côte d'Azur region. The Demirjian method based on dental calcification was used to estimate dental age. For the assessment of skeletal maturity and bone age, the Cervical Vertebral Maturation (CVM) method (Baccetti et al.) and its computerized version (Decocq et al.) were used. Spearman's correlation tests were performed to estimate the correlation between dental calcification stages and those of cervical vertebral maturation among the study population. The methods of Lin's concordance correlation coefficient and Bland and Altman were used to analyze the concordance between bone, dental and chronological ages. A moderate but statistically significant correlation was obtained between dental and skeletal developmental stages (R = 0.383-0.618). The tooth showing the highest correlation with vertebral stages was the second molar for both sexes. Earlier vertebral maturation stage affiliation was observed in girls. The results confirmed that bone and dental maturations can be assessed to estimate relevant biological ages for children in orthodontic or forensic contexts.

Assessment of maturation indicators in individuals with different skeletal malocclusion

PURPOSE

The aim of this study was to comparatively evaluate hand-wrist bones, cervical vertebrae and tooth development stages according to skeletal classification.

METHODS

The orthodontic initial records of 297 patients were used and separated into three groups according to the skeletal malocclusion. Three groups including 99 people each were sampled representing malocclusions with Angle classes I, II and III, respectively. The panoramic, cephalometric and hand-wrist radiographs of all patients included in this study were used to compare dental and skeletal maturation indicators. Calcification of teeth was rated according to the system of Demirjian. To evaluate the stage of skeletal maturation hand-wrist radiographs were analyzed according to the Grave and Brown method. Also, Hassel and the Farman method was used to classifying vertebral developmental stages. Spearman rank correlation tests, as well as Fisher exact χ² tests with r×c tables, were used for the comparison of categorical variables.

RESULTS

Hand-wrist, vertebral and dental development stages showed a statistically significant relationship (p < 0.01) for both genders and in all malocclusions. The association between the different maturation indicators used in this study and the type of malocclusion was also statistically significant for both genders. It was observed that the peak period of skeletal maturation according to the hand-wrist radiograph findings correlated with the cervical vertebrae stage C3 in girls (63.2%) and C2-C3 in boys (43.5-43.5%). The weakest correlation was seen between the dental development stages and the skeletal developmental stages in the class II group (r = 0.443-0.220 [girls]; r = 0.604-0.410 [boys]).

CONCLUSION

The use of the dental development stage as a reliable indicator of maturation was limited. According to the Demirjian method, the calcification stage of the second molar might indicate that the individual is in the pubertal peak period.

Skeletal age prediction model from percentage of adult height in children and adolescents

Skeletal age (SA) is considered the gold standard to assess the degree of maturation and has been widely used in sports, education and public health areas; however, it requires sophisticated equipment and well-trained technicians. Therefore, it is important to develop non-invasive methods for its evaluation. The aim was to develop an equation to predict SA using the percentage of adult height. SA was measured by Tanner-Whitehouse-3 method, and the percentage of adult height was estimated by two methodologies: Tanner-Whitehouse-3 method (P-TW3) and Khamis-Roche method (P-KR) using 839 schoolchildren of both sexes. Linear regression was used for predicting SA from P-TW3; then P-TW3 was replaced in the equation for P-KR value. Bland-Altman graphs, interclass correlation coefficient and Kappa index were used as validation tests. Model showed a SA predictive capacity of 93.2% in boys and 96.8% in girls. The average differences between SA measured and SA predicted by P-TW3 was 0.0504 (± 0.664) in boys and 0.0144 (± 0.435) in girls (P = 0.229 and 0.667, respectively). When P-TW3 was replaced for P-KR value in the equation, the average differences were - 0.0532 in boys and 0.0850 in girls (P = 0.509 and 0.167 respectively). The present model, based on the percentage of adult height, showed an adequate estimation of SA in children and adolescents and it can be used in the absence of bone X-ray equipment, in healthy boys aged 9 to 15 and girls 8 to 13.

Dental development in patients with and without unilateral cleft lip and palate (UCLP): a case control study

OBJECTIVE

To evaluate if the presence of unilateral cleft lip and palate (UCLP) causes delay in dental age and tooth development.

MATERIALS AND METHODS

Panoramic radiographs of 189 non-syndromic UCLP patients, aged from 6 to 20 years, were collected. Two measures of tooth development were examined: dental maturity scale for the seven left mandibular teeth (dental age-DA) and the degree of each tooth development (developmental score-DS). All the teeth except third molars were staged according to the Demirjian's method. The data of the cleft group were compared with a control group matched for age and gender, based on the findings observed in other 189 panoramic radiographs.

