Cervical Vertebral Maturation Stage Research Articles

Dental and skeletal maturation in female adolescents with temporomandibular joint osteoarthritis

Occurrence of temporomandibular disorders (TMDs) and temporomandibular joint (TMJ) osteoarthritis (OA) during adolescence may have interactions with mandibular and dental development. The aim of the present study was to investigate relationships between occurrence of TMD and TMJ OA and extents of dental and skeletal development in juvenile female patients. In total, 95 female adolescents (age range, 11-15years) were selected. Among them, 15 subjects (control) had no signs of TMD, 39 TMD patients did not have OA (TMDnoOA), 17 TMD patients were at initial stage of TMJ OA (TMJOA), and 27 patients showed progressive stage of TMJ OA (TMJOA). Dental age was estimated by Demirjian's stages used in a previous study with Korean adolescents. Craniofacial parameters and cervical vertebrae maturation (CVM) stages, representing skeletal maturity levels, were measured using lateral cephalograms. The estimated dental age was significantly lower than chronological age in all groups, but CVM differences were not statistically significant. Dental age was the lowest, and differences between the chronological age and estimated dental age were the highest among initial stage of TMJOAs followed by progressive stage of TMJOAs, TMDnoOAs and control and were not associated with CVM stages. Cephalometric parameters revealed significant clockwise rotation of the mandible among the TMJOAs compared with controls and TMDnoOAs and were not associated with CVM stages as well. The juvenile female patients with TMD, particularly TMJ OA, showed retarded dental development, mandibular backward positioning and hyperdivergent facial profiles. The TMJ OA may be associated with retarded dental development but not with skeletal maturations.

Dentoskeletal features in mixed dentition children with displaced maxillary canines in a southern Italian population.

To analyse the prevalence and the distribution of displaced, buccal/palatal maxillary canines, and the association with sagittal and vertical skeletal relationships in a southern Italian population. Consecutive records of patients were examined. Inclusion criteria were: age 7-12 years, 1-2 cervical vertebral maturation (CVM) stage, initial dental casts, intraoral photographs, panoramic, lateral and periapical radiographs. Subjects with at least one canine in Lindauer II, III or IV sector and/or α angle >31° were included in displaced maxillary canine (DMC) group, whereas those with both canines in sector I and α angle ≤31° were used as control group (CTR). According to canine bulges and/or x-ray examinations, DMC were then divided in palatal and buccal displaced canines (PDC/BDC). Sagittal and vertical skeletal relationships were evaluated using ANB and SN/GoMe angles. Chi-square tests were performed to compare the prevalence rates of skeletal features. The sample consisted of 123 children, 40 DMC and 83 CTR. The DMC group included 11 PDC and 29 BDC subjects. The M:F ratio was 1:3 in PDC and BDC, 1:1 in CTR group. The unilateral-to-bilateral ratio was 1:1 and 3:1 in PDC and BDC subjects. The most common sector combination regarding unilateral and bilateral displacements was "II" and "II,II". PDC occurred more in Class I and in hyperdivergents, whereas BDC in Class I or II and in normodivergents. DMC occurred more often in females than in males. BDC was more common than PDC and unilateral displacements occurred more frequently than bilateral ones. No significant correlation with skeletal features was observed.

THE SALIVARY BONE SPESIFIC ALKALINE PHOSPHATASE IN RELATION TO PUBERTAL GROWTH PHASE IN INDONESIAN CHILDREN

Objective: To evaluate the level of salivary Bone specific Alkaline Phosphatase (BALP) during the pubertal growth phases in Indonesian Children.Materials and Methods: The study conducted on 64 boys and 72 girls who were age group of 8 – 18 years old were randomly selected. Salivary BALP level was estimated using Enzyme-Linked Immunosorbent Assay (ELISA) commercial kits and pubertal growth phase were assessed using Cervical Vertebral Maturation (CVM) method according to Baccetti. Mean salivary BALP were compared based on pubertal growth groups by Analysis of Variance (ANOVA) test.Results: Test revealed no significant differences between groups with p value 0.312. The highest mean of salivary BALP level was found in the pre peak pubertal growth phase (CVM stage 1-2) and the lowest one was detected in the post peak pubertal growth phase (CVM stage 5-6).Conclusion: The using of salivary BALP as a biomarker for pubertal growth prediction is questionable.Keywords: Salivary, Bone specific Alkaline Phosphatase, Pubertal growth, Cervical Vertebral Maturation.

