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Comparative evaluation of permanent mandibular canine and second molar calcification stages for assessment of the skeletal maturity
Abstract
Introduction: Knowledge of the skeletal maturation status and pubertal growth spurt of an individual influences the diagnosis, treatment planning and the treatment outcome. The dental calcification stages can be used to assess the status of skeletal maturation.
... These differences could be related to the specific teeth 22,23 used in the various studies. While some authors have advised that caution be exercised when evaluating the calcification stages of lower molar for estimating skeletal 24 maturity, another author reported a better correlation of molar calcification with skeletal maturation. The use of canine calcification stages has consistently shown a good 21,25,26 correlation with skeletal maturation status . ...
BACKGROUND: Assessment of growth especially skeletal maturation, is considered vital in the treatment planning of orthodontic patients that require jaw modification. Appropriate treatment timing for jaw growth modification will determine the outcome of such intervention especially when clinicians take advantage of the pubertal growth spurt. The need for a quick, reliable and cost effective method using the mandibular canine calcification stages will be of immerse help to the orthodontist. AIMS:To determine the level of association between mandibular canine calcification stages and skeletal maturation stages.MATERIALS AND METHODS: It was a prospective cross-sectional descriptive study comprising 74 participants (5-17 years). Skeletal maturation was evaluated using the middle phalanx of the third finger (MP3), and the Demirjian method was used to stage the mandibular canine calcification stages (MCCS). The chi-square test of association and Spearman Spearman’s correlation coefficient were used to test the association and correlation between MP3 and the MCCS, respectively. The level of statistical significance was set at p<0.05.RESULTS: Overall, there was a statistically significant association between MP3-skeletal maturation and the MCCS (male r=0.836 p value<0.001; female r=0.824 p value<0.001). The stage of acceleration of pubertal growth spurt (MP3-FG) was more associated with MCCS-G for both males and females. The peak pubertal growth spurt (MP3-G) was more associated with MCCS-H for males and MCCS-G for females. CONCLUSION: There was gender variation between the association of the period of peak pubertal growth (MP3-G) and the mandibular canine calcification stage. However, There was a significant correlation between the MP3 developmental stages and MCCS.
... There is a broad literature discussing the use and reliability of these methods as estimators of chronological age in human children (e.g., Mappes et al., 1992;Koshy and Tandon, 1998;Bolanos et al., 2000;Frucht et al., 2000;Flores-Mir et al., 2006;Maber et al., 2006;Uysal et al., 2006;Cardoso, 2007;Lai et al., 2008;Tunc and Koyuturk, 2008;Al-Hadlaq et al., 2008;Maia et al., 2010;Perinetti et al., 2012), on the basis that both dental development and skeletal maturity both progress (i.e., are correlated) with age. Other studies have assessed the relationship (correlation) between skeletal and dental maturity apart from chronological age (e.g., Coutinho et al., 1993;Başaran et al., 2007;Al-Hadlaq et al., 2008;Cho and Hwang, 2009;Chaudhry et al., 2010;Chen et al., 2010;Kumar et al., 2011;R o _ zyło-Kalinowska et al., 2011;Sandeep and Sonia, 2013), and these studies essentially analyze the relative developmental patterns among somatic systems. While skeletal fusion or dental development may individually demonstrate strong correlations with age, they are not necessarily strongly correlated with each other due to differential effects of environment and other factors (e.g., Mappes et al., 1992;Cardoso, 2007). ...
This study seeks to assess the relationship between dental mineralization and skeletal development in chimpanzees (Pan troglodytes) and to evaluate the effect that differing numbers of ordinal and continuous variables have on correlation statistics, particularly in comparison with prior human studies.
This study evaluated epiphyseal fusion, dental mineralization, and growth in length of long bones using 145 juvenile chimpanzee skeletons housed in osteological collections at the Powell-Cotton Museum, the Museum of Central Africa, and the Adolph Schultz Collection.
Correlations between multiple epiphyseal fusion sites and dental maturity scores for crown and root mineralization were produced using Pearson's r, Spearman's ρ, and Kendall's τ. Correlation statistics were produced using different subgroups of epiphyseal fusion sites and long bone lengths, and both summary and individual tooth development scores.
Methodological considerations were discussed as differences in sample, measurement scale, and statistical technique had an effect on the outcome of correlations obtained. These results suggest that sampling and methodological differences between studies may affect the interpretation and comparison of correlation results, and that correlation strength differences between extant species must be considered before applying such results to questions in human biology and palaeoanthropology. Even after consideration of such factors, the correlation coefficient values for chimpanzees obtained in this study were generally stronger than those previously published in human studies, and may reflect differences in skeletal and dental developmental patterns between species. Am J Phys Anthropol, 2015. © 2015 Wiley Periodicals, Inc.
