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Table of Contents   
ORIGINAL RESEARCH  
Year : 2011  |  Volume : 22  |  Issue : 5  |  Page : 627-632
Maturation of permanent teeth in different facial types: A comparative study


1 Department of Orthodontics, Daswani Dental College, Kota, Rajasthan, India
2 Department of Orthodontics, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India

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Date of Submission12-Apr-2010
Date of Decision07-Jul-2010
Date of Acceptance11-Oct-2010
Date of Web Publication7-Mar-2012
 

   Abstract 

Background: Accurate diagnosis of dental maturation help in diagnosis, treatment planning, and timing in orthodontics and dentofacial orthopedics.
Aim and Objective: The present study is undertaken to compare and correlate chronological age and dental age of patients with average, vertical, and horizontal facial types, and to find out any sex difference in dental age in different growth patterns and to evaluated the reliability of Willem's method in Indian population.
Materials and Methods: Subjects in the age group of 8-10 years were screened from Out Patients Department of Orthodontics and Dentofacial Orthopedics and from the various school of the City, were subjected to cephalometric radiography and orthopentomograms. Angular and linear measurements used included;-SN Go-Gn angle, J.R. (Jarabak ratio) and LAFH (lower anterior facial height), to group total sample of 150 children. Group 1 (average grower), Group 2 (vertical grower), and Group 3 (horizontal grower). Then dental age for each child in different group was calculated from OPG of each subject and compared with chronological age using Student t-test.
Results: The results suggest a difference in dental age in subject with vertical and horizontal growers. Vertical grower showed earlier maturation compared to horizontal growth patterns. There was insignificant difference present when vertical grower and horizontal grower were compared with average growth pattern. Insignificant difference was found in dental age between males and females when compared to same growth pattern.
Conclusion: Subjects with vertical growth pattern matured early than having the horizontal growth pattern in the same chronological age.

Keywords: Dental maturation, different facial type, modified Willem′s method

How to cite this article:
Goyal V, Kapoor D N, Kumar S, Sagar M. Maturation of permanent teeth in different facial types: A comparative study. Indian J Dent Res 2011;22:627-32

How to cite this URL:
Goyal V, Kapoor D N, Kumar S, Sagar M. Maturation of permanent teeth in different facial types: A comparative study. Indian J Dent Res [serial online] 2011 [cited 2014 Sep 22];22:627-32. Available from: http://www.ijdr.in/text.asp?2011/22/5/627/93446
Different methods are available for estimating the dental age as advanced by Nolla's (1960), [1] Haavikko's (1970), [2] Demirjian's (1973), [3] and modified Demirjian method by Guy Willems (2001). [4] The commonly used method for accessing dental age is Demirjian's method because of it simplicity and more accuracy. This method has been widely used for the dental age estimation for year, but many authors [4],[5],[6],[7],[8],[9],[10],[11],[12],[13] reported that Demirjian's method overestimate the dental age. Willems in 2001 in a study on Belgian children established the new method of dental age estimation named Modified Demirjian method. Maber et al.[10] and Rai et al.[11] in their study also concluded that Willems [4] method was more accurate method than that of. [1],[2],[3],[14] in his study stressed that open bite subjects mature earlier than deep bite subjects and some authors suggested correlation between dental maturation and skeletal maturation. Keeping above concern in mind Janson et al.[15] was probably first to investigate the influence of facial type on dental development in subjects of the same chronological age. They showed that hyperdivergent subjects presented a tendency to have an advanced dental maturation in comparison to hypodivergent subjects. Naves et al.[16] compared the maturation stages of permanent teeth in subjects with vertical and horizontal growth pattern and concluded that subjects with vertical growth pattern had earlier dental maturation than horizontal grower.

However, Jamroz et al.[17] investigated the relationship between vertical growth pattern and dental maturation in children with long and short anterior facial height and concluded that there was no difference in dental age between long and short facial types.

Therefore, it is evident from the above studies that vertical grower mature earlier than horizontal grower whereas according to Jamroz there existed no difference between two types of facial growers. Keeping this in mind the present study has been taken up on larger sample size to compare and correlate the maturational stage of permanent teeth between 8 and 10 years of age among subjects with average, vertical, and horizontal growth patterns using modified Demirjian method as advocated by Willems. [4]


   Materials and Methods Top


The study was conducted in the Department of Orthodontics and Dentofacial Orthopedics, Kothiwal Dental College and Research Centre, Moradabad. Subjects on random basis were selected from the Out patient Department of Kothiwal Dental College and from the various school of the Moradabad City. Consent from the selected individuals was taken for participation in study and taking X-rays. Following preliminary selection criteria was used.