RESULTS

At all ages, DA was lower in the UCLP group, but not always significantly; the highest difference was - 1.411 for females at 13 years old and - 0.776 for males at 12 years old. DS of all teeth was significantly lower in the UCLP group, at all ages under 17 in females, and at all ages under 18 in males. In UCLP group, tooth development was more delayed in the maxilla compared with the mandible. No evidence of a slower development at the cleft side compared with the non-cleft side was highlighted.

CONCLUSIONS

Significant lower dental development was observed in UCLP patients compared with control ones by using DS and DA indexes.

CLINICAL RELEVANCE

These findings can help the clinicians in establishing a proper orthodontic and surgical diagnosis and treatment planning in UCLP patients and for forensic age estimation's purposes.

Correlation between skeletal development and maxillary canine eruption

Aim

The aim of this study was to find a correlation between the permanent maxillary canine eruption and the cervical vertebral maturation index (CVMI).

Materials and Methods

145 subjects (73 male and 72 female) in the age of 7-14 years were examined radiographically with lateral cephalographs and orthopantomographs. The CVM patterns were evaluated on the lateral cephalograph using the classification of Hassel and Farman. The stage of the permanent maxillary canine eruption has been investigated on the orthopantomographs depending on its vertical height in relation to the adjacent incisor. Descriptive statistics were obtained for both CVMI stages and canine eruption grading. Spearman rank correlation test was used to determine the correlation between both methods. The minimum level of significance was considered less than 0.05 (P < 0.05).

Results

Results showed a strong correlation between CVMI and the grading of the maxillary canine eruption in both female and male and the (r) value estimated was 0.862 and 0.758, respectively. Over 90% of deceleration stage of CVMI in both genders show canine eruption (pubertal growth spurt) about 91.66% for female and 95.65% for male and a small percentage of delay eruption 8.33% and 4.35% in female and male gender, respectively, with a predilection to the female gender.

Conclusions

A significant correlation between the permanent maxillary canine eruption stages and skeletal maturity was found. The eruption of maxillary canine occurs before the end of pubertal growth. Any delay in the eruption of maxillary canine after the deceleration stage of CVMI, suggesting a chance of impaction.

Radiographic Correlation of Skeletal Maturation Using the Stages of Dental Calcification in a Peruvian Population

OBJECTIVE

To identify the correlation between the Baccetti method of SM (skeletal maturation) and the stages of DC (dental calcification) using the Demirjian method in the Orthodontics Service of the Universidad Peruana Cayetano Heredia (UPCH) in Lima-Peru. Materials and Methods. The sample was obtained from panoramic and lateral radiographs of 200 subjects (116 women and 84 men) with ages between 9 and 17 years. Canine, premolar, and molar teeth calcification was evaluated using the Demirjian method while SM was evaluated by the cervical vertebrae with the Baccetti method. Spearman's correlation coefficient was used to assess the relationship between the maturation of these cervical vertebrae and DC.

RESULTS

There is a high correlation between the Baccetti method of maturation of the cervical vertebrae and the stages of DC ranging from r = 0.635 to 0.774 for men and from r = 0.677 to 0.784 for women (p < 0.001), the second lower molar being the one with the highest correlation (r = 0.774 in men) and the second lower premolar (r = 0.784 in women).

CONCLUSIONS

Stages of DC could be used as a reliable indicator of SM.

Association between mandibular second molars calcification stages in the panoramic images and cervical vertebral maturity in the lateral cephalometric images

Background

Determination of maturation and evaluation of growth potential is extremely important in clinical orthodontics. The purpose of this study was to evaluate the diagnostic performance of the mandibular second molar calcification stages for identification of growth phases.

Material and Methods

In this cross-sectional descriptive study, samples were derived from panoramic radiographs and lateral cephalograms of 125 subjects (61 males and 64 females) with age ranging from 8 to 17 years and estimates of dental maturity (Demirjian Index [DI]) and skeletal maturity (Cervical vertebral maturation indicators CVMI]) were made. Correlations between DI and CVMI were shown by Spearman’s correlation. The diagnostic performance of the DI for the identification of the growth phase were evaluated using positive likelihood ratios (LHRs), with a threshold of ≥10 for satisfactory performance.

