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Relationship between mandibular
canine calcification stages &
skeletal maturity
AJO 1993, 104: 262-8
Sandra Coutinho Guam
Peter H. Buschang Bylor, Dallas Tx
Francis Miranda Bylor, Dallas Tx
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Knowledge of the stage of maturation that a child has attained helps
in evaluating his or her progression through expected developmental
events. Such information is clinically important in:
1) Helps interdisciplinary health teams assessing patients with various
types of short stature, endocrine disorders, and/or metabolic
diseases.
Its utility is well established in syndrome identification and
forensics.
2) A childs maturity status helps better identify optimal time for
certain types of orthopedic treatments.
Variations exist between individual children in the ages at which
they attain similar developmental events.
In addition, there are diseases, systemic disorders and environmental
factors that may affect childs physiologic maturity.

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Relationship between the stages of tooth mineralization of
mandibular canine appear to co relate better with ossification
stages than the other teeth (studies by Chertkow 1979, 80 and
Alicia M. Sierra in 1987)
Interrelationship between skeletal, somatic and sexual maturity
have shown to be consistently strong.(Demirjian 1985AJO)
Given the well established relation between skeletal and somatic
maturity, stages of calcification of the mandibular canine might
be used as a first level diagnostic tool to estimate timing of
pubertal growth spurt.
Ease of recognizing dental developmental stages, together with
the availability of intra oral or panoramic radiographs in most
orthodontic or paediatric practice are practical reasons for
attempting to assess a persons physiologic maturity without
resorting to multiple hand wrist radiographs.
The purpose of this study was to verify relationships between
canine calcifications and skeletal maturity.
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Materials and Methods
Pre treatment dental OPG 200 boys, 215
girls between 7 165 years.
Skeletal age determined from hand wrist
radiographs and assessed according to Pyle
and Greulich.
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The phalangeal
maturity stages and
appearance of
adductor sesamoid
were defined by using
the Tanner
Whitehouse method.
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The development of the mandibular canines were assessed
according to Demirjian stages of dental calification.

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Results
Mean skeletal age for the presence of the
adductor sesamoid in girls 12.2 years and
boys 13.2 years.
The middle phalanx of the third finger
shows the highest relationship with canine
maturity for both sexes, followed by PP5,
DP3.
The PP3 and adductor sesamoid show
similar patterns of association with canine
maturation.

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Most subjects having attained mandibular canine
stage F show no presence of adductor sesamoid.
Stage F epiphysis of MP3 and MP5 equal to
diaphysis. This stage indicates initiation of growth
spurt.
Stage G Eruption of the canine into the oral
cavity.
Shows adductor sesamoid.
Capping of MP3, DP3, PP5.
1 year before PHV in boys.
5 months before PHV in girls.
Stage H Stage of apical closure. Fusion of
epiphysis to diaphysis.
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Conclusion
Close association exists between mandibular canine
calcification stages and skeletal maturity indicators.
The intermediate stage between stages F and G should be
used to identify early stages of pubertal growth spurt.
While there is a close relationship between canine
calcification and skeletal maturation, canine calcification
cannot and should not be used as a sole criterion to predict
developmental landmarks (I.e., onset of puberty, PHV etc.)
Dental calcification stages of mandibular canine are readily
available and easily recognized indicators of maturity
status of a person. They are simple, first level diagnostic
test to determine whether additional, more sensitive
measures of maturity are needed.
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