The relationship between dental calcification stages and skeletal maturation

Objectives: Assessment of pubertal status and pubertal growth spurt in orthodontic patients has a considerable impact on the diagnosis, treatment plan and the outcome of orthodontic treatments. Hand-wrist radiography is routinely used to evaluate skeletal development. Some studies have shown that there is an association between bone development and different stages of dental calcification; therefore, the stages of dental calcification can be used as the first tool for diagnosis, in case there is an association. This study was performed with the aim to evaluate the association between the phases of dental development and the stages of skeletal maturity.Study design: In this study, a total of 52 patients (26 males and 26 females), referring to Mashhad School of Dentistry for orthodontic treatment, were evaluated; the subjects were within the age range of 9-14 years. Hand-wrist radiographic evaluation of skeletal maturation was performed using Fishman method. Also, the Demirjian method was used to identify the stages of dental calcification by panoramic radiographs. Independent t-test and Spearman correlation coefficient were used for data analyses.Results: The mean age of males and females was 11.05 ± 1.05 and 10.62 ± 1.12 years, respectively (p=0.156). The Spearman correlation coefficients between skeletal maturity indicators (SMIs) and developmental stages of mandibular left and right canines and second molars were significant in males only (p<0.05). Also, correlation coefficients were significant between adductor sesamoid ossification and mandibular right and left canines developmental stages in males (p<0.05).Conclusions: Findings of this study showed that the correlation between dental developmental stages and skeletal maturity only were significant in males; thus, different skeletal maturity patterns in males and females might be perceptible. Key words:Skeletal maturation, hand-wrist radiography, panoramic radiography.

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.

Precise evaluation of maturational stage should be an integral part of both diagnosis and treatment. Different authors had reported different methods in an attempt to determine the best indicator of maturity. These include body height, body weight; sexual maturation; frontal sinus, chronological age, biological age or physiological age; hand-wrist maturity cervical vertebrae; dental eruption; dental calcification stages and biomarkers. Ever the method has its own advantages, disadvantages and over the other method. However, still researches are being done to explore best method to assess the maturity of an individual. This article reviews the methods of assessment of skeletal maturation.

Background And Objectives-Treatment timing has a significant role in the outcome of all dentofacial orthopedic treatments for dentoskeletal disharmonies in growing patients. Dental maturation has been proposed to be a clinically useful diagnostic aid for the identification of individual skeletal maturation stages. Aims: 1) To correlate dental calcification stages with MP3 stages in skeletal age estimation using CBCT of the left mandibular posterior teeth. 2) To determine whether dental calcification can be used as a first level diagnostic tool for assessment of skeletal maturity with MP3 stages.

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.

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.

Aim and objectiveThe study aimed at, whether the calcification stages of mandibular 1st premolar and 2nd molar can be used to assess skeletal maturity.Materials and methodsLateral cephalogram and OPG of 72 growing subjects with good health (38 girls and 34 boys; age-group of 8–17 years) were selected for a cross-sectional study, in which the identity of patients was not revealed to the investigator. The dental calcification stage of mandibular 1st premolar and 2nd molar were estimated in accordance with the Demirjian system (DI) and skeletal maturation was estimated according to cervical vertebral maturation index (CVMI) given by Hassel and Farman and these two indices were compared.ResultsChi-square test and Spearman rank-order correlation coefficient test showed that a significant relationship of mandibular 1st premolar and 2nd molar calcification stages with CVMI exists, for both males and females. In females, CVMI stage 2 showed maximum correlation to DI stage E of lower 2nd molar. In males, CVMI stage 2 showed maximum correlation to DI stage E of lower 1st premolar.ConclusionThe result of this study revealed that each stage developed prior in female subjects compared to male subjects and the calcification stages of lower 1st premolar and 2nd molar can be used to assess the peak of growth.How to cite this articleMittal K, Trehan M, Sharma S, et al. Evaluation of Skeletal Maturation Using Mandibular 1st Premolar and 2nd Molar Calcification Stages: A Cross-sectional Radiographic Study. Int J Clin Pediatr Dent 2021;14(S-1):S44–S49.

Background and objectivesOrthodontic diagnosis and treatment planning for growing children must involve growth prediction, especially in the treatment of skeletal problems. Studies have shown that a strong association exists between skeletal maturity and dental calcification stages.The present study was therefore taken up to provide a simple and practical method for assessing skeletal maturity using a dental periapical film and standard dental X-ray machine, to compare the developmental stages of the mandibular canine with that of developmental stages of modified MP3 and to find out if any correlation exists, to determine if the developmental stages of the mandibular canine alone can be used as a reliable indicator for assessment of skeletal maturity.MethodsA total of 160 periapical radiographs (80 males and 80 females), of the mandibular right canine and the MP3 region was taken and assessed according to the Dermirjian’s stages of dental calcification and the modified MP3 stages.ResultsThe correlation between the developmental stages of MP3 and the mandibular right canine in male and female groups, is of high statistical significance (p = 0.001). The correlation coefficient between MP3 stages and developmental stages of mandibular canine and chronological age in male and females was found to be not significant.ConclusionsThe correlation between the mandibular canine calcification stages and MP3 stages was found to be significant. The developmental stages of the mandibular canine could be used very reliably as a sole indicator for assessment of skeletal maturity.

