Accuracy of dental development for estimating the pubertal growth spurt in comparison to skeletal development: a systematic review and meta-analysis

Abstract

Objectives: This study aimed to search for scientific evidence concerning the accuracy of dental development for estimating the pubertal growth spurt.

Methods: It was conducted according to the statements of PRISMA. An electronic search was performed in six databases, including the grey literature. The PICOS strategy was used to define the eligibility criteria and only observational studies were selected.

Results: Out of 1,416 identified citations, 10 articles fulfilled the criteria and were included in this systematic review. The association between dental development and skeletal maturity was considered strong in seven studies, and moderate in two, although the association with the pubertal growth spurt had been verified in only four articles. According to half of the studies, the tooth that provided the greater association with the ossification centres was the lower canine. The meta-analysis performed also indicated a positive association, being stronger in females [0.725 (0.649-0.808)]. However, when the method used for dental evaluation was considered, it was possible to verify greater correlation coefficients for Nolla [0.736 (0.666-0.814)] than for Demirjian [0.631 (0.450-0.884)], at the boys sample. The heterogeneity test reached high values (Q = 51.00), suggesting a potential bias within the studies.

Conclusions: Most of individual studies suggested a strong correlation between dental development and skeletal maturation, although the association with the peakof pubertal growth spurtwas clearly cited only in some of them. However, due to the high heterogeneity found among the studies included in this meta-analysis, a pragmatic recommendation about the use of dental stages is not possible.

Figure 1.

Flowchart showing the results of the search process.

Figure 2.

Nine anatomical sites located on the thumb, second finger, third finger, hamato, pisiform and radius, adapted from Greulich and Pyle atlas (a), and six anatomical sites located on the thumb, third finger, fifth finger and radius, adapted from Fishman (b).

Figure 3.

Stages of tooth development adapted from Demirjian et al¹² (a), Nolla¹⁰ (b) and Moorrees et al¹¹(c).

Figure 4.

Overall correlation rank between dental development and skeletal maturation to male (a) and female (b) samples.

Figure 5.

Overall correlation rank between dental development and skeletal maturation and subgroup analysis according to methodological characteristics: (a) both methods; (b) only Nolla;¹⁰ and (c) only Demirjian et al.¹²

Figure 6.

Graph publication bias, indicating the heterogeneity between studies.