Skeletal Maturation Stages Research Articles

Automatic skeletal maturity grading from pelvis radiographs by deep learning for adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spine deformity governed of the spine. A child's Risser stage of skeletal maturity must be carefully considered for AIS evaluation and treatment. However, there are intra-observer and inter-observer inaccuracies in the Risser stage manual assessment. A multi-task learning approach is proposed to address the low precision issue of manual assessment. With our developed multi-task learning approach, the iliac area is extracted and forwarded to the improved Swin Transformer for Risser stage assessment. The spatial and channel reconstruction convolutional Swin block is adapted to each stage of the Swin Transformer to achieve better performance. The Risser stage assessment based on iliac region extraction had an overall accuracy of 81.53%. The accuracy increased in comparison to ResNet50, ResNet101, Uni-former, Next-ViT, ConvNeXt, and the original Swin Transformer by 5.85%, 4.6%, 3.6%, 2.7%, 2.25%, and 1.8%, respectively. The Grad-CAM visualization is used to understand the interpretability of our proposed model. The results show that the proposed multi-task learning strategy performs well on the Risser stage assessment. Our proposed automatic Risser stage assessment method benefits the clinical evaluation of AIS. Project address: https://github.com/xyz911015/Risser-stage-assessment.

The reliability of a modified three-stage cervical vertebrae maturation method for estimating skeletal growth in males and females.

Reliability of the six-stage cervical vertebrae maturation method to evaluate skeletal growth was evaluated on the combined male and female samples and revealed diverse results. The current study aimed to determine the reliability of the modified three-stage cervical vertebrae maturation method for estimating the skeletal growth of males and females. Pretreatment lateral cephalometric radiographs of 137 orthodontic patients were utilized to evaluate the intra- and inter-observer reliability of a modified cervical vertebrae maturation method. Four independent examiners categorized each radiograph into one of the three skeletal growth stages according to the cervical vertebrae morphology: (1) a pre-peak group (combining the CS1 and CS2 stages), (2) a peak group (combining the CS3 and CS4 stages), and (3) a post-peak group (combining the CS5 and CS6 stages). The Kappa index and the Fleiss multirater Kappa test were carried out to determine the reproducibility of this method. The studied sample included cephalometric radiographs of 68 males (49.6%) and 69 females (50.4%) aged between 7 and 58 years; no significant age difference was found between the sexes (p = 0.189). The overall inter-observer reliability was 0.689 (p < 0.001), and the inter-observer reliability for the post-peak stage showed only Kappa = 0.896 (p < 0.001). The Kappa values were significantly greater in males than in females during the peak stage (0.626 and 0.488, respectively). A modified three-stage cervical vertebrae maturation method showed substantial overall inter-examiner agreement; however, differential reliability for diverse skeletal maturation stages and sexes was found.

In-silico evaluation of orthodontic miniscrew-assisted rapid palatal expanders for patients with various stages of skeletal maturation

This study aimed to use a finite element method to assess the stress on the miniscrews, skeletal and dental changes resulting from maxillary expansion using either a tooth-bone-borne (TBB) or a bone-borne (BB) device on patients with various skeletal maturation. Two types of expanders were modeled using SolidWorks. The design of the 2 expanders was similar, with the exception that the BB appliance lacked support for teeth (rods and bands). Both were placed on the palatal bones with the help of 4 miniscrews as bony anchorage. Five skeletal maturation stages were examined using suture maturation classification by Angelieri. A lateral displacement of 0.2 mm was applied to simulate 1 turn of jackscrew per day. The dental and skeletal changes from the treatment were quantified. Stage A sutural maturation exhibited the greatest skeletal movement (0.13 mm/d) with a V-shaped displacement pattern. Stages B and C exhibited a more parallel expansion pattern. Stages D and E exhibited the least amount of skeletal movement with either device. Compared with the BB device, TBB demonstrated greater dental displacement. On average, the BB device exhibited a skeletal-to-dental expansion ratio of 70% from stage A to C compared with 49% with the TBB device. BB device showed more skeletal displacement than TBB, and the latter showed more dental side effects, particularly during stages B and C. The miniscrew-assisted rapid palatal expansion appliance was effective with sutural maturation stages A to C using the classification by Angelieri with a more parallel separation of the midpalatal sutures in stages B and C.

