ORIGINAL
RESEARCH
Mineralization of the lower second molar and cervical
vertebral maturation as indicators of the pubertal growth spurt in pediatric
patients
Mineralización
del segundo molar inferior y maduración vertebral cervical como indicadores del
pico de crecimiento puberal en pacientes pediátricos
Jeremy Alexander Laz Medina 1. William
Ubilla Mazzini 2. Tanya Moreira Campuzano3
1 Graduate, School of Dentistry. Universidad de Guayaquil. https://orcid.org/0009-0003-2634-9016
2 Master’s Degree in Education. Specialist in Orthodontics. Professor,
Universidad de Guayaquil. https://orcid.org/0000-0001-5940-1456
3 Specialist in Orthodontics. Professor, Orthodontics Specialization
Program, Universidad de Guayaquil. https://orcid.org/0000-0002-1158-0245
Correspondence to: william.ubillam@ug.edu.ec
Received: 25/04/2026 Accepted: 27/06/2026
ABSTRACT
In the
orthodontics practice and orthopedics, one of the most important factors is
determining biological maturity. Biological maturity, unlike chronological
age—which only takes the time elapsed since birth, indicates an individual’s
rate of development. This makes it possible to identify the appropriate time to
apply orthopedic forces and thus make the most of the patient’s growth
potential. Objective: To determine the relationship between the stages of mineralization
of the lower second molar and cervical vertebral maturation to identify the peak identification of
pubertal growth in radiographic records of patients treated at the
Comprehensive Pediatric
Dentistry Clinic of the University of Guayaquil during the year 2026.
Methodology: Quantitative approach, descriptive and correlational in nature,
with a non-experimental design. The study included a population of 60
radiographic pairs (panoramic and cephalometric) and a final sample of 40 pairs
from patients aged 6 to 12 years. Results: Conclusion: Indicators of cervical
vertebral maturation and dental mineralization of the lower second molar
exhibit a positive and statistically significant relationship. Consequently,
both processes tend to progress in parallel during growth.
Keywords: Orthodontics.
Lower second molar. Cervical vertebral maturity. Pubertal growth.
RESUMEN
En la práctica de la Ortodoncia y la Ortopedia, uno de
los factores más importantes es el establecimiento de la maduración biológica.
La madurez biológica, a diferencia de la edad cronológica que solo tiene en
cuenta el tiempo transcurrido desde el nacimiento, señala la velocidad de
desarrollo del individuo. Esto permite identificar cuándo es el momento
apropiado para aplicar fuerzas ortopédicas y así sacar el mayor provecho
posible del potencial de crecimiento del paciente. Objetivo: Determinar
la relación entre los estadios de mineralización del segundo molar inferior y
la maduración vertebral cervical para la identificación del pico de crecimiento
puberal en registros radiográficos de pacientes atendidos en la clínica
Integral de Odontopediatría de la Universidad de Guayaquil durante el año 2026. Metodología: enfoque cuantitativo, tipo
descriptivo y correlacional, diseño no experimental. Con una población de 60
pares radiográficos (Panorámico-Cefalométrico) y una muestra final de 40 pares,
de pacientes de entre 6 a 12 años de edad. Resultados: Conclusión: indicadores
de maduración vertebral cervical y mineralización dentaria del segundo molar
inferior exhiben una relación positiva y estadísticamente significativa. En
consecuencia, ambos procesos tienden a progresar de forma paralela durante el
crecimiento.
Palabras
clave: Ortodoncia. Segundo molar inferior. Madurez vertebral cervical.
Crecimiento puberal.
INTRODUCTION
The determination of biological maturation is a key
aspect of orthodontic and orthopedic practice. Unlike chronological age, which
only considers the time elapsed since birth, biological maturity indicates the
individual's rate of development, allowing the appropriate timing for the
application of orthopedic forces to be identified and thus maximizing the
patient's growth potential (1).
The reference method for
assessing maturation has traditionally been used in carpal radiographs. What
had become a standard practice has currently been replaced by the so-called
cervical vertebral maturation (CVM) analysis proposed by Baccetti.
This method has gained importance because it allows pubertal growth to be
assessed through a lateral skull radiograph and is considered a common
diagnostic procedure in orthodontics (2). Despite this, the search
for simpler approaches has led to the investigation of dental maturation as an
alternative indicator.
