Demirjian Index Research Articles

Evaluation of reliability of salivary alkaline phosphatase in comparison to other methods of assessing the skeletal maturation

Evaluation of skeletal maturation is crucial to growth determination which in turn influences orthodontic treatment planning. Various methods employed for assessment are chronological age, hand wrist maturation, cervical vertebral maturation, and dental calcification. Recently, salivary Bone specific alkaline phosphatase (BALP) have been introduced due to its role in the bone mineralization process. To test the alternate hypothesis that salivary alkaline phosphatase is a reliable indicator of skeletal maturity in comparison with other methods of assessment of skeletal maturation. Total 112 subjects were selected out of 150 subjects on the basis of inclusion and exclusion criteria, for participation in the study. For each subject, personal details including chronological age was noted. Height and weight measurements were done for calculation of body mass index (BMI). Further, Lateral Cephalogram and Orthopantomogram were obtained for assessment of cervical vertebrae maturation stages and Demirjian index. Then, an unstimulated salivary sample was collected for evaluation of alkaline phosphatase activity by colorimetric method. The data obtained was analyzed using SPSS software. The results of the present study showed that the highest correlation for skeletal maturation assessment was found with alkaline phosphatase activity. The hypothesis is accepted. Salivary Alkaline Phosphatase proved to be reliable biomarker for assessment of skeletal maturation.

Age Estimation Based on Cone-Beam Computed Tomography of the Spheno-Occipital Synchondrosis and Demirjian Method in an Iranian Population

Background: Spheno-occipital synchondrosis is a growth center that is involved in craniofacial development. Since osteogenesis of this synchondrosis occurs relatively later than other synchondroses, it has been taken into account for age estimation in forensics. This study aimed to evaluate spheno-occipital synchondrosis using Cone-Beam Computed Tomography (CBCT) in an Iranian population. Methods: In this cross-sectional study, 148 CBCT images (76 women and 72 men) of patients aged 7-25 years, with a mean age of 19.92±6.3 years, were assessed by two radiologists to analyze the spheno-occipital synchondrosis fusion degree using a four-stage system. In addition, the third molar development degree (Demirjian index) was assessed in panoramic and cross-sectional views of CBCT images. The correlation between spheno-occipital synchondrosis fusion degree and age was obtained. Multiple regression analysis was used for age estimation using spheno-occipital synchondrosis fusion degree and third molar development degree (Demirjian index). Intra-observer and inter-observer coefficients of agreements were also measured. IBM SPSS Statistics 20.0 was used. Results: There was a positive correlation between spheno-occipital synchondrosis fusion degree and age (r=0.75, p<0.001). The multiple regression model provides a more robust model than when each age marker is utilized individually. The kappa coefficient was 0.53 for inter-observer agreement and 0.77-0.92 for intra-observer agreement. Conclusion: Assessing the four-stage spheno-occipital synchondrosis fusion degree was not a robust method; however, combined with the third molar development (Demirjian index), it could be considered as an appropriate marker for age estimation in 7-25-year-old Iranian population.

Correlation Between Third Molar Mineralization and Midpalatal Suture Maturity: A Cone Beam Computed Tomography Study.

BACKGROUND Midpalatal suture ossification varies in patients of different ages, which can lead to making inaccurate presumptions when considering effective treatment timing based on chronological age. Chronological age provides only general information, whereas dental development correlates with skeletal growth, which suggests that tooth mineralization could be considered to be a precise criterion for determining the midpalatal suture's maturity. The present study was conducted to investigate the association between third-molar mineralization and midpalatal suture's maturation stages using cone-beam computed tomography (CBCT) images. MATERIAL AND METHODS The study involved 97 CBCT images of patients aged 8-37 years with normal growth and development. Subjects with cleft lip and palate, caries treatment, or present cavities in the third molars were not included in the study. The stages of midpalatal suture ossification were evaluated according to the protocol suggested by Angelieri et al, and the third-molar mineralization degree was measured by the Demirjian index. Statistical analysis was performed to evaluate correlations between the variables. RESULTS Patients with advanced third-molar mineralization stages were found to have greater midpalatal suture maturity. A statistically significant positive correlation was found between the stages of third-molar mineralization and midpalatal suture maturation (R=0.814, P<0.01). Third-molar development was also found to be associated with chronological age (R=0.883, P<0.01). CONCLUSIONS A measure of third-molar mineralization does not allow for accurate determination of the midpalatal suture maturation stage.

