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

Association between dental and skeletal maturation in Scandinavian children born between 2005 and 2010

OBJECTIVE

The aim of this cross-sectional study was to analyse the association between dental and skeletal maturation in children born between 2005 and 2010.

MATERIALS AND METHODS

Dental and skeletal maturation of 117 ethnic Scandinavian children born between 2005 and 2010 (70 girls, 47 boys, mean age 11.48 years) was analysed. Dental maturation (DM) was assessed on orthopantomographs (OPs) by using Demirjian's and Haavikko's methods while skeletal maturation was assessed on hand-wrist radiographs by use of Helm's method. The correlation between skeletal and DM was analysed using Spearman's rho (Rs). Additionally, the most frequent DM stage in relation to the skeletal maturation stage was analysed by logistic regression adjusted for age and sex.

RESULTS

The correlation between dental and skeletal maturation was significant for all teeth (Rs = 0.071-0.562; p < .000-p = .035) except for the first incisor and the first molar. Logistic regression analysis showed that when the mandibular and maxillary canines are ¾ mineralized, this is significantly associated with the beginning of the adolescent period before peak height velocity (PHV) (PP2= p < .005-< .05). Likewise, when the mandibular second premolars are ¾ mineralized, this is significantly associated with the maturation stage PP2= or S (PP2= p < .05, S: p < .005-< .05), both of which are before PHV at the beginning of the adolescent period.

LIMITATIONS

Limited sample size and the X-rays were taken before orthodontic treatment, which may have introduced a selection bias.

CONCLUSIONS

When the root of the canines or second premolars is ¾ mineralized, it may indicate the beginning of the adolescent period with increased skeletal growth intensity.

The relationship between frontal sinus dimensions and skeletal malocclusion

Purpose

The aim of this retrospective research is to compare frontal sinus dimensions in skeletal Class I, skeletal Class II, and skeletal Class III individuals and to evaluate the relationship of these dimensions with anterior skull base length and some cephalometric values.

Materials and methods

In this research, we used lateral cephalometric radiographs of 60 people aged 17 to 25. In individuals with skeletal Class I malocclusion, skeletal Class II malocclusion due to mandibular insufficiency, and skeletal Class III malocclusion due to mandibular excess, measurements of frontal sinus length and height as well as S-N, Co-A and Co- Gn lengths, ANB0, FMA0, SN-GoGn0 angles values were performed. The length between the highest point and the lowest point of the frontal sinus was calculated as the height of the frontal sinus, and the length between the most anterior and the most posterior points of the frontal sinus was calculated as the length of the frontal sinus.

Results

The frontal sinus length and height were found to be higher in skeletal Class III individuals than in skeletal Class I and skeletal Class II individuals, however, there was no significant difference between skeletal Class I and Class II individuals.

Conclusion

The increase in frontal sinus height and length correlated positively with the decrease in the ANB angle and the increase in the SN and Co-Gn lengths. The dimensions of the frontal sinus may be an indicator for the remaining mandibular growth potential.

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.

Gingival crevicular fluid alkaline phosphatase activity as growth marker: A systematic review

Background:

This review synthesizes the available evidence about the individual skeletal maturity with biological maturity indicators and compares it with the levels of gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity in growing children.

Aims:

This systematic review aimed to clarify the question: Is GCF ALP a reliable biomarker to assess skeletal maturity during growth?

Objectives:

The objective of this systematic review is to collect, compile, and review the existing evidence on the levels of GCF ALP activity in growing children and comparing its reliability with contemporary growth indicators.

Materials and Methods:

A literature appraisal executed using Entres PubMed, www.ncbi.nim.nih.gov, Scupose, Hinary, Ebsco, Embass, Cochrane; Google Scholar Electronic database search engines were used. The MeSH term used “growth markers in gingival crevicular fluid” or “growth markers in growing children.” Studies published till October, 2020, were included in this study.

Data Extraction and Quality Assessment:

The data have extracted from the selected articles based on year of publication, study design, age of subjects, instruments used, and author’s conclusions. The quality assessment was executed using BIOCROSS Scale. This scale is exclusive for cross-sectional studies with biomarkers.

