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Izvestia Journal of the Union of Scientists - Varna. Medicine and Ecology Series

Evaluation of skeletal maturity using mandibular second premolar calcification stages. A digital x-ray study

Iliyana Atanasova


Introduction: Evaluation of skeletal maturity and dental age with the aid of lateral cephalogram and panoramic radiograph plays a crucial role in orthodontic treatment planning, diagnosis and treatment timing in correction of malocclusions. Successful treatment of skeletal disharmonies may be achieved by growth modification in patients who have a certain amount of growth remaining as during the pubertal spurt.

Aim: The purpose of this study was to evaluate the correlation and efficacy of using the calcification stages of maxillary permanent left second premolar (tooth 35) to predict the skeletal maturity in Bulgarian subjects.

Materials and Methods: А total of 388 digital x-rays were evaluated. They were of 194 children in maturational stages CVM II, CVM III, and CVM IV. Developmental stages of left mandibular tooth 35 were assessed by the Demirjian et al. method (1973) and cervical vertebral maturation (CVM) stage by the Baccetti et al. method.

Results: For both genders strong correlation was found between the mineralisation stages of tooth 35 and skeletal age – for girls (r = 0.659; Р < 0.05) and for boys (r = 0.544; Р < 0.05). For boys in the CVM II stage, 100% of the studied mandibular second premolars were with open apical foramen and developmental stage G being dominant in 60.5% (Р < 0.0001). In stage CVM III the number of teeth with incomplete root development was still significant – 83.3% with prevalence of stage G (Р = 0.028). In stage CVM IV 76.9% of the left mandibular second premolars were evaluated to be in stage H by the Demirjian method (P = 0.052). For girls in the CVM II stage, 100% of the studied mandibular tooth 35 were immature with developmental stage F being dominant (Р = 0.001). In stage CVM III the share of teeth 35 with incomplete root development was 89.3% of the studied subjects with prevalence of stage G (Р < 0.0001). In stage CVM IV 51.2% of the left mandibular second premolars were evaluated to be in stage H (P = 0.879).

Conclusion: A strong correlation was found between mandibular left second premolar calcification stages and skeletal age, which eases the skeletal maturity evaluation with the aid of a single panoramic radiograph. In stage CVM II, observed at least a year before the pubertal growth spurt, with great growth potential ahead, maturational stage G of the mandibular tooth 35 could be used as a predictor of pubertal peak for boys and stage F – for girls. During the pubertal spurt – CVM III, the dominant stage of mineralisation of tooth 35 was G in both genders.


dental age, left mandibular second premolar, skeletal age, pubertal spurt, Demirjian method, Baccetti method

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