Skeletal, dental, and sexual maturation as an indicator of pubertal growth spurt.

The aims of this study were to determine the skeletal, dental, and sexual maturation stages of individuals at the peak of the pubertal growth spurt and to analyze the correlations between these parameters. The study included 98 patients, 49 females (mean chronological age 12.05 ± 0.96 years) and 49 males (mean chronological age: 13.18 ± 0.86 years), in the MP3cap stage. Skeletal maturation stages were determined using the cervical vertebral maturation (CVM) method on lateral cephalometric radiographs. The Demirjian index was used to determine dental maturation stages and dental ages on panoramic radiographs. The sexual maturation of the patients was evaluated in the pediatric endocrinology clinic by a pediatrician according to the Tanner stages. The frequencies of the variables were determined, and the Spearman rank correlation coefficients were used to analyze the correlations between the variables. It was determined that the cervical vertebral maturation stage was CS3 in 81.6% (n = 40) of both female and male patients, and 81.6% of the female and 89.8% of the male patients were in stage G in terms of mandibular second molar tooth development. According to the Tanner pubic hair staging, 73.5% of the male and 51.0% of the female patients were in Stage 3. A significant correlation was found between the cervical vertebra stages and mandibular second molar tooth development stages in both sexes and between the cervical vertebra and Tanner pubic hair stages only among the male patients (r = 0.357; p < .05). There was also a significant and strong correlation between the Tanner pubic hair stages and breast development stages (r = 0.715; p < .05). Cervical vertebral development in the CS3 stage and mandibular molar tooth development in the G stage can be considered the peak of the pubertal growth spurt. Tanner Stage 3 marks the peak of the pubertal growth spurt in males.

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 &lt; 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 = &lt; 0.001) and females (Fisher exact = 41.006, Cramer’s V = 0.623, p = &lt;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.

Correlation between Mandibular 2nd Molar Calcification Stages and CVMI among Southern Punjab Population

Aim: To find out whether a correlation exists among the CVMI and dental calcification stages. Study design: Case-control study Place and duration of study: Department of Orthodontics, Nishtar Institute of Dentistry, Multan from 1st October 2020 to 30th April 2021 Methodology: One hundred and fifty orthopantomograms and lateral cephalograms patients were incorporated. The dental maturity was evaluated using8 stages of Demirjian index from stage A to H. This index is graded by determining the calcification stages of the left mandibular second molar tooth on an orthopantomogram. The CVM stages based on the morphology of 2nd, 3rd and 4th cervical vertebral bones on a lateral cephalogram, discern the skeletal maturity. This included 6 stages from stage 1 to 6, based on the depth of concavity and shapes of the vertebrae. Results: The results showed a significant correlation amongst the dental calcification stages and CVMI, having a Pearson’s correlation coefficient ‘r’ of 0.741. A gender dimorphism was observed with males showing more progressive dental calcification stages in the CVM stages 2 and 3 as compared to their female counterparts. The dental calcification stage ‘D’ correlates with CVM stage 1 which occurs approximately 2 years prior to adolescent growth spurt. CVM stage 3 i.e. peak of adolescent growth spurt conforms to dental calcification stage ‘F’ in females and stage ‘G’ in males. The dental calcification stage ‘H’ correlated with CVM stages 5 and 6 which indicate the cessation of growth. Conclusion: The lower second molar tooth calcification stages are a valid measure of skeletal age and can be effectively utilized to estimate patient’s age in orthodontic practice. Keywords: Cervical vertebral maturation, Dental calcification, Mandibular 2nd molar, Skeletal maturity

