The Level of Alkaline Phosphatase in Saliva as Biomarker for Pubertal Growth Phase

Abstract

Abstract-The identification of the onset of pubertal growth phase in growing patients is very important for orthodontists to determine orthodontic treatment planning and timing. The timing of growth phase can be assessed using chronological age, skeletal age, physiological age, dental age and biomarkers. ALP is one of the biomarkers that can be easily obtained from saliva. The increase of ALP levels in growing subjects is one of the indications of bone mineralization. The objective of this study was to assess the level of ALP in growing subjects in relation to the pubertal growth phase and age. This research was an observational analytic research with cross sectional design. Samples in this study consisted of 57 healthy growing female subjects (age ranging from 8 to 15 years). Growth phase was assessed through the cervical vertebral maturation (CVM) method described by Hassel and Farman. The subjects were divided into three groups according to their growth phases, which were prepubertal (CVM 1 and CVM 2), pubertal (CVM 3 and CVM 4), and post pubertal (CVM 5 and CVM 6). Unstimulated whole saliva collected from each subject and the level of ALP were measured using spectrophotometer. Results showed that peak levels of ALP were observed in pubertal growth phase: 233.39 ± 106.29 (IU/L), followed by prepubertal growth phase: 192.87 ± 69.02 (IU/L), and post pubertal growth phase: 79.20 ± 31.41(IU/L). The highest ALP levels were found at 10-11 years, and at 8-9 years, 12-13 years, and 14-15 years respectively. As conclusion, the level of ALP in saliva can be used as biomarker for the pubertal growth phase identification to determine orthodontic treatment planning and timing.

Non-invasive methods for the assessment of biomarkers and their correlation with radiographic maturity indicators — a scoping review

“…The age group in the studies ranged from 6 to 24 years. The noninvasive methods used were saliva [23][24][25][26][27][28][29][30], GCF [31][32][33], and urine [34].…”

“…Twelve articles were selected for full-text review and summarized based on the following information: biomarker assessed, sample size and characteristics, sample collection protocol, processing of sample, biomarker detection method, and the radiographic method used (Table 1 ). All 12 studies were cross-sectional and included subjects of both the genders except two studies [ 28 , 34 ] that only had female participants. The age group in the studies ranged from 6 to 24 years.…”

“… Colorimetric assay Middle phalanx third finger—MP3 staging by Hagg and Taranger The levels of salivary ALP reached a peak in the G stage of MP3 followed by a decrease in the H stage. They also found that both boys and girls showed ALP levels correlating well with the G stage of MP3 Irham et al [ 28 ] Cross-sectional 57 subjects 8 to 15 years 57 females Unstimulated whole saliva was collected between 10 am to 12 pm Not specified a. Salivary ALP levels (IU/L) Samples were centrifuged for 2 min for 10,000 rpm and stored at – 80 °C. Colorimetric assay Lateral cephalogram—Cervical Vertebral Maturation Index by Hassel and Farman Increased activity of salivary ALP was seen in the pubertal phase.…”

“…Salivary ALP levels were assessed in three studies. Irham et al [ 28 ] found a significant increase in ALP levels during pubertal phase. The study by Tarvade et al [ 27 ] that used middle phalanx of the third finger (MP3) staging to correlate found the ALP levels to increase during G stage of MP3.…”

“…Out of the 12 articles, 8 studies [23][24][25][26][27][28][29] employed saliva as their sample. The biomarkers assessed in the eight studies were insulin-like growth factor 1 (IGF1) [23,29], alkaline phosphatase (ALP) [26,27,34], bone-specific alkaline phosphatase (B-ALP) [24,25], vascular endothelial growth factor (VEGF) [29], and dehydroepiandrosterone (DHEA) [30].…”