Skeletal Maturity Indicators Research Articles

Appraisal of skeletal maturity indicators with respect to non-invasive biomarkers

Non-invasive salivary biomarkers are being investigated as they may be helpful in predicting skeletal age. This study was conducted to evaluate the correlation between salivary insulin-like growth factor-1, salivary alkaline phosphatase, cervical vertebrae maturation stages and chronological age in the assessment of skeletal age during the growth period. This study also aims to find associations with mandibular base length and maxillary base length. Total 80 eligible subjects aged 7 to 21 years were selected and divided into two gender-specific groups (41 males, 39 females). A further subdivision was made on the basis of six cervical vertebral maturation stages from the lateral cephalogram. The chronological age was given for each subject, and The maxillary base length and the length of the mandibular base was calculated from the impressions on the lateral cephalogram. Saliva samples were collected from each subject to determine salivary IGF-1 and ALP levels using an enzyme-linked immunosorbent assay (ELISA). The data obtained was statistically analysed using SPSS (20.0) software. It was found that the mean IGF-1 activity in saliva was highest at CVMI stage 3 and the highest mean ALP levels in saliva occurred in males at CVMI stage 3 and in females at CVMI stage 4. Mean salivary ALP and IGF-1 levels correlate well with . Salivary ALP levels show a correlation with chronological age and could also be used as a diagnostic model to predict cervical stage. The diagnostic levels of certain biomarkers that appear in human saliva are representative of an individual's circumpubertal growth spurt. The collective pattern of increase and decrease in the sample during the circumpubertal stages is essential to study for orthodontic diagnosis and treatment planning.

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.

Evaluation and Correlation of Salivary Bone-Specific Alkaline Phosphatase Level with Skeletal Age

Background: This study aimed to measure bone-specific alkaline phosphatase (B-ALP) levels in saliva and determine how they relate to different stages of skeletal development, as assessed by hand-wrist X-rays using the Hagg and Taranger method. Since orthodontic treatment is closely linked to an individual’s growth, the development of the jaws, face, and overall body, and how they affect the alignment of teeth, the suggestion to use biomarkers to evaluate an individual’s skeletal maturity has emerged as a promising approach. Unlike traditional radiographic methods, which are subjective and based on morphology, biomarkers provide objective indicators related to the patient’s physiology, and they do not involve radiation exposure or magnification errors. The main goal of this study was to measure B-ALP levels in saliva and examine their correlation with varying degrees of skeletal maturity. In a positive correlation, the total ALP present in saliva could be a valuable biological indicator in growing patients. Methods: Thirty patients were randomly selected for the study based on the inclusion criteria: Age of the individual: 9‒19 years, with good general health and no nutritional issues. A sample of unstimulated whole saliva was collected using a passive drooling method to estimate levels of the bone alkaline phosphatase using an enzyme-linked immunosorbent assay (ELISA) kit. After saliva collection, hand-wrist radiographs were immediately obtained and manually traced onto 50-micron-thick lead acetate tracing sheets using an 0.5-mm lead pencil. The hand-wrist radiographs were then categorized into five groups, which involved analyzing the morphology of the hand-wrist radiographs: group SO (prepubertal), group S (pubertal onset), group MP3G (peak pubertal), group DP3 (pubertal deceleration), and group RJ (growth completion). Results: There were significant differences between the B-ALP levels between different skeletal ages. The salivary B-ALP values of the group MP3 were significantly higher than those of groups SO and RJ. The mean salivary B-ALP levels consistently increased from the group SO to the group MP3, followed by a gradual decrease. Conclusion: Salivary alkaline phosphatase activity was significantly higher during the peak pubertal period (group MP3) compared to both the pre-peak (group SO) and post-peak (group RJ) values. This finding suggests that salivary bone alkaline phosphatase can be used as an additional indicator alongside conventional skeletal maturation indicators to assess pubertal development.

