Skeletal Maturity Indicators Research Articles

Assessment of Midpalatal Suture Maturation by Skeletal Maturity on Hand Wrist Radiographs

The aim of this retrospective study was to evaluate the correlation between the midpalatal suture maturation and skeletal maturation in growing children aged 7 - 15 years and predict the maturational stages of the midpalatal suture corresponding to skeletal maturity assessed by the skeletal maturation indicators (SMI) and middle phalanx of the third finger (MP3) stages. The group of this retrospective study was consisted of randomly selected 132 male and 135 female in age from 7 - 15 years. The maturation of the midpalatal suture was evaluated by using images from cone-beam computed tomography (CBCT) while the skeletal age was assessed by hand-wrist radiography. CBCT images and hand-wrist radiographs used in this study were obtained from all subjects for orthodontic diagnosis before orthodontic treatment. The maturational stages of the midpalatal suture showed strong correlations with both SMI and MP3 stages. The correlation between the midpalatal suture maturation and SMI (Spearman’s correlation coefficient, ϒ<sub>S</sub> = 0.905, <i>p</i> < 0.05) was slightly greater than that of MP3 stages (ϒ<sub>S</sub> = 0.830, <i>p</i> < 0.05). There was a positive significant correlation between the midpalatal suture maturation and chronological age (ϒ<sub>S</sub> = 0.868,<i>p</i> < 0.05). CBCT for evaluation of the midpalatal suture maturational stages may be unnecessary in every pediatric patients because SMI and MP3 stages were both replaceable useful methods for assessing maturation of the midpalatal suture before orthopedic treatment. In this retrospective study, the diagnostic reliability of the SMI method for estimating midpalatal suture maturation showed better reliability than the MP3 method.

Identification of dental calcification stages as a predictor of skeletal development phase.

ABSTRACTObjective: This study aimed to establish a correlation between the stages of tooth calcification of mandibular canines and second molars with the phases of skeletal development. Methods: In a consecutive series of panoramic, cephalometric and hand-wrist radiographs of 113 individuals (60 females and 53 males) with an average age of 12.24 ± 1.81 years, the stages of mandibular canine and second molar calcification, cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI) were classified. The variables were correlated by means of the Spearman’s Rank test: chronological age, SMI, CVMI and tooth calcification stages. In order to assess whether the CVMI and tooth calcification stages were significant predictors of the SMI, an ordinal regression analysis was carried out. Results: The stages of CVMI (OR = 16.92; CI 95% = 6.45-44.39; p< 0.001) and calcification of the second molars (OR = 3.22; CI 95% = 1.50-6.92; p= 0.003) were significant predictors of SMI, however similar result was not observed for canines (OR = 0.52, CI 95% = 0.18-1.54; p= 0.239). Calcification stage E for boys, and E and F for girls corresponded to the pre-peak phase of pubertal growth. Stages G and H for boys, and F and G for girls coincided with peak of growth. In the final growth phase, the majority of second molars presented with root apex closure (stage H). Conclusion: The stages of calcification of the second molar may be considered predictors of the stage of skeletal development in the population studied.

Correlation between Insulin-Like Growth Factor I and Skeletal Maturity Indicators.

Objective: The purpose of this study was to evaluate the correlation between the growth maturity indicators in orthodontic patients. Design: This cross-sectional study was performed on 37 orthodontic patients (17 males and 20 females). An anamnesis, clinical and image examination, and blood sample collection were performed. The inclusion criteria were non-syndromic Class II patients of both gender, age ranging between 10 to 16 years. The lateral cephalometric radiographs were evaluated using 6-stage cervical vertebrae maturation (CVM) technique. The hand-wrist radiographs were staged using the 11-stage skeletal maturation indicator (SMI) technique. Blood was collected in the same week of the images to quantify IGF-1 levels in serum. Data were tested for normality by Shapiro–Wilk test. The Pearson test was used to determine the correlation strength between the variables (alpha of 5%). Results: A strong correlation was observed only between SMI stages and CVM stages in the total sample (r=0.864; p<0.0001) and according to the gender (r=0.793; p<0.0001 for females; and r=0.753; p<0.0001 for males). IGF-1 was only moderately correlated with SMI stages and CVM stages. Conclusion: Hand-wrist and cervical vertebral stages were strongly correlated among them, however, IGF-1 was only moderately correlated with both skeletal maturity indicators.

