Correlation and Correspondence between Skeletal Maturation Indicators in Hand-Wrist and Cervical Vertebra Analyses and Skeletal Maturity Score in Korean Adolescents

This retrospective observational study aimed to examine the correlation and correspondence between skeletal maturation indicators (SMI), cervical vertebral maturation indicators (CVMI), and radius-ulna-short bones (RUS) skeletal maturity scores in Korean adolescents, and to determine whether easily obtainable SMI or CVMI can replace the RUS skeletal maturity score. A total of 1017 participants were included with both hand-wrist radiograph and lateral cephalogram acquired concurrently. From the lateral cephalogram, CVMI was determined; through the hand-wrist radiograph, SMI was categorized, and the RUS skeletal maturity score was evaluated as well. Associations were examined using the Mann–Whitney U test, Spearman’s rank-order correlation analysis, and multiple correspondence analysis. There was no statistically significant difference in chronological age between males and females; however, the SMI, CVMI, and RUS skeletal maturity scores were significantly higher in females. The SMI, CVMI, and RUS skeletal maturity scores showed a statistically significant strong degree of both positive correlation and correspondence. However, a precisely corresponding RUS skeletal maturity score was difficult to obtain for a specific CVMI and SMI stage, implying the absence of a quantitative correlation. In conclusion, detailed evaluation should be conducted using the RUS skeletal maturity score, preferably in cases that require bone age determination or residual growth estimation.

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Correlation between Dental and Skeletal Maturity in Korean Children

THE JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY ◽

10.5933/jkapd.2021.48.3.255 ◽

2021 ◽

Vol 48 (3) ◽

pp. 255-268

Author(s):

Seong Jin Kim ◽

Je Seon Song ◽

Ik-Hwan Kim ◽

Seong-Oh Kim ◽

Hyung-Jun Choi

Keyword(s):

Rank Order ◽

Skeletal Maturity ◽

Correlation Coefficients ◽

Growth Period ◽

Skeletal Maturation ◽

Korean Children ◽

Panoramic Radiographs ◽

Second Molar ◽

Maturity Stages ◽

Lateral Cephalograms

The aim of this study was to investigate the relationships between the stages of calcification of various teeth and skeletal maturity stages among Korean subjects. The samples were derived from hand-wrist, panoramic radiographs, and lateral cephalograms of 743 subjects (359 males and 384 females) with ages ranging from 6 to 14 years. Calcification of seven permanent mandibular teeth on the left side were rated according to the system of Demirjian. To evaluate the stage of skeletal maturation, hand-wrist radiographs were analyzed by skeletal maturity indicators (SMI) system of Fishman and lateral cephalograms by cervical vertebral maturation (CVM) method of Baccetti. Statistically significant relationships were found between dental calcification and skeletal maturity stages according to Spearman rank-order correlation coefficients (r = 0.40-0.84, p < 0.001). The second molar showed the highest correlation and central incisor showed the lowest correlation for female and male subjects. For both sexes, canine stage G and second molar stage F were related to SMI 6 and CS 3. Because of the high correlation coefficients, this study suggests that tooth calcification stages from panoramic radiographs might be clinically useful as a maturity indicator of the pubertal growth period in Korean patients.

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Non-invasive methods for the assessment of biomarkers and their correlation with radiographic maturity indicators — a scoping review

Progress in Orthodontics ◽

10.1186/s40510-021-00372-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Veena GV ◽

Tulika Tripathi

Keyword(s):