A simplified protocol for deep quantitative proteomic analysis of gingival crevicular fluid for skeletal maturity indicators

Assessment of craniofacial skeletal maturity is of great importance in orthodontic diagnosis and treatment planning. Traditional radiographic methods suffer from clinician subjectivity and low reproducibility. Recent biochemical methods, such as the use of gingival crevicular fluid (GCF) protein biomarkers involved in bone metabolism, have provided new opportunities to assess skeletal maturity. However, mass spectrometry (MS)-based GCF proteomic analysis still faces significant challenges, including the interference of high abundance proteins, laborious sample prefractionation and relatively limited coverage of GCF proteome. To improve GCF sample processing and further discover novel biomarkers, we herein developed a single-pot, solid-phase-enhanced sample-preparation (SP3)-based high-field asymmetric waveform ion mobility spectrometry (FAIMS)-MS protocol for deep quantitative analysis of the GCF proteome for skeletal maturity indicators. SP3 combined with FAIMS could minimize sample loss and eliminate tedious and time-consuming offline fractionation, thereby simplifying GCF sample preparation and improving analytical coverage and reproducibility of the GCF proteome. A total of 5407 proteins were identified in GCF samples from prepubertal and circumpubertal groups, representing the largest dataset of human GCF proteome to date. Compared to the prepubertal group, 61 proteins were differentially expressed (31 up-regulated, 30 down-regulated) in the circumpubertal group. The six-protein marker panel, including ATP5D, CLTA, CLTB, DNM2, HSPA8 and NCK1, showed great potential to predict the circumpubertal stage (ROC-AUC 0.937), which provided new insights into skeletal maturity assessment.

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.

Correlation between the middle phalanx of the third finger skeletal maturation staging system and insulin-like growth factor-1 levels among Indian children - A 3-year longitudinal study.

Tracking insulin-like growth factor-1 (IGF-1) level alongside the middle phalanx of the third finger (MP3) staging modification could provide valuable insights into the relationship between hormonal factors and skeletal maturation during different stages of growth. Longitudinal studies indeed play a crucial role in understanding these complex relationships over time, allowing for a more comprehensive assessment of how IGF-1 might serve as a marker for pubertal growth stages. The present longitudinal prospective cohort study was done among 26 boys and 26 girls. For each child, once in every 6 months for 3 years, blood samples (to estimate IGF-1 level) and X-rays of the left hand middle finger were taken. DRG IGF-1 600 Human Enzyme-Linked Immunosorbent Assay kit was used for the quantitative measurement of IGF1 from serum. The MP3 stages of the middle phalanx of the middle finger were evaluated using a modified MP3 system. The collected data were subjected to suitable descriptive and inferential statistics. The mean IGF1 levels were significantly higher in girls compared to boys across all the stages of MP3 skeletal maturity indicators. However, in both boys and girls, IGF-1 levels showed increasing trends from Stage F to H where it peaked and showed deceleration to Stage I (P < 0.05). The observed increase in serum IGF-1 levels during pubertal stages, followed by a decline in late puberty, aligning with the stages of skeletal maturation, suggests a close relationship between hormonal changes and bone development.

The Role of Bone Alkaline Phosphatase and Osteocalcin in Saliva as Indicators of Skeletal Maturity in Children

The Role of Bone Alkaline Phosphatase and Osteocalcin in Saliva as Indicators of Skeletal Maturity in Children

Correlation of Serum Insulin-Like Growth Factor-1 and Hand Wrist Radiographs as Skeletal Maturity Indicators: an Ex-Vivo Study

Introduction: Conventional Hand and Wrist radiographs, have certain drawbacks of exposing orthodontic patients to unnecessary radiation hazards and subjectivity to errors. Serum insulin-like growth factor 1 (IGF-1) levels have been reported to increase until the pubertal peak in literature. The present study aims to assess the relationship between serum IGF-1 and skeletal maturity indicators Materials and Methods: Lateral cephalograms of 60 patients were assigned SMI stage according to Fishman’s classification system. The serum IGF-1 levels of the patients were also evaluated. Correlation between the serum IGF-1 levels, age of the patient, and their SMI stage was analyzed. Results: Pearson's coefficient of correlation revealed a non-significant weak positive correlation (p=0.69; &gt;0.05) between age and IGF-1 levels, and a non-significant weak negative correlation (p =0.52; &gt;0.05) between SMI stages and IGF-1 levels. Results of the ANOVA test indicated that there was no significant difference between mean IGF-1 levels across the different age groups and eleven SMI groups. However, there was a significant difference noted in the mean IGF-1 levels and the restructured SMI categories and groups. Conclusion: The moderate correlation between age and serum IGF-1 fluctuations during puberty underscores the hormone's pivotal role in adolescent growth. This positions serum IGF-1 as a potentially specific and reliable marker for assessing mandibular growth modifications, offering a radiation-free alternative to conventional radiographic methods

Biomarkers in Body Fluids as Indicators of Skeletal Maturity: A Systematic Review and Meta-analysis.

