1
|
Ferrillo M, Migliario M, Curci C, Renò F, Giudice A, De Sire A. Skeletal maturation evaluation: which is the reliability of dental calcification Demirjian method versus hand-wrist X-ray in growing subjects? A systematic review. Acta Odontol Scand 2024; 83:230-237. [PMID: 38699981 DOI: 10.2340/aos.v83.40485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES This systematic review aimed at evaluating the reliability of dental maturation (DM) according to Demirjian method compared to hand and wrist maturation (HWM) to assess skeletal maturity (SM) in growing subjects, to identify the teeth and the corresponding mineralisation stages related to the pubertal growth spurt (PGS). MATERIALS AND METHODS PubMed, Scopus, and Web of Science were systematically searched until January 5th, 2024, to identify observational cross-sectional studies that assessed the reliability of Demirjian method compared to the HWM methods (i.e., Grave and Brown and Fishman) in growing subjects. The quality assessment was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. RESULTS Out of 136 papers suitable for title/abstract screening, 19 included studies. Of them, 17 papers showed the reliability of Demirjian DM method compared to HWM Fishman and Grave and Brown methods to assess SM in growing subjects. According to JBI Critical Appraisal Checklist, 12 papers were high-quality studies and 7 papers were medium-quality studies. Conclusions: The mandibular second molar might be considered as the best indicator compared to other teeth and that the peak of growth occurs no earlier than stage F in females and stage G in males according to Demirjian method. Also, the mandibular canine might be analysed as indicator of SM in males, and results suggest that the peak of growth occurs no earlier than maturation stage F according to Demirjian method, only in male subjects. Further studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Martina Ferrillo
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
| | - Mario Migliario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Claudio Curci
- Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Filippo Renò
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Amerigo Giudice
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro De Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| |
Collapse
|
2
|
Rodríguez-Niklitschek C, Oporto GH, Chuhuaicura P, Alemán I, Fonseca GM. Cameriere's open apices methodology for dental age estimation in children: a scoping review from a Latin American perspective. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00646-x. [PMID: 37222903 DOI: 10.1007/s12024-023-00646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
Dental age estimation (DAE) is key to establishing an individual's identity, and this is relevant in minors. A widely used method for DAE in children is Cameriere's open apices (CAM). Despite its wide dissemination, there are no clear reports of its use in Latin American populations. A scoping review was conducted using a search strategy in the PubMed/MEDLINE database, Web of Science, and a complementary manual search. Only papers using CAM or its regression equation models for evaluating Latin American populations were included. Ten studies published between 2007 and 2020 responded to the search objective. Brazil was the country with the most studies using CAM (7/10), and the University of Macerata (Italy) was the most declared affiliation (6/10). Seven studies used the original CAM formula in populations from Brazil and Peru, while the European formula (EuCAM) was applied in Mexico, Colombia, and Brazil. Although the method underestimated the age values with acceptable error margins, the correction factor substantially improved the predictive power of the method. Some limitations of the method are highlighted. CAM and its variants can be useful for validation in Latin American settings, but attention to population structures and terminologies is suggested for future research.
Collapse
Affiliation(s)
- Cynthia Rodríguez-Niklitschek
- Escuela de Odontología, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Temuco, Chile
- Escuela de Odontología, Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
- Programa de Doctorado en Biomedicina, Universidad de Granada, Granada, Spain
- Centro de Investigación en Biología Oral (CIBO), Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
- Laboratorio de Biología Celular Y Molecular, Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
| | - Gonzalo H Oporto
- Departamento de Odontología Integral Adultos, Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
- Centro de Investigación en Biología Oral (CIBO), Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
- Laboratorio de Biología Celular Y Molecular, Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
| | - Priscila Chuhuaicura
- Escuela de Odontología, Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
- Departamento de Odontología Integral Adultos, Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
- Centro de Investigación en Biología Oral (CIBO), Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
- Laboratorio de Biología Celular Y Molecular, Facultad de Odontología, Universidad de La Frontera, Temuco, Chile
| | - Inmaculada Alemán
- Departamento de Medicina Legal, Toxicología Y Antropología Física, Universidad de Granada, Granada, Spain
- Programa de Doctorado en Biomedicina, Universidad de Granada, Granada, Spain
| | - Gabriel M Fonseca
- Departamento de Odontología Integral Adultos, Facultad de Odontología, Universidad de La Frontera, Temuco, Chile.
