Association Between Cervical Vertebral Maturation and Dental Calcification Stages in Children and Adolescents Aged 7-17 Years: A Retrospective Cross-Sectional Study

IntroductionThe timing of orthopedic and orthodontic treatment in the pubertal growth spurt necessitates an accurate prediction of skeletal maturity.Cervical vertebral maturation (CVM) staging on lateral cephalograms is widely used, whereas dental calcification can be read from routine panoramic radiographs.This study aimed to evaluate the association between cervical vertebral maturation stages and dental calcification stages of selected mandibular teeth in children and adolescents aged 7-17 years.A secondary objective was to assess whether these associations differed by sex. Materials and MethodsThis retrospective cross-sectional study included 300 children and adolescents aged 7-17 years selected using quota-based sampling, with 25 males and 25 females represented in each of the six cervical vertebral maturation stages (CS1-CS6).Lateral cephalograms were taken by the Baccetti method to be used for staging CVM.Panoramic radiographs were taken to assess the calcification status of the left mandibular canine (33), first premolar (34), second premolar (35), and second molar (37) according to Demirjian's score (A-H).The Spearman rank correlation, Fisher r-to-z test, Kruskal-Wallis test, and Mann-Whitney U test were used.Quadratic weighted kappa was used to measure intra-examiner reliability. ResultsThere were significant positive correlations between all four teeth and CVM stage (p < 0.001).Spearman's ρ for the second premolar, canine, first premolar, and second molar was 0.758, 0.756, 0.683, and 0.628, respectively, in the total sample.The second premolar showed the strongest correlation in boys (ρ = 0.807), whereas the canine showed the strongest correlation in girls (ρ = 0.763).No significant sex differences were observed in the correlation coefficients (p > 0.05).Chronological age showed a stronger correlation with CVM stage (ρ = 0.897) than any individual tooth.At the pubertal growth peak (CS3-CS4), the mandibular canine was most frequently at stage E in boys (21/50, 42%) and stage F in girls (22/50, 44%).Intra-examiner agreement was high, with weighted κ values ranging from 0.949 to 0.979.Intra-examiner reliability was high, with weighted kappa values ranging from 0.949 to 0.979 across the assessed variables. ConclusionsThere is a high correlation between calcification stages of the mandibular canine and second premolar and those of cervical vertebral maturation, and it can be used as an additional radiological, non-radiation screening tool of skeletal maturity in panoramic radiographs.They should not be used as a substitute for skeletal indicators where exact timing of the treatment is important.These cross-sectional associations do not establish temporal prediction, diagnostic accuracy, or the optimal timing of orthodontic treatment.