Correlation between skeletal maturation and developmental stages of canines and third molars among Saudi subjects

Correlation Between Third Molar Mineralization and Midpalatal Suture Maturity: A Cone Beam Computed Tomography Study

BACKGROUND Midpalatal suture ossification varies in patients of different ages, which can lead to making inaccurate presumptions when considering effective treatment timing based on chronological age. Chronological age provides only general information, whereas dental development correlates with skeletal growth, which suggests that tooth mineralization could be considered to be a precise criterion for determining the midpalatal suture's maturity. The present study was conducted to investigate the association between third-molar mineralization and midpalatal suture's maturation stages using cone-beam computed tomography (CBCT) images. MATERIAL AND METHODS The study involved 97 CBCT images of patients aged 8-37 years with normal growth and development. Subjects with cleft lip and palate, caries treatment, or present cavities in the third molars were not included in the study. The stages of midpalatal suture ossification were evaluated according to the protocol suggested by Angelieri et al, and the third-molar mineralization degree was measured by the Demirjian index. Statistical analysis was performed to evaluate correlations between the variables. RESULTS Patients with advanced third-molar mineralization stages were found to have greater midpalatal suture maturity. A statistically significant positive correlation was found between the stages of third-molar mineralization and midpalatal suture maturation (R=0.814, P<0.01). Third-molar development was also found to be associated with chronological age (R=0.883, P<0.01). CONCLUSIONS A measure of third-molar mineralization does not allow for accurate determination of the midpalatal suture maturation stage.

Accuracy of dental calcification stages for the identification of craniofacial pubertal growth spurt: proposal of referral parameters

PURPOSE

This study primarily aimed to assess the accuracy of radiographic dental calcification parameters for the identification of specific craniofacial growth stages.

METHODS

Permanent mandibular canines, premolars, and second molars of 288 patients, from 6 to 15 years old, were analysed on randomly selected panoramic radiographs, and categorised according to two calcification methods. Reproducibility analyses and data derived from panoramic records were correlated with the gold-standard method, as evaluated from lateral cephalometric teleradiographs. Accuracy tests were finally calculated, considering several cutoff points.

RESULTS

Dental calcification methods showed "strong" to "almost perfect" intra- and inter-examiner reproducibility. Significant, although weak correlations were observed for all parameters. Canine and first premolar calcification stage 8 and second premolar and second molar stage 7 showed higher sensitivity rates for identifying the pubertal growth spurt period, as well as the stage F for these teeth. Canine and first premolar stages 10 and H obtained higher specificity rates for identifying the absence of post-pubertal period.

CONCLUSIONS

The dental calcification parameters showed adequate reproducibility, in addition to significant correlations with cervical vertebrae stages. Radiographic dental calcification parameters used for the mandibular first premolar obtained high accuracy rates and were recommended for identifying specific craniofacial growth periods.

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.

A Study to Compare and Correlate the Status of Maturation in Growing Individuals Using Chronological Age Dental Maturation and Cervical Vertebrae Maturation

Aim and objective

To compare and correlate the status of maturation in growing individuals using orthopantomograph (OPG) and lateral cephalogram to establish a reliable relationship between chronological age (CA) and dental maturation (DM) with cervical vertebrae maturation index (CVMI).

Materials and methods

Lateral cephalometric radiographs and OPGs of 50 children within the circumpubertal period were collected (male n = 25, age 12–17 years, female n = 25, age 10–15 years) and evaluated for the status of maturation using CA, DM (of mandibular left canine and second molar using Demirjian Index-DI), and CVMI stages.

Results

Chronological age shows a positive correlation with CVMI stages in both groups. Gender-based association and distribution between DI stages of canine and CVMI stages shows that in both male and female sample groups DI G correlates with CVMI stage 1 and 2, DI H correlates with CVMI stage 3. Gender-based association and distribution between DI stages of 2nd molar and CVMI stages show that in the male sample group DI E shows a higher correlation with CVMI stage 1, DI F shows a higher correlation with CVMI stage 1 and 2. DI G shows a higher correlation with CVMI stages 2 and 3. DI H shows a higher correlation with CVMI stage 3. In the female sample group, DI F shows a higher correlation between CVMI stage 1 and 2, DI G and F show a higher correlation with CVMI stage 3.

Conclusion

Mandibular canine, second molar calcification stages, and CA show a positive correlation with CVMI stages in the present study, hence, this can be considered as a reliable indicator in skeletal maturity assessment.

