Cervical Vertebral Maturation Index Research Articles

Estimation of Salivary Bone Specific Alkaline Phosphatase as a Biomarker for Assessing Skeletal Maturity Indicator

ABSTRACT Background: Evaluation of skeletal maturation plays a substantial role in selection of orthodontic treatment strategies. Recently, new noninvasive methods of assessing biological mediators have been introduced to assess skeletal maturity. There is a marked rise in the value of these mediators during pubertal growth spurts. When these mediators emerge as the assessment tool for skeletal maturity determination, it can reduce radiation exposure and beneficial to the patient. Hence, the goal of this study is to validate the calculation of salivary alkaline phosphatase (ALP) as a noninvasive skeletal maturity indicator by estimating the Bone Alkaline Phosphatase (B-ALP) level in whole unstimulated saliva at different stages of skeletal maturity and correlating B-ALP level with different stages of skeletal development using cervical vertebral maturation index (CVMI) and hand-wrist MP3 (third finger middle phalanx). Materials and Methods: The test group included 90 subjects aged between 8 and 18 years requiring orthodontic treatment. The salivary samples were collected and examined by ALP kit following the manufacturer’s instructions and assessed using photo-spectrometer at 405 nm. The skeletal age was assessed using handwrist radiographs; skeletal age was determined by modified MP3 staging. Lateral cephalograms of each individual were also collected and tracing done for assessing skeletal age with CVM staging. The collected data were analyzed statistically with analysis of variance for intergroup comparison of ALP levels and Kruskal–Wallis test for intergroup comparison of CVM and MP3 stages. Results and Conclusion: Salivary ALP activity during the peak pubertal period was markedly increased when compared to pre- and post-peak values. Salivary ALP activity was in correlation with the cervical vertebral maturation and MP3 stages showing peak values at the pubertal stages. Thus, salivary B-ALP can serve as a noninvasive method of skeletal maturity assessment as an adjunct to conventional skeletal maturity indicators.

Association, diagnostic accuracy and optimal threshold of salivary IGF-1 and vitamin DBP levels for estimation of pubertal growth spurt: A cross sectional study

To determine the association of salivary IGF-1 and vitamin D Binding Protein with cervical vertebral maturation index (CVMI) across the pubertal stages and to determine the diagnostic accuracy and optimal threshold of these biomarkers for estimation of pubertal growth. Cross-sectional observational study. Material and methods. All patients in the age group of 8-23 years from the Outpatient Department of Orthodontics and Dentofacial orthopaedics, between the period of July 2020 to December 2020 meeting the eligibility criteria were included. Lateral cephalograms obtained from the patients were divided into pre pubertal, pubertal & post pubertal groups based on CVMI by Baccetti et al. Unstimulated whole saliva was collected by a swab-based method & analyzed with ELISA. Ninety-four participants were divided in three stages: prebubertal (30), pubertal (33), post pubertal (31). A significant difference was observed in the salivary IGF-1 & DBP across the three stages. Post-hoc test revealed significantly higher mean salivary IGF-1 & DBP in pubertal group than in pre & post-pubertal group. Receiver operator characteristic curve revealed excellent diagnostic accuracy for salivary IGF-1with areas under the curve (AUC) of 0.962, satisfactory for vitamin DBP with AUC of 0.831 and poor diagnostic accuracy for age with AUC of 0.536. Youden index revealed the optimal threshold to be 3.96ng/ml and 124.13pg/ml for salivary IGF-1 and vitamin DBP respectively. The levels of Salivary IGF-1 and Vitamin DBP increased during C3 and C4 stages. Compared to vitamin DBP diagnostic accuracy of salivary IGF-1 was excellent and an optimal threshold of 3.96ng/ml can be utilized to distinguish pubertal & non-pubertal participants.