This review aimed to critically appraise the evidence for biomarkers in blood serum, gingival crevicular fluid (GCF), saliva, and urine in comparison with standard radiographic indices for skeletal maturation assessment. A thorough literature search in multiple databases was conducted for biomarkers in body fluids for skeletal maturation assessed with cervical vertebrae in lateral cephalograms or on hand-wrist radiographs. Different combinations including free text, MeSH terms, and Boolean operators were used. Two researchers used strict inclusion and exclusion criteria to screen title, abstract, and full text, and used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 instrument for risk of bias assessment of individual studies. Meta-analysis was performed on eligible studies using RevMan 5 software. A total of 344 articles were screened, of which 33 met the inclusion criteria and quality assessment. The skeletal maturity indicators included insulin-like growth factors (IGF-1), alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), dehydroepiandrosterone sulfate (DHEAS), vitamin D binding protein (DBP), parathormone-related protein (PTHrP), osteocalcin, metalloproteins, and serotransferrin (TF) along with different metabolites. At puberty, a significant rise was seen in IGF-1, DBP, ALP, osteocalcin, TF, and BALP. However, the serum DHEAS and PTHrP increased from pre-pubertal to post-pubertal stages. Due to the data heterogeneity, a meta-analysis could be performed on seven studies in total on IGF-1 in serum and blood. Of these, five were included for data in males and six in females, and four studies on IGF-1 in serum and blood. A significant difference in IGF-1 levels was seen between stages of peak pubertal growth spurt (CS3 and CS4) and decelerating pubertal growth (CS5) compared with growth initiation stage (CS2). Pubertal growth spurts were correlated with peak serum IGF-1 and BALP in both sexes individually. Peak ALP levels in GCF were correlated with the pubertal spurt in a combined sample of males and females. Standard biofluid collection protocols and homogeneity in sampling and methodology are strongly recommended for future research.

Reliability of maxillary canine calcification stages and salivary alkaline phosphatase for pubertal growth prediction (cross-sectional study)

Orthodontic growth estimation for growing individuals is essential for diagnosis and treatment planning, essentially in managing cases with skeletal growth defects. Research has revealed a substantial correlation between tooth calcification stages and skeletal maturity. Also, many biomarkers have been investigated as maturity indicators, and studies show promising results. Therefore, the present research assessed if salivary alkaline phosphatase (ALP) level and maxillary canine calcification stages with developmental stages of modified middle phalanx of the third finger (MP3) are reliable skeletal maturity indicators. No previous study conducted the reliability of both canine calcification stages and ALP level as skeletal maturity indicators. In this prospective observational study with a cross-sectional design, 80 subjects aged 8- 16 years were selected. Unstimulated saliva to assess ALP, periapical radiographs for the maxillary canine to assess the dental calcification by relying on the Dermirjian's stages, and periapical radiographs for the middle phalanx of the third finger region were taken from 80 individuals (from eight to sixteen years old) to assess the skeletal maturation state. The data were analyzed using the statistical package of social science (SPSS version 26), using the Spearmen correlation test and the Kruskal-Wallis test. The maxillary canine's calcification stages and MP3 stages showed a significant correlation coefficient; however, the correlation coefficient of MP3 stages and maxillary canine calcification stages with salivary ALP was non-significant. The maxillary canine calcification stages can practically be utilized as an indicator for assessing skeletal maturity, but the salivary ALP level showed no correlation with skeletal maturity indicators. Keywords: Skeletal maturity indicator; Canine calcification stages; Alkaline phosphatase; Middle phalanx of third finger.