Results:

Literature search identified 731 records from electronic databases and from the partial grey literature (Google scholar) search. Finally, six articles fulfilled eligibility criteria included in the review.

Conclusions:

All the six studies concluded that GCF ALP activity is a reliable method in determining a skeletal maturity indicator in growing children.

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.

Supernumerary Teeth and Dental Development

PURPOSE

The aims of this study were to compare the radiographic development of permanent teeth in a group of children with and without supernumerary teeth (ST), determine whether using cone-beam computed tomography or panoramic radiography improves the accuracy of dental age (DA) estimation and investigate the effects of factors including the numbers and positions of ST.

METHODS

One hundred fifty dental radiographs of children with and without ST at the ages of 6.0 to 14.9 years were included in this study. The children in both groups were age and sex-matched. The lower left-side 7 permanent teeth were evaluated according to the Demirjian method, DA was determined. The difference between chronological age (CA) and DA (CA-DA) for the children with and without ST and further based on the number and localization of ST were calculated.

RESULTS

For all groups, the mean DA values were higher than the mean CA values. The difference between the CA and DA values in the children with ST was higher than the difference in the children without ST. Supernumerary teeth in posterior localization, multiple ST and among boys were observed to increase the differences between the mean CA and DA values. The mean age difference between radiographies in the children with and without ST was similar.

CONCLUSION

Panoramic radiography was found adequate in determination of dental development with the Demirjian method. Dental development was even more advanced in the children with ST in comparison to the control group. Clinicians should keep in mind that the dental developments of children with supernumerary teeth may be advanced.

Diagnostic assessment of tooth maturation of the mandibular second molars as a skeletal maturation indicator: A retrospective longitudinal study

INTRODUCTION

Our aim was to analyze the correlation between growth status in height and chronological age, carpal maturation, cervical maturation, and dental maturation, and assess the diagnostic performance of Demirjian's dental maturation as an indicator of the pubertal growth spurt, through a retrospective longitudinal study.

METHODS

Records of 60 Canadian patients obtained from the Burlington Growth Centre, which included height and weight charts and a set of x-rays at 6 points in time, were analyzed. The images at each point in time included 1 hand and wrist radiograph, a lateral cephalometric x-ray, and one 45° oblique cephalometric radiograph of each side, which were analyzed using the methods of Fishman, Baccetti, and Demirjian on the mandibular left and right second molars, respectively. The onset of the pubertal growth peak in height (distance to growth peak [DGP]) was identified, and the correlation between methods with DGP was assessed.

RESULTS

High levels of correlation were obtained between the methods of Fishman, Baccetti, and Demirjian with DGP. The cutoff point between prepubertal and postpubertal stages was F stage for women and G stage for men, with statistically significant levels of sensitivity and specificity for the test.

CONCLUSIONS

The use of the method of Demirjian applied to mandibular second molars is plausible as a predictor of the occurrence of the DGP for the studied population.

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.

Interceptive Dentofacial Orthopedics (Growth Modification)

Although all dentofacial deformities involve deviation of skeletal and dental units that require correction, the timing and method of treatment can vary considerably. Growth is a key consideration when managing dentofacial deformities, because it has a direct impact on the timing and method of management. Some deformities may be intercepted and managed during growth, whereas others can only be definitively managed after cessation of growth. This article focuses on clinical considerations of growth in managing dentofacial deformities, and discusses methods of growth evaluation and interceptive orthodontic management strategies in different types of dentofacial deformities.

Systematic reviews in orthodontics: Impact of the PRISMA for Abstracts checklist on completeness of reporting

INTRODUCTION

This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A).

METHODS

Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores.

RESULTS

Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting.

CONCLUSIONS

The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.

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.

Maturation of the Middle Phalanx of the Third Finger: A Comparative Study between Right and Left Hand

OBJECTIVES

Recently a classification of patient's skeletal age based on the phalanx maturation, The Middle Phalanx Maturation of the third finger (MPM) method, was suggested. The aim of this study is to evaluate if there is a difference in MPM between the right and left hand.