Comparative evaluation and correlation of CVMI stages in Class II (vertical) and Class II (horizontal) cases with Class I malocclusion, as evaluated using 3D-DVT and lateral cephalogram

Background: The cervical vertebrae have attracted the interest of orthodontists, as the cervical portion of the spine serves as a reference structure to guide the normal head position. Skeletal age is determined by examining changes occurring in the morphology of the cervical vertebrae. There is relatively little data available from all the examinations that compare cervical vertebral phases between the various malocclusions. The purpose of this study was to compare the cervical vertebral maturation index (CVMI) stages of skeletal Class I and Class II malocclusions in the horizontal as well as vertical growth patterns. With distinct malocclusions, however, there are differences in cervical vertebral phases. Aim: To evaluate, compare and correlate the skeletal maturation using CVMI stages in cases with Class II (horizontal and vertical) using 3D-DVT and lateral cephalogram. Methodology: In the present observational study, a total of 45 adult patients reporting at the Orthodontics department at a dental college and hospital set up in Wardha district and diagnosed with Class II Horizontal and/or Class II vertical will be recruited. The patients will be divided into three sub-groups and biosafety measures will be taken. Conclusions: This study would give us a scope to compare the efficiency of lateral cephalogram versus 3D-DVT in estimating the skeletal maturity of patients who need to undergo growth modification in the orofacial region and orthodontic treatment.

GROWTH INDICATORS AND THEIR RELATION IN INDIVIDUALS WITH DIFFERENT SKELETAL MALOCCLUSIONS

Objectives: The purpose of our study is to assess the correlation between chronological age, cervical vertebral maturation index and Demirjian index of the lower second molars and analyze if the correlation affected by intermaxillary sagittal malocclusion. Material and methods: 150 subjects were evaluated, with age range from 6-19 years. Skeletal maturation stages according to Baccetti method were determined in lateral cephalometric radiographs. Demirjian index for lower second molars were evaluated in panoramic x-ray. Digital lateral cephalograms and panoramic radiographs were performed by Vatech and they were analyzed and saved in DICOM format using dedicated software (Easydent version 4.1). Statistical analysis with IBM SPSS version 26 for Windows, Chicago, Illinois to assess the correlation between cervical vertebral maturation index and Demirjian index for lower second molars and intergroup comparison. Results: There is a strong positive correlation between chronological age, cervical vertebral maturation index and Demirjian index for lower second molars, with p < 0.000, Pearson correlation coefficient was from r = .847 to r = .883. The duration of prepubertal stage for class II subject was significantly longer. Whereas the actual peak of pubertal growth in class II subject was short, 3, 5 months. The overall period of growth modification raging from stage 2-4 of cervical vertebral maturation index was significantly longer in class III subjects. Conclusions: There is a strong correlation bewteen cervical vertebral maturation index and Demirjian index for lower second molars. The correlation is not affected by intermaxillary sagittal relationship, however in class II patients we have a shorter pubertal peak period and in class III there is a longer period of pubertal peak.

Correlation of Dental and Skeletal Maturity Using Dimirgian and Cervical Vertebral Maturation Indices in Orthodontic Patients

OBJECTIVES To determine the correlation between skeletal and dental maturity using the cervical vertebral maturation (CVM) index (CVMI) and Demirjian index (DI) in orthodontic patients. METHODOLOGY Panoramic and lateral cephalogram radiographs of 105 patients pretreatment records were retrieved. Tooth calcification stages for mandibular left molar were recorded using Demirjian Index on the panoramic radiograph. The skeletal maturation stages were evaluated on a lateral cephalogram through CVMI staging. Fisher’s exact test and Cramer’s V values were estimated to determine the correlation between DI and CVMI. Weighted kappa statistics were used to determine the reproducibility of inter-observer assessment of DI and CVMI. A p-value of ≤ 0.05 was taken to be statistically significant. RESULTS A statistically significant correlation is present among the various stages of DI and CVMI for the males (Fisher exact = 25.006, Cramer’s V = 0.848, p = < 0.001) and females (Fisher exact = 41.006, Cramer’s V = 0.623, p = <0.001). A comparison of DI with respect to CVMI shows a more advanced skeletal stage in males than for female subjects. CONCLUSION The correlation between CVMI and DI stages was found to be highly significant. Stage D and F of DI were significantly correlated with stage 3 and stage 4 of CVMI in females and males respectively.