  • Subjects ranged in age of 8-10 years.
  • All the permanent teeth except third molar were visible on the panoramic radiographs.
  • Subjects were excluded having any supernumerary teeth or congenital missing teeth.
Name, age, sex, date of birth of each subject was noted for categorizing and to know the chronological age of the individual. Verification of school records was made on the basis of municipal records. The lateral head cephalogram and orthopantomograms of the subjects were taken using a standardized technique using machine manufactured by Villa (Italy, Strato 2000). All the exposed films were developed using Automatic Processor (VELOPEX EXTRA-SE, India). The cephalometric tracing were carried out by using transilluminated view box on one side glazed acetate paper of 0.03 in. thickness using 4H led pencil. Set squares, half millimeter scale and protractor that could measure up to 0.5° was used to measure the angular measurements. Cephalometric landmarks and planes used in the study are given in [Figure 1].
Figure 1: Cephalometric landmark and plane

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Classification of subjects according to growth pattern

For cephalometric measurements following parameters were used for classification of growth pattern [Table 1]:
Table 1: Parameters used for classification of growth pattern

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Landmarks and planes used in cephalometric evaluation to classify sample in different growth pattern [[Figure 1]: attach is photograph with tracing having landmarks, plane showing parameters used in measurement to classify facial growth pattern in mixed dentition]. Superimposition tracing of average, vertical, and horizontal groups is shown in [Figure 2].
Figure 2: Average, vertical, and horizontal growth pattern

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Based on the above parameters all the subjects were categorized in three groups for boys and girls separately [Table 2].
Table 2: Presents Mean and S.D. of the cephalometric characteristics of each groups, having different facial growth pattern

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Determination of error in methodology used

In order to ascertain error in measurement 20 lateral cephalogram and orthopentomogram were randomly selected and the measurement obtained were compared with the first measurement of the same individuals to find out difference if any in the location of landmark, planes, effecting measurement from cephalometric tracings. OPG was used for calculating dental age based on Willem's modified method. Data were obtained from 1 st and 2 nd measurements and calculations were subjected to statistical evaluation to find out statistical difference resulting error in measurements. It is evident [Table 3] that there existed insignificant inherent error in location of landmarks and measurements. Hence, data obtained for the study was considered reliable and reproducible. ANOVA test for homogeneity of samples indicated that there existed no difference in the samples according to the chronological age. The results obtained are presented in [Table 3] and [Table 4].
Table 3: Double determination for assessment of intra operator error in measurement

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Table 4: "F" Ratio for homogeneity of sample according to chronological age

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Assessment of dental age from panoramic radiograph

Panoramic radiographs of all children were used to assess the status of tooth maturation on the basis of calcification of the permanent teeth in mandibular left quadrant, from central incisor to second molar, using the method followed by Demirjian et al.[3] [Figure 3].
Figure 3: Panoramic radiograph of female child of 9.58 years chronological age

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Dental age of each subjects were calculated according to developmental stages of the seven left permanent teeth in the mandible using Demirjian's technique. After noting all stages of teeth from central incisor to second molar. The developmental status of a particular tooth was calculated in years on the basis of Tables given by Guy Willems et al.[4] (Demirjian's Technique Revisited) [Table 5] and [Table 6]. All the values from central incisor to second molar thus obtained were summed to obtain an overall maturity score, which will indicate the dental age of that particular patient. Data obtained for all subjects in groups 1, 2, and 3 were subjected to statistical analysis. Mean, standard deviation and SEM for each variables was calculated and Student t-test was used to find the mean difference between two variables or between two groups. Level of significance was also calculated at the given degree of freedom. Dental age was calculated for each in all three groups for both sexes on the basis of [Table 5] and [Table 6] and criteria used by Willems [4] has been presented as [Figure 3] for evaluation. Results obtained after statistically calculated are presented.
Table 5: Modified methods for dental age calculation for boys

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Table 6: Modified methods for dental age calculation for girls

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   Results Top


A total of 150 patients were included in the study. Based on growth pattern, total sample was divided into average, vertical, and horizontal growth pattern. Out of selected 150 subjects, 75 were males and 75 were females and among 75 males, 25 males in each group were average grower, vertical grower, and horizontal grower. Like wise among 75 females, 25 females in each group were average grower, vertical grower, and horizontal grower.

Difference between chronological age and dental age using t-test

[Table 7] shows that both in males and female there is insignificant difference between chronological age and dental age with mean difference of 0.01 year and t-value of 0.08 for average grower, where as significant difference between chronological age and dental age is observed in vertical and horizontal grower at 5% level of significance.
Table 7: Difference between chronological age and dental age using t test in males and females


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Intergroup difference between dental ages using Student's t-test

[Table 8] shows that in males and females there is insignificant difference between dental age of group 1 versus 2 and group 1 versus 3 is obtained. Whereas significant difference between dental age of group 2 versus 3, i.e., between vertical and horizontal grower is obtained. The t-value is found to be statistically significant at 1% level of significance.
Table 8: Inter Group difference between dental ages using Students t-test in males and females

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Correlation between dental age and chronological age