Results

Correlations between second molar calcification and growth phase were 0.819 for females and 0.805 for males (P-value< 0.0001). LHR ≥10 was only observed for the identification of the post-pubertal growth phase for the H stage of the second molar.

Conclusions

In spite of the high correlation coefficients between mandibular second molar calcification stages and skeletal maturity, these stages are reliable only for the identification of the post pubertal growth phase.

Key words:Skeletal maturation, demirjian Index, mandibular second molar.

The relation between dental age and cervical vertebral maturation in orthodontic patients aged 8 to 16 years: A cross-sectional study

OBJECTIVE

This study aimed to assess the relation between the dental age of seven left mandibular teeth determined by the Demirjian's method and skeletal age determined by the Baccetti's method.

MATERIALS AND METHODS

This cross-sectional study evaluated 600 patients aged between 8-16 years, who were selected from those presenting to Orthodontics Department of Hamadan dental school and private orthodontic offices. The patients had good-quality panoramic radiographs and lateral cephalograms taken within 2 months of each other. Skeletal age was determined according to the cervical vertebral maturation (CVM) on lateral cephalograms. The dental age of seven left mandibular teeth was determined using the Demirjian's method. Data were analysed by the Spearman's and Pearson's correlation coefficients via SPSS 16.

RESULTS

CVM had significant correlations with dental age (0.780) and chronological age (0.792). Accordingly, the strongest correlation was noted between CVM and the developmental stage of second molars in both males and females. In males, the highest correlation between dental age and chronological age was in CS5 stage (0.724) while, in females, the highest correlation between dental age and chronological age was in CS4 stage (0.651).

CONCLUSION

Considering the correlation between skeletal age and dental calcification, dental age, especially the developmental stage of mandibular second molars, based on panoramic radiographs, can be served as a primary diagnostic tool for determining the skeletal maturity stage of patients.

Cervical vertebral maturation and its relationship to circum-pubertal phases of the dentition in a cohort of Portuguese individuals

Background

To explore the relationship between individual skeletal maturity as assessed by Cervical Vertebral Maturity method (CVM), circum-pubertal phases of the dentition (early mixed, intermediate mixed, late mixed and early permanent) and chronlogical age in a cohort of Portuguese individuals.

Material and Methods

This was a retrospective cross-sectional study. The sample comprised 300 Caucasian Portuguese subjects aged 6 to 16 years, (137 boys and 163 girls). All the participants had good quality panoramic and lateral cephalometric radiographs. Subject skeletal maturity was evaluated using the CVM method. Dental age evaluation was determined by using panoramic radiographs and dental casts. Descriptive statistics (absolute and relative frequencies) and percentages were obtained for the prevalence of the CVM stages in the various phases of the dentition and for the different ages for each of males and females.

Results

Prepubertal stage 1 (CS1) was predominently observed in the early mixed dentition phase followed by the intermediate mixed dentition phase. While, the CS1 stage was found in all the other phases of tooth development. There was a wide distribution of all CVM stages in the late mixed dentition and early permanent dentition phases. While, the CS3 stage was predominantly present in both the late mixed dentition and in the early permanent dentition phases. Moreover, the chronological age did not seem to be an accurate indicator in differentiating between the pre-pubertal and the pubertal growth spurt stages.

Conclusions

Early mixed dentition phase could determine with a high accuracy the prepubertal skeletal maturity stage (CS1), Furthermore, the chronological age did not seem to be an accurate indicator in differentiating between the pre-pubertal and the pubertal growth spurt stages.

Key words:Cervical vertebrae, cephalometric, panoramic, tooth calcification, portuguese.

Evaluation of the relationship between the Demirjian and Nolla methods and the pubertal growth spurt stage predicted by skeletal maturation indicators in Turkish children aged 10-15: investigation study

OBJECTIVE

The aim of this study was to investigate the possibility of evaluating the relationship between dental maturation and skeletal maturation without taking a hand-wrist radiogram outside of panoramic radiogram.

MATERIALS AND METHODS

Panoramic and hand-wrist radiographs of 717 patients (383 girls and 334 boys), with ages ranging from 10 to 15 years, were evaluated. Dental maturity stages of the mandibular canine, first premolar, second premolar and second molar teeth were determined by Demirjian's and Nolla's methods. The skeletal maturation was determined by Fishman method and bone age was determined through the Greulich and Pyle method.

RESULTS

All teeth showed positive and statistically significant correlations, the highest correlation was between the mandibular second premolar calcification stages and hand-wrist maturation stages. According to both dental age determination methods, mandibular second premolar was prominent in determining to the pubertal growth stages.

