Molar Calcification Stages Research Articles

To Evaluate Correlation Between Cervical Vertebral Maturation Stages and Third Molar Maturation Stages in North Maharashtrian Population

Introduction Assessment of growth is crucial in the diagnosis and treatment planning in orthodontics. Skeletal development can be assessed by using hand-wrist radiographs and lateral cephalograms. The advantage of the panoramic radiograph over hand wrist radiograph is that patient exposure is reduced following the ALARA principle. Aim The aim of this study was to investigate the correlation between third molar calcification stages and skeletal maturity using the CVM stages in North Maharashtrian population. Methods Dental panoramic and lateral cephalograms of subjects ranged in age from 9 to 20 years were selected. Demirjians method was used to assess the dental maturation stages of third molars on both the sides. Hassel and Farman classification was used for classifying into cervical vertebral maturation indicator stages. The collected data were statistically analyzed. Result There was a statistically significant correlation between cervical maturation stages and third molar calcification stages in North Maharashtrian population.

Relationship between Chronological Age and Dental Age Using Third Molar Calcification in the Pakistani Population

To ascertain the relationship between dental age and chronological age in patients attending dental OPDs using third molar calcification stages. A cross-sectional analytical study. Dental OPDs of Dow University of Health Sciences, Karachi, Pakistan, from November 2021 to April 2022. Dental Orthopantomograms (OPG) of 385 patients, aged 12-28 years attending the dental OPDs, were obtained during the study period. Third molar calcification stages were evaluated using the method proposed by Kohler et al. based on ten stages of tooth formation. The inter-examiner agreement was tested by adding another examiner to 100 dental OPGs after 30 days of reviewing them by one examiner. A simple linear regression model was applied between age and stage of tooth growth. A total of 121 males (31.4%) and 264 (68.6%) females were included in this study. Intra-agreement and inter-agreement were excellent (˃0.90). A total of 55 (14.28%) had half of the root completed, followed by 49 (12.72%) who had initiation of root formation and 1/3rd root completion. The left mandibular third molars were found to be more statistically significant with Kohler's stages of development in both genders. Developing third molars was significantly related to chronological age and provided the most accurate age calculation based on all tooth measurements and ratios of tooth measurements. Third molar calcification stages can be used accurately to predict age in Pakistani adolescents. Dental age estimation, Chronological age, Dental radiographs, Orthopantomograph, Third molar development.

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.

A Study to Compare and Correlate the Status of Maturation in Growing Individuals Using Chronological Age Dental Maturation and Cervical Vertebrae Maturation.

Aim and objectiveTo compare and correlate the status of maturation in growing individuals using orthopantomograph (OPG) and lateral cephalogram to establish a reliable relationship between chronological age (CA) and dental maturation (DM) with cervical vertebrae maturation index (CVMI).Materials and methodsLateral cephalometric radiographs and OPGs of 50 children within the circumpubertal period were collected (male n = 25, age 12–17 years, female n = 25, age 10–15 years) and evaluated for the status of maturation using CA, DM (of mandibular left canine and second molar using Demirjian Index-DI), and CVMI stages.ResultsChronological age shows a positive correlation with CVMI stages in both groups. Gender-based association and distribution between DI stages of canine and CVMI stages shows that in both male and female sample groups DI G correlates with CVMI stage 1 and 2, DI H correlates with CVMI stage 3. Gender-based association and distribution between DI stages of 2nd molar and CVMI stages show that in the male sample group DI E shows a higher correlation with CVMI stage 1, DI F shows a higher correlation with CVMI stage 1 and 2. DI G shows a higher correlation with CVMI stages 2 and 3. DI H shows a higher correlation with CVMI stage 3. In the female sample group, DI F shows a higher correlation between CVMI stage 1 and 2, DI G and F show a higher correlation with CVMI stage 3.ConclusionMandibular canine, second molar calcification stages, and CA show a positive correlation with CVMI stages in the present study, hence, this can be considered as a reliable indicator in skeletal maturity assessment.How to cite this articlePooja U, Lokesh NK, Alle RS, et al. A Study to Compare and Correlate the Status of Maturation in Growing Individuals Using Chronological Age Dental Maturation and Cervical Vertebrae Maturation. Int J Clin Pediatr Dent 2021;14(S-1):S50–S53.

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.

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.
 Study Design: Cross sectional study.
 Place and Duration of Study: Orthodontic department, Sandeman Provincial Hospital, Quetta, from Jan to Jun 2019.
 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.
 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.
 Conclusion: Analysis indicated that cervical vertebrae maturation index and Demirjian Index (DI) occurred earlier in femalesthan males.