STUDY DESIGN

Two hundred fifty-four patients were obtained from the Complex Operating Unit of Orthodontics of Padua University Hospital. The total sample size has been selected by appropriate statistical calculations resulting in 130 patients. It was decided to further double the sample size of a previous study to ensure a robust statistical analysis. Radiographs of the right and left were obtained using the MPM method. Stages were compared using the right hand as a reference. The statistical analysis (Fisher exact test) was performed for the entire sample and related to gender in order to compare the right and the left hand stages.

RESULTS

In MPS2, 6 out 49 (12.2%) males and 7 out 27 females (25.9%) showed MPS3 in the left hand (p-value < 0.05). In all other stages, a total agreement (100%) was found.

CONCLUSION

The authors confirm the use of the right hand as reference. In patients with MPS2 an additional radiograph on the left hand can be taken in order to increase the diagnostic accuracy. In all other stages other radiographs are not needed as a total agreement between the right and left hand was found.

Diagnostic reliability of mandibular second molar maturation in the identification of the mandibular growth peak: A longitudinal study

OBJECTIVE

To investigate the diagnostic reliability of mandibular second molar maturation in assessing the mandibular growth peak using a longitudinal design.

MATERIALS AND METHODS

From the files of the Burlington and Oregon growth studies, 40 subjects (20 from each collection, 20 males and 20 females) with at least seven annual lateral cephalograms taken from 9 to 16 years were included. Mandibular second molar maturation was assessed according to Demirjian et al., and mandibular growth was defined as annual increments of Co-Gn distance. A full diagnostic reliability analysis (including positive likelihood ratio) was performed to establish the diagnostic reliability of dental stages E, F, and (pooled) GH in identifying the imminent mandibular growth peak.

RESULTS

None of the dental maturation stages reliably identified the mandibular growth peak with greatest overall mean accuracy and positive likelihood ratio of 0.77 (stage F) and 2.7 (stage E), respectively.

CONCLUSIONS

Use of the mandibular second molar maturation is not recommended for planning treatment requiring identification of the mandibular growth peak.

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.

Assessment of the Pubertal Growth Period using the Open Apices of the Lower Teeth

AIM

The purpose of this study was to evaluate whether the open apex measurements of the lower teeth can be used for prediction of the pubertal growth spurt.

MATERIALS AND METHODS

The study group consisted of 150 males and 142 females ranging in age from 10 to 16 years. A total of 292 panoramic and 292 hand-wrist radiographs were obtained and analyzed. The skeletal maturity was determined according to the skeletal maturity indicators (SMIs) developed by Fishman. The open apices measurements of the left lower teeth were made according to the method described by Cameriere.

RESULTS

The Spearman rank order correlation coefficient revealed a relationship between the skeletal maturity stages and the open apex measurements. These correlations ranged from 0.577 for the lower second premolar to 0.830 for the lower canine. The measurement of the left lower canine showed the highest correlation, so its relationship with the SMIs was further investigated. The measurements of 6.07 (or greater) indicated to SMI4, and 2.485 (or lesser) indicated to SMI7.

CONCLUSION

The skeletal maturity well related to the measurements of the open apices of the lower teeth. Lower canine open apex measurements could be used as an indicator of the SMI4 and SMI7.

CLINICAL SIGNIFICANCE

The measurements of the open apices of the left lower canines from panoramic radiographs may be clinically useful as an indicator of the beginning and the ending of the pubertal growth period.

Gingival Crevicular Fluid as a Novel Potential Source of Biomarkers Distinguishes Pubertal from Post-Pubertal Subjects

Detection of pubertal growth peak is vital in orthodontic treatment timing and planning. Gingival crevicular fluid (GCF) contains abundant proteins from different sources and has been proven to be an ideal source of biomarkers. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS) is an advanced technique that can detect low-molecular-weight peptides with high sensitivity and resolution. The aim of this research was to identify novel candidate biomarkers in GCF to help the diagnosis of pubertal growth peak by MALDI-TOF/MS. Results showed that the peak intensities of six peptides were significantly different between two groups: 1660.2 Da, 1783.0 Da, 2912.5 Da, 4178.6 Da, 5064.9 Da, and 6108.9 Da and are considered to be potential candidate biomarkers to identify pubertal growth peak. Further studies are needed to identify sequence information of these candidate biomarkers.