The Demirjian
approach, which examines the levels of dental mineralization using panoramic
radiographs, represents a promising option due to its high consistency and low
cost. However, the international literature reports certain
discrepancies regarding the reliability of dental age in predicting the peak of
skeletal growth, indicating that ethnic and geographical factors may have a
significant impact on this relationship (3).
In
Guayaquil, there is a clinical need to determine whether identifying a specific
dental stage is sufficient to establish whether a child has entered the peak
growth period. Therefore,
this study aims to determine the statistical relationship between cervical
vertebral maturation according to Baccetti
mineralization second molar according to Demirjian.
Malocclusions are among the
most common oral health conditions in children and adolescents (3).
They affect facial aesthetics, masticatory function, and the quality of life of
affected individuals. Their high prevalence represents one of the main reasons
for consultation in orthodontics and orthopedics. Therefore, diagnosis and
treatment planning are required to assess therapeutic outcomes.
In this regard, it is
necessary to identify factors associated with treatment effectiveness that
facilitate the diagnosis of the patient's biological maturity. During the
pubertal growth period, significant skeletal changes occur, particularly in the
mandibular level. These changes increase mandibular growth and facilitate
correction of maxillomandibular discrepancies and various malocclusions.
Coordination between therapeutic intervention and the peak of growth allows
clinical outcomes to be maximized; conversely, an intervention performed
outside this period considerably reduces its effectiveness (4).
Due to this limitation,
other methods have been developed to determine skeletal maturity. Currently,
cervical vertebral maturation (CVM), assessed through cephalometric
radiographs, is considered one of the most reliable indicators for identifying
skeletal growth stages. Nevertheless, obtaining this information requires
radiographic exposure and an additional cost when the examination is not part
of the initial diagnostic protocol.
In recent years, the
development of more accessible and less invasive diagnostic methods has been
aligned with radiation protection and the ALARA principle (As Low as Reasonably
Achievable), whose purpose is to minimize exposure to ionizing radiation
without compromising diagnostic quality.
Dental mineralization of
the mandibular second molar has attracted increasing scientific interest, as it
is considered a potentially useful biological indicator of skeletal maturity.
Its development and growth occur through different stages that coincide with
pubertal growth and can be determined using panoramic radiographs, which are
commonly included in diagnostic protocols. International studies have reported
statistically significant correlations between cervical vertebral and dental
mineralization stages.
Biological maturity is a
fundamental pillar of diagnosis and therapeutic planning because it enables
identification of the period when a patient has the greatest growth potential.
In recent decades, the relationship between dental and skeletal maturation has
been investigated by numerous researchers using different diagnostic methods,
among which the Baccetti method for determining
cervical vertebral maturation and the Demirjian
method for evaluating dental mineralization stand out (6).
BACKGROUND
Martínez and Ardón, in San Salvador, El Salvador, in 2021, conducted a
literature review to evaluate whether there was a difference between the Baccetti cervical vertebral maturation method and the
Fishman carpal method for determining the peak of maximum growth. Through a
search in PubMed and SciELO, they selected 8 of 248
studies published between 2000 and 2020. Six studies showed a high correlation
between both methods, while two demonstrated a moderately positive correlation.
The authors concluded that the Baccetti method is
statistically reliable, valid, and clinically useful for assessing skeletal
maturity, in addition to reducing the need for additional carpal radiographs
and radiographic exposure of patients (7).
Lucchese A. et al., in
Milan, Italy, in 2022, conducted a systematic review to evaluate the
effectiveness of the cervical vertebral maturation (CVM) method for predicting
the pubertal growth peak. Of 1,284 articles, 43 were included. The results
showed a statistically significant, moderate-to-high correlation between the
cervical vertebral maturation method and other methods, such as carpal
radiography, chronological age, dental age, and height. They concluded that the
Baccetti method is effective for assessing skeletal
maturity, although they recommended complementing it with other biological
indicators (8).
Magalhães M. et al., in 2022, conducted a systematic review and
meta-analysis to estimate the chronological age corresponding to each cervical
vertebral maturation stage proposed by Baccetti and
to analyze differences according to sex and continent. Forty-one studies
including a total of 9,867 participants were included. The results showed that
females reached the cervical stages at younger ages than males and that
variations existed among populations. They concluded that the age ranges of the
Baccetti method should be interpreted according to
the characteristics of each region (9).