Evaluation of skeletal maturation based on permanent mandibular second molar calcification

Objective: To investigate the relationship between permanent mandibular second molar calcification stages and cervical vertebrae skeletal maturity and to evaluate whether second molar calcification stages can be used as a reliable diagnostic tool to determine skeletal maturity.Materials and Methods: The Panoramic and intraoral periapical radiographs and lateral cephalogram of 240 subjects (120 males and 120 females) with age group between 8 to 17 years were examined. The Calcification stages of mandibular second molar were rated according to Demirjian index (DI) and skeletal maturity were determined using Cervical vertebrae maturation index (CVMI) given by Hassel and Farman.Results: A highly significant association was found between CVMI and DI. DI stage E corresponded to stage 2 of CVMI (pre-pubertal growth spurt). DI stages F and G corresponded to stage 3 and 4 of CVMI (pubertal growth spurt). DI Stage H corresponded to CVMI stage 5 and 6 (end of pubertal growth spurt).Conclusion: A highly significant association exists between DI and CVMI. Mandibular second molar DI stages can be used as a reliable indicator for growth evaluation in clinical practice.

SKELETAL MATURATION EVALUATION USING MANDIBULAR SECOND MOLAR CALCIFICATION STAGES

Objective: To examine the relationship between skeletal maturity and mandibular second molar calcification stages and assessing mandibular second molar as a diagnostic tool for skeletal maturity evaluation.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Orthodontic department, Sandeman Provincial Hospital, Quetta, from Jan to Jun 2019.&#x0D; Methodology: The sample size of the study 240 comprised of equal number of males and females. Inclusion criteria was defined to include the patients (male and female) with the age from 9-16 years; on the same time, patients without facial asymmetry and without prior history of facial or neck trauma/injury or surgery were considered for the present study. Exclusion criteria was defined to exclude those patients from the study hoe had the history of bone disease and major illness in past; known cases of muscular dystrophy; any congenital malformation of cervical vertebrae and tooth caries; Low quality x-ray with poor contrast.&#x0D; Results: The study revealed association between Demirjian Index and Cervical Vertebrae Maturation Index stages (0.875) with the statistical significance. Demirjian Index Stage H indicated the greater percentage distribution at stage 4 and 6 of Cervical Vertebrae Maturation for males. Similarly, in females, demirjian index stages G and H showed the greater percentage at stage 4 and 6 of cervical vertebrae maturation index respectively.&#x0D; Conclusion: Analysis indicated that cervical vertebrae maturation index and Demirjian Index (DI) occurred earlier in femalesthan males.

Assessment of the Relationship between Skeletal Maturity and the Calcifications Stages of Permanent Canines and Second Premolars.

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.

Comparative evaluation of cervical vertebrae maturation index and stages of mandibular second molar calcification: A cross-sectional study

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.

Assessment of growth status by correlating he maturation stages of middle phalanx of the third finger and calcification stages of mandibular third molar in an institutional set up

The present study aims to assess the correlation between maturation stages of the middle phalanx of the third finger and calcification stages mandibular of the third molar in 9-16 years old children in the South Indian population. A total of 39 subjects between the age of 9-16 years were included for this study. Their pretreatment digital panoramic and hand-wrist radiographs were retrieved from the DIAS software provided by Saveetha Dental College and Hospital, Chennai, TamilNadu, India. These records were analyzed with the help of Demirjian index, used for mandibular third molar maturation stage, and Modified MP3 method, used for Middle phalanx maturation stage. Pearson's Chi-Square tests were done to analyze the association between Mp3 stages and mandibular third molar calcification stages. The statistical tests were performed in SPSS software. The results of this study showed that there is a statistically significant association between Demirjian index and modified MP3 stages in both females (p&lt;0.002) and males (p&lt;0.000). Within the limitations of this study, it was concluded that calcification stages of the lower third molar could be used as a supportive tool to assess maturation. As third molars are known to have many alterations, individual variation should be taken under consideration.