Serum IGF-1, IGFBP-3 and their ratio: Potential biochemical growth maturity indicators

BackgroundDetermination of skeletal maturation and remaining growth potential is an essential part of treatment planning in orthodontics. The aim of our study was to determine the relationship between IGF-1 levels, IGFBP-3 levels with CVM staging to track the pre pubertal and pubertal growth spurts in female patients in North Indian population.MethodsThis cross-sectional study was conducted on ninety female subjects in the age group of 8-20 years. Blood samples were collected and centrifuged and serum samples were then analysed by Human IGF-1 and IGFBP-3 enzyme-linked immunosorbent assay kits, specific for IGF-1 and IGFBP-3, respectively. CVM staging on lateral cephalometric radiograph was determined for all patients. Analysis of variance test followed by a post hoc test was used to compare mean IGF-1 and IGFBP-3 corresponding to six stages of cervical vertebrae maturation stages. Linear Pearson’s correlations were performed to determine the trends of IGF-1, IGFBP-3, and its ratio relating to CVM stage. The kappa statistic was used to measure inter and intra examiner reliability. P value <0.05 was considered as statistically significant.ResultsMean serum IGF-1 levels were found to be highest (403.3 ± 12.3 ng/ml) at CVMI3 stage of CVMI. The post-hoc test revealed a significant difference in IGF-1 levels between all stages of CVMI, thereby indicating a specific range of IGF-1 levels for a specific skeletal stage. Mean serum IGFBP-3 levels were found to be highest (5186.8 ± 1384.2 ng/ml) at CVMI4 stage of CVMI. The mean serum IGFBP-3 levels at CVMI4 were found to be significantly higher than the levels at all other CVMI stages except CVMI3 stage.ConclusionsIGF-1 and IGFBP-3 can serve as a potential biochemical indicator for assessment of skeletal maturity.

Cervical vertebral maturation: Anobjective and transparent code staging system applied to a 6-year longitudinal investigation.

To date, little information is available regarding individual cervical vertebral maturation (CVM) morphologic changes. Moreover, contrasting results regarding the repeatability of the CVM method call for the use of objective and transparent reporting procedures. In this study, we used a rigorous morphometric objective CVM code staging system, called the "CVM code" that was applied to a 6-year longitudinal circumpubertal analysis of individual CVM morphologic changes to find cases outside the reported norms and analyze individual maturation processes. From the files of the Oregon Growth Study, 32 subjects (17 boys, 15 girls) with 6 annual lateral cephalograms taken from 10 to 16years of age were included, for a total of 221 recordings. A customized cephalometricanalysis was used, and each recording was converted into a CVM code according to the concavities of cervical vertebrae (C) C2 through C4 and the shapes of C3 and C4. The retrieved CVM codes, either falling within the reported norms (regular cases) or not (exception cases), were also converted into the CVM stages. Overall, 31 exception cases (14%) were seen. with most of them accounting for pubertal CVM stage 4. The overall durations of the CVM stages 2 to 4 were about 1year, even though only 4 subjects had regular annual durations of CVM stages 2 to5. Whereas the overall CVM changes are consistent with previous reports, intersubject variability must be considered when dealing with individual treatment timing. Future research on CVM may take advantage of the CVM code system.