Accuracy of age estimation using cervical vertebral maturation index and demirjian's method: A comparative study

Dental age estimation is considered to be vital, as tooth development shows less variability than other developmental features. But in case of missing tooth it is not possible to estimate chronological age using dental age estimation methods. So there should be an alternate method for age estimation. The cervical vertebrae maturation index (CVMI) is one of the easiest and most commonly used skeletal maturity indices. Aim of this study is to check the accuracy of age estimation using CVMI and Demirjian's method with chronological age. It is a comparative study to check the accuracy of age estimation using Demirjians method and CVMI method with chronological age among Kannur population, of age range between 10-16 years. 100 panoramic radiographs and 100 lateral cephalograms of same patient were assessed using Demirjians and CVMI method respectively. The results were compared with chronological age and the data were analyzed. p value was less than 0.0001. The mean age difference for total sample using Demirjians method is -0.20+/-0.048 and using CVMI method is 0.63+/-0.08. In the age group of 15-16 years using CVMI method the mean difference is 1.34 +/- 0.09 and the p value is <0.934 which is not statistically significant. Pearson correlation coefficient shows good correlation value for total samples. The correlation between Demirjians and Chronologic age is 0.972 and CVMI with Chronologic age is 0.919. Demirjians method is better & preferred method for estimation of chronological age. But if need arises CVMI can efficiently replace the Demirjians method till the age of 14 years.

Evaluation of Skeletal Maturation Using Mandibular 1st Premolar and 2nd Molar Calcification Stages: A Cross-sectional Radiographic Study.

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.

Intelligent quantitative assessment of skeletal maturation based on multi-stage model: a retrospective cone-beam CT study of cervical vertebrae.

To develop new logistic regression estimative models of the cervical vertebral maturation index (CVMI) based on cone-beam CT (CBCT)-derived parameters for intelligent evaluating skeletal maturation. From 231 CBCT volumes (age range 7-17, mean age 11.09years), 154 were randomly selected to produce 2D sagittal projections of the second to fourth cervical vertebrae (C2-C4). From 19 quantitative parameters, significant predictors were deduced to formulate logistic models. Using the CVMI and significant predictors of 77 other subjects, performance of the models was externally examined by direct comparison and the area under the receiver operating characteristic curve (AUC). Models were modified if required, to improve their accuracy. Chronological age, C3 height ([Formula: see text], and ratio of posterior height to lower width of C4 [Formula: see text] were entered as significant predictors. Accuracy of the models was acceptable (total AUC = 0.91) except for 4th and 5th stage (AUC of 0.82 and 0.83, respectively), which were mis-predicted inversely. Adjusted models were generated by bivariate logistic regression analysis and adding significant parameters ([Formula: see text] and [Formula: see text], with odds ratios of 3.308 and 3.38, respectively) from 58 subjects in 4th and 5th stages of CVMI in the model establishment group. The total AUC increased to 0.94, along with an increase in the accuracy of the latter optimized models to 77.9 and 87%, respectively. The new intelligent models reliably estimated skeletal maturation and can be utilized in the clinical field or machine learning-based skeletal maturation assessment.

Effect of Early Spheno-Occipital Synchondrosis Fusion in Preadolescent Patients With Syndromic Craniosynostosis on Craniofacial Skeletal Patterns: A Preliminary Study Using Cephalometric Analysis.

The purpose of this study was to investigate the effects of early spheno-occipital synchondrosis (SOS) fusion in preadolescent patients with syndromic craniosynostosis (SC) on the craniofacial skeletal patterns. Twenty preadolescent SC patients were divided into the fused SOS (FS, n = 10; 8 Crouzon and 2 Apert) and not-fused SOS groups (NFS, n = 10; 9 Crouzon and 1 Apert). Lateral cephalograms (mean age: 9.60 years, cervical vertebral maturation index: stage I and II) were used to investigate the skeletal sagittal (ANB) and vertical patterns (SN-GoMe), upward inclination of the anterior cranial base (ACB; SN-FH), degree of midface hypoplasia (MH, SNA), retrusive position of orbitale (SNO), and forward position of the condyle in relation to sella (saddle angle). Using the ordinal values calculated by ethnic norm (criteria: moderate, over ±1 standard deviation, severe, over ±2 standard deviation), statistical analysis was performed. The FS group showed a higher percentage of severe MH than the NFS group (70% versus 10%, P < 0.05). Although the 2 groups did not differ in the distribution of ANB, SN-GoMe, saddle angle, and SN-FH (all P > 0.05), the FS group showed relatively higher percentages of severe Class III (100% versus 70%), severe hyper-divergent pattern (40% versus 10%), severely forward condyle position (30% versus 0%), and moderate and severe upward anterior cranial base inclination (90% versus 50%) than the NFS group. However, the 2 groups exhibited the same distribution of moderately and severely retrusive orbitale position ([50%, 20%], P > 0.05). Early SOS fusion in preadolescent SC patients might not be related to retrusive orbitale position, but to severe MH.