- Programa de Doctorado en Biomedicina, Universidad de Granada, Granada, Spain.
- Unidad de Estimación de Edad Dental, Centro de Investigación en Odontología Legal y Forense (CIO), Facultad de Odontología, Universidad de La Frontera, Francisco Salazar 01145, 4780000, Temuco, Chile.
| |
Collapse
|
3
|
Barreto BCT, Marañón-Vásquez GA, da Costa Barreto LS, Masterson D, de Souza MMG, Maia LC. Is there a correlation between dental and cervical vertebrae maturation stages in growing subjects? A systematic review with meta-analysis. Clin Oral Investig 2022; 26:3823-3842. [PMID: 35338422 DOI: 10.1007/s00784-022-04456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/13/2022] [Indexed: 11/03/2022]
Abstract
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.
Collapse
Affiliation(s)
- Bruna Caroline Tomé Barreto
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 325 - Ilha do Fundão, Rio de Janeiro, RJ, 21941-617, Brazil
| | - Guido Artemio Marañón-Vásquez
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 325 - Ilha do Fundão, Rio de Janeiro, RJ, 21941-617, Brazil.
| | - Luísa Schubach da Costa Barreto
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, State University of Rio de Janeiro, Rua 28 de Setembro, 157, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Danielle Masterson
- Health Science Center Library, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 373, Centro de Ciências da Saúde, Bloco L, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Margareth Maria Gomes de Souza
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 325 - Ilha do Fundão, Rio de Janeiro, RJ, 21941-617, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 325 - Ilha do Fundão, Rio de Janeiro, RJ, 21941-617, Brazil
| |
Collapse
|
4
|
Magat G, Ozcan S. Assessment of maturation stages and the accuracy of age estimation methods in a Turkish population: A comparative study. Imaging Sci Dent 2022; 52:83-91. [PMID: 35387103 PMCID: PMC8967497 DOI: 10.5624/isd.20210231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study assessed the associations between chronological age, dental maturation (DM), cervical vertebrae maturation (CVM), and hand-wrist maturation (HWM) in individuals aged 9-19 years. In addition, this study aimed to derive practical methods to evaluate the skeletal age using DM, CVM, or HWM for orthodontic, medical, and forensic purposes and to compare which of these 3 developmental parameters is more accurate for estimating the age of individuals in a Turkish population. Materials and Methods Panoramic, lateral cephalometric, and hand-wrist radiographs of 284 patients aged 9-19 years were used in this study. The DM, CVM, and HWM stages were determined. The Kolmogorov-Smirnov, kappa, Wilcoxon, Kruskal-Wallis, chi-square, and Spearman correlation tests and simple linear regression analysis were used for statistical analysis. The significance level was 0.05. Results Statistically significant differences were found between chronological age and DM, chronological age and CVM, and chronological age and HWM in both sexes (P<0.05). DM did not show statistically significant differences according to sex (P>0.05), but CVM and HWM were statistically different between males and females (P<0.05). The DM-estimated age yielded more accurate values than the other methods. Conclusion All correlations between skeletal and dental stages were statistically significant. Our results showed that there was no statistically significant difference between chronological age and DM-estimated age. Therefore, it can be concluded that DM stages have the potential to be used for legal purposes.
Collapse
Affiliation(s)
- Guldane Magat
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Ozcan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Nigde Omer Halisdemir University, Nigde, Turkey
| |
Collapse
|
5
|
Mardiati E, Komara I, Halim H, Kurnia D, Maskoen AM. Sensitivity and Specificity of Mandibular Third Molar Calcification at Chronological Age and Hand Wrist Maturation Stage to Discriminate Between Female and Male at Pubertal Growth Period. Open Dent J 2021. [DOI: 10.2174/1874210602115010551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The mandibular third molar is the last tooth that is not completely developed by the time pubertal growth has been finished. Maturation of the mandibular third molar is one of the physiological maturation indicators that can be used to determine the stage of pubertal growth.
Objective:
The aim of the study was to determine the sensitivity and specificity of mandibular third molar calcification at chronological age and hand wrist maturation stage to discriminate between female and male at pubertal growth period.
