REBOUÇAS, Patrícia Ravena M.; ALENCAR, Catarina Ribeiro Barros de; ARRUDA, Maria Jacinta A. L. L. A.; LACERDA, Rosa Helena W.; MELO, Daniela P. de; BERNARDINO, Ítalo de M.; BENTO, Patrícia M.

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Dental Press Journal of Orthodontics

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ORIGINAL ARTICLE • Dental Press J. Orthod. 26 (04) • 2021 • https://doi.org/10.1590/2177-6709.26.4.e2119292.oar copiar

Identification of dental calcification stages as a predictor of skeletal development phase

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

O presente estudo objetivou estabelecer uma correlação entre os estágios de calcificação dentária de caninos e segundos molares inferiores e as fases do desenvolvimento esquelético.

Métodos:

Em uma série consecutiva de radiografias panorâmicas, cefalométricas e de mão e punho de 113 indivíduos (60 meninas e 53 meninos) com idade média de 12,24 ± 1,81 anos, foram classificados os estágios de calcificação do canino e do segundo molar inferiores, indicadores de maturação das vértebras cervicais (IMVC) e indicadores de maturação esquelética (IME). As variáveis foram correlacionadas pelo teste de Correlação de Rank de Spearman: idade cronológica, IME, IMVC e estágios de calcificação dentária. A fim de avaliar se os estágios do IMVC e da calcificação dentária foram preditores significativos do IME, foi realizada uma análise de regressão ordinal.

Resultados:

Os estágios de IMVC (OR = 16,92; IC 95% = 6,45-44,39; p< 0,001) e calcificação dos segundos molares (OR = 3,22; IC 95% = 1,50-6,92; p= 0,003) foram preditores significativos de IME; no entanto, esse não foi o caso com dentes caninos (OR = 0,52, IC 95% = 0,18-1,54; p= 0,239). Os estágios de calcificação E para meninos e E e F para meninas corresponderam à fase pré-pico de crescimento puberal. Os estágios G e H para meninos e F e G para meninas coincidiram com o pico de crescimento. Na fase final de crescimento, a maioria dos segundos molares apresentou fechamento do ápice radicular (estágio H).

Conclusão:

Os estágios de calcificação do segundo molar podem ser considerados preditores do estágio de desenvolvimento esquelético na população estudada.

Palavras-chave:
Ossos do carpo; Vértebras cervicais; Ortodontia; Radiografia

STAGE	EVENTS
A	Calcification of single occlusal points, without fusion of different calcifications.
B	Fusion of mineralization points; the contour of the occlusal surface is recognizable.
C	Enamel formation has been completed at the occlusal surface, and dentin formation has commenced. The pulp chamber is curved, and no pulp horns are visible.
D	Crown formation has been completed to the level of the cementoenamel junction. Root formation has commenced. The pulp horns are beginning to differentiate, but the walls of the pulp chamber remain curved.
E	The root length remains shorter than the crown height. The walls of the pulp chamber are straight, and the pulp horns have become more differentiated than in the previous stage. In molars the radicular bifurcation has begin to calcify.
F	The walls of the pulp chamber now form an isosceles triangle, and the root length is equal to or greater than the crown height. In molars, bifurcation has developed sufficiently to give the roots a distinct form.
G	The walls of the root canal are now parallel, but the apical end is partially open. In molars, only the distal root is rated.
H	The root apex is completely closed (distal root in molars). The periodontal membrane surrounding the root and apex is uniform in width throughout.

STAGE	OSSIFICATION EVENTS	PUBERTAL GROWTH STAGE
1	The lower borders of all the three vertebrae (C2-C4) are flat. The bodies of both C3 and C4 are trapezoid in shape.	Onset
2	A concavity is present at the lower border of C2. The bodies of both C3 and C4 are still trapezoid in shape.	Onset
3	Concavities at the lower borders of both C2 and C3 are present. The bodies of C3 and C4 may be either trapezoid or rectangular horizontal in shape.	Peak
4	Concavities at the lower borders of C2, C3, and C4 now are present. The bodies of both C3 and C4 are rectangular horizontal in shape.	Peak
5	The concavities at the lower borders of C2, C3, and C4 are still present. At least one of the bodies of C3 and C4 is squared in shape. If not squared, the body of the other cervical vertebra is still rectangular horizontal.	End
6	The concavities at the lower borders of C2, C3, and C4 are still evident. At least one of the bodies of C3 and C4 is rectangular vertical in shape. If not rectangular vertical, the body of the other cervical vertebra is squared.	End

STAGE	OSSIFICATION EVENTS	PUBERTAL GROWTH STAGE
1	The proximal phalanx of third finger shows equal widths of epiphysis and diaphysis.	Pre-puberty
2	The middle phalanx of third finger shows equal widths of epiphysis and diaphysis.
3	The middle phalanx of fifth finger shows equal widths of epiphysis and diaphysis
4	Appearance of adductor sesamoid of the thumb.	Puberty
5	Capping of epiphysis of distal phalanx on the third finger
6	Capping of epiphysis on middle phalanx on the third finger
7	Capping of epiphysis of middle phalanx on fifth finger.
8	Fusion between epiphysis and diaphysis of the distal phalanx on the third finger.	Late puberty
9	Fusion between epiphysis and diaphysis of the proximal phalanx of the third finger.
10	Fusion between epiphysis and diaphysis of middle phalanx on the third finger.
11	Fusion of epiphysis and diaphysis seen in the radius.	Post-puberty