Correlation between chronological age and skeletal age using cvmi and modified MP3 methods.

Chronological age conveys only a rough approximation of the maturational status of a person whereas skeletal maturity indicators give a more accurate estimation. Therefore, it is of interest to document the correlation between chronological and skeletal age using CVMI and modified MP3 methods. A total of 39 subjects between the age ranges of 9-16 years were selected for this study. Pre-treatment lateral cephalograms and hand-wrist radiographs of the subjects were used. The skeletal age was analyzed by the Cervical Vertebrae Maturity Index (CVMI) and modified MP3 methods. The data was analyzed with SPSS software version 23.00. Kendall's Tau correlation test was performed to estimate the correlation between chronological age and skeletal age among the subjects and a linear regression test was also performed. Positive correlation was found between chronological age and skeletal age assessed by CVMI method (r= 0.398) and modified MP3 method (r=0.382) with p value >0.003. Thus it can be concluded that there was a positive correlation between chronological age and skeletal age among all the subjects.

Evaluation of relationship between chronological age cervical vertebrae maturation index method and canine calcification stages for the assessment of optimal treatment timing in orthodontic patients

Introduction: The study was undertaken to evaluate the reliability of cervical vertebrae as skeletal age maturation in response to chronological age and evaluate the relationship between DEMIRIJAN system of mandibular canine calcification and cervical vertebral maturation as a clinical method for skeletal maturation indicator. Materials and Methods: 120 children (60 females and 60 males) were randomly selected in the age range of 8-14 years. Results: 23.3% of males showed E stage of (canine calcification stage) CCS and stage II of cervical vertebral maturation (CVM), 16.6% showed F stage of CCS and stage III of CVM, 13.3% showed stage G of CCS and Stage III of CVM 8.3% showed stage G of CCS and stage IV of CVM. 13.3% of females showed E stage of CCS and stage II of CVM, 13.3% showed F stage of CCS and stage III of CVM, 16.67% showed stage G of CCS and Stage III of CVM, 15% shows stage G of CCS and stage IV of CVM,. Conclusions: The correlation values between the Chronological age, dental calcification stages and cervical vertebrae maturation method were high. Attaining of maturity in canine calcification and cervical vertebrae maturational stages was ahead in females when compared to males. Keywords: Cervical vertebrae, Cephalometrics, Canine calcification.

Computerized method for calculating cervical vertebral maturation

For Helm, "the rhythm of facial growth often governs the course of orthodontic treatment". The moment of treatment is an important dimension for our therapy to last a minimum of time with a greatest chance of success and stability. This notion of processing time is a daily requirement in our practices. The radiographs of the wrists will gradually disappear according to the ALARA principle, since we can in a single irradiation, via the profile radiography, have sufficient information to situate the patient on its growth curve. The vertebral stages are good biological indicators of individual skeletal maturity but their interpretation remains difficult. In this work, a computerized method was used to determine the stage of vertebral maturation in a reliable and reproducible manner. In this study, 15young boys and 15young girls (total 30patients) were included, 12,2years old on average with a standard deviation of 2,6years. To determine the skeletal age of these patients, the practitioner made an hand-wrist x-ray and, for diagnostic reasons, he also made a profile radiography the same day. The patients who didn't made an hand-wrist x-ray were excluded. The vertebral computerized method seems to be a reliable method to be used in orthodontic practices. Other studies would allow to use this method for average ages, gender-appropriate.

