Skeletal maturity assessment using calcification stages of mandibular canine

Ritesh Singla; Arun S Urala; R Vineetha; Nishu Singla

doi:10.4103/jioh.jioh_89_17

ORIGINAL RESEARCH

Year : 2017 | Volume : 9 | Issue : 3 | Page : 126-129

Skeletal maturity assessment using calcification stages of mandibular canine

Ritesh Singla¹, Arun S Urala¹, R Vineetha², Nishu Singla³
¹ Department of Orthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
² Department of Oral Medicine, Radiology and Diagnosis, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
³ Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India

Date of Web Publication

27-Jun-2017

Correspondence Address:
Nishu Singla
Department of Public Health Dentistry, Manipal College of Dental Sciences, Madhav Nagar, Manipal - 576 104, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jioh.jioh_89_17

Abstract

Aim: The aim of this study was to correlate the growth phase of skeletal tissues with the calcification stages of mandibular canine. Materials and Methods: It was a cross-sectional observational study. Anonymized digital orthopantomogram and lateral cephalogram records of 300 pretreatment orthodontic patients aged 8–15 years were collected and analyzed. The calcification stages of right mandibular canine were scored on panoramic radiographs in accordance to the Gleiser and Hunt modified method of assessing tooth mineralization. The growth phase of skeletal maturation was scored on lateral cephalogram in accordance to the cervical vertebral maturation (CVM) method proposed by Baccetti et al. Results: A positive significant correlation was attained relating CVM Stages 1, 2, and 3 with mandibular canine calcification Stages 2, 3, and 4, respectively. Conclusion: The calcification stages of mandibular canine can be implemented for assessing the skeletal maturity clinically.

Keywords: Canine calcification, cervical vertebral maturation, skeletal maturity

How to cite this article:
Singla R, Urala AS, Vineetha R, Singla N. Skeletal maturity assessment using calcification stages of mandibular canine. J Int Oral Health 2017;9:126-9

How to cite this URL:
Singla R, Urala AS, Vineetha R, Singla N. Skeletal maturity assessment using calcification stages of mandibular canine. J Int Oral Health [serial online] 2017 [cited 2023 Jun 4];9:126-9. Available from: https://www.jioh.org/text.asp?2017/9/3/126/209060

Introduction

Evaluation of dental development and skeletal maturity has become an integral part of diagnosis and treatment planning in orthodontics. The optimal treatment timing for orthodontic growth amendment is characteristically related with the peak of skeletal maturity of a growing individual. The identification of periods of accelerated growth or growth spurts can significantly contribute to the correction of skeletal discrepancies in the patient. A number of methods had been reported to identify maturation indicators representing stages of bone development for each age level. Hand-wrist and cervical vertebral methods have been explored extensively as indicators of skeletal maturity.

Cervical vertebral maturation (CVM) method proposed by Baccetti et al. is an established reliable method for assessing skeletal maturity. The estimation of the growth phase can be appraised through the analysis of the morphological appearance of the bodies of 2^nd, 3^rd, and 4^th cervical vertebrae on a single lateral cephalogram. The advantage of CVM method is that it is performed on the lateral cephalogram, the radiographic record used routinely for orthodontic diagnosis, and treatment planning.^[1],[2] However, it is not an essential diagnostic record for all patients. Thus, identification of other valid and reliable indicators will be equally helpful in making rational treatment planning for a growing individual.

Dental maturation has also been considered as a possible indicator for the growth stage of an individual.^{[3],[4],[5],[6],[7],[8],[9]} Dental development can be evaluated by the stage of tooth eruption, the stage of tooth mineralization, or stages of crown or root formation of developing teeth. Dental mineralization was established as the most reliable method to determine dental maturation.^[10],[11] Furthermore, panoramic radiographs are taken regularly in orthodontic practice and can be used reliably to assess dental maturity. Evaluation of dental maturation in the patients can be further correlated to predict the growth phase of the person.

The aim of this investigation was to determine the growth phase of the individual based on the mandibular canine calcification (MCC) stages on the panoramic radiographs. The validity of MCC stages is checked by comparing it with CMV stages using Baccetti et al's. method.

Materials And Methods

It was a cross-sectional, observational study. The approval to conduct the research was obtained from the Ethical Committee of the Manipal University (IEC-738/2016). The study involved anonymized digital orthopantomogram and lateral cephalogram records of 300 orthodontic patients who reported to the Department of Orthodontics for the treatment between 2014 and 2015. The anonymization of the radiographs was done by a radiograph technician who was not the part of the study. The details of the patients were removed by the technician and a number was assigned to each radiograph for anonymization. A total of 412 anonymized patients' radiographic records were obtained from the Department of Oral Medicine and Radiology. Those radiographs that did not fulfill the inclusion criteria were not included for the analysis in the study. Hence, the final sample size used for analysis consisted of 300 orthodontic patients' records. The study was carried out for 6 months.