Influence of BMI percentile on craniofacial morphology and development in children and adolescents.

The prevalence of childhood and adolescent obesity is increasing worldwide. Reports suggest that elevated body mass index (BMI) is associated with larger craniofacial dimensions and advanced dental and skeletal development. Such an association is important for timing orthodontic treatment relative to pubertal growth and dental eruption. To evaluate associations between BMI, craniofacial morphology, dental age, and cervical vertebrae maturation staging (CVMS), 400 participants were consecutively selected (8-15 years, n = 200 overweight and obese BMI >85%, 200 normal weight) from the University of North Carolina database. Records were analysed for cephalometric measures, Demirjian index values, and CVMS. Bivariate statistics and linear regression analysis evaluated whether CVMS, dental age, and cephalometric dimensions varied with BMI. Overweight/obese children and adolescents had a proportionally larger bimaxillary prognathic skeletal pattern compared to those of normal weight. These cephalometric measurements [articulare-gnathion (Ar-Gn), condylion-anterior nasal spine (Co-ANS), sella-gonion (S-Go), nasion-menton (N-Me), anterior nasal spine-menton (ANS-Me), sella-nasion-A point (SNA), sella-nasion-B point (SNB), and sella-nasion-pogonion (SNPg)] were significantly different [statistically (P < 0.05) and clinically (>2 mm or >2 degrees)] between the two study groups, with a linear relationship between BMI percentile and craniofacial dimension. The overweight/obese BMI group had a mean dental age 1.4 years advanced relative to the normal weight group (P < 0.05), with an advancement of nearly one CVM stage between the ages of 12 and 14 (P < 0.05). The study is retrospective. Obese/overweight children and adolescents have proportionally larger antero-posterior and vertical dimensions and are more likely to experience advanced dental and skeletal maturation. Obese/overweight subjects may enter their growth spurt at a younger age and have earlier eruption of teeth, affecting treatment timing. BMI percentile should be a consideration for orthodontic treatment in growing patients.

Association between mandibular second molars calcification stages in the panoramic images and cervical vertebral maturity in the lateral cephalometric images.

BackgroundDetermination of maturation and evaluation of growth potential is extremely important in clinical orthodontics. The purpose of this study was to evaluate the diagnostic performance of the mandibular second molar calcification stages for identification of growth phases. Material and MethodsIn this cross-sectional descriptive study, samples were derived from panoramic radiographs and lateral cephalograms of 125 subjects (61 males and 64 females) with age ranging from 8 to 17 years and estimates of dental maturity (Demirjian Index [DI]) and skeletal maturity (Cervical vertebral maturation indicators CVMI]) were made. Correlations between DI and CVMI were shown by Spearman’s correlation. The diagnostic performance of the DI for the identification of the growth phase were evaluated using positive likelihood ratios (LHRs), with a threshold of ≥10 for satisfactory performance. ResultsCorrelations between second molar calcification and growth phase were 0.819 for females and 0.805 for males (P-value< 0.0001). LHR ≥10 was only observed for the identification of the post-pubertal growth phase for the H stage of the second molar. ConclusionsIn spite of the high correlation coefficients between mandibular second molar calcification stages and skeletal maturity, these stages are reliable only for the identification of the post pubertal growth phase. Key words:Skeletal maturation, demirjian Index, mandibular second molar.

Evaluation of skeletal maturation in Indian adolescents using calcification stages of permanent mandibular second molar

Aim: The aim of this study was to investigate the relationships between the stages of calcification of teeth (permanent mandibular second molar) and cervical vertebrae maturation (CVM). Materials and Methods: This study was conducted on 200 Indian children (98 boys and 102 girls), whose panoramic radiographs (orthopantomogram) for mandibular second molar tooth calcification stages and visual appraisals of the lateral cephalograms for CVM stages, were recorded using Demirjian Index (DI) and CVM indicator (CVMI). Results: Each stage appeared earlier in female participants than males. A highly significant association was found between DI and CVMI. Stage F and G of DI, which corresponds to Stage 3 of CVMI indicated the start of the peak in mandibular growth, which would be appropriate time to plan for growth modification appliance placement. Stage G of DI also corresponds to Stage 4 of CVMI, i.e., deceleration of adolescent growth spurt. Stage H of DI corresponding to CVMI Stages 5 and 6 indicates that the peak of mandibular growth has already occurred and is not appropriate for functional appliances. Conclusion: Mandibular second molar calcification stages are reliable skeletal maturity indicators for the evaluation of growth phases in children.