Ferrillo M. et al., in Catanzaro, Italy, in 2024, conducted a
systematic review to evaluate the reliability of dental maturation according to
the Demirjian method as an indicator of skeletal
maturity. Of 136 articles, 19 were selected, of which 17 demonstrated adequate
reliability for estimating skeletal maturation. The results showed that the
mandibular second molar had the greatest predictive capacity, with the pubertal
growth peak occurring between stage F in females and stage G in males. They
concluded that the Demirjian method is a reliable
tool for assessing biological maturation, although further research is required
(10).
Ercan and Yüksel, in Nevşehir, Turkey, in
2023, conducted a cross-sectional observational study to determine skeletal,
dental, and sexual maturation stages during the pubertal growth peak. The study
included 98 patients, comprising 49 females and 49 males. Overall, 81.6% of
patients of both sexes were classified as being in cervical vertebral
maturation stage CS3, while 81.6% of females and 89.8% of males showed stage G
of mandibular second molar mineralization. A significant correlation was
found between both methods and sex (p < 0.05). The authors concluded that
stages CS3 and G correspond to the pubertal growth peak and that the mandibular
second molar is a useful indicator of biological maturation (10).
Vásquez Pacheco et al., in
Villahermosa, Tabasco, Mexico, in 2025, conducted an analytical,
cross-sectional observational study to determine the correlation between the Baccetti skeletal maturation method and the dental
calcification stages of the Demirjian method. A total
of 202 radiographs were analyzed, including 101 panoramic radiographs and 101
lateral skull radiographs from patients aged 9 to 18 years. They found a strong
positive correlation between the Demirjian and Baccetti stages (r = 0.729; p < 0.001), as well as
between these methods and chronological age. The authors concluded that both
methods are reliable tools for estimating biological maturity and guiding
orthodontic treatment planning (11).
Kamran et al., in Swat,
Pakistan, in 2023, conducted a descriptive cross-sectional study to determine
the correlation between skeletal maturation and the mineralization stages of
the mandibular second molar. One hundred patients aged between 8 and 16 years
were examined. Spearman's results demonstrated a very high and statistically
significant correlation between dental mineralization stages and vertebral
maturation stages (r = 0.97; p < 0.001). They concluded that mandibular
second molar mineralization is a reliable indicator of skeletal maturation and
the pubertal growth peak (11).
Fajardo Morales et al., in
Cuenca, Ecuador, conducted a study to estimate the correlation between
chronological and dental age and cervical vertebral maturation stages. The
research used a quantitative, observational, and correlational approach through
the analysis of 400 panoramic and lateral cephalometric radiographs; 205 were
from females and 195 from males, aged between 4 and 17 years. They found
correspondence between Demirjian stage D and Baccetti CVM I, as well as between stage E and CVM II. In
addition, they identified a moderate relationship between both methods in the
mandibular second molar. They concluded that there is a significant
relationship between dental maturation, vertebral maturation, and chronological
age, without important differences according to sex (13).
MATERIALS AND METHODS
Research Approach
The present research was
conducted using a quantitative approach, since the study variables were
recorded in structured categories and subsequently converted into data for
statistical analysis. Dental mineralization and cervical maturation stages were
represented on ordinal scales, while sex and chronological age were used as
complementary variables to characterize the sample. This approach made it
possible to quantify the frequency and distribution of the Demirjian
and Baccetti stages, as well as to analyze the
statistical relationship between both indicators. Consequently, the findings
were presented using percentages, tables, and graphical representations of
association.
Types of Research
According to its scope, the
study was both descriptive and correlational. It was descriptive because it
characterized the distribution of dental and cervical maturation stages
according to sex and chronological age. It was also correlational because it established
the monotonic relationship between both stages without the need to establish a
causal relationship between them. The study had an observational,
non-experimental design, since there was no manipulation of variables and no
interventions were performed. Data was collected through observation and
classification of existing radiological studies. It was also cross-sectional
because a single radiographic pair from everyone was analyzed at a specific
point in time. Likewise, it was retrospective because previously obtained
imaging studies, originally acquired for dental care purposes during 2026, were
used.
The population consisted of
60 radiographic pairs from pediatric patients treated at the Comprehensive
Pediatric Dentistry and Orthopedics Clinic during 2026. The studies consisted
of a panoramic radiograph and a lateral cephalometric skull radiograph belonging
to the same individual. Non-probability convenience sampling was performed,
using the available radiographic pairs that met the inclusion and exclusion
criteria. Forty pairs of panoramic and cephalometric radiographs were
ultimately selected, corresponding to patients between 6 and 12 years of age,
of whom 24 were male and 16 were female.
