|Year : 2017 | Volume
| Issue : 3 | Page : 108-111
Assessment of skeletal and dental maturity indicators and comparison of maturity indicators in vertical and horizontal growth pattern individuals with normal growth pattern individuals
Amol Verulkar1, Pritesh Singla2, Harshal Ashok Patil3, Pawankumar Dnyandeo Tekale4
1 Department of Orthodontics, VYWS Dental College, Amravati, Maharashtra, India
2 Department of Orthodontics and Dentofacial Orthopedics, AIDSR Dental College, Bathinda, Punjab, India
3 Private Orthodontic Practice, Aditya Chambers, Housing Society, Jalgaon, Maharashtra, India
4 Department of Orthodontics, Dr. Rajesh Ramdasji Kambe Dental College and Hospital, Akola, Maharashtra, India
|Date of Web Publication||14-Jun-2017|
Harshal Ashok Patil
Private Orthodontic Practice, Aditya Chambers, Housing Society, Jalgaon - 425 001, Maharashtra
Source of Support: None, Conflict of Interest: None
Objective: The purpose of the present study was carried out to establish whether the vertical and horizontal growth patterns influence the rate of dental and skeletal maturation as compared to normal growth patterns.
Materials and Methods: This study comprised sixty samples divided into three groups. Group I normal grower (control), Group II-vertical growers, and Group III-horizontal growers. Each sample was assessed for skeletal and dental age using cervical vertebrae maturation index (CVMI), skeletal maturity indicator stages and canine calcification stages, respectively. All data in the groups were analyzed by analysis of variance test. Subgroup data and comparisons were analyzed by Dunnett D-test and -test.
Results: Results showed that dental maturation was delayed in horizontal growers as compared to vertical growers with = 0.00 and 0.044. There was nonsignificant difference in dental maturation of male and females with >0.05. The comparison of skeletal maturation by hand-wrist radiograph showed significant variation in Group III with delayed skeletal maturation of horizontal growers than control group with P < 0.05. Dunnett D-test showed main skeletal age by CVMI was significant with = 0.00 which indicates that skeletal age of Group III to be lower in all groups. Rest was nonsignificant.
Conclusion: Individuals with horizontal growth pattern showed delayed dental maturation when compared to vertical growers.
Keywords: Cervical vertebrae maturation index, dental age, skeletal age, skeletal maturity indicator
|How to cite this article:|
Verulkar A, Singla P, Patil HA, Tekale PD. Assessment of skeletal and dental maturity indicators and comparison of maturity indicators in vertical and horizontal growth pattern individuals with normal growth pattern individuals. Int J Orthod Rehabil 2017;8:108-11
|How to cite this URL:|
Verulkar A, Singla P, Patil HA, Tekale PD. Assessment of skeletal and dental maturity indicators and comparison of maturity indicators in vertical and horizontal growth pattern individuals with normal growth pattern individuals. Int J Orthod Rehabil [serial online] 2017 [cited 2018 May 27];8:108-11. Available from: http://www.orthodrehab.org/text.asp?2017/8/3/108/208067
| Introduction|| |
The assessment of maturational status is a decisive factor in diagnosis, treatment planning, and the eventual outcome of orthodontic treatment. Assessing maturational status is more important when the clinical considerations are based strongly on the increased or decreased rates of craniofacial growth left, such as the timing and use of extraoral traction and the use of functional appliances. Furthermore, it helps in predicting future growth potential of the facial skeleton to ensure the successful outcome of the treatment of dentofacial deformities. Racial and sexual differences and other less tangible factors such as climate, nutrition, socioeconomic levels, and urbanization may influence the rates of physiologic maturity of a child. This renders the chronological age as an unreliable indicator of maturational levels. The hand-wrist radiograph is commonly used for the assessment of skeletal development as many investigators have found a significant correlation between maturation stages.,,,, Also, changing concavities in the lower border of cervical vertebrae are also found to be a reliable method for assessing skeletal development apart from hand wrist.,,,,, Coutinho et al. found a close relationship between the canine calcification stage G in the mandible with the pubertal growth spurt. However, it remains questionable whether association based on dental stages are strong enough to make reliable clinical predictions. The difference in dental maturation between skeletal open bite and skeletal deep bite individuals was investigated by Janson et al. and reported that skeletal open bite individuals presented a slight tendency to have an advanced dental maturation expressed by the dental age. Nanda, and Rowe  also concluded that timings of the adolescent growth spurt for various facial dimensions in open bite faces were earlier than deep bite faces. In addition, studies conducted by different investigators to assess the correlation between different facial types, i.e. skeletal open bite and skeletal deep bite on dental maturation have shown that there is a difference in the timings of dental maturation between these extreme vertical facial types. The timing of craniofacial growth and its relationship to other developmental events presents a particular challenge in individuals exhibiting variations in facial form. Considering the lack of data on variability of skeletal maturation between the two facial types, the present study was carried out to establish whether the vertical and horizontal growth patterns influence the rate of dental and skeletal maturation as compared to normal growth patterns. Furthermore, the study probed any sexual dimorphism on the rate of dental and skeletal maturation between the vertical and the horizontal growers.