Evaluation of Changes in Condylar Cartilage Thickness Using MRI and Ultrasound Imaging in Patients Treated by Mandibular Advancement With Myofunctional Appliance: An In-Vivo Pilot Study.

IntroductionThe changes occurring due to growth modulation of the condylar cartilage act as an important mechanism for mandibular advancement using myofunctional appliance therapy. So this study aims to evaluate the condylar cartilage thickness by using MRI and USG in patients undergoing myofunctional appliance therapy for mandibular advancement with the null hypothesis being that there are no changes seen in the thickness of condylar cartilage in growing children.Materials and methodsA prospective evaluation of samples having skeletal Class-II malocclusion ranging between cervical vertebral maturation index (CVMI) stage II and III, requiring twin block functional therapy was performed. Ten patients were selected randomly who underwent MRI and USG in the open and close positions for the evaluation of condylar cartilage thickness and the dimensional changes in the width of the right and left condyle in mm at T0 and T1.ResultThere was no statistically significant difference between the values interpreted by MRI or USG imaging when compared at T0 and T1 and in the open and closed mouth on the left and right sides. At T0, the mean thickness noted was 0.49 mm and 0.48 mm during opening and closing on the left side and 0.52 mm in both positions on the right side. At T1, the mean thickness noted was 0.8 and 0.79mm during opening and closing on the left side, whereas it was 0.81 mm in both positions on the right side.ConclusionThe condylar cartilage thickness increases significantly after twin block therapy suggestive of mandibular growth in skeletal class II malocclusion. It can be inferred that both MRI and USG carry equal diagnostic interpretation, as there was no statistically significant difference between the two imaging modalities.

Developmental morphology of the cervical vertebrae and the emergence of sexual dimorphism in size and shape: A computed tomography study.

Cervical vertebral bodies undergo substantial morphological development during the first two decades of life that are used clinically to visually determine skeletal maturation with the cervical vertebral maturation index (CVMI). CVMI defines six stages that capture the morphological transformations from 6 years to 18 years. However, CVMI has poor reproducibility given its qualitative nature and does not account for sexual dimorphism. This study aims to quantify the morphological development of the cervical vertebral bodies C2-C7 in size (height and depth) and shape and examine the emergence of sexual dimorphism. Using 115 (70 M;45F) computed tomography studies from typically developing individuals ages 6months to 20 years, landmarks were placed at the margins of the C2-C7 cervical vertebral bodies in the midsagittal plane for size and shape analysis. Findings revealed a dichotomy in the growth trends of height versus depth. The C2-C7 growth in depth gained the majority of the adult size by age 5 years, while the C3-C7 growth in height displayed two periods of accelerated growth during early childhood and puberty. Significant sex differences were found in height and depth growth trends and the form-space ontogenetic trajectories during puberty, with minor but evident differences emerging at age 3 years. Female C2-C7 depth measures were smaller than males at all ages. However, sex differences in height became evident due to males continuing to grow after females reach maturity. Findings quantify the morphological developmental stages of CVMI and emphasize the need to account for sex differences when assessing skeletal maturation.

