RELATIONSHIP BETWEEN BODY MASS INDEX PERCENTILE AND

SKELETAL MATURATION AND DENTAL DEVELOPMENT IN ORTHODONTIC

PATIENTS
-Kevin B Mack, Ceib Philips, Nina Jain, Lorne D. Koroluk

Am J Orthod Dentofac Orthop 2013;143:228-34

INTRODUCTION
• Recently rates of obesity have been increasing among both children
and adults.
• Many methods of assesing weight status has been recognised like
biomass impedence, Body mass index etc.

quick,
non invasive &
readly accessible.
 Dental
Growing development
Timing of orthodontic
pateints
treatment and
Treatment modality
Skeletal
Maturation

The objective of this retrospective study was to assess the relationship between weight status
by using BMI percentiles and skeletal and dental development in large group of actively
growing orthodontic patients.
Materials And Methods
• Potential subjects consisted of consequetive pateints who had initial pre
treatment orthodontic record in the graduate orthodontic clinic at the Univesity
of North Carolina.

• INCLUSION CRITERIA:
Pretreatment panoramic and lateral cephalometric radiographs of
adequate diagnostic quality taken within one month of each other.
Height and weight recorded within one month of each other
Age greater than 8 and less than 17 years
Full compliment of mandibular teeth should be present excluding third
molars
• EXCLUSION CRITERIA
2nd, 3rd and 4th cervical vertebra not completly visible in the
cephalometric radiograph.
Congenital anomalies of 2nd, 3rd and 4th cervical vertebrae
Congenital tooth anomalies, and
Any significant medical history that would affect the physical
growth and development.
Goal for the sample size was set at 500 subjects.

A computer search of the permanent patient database in the Department

of Orthodontics identified all subjects seen for initial records between
July 1, 2005, and July 31, 2009, along with their height, weight, date of
birth, sex, and race

At the initial record appointment, height and weight were recorded

using a wall mounted stadiometer, and a standard mechanical scale.
OPG & Lateral cephalograms were also obtained.

Subjects who met the radiographic and inclusion and exclusion criteria
were included till 540 eligible subjects have been selected.
• Panoramic radiographs were veiwed to assess dental maturity score
and dental age using, Demirjian Index.

• Lateral cephalometric radiographs were assessed for 2nd, 3rd and 4th
cervical vertebrae to determine the cervical vertebrae maturation stage
according to recent modification to the Lampersky method.

• Raw BMI scores are calculated using height and weight data.
The raw BMI score, age, and sex were used to obtain the BMI percentile
value for each subject with age- and sex-specific growth charts from the
Centers for Disease Control.
STATISTICAL ANALYSIS

• Bivariate analyses were performed with analysis of variance (ANOVA)

(race vs BMI percentile and dental age),
unpaired t tests (sex vs BMI and dental age), and
chi-square tests (sex and race vs cervical vertebral maturation).
RESULTS
• They reviewed 540 subjects.
• Out of all, approximately 70% of the sample was white, 12% African
american, 12% Latino and 6% others.
• 56.3% of the sample size were females.
• 30% of the sample was categorised as over weight or obese.
• Only 3.8％ was underweight.
• All cervical vertebral maturation stages were represented. Although
most subjects were in stage 3, 4 or 5.
• The mean chronologic age (13.07 years) was statistically different
from mean dental age (14.24 years)
• The mean dental advancement was 1.17 years.
• On average, boys were more dentally advanced than girls (1.33 vs
1.05).
• There were no statistically significant mean differences among racial
groups for chronologic age, dental age, difference between
chronologic and dental ages or BMI percentiles.
• Boys and girls were not statistically significantly different in
chronologic age but were significantly different, with respect to dental
age and BMI percentile (unpaired t test, P <0.01 and
P<0.01, respectively).

• Boys were more advanced in dental age and had lower BMI
percentiles than girls.
• More girls were overweight than boys.