		CA	SMI	CVMI	CCS	MCS
TOTAL SAMPLE	CA	1
	SMI	0.743*	1
	CVMI	0.771*	0.903*	1
	CCS	0.789*	0.712*	0.717*	1
	MCS	0.833*	0.735*	0.662*	0.784*	1
BOYS	CA	1
	SMI	0.856*	1
	CVMI	0.886*	0.888*	1
	CCS	0.789*	0.719*	0.748*	1
	MCS	0.852*	0.803*	0.735*	0.812*	1
GIRLS	CA	1
	SMI	0.858*	1
	CVMI	0.847*	0.896*	1
	CCS	0.810*	0.801*	0.756*	1
	MCS	0.827*	0.805*	0.672*	0.760*	1

Pubertal growth stage	Chronological age (years)
	Male	Female
	Mean (SD)	Mean (SD)
Onset	10.67 (1.20)^Aa	10.15 (0.78)^Aa
Peak	12.91 (1.09)^Ab	10.74 (0.92)^Ba
End	14.03 (1.03)^Ab	13.23 (1.36)^Bb

Predictors	Estimate	SE	Wald	OR	CI 95%	p-value
CVMI	2.83	0.49	33.04	16.92	6.45-44.39	< 0.001
CCS	-0.65	0.55	1.38	0.52	0.18-1.54	0.239
MCS	1.17	0.39	8.96	3.22	1.50-6.92	0.003

Predictors	Estimate	SE	Wald	OR	CI 95%	p-value
CVMI	2.22	0.58	14.43	9.22	2.93-28.98	< 0.001
CCS	-0.43	0.80	0.28	0.65	0.14-3.14	0.594
MCS	1.63	0.72	5.15	5.13	1.25-21.06	0.023

Predictors	Estimate	SE	Wald	OR	CI 95%	p-value
CVMI	3.51	0.94	14.04	33.34	5.33-208.66	< 0.001
CCS	-0.91	0.85	1.14	0.40	0.08-2.14	0.286
MCS	1.19	0.56	4.55	3.30	1.10-9.88	0.033

Variable		Sex
		Male	Female	Total
		n (%)	n (%)	n (%)
ONSET	Canine calcification stages
	D	0 (0.0)	0 (0.0)	0 (0.0)
	E	0 (0.0)	1 (11.1)	1 (3.3)
	F	12 (57.1)	5 (55.6)	17 (56.7)
	G	5 (23.8)	2 (22.2)	7 (23.3)
	H	4 (19.0)	1 (11.1)	5 (16.7)
	Molar calcification stages
	D	1 (4.8)	1 (11.1)	2 (6.7)
	E	10 (47.6)	3 (33.3)	13 (43.3)
	F	4 (19.0)	3 (33.3)	7 (23.3)
	G	4 (19.0)	2 (22.2)	6 (20.0)
	H	2 (9.5)	0 (0.0)	2 (6.7)
	Cervical vertebrae maturation indicators
	1	5 (23.8)	3 (33.3)	8 (26.7)
	2	10 (47.6)	2 (22.2)	12 (40.0)
	3	6 (28.6)	4 (44.4)	10 (33.3)
	4	0 (0.0)	0 (0.0)	0 (0.0)
	5	0 (0.0)	0 (0.0)	0 (0.0)
	6	0 (0.0)	0 (0.0)	0 (0.0)
PEAK	Canine calcification stages
	D	0 (0.0)	0 (0.0)	0 (0.0)
	E	0 (0.0)	0 (0.0)	0 (0.0)
	F	1 (7.1)	3 (18.8)	4 (13.3)
	G	4 (28.6)	10 (62.5)	14 (46.7)
	H	9 (64.3)	3 (18.8)	12 (40.0)
	Molar calcification stages
	D	0 (0.0)	1 (6.2)	1 (3.3)
	E	0 (0.0)	2 (12.5)	2 (6.7)
	F	1 (7.1)	7 (43.8)	8 (26.7)
	G	8 (57.1)	5 (31.2)	13 (43.3)
	H	5 (35.7)	1 (6.2)	6 (20.0)
	Cervical vertebrae maturation indicators
	1	0 (0.0)	0 (0.0)	0 (0.0)
	2	1 (7.1)	0 (0.0)	1 (3.3)
	3	5 (35.7)	5 (31.2)	10 (33.3)
	4	6 (42.9)	9 (56.2)	15 (50.0)
	5	2 (14.3)	2 (12.5)	4 (13.3)
	6	0 (0.0)	0 (0.0)	0 (0.0)
END	Canine calcification stages
	D	0 (0.0)	0 (0.0)	0 (0.0)
	E	0 (0.0)	0 (0.0)	0 (0.0)
	F	0 (0.0)	1 (2.9)	1 (1.9)
	G	1 (5.6)	3 (8.6)	4 (7.5)
	H	17 (94,4)	31 (88.6)	48 (90.6)
	Molar calcification stages
	D	0 (0.0)	1 (2.9)	1 (1.9)
	E	0 (0.0)	0 (0.0)	0 (0.0)
	F	0 (0.0)	1 (2.9)	1 (1.9)
	G	3 (16.7)	9 (25.7)	12 (22.6)
	H	15 (83.3)	24 (68.6)	39 (73.6)
	Cervical vertebrae maturation indicators
	1	0 (0.0)	0 (0.0)	0 (0.0)
	2	0 (0.0)	0 (0.0)	0 (0.0)
	3	1 (5.6)	0 (0.0)	1 (1.9)
	4	3 (16.7)	4 (11.4)	7 (13.2)
	5	4 (22.2)	8 (22.9)	12 (22.6)
	6	10 (55.6)	23 (65.7)	33 (62.3)

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