Hand skeletal maturity and its correlation with mandibular dental development

Background/Objectives: This retrospective longitudinal study analyzed height growth velocity (GV) across skeletal maturity indicator (SMI) intervals in Korean adolescents with skeletal Class II malocclusion to identify the timing and duration of peak height velocity (PHV) and to define a PHV window relevant to growth-modification treatment. Methods: Sixty patients (30 males, 30 females) were followed for at least six years with serial hand-wrist radiographs and height records. GV was calculated for each SMI interval, defined as the period between adjacent SMI stages. In females, the timing of menarche by SMI stage was also recorded. Results: GV increased with skeletal maturation and was greatest at the SMI 5-6 interval in both sexes. In males, GV was already high at SMI 4-5 and did not differ significantly from that at SMI 5-6, whereas in females GV remained high at SMI 6-7 and did not differ significantly from that at SMI 5-6. In all female subjects, menarche occurred after PHV and coincided with growth deceleration. GV declined markedly after SMI 7-8, with minimal growth beyond SMI 11. Conclusions: These findings indicate that the PHV window spans SMI 4-6 in males and SMI 5-7 in females, suggesting that growth-modification therapy may achieve optimal outcomes when initiated within these stages. Because this study evaluated height rather than maxillomandibular growth and individual variation persists, SMI stage alone cannot define PHV, and additional assessments of growth are required when determining the timing of orthopedic intervention.

Animal studies have shown that under-nourishment alters skeletal maturation stage and growth.1,2 Malnourished children have shown significantly slower skeletal maturation rate and delayed puberty.3,4 Tooth eruption has a poor correlation with general body and facial growth as compared to skeletal maturation.5 In our previous study we reported that calcification pattern of the mandibular second molar has been highly correlated with skeletal maturation events6. To our best knowledge, no previous study in Indian has simultaneously analyzed the possible influence of growth stunting on skeletal maturation and dental development evaluated through radiographs in preaddesents and adolescents. The objective of this study was to evaluate whether malnutrition status was associated with maturation stages of the medium phalanx of the third finger (MP3) and dental development of mandibular second molar in north Indian children. A sample of 40 school children aged between (B-16) years were selected from out patient Department Govt Dental College, PGIMS, Rohtak (India). All the children were from at least one previous generation of ancestors without any clinically determined chronic medical disease or syndrome. Skeletal maturation was evaluated through a periapical radiograph of the MP3 from the hand (Dept of Orthodontics, Govt Dental College, PGIMS, Rohtak (India). The maturation stage selective to the peak of high velocity was determined for each individual using five-point ordinal scale as in the previous study.8 Demirijian et al. classification for the mandibular second molar was used. All the data were analyzed with SPSS statistical (SPSS 7.0). Figure 1 Table 1: Skeletal maturation stage of the MP and dental development stage of second molar. There was a highly statistically significant difference for skeletal maturation and dental developmental stage in gender (p<0.01) while no statistically significance difference for skeletal maturation and dental developmental stage according to nutrition was found. Malnutrition was not associated with dental developmental and skeletal maturity stages in north of India.

Introduction: The accurate assessment of skeletal maturation and residual growth is critically important in orthodontics, especially in insulin-dependent diabetes mellitus growing subjects in which the available data on their growth are conflicting and are mainly derived from cross-sectional studies. Aim of the study: This study aimed to examine the association between the calcification stages of the second mandibular molar, the maturation of the middle finger phalanx, and the chronological age of the patients. Material and Methods: The sample consisted of 80 Iraqi subjects of Type1 Diabetic Mellitus (T1DM), 40 males and 40 females. For each subject, two per apical radiographic were used, one for the mandibular right second molar and the other for the middle phalanx of the middle finger (MP3). Demirjian method (1973) was assessed for the ossification of teeth, while Staging of the Middle phalanx of the third finger radiographs was done according to the Rajagopal and Kansal method. Result: The results showed no significant association between skeletal and dental maturity for both genders in T1DM growing subjects and a negative association can be seen between dental age and skeletal age in total, male and female T1DM subjects. Conclusion: mandibular second molar calcification stages of Demirgian's classification are unreliable as a skeletal maturity indicator in TIDM.