Unit of Analysis
The unit of analysis was
represented by radiographic pairs belonging to the same individual. On the
cephalometric or lateral skull radiograph, cervical vertebrae C2, C3, and C4
were analyzed using the Baccetti method. On
orthopantomograms or panoramic radiographs, the left mandibular second molar,
corresponding to tooth 3.7, was evaluated using the Demirjian
method.
Inclusion Criteria: Radiographs from male and female patients aged between
6 and 12 years, with adequate radiographic clarity of both the left mandibular
second molar, tooth 3.7, on the panoramic radiograph and cervical vertebrae C2,
C3, and C4 on the cephalometric radiograph.
Exclusion Criteria: Radiographs outside the established age range, with
distortions that prevented visualization of the structures of interest, and
dental anomalies involving the left mandibular second molar, including
agenesis, ectopic eruption, or impaction.
Data Collection Techniques
and Instruments
Data were collected using
an indirect, structured, non-participant radiographic observation technique,
since these variables were identified through the analysis of previously
obtained imaging studies without intervention or direct contact with the
patients. The instrument used was a structured data collection table developed
specifically for the research. The table included specific fields such
as study code, sex, age, Demirjian stage, and Baccetti stage. To maintain patient confidentiality, the
names associated with each record were replaced with alphanumeric codes ranging
from P01 to P40.
Data Collection Procedure
The data collection process
was conducted consecutively, considering the following aspects:
·
The
radiographic records were provided by students who were conducting clinical
cases related to Pediatric Dentistry and Orthopedics at the faculty during
2026. Initially, 60 radiographic pairs were collected. Each pair consisted of a
panoramic radiograph and a lateral cephalometric radiograph from the same
patient.
·
Each
radiographic set was checked to ensure that it included information regarding
the patient's age and sex, as well as adequate diagnostic quality for the left
mandibular second molar and cervical vertebrae C2, C3, and C4. Considering the
established inclusion and exclusion criteria, 40 radiographic pairs were
selected to constitute the final study sample.
·
The
selected studies were anonymized by assigning alphanumeric codes from P01 to
P40 to safeguard patient identity and confidentiality. During the research
process, a formal request was prepared and submitted to the Dean of the Faculty
of Dentistry at the University of Guayaquil to obtain the institutional
authorization required for the academic and scientific use of the imaging
studies included in the research.
·
First,
vertebrae C2, C3, and C4 were examined on the lateral cephalometric
radiographs, considering the concavities of their lower borders and the shape
of the vertebral bodies, to assign the corresponding stage from CS1 to CS6
using the Baccetti method.
·
Next,
the orthopantomograms were evaluated, examining the left mandibular second
molar corresponding to tooth 3.7. The Demirjian
method was applied, and the mineralization stage from A to H was determined
according to crown formation, bifurcation, and apical closure.
·
Age,
sex, and maturation stages were recorded in a structured data collection table
developed in Microsoft Excel. Subsequently, the information was examined to
identify missing records, duplicates, or possible coding errors.
·
The
weighted Kappa coefficient was then applied to measure interobserver agreement,
and statistical analysis was performed using Spearman's rho coefficient on the
collected data. The results were presented using frequency tables, percentages,
and graphical representations.
Statistical Processing and
Analysis
The data collected from the
radiographs were stored, classified, coded, and cleaned in a structured data collection
table in Microsoft Excel. The table contained the code assigned to each case,
age, sex, Demirjian stage, and Baccetti
stage. Before analysis, the consistency of the classifications was verified,
and the weighted Kappa coefficient was calculated by comparing the results
determined by the researcher with those provided by the second specialist
evaluator. Based on descriptive statistics, absolute frequencies and
percentages were determined to understand the distribution of both stages. The
results were organized overall and according to the chronological age and sex
of the individuals. Cross-tabulations and bar charts were also prepared for
data interpretation.
To relate the indicators
analyzed to the pubertal growth peak, the Baccetti
stages were grouped according to the degree of skeletal maturation: CS1 and CS2
corresponded to the prepubertal stage, CS3 and CS4 to the circumpubertal phase,
and CS5 and CS6 to the post pubertal stage. For studies classified as CS3 and
CS4, the frequencies and percentages of the Demirjian
stages were calculated in order to identify the mineralization stages of the
mandibular second molar that occurred most frequently around the pubertal
growth peak.