Application of the twin-block appliance combined with braces in the treatment of a patient with distal occlusion

Relevance. Distal occlusion is one of the most frequently encountered anomalies in orthodontic practice among patients with both temporary and permanent dentitions. When selecting a treatment method for this anomaly, it is crucial to consider several significant factors, including the craniofacial stage of skeletal maturity and the type of jaw growth. Special attention should be given to the method of treating patients with incomplete skeletal growth using a twin-block appliance, followed by continued orthodontic treatment with fixed orthodontic appliances (braces).Clinical case description. This article presents a clinical case of treating a patient with distal occlusion in the peripubertal stage of skeletal growth, which is the most optimal for the initial stage of orthodontic treatment.Conclusion. Sequential treatment of distal occlusion during the pubertal growth spurt using a twin-block appliance and braces allows achieving the most physiological jaw relationship, ensuring proper functioning of the dentoalveolar system and harmonious development of the body as a whole.

Protocolo de tratamento ortodôntico em adultos jovens com endognatia maxilar utilizando o expansor rápido palatino ancorado em mini-implante

Introduction: Maxillary endognathia is a skeletal malocclusion that, if left untreated, can evolve into a complex malocclusion, which hinders facial development and creates breathing problems due to nasal constriction. In 2010, Lee and collaborators created a mini-implant-assisted rapid maxillary expansion (MARPE) technique. Objectives: To describe the MARPE protocol and its clinical effects. Materials and methods: A bibliographic search was carried out in the Pubmed, Science Direct, Scielo and Google Scholar databases referring to the last 10 years. Results: The search strategies described enabled 150 articles to be obtained which went through various selection stages. In the end, 15 articles were evaluated and selected for this review. Discussion: The MARPE technique has reduced the skeletal, dento-alveolar and periodontal side effects caused by conventional appliances, optimizing the potential for skeletal expansion in individuals with advanced stages of skeletal maturation. Conclusion: The MARPE appliance has bone and dental anchorage. The clinical effects include the opening of the maxilla in the frontal plane, an increase in the volume of the nasal cavity after expansion, an increase in the interzygomatic distance, an increase in the average width of the face and the width of the alar base and widening of the nose. There was also a decrease in buccal bone thickness and alveolar crest height and a buccal inclination in the premolars and molars. In carrying out this research, we found that there are few or practically no studies on the effect on the pulp cavity, root resorption and orbital volume.

Evaluation of The Relationship Between Dental and Cervical Vertebrae Maturation in Terms of Age Determination

Aim: Age determination is a very important issue in anthropology, forensic science, and dentistry. Today, the most commonly used methods for age determination are the methods in which tooth and bone development are evaluated. This study aims to evaluate the relationship between gender, chronological age, dental maturation, and cervical vertebral maturation in individuals aged 8-25 years. Material and Method: Digital panoramic, lateral cephalometric radiographs of 500 patients aged 8-25 years were used in this study. Cervical vertebra maturation was evaluated using the dental maturation-modified Demirjian classification system of Baccetti et al. Means, minimum, maximum, and standard deviations were calculated and analyzed as descriptive statistics. Kolmogorov-Smirnov, Kappa, Kruskal-Wallis, Chi-Square, Linear Regression, and Spearman Correlation tests were used for statistical analysis. Results: There was a statistically significant difference between chronological age and dental maturation and cervical vertebral maturation levels (p &lt;0.01). While dental maturation levels did not differ significantly according to gender (p&gt; 0.05), cervical vertebra maturation was statistically different (p &lt;0.01). There was a positive correlation between chronological age and dental maturation, and cervical vertebral maturation levels (p &lt;0.01). There was a strong correlation between dental maturation and cervical vertebral maturation levels (p &lt;0.01). Conclusion: The findings of this study showed that skeletal maturity increased with the increase in chronological and dental age for both genders. The earlier formation was consistently observed for each stage of skeletal maturation in females. All correlations between skeletal and dental maturations were statistically significant.

Assessment of mandibular trabecular structure and cervical vertebral maturation using fractal analysis.