Three-dimensional analysis of pharyngeal airway morphology in Japanese female adolescents

PurposeThis cross-sectional study evaluated the three-dimensional craniofacial skeletal and pharyngeal airway morphology and the changes associated with skeletal maturation in Japanese female adolescents. Materials and methodsThe subjects were examined by cone-beam computed tomography and divided into two groups according to the stage of cervical vertebral maturation (adolescent group: 34 subjects, cervical stages 2 and 3, mean age 11.15±0.86years; and late-adolescent group: 27 subjects, cervical stages 4 and 5, mean age 14.23±1.13years). The size of the craniofacial skeleton and pharyngeal airway in each group were measured. Statistical differences between the two groups were determined using Student’s t-test. Pearson’s correlation coefficient was used to determine the relationships between the skeletal and pharyngeal variables in each group. ResultsThe skeletal and pharyngeal airway parameters were significantly larger in the late-adolescent group than in the adolescent group. In the adolescent group, the anteroposterior position of the maxilla and mandible was significantly positively correlated with the volume of the nasopharyngeal airway (P<0.05). The mandibular size was significantly positively correlated with the oropharyngeal length and volume (P<0.01). In the late-adolescent group, we did not find any correlations between skeletal size or position and the volume of the pharyngeal airway during the adolescent period. ConclusionsThe nature of the relationship between skeletal morphology and pharyngeal airway volume seems to change from adolescence to late adolescence.

Racial and sex differences in timing of the cervical vertebrae maturation stages

Our objective was to investigate skeletal maturation of female and male subjects from different racial groups by comparing the cervical vertebrae maturation (CVM) stages. The study included 3 racial groups: white, African American, and Hispanic subjects. Each group was subdivided into female and male. The age range of the subjects was between 7 and 18years. The sample included 60 lateral cephalographs for each subgroup. Skeletal maturation of the cervical vertebrae was assessed according to a method that described 6 CVM stages. Racial differences were evident in the mean ages of CVM stages 2, 3, 4, and 5 (P=0.002; P=0.003; P=0.001; and P=0.001, respectively) among females; among males, only stage 3 was different (P=0.001). Sex differences in the mean ages of stages 1, 2, and 3 in Hispanic subjects (P<0.001), and in stages 2 and 3 in African American subjects (P=0.019 and P<0.001) and white subjects (P=0.004 and P<0.001) were detected. In both sexes, racial differences were not apparent between whites and African Americans, but differences were evident between Hispanics vs both whites and African Americans. Sex differences were apparent between the sexes in each of the 3 ethnic groups in CVM stages 2 and 3. No sex differences were detected in stages 4, 5, or 6 in any of the 3 racial groups. It is recommended to consider racial and sex differences when using the CVM stage as a skeletal maturation indicator.

ABSENCE OR PRESENCE OF MID-PALATAL SUTURE IN PATIENTS WITH COMPLETE UNILATERAL CLEFT LIP AND PALATE, (A RETROSPECTIVE STUDY)

Background: The absence/presence of the mid-palatal suture in patients with cleft lip and palate has never been well investigated, although this is essential for the rapid palatal expansion and maxillary growth modification. The aim of this study was to test the hypothesis that the mid-palatal suture is present in patients with unilateral complete cleft lip and palate (UCLP).Methods: Twenty-three consecutive growing patients with UCLP who received cone beam computed tomography (CBCT) and maxillary growth modification at the bone age of cervical vertebral maturation stage 2 (CVS2) from 2007-2013 were included. For each patient, the CBCT axial sections right before the treatment were examined for the prevalence of presence, extent of suture in maxilla, and maturation of mid-palatal suture at the basal and alveolar bone levels. The data were analysed statistically.Results: The prevalence of presence of mid-palatal suture was 100.00% at the basal-bone levels but decreased significantly (p<0.001) to 60.87% at the alveolar levels. The incidence of late stage suture maturation was 86.96% at the basal-bone levels and decreased significantly (p<0.001) to 14.29% at the alveolar levels when the mid-palatal suture is present. The extent of suture in the maxilla was 72.00±20.52% at the basal-bone levels and decreased significantly (p<0.001) to 28.54±27.00% at the alveolar levels.Conclusions: Although the mid-palatal suture in patients with UCLP is present, it fades away sharply and matures gradually from the basal bone down to the alveolar bone level of maxilla at the bone age of CVS2.

