Frontal sinus development as an indicator for somatic maturity at puberty?

Ontogenetic patterns in human frontal sinus shape: A longitudinal study using elliptical Fourier analysis

Frontal sinus morphology is highly variable across individuals, but little is known regarding how or at what age that variation is reached. Existing ontogenetic studies are conflicting and often cross-sectional in nature, limiting understanding of individualistic growth. Studies investigating sinus growth with longitudinal series often focus on lateral cephalograms and consequently do not capture the sinus morphological features that are most relevant to clinical and medicolegal settings (e.g., arcade/scalloping, width-to-height dimensions, asymmetry). Longitudinal analysis of sinus morphology from frontal radiographs is important to understand when sinus morphology stabilizes. The purpose of this study was to investigate at what age the frontal sinus attains its final shape, and whether sex-based differences in ontogeny are evident, using a longitudinal sample of posterior-anterior (PA) frontal radiographs from the AAOF Legacy Collection. Frontal sinus outlines were manually traced in 935 radiographs from 111 individuals (55F/56M) spanning 8-29 years of age. Outlines were subjected to elliptical Fourier analysis (EFA) and underwent principal components analysis (PCA). PC1 (51.02% of variation) appears to represent the relative height and breadth of the sinus, PC2 (11.73%) and PC3 (10.03%) captures the degree of relative complexity in the outlines. Individual PC scores were plotted against age-in-months with individual Loess growth curves. Overall, younger individuals typically display relatively shorter, flatter sinuses, increasing in vertical complexity with age. Mixed-effect models on PC1 indicate significant effects for the repeated measure of years (p < 0.001). Within individuals, Euclidean distances of PCs between each sinus outline and their oldest-age outline (i.e., final morphology) were calculated and plotted against age-in-months with Loess growth curves. The results indicate that final frontal sinus morphology is mostly attained by 20 yoa regardless of sex. There is sexual dimorphism in ontogenetic trajectories: females attain frontal sinus shape earlier than males. Specifically, Loess growth curves of the Euclidean distances to final sinus shape indicate that female shape shows decreased development at 14-16 yoa, with males approaching stabilization at 18-20 yoa. These trends were supported by paired t-tests on PC1 between each year and the oldest age, whereby significant differences end for females starting at 15 and 18 yoa for males. The timing of shape-stabilization in the current study closely aligns with previous studies on linear and size dimensions, indicating a close relationship between the ontogeny of frontal sinus shape and size. This research has several implications in diverse fields. Documenting ontogenetic patterns in modern humans could lead to more accurate interpretations of frontal sinus variation in hominin lineages. Understanding the age at which frontal sinus shape and size stabilizes in pediatric populations has important clinical implications, with future studies needed to investigate if/how sinus development directly relates to sinonasal disease susceptibility (e.g., sinusitis), surgical complications, and/or expected trauma patterns. For forensic practitioners utilizing frontal sinus comparisons for decedent identifications, it is important to know at what age these features stabilize to understand how much change may be expected between antemortem and postmortem radiographs.

Morphological and dimensional variations of the frontal air sinuses in a group of adolescent Caucasians and Chinese in different skeletal malocclusions: a cross-sectional cephalometric study

OBJECTIVE

This study aimed to evaluate the morphological and dimensional variations of the frontal air sinuses in a group of adolescent Caucasians and Chinese with different skeletal malocclusions in both genders.

MATERIALS AND METHODS

This retrospective study included 290 adolescent Caucasians and Chinese patients with 145 each. Each sample included 90 females and 55 males and was categorized based on ANB angle in reference to each population norms into 65 skeletal class I, 50 skeletal class II, and 30 skeletal class III malocclusions. All linear, angular, and surface area measurements of the frontal air sinuses were evaluated using lateral cephalometric radiographs and calculated using Winceph version 8 software. The frontal air sinus parameters were compared between genders and the two ethnic groups using an independent sample t-test. ANOVA with Tukey's post hoc tests were used to compare the frontal air sinus parameters between the three skeletal malocclusions.