Correlation between fusion of spheno-occipital synchondrosis and cervical vertebral maturation: A CBCT and cephalometric assessment

The aim of this study was to determine among young orthodontic patients the relation between the spheno-occipital synchondrosis (SOS) fusion and the cervical vertebral maturation (CVM) and to look for an eventual impact of gender, skeletal class and vertical pattern on their association. CBCT scans and lateral cephalometric radiographs of 117 patients, aged between 8 and 18 years, were selected. SOS fusion was assessed on a mid-sagittal cut of the CBCT scans. CVM was evaluated on the lateral cephalograms as well as ANB and GoGn-SN angles. Spearman correlation test was used to assess the relationship between SOS and CVM. Fisher's exact test was performed at every CVM stage to analyse the association between SOS and other variables (gender, skeletal class, and vertical pattern). Cohen's kappa analysis was used for reliability. A strong correlation was found between SOS maturation and CVM (r=0.852, P<001). Fisher's exact test indicated significant association only between gender and SOS in CVM stage 2 group, and between vertical pattern and SOS in CVM stage 4. Cohen's kappa analysis showed moderate inter and intra-rater reliability for CVM index (k=0.50 and 0.53 respectively, P<.001), strong inter-rater reliability (k=0.80, P<.001) and almost perfect intra-rater reliability (k=0.85, P<.001) for SOS index. SOS fusion correlates well with CVM and might be a reliable tool for skeletal maturation assessment. Girls seem to have an earlier fusion of SOS in relation to their respective CVM compared to boys, and the vertical pattern could influence the association between SOS and CVM stages.

Correlations among chronological age, cervical vertebral maturation index, and Demirjian developmental stage of the maxillary and mandibular canines and second molars.

Estimation of growth spurt from chronological age or dental development is of clinical interest to orthodontists. Since results in this regard are highly controversial and limited, this study was conducted to investigate associations among chronological age, skeletal development (cervical vertebral maturity [CVM]), and dental calcification (Demirjian) in girls and boys, independently. Panoramic radiographs and lateral cephalographs of 112 boys and 112 girls were evaluated. Demirjian stages of dental development of the bimaxillary canines and second molars were determined. CVM stages of skeletal growth were as well estimated. Correlations among these were assessed. Differences between sexes and between maxilla/mandible arches were assessed. Cutoff points in Demirjian and chronological age reflecting skeletal growth spurt were found using receiver operator characteristic curve (α = 0.05, β = 0.9 separately for girls and boys). Sex dimorphism existed both in CVM index and in Demirjian indexes. Compared to dental development and calcification, chronological age was the best predictor of skeletal growth and maturation. In estimating chronological age by radiography means, in girls, Demirjian method was better than CVM. In boys, Demirjian was better than CVM in the case of the molars but not canines. The cutoff points estimated for chronological age and dental calcification that can reflect skeletal growth spurt (between CS-3-and-CS-4) were as follows: in boys, age of 12years; in girls, age between 11 and 12years; the upper and lower canines: between G and H; the maxillary and mandibular second molars: between F and G; in the case of all teeth: between F and G.

Correlating the Age Estimated by Nolla's Method and Modified Demirjian Method with Cervical Vertebral Maturation Index: A Cross-Sectional Study

Introduction: Among various methods of dental age (DA) estimation, Demirjian method and Nolla’s method are commonly used. One of the methods of determining cervical vertebral morphology was given by Hassel and Farman. Indian age-specific modified Demirjian method by Acharya has not been utilized in the Hyderabad population, and the age derivation information is sparse. Objectives: To correlate the DA using modified Demirjian’s method and Nolla’s method using orthopantomograph with skeletal maturation by cervical vertebral maturation index (CVMI) method using lateral cephalogram. They were compared and correlated for assessing chronological age (CA) and determining the accuracy. Materials and Methods: Among 200 boys and girls (100 each) between 6 and 21 years, the DA was evaluated using orthopantomogram by Ashith Acharya’s modified Demirjian method and also by Nolla’s method. The skeletal maturation was assessed by CVMI method given by Hassel and Farman using lateral cephalogram. These were compared and correlated with CA. The data derived were statistically analyzed using SPSS software 20.0 version. Results: The maximum underestimation of age was found within the age group of 19–19.9 years using Ashith Acharya’s modified Demirjian method and 18-18.9 years using Nolla’s method with median values of −5.05 and −5.03, respectively. Statistically significant difference was found between CAs and cervical vertebral maturation stages in both genders (P = 0.000). The study showed that girls had a late dental development compared to corresponding cervical maturation. Conclusions: The methods of age estimation were not reliable in predicting the accurate age in the Indian population.