Correlation between Serum IGF-1, IGFBP-3 Levels, and Hand-Wrist Radiographs in Determining Skeletal Maturity

The aim of this study was to assess the correlation between serum levels of insulinlike growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), and hand-wrist radiographs using a skeletal maturity indicator (SMI) and the middle phalanx of the third finger (MP3). Hand-wrist radiographs and blood samples from 205 patients aged 7 - 17 years were retrospectively analyzed by two dentists using the SMI stages, MP3 stages, and serum IGF-1 and IGFBP-3 levels. Serum IGF-1 levels were highest at the SMI 6 - 8 and MP3 - G stage and lowest at the SMI 1 - 3 and MP3 - F stage (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001). Serum IGFBP-3 levels were highest at the SMI 9 - 10 and MP3 - I stage and lowest at the SMI 1 - 3 and MP3 - FG stage (&lt;i&gt;p&lt;/i&gt; = 0.010, 0.030). As a result of Pearson correlation analysis, a relatively high correlation was found between skeletal maturity using the SMI and MP3 stages and serum IGF-1 levels (&lt;i&gt;r&lt;/i&gt; = 0.698, 0.622, &lt;i&gt;p&lt;/i&gt; &lt; 0.0001). According to the results of this study, serum IGF-1 levels can be used as an auxiliary measure to evaluate the skeletal maturity of children and adolescents in dentistry. The range from the mean serum IGF-1 level of 472 µg/L in SMI 6 stage to the mean IGF-1 level of 510.63 µg/L in MP3 G stage could be considered as the peak height velocity in clinical practice.

The Correlation between Quantitative Cervical Vertebral Maturation and Mandibular Dimensions in Children Aged 8-16 Years: A Cross-Sectional Analytical Study

Background: During growth modification, the mandible plays a crucial role in functional orthopaedic treatment. To maximize the efficacy and efficiency of functional appliance therapy, one must know when to initiate treatment. To maximize the efficacy and efficiency of functional appliance therapy, one must know when to initiate treatment. To accurately determine when to initiate functional appliance therapy, the contemporary maturity indicators utilised are subjective with poor reproducibility and validity. Quantitative cervical vertebral maturity indicators are quantitative with good reproducibility. Objective: To determine the correlation between quantitative cervical vertebral maturation and mandibular dimensional changes in 8–18-year-old growing children. Material and Method: In this prospective cross-sectional analytical study, 164 samples were employed with an age range of 8–18 years. Samples were divided into four groups as per the quantitative cervical vertebral maturity indicator. Pubertal staging was analysed utilising the Li Chang, et al. method on a lateral cephalometric radiograph, and mandibular dimensions were measured as the total mandibular length of a condylon-gnathion line, the height of the mandibular ramus from the condylon-gonion intersection line, and the length of the mandibular body from the gonion intersection-gnathion line. Statistical Analysis: The data obtained was analyzed using Statistical Package for the Social Sciences (SPSS) software; descriptive statistics, student t test and bivariant analysis were applied. Results: The mean total mandibular length was seen at its maximum in periods of high acceleration velocity. Intergroup analysis shows significant differences between the groups, and there is a strong correlation between maturational stage and mandibular dimensional change. Conclusions: During functional orthopaedic treatment planning, the mandible can be utilised as a skeletal maturity indicator.

Evaluation of Cervical Vertebral Maturation Angular Measurements as a Tool to Assess Skeletal Maturity: A Radiological Study.

The purpose of the present research was to evaluate the comparison between the Skeletal Maturation phases of Fishman's hand-wrist skeletal maturation index (SMI) and cervical vertebral maturation angle (CVMA). Assessment and comparison of Skeletal Maturation utilizing the hand-wrist bone radiograph by Fishman's system of skeletal maturation indicator (SMI), cervical vertebra maturation stages (CVMS), and lateral cephalogram by cervical vertebral maturation angle (CVMA) conducted on 150 subjects (75 male and 75 female). Chi-square was used to reveal the significance of study parameters on a categorical scale between SMI, CVMS, CVMA, and multiple regression analysis conducted to envisage the connotation of the dependent variable. Multiple regression analysis models exhibited 61.9% of the variance for CVMA with autonomous variables. In multiple regression analysis, there is no substantial association (P > 0.05) between age and CVMA. The correlation of SMI and CVMA values utilizing Pearson's correlation coefficient for males and females presented positive association with R value of 0.801 for males and 0.834 for females and a P value of < 0.001. As compared to other maturity indicators like hand and wrist, cervical vertebral angular measurements were reliable enough for assessing the degree of skeletal maturation.

Using artificial intelligence models to evaluate envisaged points initially: A pilot study.