This study primarily aimed to assess the accuracy of radiographic dental calcification parameters for the identification of specific craniofacial growth stages. Permanent mandibular canines, premolars, and second molars of 288 patients, from 6 to 15years old, were analysed on randomly selected panoramic radiographs, and categorised according to two calcification methods. Reproducibility analyses and data derived from panoramic records were correlated with the gold-standard method, as evaluated from lateral cephalometric teleradiographs. Accuracy tests were finally calculated, considering several cutoff points. Dental calcification methods showed "strong" to "almost perfect" intra- and inter-examiner reproducibility. Significant, although weak correlations were observed for all parameters. Canine and first premolar calcification stage 8 and second premolar and second molar stage 7 showed higher sensitivity rates for identifying the pubertal growth spurt period, as well as the stage F for these teeth. Canine and first premolar stages 10 and H obtained higher specificity rates for identifying the absence of post-pubertal period. The dental calcification parameters showed adequate reproducibility, in addition to significant correlations with cervical vertebrae stages. Radiographic dental calcification parameters used for the mandibular first premolar obtained high accuracy rates and were recommended for identifying specific craniofacial growth periods.

Aim: This study aims to evaluate the relationship between stages of mandibular second molar calcification and cervical vertebrae maturity (CVM) staging for the assessment of pubertal growth spurts in patients.Materials and Methods: Pretreatment panoramic and lateral cephalometric radiographs of 400 patients (200 males and 200 females) were evaluated to ascertain the association of Demirjian index (DI) and CVM method.Results: A highly significant correlation between Cervical vertebrae maturation Index (CVMI) and DI was calculated using Sakoda adjusted Pearson contingency coefficient (r) and a positive correlation was found between CVM and DI in male samples as r = 0.785 and female sample as r = 0.803.Conclusion: A highly significant correlation (r = 0.785 for male subjects and 0.803 for female subjects) was found between DI and CVMI and female subjects showed a higher correlation between skeletal and dental maturity compared to male subjects.

Aim: The aim of this study is to assess, (1) the relationship between cervical vertebrae maturation and mandibular canine calcification stages; and (2) whether the mandibular canine calcification stages can be used as indicators to determine skeletal maturity. Materials and Methods: A descriptive, retrospective, and cross-sectional study was designed. A null hypothesis was proposed that there was no relationship between cervical vertebrae maturation and the mandibular canine calcification stages. Pre-treatment orthopantomograms (OPGs) and lateral cephalograms of 99 males and 110 females of Rwanda ethnicity were selected. The cervical vertebrae maturation index (CVMI) proposed by Hassel and Farman was used to evaluate the skeletal maturation level, and the mandibular canine calcification stages were assessed with the Demirjian Index (DI). Results: A significant association was found between the CVMI and DI stages, as evaluated by the Pearson contingency coefficient values (0.599 for males and 0.719 for females). Canine stage F in males and canine stage E in females could represent the CVMI 2 stage and indicate the onset of a period of accelerating growth. Conclusions: The mandibular canine calcification stages might be clinically used as maturity indicators of the pubertal growth period, but only during the onset and accelerating phases.

Objective: to investigate the reliability of mandibular canine maturation stages in predicting pubertal growth spurt in a sample of Egyptian orthodontic patients. Materials and Methods: A retrospective, cross-sectional study was carried out on the radiographic records (left lateral cephalometric, panoramic and left hand and wrist x-rays) obtained from 250 patients who were attending private clinics on Delta area, Egypt. The age was selected between 7 and 18 years. Mandibular canine calcification stages (MCC) were assessed according to Demirjian’s method for dental maturity assessment. Skeletal maturity was assessed by the ossification stages of the middle phalanx of the third finger (MP3) using Hagg and Taranger method and the cervical vertebrae maturation index (CVMI) was evaluated using Hassel and Farman method. MCC stages were statistically correlated to both MP3 stages and CVMI stages. The significance level was set at P ≤ 0.05. Statistical analysis was performed with IBM® SPSS® Statistics Version 20 for Windows. Results: Chi-square tests have shown highly significant associations between the mandibular canine calcification stages (MCC) and both CVMI and MP3 maturation stages (p < 0.001). MCC stage F had shown a moderate correlation with MP3 FG and CVMI 2 that corresponded to the onset of pubertal growth. Conclusions: MCC stage F can be used for prediction of the onset of pubertal growth, while prediction of the peak or the post peak periods using MCC method may be unreliable. Key words: Pubertal growth, MP3 stages, CVMI stages, MCC stages.