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<0.002) and males (p<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.

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.

A radiographic assessment of the correlation between the calcification stages of the mandibular second molar and the middle phalanx of the third finger of 9\u201316 years old children

BackgroundHand-wrist radiographs and orthopantomographs are routinely used for assessing skeletal and dental maturation and analyzing skeletal morphology and growth patterns. Though minimal radiation is associated with a hand-wrist radiograph, it would be superlative to assess the growth stage without an additional radiograph.AimTo assess the correlation between the calcification stages of mandibular second molar and the modified middle phalanx of the third finger (modified MP3) of 9 to 16 year old children.DesignIn this cross-sectional observational study we assessed the dental calcification of the mandibular second molar on orthopantomograms using Demirjian’s tooth developmental stages and skeletal maturity of the middle phalanx of the third finger on hand-wrist radiographs using modified MP3 method proposed by Rajagopal and Kansal (J Clin Orthod 36(7):398, 2002) of 100 children (48 boys and 52 girls), aged between 9 and 16 years.ResultsA strong association was found between calcification stages of mandibular right second molar and the developmental stages of the modified middle phalanx of the third finger of right hand in both the gender. Spearman rank order correlation coefficients between the developmental stages of the modified MP3 of hand and the developmental stages of the mandibular second molar and found to be statistically significant positive in males (0.62) and females (0.41) when Demirjian’s Index (DI) and modified middle phalanx of the third finger stages were compared.ConclusionThere was a good concordance between the stages of modified middle phalanx of the third finger and the Demirjian’s tooth developmental stages. Demirjian’s second molar calcification stages can be a better choice for predicting skeletal maturity because of its simplicity and reliability.

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.

Relationship between dental calcification and skeletal maturation in a Peruvian sample.

ABSTRACTObjective: the objective of the study was to determine the relationship between dental calcification stages and skeletal maturation in a Peruvian sample. Methods: panoramic, cephalometric and carpal radiographs of 78 patients (34 girls and 44 boys) between 7 and 17 years old (9.90 ± 2.5 years) were evaluated. Stages of tooth calcification of the mandibular canine, first premolar, second premolar, and second molar and the skeletal maturation with a hand-wrist and a cervical vertebrae method were assessed. The relationships between the stages were assessed using Spearman’s correlation coefficient. Additionally, the associations of mandibular and pubertal growth peak stages with tooth calcification were evaluated by Fisher’s exact test. Results: all teeth showed positive and statistically significant correlations, the highest correlation was between the mandibular second molar calcification stages with hand-wrist maturation stages (r = 0.758, p < 0.001) and with vertebrae cervical maturation stages (r = 0.605, p < 0.001). The pubertal growth spurt was found in the G stage of calcification of the second mandibular molar, and the mandibular growth peak was found in the F stage of calcification of the second molar. Conclusion: there was a positive relationship between dental calcification stages and skeletal maturation stages by hand-wrist and cervical vertebrae methods in the sample studied. Dental calcification stages of the second mandibular molar showed the highest positive correlation with the hand-wrist and cervical vertebrae stages.

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.

Radiographic assessment of third molars development and it's relation to dental and chronological age in an Iranian population.

The aim of the present study was to estimate chronological age based on third molar development and to determine the association between dental age and third molar calcification stages. In this cross-sectional study, 505 digital panoramic radiographs of 223 males (44.2%) and 282 females (55.8%) between the age of 6 and 17 were selected from patients who were treated in Departments of Pediatrics and Orthodontics of Isfahan University of Medical Sciences between the years of 2009 and 2013. Correlation between chronological age and third molar development was analyzed with SPSS 21 using Spearman's Rank correlation coefficient, Chi-square test and multiple regression statistical tests (P < 0.05). All third molars demonstrated a highly significant correlation with dental age (P < 0.001). The teeth showing the highest relationship with dental age were mandibular left third molar in males and mandibular right third molar in females (r s = 0.072). When multiple regression was used to predict dental age based on molar calcification stage, the only significant correlation was between maxillary left third molar in males (P < 0.05). There was no statistically significant correlation for any of third molars in females. Relationship between chronological age and molars development stage was significant in all age subgroups and in both gender (P < 0.001). Strong correlation was observed between left third molars and dental age in males. Results showed that third molar calcification stage can be used as an age predictor and in general mandibular teeth seems to be more reliable for this purpose in both genders and in all ages.

Estimation of legal age using calcification stages of third molars in living individuals.