CONCLUSIONS

There was a positive relationship between dental calcification stages and skeletal maturation stages, in the study population. Dental calcification stages of the second mandibular premolar showed the highest positive correlation with the skeletal maturation stages.

Assessment of skeletal maturity using the calcification stages of permanent mandibular teeth

INTRODUCTION

Knowledge of the growth status of patients is essential to formulate and initiate a precise treatment plan. This study aimed at determining the role of calcification of permanent mandibular teeth for the assessment of skeletal maturity.

METHODS

A cross-sectional study was conducted using lateral cephalograms and dental panoramic radiographs of 360 patients (ages 7-18 years) equally divided into six groups according to cervical vertebral maturation stages. Skeletal age was determined using Baccetti et al. method and dental age was calculated using Nolla and Demirjian methods.

RESULTS

Mean chronological stage at CS5 revealed a significant difference between male and female subjects (p= 0.003), which showed that the latter achieved skeletal maturity one year earlier than the former. A significant difference (p= 0.007) was found for dental age using Nolla's stages at CS3, which showed females demonstrated a dental age of 1.4 years less than males. Mandibular canine showed the highest correlation with Demirjian index (DI) in males (rho = 0.818) and females (rho = 0.833). Mandibular second premolar showed the highest correlation with Nolla's stages in males (rho = 0.654) and females (rho = 0.664).

CONCLUSION

Comparisons between sexes revealed that females are skeletally and dentally advanced. The DI indicated stage F and Nolla's stages identified stages 9, 10 to be indicative of CS2-3 for the mandibular canine and stages F and G and 9-10 for CS2-3 for the first premolars, second premolars and second molars, respectively.

Correlation between Cervical Vertebral Maturation Stages and Dental Maturation in a Saudi Sample

Background

The aim of the present study was to compare the cervical vertebra maturation stages method and dental maturity using tooth calcification stages.

Methods

The current study comprised of 405 subjects selected from orthodontic patients of Saudi origin coming to clinics of the specialized dental centers in western region of Saudi Arabia. Dental age was assessed according to the developmental stages of upper and lower third molars and skeletal maturation according to the cervical vertebrae maturation stage method. Statistical analysis was done using Kruskal-Wallis H, Mann-Whitney U test, Chi-Square test; t-test and Spearman correlation coefficient for inter group comparison.

Results

The females were younger than males in all cervical stages. The CS1-CS2 show the period before the peak of growth, during CS3-CS5 it's the pubertal growth spurt and CS6 is the period after the peak of the growth. The mean age and standard deviation for cervical stages of CS2, CS3 and CS4 were 12.09 ±1.72 years, 13.19 ±1.62 and 14.88 ±1.52 respectively. The Spearman correlation coefficients between cervical vertebrae and dental maturation were between 0.166 and 0.612, 0.243 and 0.832 for both sexes for upper and lower third molars. The significance levels for all coefficients were equal at 0.01 and 0.05.

Conclusion

The results of this study showed that the skeletal maturity increased with the increase in dental ages for both genders. An early rate of skeletal maturation stage was observed in females. This study needs further analysis using a larger sample covering the entire dentition.

Estimation of Dental and Bone Age in Obese Children of South India

Aim:

Determination of skeletal and dental age is very essential for Pediatric dentist and orthodontist to formulate a treatment plan, and it is a source of supplemental information for Pediatrics, Orthopedics, and Forensics. There are no available studies in the literature about the comparison of dental and bone age with chronological age in obese children of south India. Accordingly, the aim of this study was to evaluate and compare dental age, bone age, and chronological age in obese children of south India.

Materials and Methods:

Ethical approval was obtained from the ethical committee of college, and informed consent was obtained from parents of the study participants. A total of 100 obese study participants were selected between 8 to 14 years age group. Date of birth was considered to obtain chronological age. Demirjian's method was used to assess dental age. Bjork, Grave, and Brown's method was followed to detect bone age using hand-wrist radiograph. The comparison of three ages was done using the unpaired Student's t-test and Pearson's correlation coefficient.

Results:

Dental age and bone age were advanced in comparison to chronological age in both sexes and its statistically significant (P < 0.001). There was a positive correlationship between three ages in both sexes.

Conclusion:

As per our study, dental age and bone age were advanced in obese children, but dental age was more advanced. Dental age and bone age can be considered as variables for diagnosing the impact of growth in obese children. In the future, further studies are required to support our findings.