RESULT

The frontal air sinus width and surface area were found to be significantly greater in Caucasians when compared with Chinese patients. According to gender, the frontal air sinus length, width, and surface area, as well as the glabella convexity, were greater in males than females, while the frontal air sinus index (length/width) was significantly greater in females than males in both ethnic groups. In both ethnic groups, the frontal air sinus surface area was significantly greater in skeletal class III malocclusion when compared to skeletal class I and class II malocclusions in Caucasians (P = 0.0022) and Chinese (P = 0.0097). There was a weak-to-moderate correlation between the frontal air sinus parameters and the nasio, sella, and glabella positions (R = -0.56 to 0.62).

CONCLUSION

The frontal air sinus dimensions and surface area varied greatly in between ethnic groups, genders, and malocclusion types. The frontal air sinus parameters were correlated with nasion, sella, and glabella positions.

CLINICAL RELEVANCE

These findings could assist orthodontists, ENT specialist, and forensic medical investigators to focus on the size of frontal sinus during treatment planning, the relationship between the size of frontal air sinus and malocclusions, and age determination.

Evaluation of Skeletal Maturation Using Mandibular 1st Premolar and 2nd Molar Calcification Stages: A Cross-sectional Radiographic Study

Aim and objective

The study aimed at, whether the calcification stages of mandibular 1st premolar and 2nd molar can be used to assess skeletal maturity.

Materials and methods

Lateral cephalogram and OPG of 72 growing subjects with good health (38 girls and 34 boys; age-group of 8–17 years) were selected for a cross-sectional study, in which the identity of patients was not revealed to the investigator. The dental calcification stage of mandibular 1st premolar and 2nd molar were estimated in accordance with the Demirjian system (DI) and skeletal maturation was estimated according to cervical vertebral maturation index (CVMI) given by Hassel and Farman and these two indices were compared.

Results

Chi-square test and Spearman rank-order correlation coefficient test showed that a significant relationship of mandibular 1st premolar and 2nd molar calcification stages with CVMI exists, for both males and females. In females, CVMI stage 2 showed maximum correlation to DI stage E of lower 2nd molar. In males, CVMI stage 2 showed maximum correlation to DI stage E of lower 1st premolar.

Conclusion

The result of this study revealed that each stage developed prior in female subjects compared to male subjects and the calcification stages of lower 1st premolar and 2nd molar can be used to assess the peak of growth.

How to cite this article

Mittal K, Trehan M, Sharma S, et al. Evaluation of Skeletal Maturation Using Mandibular 1st Premolar and 2nd Molar Calcification Stages: A Cross-sectional Radiographic Study. Int J Clin Pediatr Dent 2021;14(S-1):S44–S49.

Relationship of Frontal Sinus Size and Maturation of Cervical Vertebrae for Assessment of Skeletal Maturity

Objectives:

This study aimed to assess the relationship of frontal sinus height and width with the cervical vertebral maturation (CVM) for assessment of skeletal maturity.

Materials and Methods:

This retrospective study evaluated lateral cephalograms of 132 patients between 8 to 21 years, including 66 males and 66 females. For each of the six stages of the CVM, 22 patients (11 males and 11 females) were evaluated. The Ertuk’s method was used to measure the height and width of the frontal sinus. The sinus height to width ratio was calculated and considered as the sinus index. The CVM was evaluated on the same lateral cephalograms using the Baccetti’s method. The correlation of frontal sinus height and width with the CVM was analyzed, and comparisons were made using independent t-test, ANOVA, Mann-Whitney test, and Kendall’s tau-b correlation coefficient.

Results:

The sinus width was 10.85±2.7 mm in males and 9.47±2.6 mm in females. The sinus index was 2.43±0.37 in males and 2.66±0.32 in females (P<0.000). The frontal sinus index and width were significantly greater in males but the sinus length was not significantly different between males and females (P=0.383). Significant differences were found in stages 2 and 3, and also 4 and 5 in females and 2 and 3, 3 and 4, and 4 and 5 in males. The mean frontal sinus index had a significant correlation with the CVM stage in both groups.

Conclusion:

According to the results, the frontal sinus index cannot be used as a predictor of skeletal maturity.

Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity

INTRODUCTION

Various methods have been proposed to evaluate a patient's developmental status. However, most of them lacked precision and failed to give a reliable estimate of skeletal maturity. The aims of this study were to evaluate the association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity and to determine its validity in assessing the different stages of the adolescent growth spurt.

METHODS

A cross-sectional study was performed on the pretreatment lateral cephalograms of 252 subjects aged 8 to 21 years. The sample was divided into 6 groups based on the cervical vertebral maturation stages. The frontal sinus index was calculated by dividing the frontal sinus height and width, and the cervical stages were evaluated on the same radiograph. The Kruskal-Wallis test was applied to compare frontal sinus index values at different cervical stages, and the post hoc Dunnett T3 test was applied to compare frontal sinus index values between adjacent cervical stages for each sex. The Kendall tau-b values were computed to assess the correlation between the cervical stages and the sinus index. A P value of ≤0.05 was considered statistically significant.

RESULTS

The height and width of the frontal sinus were significantly larger in the male subjects than in the females. A significant association was found between the frontal sinus height and width and cervical stages (P ≤0.001) in both sexes. However, the changes in the frontal sinus index across the different cervical stages were found to be significant (P ≤0.001) in male subjects only. Similarly, a weak negative correlation was found between the sinus index and the cervical stages in male subjects (tau-b = -0.271; P <0.001), whereas no correlation was found in female subjects (tau-b = -0.006; P <0.928). However, the post hoc analysis showed that the values of the sinus index were comparable between any 2 adjacent cervical stages.

CONCLUSIONS

The frontal sinus index cannot be used to identify the prepubertal, pubertal, and postpubertal stages of the adolescent growth spurt. Therefore, it cannot be used as a reliable maturity indicator.

Relationship between anterior occlusion and frontal sinus size

OBJECTIVE

To determine the relationship between anterior occlusion and frontal sinus size.

METHODS

The patient database at the Eastman Institute for Oral Health, University of Rochester, was searched for male patients older than 15 years and females older than 13 years of age. After applying inclusion and exclusion criteria, participants' photos and lateral cephalometric and posteroanterior radiographs were examined then classified into a control class I group (n = 20, 15.7 ± 2.7 years) and eight malocclusion groups (n = 136, 16.1 ± 2.1 years). The frontal sinus area on the lateral cephalometric radiograph and on the posteroanterior radiograph were measured and compared between groups.

RESULTS

One-way analysis of variance demonstrated a significant difference among all nine groups (P = .0001). Pairwise comparison showed a significant difference between the class I group and all other malocclusion groups (P < .05) except the edge-to-edge group for both radiographs and except the bimaxillary protrusion group for the lateral cephalometric radiographs. Tukey's method was not able to demonstrate a significant difference among the subgroups of skeletal malocclusions (P > .05). Linear regression analyses with stepwise model selection demonstrated that anterior cranial base, mandibular plane angle, and upper incisor inclination commonly have a significant effect on frontal sinus size.

CONCLUSION

The frontal sinus size could be used as an indicator of harmonious anterior occlusion. There were no differences among the subgroups of each skeletal malocclusion. The anterior cranial base, facial height, and maxillary incisor inclination appear to have a significant effect on frontal sinus size.

Assessment of the Pubertal Growth Period using the Open Apices of the Lower Teeth

AIM

The purpose of this study was to evaluate whether the open apex measurements of the lower teeth can be used for prediction of the pubertal growth spurt.

MATERIALS AND METHODS

The study group consisted of 150 males and 142 females ranging in age from 10 to 16 years. A total of 292 panoramic and 292 hand-wrist radiographs were obtained and analyzed. The skeletal maturity was determined according to the skeletal maturity indicators (SMIs) developed by Fishman. The open apices measurements of the left lower teeth were made according to the method described by Cameriere.

RESULTS

The Spearman rank order correlation coefficient revealed a relationship between the skeletal maturity stages and the open apex measurements. These correlations ranged from 0.577 for the lower second premolar to 0.830 for the lower canine. The measurement of the left lower canine showed the highest correlation, so its relationship with the SMIs was further investigated. The measurements of 6.07 (or greater) indicated to SMI4, and 2.485 (or lesser) indicated to SMI7.