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.

In the growing years, indicators of the level of maturational development of the individual provide the best means for evaluating biologic age and the associated timing of skeletal growth. The relative stage of maturity of a child may be determined by comparing the child's hand-wrist radiograph to the known standards of skeletal development. In this study, we assessed various levels of skeletal maturation and also identified the relationship between chronological age (CA) and maturation stage using the hand-wrist radiographs in adolescents of Indian origin. Three hundred and thirty hand-wrist digital radiographs of individuals aged 8 to 18years were evaluated for skeletal maturity levels using Fishman's method. The data was analysed using the SPSS software package (version 12, SPSS Inc., Chicago, IL, USA). Regression analysis was performed for calculating bone age of both males and females. Spearman's rank-order correlation coefficients were estimated separately for males and females to assess the relation between CA and maturation level. An association between skeletal maturation indicator stages and CA (r = 0.82) was significant. Interestingly, female subjects were observed to be advanced in skeletal maturity compared to males. Regression equations were derived to calculate bone age in males, females and the whole sample. The results of this study showed significant association between hand-wrist skeletal maturation levels and CA. Digital radiographic assessment of hand-wrist skeletal maturation can be used as a better choice for predicting average bone age of an individual because of its simplicity, reliability and lesser radiation exposure.

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

A comparison of spheno-occipital synchondrosis fusion, hand-wrist maturation, and cervical vertebral maturation for assessing skeletal maturation in Chinese adolescents: A cross-sectional study.

Objective This study assessed the accuracy of Demirjian's and Cameriere's methods for age estimation in Iranian children using panoramic radiographs. Materials and Methods This cross-sectional study evaluated 212 panoramic radiographs of 6- to 10-year-old children retrieved from the archives of an oral and maxillofacial radiology department from 2011 to 2017. The chronological age of children at the time of radiography was determined by subtracting the date of radiography from their birth date. The developmental stage of 7 permanent left mandibular teeth was determined according to Demirjian's method. The stage of dental maturation was determined according to Cameriere's method by using the normalized values for 7 permanent left mandibular teeth and the number of teeth with complete root development. The error value of the two methods was calculated by comparing them with the actual chronological age of male and female children, and the absolute error values of the two methods were compared with paired t-tests. Results The mean error value of Demirjian's and Cameriere's methods was found to be 0.84 and −0.06 in girls and 0.93 and 0.04 in boys, respectively. Significant differences were noted in the absolute error of the two methods compared with the chronological age of male and female children (both Ps < 0.001). Conclusion In conclusion, this study indicated that Cameriere's method was more accurate than Demirjian's method for age estimation in Iranian children.

The aim of the study was to investigate the relation between dental calcification stages and the skeletal maturation in hand and wrist region and cervical vertebrae.The sample include panoramic,handwrist, and lateral cephalometric radiographs of 550 subjects aged from 6.5to 17 years. Dental development was rated and skeletal maturation was evaluated.Thecorrelation was a highly significant positive correlationbetween dental calcification stages and hand wrist maturation stages ranged from 0.82 to 0.86 for females and 0.86 to 0.88 for males. The correlation between dental calcification and cervical vertebral maturation was ranged from 0.82 to 0.84 in females and 0.80 to 0.83 in males.Dental calcification stages can be used as a diagnostic tool for determining the growth in orthodontic patients.