Changes in bone trabeculae occur during skeletal maturation. Fractal analysis is a technique for assessing changes in the internal structure of the bone. The aim of this study was to investigate correlation of bone trabeculation measured on panoramic and lateral cephalometric radiographs with cervical vertebral maturation stages (CVMS). CVMS was evaluated on lateral cephalometric radiographs of 120 individuals aged 6 to 18 years. The subjects were divided into 6 groups (n= 20 each) according to CVMS. On panoramic and lateral cephalometric radiographs, fractal dimension (FD) analyses were performed in mandibular corpus, gonial and condylar regions and cervical vertebral bodies (C2, C3, C4). FD measurements from the mandibular corpus region bilaterally and C2-C4 vertebral bodies showed significant positive correlations with CVMS (r= 0.418, r= 0.412, r= 0.324, r= 0.304, r= 0.263, respectively). Significant differences were found in the FD values of the right/left mandibular corpus and C2 and C3 vertebrae compared to CVMS (P< 0.001, P< 0.001, P= 0.005, P= 0.019, respectively). Significant positive moderate correlations between the FD values of the right and left mandibular corpus and CVMS suggest that fractal analysis may be useful in determining skeletal maturity stage. The significant FD values obtained from the right/left mandibular corpus, and C2 and C3 vertebra indicate that the complexity of the internal trabecular structure increases with maturation.

Entheseal variation and locomotor behavior during growth.

Entheses are acknowledged as skeletal markers capable of revealing several biological and behavioral aspects of past individuals and populations. However, entheseal changes (ECs) of juvenile individuals have not yet been studied with a systematic approach. This contribution aims at investigating the morphological changes occurring at the femoral insertion of the gluteus maximus and tibial origin of the soleus muscles to highlight a potential link between the morphological features of those entheses and skeletal maturity in relation to sex, age, and locomotor developmental patterns. The sample consisted of 119 skeletons (age-at-death: 0-30 years) belonging to the Documented Human Skeletal Collection of the Certosa Cemetery (Bologna, Italy). The entheseal variation during the last stages of skeletal maturation in young adults was assessed using existing recording standards. A recording protocol for each enthesis was developed for immature individuals to subdivide the morphological variability into discrete categories. Univariate, bivariate, and multivariate statistical analyses were performed to investigate the variation of entheseal morphologies and measurements in relation to bone metrics, degree of epiphyseal closure, sex, age, and locomotor developmental patterns. A statistically significant relationship was observed between ECs morphological patterns and age for both entheses, while sexual differences were negligible. A relationship between ECs morphological pattern and locomotor milestones emerged only for the gluteus maximus. Even though further testing is needed on other documented skeletal collections, our protocol could be usefully applied in forensic and archaeological fields and serving as important reference for evolutionary investigations.

Adolescent idiopathic scoliosis: is there a relationship between Risser staging and the proximal humerus ossification system?

To evaluate whether there is a mismatch between Risser staging and the proximal humerus ossification system (PHOS); and to analyze the correlation in the skeletal maturity stages between the two humeral epiphyses. Data from patients aged 10 to 18years with adolescent idiopathic scoliosis (AIS) seen between 2018 to 2021 were analyzed. In an anteroposterior (AP) spine radiograph the ossification process was evaluated using the Risser classification method and bilateral PHOS (if both humeral epiphyses were visualized). A mismatch between methods was defined as a Risser 0-1 (relatively skeletally immature) with a PHOS 4-5 (skeletally mature), or a Risser 2-5 (relatively skeletally mature) with a PHOS 1-3 (skeletally immature). The McNemar test was used to calculate the significance of the mismatch. A mismatch between Risser and PHOS stages was observed in 28.5% of 105 patients, which was statistically significant (p < 0.001). Of the 49 patients with a Risser 0-1, 55.1% (n = 27) had a PHOS 4-5. None of the patients with a Risser 2-5 had a PHOS 1-3. In the 47 patients in whom both humeri were visualized, the absolute correlation between the left and right PHOS values was 95.7%. Of AIS patients who are relatively skeletally immature according to Risser staging, more than half may be skeletally mature when measured with PHOS. In patients with a Risser 0-1, it is recommended to measure skeletal maturity in an AP spine radiograph using the PHOS method, which may more accurately guide treatment decision-making, without the need to visualize both humeral epiphyses in this radiographic projection. IV.