Estimation of Correlation between Chronological Age, Skeletal Age and Dental Age in Children- A Cross-sectional Study

Introduction

In the modern era, identification and determination of age is imperative for diversity of reasons that include disputed birth records, premature delivery, legal issues and for validation of birth certificate for school admissions, adoption, marriage, job and immigration. Several growth assessment parameters like bone age, dental age and the combination of both have been applied for different population with variable outcomes. It has been well documented that the chronological age does not necessarily correlate with the maturational status of a child. Hence, efforts were made to determine a child's developmental age by using dental age (calcification of teeth) and skeletal age (skeletal maturation).

Aim

The present study was aimed to correlate the chronological age, dental age and skeletal age in children from Southeastern region of Andhra Pradesh, India.

Materials and Methods

Out of the total 900 screened children, only 100 subjects between age groups of 6-14 years with a mean age of 11.3±2.63 for males and 10.77±2.24 for females were selected for the study. Dental age was calculated by Demirjian method and skeletal age by modified Middle Phalanx of left hand third finger (MP3) method. Pearson's and Spearman's correlation tests were done to estimate the correlation between chronological, dental and skeletal ages among study population.

Results

There was a significant positive correlation between chronological age, dental age and all stages of MP3 among males. Similar results were observed in females, except for a non-significant moderate correlation between chronological age and dental age in the H stage of the MP3 region.

Conclusion

The results of the present study revealed correlation with statistical significance (p<0.05) between chronological, dental and skeletal ages among all the subjects (48 males and 52 females) and females attained maturity earlier than males in the present study population.

Correlation between spheno-occipital synchondrosis, dental age, chronological age and cervical vertebrae maturation in Turkish population: is there a link?

OBJECTIVE

To assess the correlation between third molar mineralization (TMM), spheno-occipital synchondrosis (SOS) fusion, chronologic age and cervical vertebrae maturation (CVM) for skeletal maturation.

MATERIALS AND METHODS

Radiographs for 116 patients between 8 and 28 years were evaluated for age determination using mandibular TMM, SOS fusion and CVM. Spearman Correlation and Kappa test analyses were used to assess the relationship between variables and for intraobserver reliability.

RESULTS

Strong correlation was found between chronological age and TMM for males (r = .802) and females (r = .842), very strong correlation was found between age and CVM for males (r = .812) and moderate for females (r = .449), it was strong between age and SOS fusion for males (r = .810) and females (r = .643). Correlation between TMM and SOS was found to be strong for males (r = .759) and moderate for females (r = .534), it was strong between TMM and CVM for males (r = .723) and weak for females (r = .371). Very strong correlation was found between CVM and SOS fusion for males (r = .851) and strong correlation for females (r = .618).

CONCLUSION

Good correlation was found between the degrees of TMM, fusion of SOS and CVM in young Turkish population.

Diagnostic assessment of skeletal maturity through dental maturation in Hispanic growing individuals

Background

The aim of this study was to explore dental maturation as a diagnostic test for skeletal maturation.

Materials and Methods

Six hundred and fifty-seven growing individuals were classified according to their cervical vertebral maturity and dental maturity, both determined in lateral cephalograms and panoramic radiographs, respectively. The correlation between cervical and dental stages was established for each gender. A receiver operating characteristic curve analysis was made, and sensitivity and specificity values were established.

Results

Correlation was found between cervical and dental maturation for females (r = 0.73; P < 0.001) and males (r = 0.60; P < 0.001). Sensitivity for dental Stage F, as an indicator of a postmaturation peak stage, was 87.21% for females and 97.1% for males, whereas specificity for the same stage was 82.92% and 72.3% for females and males, respectively.

Conclusions

Dental maturation evaluation could contribute determining whether a patient is in a pre- or post-growth spurt stage.

Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies

Current evidence on the reliability of growth indicators in the identification of the pubertal growth spurt and efficiency of functional treatment for skeletal Class II malocclusion, the timing of which relies on such indicators, is highly controversial. Regarding growth indicators, the hand and wrist (including the sole middle phalanx of the third finger) maturation method and the standing height recording appear to be most reliable. Other methods are subjected to controversies or were showed to be unreliable. Main sources of controversies include use of single stages instead of ossification events and diagnostic reliability conjecturally based on correlation analyses. Regarding evidence on the efficiency of functional treatment, when treated during the pubertal growth spurt, more favorable response is seen in skeletal Class II patients even though large individual responsiveness remains. Main sources of controversies include design of clinical trials, definition of Class II malocclusion, and lack of inclusion of skeletal maturity among the prognostic factors. While no growth indicator may be considered to have a full diagnostic reliability in the identification of the pubertal growth spurt, their use may still be recommended for increasing efficiency of functional treatment for skeletal Class II malocclusion.