Scoping Review ◽

Literature Search ◽

Skeletal Maturity ◽

Skeletal Maturation ◽

Cochrane Library ◽

Subjective Perception ◽

Cochrane Central Register ◽

Non Invasive ◽

Pubertal Growth ◽

Significant Difference

Abstract Background Detection of skeletal maturity is vital in orthodontic treatment timing and planning. Traditional methods include hand-wrist radiography and cervical vertebral maturation index (CVMI). Though the radiographic methods are well established and routinely used to assess skeletal maturation, they carry the drawback of subjective perception and low reproducibility. With evolving concepts, skeletal maturation has been assessed quantitatively through biomarkers obtained from saliva, gingival crevicular fluid (GCF), and urine. The scoping review aims to explore the various biomarkers assessed through non-invasive methods and their correlation with radiographic skeletal maturity. Methodology The literature search was carried out on MEDLINE via Pubmed, Cochrane Library (Cochrane database of systematic reviews), Cochrane central register of controlled trials (CENTRAL), Google Scholar, Semantic Scholar, ScienceDirect, and Opengrey.eu for articles up to and including November 2020. Pertinent articles were selected based on inclusion and exclusion criteria. The results were tabulated based on the type of sample collected, the biomarker assessed, method of sample collection, and the radiographic method used. Results The literature search resulted in 12 relevant articles. Among all the studies, 10 studies showed that the concentration of biomarkers increases during the pubertal growth peak. On the contrary, 2 articles showed no significant difference between the levels of biomarkers and pubertal growth peak. Conclusion It can be concluded that the level of biomarkers increases during the pubertal growth spurt and can provide a quantitative way of assessing skeletal maturity.

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The Relationship Between Salivary Dehydroepiandrosterone Sulphate (DHEAS) Levels and Skeletal Maturation Parameters Before and During Pubertal Growth Spurt in Children

Iranian Journal of Orthodontics ◽

10.5812/ijo.116370 ◽

2021 ◽

Vol 15 (2) ◽

Author(s):

Tahseen Sultana ◽

Penmetcha Sarada ◽

Namineni Srinivas ◽

C H Sampath Reddy ◽

S Ojass KUMAR ◽

...

Keyword(s):

Skeletal Maturity ◽

Cervical Vertebrae ◽

Cervical Vertebra ◽

Skeletal Maturation ◽

Growth Spurt ◽

P Value ◽

Group I ◽

Lateral Cephalograms ◽

Group Ii ◽

Two Stages

Objectives: This study aimed to assess the skeletal maturation by using salivary DHEAS levels and its correlation with existing skeletal maturity parameters represented by cervical vertebrae and MP3 region radiographs in adolescents in pre-pubertal and pubertal age groups. Methods: In this study, 80 children in the age range of 8 - 14 years were divided into two equal groups based on their chronological age as group I (pre-pubertal group) and group II (pubertal group). Pre-existing lateral cephalograms and medial phalanx of third finger (MP3) radiographs of their left hands were assessed. The levels of the DHEAS of each individual were analysed by ELISA kit. ANOVA with post-hoc Tukey’s test and student t-test were used for statistical analysis. P-value < 0.05 was considered significant. Results: The mean level of DHEAS values shown in the present study was 4.36 +/- 0.32 ng/mL in group I and 5.73+/-0.39 ng/mL in group II. This study showed that in group I, more subjects were in stage 1 of cervical vertebral maturation than stage 2 and there were significant differences between the two stages (P-value = 0.011); also, in group II, more subjects were in stage 3 than 4 and there were significant differences between the two stages (P-value = 0.017). This study revealed the highest salivary DHEAS levels to be in the F stage of pre-pubertal MP3 development in addition to the H stage of MP3 development in pubertal children. This study noted that there were significant differences for salivary DHEAS levels between males and females not only in pre-pubertal (P-value = 0.031), but also in pubertal stages (P-value < 0.001). Conclusions: Salivary DHEAS, like cervical vertebra and MP3 radiographs, can be used for growth assessment in young adolescents.

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Realistic high-resolution lateral cephalometric radiography generated by progressive growing generative adversarial network and quality evaluations

Scientific Reports ◽

10.1038/s41598-021-91965-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mingyu Kim ◽

Sungchul Kim ◽

Minjee Kim ◽

Hyun-Jin Bae ◽

Jae-Woo Park ◽

...