Evaluation of soft-tissue changes in young adults treated with the Forsus fatigue-resistant device

This study aimed to evaluate the effects of the Forsus fatigue-resistant device (FRD) EZ2 appliance (3M Unitek, Monrovia, Calif) on facial soft tissues by using images obtained from cephalometric radiographs and 3-dimensional (3D) facial scanning system. A total of 20 patients treated with the Forsus FRD EZ2 appliance were included in this study. The cervical vertebral maturation index was used to determine growth and development stages, and the subjects were investigated at cervical vertebral maturation stages 5 and 6 (ie, postpeak period). Three-dimensional facial scanning images were obtained with 3dMD Face (3dMD Ltd, Atlanta, Ga). Cephalometric radiographic images were taken before placement of the appliance (T0), immediately after removal (T1), and at the 6-month (T2) follow-up after the removal of the appliance. For comparison of the data, one-way repeated-measures analysis of variance and paired t test were used at P<0.05. Statistically significant changes were found in the Wits value, IMPA, L1P-NB (°), L1-NB (mm), L1P-APog, U1P-L1P, overjet, overbite, Ls-E, and labiomental angle in T0-T1. In T0-T2, statistically significant changes in the Wits, IMPA, L1P-NB (°), overjet, overbite and Ls-E values were observed. The results revealed that the correction of malocclusion with Forsus FRD EZ2 appliance in patients at the postpeak period was mainly dentoalveolar. The soft tissues were affected to a limited extent. Three-dimensional facial scanning demonstrated similar accuracy and precision to traditional cephalometry, being a repeatable and accurate tool for linear and surface measurements.

Comparison of 2 treatment protocols using fixed functional appliances in Class II malocclusion: Treatment results and stability

The objective of this research was to compare the 2 treatment protocols including a functional mandibular advancer (FMA; Forestadent, Pforzheim, Germany) followed by multibracket appliances (MBAs) vs a Forsus device (3M Unitek, Monrovia, Calif) in combination with MBA concerning treatment outcomes and posttreatment stability. This study was conducted using lateral cephalograms of patients who were treated with MBA, which was used either after an FMA or concurrently with a Forsus device, and of patients who had untreated Class II malocclusion (control group). Each group consisted of 19 subjects in cervical stage 2 or cervical stage 3 stages according to the cervical vertebral maturation index. Cephalograms were taken for the treated groups at T1 (pretreatment), T2 (completion of the MBA treatment), and T3 (at least 2years after T2). Significant intergroup differences at the T1-T2 period were observed in favor of the FMA concerning mandibular advancement, intermaxillary relationship, and mandibular elongation. With Forsus treatment, restrained maxillary growth and a slightly improved intermaxillary relationship rebounded after treatment (P<0.05). At the end of treatment, mandibular incisor protrusion and occlusal plane rotation were greater in the Forsus group than in the FMA group (P<0.05), and maxillary incisor retroclination was significant in the Forsus group. During the posttreatment period, although no significant changes were present in the incisors' inclination, relapses of the T1-T2 improvements in overjet and overbite and the recidive of the occlusal plane rotation were significantly higher in the Forsus group. Treatment protocol including an FMA was found to be more effective with mandibular skeletal effects and was more stable with a lesser degree of relapse in overjet and overbite than the Forsus protocol.

Correlation between skeletal development and maxillary canine eruption.

The aim of this study was to find a correlation between the permanent maxillary canine eruption and the cervical vertebral maturation index (CVMI). 145 subjects (73 male and 72 female) in the age of 7-14 years were examined radiographically with lateral cephalographs and orthopantomographs. The CVM patterns were evaluated on the lateral cephalograph using the classification of Hassel and Farman. The stage of the permanent maxillary canine eruption has been investigated on the orthopantomographs depending on its vertical height in relation to the adjacent incisor. Descriptive statistics were obtained for both CVMI stages and canine eruption grading. Spearman rank correlation test was used to determine the correlation between both methods. The minimum level of significance was considered less than 0.05 (P < 0.05). Results showed a strong correlation between CVMI and the grading of the maxillary canine eruption in both female and male and the (r) value estimated was 0.862 and 0.758, respectively. Over 90% of deceleration stage of CVMI in both genders show canine eruption (pubertal growth spurt) about 91.66% for female and 95.65% for male and a small percentage of delay eruption 8.33% and 4.35% in female and male gender, respectively, with a predilection to the female gender. A significant correlation between the permanent maxillary canine eruption stages and skeletal maturity was found. The eruption of maxillary canine occurs before the end of pubertal growth. Any delay in the eruption of maxillary canine after the deceleration stage of CVMI, suggesting a chance of impaction.