Methods:
It is a retrospective study with a cross-sectional approach using panoramic and hand-wrist digital radiographs of 279 females and 144 males, age 8-17 years, with a total of 423 panoramic radiographs and 423 hand-wrist radiographs. Statistical analysis was performed using Excel Mega Stat. ANOVA to analyze the differences between mandibular third molar calcification at chronological age and hand-wrist maturation stage, and t-test was used to analyze the differences between females and males. Spearman rank correlation was used for the analysis of the correlation between mandibular third molar calcification with chronological age and hand-wrist maturation stage; sensitivity and specificity were used to discriminate the pubertal growth period between mandibular third molar calcification and hand-wrist maturation stage.
Results:
There were significant differences found in mandibular third molar crown maturation stage B and C, but no significant difference was observed between mandibular third molar stage A, D, E, F, G and H, between females and males. The highest percentage of mandibular third molar crown formation in females was observed at stage D (6.68%) at MP3u, and in males, it was observed at stage D (8.83%) at SMI-4. The highest percentage of root formation in females was stage E (8.24%) at the SMI-10 stage, and males stage F (4.86%) at MP3u. The correlation was observed between mandibular third molar calcification with hand-wrist, females 0.22 and males 0.43, and chronological age 0.60 for females and 0.69 for males. The highest sensitivity of mandibular third molar calcification of 97.0% was observed in female at SMI-4 of hand-wrist maturation with specificity of 100%, while in male, a sensitivity of 94.5% was observed at SMI-2 stage with a specificity of 99.99%.
Conclusion:
There were significant differences found in mandibular third molar calcification between females and males except for stage B and stage C; weak correlation was observed between mandibular third molar calcification and hand-wrist, and moderate correlation was observed with chronological age. The sensitivity and specificity in females and males indicate that mandibular third molar calcification is only useful for diagnosing the pre-pubertal growth phase.
Collapse
|
6
|
The Correlation between Dental Stages and Skeletal Maturity Stages. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9986498. [PMID: 34212048 PMCID: PMC8211505 DOI: 10.1155/2021/9986498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/27/2022]
Abstract
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.
Collapse
|
7
|
Koçak T, Akan B. Assessment of maturation indicators in individuals with different skeletal malocclusion. J Orofac Orthop 2021; 82:187-197. [PMID: 33725143 DOI: 10.1007/s00056-021-00286-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Burçin Akan
- Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi University, 35640, Izmir, Turkey.
| |
Collapse
|
8
|
Paz Cortés MM, Rojo R, Alía García E, Mourelle Martínez MR. Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study. BMC Pediatr 2020; 20:361. [PMID: 32736612 PMCID: PMC7393889 DOI: 10.1186/s12887-020-02247-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Rosa Rojo
- Faculty of Dentistry, Alfonso X El Sabio University, Villanueva de la Cañada, 28691, Madrid, Spain.
| | - Esther Alía García
- Faculty of Dentistry, Alfonso X El Sabio University, Villanueva de la Cañada, 28691, Madrid, Spain
| | | |
Collapse
|
9
|
Wang M, Fan L, Shen S, Bai X, Wang J, Ji F, Tao J. Applicability of the third molar maturity index for assessment of age of majority in Eastern China. Leg Med (Tokyo) 2019; 41:101639. [DOI: 10.1016/j.legalmed.2019.101639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 01/26/2023]
|
10
|
Mollabashi V, Yousefi F, Gharebabaei L, Amini P. The relation between dental age and cervical vertebral maturation in orthodontic patients aged 8 to 16 years: A cross-sectional study. Int Orthod 2019; 17:710-718. [PMID: 31494086 DOI: 10.1016/j.ortho.2019.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- Vahid Mollabashi
- Hamadan University of Medical Science, Dental school, Orthodontics Department, Hamadan, Iran
| | - Faezeh Yousefi
- Hamadan University of Medical Science, Dental school, Oral and Maxillofacial Radiology Department, Hamadan, Iran.
| | | | - Payam Amini
- Reproductive Epidemiology Research Center, Department of Epidemiology and Reproductive Health, Royan, Tehran, Iran
| |
Collapse
|