Residents’ journal review

Residents’ journal review

Evaluation of dental and skeletal maturity using digital panoramic radiographs and digital cephalograms

Background: Assessing the maturational status and pubertal growth spurt of a patient has considerable influence on diagnosis, treatment planning, and the outcome of orthodontic treatment. Objectives: To assess the usefulness of panoramic radiographs as a tool to estimate the growth and to ascertain the importance of tooth calcification stages as an indicator of maturity by using digital panoramic radiographs. Methods: We compared the dental maturity assessed by calcification of mandibular canine, first premolar, second premolar, and second molars using digital panoramic radiographs and skeletal maturity assessed by cervical vertebral maturation stages using lateral cephalograms and hand-wrist radiographs. Skeletal maturity was assessed using a cervical vertebrae maturation technique; hand-wrist maturity was evaluated using Fishman skeletal maturity indicators. Dental maturity was estimated according to guidelines of Demirjian. Spearman rank–order correlation coefficients were used to determine the correlation between tooth calcification stages and skeletal maturity assessed on panoramic radiographs, lateral cephalograms, and hand-wrist radiographs of 60 patient participants, including 45 boys and 15 girls. Results: The panoramic radiograph is a reliable tool with which to estimate of growth and development of boys. Conclusion: The relationship between tooth calcification stages and the skeletal maturity indicators in boys allows clinicians to identify the stage of the pubertal growth from panoramic radiographs. It is appropriate to put these skeletal and dental maturation relationships into daily orthodontic diagnostic practice.

Correlation between Dental Maturity by Demirjian Method and Skeletal Maturity by Cervical Vertebral Maturity Method using Panoramic Radiograph and Lateral Cephalogram

Introduction: Radiographs are effective tools in assessing the stages of bone maturation in dentistry. The cervical vertebral maturation method is a proven effective tool in assessing the adolescent growth spurt than hand-wrist radiographs in an individual. Assessment of dental calcification stages are a reliable method for determining dental maturity. Panoramic imaging can be used as the primary imaging modality for assessing maturity if a correlation can be found out between tooth calcification stages and cervical vertebral maturation stages. This study was conducted to determine the correlation between dental maturity stage and cervical vertebral maturity stage and to estimate predictor variables for cervical vertebral maturation stages (CVMS) stratified by gender in a tertiary hospital setting. Materials and Methods: A descriptive study was conducted among patients accessing orthodontic care in radiology outpatient clinic, Oral Medicine and Radiology department, Government Dental College Thiruvananthapuram for a period of 15 months. Participants were selected between the ages of 8 and 16 years. Panoramic radiographs and lateral cephalograms were used to determine dental maturity stages using Demirjian method and CVMS using Bacetti and Franchi method, respectively. Results: One hundred patients (males = 46, females = 54) were included in the study; the spearman rank order correlation revealed significant relationship. The correlation ranged from 0.61 to 0.74 for females and 0.48 to 0.51 for males. Second premolar showed highest correlation and canine the lowest for both females and males. Stage G of mandibular second premolar signifies the pubertal growth period in this study population. By ordinal regression model, G stage of second premolar was found to be a significant predictor in males and stage H followed by G and F in females for the age group of 12–14 years. Conclusion: Dental maturation stages were significantly correlated with CVMS. The development stages of mandibular second premolar had the strongest correlation with cervical vertebral maturity in both males and females. G stage of mandibular second premolar can be clinically used as a maturity indicator in the pubertal growth period. Moreover, G stage of second premolar can be used as a significant predictor for the age group of 12–14 years in both males and females.

