Menarchal status as an indicator of mandibular second molar maturation in female adolescents

BACKGROUND: Menarchal status is a key pubertal milestone in females, yet its relationship with dental maturation has not been adequately explored using multivariate approaches. This study aimed to evaluate the association between menarchal status and mandibular second molar calcification stages in female adolescents, and to determine whether menarchal status is associated with dental maturation after controlling for chronological age and vertical facial pattern. METHODS: This retrospective cross-sectional study included 180 Turkish female patients aged 9-16 years, equally distributed into three groups: pre-menarche (n = 60), early post-menarche (0-1 year, n = 60), and late post-menarche (> 1 year, n = 60). Mandibular second molar calcification was assessed using the Demirjian index (stages D-H). Chronological age across groups was compared using the Kruskal-Wallis test with Dunn post-hoc comparisons. Demirjian stages were analysed using the Kruskal-Wallis test with post-hoc comparisons, Spearman correlation, and ordinal logistic regression analysis controlling for vertical facial pattern (α = 0.05). RESULTS: Demirjian stage distribution differed significantly across menarchal groups (H = 110.49, p < 0.001), with median stages progressing from E to G to H. Menarchal status showed a strong positive correlation with dental maturation (ρ = 0.785, p < 0.001). In multivariate analysis, menarchal status was significantly associated with Demirjian stage (OR = 26.82, 95% CI: 13.66-52.68, p < 0.001); however, the magnitude of this effect partly reflects the equal-group design, and model fit was comparable to that of chronological age (AIC: 377.3 vs. 379.6). CONCLUSIONS: Menarchal status is strongly associated with mandibular second molar maturation, with model fit comparable to chronological age. These findings suggest that menarchal history may serve as a clinically accessible, non-invasive biological marker to complement dental maturation assessment in orthodontic treatment planning.