Radiological age assessment based on clavicle ossification in CT: enhanced accuracy through deep learning

BackgroundRadiological age assessment using reference studies is inherently limited in accuracy due to a finite number of assignable skeletal maturation stages. To overcome this limitation, we present a deep learning approach for continuous age assessment based on clavicle ossification in computed tomography (CT).MethodsThoracic CT scans were retrospectively collected from the picture archiving and communication system. Individuals aged 15.0 to 30.0 years examined in routine clinical practice were included. All scans were automatically cropped around the medial clavicular epiphyseal cartilages. A deep learning model was trained to predict a person’s chronological age based on these scans. Performance was evaluated using mean absolute error (MAE). Model performance was compared to an optimistic human reader performance estimate for an established reference study method.ResultsThe deep learning model was trained on 4,400 scans of 1,935 patients (training set: mean age = 24.2 years ± 4.0, 1132 female) and evaluated on 300 scans of 300 patients with a balanced age and sex distribution (test set: mean age = 22.5 years ± 4.4, 150 female). Model MAE was 1.65 years, and the highest absolute error was 6.40 years for females and 7.32 years for males. However, performance could be attributed to norm-variants or pathologic disorders. Human reader estimate MAE was 1.84 years and the highest absolute error was 3.40 years for females and 3.78 years for males.ConclusionsWe present a deep learning approach for continuous age predictions using CT volumes highlighting the medial clavicular epiphyseal cartilage with performance comparable to the human reader estimate.

Orthodontic-surgical Management of the Horizontal Unilateral Condylar Hyperplasia

Introduction: To describe the orthodontic-surgical approach we used in a sample of patients affected by the horizontal type of Unilateral Condylar Hyperplasia (UCH), that is a progressive disease that leads to mandibular asymmetry and midline deviation. Material and Methods: A retrospective observational cohort study was designed on 29 consecutive patients affected by horizontal UCH (23 females, 6 males; mean age, 22.4 y.o. ± 7.9) treated in the Units of Orthodontics and Maxillo-Facial Surgery. Descriptive statistics was performed. Correlations were tested between type of surgery and stage of skeletal maturation, presence of Temporo-mandibular Disorders, and condylar activity, evaluated with SPECT. Duration was correlated with type of surgery, and the mean duration of therapy was compared between patients who underwent condylectomy and those who underwent orthognathic surgery. Results: Females were more affected than males and had higher mean age. Temporo-mandibular Disorders were present in 31% of the sample. All patients with positive SPECT (15) were treated with condylectomy, alone or associated with orthognathic surgery, followed by post-surgical orthodontics. Patients with negative SPECT were treated with orthognathic surgery if adult (12), condylectomy if in age of skeletal growth (2). Discussion: The choice of the therapeutic approach has depended on skeletal maturation, condylar activity, and extent of dental compensations. Early condylectomy eliminates the etiologic cause of the Hyperplasia in patients with active condylar growth. In patients in age of growth, either if positive or negative to SPECT, early TMJ surgery eliminates the asymmetric growth and leads to symmetrization of the mandibular growth rate, acting as interceptive treatment.

Non-coding RNA regulation of Magang geese skeletal muscle maturation via the MAPK signaling pathway.

Skeletal muscle is a critical component of goose meat and a significant economic trait of geese. The regulatory roles of miRNAs and lncRNAs in the maturation stage of goose skeletal muscle are still unclear. Therefore, this study conducted experiments on the leg muscles of Magang geese at two stages: 3-day post-hatch (P3) and 3 months (M3). Morphological observations revealed that from P3 to M3, muscle fibers mainly underwent hypertrophy and maturation. The muscle fibers became thicker, nuclear density decreased, and nuclei moved towards the fiber edges. Additionally, this study analyzed the expression profiles of lncRNAs, miRNAs, and mRNAs during the skeletal muscle fiber maturation stage, identifying 1,949 differentially expressed mRNAs (DEMs), 21 differentially expressed miRNAs (DEMIs), and 172 differentially expressed lncRNAs (DELs). Furthermore, we performed enrichment analyses on DEMs, cis-regulatory genes of DELs, and target DEMs of DEMIs, revealing significant enrichment of signaling pathways including MAPK, PPAR, and mTOR signaling pathways. Among these, the MAPK signaling pathway was the only pathway enriched across all three types of differentially expressed RNAs, indicating its potentially more significant role in skeletal muscle maturation. Finally, this study integrated the targeting relationships between DELs, DEMs, and DEMIs from these two stages to construct a ceRNA regulatory network. These findings unveil the potential functions and mechanisms of lncRNAs and miRNAs in the growth and development of goose skeletal muscle and provide valuable references for further exploration of the mechanism underlying the maturation of Magang geese leg muscle.

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.