Parathyroid Hormone Related Protein - A Skeletal Biomarker – A Review

The discovery of Parathyroid hormone-related protein (PTHrP) was through its structural and functionalhomology with parathyroid hormone. It is secreted by cancers and it interacts with parathyroid hormonereceptors in kidney and bone to cause humoral hypercalcemia of malignancy and paraneoplastic syndrome andplays an important role in cellular differentiation and proliferation, embryonic development, transepithelialcalcium transport and in the regulation of smooth muscle contraction.Its intracrine, paracrine and endocrinemodes of action play a central role in organogenesis and drives numerous physiologic and pathologicconditions.It is initially translated as a preprohormone which is posttranslationally processed to yield afamily of mature secretory forms. The aminoterminal portion of the molecule is homologous to parathyroidhormone.As PTHrP plays a vital role in the regulation of endochondral bone development it was surmisedthat it could also serve as an ideal biologic skeletal maturity indicator to detect peak pubertal growth spurt.

Are Dental Maturation, Skeletal Maturation, and Chronological Age Associated With Complete Cleft Lip and Palate?

The relationship between dental and skeletal development levels was determined in individuals with cleft lip and palate and a control group comprising individuals without cleft lip and palate. Retrospective, cross-sectional study. A university clinic specializing in orthodontic and pedodontic care. A total of 198 patients with cleft lip and palate (99 females, 11.66 ± 2.36 years; 99 males, 12.44 ± 2.33 years) and 198 patients without cleft lip and palate (99 females, 11.88 ± 2.26 years; 99 males, 12.99 ± 2.25 years). None. The Demirjian method and cervical vertebra maturation method were used to evaluate panoramic and lateral cephalometric radiographs, respectively. The Fishman maturation predictors were determined from hand-wrist radiographs. Statistically significant correlations were found between the chronological age and the dental age in both the groups (P < .05). Significant correlations between skeletal maturation indicators and dental maturation indicators were observed in both groups and sexes (P < .05), with a stronger correlation among teeth with incomplete dental maturation. Dental age was found to be significantly lower (female, P = .001; male, P = .001) in individuals with cleft lip and palate (female, 11.71 ± 2.58 years; male, 12.51 ± 2.62 years) compared to those in the control group (female, 12.95 ± 2.47 years; male, 13.64 ± 2.37 years). A high correlation between the results of the evaluated radiographic methods and chronological age supports their use for accurate age estimation in the patients with cleft lip and palate.

Assessment of Relationship Between Insulin-Like Growth Factor- 1 Levels And Mp3 Radiographs in Determining Skeletal Maturity

Context: The clinical importance of evaluating skeletal maturation has long been recognized by the health professions. Skeletal maturation is an integral part of individual patterns of growth and development.With many orthodontic patients, pubertal growth needs to be factored into the diagnostic equation.Accurate prediction of the timing of the pubertal growth spurt and the amount of remaining growth affects the treatment decisions in orthodontics, orthognathic surgery and dental implantology.IGF-1 mirrors growth hormone levels. Thus, IGF-I might be a good indicator of residual mandibular growth. Aims: To establish a relationship between IGF-1 levels evaluated from blood samples and MP3 stages of skeletal maturity. To investigate the relationship between the IGF-1 and the skeletal age. Methods and Material: The sample size consisted of 40 subjects between the age group of 5 – 25 including both the sexes. The periapical radiographs for MP3 and blood sample for IGF-1 was collected. Sample was sent to the lab to determine IGF-1 values. Statistical analysis used: Descriptives, ONE way ANOVA, POST HOC test, Spearman coefficient. Results: Results showed that IGF-1 levels at the peak pubertal growth were statistically higher than the start of pubertal growth, acceleration, deceleration, maturation of growth spurt and on completion of growth. There was statistically significant positive correlation between IGF-1 and MP3 stages. Conclusions: From the present study it can be concluded that IGF-1 can be successfully used as a skeletal maturity indicator. Key-words: IGF-1, MP3, GH Key Messages:The results of this study shows that mean IGF-I levels at pubertal and post pubertal stages were significantly higher than at the other stages. From the present study it can be concluded that IGF-1 can be successfully used as a skeletal

Evaluation of cephalometric characteristics and skeletal maturation of the cervical vertebrae and hand-wrist in girls with central precocious puberty.