The morphology of the finger bones in hand-wrist radiographs (HWRs) can be considered as a radiological skeletal maturity indicator, along with the other indicators. This study aims to validate the anatomical landmarks envisaged to be used for classification of the morphology of the phalanges, by developing classical neural network (NN) classifiers based on a sub-dataset of 136 HWRs. A web-based tool was developed and 22 anatomical landmarks were labeled on four region of interests (proximal (PP3), medial (MP3), distal (DP3) phalanges of the third and medial phalanx (MP5) of the fifth finger) and the epiphysis-diaphysis relationships were saved as "narrow,""equal,""capping" or "fusion" by three observers. In each region, 18 ratios and 15 angles were extracted using anatomical points. The data set is analyzed by developing two NN classifiers, without (NN-1) and with (NN-2) the 5-fold cross-validation. The performance of the models was evaluated with percentage of agreement, Cohen's (cκ) and Weighted (wκ) Kappa coefficients, precision, recall, F1-score and accuracy (statistically significance: p < 0.05). Method error was found to be in the range of cκ: 0.7-1. Overall classification performance of the models was changed between 82.14% and 89.29%. On average, performance of the NN-1 and NN-2 models were found to be 85.71% and 85.52%, respectively. The cκ and wκ of the NN-1 model were changed between -0.08 (p > 0.05) and 0.91 among regions. The average performance was found to be promising except the regions without adequate samples and the anatomical points are validated to be used in the future studies, initially.

Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation.

Growth measurement has always been essential to identify the best time to employ orthopedic or orthodontic appliances. Optimal timing for orthodontic treatment is strictly linked to the identification of periods of craniofacial growth when treatment is more effective.The aim of this study was to compare two different methods, middle phalanx maturation (MPM) and cervical vertebrae maturation (CVM), used to evaluate the stage of facial growth. The research data was collected from July 2018 to April 2019 at the Dental Clinic of the San Gerardo Hospital in Monza. The study included a sample of 98 patients-46 males and 52 females. For each patient, a latero-lateral teleradiography of the skull and an X-ray on the middle finger of the right hand were obtained.The statistical analysis of the comparison of the stages of skeletal maturation obtained by the MPM and CVM methods was performed using the correlation coefficient for ranks of Spearman. A descriptive statistical analysis of the entire sample of 98 patients was performed (mean age of 12.2 years and median of 12.2 years). The average age of females in every single stage of MPM was significantly lower than the average age of males. Of the total sample, 87 patients (88.8%) showed complete agreement between the two methods. The results obtained from the statistical analysis of this study allowed us to confirm a satisfactory agreement between the two methods.The intermediate phalanx method is a valid and alternative indicator to CVM for the identification of the puberty growth peak. We can, therefore, consider the MPM method a valid indicator of skeletal maturity. Mirabelli L, Bianco E, Pigato G, et al. Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation. Int J Clin Pediatr Dent 2023;16(2):327-332.

Prediction of Fishman’s skeletal maturity indicators using artificial intelligence

The present study aimed to evaluate the performance of automated skeletal maturation assessment system for Fishman’s skeletal maturity indicators (SMI) for the use in dental fields. Skeletal maturity is particularly important in orthodontics for the determination of treatment timing and method. SMI is widely used for this purpose, as it is less time-consuming and practical in clinical use compared to other methods. Thus, the existing automated skeletal age assessment system based on Greulich and Pyle and Tanner-Whitehouse3 methods was further developed to include SMI using artificial intelligence. This hybrid SMI-modified system consists of three major steps: (1) automated detection of region of interest; (2) automated evaluation of skeletal maturity of each region; and (3) SMI stage mapping. The primary validation was carried out using a dataset of 2593 hand-wrist radiographs, and the SMI mapping algorithm was adjusted accordingly. The performance of the final system was evaluated on a test dataset of 711 hand-wrist radiographs from a different institution. The system achieved a prediction accuracy of 0.772 and mean absolute error and root mean square error of 0.27 and 0.604, respectively, indicating a clinically reliable performance. Thus, it can be used to improve clinical efficiency and reproducibility of SMI prediction.