Effect of SEC III protocol on upper airway dimensions in growing class III patients: a retrospective study

BackgroundThe primary objective of the study was to evaluate the effects of SEC III (Splints, Class III Elastics, and Chin cup) protocol on the upper airway dimensions using lateral cephalometric radiographs. The secondary objectives were to evaluate the skeletal and dental effects of the SEC III protocol using lateral cephalometric radiographs.MethodsThe pre- and post-treatment lateral cephalometric radiographs of 24 patients treated using the SEC III protocol were used to address the aim of the study. Children in the pre-pubertal (CS-1 or CS-2) or circumpubertal (CS-3 or CS-4) skeletal maturation stage and having class III dentoskeletal malocclusion were included in the study. Patients with a history of previous orthodontic treatment, maxillofacial surgery or trauma, tonsillectomy, adenoidectomy, or craniofacial malformations were excluded. The pre-treatment and post-treatment lateral cephalometric radiographs were traced, then airway measurements, skeletal measurements, and dental measurements were performed. The results were analysed using paired samples t-test or Wilcoxon signed rank test according to the data normality.ResultsData of 6 males and 18 females were analysed (Mean age = 11.21 ± 1.02 years). Duration of active treatment was 5.75 ± 1.03 months. Treatment using SEC III protocol resulted in a significant increase in ANB angle (2.92 ± 1.50 degrees, p < 0.001) and Wits appraisal (3.31 ± 1.99 mm) (p < 0.001). The increase in the mandibular plane angle (0.75 ± 1.42 degrees, p = 0.02) and the maxillary length (2.29 ± 2.69 mm, p < 0.001) was statistically significant. Contrarily, the mandibular length did not change significantly (p = 0.10). The maxillary incisors were significantly proclined (4.38 ± 4.28 degrees; p < 0.001), while the mandibular incisors were significantly retroclined (-5.79 ± 6.21 degrees; p < 0.001) following treatment. The change in the nasopharyngeal airway and the retropalatal airway was not statistically significant. The middle and inferior pharyngeal space (retroglossal airway) significantly decreased by 1.33 ± 1.97 mm (p = 0.003) and 1.96 ± 2.48 mm (p = 0.001), respectively.ConclusionsEarly class III correction using SEC III protocol reduced the retroglossal airway dimensions but did not affect the nasopharyngeal and retropalatal airway dimensions. Correction of the class III dentoskeletal relationship was obtained through both skeletal and dental changes.

Assessment of correlation between hand-wrist maturation and cervical vertebral maturation: a fractal analysis study

BackgroundTo investigate whether fractal dimension (FD) measurements from hand-wrist radiographs and lateral cephalometric radiographs are correlated with each other and with skeletal maturation stages.MethodsIn this retrospective study conducted on hand-wrist and lateral cephalometric radiographs obtained from patients between 2017 and 2023, hand-wrist maturation stages (HWMS) and cervical vertebral maturation stages (CVMS) of 144 subjects (6 to 17 years of age) were assessed radiographically. The participants were divided into nine groups (n = 16 each) based on HWMS. Fractal analysis was performed on the radiographs of the radius, the middle finger phalanges (proximal, medial and distal), and the cervical vertebral bodies (C2, C3, C4). Mean and standard deviation values, Spearman’s and Pearson correlation analyses, one-way ANOVA, Kruskal-Wallis H tests and Mann-Whitney-U test were used to evaluate the data.ResultsPositive correlations were found between the FD values of the radius and HWMS or CVMS (r = .559, P = .001, r = .528 P = .001 respectively). The FD values of the radius were positively correlated with those of all cervical vertebrae (C2, C3, C4), proximal and medial phalanges as well as age. FD values measured from the proximal phalanx, medial phalanx and radius showed significant differences among both HWMS and CVMS (P < .05). HWMS was strongly correlated with CVMS (r = .929, P = .001). Age was strongly correlated with HWMS (r = .795, P = .001) and CVMS (r = .756, P = .001). There was a significant difference in terms of age distribution among HWMS and CVMS (P < .05).ConclusionsFD measurements on hand-wrist radiographs can provide useful information for the assessment of skeletal maturation stage. Especially, FD measurements from the radius are important and more reliable to predict skeletal maturation stage.