Longitudinal evaluation of the association between Insulin-like growth factor-1, Bone specific alkaline phosphatase and changes in mandibular length

The aim of the current longitudinal study was to assess the levels of serum Bone-specific alkaline phosphatase (BALP) and serum Insulin like growth factor-1 (IGF-1) in different cervical vertebral maturation index (CVMI) stages and observe their association with the mandibular growth. Blood samples and lateral cephalograms of 63 subjects (age group of 11–17 years) were obtained at two time points, 12 months apart. On the basis of CVMI, all subjects were divided into six groups based on whether the subjects remained in same CVMI stage or transitioned to the next CVMI stage. Annual mandibular length was related with serum BALP and serum IGF-1 levels estimated using ELISA. Serum IGF-1 and BALP attained highest levels at CVMI stage 3 with peak BALP levels observed earlier than IGF-1. Although a positive correlation was determined between IGF-1 and BALP but BALP followed skeletal growth pattern more precisely. Overall IGF-1 and BALP were negatively correlated with mandibular length with notable growth in CVMI groups 3–3 (P < 0.01), 3-4 (P < 0.01), 4-4 (P < 0.001) and 5-5 (P < 0.001). In conclusion, BALP is a potential biomarker for skeletal growth assessment. However, the mandibular growth pattern was independent of changes in IGF-1 and BALP.

Skeletal Age-related Changes of Midpalatal Suture Densities in Skeletal Maxillary Constriction Patients: CBCT Study

To determine if density measurements of the midpalatal suture and cervical vertebral maturation index (CVMI) are related, and to investigate if CVMI could help in predicting of the developmental status of the midpalatal suture. Cone-beam computed tomography (CBCT) images of 95 skeletal maxillary constriction patients (aged 8 to 18 years) were examined. The maturational stages of the cervical vertebrae were visually defined, and midpalatal suture density in the anterior region, the middle region, and the posterior region were measured. One-way ANOVA and Fisher's least significant difference (LSD) post-hoc test were used for statistical assessment. Significant differences were found in MPDS: in anterior region between (c1,c2,c3,c4) and (c5,c6) stages, in middle region between (c1,c2,c3) and (c5,c6) stages, and in posterior region between (c1,c2,c3) and (c4,c5,c6) stages. Midpalatal suture densities in all regions increase with skeletal maturation advancement.The significant increase after puberty may have the key role in decreasing the skeletal effects of RME after that age. Clinical significances: It is important to assess the midpalatal suture density to choose between rapid maxillary expansion (RME) and surgically assisted rapid maxillary expansion (SARME). This study revealed a significant increase in the midpalatal suture density after puberty. Thus, it may better to perform RME before puberty.

Bone-specific alkaline phosphatase – a potential biomarker for skeletal growth assessment

The present study was aimed to assess levels of serum Bone-specific alkaline phosphatase (BALP) and serum Insulin-like growth factor-1 (IGF-1) and comparing with cervical vertebral maturation index (CVMI) stages. Cross-sectional study. Maulana Azad Institute of Dental Sciences, New Delhi, India. 150 subjects (75 males and 75 females) in the age group of 8-20 years. Subjects were divided into six CVMI stages. Enzyme-linked immunosorbant assay was performed for the estimation of serum BALP and serum IGF-1 levels. Mann-Whitney U test was performed to compare mean ranks of serum BALP and serum IGF-1 with different CVMI stages. Spearman correlation between serum BALP and serum IGF-1 was done across 6 CVMI stages. Peak serum IGF-1 levels were found at CVMI stages 4 and 3 for males and females respectively. Peak levels for serum BALP were found at stage 3 for both genders with significant differences from other stages. A statistically significant correlation was seen between serum IGF-1 and serum BALP from CVMI stages 1 to 3 and 4 to 6 (p < .01). BALP showed promising results and can be employed as a potential biomarker for the estimation of growth status.