Comparison of three-dimensional maxillary growth across spheno-occipital synchondrosis maturation stages

BackgroundThis study aimed to three-dimensionally compare the maxillary growth among the spheno-occipital synchondrosis (SOS) maturation stages in both genders.MethodsThis is a cross-sectional study of a retrospective type in which cone-beam computed tomography (CBCT) images of 500 patients aged 6 to 25 years (226 males and 274 females) were analyzed. The SOS was evaluated using the four-stage scoring system; completely open, partially fused, semi-fused, or completely fused. The SOS scoring and three-dimensional cephalometric measurements were analyzed by Invivo 6.0.3 software. Descriptive and analytical statistics were performed and a P-value < 0.05 was considered statistically significant.ResultsThere was a statistically significant difference in maxillary measurements among SOS maturation stages in both genders (P < 0.05). The mean differences in the maxillary growth among the SOS maturation stages between SOS stages 2 and 3 were higher than those between stages 1and 2 and stages 3 and 4 for maxillary length and height in both genders. However, the mean difference in the maxillary width was higher between SOS stages 1 and 2 than those stages 2 and 3 and stages 3 and 4. On other hand, there may be lesser maxillary growth between SOS stages 3 and 4 for maxillary width, length (in males), and height. The growth curves showed high active growth of the maxilla as the SOS was still fusing (especially stage 2 and 3) than those of the fused (stage 4). Moreover, the acceleration of growth occurred earlier in females than males regarding chronological age but not for SOS maturation stages.ConclusionsThe SOS maturation stages are valid and reliable maxillary skeletal maturation indicators for three-dimensional maxillary growth in both genders.

Relationship between skeletal maturity indicators and dental calcification stages in a sample pediatric population.

Human growth shows considerable variation. In addition to constitutional differences in the timing of maturation, there are diseases, systemic disorders and environmental factors that may affect a child's physiologic maturity. Interrelationships among skeletal, somatic and sexual maturity have been shown to be consistently strong. The study was conducted to evaluate the relationship between dental calcification stages and skeletal maturity indicators. The hand wrist radiographs, the lateral cephalogram and the orthopantomogram (OPG) of 120 patients (60 males and 60 females, age group 8-14 years) were taken. The hand wrist radiographs were analyzed using Fishman's skeletal maturity index (SMI), and the cephalograms analyzed by cervical vertebrae maturation (CVM) by Baccetti. OPG was analyzed according to the Demirjian's system. On assessment, cervical vertebrae maturation indicator (CVMI) staging showed significant results with a correlation coefficient of 0.716 being the highest in canines in males while assessment of dental calcification stages and its comparison with skeletal maturity indicator showed insignificant results. The correlation coefficient values were 0.11, 0.09, 0.09 and 0.13 for canine, first premolar, second premolar and second molar respectively. There is a strong correlation between the maturation stage of cervical vertebrae and calcification stages of canine, first premolar, second premolar and second molar as determined by Demirjian's method.

Reliability of salivary biomarkers as skeletal maturity indicators: A systematic review

To assess the reliability of different salivary biomarkers as skeletal maturity indicators when compared with other methods of skeletal maturity assessment. A comprehensive search was conducted on three electronic databases: PUBMED, Google scholar and Cochrane library for the articles published from 2000 to July 2021. Assessment of skeletal age on the basis of levels of different salivary biomarkers at different pubertal stages was considered as the primary outcome. Electronic search, data collection and risk of bias assessment were performed by two authors with conflict resolution by the third author. Total 158 articles were retrieved after screening of titles, abstracts and full texts of all articles, of which 15 articles were selected for qualitative synthesis. All these studies were cross-sectional in design. These studies compared the levels of different salivary biomarkers as Alkaline Phosphatase (ALP), Insulin-like Growth Factor - I (IGF-I), Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), Cortisol, Indian Hedgehog (IHH) protein and Dehydroepiandrosterone sulphate (DHEAS) with other methods of skeletal age estimation. Out of these six biomarkers salivary IGF-1 is a reliable indicator for skeletal maturity assessment. The current evidence suggests that salivary biomarkers can be used as an adjunct for growth prediction during orthodontic treatment planning along with other methods of skeletal maturation assessment. Still there is need for further research with longitudinal studies in this field.

Indicators of skeletal maturity using biochemical and radiographical markers: A review of literature

Skeletal maturation can occur at different ages in each person; diagnosing and predicting skeletal maturation time is very important in orthodontic treatments. Therefore, many methods have been introduced to help diagnose more accurately and at a lower cost. The primary aim of this review is to provide a summary of several methods which are used to determine the skeletal maturity stage.