Spearman's rho coefficient
was applied because the Demirjian and Baccetti stages are ordinal variables. This analysis
allowed the strength and direction of the monotonic relationship between the
two variables to be determined. A two-tailed test was applied, and a
statistical significance level of 0.05 was established. Findings with a p-value
lower than 0.05 were considered statistically significant.
For statistical analysis,
the Demirjian stages were coded as follows: A = 1, B
= 2, C = 3, D = 4, E = 5, F = 6, G = 7, and H = 8. The Baccetti
stages were coded as follows: CS1 = 1, CS2 = 2, CS3 = 3, CS4 = 4, CS5 = 5, and
CS6 = 6.
Ethical Considerations
During the research
process, a request was submitted to the Dean of the Faculty of Dentistry of the
University of Guayaquil to formalize the institutional authorization required
for the academic use of the radiological studies included in the research.
Since the research was considered observational and retrospective, no new
radiological examinations or clinical interventions were performed on the
patients. The confidentiality of the information was ensured through
anonymization of the radiographic records. Identifying information, such as
patient names, was replaced in the data collection table with codes ranging
from P01 to P40. The imaging records were kept under the custody of the
researcher and were not shared with individuals outside the research team.
Likewise, the analysis performed by the second evaluator was conducted using
coded radiographs without access to information that could identify the patients.
RESULTS
An analysis was conducted
of the 40 radiographic pairs corresponding to pediatric patients aged between 6
and 12 years. The weighted Kappa agreement index was calculated, with the
following results:
Table 1.
Distribution of the sample according to chronological age
|
Age (years) |
Frequency |
Percentage |
|
6 |
7 |
17.5% |
|
7 |
9 |
22.5% |
|
8 |
13 |
32.5% |
|
9 |
4 |
10.0% |
|
10 |
3 |
7.5% |
|
11 |
2 |
5.0% |
|
12 |
2 |
5.0% |
|
Total |
40 |
100.0% |
Source:
prepared by the authors based on the research database.
Interpretation: The sample consisted of 40 radiographic pairs from
patients aged between 6 and 12 years. The most frequent age was 8 years, with
13 individuals, corresponding to 32.5% of the sample, followed by 7 years, with
9 cases (22.5%), and 6 years, with 7 cases (17.5%). Lower frequencies were
observed among patients aged 9 to 12 years: 9-year-olds accounted for 4 cases
(10.0%), while 10-year-olds accounted for only 3 records (7.5%). The lowest
figures were observed among 11- and 12-year-olds, with 2 study pairs and 5.0%
in each group.
Table 2.
Distribution of the sample according to sex
|
Sex |
Frequency |
Percentage |
|
Male |
24 |
60.0% |
|
Female |
16 |
40.0% |
|
Total |
40 |
100.0% |
Source:
prepared by the authors based on the research database.
Interpretation: Of the 40 imaging pairs included in the study, 24
were from male patients (60.0%), whereas 16 were from female patients (40.0%).
Thus, there was a predominance of male participants in the analyzed sample.
CERVICAL VERTEBRAL
MATURATION ACCORDING TO BACCETTI
Table 3.
Distribution of Baccetti stages according to sex
|
Stage |
Male n |
Male % |
Female
n |
Female
% |
Total
n |
Total % |
|
CS1 |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
CS2 |
3 |
12.5% |
1 |
6.3% |
4 |
10.0% |
|
CS3 |
17 |
70.8% |
9 |
56.3% |
26 |
65.0% |
|
CS4 |
4 |
16.7% |
6 |
37.5% |
10 |
25.0% |
|
CS5 |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
CS6 |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
Total |
24 |
100.0% |
16 |
100.0% |
40 |
100.0% |
Source:
prepared by the authors based on the research database.
Interpretation: Stage CS3 was the most frequent in both sexes. In the
male group, it was detected in 17 records, representing 70.8%, while in the
female group, 9 cases were identified, corresponding to 56.3%. On the other
hand, stage CS4 showed a higher incidence among females, with 6 records
(37.5%), compared with 4 cases (16.7%) among males. Stage CS2 accounted for
12.5% of the male frequency and 6.3% of the female frequency. No cases were
found in CS1, CS5, or CS6.
Table 4.