ObjectiveThis study aimed to evaluate the differences in cephalometric characteristics and skeletal maturation in girls with central precocious puberty (CPP) via lateral and hand-wrist radiographs. We also aimed to identify the indicators that are most effective for determining skeletal maturity in these patients.MethodsThe study included 70 Korean girls (mean age, 8.5 ± 0.5 years) diagnosed with CPP at the Department of Pediatrics, and 48 normal healthy age-matched girls who visited the Department of Orthodontics and had no history of hormone treatment or growth problems. Skeletal maturation was evaluated using lateral cephalometric and hand-wrist radiographs using cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI).ResultsThe mean mandibular plane angle was smaller in the CPP group than in the control group (35.8° ± 4.9° vs. 39.0° ± 6.5°), resulting in greater posterior facial height (p = 0.003). SMI was significantly greater in the CPP group (3.5 ± 1.4 vs. 2.0 ± 1.0) than in the control group (p = 0.001) and was significantly associated with CPP (r = 0.492; p = 0.001), whereas CVMI was not.ConclusionsIn comparison with the control group, the CPP group exhibited a smaller mandibular plane angle, greater posterior facial height, and greater skeletal maturation. SMI may be more suitable than CVMI for determining skeletal maturation in CPP. Hand-wrist radiography is recommended in addition to lateral cephalogram for predicting growth in girls with CPP.

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English

Assessing the accuracy of Cameriere\u2019s Indian-specific formula for age estimation on right and left sides of orthopantomogram

BackgroundAge estimation is of prime importance in forensic science and clinical dentistry. In children, age estimation can be done by skeletal maturity indicators like hand-wrist radiographs and dental age estimation. Skeletal maturity indicators compared with dental age estimation is limited as they are influenced by various environmental parameters, whereas calcification of teeth depends on genes rather than environmental factors. Many of the dental age estimation methods use extracted teeth, which are quite invasive, whereas Cameriere’s method is a recently introduced radiographic method first in European population; where in age estimation is done using open apices of teeth by orthopantomogram (OPG). Indian-specific formula was introduced later using permanent mandibular teeth on left side of jaw. The present study aimed to estimate the age and also to determine the accuracy of Cameriere’s method using Indian-specific formula on both right and left sides of mandible in Khammam population of South India and also to determine the side which can be efficient in determining age.MethodologyThe present study comprised radiographs of 50 subjects (25 boys and 25 girls) ranging from 5 to 15 years. The soft copies of the radiographs of selected subjects were retrieved from the computer attached to the digital orthopantomogram machine (Orthophos XG5; Sirona Dental Systems). The 7 left and right permanent mandibular teeth were assessed in OPGs. The number of teeth with closed apical and with open apical ends of roots was examined and measured. The values were tabulated based on the Cameriere method of age estimation using Indian-specific formula. Statistical analysis was done using paired t test and Karl Pearson’s correlation coefficient test.ResultsComparison of dental age with chronological age in males showed non-significant results on both left and right sides of the OPG with a p value of 0.3765 and 0.3045, respectively. Likewise in females, p values of 0.2167 and 0.8089 were noted. When males and females were compared, non-significant results were obtained with a p value of 0.1613 in the age estimated on the left side of the OPG and a p value of 0.4322 on the right side of the OPG. Correlation test showed that left side of the OPG showed better results in determining age than the right side of the OPG with an r value of 0.9982 and 0.9485 in males and females, respectively.ConclusionCameriere’s method of age estimation using Indian-specific formula proves to be an accurate and a reliable method which can be used to assess the chronological age of individuals. There is also a good correlation found between the chronological age and dental age of younger age group individuals.

Mandibular Canine Calcification Stages as an Indicator of Skeletal Maturity.