• There was a statistically significant difference in the prevalence of

prespurt (cervical vertebral maturation stages 1-3) vs postspurt
(cervical vertebral maturation stages 4-6) stage among the racial
groups (chi-square test, P <0.05) and between boys and girls (chi-
square test, P <0.001)
• Both chronologic and dental ages increased incrementally with increases in
cervical vertebral maturation stage
DISCUSSION
• Intraexaminer reliability was excellent in this study, with only the mandibular
first molar having only a “good” weighted kappa statistic (0.66).
• Weight status was defined in this study by using established parameters for
underweight, normal weight, overweight, and obesity based on percentile data.
• In their sample, BMI percentile, on average, was slightly higher in girls, and
the proportion of girls in the overweight and obese categories was slightly
greater than in boys (32% vs 27%).
• They found no mean differences in dental age, chronologic age, or the
difference between dental and chronologic ages among the races.
• From the final model for dental age it was concluded that for every 1
percentile of increase in BMI percentile for age,

there was a 0.005-year increase in dental age.

This means that for 13-year-old children at the extremes of BMI
percentiles—fifth and 95th—we could expect to see a mean dental age
difference as great as 5.4 months.

• In this study, girls demonstrated a statistically significant increased

prevalence of advanced cervical vertebral maturation stages.

• For 2 children of the same age, a child at the 95th percentile is nearly 3
times more likely to be in hand-wrist radiograph stage 4, 5, or 6 vs
stages 1 through 3 than a child at the fifth percentile would be.
CONCLUSIONS

• The following conclusions were identified.

1. In this sample of orthodontic patients, there was a significant
relationship between weight status as defined by BMI percentile and
dental age and cervical vertebral maturation stage. An increase in BMI
percentile appears to be associated with an increase in both dental and
skeletal development.
2. A significant percentage of orthodontic patients are either overweight
or obese. As health care professionals, it might be beneficial for
orthodontists to collect objective weight information for treatment
planning purposes as well as health counseling.
 DERMATOGLYPHIC DEVELOPMENT
AND
TIMING OF MATURATION
HUMAN BIOLOGY, VOL 59, No.2 (APRIL 1987) 357-373
ROBERT J. MEIER, CHERYL SORENSON GOODSON, EILEEN M. ROCHE, Ellen M. Roche
• The use of DERMTOGLYPHIC features as markers of early fetal
development has received limited prior attention , although
environmental insult of varying types occuring during the time of
dermatoglyphic formation has been demonstrated to have a significant
effect on dermatoglyphic trait.

• The present study was undertaken to investigate the possible

relationship between timing of maturation within sexes and the
expression of major dermatoglyphic traits, both digital and palmer. It
was hypothesized that both male and female late maturers would
demonstrate higher ridge count with higher whorl frequencies, due to
an unexpected delay in VOLAR PAD regression.
METHODS
• The sample included 83 males & 104 females participants from Fels
Longitudinal study.
• The prints were taken using Faurots Inkless method.
• Digital ridge count included both ulnar and radial count.
• Absolute finger ridge count was calculated.
• Pattern classification was according to Henry system with some
modifications.
• Subjects were classified as Early or Late maturers on the basis of Peak
height velocity for males and, age at menarche for females.

EARLY
LATE MATURERS
MATURERS
Age of peak height Age of peak height
velocity / age at velocity / age at
menarche was menarche was one
earlier than one standard deviation
standard deviation or more above the
below the mean for mean age of the
appropriate variable. appropriate variable.
RESULTS
• For males, all ridge count variables and digital pattern intensities
demontrated Late maturers to have higher values than Early
maturers.

indicating strong tendency for late maturers to have more complex

patterns.

• And, none of the palmer pattern intensities measures demontrated

significant differences in males.
• Late maturers had higher ridge count than early maturers.
• For Females, the tendency for having complex patterns in late
maturing individuals was not as strong as in males.

• Digital pattern intensity showed reversal in direction in females.

• Early maturers had higher digital pattern intensities than Late
maturers.
• Late maturers had higher palmer pattern intensities than in early
maturers.
• Ridge count analyses showed no clear consistency as it did for
females.
CONCLUSION
• The results of this study demonstrated a delay in dermatoglyphic
development leads to higher frequencies of digital whorls and palmer
patterns.