Distribution of Baccetti stages according to
chronological age
|
Age (years) |
Total
by age |
CS2 n |
CS2 % |
CS3 n |
CS3 % |
CS4 n |
CS4 % |
|
6 |
7 |
2 |
28.6% |
5 |
71.4% |
0 |
0.0% |
|
7 |
9 |
2 |
22.2% |
7 |
77.8% |
0 |
0.0% |
|
8 |
13 |
0 |
0.0% |
11 |
84.6% |
2 |
15.4% |
|
9 |
4 |
0 |
0.0% |
1 |
25.0% |
3 |
75.0% |
|
10 |
3 |
0 |
0.0% |
1 |
33.3% |
2 |
66.7% |
|
11 |
2 |
0 |
0.0% |
1 |
50.0% |
1 |
50.0% |
|
12 |
2 |
0 |
0.0% |
0 |
0.0% |
2 |
100.0% |
|
Total |
40 |
4 |
10.0% |
26 |
65.0% |
10 |
25.0% |
Source:
prepared by the authors based on the research database.
Interpretation: Among 6-year-olds, stage CS3 predominated at 71.4%,
while CS2 was present in 28.6%. At 7 years, CS3 also remained the most common
stage, reaching 77.8%. In the 8-year-old group, 84.6% were classified as CS3
and 15.4% as CS4. From the age of 9 years onward, an increase in the proportion
of CS4 was observed, representing 75.0% at 9 years, 66.7% at 10 years, 50.0% at
11 years, and 100% at 12 years, based on two study cases. Descriptively, a
trend toward more advanced vertebral stages was observed as chronological age
increased.
DENTAL MINERALIZATION OF
THE MANDIBULAR SECOND MOLAR 3.7 ACCORDING TO DEMIRJIAN
Table 5.
Distribution of Demirjian stages according to sex
|
Stage |
Male n |
Male % |
Female
n |
Female
% |
Total
n |
Total % |
|
A |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
B |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
C |
7 |
29.2% |
4 |
25.0% |
11 |
27.5% |
|
D |
11 |
45.8% |
5 |
31.3% |
16 |
40.0% |
|
E |
4 |
16.7% |
4 |
25.0% |
8 |
20.0% |
|
F |
2 |
8.3% |
2 |
12.5% |
4 |
10.0% |
|
G |
0 |
0.0% |
1 |
6.3% |
1 |
2.5% |
|
H |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
Total |
24 |
100.0% |
16 |
100.0% |
40 |
100.0% |
Source:
prepared by the authors based on the research database.
Interpretation: Stage D was the most common in both sexes. The male
group recorded 11 studies, equivalent to 45.8%, whereas the female group had 5
cases, representing 31.3%. In stage C, males predominated with 29.2%, compared
with 25.0% among females.
On the other hand, stages E
and F showed higher proportions among females, with 25.0% and 12.5%,
respectively, compared with 16.7% and 8.3% among males. There was a single
radiographic case classified as stage G, accounting for 6.3% of the female
group. No studies were identified in stages A, B, or H.
Table 6.
Distribution of Demirjian stages according to
chronological age
|
Age (years) |
Total
by age |
C n |
C % |
D n |
D % |
E n |
E % |
F n |
F % |
G n |
G % |
|
6 |
7 |
7 |
100.0% |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
7 |
9 |
3 |
33.3% |
6 |
66.7% |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
8 |
13 |
1 |
7.7% |
8 |
61.5% |
3 |
23.1% |
1 |
7.7% |
0 |
0.0% |
|
9 |
4 |
0 |
0.0% |
2 |
50.0% |
1 |
25.0% |
1 |
25.0% |
0 |
0.0% |
|
10 |
3 |
0 |
0.0% |
0 |
0.0% |
3 |
100.0% |
0 |
0.0% |
0 |
0.0% |
|
11 |
2 |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
2 |
100.0% |
0 |
0.0% |
|
12 |
2 |
0 |
0.0% |
0 |
0.0% |
1 |
50.0% |
0 |
0.0% |
1 |
50.0% |
|
Total |
40 |
11 |
27.5% |
16 |
40.0% |
8 |
20.0% |
4 |
10.0% |
1 |
2.5% |
Source: prepared by the
authors based on the research database.
Interpretation: At 6 years
of age, all cases were classified as Demirjian stage
C. At 7 years, stage D was the most common, accounting for 66.7%, followed by
stage C, which accounted for the remaining 33.3%. In the 8-year-old group,
stage D predominated at 61.5%.
