Relationship Agreement Between Demirjian Tooth Development and Fishman Skeletal Maturity in Thai Children and Adolescents

Growth of the maxilla and mandible can be evaluated by skeletal maturity assessments from hand-wrist radiographs; however, additional doses of radiation are required in spite of available panoramic radiographs from routine dental care. Therefore, this cross-sectional study aimed to evaluate the correlation between the Demirjian tooth development method from panoramic radiographs and Fishman skeletal maturity from hand-wrist radiographs in a population in southern Thailand. We further aimed to appraise skeletal age from dental development easily seen on a routine panoramic radiograph. Samples consisted of 328 pairs of radiographs (177 males and 151 females) aged between 9 and 15 years. The Demirjian tooth development method identified tooth development in stages from A to H of the left mandibular canine, first and second premolars, and the second molar. Fishman identified 11 skeletal growth indicators (SMIs) that can be grouped into three growth periods: pre-peak (SMI 1-4), peak (SMI 5-7), and post-peak (SMI 8-11). The relationship was analyzed using Spearman correlation coefficients. The results found that tooth 34 and tooth 37 in males demonstrated potential as reliable indicators to identify the transition from pre-peak to peak growth periods. However, in females, the peak period showed considerable variability and overlapping that made it challenging to pinpoint the peak period with certainty. However, teeth 33, 34, 35, and 37 clearly identified the pre-peak and post-peak growth periods. Therefore, additional diagnostic methods may be necessary to accurately identify the peak growth period for clinical decision-making.