CONCLUSION

The skeletal maturity well related to the measurements of the open apices of the lower teeth. Lower canine open apex measurements could be used as an indicator of the SMI4 and SMI7.

CLINICAL SIGNIFICANCE

The measurements of the open apices of the left lower canines from panoramic radiographs may be clinically useful as an indicator of the beginning and the ending of the pubertal growth period.

A Study of Correlation of Various Growth Indicators with Chronological Age

Introduction: The aim of this study was to assess the relationship of chronological age with cervical vertebrae skeletal maturation, frontal sinus width and antegonial notch depth and a correlation, if any, among the three variables.

Materials and methods: The samples were derived from lateral cephalometric radiographs of 80 subjects (40 males, 40 females; age range: 10 to 19 years). Cervical vertebral development was evaluated by the method of Hassel and Farman, frontal sinus width was measured by the method described by Ertürk and antegonial notch depth as described by Singer et al. The Pearson’s correlation coefficients were estimated to assess the relationship of chronological age with cervical vertebrae skeletal maturation, frontal sinus width and antegonial notch depth.

Results: The Pearson’s correlation coefficient were 0.855 (p < 0.001) between chronological age and cervical vertebrae skeletal maturation, and 0.333 (p < 0.001) between chronological age and frontal sinus width.

Conclusion: A highly significant positive correlation was found between chronological age and cervical vertebrae skeletal maturation, and between chronological age and frontal sinus width. Nonsignificant correlation was found between chronological age and antegonial notch depth.

How to cite this article: Singh S, Sandhu N, Puri T, Gulati R, Kashyap R. A Study of Correlation of Various Growth Indicators with Chronological Age. Int J Clin Pediatr Dent 2015;8(3): 190-195.

Guias clínicos e radiográficos utilizados para a predição do surto de crescimento puberal

OBJETIVO: o objetivo desse artigo é chamar a atenção para a organização das informações disponíveis nos exames e durante o tratamento ortodôntico de indivíduos em crescimento, as quais servem como guias para a predição do estágio do surto de crescimento puberal. CONCLUSÃO: tais informações fornecem oportunidades de acréscimos no diagnóstico e prognóstico dos casos e na tomada de decisões do planejamento, evolução do tratamento e da fase de contenção, principalmente daqueles pacientes que apresentam más oclusões associadas a desarmonias esqueléticas.

Three-dimensional computed tomographic analysis of frontal sinus in Asians

Although there are many reports on the measurement of the paranasal sinuses, few studies examined the development of frontal sinus with three-dimensional computed tomography (CT), especially in children. In this study, we evaluated the normal development of frontal sinus in Asian children, and we also analyzed the height, length, and width of the frontal sinus in Korean adults with three-dimensional CT imaging. We retrospectively reviewed three-dimensional facial bone CT of a total of 352 patients younger than 23 years. The occurrence of the frontal sinus was evaluated by their age. The maximal length, height, and width were measured with a computer device. The volume of the frontal sinus was also evaluated. In those older than 4 years, the pneumatization of frontal sinus was detected. Frontal sinus developed continuously and was observed in almost every child older than 17 years. The length, height, width, and volume of the frontal sinus continuously increased until the age of 20. The maximal growth of the frontal sinus was observed at puberty. The width and volume of the frontal sinus showed a high correlation coefficient (r=0.8) relative to the height or length. In adults, the mean height, width, depth, and volume of the frontal sinus were 27.2±7.0 mm, 52.5±17.1 mm, 22.0±6.3 mm, 8.39±3.78 cm, respectively. The results of this study may be helpful in understanding the normal development of frontal sinuses in children. It could be also helpful for further research and surgical approaches for frontal sinuses.

Correlation between dental maturity and cervical vertebral maturity

OBJECTIVE

The aim of this study was to investigate the association between dental and skeletal maturity.