ACCURACY OF ESTIMATING AGE FROM CERVICAL VERTEBRAL MATURATION AND MANDIBULAR MOLAR MATURATION

Age estimation is required for forensic cases such as minors without documentation and age disputed by asylum seekers. Cervical vertebral maturation (CVM) has potential to estimate age as a new method of analysis of shape change during adolescence and adulthood. The aim of this study was to assess the accuracy of estimating age using Lamparski’s method of cervical vertebra maturation, the mandibular second (M2) and third molars (M3) in a group of males. The test sample consisted of lateral cephalograms of 60 boys from the Bolton-Brush online collection and 53 from Burlington online collection aged 10 to 15 years. CVM age was calculated from age category and mean age and transition age of CVM stages, calculated from raw data of 69 boys (aged 9 to 15 years) studied by Lamparski (1972). Dental age was calculated using mandibular second and third molar stages from Liversidge (2009). The mean difference and absolute mean difference between CVM age and dental ages and chronological ages was calculated. CVM and molar tooth stage assessment reliability was assessed by duplicate readings by the first author. Results show that Lamparski’s method of CVM mean age was most accurate and had considerably smaller standard deviation and smallest absolute mean difference than other method of M2 or M3 (mean difference -0.49, SD 0.23, absolute mean difference 0.49 years). CVM has potential as a possible method of estimating age for this age group, particularly when M2 is mature or M3 is missing.

Effects of hybrid-Hyrax, Alt-RAMEC and miniscrew reinforced heavy Class III elastics in growing maxillary retrusive patients. A four-year follow-up pilot study

Abstract Introduction The aim of this study was to evaluate the short- and long-term effects of hybrid-Hyrax, Alt-RAMEC and applied, miniscrew reinforced, heavy intermaxillary elastics on a modified lingual arch in growing skeletal Class III patients. Methods Fifteen subjects (seven male, eight female) were included, with an average age of 12.52 ± 0.94 years, of cervical vertebrae maturation (CVM) stage CS2-CS4 and skeletal Class III malocclusions due to a retrognathic maxilla. Nine weeks of Alt-RAMEC were followed by eight to nine weeks of maxillary protraction with heavy 400 gm Class III elastics worn 24 h/day. Treatment was finalised with orthodontic fixed appliances. Cone beam computed tomographic (CBCT) scans were taken initially (T1), at the end of maxillary protraction (T2) and four years after active orthopaedic treatment (T3). Cephalometric measurements were performed on reconstructed lateral cephalograms and the differences between time intervals were calculated using an analysis of variance (ANOVA). Results A positive overjet was achieved in all but one subject. From T1 to T2, A point advanced 3.12 ± 3.42 mm and from T2 to T3 advanced a further 2.21 ± 3.49 mm. Significant initial increases in SNA of 1.05° ± 1.10° (p = 0.004), ANB of 2.71° ± 1.01° (p = 0.00), Wits of 4.49 ± 2.21 mm (p = 0.00) and overjet of 4.90 ± 1.66 mm (p = 0.00) were accomplished and maintained without significant changes in the vertical dimension. Upper and lower incisor inclinations were not affected by the protraction protocol but significantly increased (U1-PP: 8.39° ± 5.59°) between T2 and T3. SNB decreased initially by 1.67° ± 1.34° (p = 0.00) but relapsed due to residual mandibular growth and a counterclockwise rotation of the mandibular plane. Conclusion The hybrid-Hyrax Alt-RAMEC combined with miniscrew reinforced heavy Class III elastics resulted in a favourable and stable Class III correction.

Skeletal maturity assessment using calcification stages of mandibular canine

Aim: The aim of this study was to correlate the growth phase of skeletal tissues with the calcification stages of mandibular canine. Materials and Methods: It was a cross-sectional observational study. Anonymized digital orthopantomogram and lateral cephalogram records of 300 pretreatment orthodontic patients aged 8–15 years were collected and analyzed. The calcification stages of right mandibular canine were scored on panoramic radiographs in accordance to the Gleiser and Hunt modified method of assessing tooth mineralization. The growth phase of skeletal maturation was scored on lateral cephalogram in accordance to the cervical vertebral maturation (CVM) method proposed by Baccetti et al. Results: A positive significant correlation was attained relating CVM Stages 1, 2, and 3 with mandibular canine calcification Stages 2, 3, and 4, respectively. Conclusion: The calcification stages of mandibular canine can be implemented for assessing the skeletal maturity clinically.

Five radiographic methods for assessing skeletal maturity in a Spanish population: is there a correlation?