| Materials and Methods|| |
The study consisted of sixty individuals of chronological ages between 8 and 14 years. Selection criteria include individuals with no history of bony deformities and pathosis, no muscular dystrophy, congenital abnormalities, traumatic injuries to the jaws and hands. Approval from Ethical Committee of Datta Meghe Institute of Medical Sciences Deemed University was taken before the study. Lateral cephalogram, orthopantomogram (OPG) (PlanmecaProline and Vision 100A) and hand-wrist radiographs were taken for each sample. Mandibular plane angle was used to divide the samples into three groups, i.e. Group I (normal growers-control group), Group II (vertical growers), and Group III (horizontal growers). Group II and Group III were further subdivided into two subgroups as subgroup A (males) and B (females).
All the samples were evaluated for their respective stages of skeletal and dental maturation as per the methods developed by Fishman for skeletal maturity indicator (SMI) stages using hand-wrist radiographs, for cervical vertebrae maturation index (CVMI) stages using lateral cephalogram. Demirjian et al. index was used to assess dental age using OPG.
| Results|| |
The mean chronological age for Groups I, II, and III was 10.90 ± 0.47, 10.14 ± 0.98, and 10.24 ± 1.45, respectively [Table 1].
|Table 1: Mean dental age (years) in three groups (descriptive statistics)|
Click here to view
The analysis of variance (ANOVA) (one-way ANOVA test) showed that there exists statistically significant variation in all the three types of growth patterns with P < 0.05 (0.00). Multiple comparison Dunnet D-test showed that mean dental age of Group III was lowest followed by Group II as compared with P = 0.00 and 0.044, respectively [Table 2].
Independent t-test showed statistically significant variation with P = 0.01, suggestive of delayed dental maturation in horizontal growers when compared to vertical growers [Table 3].
|Table 3: Results of independent t-test between dental ages of vertical (Group II) and horizontal group (Group III)|
Click here to view
Dental maturation in subgroups was found to be significant with P value >0.05 (0.01) suggestive of female vertical growers to be ahead in growth spurt as compared to male vertical growers. However, the present study showed no significant difference in dental maturation in female horizontal growers [Table 4].
|Table 4: Results of independent t-test in horizontal and vertical subgroups (male and female)|
Click here to view
Horizontal growers, when compared to normal growers, showed delayed skeletal maturation whereas no significant variation in skeletal maturation was seen when vertical growers were compared to normal growers [Table 5].
|Table 5: Multiple comparison within groups: Dunnett D-test (skeletal maturation indicators with hand wrist)|
Click here to view
Independent t-test showed that the skeletal age is ahead in Group II as compared to Group III but with statistically nonsignificant (P > 1.77) [Table 6]. Suggestive of nonsignificant variation in skeletal maturation when horizontal growers were compared to vertical growers.
|Table 6: Results of independent t-test between skeletal ages of Group II and Group III using skeletal maturation indicators|
Click here to view
A significant difference between males and females was found in subgroup II with P < 0.05 (0.04) suggestive of male vertical growers being ahead of skeletal maturation when compared to female vertical growers [Table 7].
|Table 7: Results of independent t-test for skeletal age between subgroups (using skeletal maturation indicators)|
Click here to view
Multiple comparison Dunnet D-test showed mean skeletal age of Group III to be lowest followed by Group II and was statistically significant with P = 0.00 and 0.003, respectively, when compared with Group I [Table 8].
|Table 8: Multiple comparison within group: Dunnett D-test (cervical vertebrae maturation indicators)|
Click here to view
In addition, no significant variation in skeletal maturation was observed when horizontal growers were compared to vertical growers [Table 9] and [Table 10].
