Diagnostic performance of dental maturity for identification of skeletal maturation phase

Abstract

The objective of this study is to analyse the diagnostic performance of the circumpubertal dental maturation phases for the identification of individual-specific skeletal maturation phases. A total of 354 healthy subjects, 208 females and 146 males (mean age, 11.1 ± 2.4 years; range, 6.8-17.1 years), were enrolled in the study. Dental maturity was assessed through the calcification stages from panoramic radiographs of the mandibular canine, the first and second premolars, and the second molar. Determination of skeletal maturity was according to the cervical vertebra maturation (CVM) method on lateral cephalograms. Diagnostic performances were evaluated according to the dental maturation stages for each tooth for the identification of the CVM stages and growth phases (as pre-pubertal, pubertal, and post-pubertal) using positive likelihood ratios (LHRs). A positive LHR threshold of 10 or more was considered for satisfactory reliability of any dental maturation stage for the identification of any of the CVM stages or growth phases. The positive LHRs were generally less than 2.0, with a few exceptions. These four teeth showed positive LHRs greater than 10 only for the identification of the pre-pubertal growth phase, with values from 10.8 for the second molar (stage E) to 39.3 for the first premolar (stage E). Dental maturation assessment is only useful for diagnosis of the pre-pubertal growth phase, and thus, precise information in relation to the timing of the onset of the growth spurt is not provided by these indices.

Skeletal maturity assessment using mandibular canine calcification stages

“…For both genders, canine root formation was complete (stage H) in the majority of subjects at CVMI stages 5 and 6. These results are consistent with the results of other similar studies (15,16,21).…”

“…Studies have found that CVMI is a reliable method for skeletal maturity assessment (9,13,15,19,21). Some studies report high correlations between calcification stages of teeth (dental maturity) and skeletal maturity indicators (13)(14)(15)(16). Some authors investigated correlations between calcification stages of some teeth (canines, second and third molars), and they found that the calcification stage of mandibular canine showed a significant correlation with skeletal maturity (17,18,21).…”

“…Assessment of skeletal maturity, based on the stages of tooth calcification, has certain advantages, as it allows assessment based on panoramic radiographs that are routinely used for diagnosis, and assessment may be carried out by analysing retroalveolar radiographs. Stages of teeth development are associated with growth and development, which means that dental maturity may be used as a parameter for assessment of skeletal maturity, as has been shown by numerous studies (13)(14)(15)(16). Some authors noted that the developmental stages of certain teeth, for example canines (17,18) and second molars (19), show a high correlation with skeletal maturity.…”

“…Franchi et al (12) showed a poor correlation between the phases of dentition and skeletal maturity. In addition to tooth eruption, dental maturity is estimated through the stages of calcification, and this is a much more reliable parameter for assessment of skeletal maturity (13)(14)(15)(16). For all these reasons, dental maturity is recommended as a clinically useful diagnostic tool for assessment of skeletal maturity.…”

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

“…Therefore, dental maturation has been proposed as a useful method for assessing the pubertal growth spurt. 8 Many studies have been performed, including a meta-analysis, 11 evaluating the correlation between mandibular second molar maturation and the HWM, [12][13][14] MPM, 15 and CVM 16,17 methods. High correlations were reported between mandibular second molar maturation and the other maturation methods studied in all these investigations regardless of the ethnicity of the sample population.…”