ABSTRACTAims:The aim of this study was to verify whether there is significant relationship between stages of mandibular canine calcification and skeletal maturation and to determine whether the same can be used as a reliable diagnostic aid to assess skeletal maturity.Materials and Methods:The sample consisted of 50 males and 50 females aged between 8 and 15 years. Two radiographs namely orthopantomograph and handwrist radiograph were taken for this study. Skeletal age was ascertained from handwrist radiographs according to the method introduced by Fishman L.S. The developmental stages of mandibular canine were assessed according to Demirjian’s stages of dental calcification.Results:The relationship between canine stage calcification and skeletal maturity index was statistically significant in all stages.Interpretation and Conclusion:Mandibular canine calcification stages can be recommended as a supplemental diagnostic aid. Similar studies may be conducted in different population to rule out any possible racial and regional influences on growth characteristics.

A Comparison of Accuracy of Skeletal Maturity Indicators Using Cone-beam Computed Tomography, Lateral Cephalogram, and Hand-wrist Radiograph in Circumpubertal Dravidian Population

A Comparison of Accuracy of Skeletal Maturity Indicators Using Cone-beam Computed Tomography, Lateral Cephalogram, and Hand-wrist Radiograph in Circumpubertal Dravidian Population

Correlation between Chronological Age, Cervical Vertebral Maturation and Fishman’s Skeletal Maturity Indicators in Central India Population

Introduction: Skeletal maturity indicators are very important indicators when diagnosing and panning the treatment in growing population. Cervical Vertebrae Method (CVM) and Fishman’s Skeletal Maturity Indicators are two commonly used methods for the diagnosis and treatment planning. The aim of the study was to investigate the correlation between cervical vertebral maturation (CVM)and Fishman’s hand-wrist skeletal maturity indicator and chronological age by including subjects within the range of circumpubertal growth spurt in Central India.&#x0D; Materials &amp; Method: One Twenty Five contemporary hand-wrist and lateral cephalometric radiographs from population of Central India were randomly selected and analyzed. All subjects were within the circumpubertal period i.e. female subjects were between 10 and 15 years of age, and the male subjects were between 12 and 17 years of age. The hand-wrist bone analysis was evaluated using the method developed by Fishman whereas cervical vertebra bone analysis was evaluated using the method developed by Baccetti and co-workers. These two methods and chronological age were correlated using the Spearman rank correlation analysis.&#x0D; Result: CVM was significantly correlated with hand-wrist maturation (r=0.8868). However low correlation was found between the CVM and chronological age( r =0.7139) and little correlation was found between the HWM and chronological age ( r =0.6892).&#x0D; Conclusion: CVM is a valid indicator of skeletal growth during the circumpubertal growth period and has a high correlation with the HWM for the Central India population. However chronological age is not suitable to measure skeletal maturity as shown by the low correlations found between the chronological age and both CVM and HWM.

Insulin Like Growth Factor-1―A Skeletal Maturity Indicator―A Review

In orthodontic treatment planning decisions assessment of growth status plays a vital role and that the adolescent growth spurt is considered an ideal time to mete out growth modification therapy. Various radiologic and non-radiologic skeletal maturity indicators have been in use with its attendant advantages and disadvantages. Insulin like Growth Factor-1 (IGF-1) is one such non-radiologic biomarker that could be used to estimate the amount of available growth present to help treat jaw discrepancies in the circumpubertal period of growth as the mean levels of it has been reported to be high during cicumpubertal growth. Internationally peer reviewed and valid indexed reference articles pertaining to IGF-1 and its predictive usefulness in estimating the peak pubertal growth spurt used alone or in combination with the other radiologic skeletal maturity indicators was segregated and diligently perused. Information gleaned from the literature review revealed that IGF-1 was indeed effective in assessing the circumpubertal growth spurt. It had a high correlation with the cervical stages C3 and C4 as seen on lateral cephalograms as also with the stages pertaining to peak pubertal growth as seen on handwrist radiographs and middle phalanx 3 (MP3) on periapical x-rays. IGF-1 was an effective and alternative biomarker for estimation of peak pubertal growth spurt used alone or in combination with the other radiologic biomarkers.