Keyword(s):

Class Imbalance ◽

Cervical Vertebra ◽

Turing Test ◽

Generative Adversarial Networks ◽

Posterior Arch ◽

Generative Adversarial Network ◽

Lateral Cephalogram ◽

Adversarial Network ◽

Significant Difference ◽

External Test

AbstractRealistic image generation is valuable in dental medicine, but still challenging for generative adversarial networks (GANs), which require large amounts of data to overcome the training instability. Thus, we generated lateral cephalogram X-ray images using a deep-learning-based progressive growing GAN (PGGAN). The quality of generated images was evaluated by three methods. First, signal-to-noise ratios of real/synthesized images, evaluated at the posterior arch region of the first cervical vertebra, showed no statistically significant difference (t-test, p = 0.211). Second, the results of an image Turing test, conducted by non-orthodontists and orthodontists for 100 randomly chosen images, indicated that they had difficulty in distinguishing whether the image was real or synthesized. Third, cephalometric tracing with 42 landmark points detection, performed on real and synthesized images by two expert orthodontists, showed consistency with mean difference of 2.08 ± 1.02 mm. Furthermore, convolutional neural network-based classification tasks were used to classify skeletal patterns using a real dataset with class imbalance and a dataset balanced with synthesized images. The classification accuracy for the latter case was increased by 1.5%/3.3% at internal/external test sets, respectively. Thus, the cephalometric images generated by PGGAN are sufficiently realistic and have potential to application in various fields of dental medicine.

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The Correlation between Dental Stages and Skeletal Maturity Stages

BioMed Research International ◽

10.1155/2021/9986498 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Ayah Jourieh ◽

Haris Khan ◽

Samer Mheissen ◽

Muhammad Assali ◽

Mohammad Khursheed Alam

Keyword(s):

Rank Order ◽

Skeletal Maturity ◽

Growth Period ◽

Panoramic Radiograph ◽

Skeletal Maturation ◽

Dental Maturation ◽

Second Molar ◽

Maturity Stages ◽

Study Results ◽

Roc Area

Introduction. The determination of skeletal maturity stages is very important in orthodontic treatment planning, especially skeletal discrepancies in growing individuals. A hand-wrist radiograph is considered the most accurate approach for skeletal maturity detection. Dental calcification stages have been suggested as an alternative diagnostic method to decrease radiation exposure. The recent study is aimed at detecting the efficacy of dental calcification stages in assessing skeletal maturity during the prepubertal and pubertal growth periods. Methods. Patients’ records were collected from the Aleppo Orthodontic Center. Dental maturity stages were assessed from a panoramic radiograph using the Demirjian method, while skeletal maturity stages were determined using the Björk method. Four permanent left mandibular teeth were included (canine, 1st premolar, 2nd premolar, and 2nd molar) for the study. Results. From 517 records, 295 records (145 males and 150 females) were included. The Spearman rank-order correlation coefficients between skeletal maturation and dental maturation were strong and statistically significant (ranging from 0.789 to 0.835). The highest correlation was between skeletal stages and the second molar ( r = 0.829 and 0.88 in males and females, respectively). Receiver operating characteristic (ROC ) curve suggested a high validity of the sum of dental stages for the four teeth in identifying MP3= stage (sensitivity was 70%, specificity was 92.77%, and ROC area was 0.81) but not for MP3cap (sensitivity was 50.85%, specificity was 81.36%, and ROC area was 0.66). Conclusions. The correlation between the skeletal maturity stages and the dental calcification stages was high. The orthodontist can use the dental stages as a definite diagnostic tool for prepubertal growth period.

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Characteristics of femoroacetabular impingement morphology and relation with skeletal maturity among asymptomatic adolescents

Acta Orthopaedica Belgica ◽

10.52628/87.1.07 ◽

2021 ◽

Vol 87 (1) ◽

pp. 47-54

Author(s):

Mehmet Kaymakoglu ◽

Raziye Dut ◽

Duygu Imre ◽

Fatma Bilge Ergen ◽

Mehmet Ali Talmac ◽

...