The increased number of adolescents and young adults with unknown or inaccurately given date of birth is a current issue in justice and legal medicine. The objective of this study was to determine the extent to which third molar calcification stages assessed on panoramic X-rays could be useful as additional criteria for forensic age estimation in living individuals, focusing on the legally important ages 17 and 18. In a retrospective multi-center study, the developmental stage of each individual's third molar was analyzed using Demirjian's scale in 2360 cases. Additionally, sex, age and ancestry were assessed. Individuals with the lowest calcification stage of all present molars in stage H were ≥18 years with a likelihood of ≥99.05% in the female (n=388), and ≥99.24% in the male (n=482) population. The lowest calcification stage of all present third molars proved to be useful as an additional reliable criterion for the determination of an age ≥18 years.

Assessment of skeletal maturation using mandibular second molar maturation stages.

To investigate the relationship between cervical vertebrae maturation and mandibular second molar calcification stages. The study was designed as a retrospective, descriptive and crosssectional research project. Pre-treatment lateral cephalograms and panoramic radiographs of 99 males and 110 females in the age range of 7 to 18 years 7 months were evaluated with Demirjian Index (DI) and cervical vertebrae maturation indicators (CVMI) of Hassel and Farman. A null hypothesis was proposed that there is no relation between CVMI and DI. A highly significant association (Pearson's contingency coefficient 0.713 for males and 0.863 for females) was found between DI and CVMI. In males, the DI stage E corresponded to stage 2 of CVMI (pre-peak of pubertal growth spurt) and DI stages F and G corresponded to stages 3 and 4 of CVMI (peak of pubertal growth spurt). DI stage H was associated with stages 5 and 6 of CVMI (end of pubertal growth spurt). In females, the DI stages C, D corresponded to CVMI stages 1, 2; DI stages E, F with CVMI stages 3, 4; DI stages G, H with CVMI stages 5, 6. Mandibular second molar calcification stages can be used as indicators for assessment of skeletal maturity.

Second molar calcification stages to evaluate skeletal maturation: A cross-sectional radiographic study

Objectives: The aim of this cross-sectional radiographic study was to investigate the relationship between mandibular second molar calcification stages and cervical vertebrae maturity indicators, and further to evaluate whether the second molar calcification stages can be used as a reliable diagnostic tool to assess skeletal maturity and optimal treatment timing. Materials and Methods: Samples were derived from panoramic radiographs and lateral cephalograms of 101 subjects (47 males 54 females) with ages ranging from 10 to 18years. Estimates of dental maturity (Demirjian index, D.I) and skeletal maturity (cervical vertebrae maturation indicators, CVMI) were made. The modified version of the CVMI method by Macnamara and Baccetti was used. Results: A highly significant association (P DI stage E corresponds to stage 2 of CVMI (pre-peak of pubertal growth spurt) DI stage F corresponded to stage 3 of CVMI (peak of pubertal and mandibular growth) DI stage G corresponded to stages 4 and 5 of CVMI (peak in mandibular growth has occurred within 1 or 2 years before this stage) DI stage H was associated with stage 6 of CVMI (end of pubertal growth spurt). Conclusion: A highly positive correlation exists between DI of mandibular second molars and CVMI. Stage F of Demirjian index, with the root length equal to or greater than the crown height corresponds to stage 3 of CVMI indicating the start of peak in mandibular growth which would be appropriate time to plan for functional appliances. Therefore, mandibular second molar calcification stages are reliable skeletal maturity indicator, which can be used to predict the growth status in determining the optimal treatment timing.

Skeletal maturation evaluation using mandibular second molar calcification stages

To investigate (1) the relationships between the stages of mandibular second molar calcification and skeletal maturity; and (2) whether second molar calcification stages can be used as a reliable diagnostic tool to determine skeletal maturity. Samples were derived from panoramic radiographs and lateral cephalograms of 300 subjects (137 males and 163 females) with ages ranging from 9 to 18 years, and estimates of dental maturity (Demirjian Index [DI]) and skeletal maturity (cervical vertebrae maturation indicators [CVMI]) were made. A highly significant association (C* = 0.854 for males and 0.866 for females) was found between DI and CVMI. DI stage E corresponded to stage 2 of CVMI (pre-peak of pubertal growth spurt) and DI stages F and G corresponded to stages 3 and 4 of CVMI (peak of pubertal growth spurt). DI stage H was associated with stages 5 and 6 of CVMI (end of pubertal growth spurt). A highly significant association exists between DI and CVMI. Mandibular second molar DI stages are reliable indicators of skeletal maturity.