Objectives: The need for accurate techniques of estimating age has sharply increased in line with the rise in illegal migration and the political, economic and socio-demographic problems that this poses in developed countries today. The methods routinely employed for determining chronological age are mainly based on determining skeletal maturation using radiological techniques. The objective of this study was to correlate five different methods for assessing skeletal maturation.Materials and methods: 606 radiographs of growing patients were analyzed, and each patient was classified according to two cervical vertebral-based methods, two hand-wrist-based methods and one tooth-based method. Spearman’s rank-order correlation coefficient was applied to assess the relationship between chronological age and the five methods of assessing maturation, as well as correlations between the five methods (p < 0.05).Results: Spearman’s rank correlation coefficients for chronological age and cervical vertebral maturation stage using both methods were 0.656/0.693 (p < 0.001), respectively, for males. For females, the correlation was stronger for both methods. The correlation coefficients for chronological age against the two hand-wrist assessment methods were statistically significant only for Fishman’s method, 0.722 (p < 0.001) and 0.839 (p < 0.001), respectively for males and females.Conclusions: The cervical vertebral, hand-wrist and dental maturation methods of assessment were all found to correlate strongly with each other, irrespective of gender, except for Grave and Brown’s method. The results found the strongest correlation between the second molars and females, and the second premolar and males.Clinical relevance: This study sheds light on and correlates with the five radiographic methods most commonly used for assessing skeletal maturation in a Spanish population in southern Europe.

The duration of pubertal growth peak among three skeletal classes.

ABSTRACTIntroduction: Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability. Objective: The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes. Methods: A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. The cervical vertebral maturation stage was recorded by means of Baccetti's method. The mean ages at CS3 and CS4 and the CS3-CS4 age interval were compared between boys and girls and among three skeletal classes. Results: Pubertal growth peak occurred on average four months earlier in girls than boys (p = 0.050). The average duration of pubertal growth peak was 11 months in Class I, seven months in Class II and 17 months in Class III subjects. Interclass differences were highly significant (Cohen's d > 0.08). However, no significant difference was found in the timing of pubertal growth peak onset among three skeletal classes (p = 0.126 in boys, p = 0.262 in girls). Conclusions: Girls enter pubertal growth peak on average four months earlier than boys. Moreover, the duration of pubertal growth peak is on average four months shorter in Class II and six months longer in Class III subjects as compared to Class I subjects.

Serum and urine insulin-like growth factor-1 as biochemical growth maturityindicators.

Biochemical markers are agents directly involved in bone growth and remodeling and can be quantitatively evaluated from various biologic fluids. The aim of this study was to assess the changes in thelevels of insulin-like growth factor-1 (IGF-1) in serum and urine as a growth maturity indicator and to compare them with the cervical vertebral maturation radiographic stages. The study was conducted with 72 female subjects aged 8 to 20years. Cervical vertebral maturation stages, and serum and urine IGF-1 levels were recorded for all subjects, and the subjects were equally divided into the 6 cervical vertebral maturation groups. Median values of IGF-1 for each stage of cervical vertebral maturation were calculated and statistically compared with those of the other stages. The levels of serum and urine IGF-1 at stage 4 of cervical vertebral maturation were significantly higher than those from the other stages (P<0.01). Stage 4 corresponded to a mean age of 13.67years. A significant correlation was observed between serum and urineIGF-1 (P<0.001). Urine IGF-1 follows the growth curve similar to serum IGF-1. Thus, urine IGF-1 may be regarded as a promising noninvasive tool for growth assessment. Further research is necessary to validate these results in a different population and with a larger sample.

Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity.

