title: Dental calcification stages as determinants of the peak growth period.
abstract: OBJECTIVE
  The objective of this study was to investigate the diagnostic accuracy of dental maturation stages for identifying individual-specific skeletal maturation phases.
  
  
  METHODS
  Prior to initiating this study, 255 orthodontic patients comprising 145 girls and 110 boys from the Department of Orthodontics, Aristotle University of Thessaloniki, Greece were identified. Lateral cephalometric and panoramic radiographs were evaluated. Dental calcification stages were assessed according to the Demirjian method and skeletal maturation according to the cervical vertebral maturation stage (CVMS) method. Statistical assessments included Spearman Brown formula, descriptive statistics, Spearman's rho correlation coefficient, and positive likelihood ratios (LHRs).
  
  
  RESULTS
  The highest (r = 0.725) correlations were found for second molars and the lowest correlation for canines (r = 0.463, p < 0.001). Positive LHR values exceeding ten were found to identify the pre-peak growth phase in conjunction with the second molar (stage D), second premolar (stage E), and first premolar (stages D and E). Only the second molar (stage F) yielded positive LHR values for identifying the peak growth phase. The positive LHR values for the second molar also facilitated identification of the post-peak growth phase (stage H). Taking the clinical diagnostic efficacy of the second molar into account in identifying these growth phases, we calculated the positive LHRs of the second molar to determine dental maturation stages for diagnosing CVMS II and III. Positive LHR values greater than 10 identified CVMS II (stage D).
  
  
  CONCLUSIONS
  Evaluating dental maturation is a useful initial diagnostic step when assessing skeletal growth. The calcification stages of the second molar provide reliable diagnostic information with which to determine the pubertal growth spurt.
authors.affiliation: Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. info@orthosmile.gr.|, Kozani, Greece. info@orthosmile.gr.
authors.forename: George
authors.initials: G
authors.lastname: Litsas
authors.affiliation: Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.|Dubai College of Dental Medicine, Dubai, United Arab Emirates.
authors.forename: Athanasios E
authors.initials: AE
authors.lastname: Athanasiou
authors.affiliation: Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Moschos A
authors.initials: MA
authors.lastname: Papadopoulos
authors.affiliation: Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Ioulia
authors.initials: I
authors.lastname: Ioannidou-Marathiotou
authors.affiliation: Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Karagiannis
mesh_terms: D000293:Adolescent; D000366:Age Determination by Teeth / Q000379:methods*; D000375:Aging / Q000502:physiology; D000465:Algorithms; D001846:Bone Development / Q000502:physiology*; D002508:Cephalometry / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D011861:Radiography, Dental / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014070:Tooth / Q000000981:diagnostic imaging / Q000254:growth & development*; D014074:Tooth Calcification / Q000502:physiology*
keywords: Dental maturation stages; Molars; Orthognathic surgery; Positive LHR values; Pubertal growth spurt