We read with the greatest attention the article by Lopes et al on the usefulness of dental maturation as a diagnostic aid in the identification of the different growth phases defined as onset, pubertal growth spurt (PGS), and end.
The authors concluded that “As a clinical implication from our study, the association between the tooth mineralization stages and the skeletal maturation indicators allows clinicians to easily identify the pubertal growth period from the panoramic or intraoral radiographs.” The authors correctly reported that “A high correlation coefficient does not provide information about whether the dental maturation stage is satisfactory for diagnostic identification of the skeletal maturation stage.” However, in spite of that, this is a further correlation study between dental and skeletal maturation missing any diagnostic reliability analysis. Although it is a sophisticated procedure, the multiple ordinal regression analysis used by the authors remains an “association” analysis, which is unable to determine the capability of dental maturation in the identification of the different growth phases in individual subjects. The issue of the proper investigation on the diagnostic reliability of dental maturation in assessing the growth phase was raised years ago by our research team, which suggested the use of proper diagnostic performance analysis instead of correlation analyses. Among the diagnostic parameters we introduced was the positive likelihood ratio (LHR) that provides an estimate of how much a given dental maturation stage changes the odds of having a given growth phase. A threshold of ≥10 for a positive LHR is considered for assessment of satisfactory diagnostic reliability.
As we did in our previous meta-analysis, we have herein calculated the positive LHRs from the study by Lopes et al ( Table ), revealing that
- 1.
With few differences between the sexes, few maturational stages up to stage F for the canine, second premolar, and second molar were reliable in the identification of the onset (prepubertal growth phase).
- 2.
The mandibular second molar stage H was reliable in the identification of the end of the PGS (postpubertal growth phase).
- 3.
The first premolar did not reach a satisfactorily level of diagnostic reliability in the identification of any growth phase.
- 4.
No investigated tooth or mineralization stage is a reliable indicator of the PGS.
| Growth phase, stage | Canine | First premolar | Second premolar | Second molar | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Females | Males | Females | Males | Females | Males | Females | Males | |||||||||
| n | LHR (95% C1) | n | LHR (95% CI) | n | LHR (95% CI) | n | LHR (95% CI) | n | LHR (95% CI) | n | LHR (95% CI) | n | LHR (95% CI) | n | LHR (95% CI) | |
| Onset | ||||||||||||||||
| D | 0 | – | 0 | – | 1 | – | 0 | – | 2 | – | 0 | – | 20 | – | 1 | – |
| E | 2 | – | 0 | – | 28 | 12.2 ∗ (5.3, 28.1) | 2 | – | 35 | 5.2 (0.5, 56.8) | 7 | – | 33 | 17.6 ∗ (5.4, 57.1) | 13 | – |
| F | 38 | 3.0 (1.5, 6.0) | 19 | 20.8 ∗ (7.4, 58.5) | 25 | 3.5 (2.1, 5.8) | 21 | 11.5 ∗ (5.4, 24.4) | 20 | 9.2 (4.9, 17.3) | 27 | 5.1 (3.2, 8.12) | 6 | 5.8 (3.4, 10.0) | 24 | 28.5 ∗ (6.6, 122) |
| G | 15 | 0.6 (0.3, 1.3) | 24 | 5.5 (3.3, 9.3) | 6 | 0.4 (0.2, 1.0) | 23 | 3.7 (2.3, 5.9) | 4 | 1.5 (1.0, 2.5) | 14 | 1.4 (0.8, 2.4) | 2 | 0.5 (0.2, 1.1) | 12 | 7.5 (4.2, 13.5) |
| H | 6 | 7 | 0.2 (0.1, 0.3) | 1 | 0.0 (0.0, 0.2) | 4 | 0.1 (0.0, 0.2) | 0 | 0.2 (0.1, 0.5) | 2 | 0.1 (0.0, 0.2) | 0 | 0.1 (0.0, 0.2) | 0 | 0.5 (0.3, 0.8) | |
| Peak | ||||||||||||||||
| D | 0 | – | 0 | – | 0 | – | 0 | – | 1 | 0.7 (0.1, 7.8) | 0 | – | 3 | 0.2 (0.1, 0.7) | 0 | – |
| E | 0 | – | 0 | – | 6 | 0.3 (0.1, 0.7) | 0 | – | 10 | 0.4 (0.2, 0.8) | 0 | – | 15 | 0.6 (0.4, 1.1) | 2 | 0.2 (0.1, 1.0) |
| F | 13 | 1.2 (0.6, 2.4) | 4 | 0.3 (0.1, 0.9) | 19 | 1.1 (0.6, 1.8) | 8 | 0.6 (0.3, 1.3) | 32 | 2.1 (1.3, 3.3) | 23 | 1.3 (0.8, 2.2) | 29 | 4.1 (2.1, 8.0) | 14 | 0.9 (0.5, 1.7) |
| G | 25 | 4.4 (2.1, 9.3) | 19 | 1.2 (0.7, 2.1) | 30 | 3.3 (1.8, 6.0) | 27 | 1.8 (1.1, 3.0) | 32 | 1.6 (1.0, 2.4) | 41 | 4.0 (2.3, 6.8) | 43 | 1.4 (1.0, 1.9) | 80 | 3.0 (2.2, 3.9) |
| H | 54 | 1.1 (0.9, 1.4) | 82 | 1.1 (0.9, 1.2) | 36 | 0.8 (0.6, 1.1) | 70 | 0.9 (0.8, 0.1) | 16 | 0.5 (0.3, 0.9) | 41 | 0.6 (0.4, 0.7) | 2 | 0.1 (0.0, 0.5) | 9 | 0.2 (0.1, 0.3) |
| End | ||||||||||||||||
| D | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – |
| E | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – |
| F | 0 | – | 0 | – | 0 | – | 0 | – | 2 | 0.1 (0.0, 0.4) | 0 | – | 4 | 0.3 (0.1, 0.7) | 0 | – |
| G | 2 | 0.1 (0.0, 0.6) | 0 | – | 7 | 0.4 (0.2, 0.9) | 0 | – | 25 | 1.5 (1.0, 2.3) | 2 | 0.0 (0.0, 0.2) | 43 | 2.1 (1.6, 2.9) | 30 | 0.4 (0.3, 0.6) |
| H | 67 | 2.8 (2.2, 3.4) | 114 | 1.7 (1.5, 2.0) | 62 | 3.7 (2.8, 4.9) | 114 | 2.1 (1.8, 2.5) | 42 | 5.8 (3.5, 9.5) | 112 | 3.5 (2.7, 4.6) | 22 | 24.4 ∗ (5.9, 100) | 84 | 12.7 ∗ (6.7, 24.1) |
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