Skeletal maturation refers to the degree of development of ossification in bone. Residual facial growth and timing are amongst the most critical aspects for the application of treatment planning and retention in Orthodontics. Starting treatment in a growing patient at the right time has demonstrated significant favorable effects in the correction of skeletal and dental disharmonies in transverse, sagittal, and vertical planes. Hence, it is of fundamental importance to determine the level of biologic maturation and the subsequent evaluation of growth potential during preadolescence and adolescence.
The development status of an individual can be assessed using growth indicators such as chronological age, peak height velocity, facial growth spurt, radiographic assessment of skeletal maturation and staging of dental age. Considering a great variability of inter-? observer agreement in the use of the various growth maturity indicators, strict adherence to clearly explained diagnostic characteristics for each method of growth assessment is highly recommended. Besides, Hassel and Farman have stated that as skeletal maturation is a continuous process, one diagnostic tool should not be relied on too heavily. Thus, the various growth maturity indicators must be used together when considering Orthodontic corrections to ensure accuracy.
The advent of biochemical markers, like Insulin-?like Growth Factor-?1 (IGF-?1) and Alkaline Phosphatase (ALP) provide newer possibilities for growth assessment. These represent agents that are directly involved in bone growth and remodeling. Multiple studies have suggested that the changes in the levels of biomarker with bone growth and remodeling are related to pubertal stages. Biomarkers have the advantage of being quantitatively evaluated from various biological fluids like blood, saliva and urine, thus overcoming the subjectivity associated with radiographs.
In this talk I will present evidence-?based guidelines for assessment of skeletal maturation using physiologic, radiological and biochemical diagnostic tools. I will also present results on a clinical study done to assess the applicability of serum and urine IGF-?1 in identifying skeletal maturation stage. The clinical study was performed at the Maulana Azad Institute of Dental Sciences, New Delhi with female subjects in the age range 8 to 20. I will present the design of experiments, collection and processing of samples and analysis of the collected data. Our key results indicate that IGF-?1 can be used as an objective quantitative method to identify skeletal maturation stage. Urine IGF-?1 promises to be a noninvasive surrogate of serum IGF-?1 that opens tremendous opportunities in clinical orthodontics. As tools for biochemical assays are becoming readily available in diagnostic laboratories, collection of serum and urine for subsequent identification and monitoring of maturation age can add a significant benefit to personalized and effective orthodontic treatments.