Keyword(s):

Femoral Neck ◽

Skeletal Maturity ◽

Alpha Angle ◽

Morphological Characteristics ◽

Skeletal Maturation ◽

Physiological Status ◽

Triradiate Cartilage ◽

Center Edge ◽

Significant Difference ◽

Femoral Physis

The aim of this study was to analyze presence of the morphological characteristics and prevalence of FAI in asymptomatic adolescents and assess the relation of skeletal maturation with development of FAI morphology. Abdominopelvic computed tomography (CT) of 265 adolescents (9-19 years old) who were admitted to the emergency department between 2011 and 2016 were evaluated retrospectively. Radial reformatted CT images from the femoral neck were created using the multiplanar reconstruction (MPR) method. The femoral neck was divided into 12 segments and alpha angle (AA), femoral head-neck ratio (FHNR) and center-edge angle (CEA) were measured from each segment. Additionally, images were evaluated for the physiological status (open or closed) of the triradiate- cartilage and proximal femoral epiphyses. 204 hips from 102 patients (32 females, 70 males) were retrospectively reviewed. There were 27 (26.5%) patients with cam-type morphology and 18 (17.6%) patients with pincer-type morphologies. No statistically significant difference was detected between the prevalences of cam and pincer morphologies between the two genders. Cam deformity was most frequently seen in anterosuperior segment. All of the patients (100%) with pincer-type morphology and 88% of the patients with cam-type morphology had closed triradiate cartilage, 89% of the patients with cam morphology and 83% with pincer morphology had open proximal femoral physis. Our results showed that prevalence of cam and pincer-type morphology in asymptomatic adolescents is similar to asymptomatic adults. Our findings also indicate that cam- and pincer-type FAI morphologies likely develop during late adolescence after closure of triradiate cartilage and before closure of proximal femoral physis. Level of Evidence - 3

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The Difference in Cervical Vertebral Skeletal Maturation between Cleft Lip/Palate and Non-Cleft Lip/Palate Orthodontic Patients

BioMed Research International ◽

10.1155/2018/5405376 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Waeil Batwa ◽

Khalid Almoammar ◽

Aziza Aljohar ◽

Abdullah Alhussein ◽

Saad Almujel ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Skeletal Maturity ◽

Skeletal Maturation ◽

Growth Spurt ◽

Male Population ◽

Significant Difference ◽

Cleft Lip Palate ◽

Orthodontic Patients ◽

Saudi Male

Objective. The aim was to evaluate differences in the cervical vertebral skeletal maturity of unilateral cleft lip and palate (UCLP) and non-cleft lip/palate (non-CLP) Saudi male orthodontic patients. Method. This cross-sectional multicenter study took place at the dental school, King Saud University and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between October 2014 and September 2015. The records of Saudi male orthodontic patients with UCLP n=69 were collected. Cervical vertebral maturation was assessed using their cephalometric radiographs. The records of 138 age-matched non-CLP Saudi male orthodontic patients served as controls. Results. There was a significant difference in skeletal maturity between the UCLP and non-CLP groups, as evident in the delayed skeletal development among the UCLP participants. Moreover, pubertal growth spurt onset was significantly earlier in the non-cleft participants in comparison with the UCLP participants p=0.009. Conclusions. There is delayed skeletal maturity among the UCLP Saudi male population in comparison with their non-CLP age-matched peers.

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A comparison of 3 different methods for assessment of skeletal age when treating leg-length discrepancies: an inter- and intra-observer study

Acta Orthopaedica ◽

10.2340/17453674.2021.1133 ◽

2022 ◽

Vol 93 ◽

pp. 222-228

Author(s):

Anne Berg Breen ◽

Harald Steen ◽

Are Pripp ◽

Ragnhild Gunderson ◽

Hilde Kristine Sandberg Mentzoni ◽

...