© 2015 Wiley Periodicals, Inc.
The purpose of this systematic review was to evaluate the predictive value of hand-wrist radiographic assessment of skeletal maturity in estimating facial growth timing and velocity. A search of PubMed, Medline, Cochrane Database of Systematic Reviews, Embase, Web of Sciences, and Lilacs identified 16 articles that met the following inclusion criteria: use of hand-wrist radiographs for skeletal maturation determination, facial growth evaluated through cephalometric radiographs, and cross-sectional or longitudinal studies. Five articles were rejected because of major methodological issues. Most of the remaining articles had small sample size, and there was no report of randomization or method error. Skeletal maturity determined by hand-wrist radiographic analysis was well related to overall facial growth velocity. Maxillary and mandibular growth velocities were related to skeletal maturity, but their relationship was less robust than that for overall facial growth. The available articles have not adequately defined a relationship between cranial base growth velocity and skeletal maturity. Hand-wrist radiographic assessment of skeletal maturity for use in facial growth prediction should include bone staging as well as ossification events. The role of skeletal maturity assessment in clinical and research applications is discussed and recommendations are provided.
To investigate (1) the relationships between the stages of mandibular second molar calcification and skeletal maturity; and (2) whether second molar calcification stages can be used as a reliable diagnostic tool to determine skeletal maturity.
Samples were derived from panoramic radiographs and lateral cephalograms of 300 subjects (137 males and 163 females) with ages ranging from 9 to 18 years, and estimates of dental maturity (Demirjian Index [DI]) and skeletal maturity (cervical vertebrae maturation indicators [CVMI]) were made.
A highly significant association (C* = 0.854 for males and 0.866 for females) was found between DI and CVMI. DI stage E corresponded to stage 2 of CVMI (pre-peak of pubertal growth spurt) and DI stages F and G corresponded to stages 3 and 4 of CVMI (peak of pubertal growth spurt). DI stage H was associated with stages 5 and 6 of CVMI (end of pubertal growth spurt).
A highly significant association exists between DI and CVMI. Mandibular second molar DI stages are reliable indicators of skeletal maturity.
The relationship between early radiographic evidence of calcification of the adductor sesamoid of the first metacarpophalangeal joint and the state of maturity of certain teeth was investigated. Data were obtained from the records of one hundred and forty children of Caucasoid origin, comprising ninety-three girls and forty-seven boys. Calcification of the adductor sesamoid was closely related to the completion of root mineralization of the mandibular canine prior to apical closure. No significant sex differences were noted in the state of maturation of the tooth in relation to this particular stage of skeletal development. Correlations among the remaining teeth studied were low, the distribution of calcification stages being widely dispersed with significant sex differences evident. Based on the findings of this study, the completion of root formation of the mandibular canine prior to apical closure may be used as a maturity indicator for the commencement of the circumpubertal growth spurt with a similar degree of confidence as the calcification of the adductor sesamoid of the thumb. It should be noted, however, that racial variations might exist in the relationship between the state of maturity of this tooth and the commencement of mineralization of the sesamoid. Caution should thus be exercised in the application of these findings to other racial groups.
Two groups of adolescent orthodontic patients, one from the Midwest and one from the Midsouth, were compared to test the clinical impression that the permanent teeth of southern children form and erupt at significantly later ages. Indeed, a marked difference is documented, with the Midsouth series achieving mineralization stages at least 1 1/2 years later on average. This suggests that regional differences are appreciably greater than previously suspected. Clinical consequences revolve on the use of conventional (generally Northeast-based) norms for tooth formation and eruption and predictive models of facial growth. In contrast, the analysis of rates of hand-wrist development (bone age) of these same subjects disclosed no difference; this further confirms the essential independence of development of the dental and osseous tissue systems.
The purpose of this study was to assess the relevance of hand-wrist radiographs to craniofacial growth and clinical orthodontics. Serial annual cephalometric and hand-wrist radiographs and standing height measurements were obtained from a sample of 47 girls (ages 10 through 15 years) and 39 boys (ages 11 through 16 years) from the Bolton-Brush data base. Four skeletal linear measurements showing statistically significant increases were analyzed: SN, GoGn, SGo, and NMe. The hand-wrist radiographs were scored by the Tanner-Whitehouse TW2 RUS method of skeletal maturity assessment. The results of the study indicated that statural height and hand-wrist skeletal maturation in both sexes are significantly related. The children demonstrated a large variety of growth patterns, and growth spurts could not be consistently observed on an individual basis. Because of low statistical correlations, the relationship between acceleration and deceleration in growth of the specific craniofacial dimensions and statural height or skeletal maturity was not deemed clinically significant for prediction. However, it may be used as a factor for consideration in diagnosis and treatment planning of an individual case.