Assessment of skeletal maturity using the calcification stages of permanent mandibular teeth.

Introduction: Knowledge of the growth status of patients is essential to formulate and initiate a precise treatment plan. This study aimed at determining the role of calcification of permanent mandibular teeth for the assessment of skeletal maturity. Methods: A cross-sectional study was conducted using lateral cephalograms and dental panoramic radiographs of 360 patients (ages 7-18 years) equally divided into six groups according to cervical vertebral maturation stages. Skeletal age was determined using Baccetti et al. method and dental age was calculated using Nolla and Demirjian methods. Results: Mean chronological stage at CS5 revealed a significant difference between male and female subjects (p= 0.003), which showed that the latter achieved skeletal maturity one year earlier than the former. A significant difference (p= 0.007) was found for dental age using Nolla’s stages at CS3, which showed females demonstrated a dental age of 1.4 years less than males. Mandibular canine showed the highest correlation with Demirjian index (DI) in males (rho = 0.818) and females (rho = 0.833). Mandibular second premolar showed the highest correlation with Nolla’s stages in males (rho = 0.654) and females (rho = 0.664). Conclusion: Comparisons between sexes revealed that females are skeletally and dentally advanced. The DI indicated stage F and Nolla’s stages identified stages 9, 10 to be indicative of CS2-3 for the mandibular canine and stages F and G and 9-10 for CS2-3 for the first premolars, second premolars and second molars, respectively.

Correlation between Maxillary Canine Calcification and Skeletal Maturation.

Skeletal maturation assessment has a great role in many health professions especially in Orthodontics & Dentofacial Orthopedics. Functional appliances have proved to be more effective when used at the peak of mandibular growth, rather than before. The aim of this study was to evaluate whether the calcification stages of permanent maxillary canine are useful to assess skeletal maturity. In this cross-sectional study, samples were derived from panoramic radiographs and lateral cephalograms of 300 subjects (137 males and 163 females) with their age ranging from 9 to 18 years. Dental maturity {Demirjian Index (DI)} and skeletal maturity {Cervical Stages (CS)} were assessed from radiographs. The Pearson chi-square test (χ2) and Sakoda adjusted Pearson contingency coefficient (C*) were calculated to determine the correlation between DI and CS. A highly significant association (C* = 0.851, p<.001for males and 0.879, p<.001 for females) was found between DI and CS. DI stage E coincided with CS2 (pre-peak of pubertal growth spurt) & DI stage F coincided with CS3 (peak of pubertal growth spurt) for all the subjects. DI stage H corresponded to CS5 and CS6 (end of peak of pubertal growth spurt). A highly significant association was found between DI and CS. Maxillary canine DI stages could be useful to assess skeletal maturity.

Predictive Value of Dental Maturity for a Positive Gonadotropin-Releasing Hormone Stimulation Test Result in Girls with Precocious Puberty.