Objectives: To determine the predicting the effect of BMI-index percentile on the skeletal maturation of Nigerian children. &#x0D; Design: A prospective cross-sectional study.&#x0D; Setting: This study was conducted in a tertiary health care facility in North-Central Nigeria.&#x0D; Participants: Children between the ages of 5-17 years consisting of 44 males and 30 females that presented in the Child Dental clinic over a period of eight months were recruited for the study.&#x0D; Main outcome measured: Skeletal maturation was assessed using the middle phalanx of the third finger (MP3) while the standard WHO growth chart specific for age (2-20 years) and gender was used for grading BMI-percentile. The unpaired t-test was used to compare mean chronological age of the stages of MP3 according to gender. Multinomial logistic regression used to determine the predictive effect of age, gender and BMI percentile on pubertal growth spurt.&#x0D; Results: The BMI-percentile had weak correlation with the pubertal growth spurt (r=0.089, p=0.448). Gender (p=0.004) and chronological age had significant (p&lt;0.001) predictive effect on the skeletal maturation. A one-percentile increase in the BMI-percentile decreases the likelihood of healthy children to be in the peak-pubertal by 1.504 when compared to obese children (p=0.305). &#x0D; Conclusions: This study showed that BMI-percentile is a weak predictor of skeletal maturation. However, obese children had a tendency towards advanced skeletal maturation than healthy participants. It is therefore suggested that orthodontists should consider early implementation of jaw modification treatments among obese children.

OBJECTIVES: To determine the correlation between chronological age (CA) and mandibular third molar (MTM) development in a sample of Khyber Pakhtunkhwa (KP) population. Furthermore, to provide forensic reference data for age determination from MTM mineralisation. Finally, to derive regression formulae specific to this population to estimate age using MTM calcification stages. METHODOLOGY: Four hundred and seventy orthopantomographs (OPGs) of patients aged between 13-26 years from the Orthodontics department archive at the main tertiary dental hospital of KP were studied for development of MTM staging using Demirjian's method. Spearman's Correlation was applied to determine any relationship between CA and MTM development. An Independent two-sample t-test was performed to compare third-molar development in males and females. Population-specific models was developed using quantile regression analysis. RESULTS: A strong positive correlation was found between CA and MTM development (rs = 0.853; p- &lt;0.001). The median quantile regression equation developed for entire sample is: Age = 8.8+ 1.4(developmental stage). Ninety-four percent of males and females at stage H were at least 18 years or older. CONCLUSION: Mandibular third-molars can be an appropriate guide for CA estimation in the KP population. Stage H is likely to occur at 18 years of age. This may be valuable for medicolegal suits requiring CA estimation. KEYWORDS: forensic odontology, forensic anthropology, panoramic radiographs, chronological age estimation, mandibular third-molar, Pakistan HOW TO CITE: Tariq Q, Tareen MA, Uddin I, Hussain U. Radiographic employment of mandibular third-molar mineralisation to estimate chronological age in a population of Peshawar, Pakistan. J Pak Dent Assoc 2021;30(1):39-44.

The aim of our study is to compare the relationship between hand-wrist and cervical vertebra maturation stages with chronological age and to investigate the effect of malocclusion type on the relationship between these methods. Hand-wrist and cephalometric radiographs of 1000 patients (526 females, 474 males) with a mean age of 13.41 ± 1.83 were analyzed. The methods of Bacetti et al. were used for the cervical vertebra maturation stage, and Björk, Grave and Brown's methods were used for the hand-wrist maturation stage. One-way ANOVA test was applied to compare skeletal classes between them. Tukey post hoc test was used to determine the differences. The relationship between the malocclusion type, cervical vertebra and hand-wrist maturation stages was evaluated with the Spearman correlation test. Spearman's correlation coefficient was 0.831, 0.831 and 0.760 in Class I, II and III females, respectively. In males, it was calculated as 0.844, 0.889 and 0.906, respectively. When sex and malocclusion were not differentiated, the correlation was found to be 0.887. All were statistically significant (P < 0.001). The highest correlation was observed in class III males, while the lowest was found in class III females. Cervical vertebrae can be used safely to assess pubertal spurt without hand-wrist radiography. Diagnosing growth and development stages from cephalometric images is important in reducing additional workload and preventing radiation risk.