Utility of panoramic radiography for identification of the pubertal growth period

INTRODUCTION

Our aim in this study was to investigate the association between dental mineralization stages and the periods of the pubertal growth spurt (PGS).

METHODS

The sample included panoramic and hand-wrist radiographs from 491 subjects (222 boys, 269 girls) aged 7 to 17 years. Dental development was rated, and skeletal maturation was evaluated. The relevant associations were investigated by analysis of ordinal multinomial logistic regression.

RESULTS

The second molar (odds ratio [OR] = 4.34) and the first premolar (OR = 2.45) were the best growth predictors for girls. For boys, the second molar (OR = 6.80), second premolar (OR = 2.41), and canine (OR = 3.21) proved to be the best predictors. Stages D and E of the second molar for girls, and stages E and F for boys, corresponded to the onset of the accelerated growth spurt. Stage F of the second molar for girls and stage G for boys corresponded to the peak of the PGS. At the end of the PGS, most teeth had already attained apical closure. In girls, however, most second molars were found at stage G.

CONCLUSIONS

An association exists between the dental mineralization stages and the periods of the PGS, especially for second molars. Panoramic radiographs can be used as the first diagnostic tool to estimate the pubertal growth period.

Dental calcification stages as determinants of the peak growth period

OBJECTIVE

The objective of this study was to investigate the diagnostic accuracy of dental maturation stages for identifying individual-specific skeletal maturation phases.

SUBJECTS AND METHODS

Prior to initiating this study, 255 orthodontic patients comprising 145 girls and 110 boys from the Department of Orthodontics, Aristotle University of Thessaloniki, Greece were identified. Lateral cephalometric and panoramic radiographs were evaluated. Dental calcification stages were assessed according to the Demirjian method and skeletal maturation according to the cervical vertebral maturation stage (CVMS) method. Statistical assessments included Spearman Brown formula, descriptive statistics, Spearman's rho correlation coefficient, and positive likelihood ratios (LHRs).

RESULTS

The highest (r = 0.725) correlations were found for second molars and the lowest correlation for canines (r = 0.463, p < 0.001). Positive LHR values exceeding ten were found to identify the pre-peak growth phase in conjunction with the second molar (stage D), second premolar (stage E), and first premolar (stages D and E). Only the second molar (stage F) yielded positive LHR values for identifying the peak growth phase. The positive LHR values for the second molar also facilitated identification of the post-peak growth phase (stage H). Taking the clinical diagnostic efficacy of the second molar into account in identifying these growth phases, we calculated the positive LHRs of the second molar to determine dental maturation stages for diagnosing CVMS II and III. Positive LHR values greater than 10 identified CVMS II (stage D).

CONCLUSION

Evaluating dental maturation is a useful initial diagnostic step when assessing skeletal growth. The calcification stages of the second molar provide reliable diagnostic information with which to determine the pubertal growth spurt.

Assessment of skeletal maturation with permanent mandibular second molar calcification stages among a group of Nepalese orthodontic patients

Background

Assessment of growth status of a patient is a key component in orthodontic diagnosis and treatment planning for growing patients with skeletal discrepancy. Skeletal maturation based on hand-wrist radiograph and cervical vertebral maturation (CVM) are commonly used methods of growth assessment. Studies have shown that stages of dental calcification can also be used to assess skeletal maturation status of an individual, whereas other studies have suggested that the relationship between dental calcification and skeletal maturation should be interpreted with caution owing to racial variation.

Objective

To evaluate the relationship between permanent mandibular second molar calcification stages and skeletal maturity assessed by CVM among a group of Nepalese orthodontic patients.

Materials and methods

One hundred and sixty-eight digital radiographs (84 orthopantomograms and 84 lateral cephalograms) were obtained from the records of 84 patients who sought orthodontic treatment in Orthodontic and Dentofacial Orthopaedic Unit, Department of Dentistry, Institute of Medicine, Kathmandu. Two parameters were used in this study, namely, CVM stages from lateral cephalogram and Demirjian index (DI) stages from orthopantomogram. The evaluation of digital radiographs was carried out on a computer screen with a resolution of 1,280×800 pixels. The association between DI stages of permanent mandibular second molar and CVM stages was assessed.