A correlation between the timing of skeletal maturity and dental development in black South African Patients

The growth potential of patients has a significant influence on the timing of orthodontic intervention and treatment modalities. Skeletal maturity and dental development are biological maturity indicators which can be used to determine the growth status of an individual.ObjectivesTo correlate the dental maturational stages of black South African individuals with the stages of skeletal maturation and to determine the diagnostic accuracy of using dental developmental stages to identify an individual’s skeletal maturity.DesignRetrospective, cross-sectional study.MethodsSkeletal maturity and dental development of 224 subjects were assessed using lateral cephalograms and panoramic radiographs, respectively. Statistical analyses included descriptive statistics, Spearman’s correlation coefficient and positive likelihood ratios (LHR).ResultsThe highest (rs =0.759, p&lt;0.001) correlation with skeletalmaturity was identified for the second molar and the lowest correlation (rs=0.662, p&lt;0.001) for the canine. Positive LHR&gt;10 combined with sensitivity and specificity testing revealed that the second premolar (stage E), second molar (stage F) and second molar (stage H) have the most significant diagnostic reliability to identify the pre-pubertal, pubertal and post-pubertal growth phases, respectively. ConclusionDental development is a valuable diagnostic tool to assess skeletal maturation. The calcification of the second molar (stage F) is predictive of the pubertal growth phase.

Fixed Functional Appliance Therapy With and Without Skeletal Anchorage in Class II Malocclusion: A Systematic Review of Randomized Controlled Trials

Background: For its synergistic effects in producing skeletal changes as well as to lessen the proclination of the lower incisors, which is a common negative result of mandibular advancement, fixed functional appliances with skeletal anchorage have recently been used. Aim: Objective was to evaluate the skeletal and dentoalveolar effects with fixed functional appliances with and without skeletal anchorage. Methods: Electronic database search and manual search were performed up to 2021, April in four databases namely The Cochrane Library, PubMed, Lilac, and Google Scholar. RCTs that employed the use of fixed functional appliances in Class II malocclusion with and without skeletal anchoring were collected. Two co-authors independently extracted the data, and a pre-designed template was followed during the data extraction process. Data including inclusion and exclusion criteria; study design, the year of publication; age and gender of the patients; type of fixed functional device; stage of skeletal maturation; size and site of mini-implant or miniplate placement, amount of force applied in grams or Newtons; method of study outcome assessment (2D or 3D); and follow up were collected. The skeletal and dentoalveolar parameters were extracted. Results: The risk of bias was evaluated, and the SMD and 95% confidence intervals (CIs) were also calculated. Four RCTs were evaluated for qualitative and quantitative analysis. The review involved data of 179 Class II individuals. The results of a random-effects meta-analysis showed that the SNB differed significantly from the control group (SMD = 0.50 (95% CI –1.55 to –0.10)). No significant differences noted between the two groups in terms of lower incisor inclination and mandibular length changes [SMD = –0.04 (95% CI −2.06 to 1.98) and –1.33 (95% CI −3.28 to 0.62), respectively]. The studies under this were not able to provide enough data to draw any conclusions about the effects of using skeletal anchorage with FFA. Conclusion: According to the evidence that is currently available, using FFA coupled with skeletal anchorage does not appear to have any superior skeletal effects than those without skeletal anchorage.

Postmortem computed tomography assessment of skeletal and dental age in Polish children, adolescents, and young adults

This paper presents a retrospective analysis of postmortem computed tomography (PMCT) scans of secondary ossification centers in the medial clavicular epiphysis, iliac crest apophysis, proximal humeral epiphysis, distal femoral epiphysis, proximal tibial epiphysis, and distal tibial epiphysis. At the same time, we analyzed PMCT scans of the maxillary and mandibular incisors, canines, premolars, and molars. We assessed 203 corpses, whose age ranged from 2 to 30 years, including 156 males and 47 females. The purpose of our study was to compare the processes of secondary ossification center fusion and permanent tooth maturation. Our research hypothesis was that certain stages of skeletal and dental maturation occur along consistent timelines that can be related to the chronological age. Secondary ossification center fusion was evaluated based on Kreitner and also McKern and Steward’s classifications. The process of permanent tooth maturation was evaluated with Demirjian’s method. Spearman’s correlation coefficients (Rho) were positive in all analyses, which indicates that epiphyseal fusion progresses with age. The strongest relationship between the age and the stages of ossification was observed in the proximal tibial epiphysis (p < 0.001; Rho = 0.93) in females and in the medial clavicular epiphysis (p < 0.001; Rho = 0.77) in males. Studies show the importance of concomitant analysis of skeletal and dental maturation with a subsequent comparison of the results to achieve a greater precision in age estimation. A comparison of the results obtained in the study population of Polish children, adolescents, and young adults with the results of other studies in populations of similar ages showed a number of similarities in the time windows of dental and skeletal maturation. These similarities may help in age estimation.

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

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