STUDY DESIGN

Digital panoramic radiographs and lateral skull cephalograms of 302 patients (134 boys and 168 girls, ranging from 8 to 16 years of age) were examined. Dental maturity was assessed by calcification stages of the mandibular canines, first and second premolars, and second molars, whereas skeletal maturity was estimated by the cervical vertebral maturation (CVM) stages. The Spearman rank-order correlation coefficient was used to measure the association between CVM stage and dental calcification stage of individual teeth.

RESULTS

The mean chronologic age of girls was significantly lower than that of boys in each CVM stage. The Spearman rank-order correlation coefficients between dental maturity and cervical vertebral maturity ranged from 0.391 to 0.582 for girls and from 0.464 to 0.496 for boys (P < 0.05). In girls, the mandibular second molar had the highest and the canine the lowest correlation. In boys, the canine had the highest and the first premolar the lowest correlation.

CONCLUSIONS

Tooth calcification stage was significantly correlated with cervical vertebral maturation stage. The development of the mandibular second molar in females and that of the mandibular canine in males had the strongest correlations with cervical vertebral maturity. Therefore, it is practical to consider the relationship between dental and skeletal maturity when planning orthodontic treatment.

A relação entre o crescimento mandibular e a maturação esquelética em jovens brasileiras melanodermas

OBJETIVO: avaliar o grau de correlação existente entre o crescimento mandibular e a maturação esquelética em jovens brasileiras melanodermas. MÉTODOS: examinou-se 140 telerradiografias, obtidas em norma lateral e 140 radiografias de mão e punho de jovens do gênero feminino, brasileiras, melanodermas, com 8 a 14 anos de idade, com oclusão normal ou má oclusão de Classe I, de Angle, não submetidas a tratamento ortodôntico prévio. Nas radiografias da mão e do punho, avaliou-se o desenvolvimento dos centros de ossificação da falange proximal do 3º dedo e da epífise distal do osso rádio, apoiando-se no método descrito por Eklöf e Ringertz; e nas telerradiografias, obtidas em norma lateral, analisou-se a pneumatização do seio frontal, de acordo com o método descrito por Rüf e Pancherz, e as medidas cefalométricas representativas do crescimento mandibular (Co-Go, Co-Gn, Go-Gn e Fg-Pg). Os dados obtidos foram submetidos à análise estatística, utilizando-se a Correlação de Pearson, para determinar o grau de relacionamento entre as variáveis. RESULTADOS E CONCLUSÃO: ocorreu uma correlação altamente significativa entre os centros de ossificação observados na radiografia de mão e punho e as medidas cefalométricas representativas do crescimento mandibular (r = 0,777). Apesar de estatisticamente significativa, ocorreu uma baixa correlação entre a pneumatização do seio frontal e os eventos da maturidade esquelética (r = 0,306), assim como a relação entre a pneumatização do seio frontal e as medidas cefalométricas representativas do crescimento mandibular (r = 0,218).

Association of frontal sinus development with somatic and skeletal maturation in Aboriginal Australians: a longitudinal study

There have been very few studies of frontal sinus development and its association with other growth parameters in humans. The aim of this study was to investigate the relationship of frontal sinus development with somatic and skeletal maturation in a sample of Aboriginal Australians. The sample comprised 31 individuals, of whom 17 were males and 14 females. For the selected subjects the following records were available: lateral head radiographs, hand-wrist radiographs and stature recordings, generally covering the age range from 7 to 18 years. Descriptive statistics for frontal sinus size, skeletal ossification and body height were calculated at yearly intervals and comparisons made between the sexes. Growth velocities in frontal sinus height, frontal sinus depth and stature were also calculated for both sexes. The frontal sinus was found to display a well-defined adolescent growth spurt, with its peak velocity occurring after the peak velocity in body height. Females were found to attain peak velocity in sinus height earlier, on average, than males but they attained peak velocity in sinus depth at a similar age to males. The sequence of hand-wrist ossification events followed a similar pattern in both sexes, with events in females occurring approximately one year earlier than those in males. These results indicate that an adolescent spurt is present in frontal sinus growth and that the spurt tends to occur after statural velocity has peaked. Hand-wrist ossification events also tend to have a close relationship to peak statural and frontal sinus velocity and these relationships may be useful in clinical situations for predictive purposes.