Results

A statistically significant association was found between DI and CVM stages for both male and female subjects with Pearson’s contingency coefficient value of 0.751 and 0.766 for male and female subjects, respectively.

Conclusion

Skeletal maturation can be reliably assessed with dental calcification stages of permanent mandibular second molar for Nepalese orthodontic patients.

Dental and Chronological Ages as Determinants of Peak Growth Period and Its Relationship with Dental Calcification Stages

Purpose:

To investigate the relationship between dental, chronological, and cervical vertebral maturation growth in the peak growth period, as well as to study the association between the dental calcification phases and the skeletal maturity stages during the same growth period.

Methods:

Subjects were selected from orthodontic pre-treatment cohorts consisting of 420 subjects where 255 were identified and enrolled into the study, comprising 145 girls and 110 boys. The lateral cephalometric and panoramic radiographs were examined from the archives of the Department of Orthodontics, Aristotle University of Thessaloniki, Greece. Dental age was assessed according to the method of Demirjian, and skeletal maturation according to the Cervical Vertebral Maturation Method. Statistical elaboration included Spearman Brown formula, descriptive statistics, Pearson’s correlation coefficient and regression analysis, paired samples t-test, and Spearman’s rho correlation coefficient.

Results:

Chronological and dental age showed a high correlation for both gender(r =0.741 for boys, r = 0.770 for girls, p<0.001). The strongest correlation was for the CVM Stage IV for both males (r=0.554) and females (r=0.68). The lowest correlation was for the CVM Stage III in males (r=0.433, p<0.001) and for the CVM Stage II in females (r=0.393, p>0.001). The t-test revealed statistically significant differences between these variables (p<0.001) during the peak period. A statistically significant correlation (p<0.001) between tooth calcification and CVM stages was determined. The second molars showed the highest correlation with CVM stages (CVMS) (r= 0.65 for boys, r = 0.72 for girls).

Conclusion:

Dental age was more advanced than chronological for both boys and girls for all CVMS. During the peak period these differences were more pronounced. Moreover, all correlations between skeletal and dental stages were statistically significant. The second molars showed the highest correlation whereas the canines showed the lowest correlation for both gender.

Accuracy of two dental and one skeletal age estimation methods in 6-16 year old Gujarati children

Introduction:

Age estimation is of immense importance not only for personal identification but also for treatment planning in medicine and dentistry. Chronologic age conveys only a rough approximation of the maturational status of a person, hence dental and skeletal ages have been explored as maturity indicators since decades. The tooth maturation provides a valuable indicator of dental age and serves as a better index of the maturation of a child as compared to other maturity indicators.

Aims and Objectives:

To test the applicability of Demirjian's and Willem's dental age assessment methods as well as Greulich and Pyle skeletal age assessment method in children residing in Gandhinagar district.

Materials and Methods:

The study consisted of randomly selected 180 subjects (90 males and 90 females) ranging from 6 to 16 years age and residing in Gandhinagar district. Dental age estimation was performed from radiovisuograph (RVG) images of mandibular teeth of left quadrant by both Demirjian's and Willem's methods. Skeletal age estimation was done from right hand wrist radiograph by Greulich and Pyle method. The differences between the chronological age and the estimated dental and skeletal ages were statistically tested using paired ‘t’ test. The correlation between chronological age, dental and skeletal age estimation methods was confirmed statistically by Pearson's correlation. The reproducibility of the estimations was statistically tested using the Pearson's Chi-square test.

Results:

Amongst the age estimation methods used in this study, the Willem's dental age estimation method proved to be the most accurate and consistent.

Conclusion:

Although various age estimation methods do exist, the results are varied in different populations due to ethnic differences. However, till new tables are formulated, the Willem's method (Modified Demirjian method) can be accurately applied to estimate chronological age for the population residing in Gandhinagar district.

Tooth mineralization stages as a diagnostic tool for assessment of skeletal maturity

INTRODUCTION

The objective of this study was to determine whether dental calcification can be used as a first-level diagnostic tool for assessment of skeletal maturity.

METHODS

A total of 150 healthy subjects (79 boys, 71 girls; mean age, 12.19 ± 2.03 years; range, 8-16 years) were enrolled in the study. Dental maturity was assessed through the calcification stages from panoramic radiographs of the mandibular canine, the first and second premolars, and the second molar. Determination of skeletal maturity was according to the modified middle phalanx of third finger (MP3) stages method on digital radiographs.