The commencement of adolescent peak growth velocity in body height and facial growth is closely related in timing to certain ossification events which occur in the hand and wrist. An investigation into calcification patterns of the teeth revealed a high degree of correlation between the stage of mineralization of the lower canine and these events. The possibility of the use of this tooth as a maturational indicator of the pubertal growth spurt is discussed.
The dental development of a genetically homogeneous French-Canadian group of children ranging in age from 2.5 to 19 years was evaluated from 5,437 panoramic radiographs by the method of Demirjian et al. The maturity of each mandibular tooth was evaluated individually. For each stage of each tooth, the developmental curves of boys and girls were compared. A common pattern was found for each tooth, namely the chronological similarity between boys and girls in the early stages of development and the advancement of girls over boys for the later stages. Development scores were given to the seven mandibular teeth. Up to five to six years of age, no difference was found in the timing of dental development between boys and girls, in contrast to the older ages where girls were always more developed than boys. When the emergence curve was plotted with developmental curves, a close relation was established between the stage of formation of all teeth and their emergence, hence the predictive value of the use of dental maturity curves in clinics.
Hand wrist radiographs and dental panoramic radiographs of 200 boys and 215 girls were assessed to determine the relationship between the developmental stages of the mandibular canine and skeletal maturity indicators of the pubertal growth spurt. Chi-square and Kendall's tau statistics demonstrated significant (P < 0.001) relationships between skeletal maturity indicators. Associations between canine development and skeletal maturity ranged from 0.53 to 0.85. Most children having attained canine stage G showed the presence of the adductor sesamoid (81%), capping of the diaphysis of the third middle phalanx (77%), and capping of the fifth proximal phalanx (87%). Growth reference data for American children suggest that stage G occurred approximately 0.4 years and 1.3 years before peak height velocity for girls and boys, respectively. It is indicated that canine calcification could serve as a useful tool for evaluating childrens' skeletal maturation and, by association, somatic maturity.
To study the relationship between mandibular canine calcification and skeletal maturity.
Hand wrist and mandibular canine radiographs of 106 boys and 152 girls in Beijing area were assessed.
Mandibular canine calcification coincides with the initiation of puberty in male (93.8%) and with the deceleration of puberty in female(89.7%). However the coincidence with the indicators of other pubertal stages was less than 50%.
Mandibular canine calcification just can give an initial assessment for estimating the timing of puberty.
A comparative evaluation of hand wrist and cervical vertebrae was done to know the validity of cervical vertebrae as maturity indicators. A sample of 50 subjects (25 females and 25 males) in the age group of 10-12 years were selected on criteria of normal occlusion and the result showed that cervical vertebrae can be used with the same confidence as hand wrist radiographs to evaluate skeletal maturity, thus avoiding the need for an additional radiograph.
To compare skeletal maturation as measured by hand-wrist bone analysis and by cervical vertebral analysis.
A radiographic hand-wrist bone analysis and cephalometric cervical vertebral analysis of 30 patients (14 males and 16 females; 7-18 years of age) were examined. The hand-wrist bone analysis was evaluated by the Bjork index, whereas the cervical vertebral analysis was assessed by the cervical vertebral maturation stage (CVMS) method. To define vertebral stages, the analysis consisted of both cephalometric (13 points) and morphologic evaluation of three cervical vertebrae (concavity of second, third, and fourth vertebrae and shape of third and fourth vertebrae). These measurements were then compared with the hand-wrist bone analysis, and the results were statistically analyzed by the Cohen kappa concordance index. The same procedure was repeated after 6 months and showed identical results.
The Cohen kappa index obtained (mean +/- SD) was 0.783 +/- 0.098, which is in the significant range. The results show a concordance of 83.3%, considering that the estimated percentage for each case is 23.3%. The results also show a correlation of CVMS I with Bjork stages 1-3 (interval A), CVMS II with Bjork stage 4 (interval B), CVMS III with Bjork stage 5 (interval C), CVMS IV with Bjork stages 6 and 7 (interval D), and CVMS V with Bjork stages 8 and 9 (interval E).
Vertebral analysis on a lateral cephalogram is as valid as the hand-wrist bone analysis with the advantage of reducing the radiation exposure of growing subjects.