Pearson's correlation coefficient "r" was calculated between dental age and chronological age. It is observed that significant correlation exist in both male and female and in different growth pattern at 1% level of significance [Table 9] and this relation also exists in combined sample in different groups irrespective of sex.
Table 9: Correlation between, dental age and chronological age in different growth pattern of males and females

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Correlation between dental age and type of growth pattern

Pearson's correlation coefficient "r" was calculated in different growth pattern (Groups) in both sex in relation to dental age, SN Go-Gn angle, Jarabak ratio was found to be significantly correlated at 5% level of significance and lower anterior facial height was found to be correlated at 1% level of significance with dental age [Table 10].
Table 10: Correlation between, dental age and SN Go-Gn, Jarabak ratio and (lower anterior facial height) LAFH

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   Discussion Top


Janson et al.[15] investigated the influence of facial type on dental development in subjects of the same chronological age. They showed that long face subjects presented a tendency to have an advanced dental maturation in comparison to short face subjects by 6 months. Naves et al.[16] compared the maturation stages of permanent teeth in subjects with vertical and horizontal growth pattern and concluded that subjects with vertical growth pattern had dental maturation earlier than the horizontal growers. However, Jamroz et al.[17] investigated the relationship between vertical growth pattern and dental maturation in children with long and short anterior facial height and concluded that the difference in dental age between long and short facial types was statistically insignificant.

According to Nanda, [14] Janson, [15] Naves, [16] vertical grower mature early in dental age but according to Jamroz, [17] there is no difference between dental ages of short and long face, so there is difference of opinion amongst authors [14],[15],[16],[17] our aim was to reascertain the difference between dental ages in average, vertical, and horizontal growth pattern. The method used in this study for dental age assessment was as suggested by Willems et al.[4] known as modified Demirjian method. Studies done by Maber [8] and Rai [9] suggested Willems method to be most accurate when compared with other methods.

In the present study comparison of chronological age with dental age with in the group was assessed by using Student t-test. Difference between chronological age and dental age was found to be insignificant in average growers in both the sex and significant in vertical and horizontal grower. This suggests that the method used for dental age estimation can be used for Indian population for assessment of chronological age for average growers. In vertical growers, these results indicate that there is a higher predominance of earlier maturation that is dental age is ahead of chronological age. Whereas in horizontal growers, there is a higher predominance of late maturation that is chronological age ahead of dental age. Results of the present study are similar to that reported by Janson et al.[15] studied subjects on the basis of lower anterior facial height as percentage of total facial height, Naves et al.[16] compared maturation of permanent teeth in subjects with vertical and horizontal growth pattern, where as result of present study was not supporting the study done by Jamroz et al.[17]

Mean of dental age in males and females in different subgroups when comparing statistically by using t-test shows that. The differences in dental age of average grower versus vertical grower and average grower versus horizontal grower was existed but was statistically insignificant in both males and females. However, when we compare dental age of vertical grower versus horizontal grower, there is statistically significant difference in both males and females. Results of the present study is similar as suggested by Janson et al.[15] who studied subjects on the basis of lower anterior facial height as percentage of total facial height and on the amount of open bite or deep bite. Whereas Naves et al.[16] compared maturation of permanent teeth in subjects with vertical and horizontal growth pattern and suggest vertical growers are earlier mature than horizontal grower. The present study suggests that vertical growers mature early than horizontal growth pattern when compared to each other but when we compare both with the average grower the difference found is insignificant.

In the present study, correlation "r" between dental age and chronological age was found to be significant in both male and female and in different growth pattern at 1% level of significance [Table 9]. This relation also exists in combined sample in different groups irrespective of sex. Which shows that with the increase of chronological dental age is increasing. When correlation "r" was calculated in different growth pattern (Groups) in both sex in relation to dental age, SN-GoGn angle, Jarabak ratio was found to be significantly correlated at 5% level of significance and lower anterior facial height was found to be correlated at 1% level of significance [Table 10], which shows that with the increase of dental age SN-GoGn, Jarabak ratio and lower anterior facial height also increasing. Result shows that there exists correlation between SN-GoGn, Jarabak ratio and lower anterior facial height. Further longitudinal study on larger sample is required to confirm the results.


   Conclusion Top


From the above analysis and obtained results following conclusion can be drawn that Willem's method was found to be reliable and accurate in calculating the dental age in Indian population. Vertical grower demonstrated advanced dental age when compared to chronological age and Horizontal grower demonstrated retarded dental age then chronological age in both the sexes. Irrespective of sex and facial growth pattern, chronological age is related to dental age. [20]

 
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2.Haavikko K. The formation and the alveolar and clinical eruption of the permanent teeth. An orthopantomographic study. Suom Hammaslaak Toim 1970;66:103-70.  Back to cited text no. 2
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Correspondence Address:
Vikas Goyal
Department of Orthodontics, Daswani Dental College, Kota, Rajasthan
India
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DOI: 10.4103/0970-9290.93446

PMID: 22406703

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