RESULTS

Diagnostic ability was evaluated according to the dental maturation stages for each tooth for identification of the MP3 stages and the growth phases (prepubertal, pubertal, postpubertal) using positive likelihood ratios. Dental maturation stage E of the first premolars and the combination of canine stage F, first premolar stage E, second premolar stage E, and second molar stage D (FEED) gave the highest values for identification of the prepubertal growth phase, and stage H of the second molar had the highest value for identification of the postpubertal growth phase.

CONCLUSIONS

Dental maturation assessment is only useful for diagnosis of the prepubertal and postpubertal growth phases.

The diagnostic performance of dental maturity for identification of the circumpubertal growth phases: a meta-analysis

The present meta-analysis initially evaluates the reliability of dental maturation in the identification of the circumpubertal growth phases, essentially for determining treatment timing in orthodontics. A literature survey was performed using the Medline, LILACS and SciELO databases, and the Cochrane Library (2000 to 2011). Studies of the correlation between dental and cervical vertebral maturation methods were considered. The mandibular canine, the first and second premolars, and the second molar were investigated. After the selection, six articles qualified for the final analysis. The overall correlation coefficients were all significant, ranging from 0.57 to 0.73. Five of these studies suggested the use of dental maturation as an indicator of the growth phase. However, the diagnostic performance analysis uncovered limited reliability only for the identification of the pre-pubertal growth phase. The determination of dental maturity for the assessment of treatment timing in orthodontics is not recommended.

Diagnostic performance of combined canine and second molar maturity for identification of growth phase

Background

The objective of this research is to analyze the diagnostic performance of the circumpubertal dental maturation stages of the mandibular canine and second molar, as individual teeth and in combination, for the identification of growth phase.

Methods

A total of 300 healthy subjects, 192 females and 108 males, were enrolled in the study (mean age, 11.4 ± 2.4 years; range, 6.8 to 17.1 years). Dental maturity was assessed through the calcification stages from panoramic radiographs of the mandibular canine and second molar. Determination of growth phase (as pre-pubertal, pubertal, and post-pubertal) was carried out according to the cervical vertebral maturation method. The diagnostic performances of the dental maturation stages, as both individual teeth and in combination, for the identification of the growth phase were evaluated using positive likelihood ratios (LHRs), with a threshold of ≥10 for satisfactory performance.

Results

For the individual dental maturation stages, most of these positive LHRs were ≤1.6, with values ≥10 seen only for the identification of the pre-pubertal growth phase for canine stage F and second molar stages D and E, and for the post-pubertal growth phase for second molar stage H. All of the combined dental maturation stages yielded positive LHRs up to 2.6.

Conclusions

Dental maturation of either individual or combined teeth has little role in the identification of the pubertal growth spurt and should not be used to assess timing for treatments that are required to be performed at this growth phase.

Correlation between dental and cervical vertebral maturation in Iranian females

BACKGROUND

Considerable variations in the development stage among patients of the same chronological age have led to introduce the concept of the developmental age based on the maturation of different organs such as cervical vertebrae or teeth.

OBJECTIVES

The purpose of this study was to investigate the correlation between the stages of tooth calcification and the cervical vertebral maturation in Iranian females.

PATIENTS AND METHODS

Four hundred females (age range, 8 to 14 years) participated in the study. To determine the dental maturational stage, calcification of the mandibular teeth except for third molars were rated according to the method suggested by Demirjian et al. To evaluate the stage of skeletal maturation, cervical vertebral morphologic changes were assessed on lateral cephalometric radiographs according to the method explained by Baccetti et al. Correlations between bone maturation and teeth calcification were showed by Spearman's correlation and Kendall's tau-b coefficients. The relevant associations were investigated by ordinal logistic regression models.

RESULTS

Correlations between the two stages were observed in the first and second premolars, canine and central incisors. All these correlations were significant. The association between cervical vertebral maturation and tooth calcification was greatest in the lateral incisor (odds ratio (OR) = 11, 95% confidence interval (CI): 6.6-18.3). However, considering the 95% CI for OR, no significant difference was detected among the second molar, first molar and lateral incisor.

CONCLUSION

The relationship between calcification of teeth and maturation of cervical bones was significant. Bone maturation can be predicted by using teeth calcification stages, especially in the second molar, first molar and lateral incisor.