Keyword(s):

Skeletal Maturity ◽

Intraclass Correlation ◽

Age Determination ◽

Bone Age ◽

Systematic Difference ◽

Skeletal Age ◽

Leg Length ◽

Left Elbow ◽

Comparison Results ◽

Significant Difference

Background and purpose — Skeletal maturity is a crucial parameter when calculating remaining growth in children. We compared 3 different methods, 2 manual and 1 automated, in the radiological assessment of bone age with respect to precision and systematic difference. Material and methods — 66 simultaneous examinations of the left hand and left elbow from children treated for leg-length discrepancies were randomly selected for skeletal age assessment. The radiographs were anonymized and assessed twice with at least 3 weeks’ interval according to the Greulich and Pyle (GP) and Sauvegrain (SG) methods by 5 radiologists with different levels of experience. The hand radiographs were also assessed for GP bone age by use of the automated BoneXpert (BX) method for comparison. Results — The inter-observer intraclass correlation coefficient (ICC) was 0.96 for the GP and 0.98 for the SG method. The inter- and intra-observer standard error of the measurement (SEm) was 0.41 and 0.32 years for the GP method and 0.27 and 0.21 years for the SG method with a significant difference (p < 0.001) between the methods and between the experienced and the less experienced radiologists for both methods (p = 0.003 and p < 0.001). In 25% of the assessments the discrepancy between the GP and the SG methodwas > 1 year. There was no systematic difference comparing either manual method with the automatic BX method. Interpretation — With respect to the precision of skeletal age determination, we recommend using the SG method or preferably the automated BX method based on GP assessments in the calculation of remaining growth.

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THU0433 TREATMENT WITH PEGLOTICASE IMPROVES HEPATIC FIBROSIS ESTIMATED BY FIBROSIS-4 INDEX IN SUBJECTS WITH CHRONIC REFRACTORY GOUT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2360 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 454.1-454

Author(s):

N. Schlesinger ◽

A. Yeo ◽

P. Lipsky

Keyword(s):