At 9 years, stage D
accounted for 50.0%. At 10 years, all studies were categorized as stage E,
while those at 11 years were classified as stage F. Finally, cases at 12 years
were found in stages E and G, each accounting for 50.0%. The results indicated
progressive advancement in dental mineralization as age increased.
RELATIONSHIP BETWEEN THE
DEMIRJIAN AND BACCETTI METHODS
Table 7.
Cross-tabulation of Demirjian and Baccetti
stages
|
Demirjian |
CS2 n |
CS2 % |
CS3 n |
CS3 % |
CS4 n |
CS4 % |
Total
n |
Total % |
|
A |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
B |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
C |
2 |
18.2% |
9 |
81.8% |
0 |
0.0% |
11 |
27.5% |
|
D |
2 |
12.5% |
13 |
81.3% |
1 |
6.3% |
16 |
40.0% |
|
E |
0 |
0.0% |
3 |
37.5% |
5 |
62.5% |
8 |
20.0% |
|
F |
0 |
0.0% |
1 |
25.0% |
3 |
75.0% |
4 |
10.0% |
|
G |
0 |
0.0% |
0 |
0.0% |
1 |
100.0% |
1 |
2.5% |
|
H |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
0 |
0.0% |
|
Total |
4 |
10.0% |
26 |
65.0% |
10 |
25.0% |
40 |
100.0% |
Source:
prepared by the authors based on the research database.
Interpretation: According
to Demirjian, stages C and D were predominantly
concentrated in Baccetti stage CS3, with 81.8% and
81.3%, respectively, and lower percentages in stages CS2 and CS4. Stages E, F,
and G showed greater concentration in CS4, with 62.5%, 75.0%, and 100%,
respectively. Stages E and F showed lower concentrations in CS3, with 37.5% and
25.0%, respectively. These findings demonstrate a concomitant progression
between dental mineralization stages and cervical vertebral maturation stages.
Table 8.
Correlation between Demirjian and Baccetti
stages
|
Variables |
n |
Spearman's
rho |
p-value |
Direction |
Interpretation |
|
Demirjian–Baccetti |
40 |
0.633 |
< 0.001 |
Positive |
Strong
and statistically significant |
Source:
prepared by the authors based on the research database.
Spearman's rho coefficient
showed a value of 0.633, with a statistical significance of less than 0.001.
This result demonstrated a positive, strong, and statistically significant
association between the Demirjian and Baccetti stages. Consequently, as the mineralization stage
of the mandibular second molar progressed, a tendency toward advancement in the
cervical vertebral maturation stage was also observed. Because the p-value was
lower than the predefined significance level of 0.05, the null hypothesis, which
stated that there was no relationship between the two variables, was rejected.
DISCUSSION
The assessment of
biological maturation is crucial for determining the appropriate timing of
treatments that require the patient's maximum growth potential. In this regard,
the present study evaluated the relationship between mineralization of the left
mandibular second molar using Demirjian and cervical
vertebral maturation using the Baccetti method in
radiographic studies corresponding to patients aged 6 to 12 years. The main
finding was a strong, positive, and statistically significant association
between both parameters, with a Spearman's rho of 0.633 and a p-value <
0.001. This indicates that as dental mineralization stages advanced, cervical
maturation stages also tended to advance.
Interobserver agreement
confirmed the reproducibility of the assessments. The linear weighted Kappa
coefficient was reported as 0,735 for Demirjian and 0,759
for Baccetti, indicating substantial agreement. These
results demonstrated adequate consistency between the stages assessed by the
researcher and those assessed by the evaluator.
Regarding cervical
vertebral maturation, Baccetti stage CS3 was the most
frequent, accounting for 65.0%, followed by CS4 at 25.0% and CS2 at 10.0%. The
frequency of cases classified as CS3 and CS4 indicates that a large proportion
of the sample was in intermediate or circumpubertal maturation phases associated
with maximum growth acceleration. This finding is consistent with Ercan and Yüksel (10), who reported a predominance of CS3
during the pubertal growth peak in 81.6% of their participants.