Dental maturity is associated with skeletal maturity, which is advanced in girls with central precocious puberty (CPP). We investigated the performance of dental maturity as a screening method for CPP using mandibular second premolar and molar calcification stages, assessed the associated anthropometric and laboratory factors, and evaluated pubertal response predictors using the gonadotropin-releasing hormone stimulation test (GnRHST) in prepubertal and pubertal girls. A prospective case-control study was conducted in girls, aged 7.0–8.9 years, classified into pubertal (peak luteinizing hormone [LH] after GnRHST ≥ 5 IU/L), prepubertal (peak LH < 5 IU/L), and control groups. Auxological and biochemical tests, panoramic radiographs, and GnRHSTs in participants with breast development were conducted. Dental maturity was assessed using the Demirjian index (DI). We included 103 girls (pubertal, 40; prepubertal, 19; control, 44). Chronological age (CA) was not significantly different between groups. Bone age (BA) and BA advancement was higher in the pubertal and prepubertal groups. Increased DI values at the mandibular second premolar and molar were significantly associated with CA, BA, BA advancement, height standard deviation score (SDS), peak LH after GnRHST, and insulin-like growth factor-I (IGF-I) (all P < 0.05). Moreover, odds ratio (OR) of the mandibular second premolar and molar (a DI value of ≥ E) for predicting a positive response to GnRHST was 8.7 (95% confidence intervals [CI], 2.9–26.1) and 5.2 (95% CI, 2.2–12.7), respectively. Dental maturity was a strong predictor for diagnosing CPP. Determining dental maturity in girls with suspected precocious puberty might help determine the performance of GnRHSTs.

Assessment of skeletal maturation with permanent mandibular second molar calcification stages among a group of Nepalese orthodontic patients.

BackgroundAssessment of growth status of a patient is a key component in orthodontic diagnosis and treatment planning for growing patients with skeletal discrepancy. Skeletal maturation based on hand-wrist radiograph and cervical vertebral maturation (CVM) are commonly used methods of growth assessment. Studies have shown that stages of dental calcification can also be used to assess skeletal maturation status of an individual, whereas other studies have suggested that the relationship between dental calcification and skeletal maturation should be interpreted with caution owing to racial variation.ObjectiveTo evaluate the relationship between permanent mandibular second molar calcification stages and skeletal maturity assessed by CVM among a group of Nepalese orthodontic patients.Materials and methodsOne hundred and sixty-eight digital radiographs (84 orthopantomograms and 84 lateral cephalograms) were obtained from the records of 84 patients who sought orthodontic treatment in Orthodontic and Dentofacial Orthopaedic Unit, Department of Dentistry, Institute of Medicine, Kathmandu. Two parameters were used in this study, namely, CVM stages from lateral cephalogram and Demirjian index (DI) stages from orthopantomogram. The evaluation of digital radiographs was carried out on a computer screen with a resolution of 1,280×800 pixels. The association between DI stages of permanent mandibular second molar and CVM stages was assessed.ResultsA statistically significant association was found between DI and CVM stages for both male and female subjects with Pearson’s contingency coefficient value of 0.751 and 0.766 for male and female subjects, respectively.ConclusionSkeletal maturation can be reliably assessed with dental calcification stages of permanent mandibular second molar for Nepalese orthodontic patients.

Evaluation of skeletal maturation using mandibular third molar development in Indian adolescents.

Objective:This study was done with the following objectives: to estimate dental maturity using the Demirjian Index (DI) for the mandibular third molar; to investigate the relationship between dental maturity and skeletal maturity among growing patients; to evaluate the use of the mandibular third molar as an adjunctive tool for adolescent growth assessment in combination with the cervical vertebrae; to evaluate the clinical value of the third molar as a growth evaluation index.Materials and Methods:Samples were derived from panoramic radiographs and lateral cephalograms of 615 subjects (300 males and 315 females) of ages ranging 9-18 years, and estimates of dental maturity (DI) and skeletal maturity [cervical vertebrae maturation indicators (CVMI)] were made.Results:A highly significant association (r = 0.81 for males and r = 0.72 for females) was found between DI and CVMI. DI Stage B corresponded to Stage 2 of CVMI (prepeak of pubertal growth spurt) in both sexes. In males, DI stages C and D represent the peak of the pubertal growth spurt. In females, stages B and C show that the peak of the pubertal growth spurt has not been passed. DI stage E in females and DI Stage F in males correlate that the peak of the pubertal growth spurt has been passed.Conclusion:A highly significant association exists between DI and CVMI. Mandibular third molar DI stages are reliable adjunctive indicators of skeletal maturity.