|Table 9: Results of independent t-test between skeletal ages (cervical vertebrae maturation indicators) of vertical and horizontal group|
Click here to view
|Table 10: Results of independent t-test between skeletal age between subgroups (using cervical vertebrae maturation indicators)|
Click here to view
| Discussion|| |
The present study showed results which are comparable to those of Neves et al. showing early maturation and a more advanced dental age for the vertical growers with the mean difference of 1.00 as compared to horizontal growers. Also Janson et al. studied the differences in dental maturation between skeletal open and deep bite individuals in forty individuals with mean of 9.2 years and reported that skeletal open bite individuals have advanced dental maturation, expressed by dental age, as compared to skeletal deep bite individuals. Dental maturation in subgroups was found to be significant with P value > 0.05 (0.01) suggestive of female vertical growers to be ahead in growth spurt as compared to male vertical growers. However, the present study showed no significant difference in dental maturation in female horizontal growers. This is comparable with the results of Nanda  who conducted a study on 16 males and 16 females and reported that female open bite individuals were earlier in timing of adolescent growth spurt than the male open bite individuals comparison of skeletal maturation in all three groups: A clinical implication of these results is that orthodontic treatment of patients with an open bite may begin earlier than in those with a horizontal pattern, not only because their pubertal facial growth spurt manifests earlier, but also because tooth calcification and subsequent eruption may occur earlier. This is especially true for fixed appliance that depends on the eruption of the second molars during the initial stages of treatment. In contrast, patients with a predominantly horizontal facial pattern may have their treatment started later since the pubertal facial growth spurt will occur later, as well as tooth calcification and eruption.
| Conclusion|| |
Following conclusions were drawn:
- Dental maturation in vertical and horizontal growing individuals using OPG:
- Individuals with horizontal growth pattern showed delayed dental maturation when compared to vertical growers
- Female vertical growers are ahead of males in dental maturation.
Skeletal maturation in vertical and horizontal growing individuals using SMI and CVMI:
- Although it was found that horizontal growth pattern individuals showed a delay in skeletal maturation when compared to vertical growers, the difference was not statistically significant
- Female vertical growers have advanced skeletal maturation than male vertical growers.
Skeletal maturation in vertical and horizontal growing individuals using CVMI in lateral cephalogram:Although female vertical and horizontal growers have advanced skeletal maturation, the difference was not statistically significant.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chertkow S. Tooth mineralization as an indicator of the pubertal growth spurt. Am J Orthod Dentofacial Orthop 1980;49:282-8.
Fishman LS. Chronological versus skeletal age, an evaluation of craniofacial growth. Angle Orthod 1979;49:181-9.
Fishman LS. Maturational patterns and prediction during adolescence. Angle Orthod 1987;57:178-93.
Johnston FE, Hufham HP Jr., Moreschi AF, Terry GP. Skeletal maturation and cephalofacial development. Angle Orthod 1965;35:1-11.
Roche AF, Davila GH. The reliability of assessments of the maturity of individual hand-wrist bones. Hum Biol 1976;48:585-97.
Fishman LS. Radiographic evaluation of skeletal maturation. A clinically oriented method based on hand-wrist films. Angle Orthod 1982;52:88-112.
Lamparski D. Skeletal age assessment utilizing cervical vertebrae. Am J Orthod Dentofacial Orthop 1995;107:58-66.
Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 1995;107:58-66.
Green LJ. The interrelationship among height, weight and chronological, dental and skeletal ages. Angle Orthod 1961;31:189-93.
García-Fernandez P, Torre H, Flores L, Rea J. The cervical vertebrae as maturational indicators. J Clin Orthod 1998;32:221-5.
Negi NS. Assessment of growth impetus using MP3 maturation and its correlation with CVMI and dental age. J Indian Orthod Soc 2003;36:204-13.
Dabla N. A comparative evaluation of modified MP3 and CVMI stages as maturation indicators. J Indian Orthod Soc 2006;39:147-54.
Coutinho S, Buschang PH, Miranda F. Relationships between mandibular canine calcification stages and skeletal maturity. Am J Orthod Dentofacial Orthop 1993;104:262-8.
Janson GR, Martins DR, Tavano O, Dainesi EA. Dental maturation in subjects with extreme vertical facial types. Eur J Orthod 1998;20:73-8.
Nanda SK, Rowe TK. Circumpubertal growth spurt related to vertical dysplasia. Angle Orthod 1989;59:113-22.
Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973;45:211-27.
Neves LS, Pinzan A, Janson G, Canuto CE, de Freitas MR, Cançado RH. Comparative study of the maturation of permanent teeth in subjects with vertical and horizontal growth patterns. Am J Orthod Dentofacial Orthop 2005;128:619-23.
Nanda SK. Patterns of vertical growth in the face. Am J Orthod Dentofacial Orthop 1988;93:103-16.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]