Stage CS3 predominated in
both males and females, with relatively similar percentages; however, CS4 was
observed in 37.5% of females and 17.7% of males. This trend may be related to
earlier skeletal maturation in females, according to Magalhães
et al., who found that females may reach more advanced stages earlier than
males (14). However, these differences are descriptive only and
cannot be interpreted as statistically significant. Regarding age, CS3
predominated between 6 and 8 years, whereas CS4 increased from 9 years onward.
This progression is consistent with the developmental sequence described by Magalhães et al. (14). Nevertheless, the presence
of different cervical stages among individuals of similar chronological age
demonstrates that chronological age alone is not a reliable indicator of
biological maturation. Furthermore, the groups aged 10 years and older
contained few records; therefore, their percentage-based interpretation should
be approached with caution.
Regarding dental
mineralization of the mandibular second molar, Demirjian
stage D was the most predominant, accounting for 40.0%, followed by C at 27.5%
and E at 20.0%; F and G were the stages with lower
percentages, at 10% and 2.5%, respectively. Distribution according to sex
showed a higher representation among females in the more advanced stages,
consistent with the trend observed using Baccetti.
Age demonstrated an orderly
progression, with 6-year-olds classified as stage C, 7- and 8-year-olds
predominantly in stage D, and 10- and 11-year-olds identified in stages E and
F, respectively. These observations demonstrate that mandibular second molar
development increases as age advances. However, individual variability was
observed, reinforcing the need to use maturation indicators with greater
validity.
The cross-tabulation showed
that 81.8% of records classified as stage C and 81.3% of those classified as
stage D coincided with Baccetti stage CS3. In
contrast, the more advanced dental stages showed correspondence with CS4 in
62.5% of stage E, 75.0% of stage F, and the single stage G case. Thus, the
progression of dental development was accompanied by advancement in cervical
vertebral maturation.
This relationship was
validated through Spearman's rho, which demonstrated a value of 0.633,
indicating a strong positive association. This result is consistent with that
reported by Martínez and Ardón et al. (15),
who observed a high relationship between the indicators in most of the studies
analyzed. Similarly, Vásquez Pacheco et al. (16) found a strong
positive correlation of 0,729.
CONCLUSIONS
It was determined that
cervical vertebral maturation and dental mineralization of the mandibular
second molar exhibit a positive and statistically significant relationship.
Consequently, both processes tend to progress in parallel during growth.
Cervical vertebral
assessment revealed that most records were in circumpubertal stages of
maturation, with a predominance of CS3 and a greater presence of CS4 between older
age groups. Likewise, the female group showed higher concentrations in more
advanced cervical stages. Mineralization of the mandibular second molar
demonstrated a consistent progression with
chronological age. Early and intermediate stages were more frequent among
younger individuals, whereas more advanced dental stages corresponded to older
age groups, with slight descriptive differences according to sex.
The correspondence observed
between Demirjian stages C and D and Baccetti stage CS3, as well as between stages E, F, and G
and CS4, supports the use of the mandibular second molar as an
additional indicator for estimating the pubertal growth period. Nevertheless,
its assessment should be complemented by subsequent skeletal and clinical
analysis, since a precise equivalence between all stages cannot be established.
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DECLARATION OF
CONTRIBUTIONS
“Conceptualization and
design: Jeremy Laz, William Ubilla, Tanya Moreira; Literature review: Jeremy
Laz, William Ubilla; Methodology and validation: Jeremy Laz, William Ubilla;
Formal analysis: Jeremy Laz, William Ubilla, Tanya Moreira; Investigation and
data collection: Jeremy Laz; Resources: Tanya Moreira; Data analysis and interpretation:
Jeremy Laz, William Ubilla; Writing – original draft preparation: Jeremy Laz;
Writing – review and editing: Jeremy Laz, William Ubilla, Tanya Moreira;
Supervision: William Ubilla, Tanya Moreira; Project administration: Jeremy Laz,
William Ubilla; Funding acquisition: Not applicable.”
CONFLICTS OF
INTEREST
The authors declare that
there were no conflicts of interest during the conduct of the research. The
manuscript was submitted exclusively to the Scientific Journal “Especialidades Odontológicas UG”
for review and publication.
FUNDING
The authors declare that
the research was conducted using their own funds.
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HOW TO CITE:
Laz Medina JA. Ubilla
Mazzini W. Moreira Campuzano T. Mineralization of the
mandibular second molar and cervical vertebral maturation as indicators of the
pubertal growth spurt in pediatric patients. Revista
Científica Especialidades Odontológicas UG. 2026;9(2):15–24.