How to cite this article

Pooja U, Lokesh NK, Alle RS, et al. A Study to Compare and Correlate the Status of Maturation in Growing Individuals Using Chronological Age Dental Maturation and Cervical Vertebrae Maturation. Int J Clin Pediatr Dent 2021;14(S-1):S50–S53.

The Correlation between Dental Stages and Skeletal Maturity Stages

Introduction

The determination of skeletal maturity stages is very important in orthodontic treatment planning, especially skeletal discrepancies in growing individuals. A hand-wrist radiograph is considered the most accurate approach for skeletal maturity detection. Dental calcification stages have been suggested as an alternative diagnostic method to decrease radiation exposure. The recent study is aimed at detecting the efficacy of dental calcification stages in assessing skeletal maturity during the prepubertal and pubertal growth periods.

Methods

Patients' records were collected from the Aleppo Orthodontic Center. Dental maturity stages were assessed from a panoramic radiograph using the Demirjian method, while skeletal maturity stages were determined using the Björk method. Four permanent left mandibular teeth were included (canine, 1st premolar, 2nd premolar, and 2nd molar) for the study.

Results

From 517 records, 295 records (145 males and 150 females) were included. The Spearman rank-order correlation coefficients between skeletal maturation and dental maturation were strong and statistically significant (ranging from 0.789 to 0.835). The highest correlation was between skeletal stages and the second molar (r = 0.829 and 0.88 in males and females, respectively). Receiver operating characteristic (ROC ) curve suggested a high validity of the sum of dental stages for the four teeth in identifying MP3= stage (sensitivity was 70%, specificity was 92.77%, and ROC area was 0.81) but not for MP3cap (sensitivity was 50.85%, specificity was 81.36%, and ROC area was 0.66).

Conclusions

The correlation between the skeletal maturity stages and the dental calcification stages was high. The orthodontist can use the dental stages as a definite diagnostic tool for prepubertal growth period.

Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study

Background

The objective of this study was to evaluate and compare the validity and accuracy of the Willems, Demirjian and Nolla methods in predicting chronological age in a Spanish ethnicity population.

Methods

A sample of 604 orthopantomographs of Spanish children aged 4 to 13 years was evaluated by two independent evaluators. Descriptive statistics were applied to calculate the chronological age and dental age, presenting the mean and standard deviation. The difference between dental age and chronological age was calculated for each method. A positive result indicated an overestimation and a negative figure indicated an underestimation. The Wilcoxon test for paired data and Spearman’s correlation coefficient were applied by age groups and sex to compare the chronological age and dental age of each method (that of Willems, Demirjian and Nolla). Statistical tests were performed at a 95% confidence level.

Results

The interexaminer agreement was 0.98 (p = 0.00), and the intraexaminer agreement was 0.99 (p = 0.00). The Willems method significantly overestimated the age of boys (0.35 years (0.93)) and girls (0.17 years (0.88)). The Demirjian method significantly overestimated the age of boys (0.68 years (0.95)) and girls (0.73 years (0.94)). The Nolla method significantly underestimated age in boys (0.44 years (0.93)) and girls (0.82 years (0.98)).

Conclusions

In the Spanish population, the use of the Demirjian method for legal and medical purposes is frequent. This study reveals that the Willems method is more appropriate due to its greater precision in estimating dental age.

Comparison of actual porcine tooth crown development stages and computer image analysis

Tooth developmental stage evaluation is important in dental and chronological age estimation, and it is important for accurate diagnoses and appropriate treatment in dental practice. It is routinely assessed by clinical observations and radiographic techniques. This study aimed at ascertaining tooth developmental stage judgments made by examiners and Mimics software according to the Nolla method with radiographs. Meanwhile, the true tooth developmental stages would be explored with histological analysis. Twenty freshly slaughtered porcine heads were collected and hemisected, and both the left and right mandibular samples were numbered. The developmental stages of the second and third permanent molars (M2 and M3) were evaluated by examiners and Mimics software analysis. The ratio of the radiopaque calcified area to the dental follicle (RCA/DF) at different stages was calculated. Both non-decalcified and decalcified samples were processed for histologic observation. The results showed significant differences between RCA/DF ratios from different developmental stages. There was a high positive correlation between the examiners' evaluation results and Mimics analysis results. Radiograph judgments and histology observation results were consistent from Stages 2-6. However, radiograph images of Stage 1 samples showed only crypts present, while under a surgical operating microscope, a bell-shaped tooth germ was observed. This was also confirmed by normal and hard tissue histology. In conclusion, radiograph judgments made by either examiners or Mimics software were both reliable. Mimics analysis can be a useful tool in evaluating tooth developmental stages. However, judgments need to be made cautiously in early developmental stages.

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.