Background: Age estimation is forensic science to help victims of disasters, accidents, or criminal cases. Age estimation using panoramic radiographs can be an option. The use of panoramic radiographs in age estimation requiring some methods, one of them is Demirjian method. The assement of tooth age by the Demirjian method is based of the tooth maturation process approach as the indicator.This study aim was to determine the description of biological age estimation using the Demirjian method in the city of Semarang. Method: The design of this research was a cross-sectional study with a total sample 152 (71 boys and 81 girls). The estimated age of the Demirjian method used 7 left mandibular teeth except for the third molar. The age assessment was based on 8 stages of crown calcification to the root, after each tooth score has been added and the maturation score is calculated, and subsequent maturation scores are converted into the age of the tooth to determine the age of 3-16 years. Data analysis using the SPSS program and analyzed by descriptive test. Result: The results obtained by the average difference in biological age and chronological age was 1.1 years and there was 87 data that under estimation, 57 data over estimation, and 8 data on estimation. Conclusion: The depiction of biological age in Semarang, the age group between 3-26 years the average Demirjian method is 1.1 years.

BackgroundThe correlation between dental maturity and skeletal maturity has been proposed, but its clinical application remains challenging. Moreover, the varying correlations observed in different studies indicate the necessity for research tailored to specific populations.AimTo compare skeletal maturity in Korean children with advanced and delayed dental maturity using dental maturity percentile.DesignDental panoramic radiographs and cephalometric radiographs were obtained from 5133 and 395 healthy Korean children aged between 4 and 16 years old. Dental maturity was assessed with Demirjian’s method, while skeletal maturity was assessed with the cervical vertebral maturation method. Standard percentile curves were developed through quantile regression. Advanced (93 boys and 110 girls) and delayed (92 boys and 100 girls) dental maturity groups were defined by the 50th percentile.ResultsThe advanced group showed earlier skeletal maturity in multiple cervical stages (CS) in both boys (CS 1, 2, 3, 4, and 6) and girls (CS 1, 3, 4, 5, and 6). Significant differences, as determined by Mann-Whitney U tests, were observed in CS 1 for boys (p = 0.004) and in CS 4 for girls (p = 0.037). High Spearman correlation coefficients between dental maturity and cervical vertebral maturity exceeded 0.826 (p = 0.000) in all groups.ConclusionA correlation between dental and skeletal maturity, as well as advanced skeletal maturity in the advanced dental maturity group, was observed. Using percentile curves to determine dental maturity may aid in assessing skeletal maturity, with potential applications in orthodontic diagnosis and treatment planning.

This study aimed to evaluate the relationship between the calcification stages of permanent maxillary and mandibular canines and second premolars and skeletal maturity in both sexes. This study included 138 patients (82 females, 56 males) who were treated in the Department of Orthodontics, Altınbaş University. The mean age of the patients was 12.31±1.76 years, ranging from 7.8 years to 15.8 years. Dental maturity stages of canines and second premolars were evaluated according to the Demirjian index on digital panoramic radiograph. The skeletal maturation stage was determined using the cervical vertebral maturation (CVM) index. The Pearson correlation analysis was performed to assess the association among CVM stages and calcification stages of canines, second premolars, sex, and chronological ages. A statistically significant correlation was found between CVM and the calcification stages of the canines and second premolars (p<0.05). The calcification stages of the canines and second premolars had the highest distribution of Stage F and Stage G at CVM2 (p<0.01). For the canines and second premolars, Stage H corresponded to CVM3 in female patients and a high percentage of Stage G corresponded to CVM3 in the male group. A significant correlation was found between the calcification stages of maxillary and mandibular canines, second premolars, and skeletal maturity in both sexes. It was observed that calcification stages and cervical maturations were advanced in female subjects compared with male subjects.