Osteocalcin as a Skeletal Maturity Indicator:A Review

Bone mineral metabolism helps in understanding the sequence of boneloss and bone remodeling and in identifying those persons at risk from osteoporosis. One of the approaches that has yielded useful information is the examination of the role of collagenous and noncollagenous bone proteins in bone mineral metabolism. Osteoblasts are the cells responsible for new bone formation, and osteoclasts the cells for resorption. Osteocytes are derived from osteoblasts but their function although not precisely established probably involves calcium homeostasis and bone cell destruction comparable to osteoclastosis. The term remodeling or bone turnover refers to the sequential processes of resorption and subsequent formation for maintenance of mineral homeostasis. In normal man this remodeling cycle occurs at a particular site about every 3 months. The osteoclasts and osteoblasts which are responsible for remodeling appear to be anatomically linked or coupled in equilibrium. Osteocalcin (OC) acts as a regulator of bone mineralization. It also regulates osteoblast and osteoclast activity. This review article lays emphasis on the structure and interaction of OC with various other molecules; its skeletal effects and therapeutic applications.

Diagnostic performance of eruption stages for identification of skeletal maturity.

Objectives:To investigated the diagnostic performance of circumpubertal eruption stages which identify skeletal maturity stages using the cervical vertebral maturation (CVM) method in a Saudi population.Methods:This is a retrospective cross-sectional study. Lateral cephalograms, panoramic radiographs, and intraoral pictures of 600 orthodontic patients (284 boys, 316 girls) who met inclusion criteria were assessed. Records were retrieved between January 2016 and April 2018. The diagnostic performance of eruption stages for identifying skeletal maturity was tested with positive likelihood ratios (LHR+).Results:Prevalence of each CVM stage in the eruption stages was reported. For every eruption stage, LHR+ was reported in order to identify every CVM stage. The majority of the LHR+ values were ≤3.5, with a significant value of ≥10 for the identification of the post-pubertal growth stage. The other eruptions stages did not strongly predict skeletal maturity.Conclusion:In treatment planning for cases that require identifying the growth peak, the use of eruption stages is not recommended as an indicator of skeletal maturity except for the early permanent dentition stage where strong diagnostic performance for identifying post-pubertal skeletal growth stage has been shown.

Insulin-like Growth Factor I as a Skeletal Maturity Indicator:

Insulin-like Growth Factor I as a Skeletal Maturity Indicator:

Serum Insulin Like Growth Factor-1– A Skeletal Maturity Indicator for the Assessment of Orthopedic Treatment Timing of Skeletal Class II Malocclusion

Orthodontic treatment planning decisions are dependent on the assessment of growth status. Skeletal maturity could be assessed with various radiologic and non-radiologic biologic markers.The purpose of our study was to investigate the reliability of serum Insulin like Growth Factor – 1(IGF-1) as a skeletal maturity indicator in comparison to the stages in cervical vertebral maturation (CVM). Twenty five subjects with skeletal class II malocclusion in the age range of 11-19 years were recruited for the study. The cervical vertebrae staging was assessed by lateral cephalograms. Blood was collected aseptically and serum was separated. The serum levels of IGF- 1 were quantitatively assessed using a commercial ELISA kit, IGF-1 600 ELISA (DRG Instruments GmbH, Germany). There was a significant decline in the mean IGF-1 levels with increase in age in both the sexes. Statistically significant difference was observed in the concentration of IGF-1 among the different age groups. There was a significant decline in the mean IGF-1 levels with increase in CVM staging from stage 2 to stage 4. IGF-1 could be a more reliable biologic skeletal maturity indicator in comparison to cervical vertebral maturity indicator and thus could predict more accurately the growth status of the mandible to facilitate correction of skeletal class II jaw discrepancies.