Inclusion and exclusion criteria

Inclusion criteria were good quality pretreatment panoramic and lateral cephalometric radiographs of children in the age group of 8–15 years with normal growth and development. Exclusion criteria were radiographs of children with congenital anomalies, syndromes, or congenitally missing teeth.

Radiographic assessment

The calcification stages of right mandibular canine were scored on panoramic radiographs in accordance to the Gleiser and Hunt modified method of assessing tooth mineralization which was made simpler from 10 to 5 stages [Table 1]. The growth phase of skeletal maturation was scored on lateral cephalogram in accordance to the CVM method proposed by Baccetti et al. [Figure 1].

Table 1: The developmental stages of mandibular canine

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Figure 1: Morphologic appearance of cervical vertebrae C2, C3, and C4.

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Statistical analysis

Statistical analyses of the data were performed using Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA). Associations between the variables were analyzed using Chi-square test and Spearman's rank correlation. The cutoff level for statistical significance was taken at P < 0.01.

Results

The association among the calcification stages of mandibular canine and the stages of skeletal maturity is shown in [Table 2]. CVM Stage 1 correlated with MCC Stage 2 where the root length of the mandibular canine is lesser than the crown length (P< 0.01). The CVM Stage 2 indicating prepeak of pubertal growth spurt correlated with the MCC Stage 3 where root length of the mandibular canine is equal or more than the crown length (Stage 3, P< 0.01). The CVM Stage 3 signifying peak of pubertal growth spurt correlated with the MCC Stage 4 where apical apex of the root canal of the mandibular canine is partially opened (P< 0.01). CVM Stages 4, 5, and 6 correlated with the MCC Stage 5 where mandibular canine is completely formed (P< 0.01). The scatter plot [Figure 2] shows the line of fit which reveals a significant positive correlation between the two variables (P< 0.01, r = 0.829).

Table 2: Association among mandibular canine calcification stages and cervical vertebral maturation stages

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Figure 2: Correlation between mandibular canine calcification stages and cervical vertebral maturation stages (P < 0.001, r = 0.829).

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Discussion

Recognition of the maturation status of a growing individual can play a vital role in the diagnosis, treatment planning, and treatment outcome. In the present study, the growth phase of the individual was assessed based on the MCC stages. The calcification of mandibular canines begins at the age of 4 months and crown completely matures by the age of 7 years. The permanent canines usually erupt in the oral cavity at about 9–10 years of age. The calcification stages of mandibular canines can be easily recognized in the panoramic radiographs. Among all the tested teeth in the previous studies, mandibular canines have shown a significant association with the stages of development.^{[12],[13],[14],[15],[16],[17]} In addition, hypodontia of permanent canine is extremely rare and the prevalence ranges from 0.18% to 0.29%.^[18] Moreover, mandibular permanent canines rarely show morphological variations in their development.^[19]

The age group of 8–15 years selected in the present study was in accordance with the other similar studies.^[20],[21] The skeletal age assessment becomes very critical as orthodontic treatment is often performed at this age group. The present study evaluated the correlation between skeletal age and calcification stages of mandibular canines. It found a strong correlation between CVM Stages 1, 2, 3 and MCC Stages 2, 3, 4, respectively, with skeletal age and calcification stages, while CVM Stages 4, 5, and 6 corresponded with the completely formed mandibular canines (Stage 5). It showed that canine calcification stages could be considered as indicative of growth status in the beginning stages only. This was in conformity with the research done by Džemidžic et al.,^[21] Vijayalakshmi and Sathiasekar,^[22] and Divyashree et al.^[23] It also implies that the interpretation of the relationship between MCC stages with the later stages of skeletal maturity was irrelevant.

The growth potential of the adolescent patient can be easily determined based on the calcification stages of mandibular canines in the panoramic radiographs. These radiographs are essential diagnostic radiographs for the patients who need orthodontic treatment which will further reduce the radiation exposure to them. This method is simple, practical, and easier to apply than other existing methods. This method can be used clinically as a reliable indicator for assessing skeletal maturity for growing individuals. It can aid in more objective diagnostic evaluation and treatment planning when determination of growth spurt stage is important.

Conclusion

It can be concluded that this method based on the calcification stages of mandibular canine could be considered as indicative of growth status in the beginning stages. The root length of the mandibular canine when equal or more than the crown length can indicate prepeak growth spurt and mandibular canine root with an opened apical end can indicate peak pubertal growth spurt. The relationship between MCC stages with the later stages of skeletal maturity was meaningless. However, further studies are recommended to explore validation of this method on a larger sample and other populations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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