Various methods have been proposed to evaluate a patient's developmental status. However, most of them lacked precision and failed to give a reliable estimate of skeletal maturity. The aims of this study were to evaluate the association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity and to determine its validity in assessing the different stages of the adolescent growth spurt. A cross-sectional study was performed on the pretreatment lateral cephalograms of 252 subjects aged 8 to 21years. The sample was divided into 6 groups based on the cervical vertebral maturation stages. The frontal sinus index was calculated by dividing the frontal sinus height and width, and the cervical stages were evaluated on the same radiograph. The Kruskal-Wallis test was applied to compare frontal sinus index values at different cervical stages, and the post hoc Dunnett T3 test was applied to compare frontal sinus index values between adjacent cervical stages for each sex. The Kendall tau-b values were computed to assess the correlation between the cervical stages and the sinus index. A P value of≤0.05 was considered statistically significant. The height and width of the frontal sinus were significantly larger in the male subjects than in the females. A significant association was found between the frontal sinus height and width and cervical stages (P≤0.001) in both sexes. However, the changes in the frontal sinus index across the different cervical stages were found to be significant (P≤0.001) in male subjects only. Similarly, a weak negative correlation was found between the sinus index and the cervical stages in male subjects (tau-b=-0.271; P<0.001), whereas no correlation was found in female subjects (tau-b=-0.006; P<0.928). However, the post hoc analysis showed that the values of the sinus index were comparable between any 2 adjacent cervical stages. The frontal sinus index cannot be used to identify the prepubertal, pubertal, and postpubertal stages of the adolescent growth spurt. Therefore, it cannot be used as a reliable maturity indicator.

Relationship between body mass and dental and skeletal development in children and adolescents.

The purpose of this investigation was to determine whether a relationship exists between body mass and dental and skeletal development in children and adolescents. A sample of 197 orthodontic patients (82 boys, 115 girls) was selected. Ethnicity was recorded, and body mass index (BMI) was calculated according to the standard equation from the Centers for Disease Control and Prevention, and then a BMI percentile according to sex and age was obtained. The panoramic radiographs were used to calculate the dental ages with an index. The chronologic ages were subtracted from the calculated dental ages to determine a "dental age difference" for each subject. The lateral cephalogram radiographs were analyzed for skeletal development using the cervical vertebral maturation stage method. The white population (60%) had an average BMI percentile of 53.6 and was statistically different from the Hispanic/black population (40%), which had an average percentile of 64.3. There were no significant differences for boys and girls for the BMI percentile and dental age difference, or for the BMI percentile and cervical vertebral stages. The multiple regression model showed that BMI percentile and ethnicity were statistically significant explanatory variables for the dental age difference. A relationship exists between body mass and dental and skeletal development. BMI percentile, dental age difference, and cervical vertebral stage are weakly correlated. No significant differences existed between boys and girls in any variables. BMI percentile and ethnicity are weak predictors of the discrepancy between dental age and chronologic age.

Dental calcification stages as determinants of the peak growth period.

The objective of this study was to investigate the diagnostic accuracy of dental maturation stages for identifying individual-specific skeletal maturation phases. Prior to initiating this study, 255 orthodontic patients comprising 145 girls and 110 boys from the Department of Orthodontics, Aristotle University of Thessaloniki, Greece were identified. Lateral cephalometric and panoramic radiographs were evaluated. Dental calcification stages were assessed according to the Demirjian method and skeletal maturation according to the cervical vertebral maturation stage (CVMS) method. Statistical assessments included Spearman Brown formula, descriptive statistics, Spearman's rho correlation coefficient, and positive likelihood ratios (LHRs). The highest (r=0.725) correlations were found for second molars and the lowest correlation for canines (r=0.463, p<0.001). Positive LHR values exceeding ten were found to identify the pre-peak growth phase in conjunction with the second molar (stage D), second premolar (stage E), and first premolar (stages D and E). Only the second molar (stage F) yielded positive LHR values for identifying the peak growth phase. The positive LHR values for the second molar also facilitated identification of the post-peak growth phase (stage H). Taking the clinical diagnostic efficacy of the second molar into account in identifying these growth phases, we calculated the positive LHRs of the second molar to determine dental maturation stages for diagnosing CVMS II and III. Positive LHR values greater than 10 identified CVMS II (stage D). Evaluating dental maturation is a useful initial diagnostic step when assessing skeletal growth. The calcification stages of the second molar provide reliable diagnostic information with which to determine the pubertal growth spurt.