Liver Disease ◽

Linear Regression ◽

Rank Order ◽

Linear Regression Analysis ◽

Area Under The Curve ◽

Serum Urate ◽

Complete Analysis ◽

Alcoholic Fatty Liver ◽

Significant Difference ◽

The Impact

Background:Hyperuricemia is associated with non-alcoholic fatty liver disease (NAFLD)1,2, but the relationship to fibrosis remains uncertain3. Moreover, it is not known whether lowering serum urate will affect the course of NAFLD. The availability of data from two randomized trials of pegloticase, a pegylated recombinant mammalian uricase, that profoundly decreases serum urate afforded the opportunity to test the hypothesis that lowering urate might improve NAFLD.Objectives:To determine whether treatment of chronic refractory gout patients with pegloticase was associated with improvement in NAFLD determined by Fibrosis 4 index (Fib4).Methods:Databases from patients with chronic refractory gout who participated in two randomized 6 month clinical trials (RCTs) of pegloticase were analyzed4. Sub-sets who had persistent urate lowering to levels <1 mg/dL in response to biweekly pegloticase (Responders, n=36) were compared to those who received placebo (n=43). Since liver biopsy information was not available on these subjects, we relied on Fib4, a validated non-invasive estimate of liver fibrosis in a variety of liver diseases5,6calculated from measurements of AST, ALT, platelet count and age (Age x AST/platelets x √ALT). A Fib4 value of 1.3 is an indication that further evaluation of liver disease is warranted.Results:At baseline, the mean Fib4 values were 1.40 ± 0.86 in pegloticase responders and 1.04 ± 0.53 in subjects receiving placebo. As shown in figure 1, subjects receiving placebo exhibited a change of 0.26 ± 0.41 in the Fib4 score over the six months of the RCTs compared with 0.13 ± 0.62 in the pegloticase responders (p=0.048; by linear regression). When only the subjects with a Fib4 value > 1.3 were considered, a significant difference in the change in the Fib4 values over the 6 months of the trial between pegloticase responders and those receiving placebo was also observed (-0.15 ± 0.67 vs 0.37 ± 0.42, p=0.004, by linear regression). The correlations between serum urate area under the curve (AUC) over the 6 months of the trial and the change in Fib4 value was rs=0.33, p=0.0.0004 (Spearman rank-order correlation coefficient). Finally, multiple linear regression analysis indicated serum urate AUC (as a surrogate measure for group) is the main contributor to the change in Fib4 (p=0.018 by linear regression).Conclusion:The data are consistent with the conclusion that persistent lowering of serum urate had a significant impact on Fib4 levels, implying a possible effect on the course of NAFLD. The results support a more complete analysis involving biopsy examination of the impact of urate on liver inflammation and fibrosis.References:[1]Yang C et al. PlosOne2017; 12:e0177249[2]Jaruvongvanich V et al. Eur J Gastroenterol Hepatol 2017; 29:1031[3]Jaruvongvanich V et al. Eur J Gastroenterol Hepatol 2017; 29:694[4]Sundy JS, et al. JAMA. 2011; 306 (7):711-20[5]Sterling RK et al. Hepatol 2006; 43:1317[6]Shah AG et al. Clin Gastroenterol Hepatol 2009;7:1104Disclosure of Interests: :Naomi Schlesinger Grant/research support from: Pfizer, Amgen, Consultant of: Novartis, Horizon Therapeutics, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Anthony Yeo Employee of: Horizon Therapeutics, Peter Lipsky Consultant of: Horizon Therapeutics

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Analysis of Bone Age Data From National Cooperative Growth Study Substudy VII

PEDIATRICS ◽

10.1542/peds.104.s5.1031 ◽

1999 ◽

Vol 104 (Supplement_5) ◽

pp. 1031-1036

Author(s):

Stephen F. Kemp ◽

Judy P. Sy

Keyword(s):

Age Determination ◽

Bone Age ◽

Strongly Correlated ◽

Growth Study ◽

Gh Therapy ◽

Pubertal Stage ◽

Significant Difference ◽

Clinically Significant ◽

National Cooperative ◽

Age Determinations

National Cooperative Growth Study substudy VII was conducted 1) to compare standardized hand–wrist and knee bone age determinations in pubertal children treated with growth hormone (GH); 2) to compare local determinations of bone ages with centrally determined bone ages; 3) to relate the response to GH therapy to the bone age determinations; and 4) to ascertain the predictive value of each type of bone age determination. Eligible subjects were those in the National Cooperative Growth Study who were at Tanner pubertal stage 2 or greater for breasts (girls) or genitals (boys). Radiographs of the hand–wrist were taken annually, and radiographs of the knee were taken at the beginning and the end of the study. Separate bone age determinations were made from these radiographs. A combined hand–wrist and knee bone age determination also was derived. There were 990 patients in the study; in 925 (677 boys), there were both hand–wrist and knee bone age determinations from the baseline pubertal radiographs. There was only one radiographic assessment in 496 patients, two in 205 patients, and three to eight in the remaining patients. The strongest correlation was between the hand–wrist bone age and the hand–wrist plus knee bone age (r = .995). Also strongly correlated were knee with hand–wrist (r = .872) and knee with hand–wrist plus knee (r = .914). For none of these bone age methods was any statistically significant difference found between the methods. The locally determined bone ages correlated strongly with the centrally determined bone ages for knee (r = .850), hand–wrist (r = .928), and hand–wrist plus knee (r = .930); however, the locally determined knee and hand–wrist values were less (by ∼0.3 year) than the centrally determined values. These differences, however, do not appear to be clinically significant.

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