|Year : 2012 | Volume
| Issue : 4 | Page : 301-304
An assessment of the relationship between cervical vertebrae maturation index and eruption of permanent maxillary canines
DS Kothavade1, RK Pandey1, A Nagar2
1 Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, C.S.M. Medical University, Lucknow, Uttar Pradesh, India
2 Department of Orthodontics, Faculty of Dental Sciences, C.S.M. Medical University, Lucknow, Uttar Pradesh, India
|Date of Web Publication||19-Mar-2013|
D S Kothavade
C/O Prof. R.K. Pandey, 1/30 Sector-I, Jankipuram, Lucknow - 226 021
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim : The purpose of the present study was to establish the relationship between the eruption of permanent maxillary canines and cervical vertebral maturation stages (CVMs) to assess an alternative method for determining time of canine eruption in the late mixed dentition. Materials and Methods : One hundred and twenty subjects with erupting permanent maxillary canines were observed both intraorally and radiographically with orthopantamograms. Lateral cephalograms were recorded to divide subjects according to CVM stage into prepeak (CS1 and CS2), peak (CS3 and CS4) and postpeak (CS5 and CS6) groups of puberty. Statistical Analysis : The differences between the prevalence rates of canine eruption in different groups of puberty were estimated using 'z test'. Results : Prepeak group comprised of forty six subjects, peak group sixty eight subjects and postpeak group six subjects. The differences in prevalence rates between peak and prepeak and between peak and postpeak groups were noticed highly significant (p<0.001), while prevalence rates between peak and postpeak was found less significant ( p0 <0.01). Conclusion : Eruption of the permanent maxillary canine can occur at any CVM stage till end of the puberty or after puberty (CS1-CS6). Thus, an absence of maxillary canine during or after postpeak stage of puberty (CS5 or CS6) suggests delayed eruption and canine impaction.
Keywords: Cervical vertebrae maturation index, Maxillary canine, Eruption
|How to cite this article:|
Kothavade D S, Pandey R K, Nagar A. An assessment of the relationship between cervical vertebrae maturation index and eruption of permanent maxillary canines. J Indian Soc Pedod Prev Dent 2012;30:301-4
|How to cite this URL:|
Kothavade D S, Pandey R K, Nagar A. An assessment of the relationship between cervical vertebrae maturation index and eruption of permanent maxillary canines. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2020 Jan 23];30:301-4. Available from: http://www.jisppd.com/text.asp?2012/30/4/301/108925
| Introduction|| |
Normal eruption of the permanent maxillary canines plays an important role in the development of the occlusion, as 'they form the foundation for an esthetic smile and functional occlusion'.  Permanent maxillary canine has an extended development period and it travels the longest, tortuous path of eruption through different developmental positions, before emerging in complete occlusion. , These factors cause an increased potential for mechanical disturbances, resulting in deflection from normal path of eruption and, often impaction. They are the second most frequently impacted teeth with the frequency of 0.8% to 3.6%. 
Therefore, any factor that interferes with development and eruption of maxillary canine can have serious consequences such as cystic follicular lesions and infections and compromising the life span of lateral incisors due to root resorption. ,, Lack of eruption or ectopic eruption of canine can often require complex multidisciplinary treatment including surgical, restorative, periodontal and orthodontic components.
The literature indicates an average age of about 12 for girls and 13 years for boys for maxillary canine emergence. , Individual variability of canine eruption has been reported to be great, and more importantly, a weak correlation has been observed between chronological age and biological processes related to tooth development and eruption. , Therefore, it is difficult to define delayed eruption or impaction of canine on the basis of the subject's age or dentition stage.
Alternatively, biological indicators of skeletal maturity are available for a more reliable assessment of dentoskeletal events in growing subjects. Studies by Baccetti et al.  have shown that, eruption of permanent maxillary canine can occur at any stage in cervical vertebral maturation (CVM) till end of the puberty. Hagg and Taranger  and Bjork and Helm  confirmed these findings using hand-wrist method to assess the puberty. Recently, evaluation with CVM method has gained acceptance for the appraisal of skeletal maturity in orthodontic subjects. 
The present study was aimed to assess the relationship between the eruption of the permanent maxillary canines and the stages of CVM and to establish an alternative method for predicting time of canine eruption in the late mixed dentition.
| Materials and Methods|| |
The present study comprised of one hundred and twenty child subjects reporting to the Out Patient Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, C.S.M. Medical University, Lucknow (U.P), India, within one year period. An informed consent was obtained from parent/guardian prior to inclusion of the subject in the study. The research work was approved by the ethical committee of research cell, C.S.M. Medical University, Lucknow.
The child subjects aged 8-14 years, with at least one permanent maxillary canine during the final phase of intraoral eruption were analyzed. This phase of eruption was defined as the emergence of the canine from the initial appearance of the tip of the cusp in the dental arch to a 1-mm short of the occlusal plane. The child subjects with history of orthodontic treatment, multiple tooth agenesis, craniofacial anomalies, traumatic injuries or massive caries of the dentition, pathologic obstacles to the eruption pathway of the maxillary canines (e.g: Odontomas, cysts, supernumeraries) were excluded from the study.
Lateral cephalograms [Figure 1], dental casts and intraoral photographs [Figure 2], orthopantomograms [Figure 3] were recorded for each child subject at the same time and erupting permanent maxillary canine analyzed accordingly.
|Figure 1: Lateral cephalogram of a subject aged 11years 11 months with right permanent maxillary canine during final phase of eruption showing cervical vertebral maturation stage-3|
Click here to view
|Figure 2: Intraoral photograph (mirror image) showing right permanent maxillary canine during final phase of eruption|
Click here to view
|Figure 3: Orthopantamogram of subject illustrating the distance from the tip of the erupting right permanent maxillary canine and the maxillary occlusal plane|
Click here to view
CVM stage was evaluated from the lateral cephalogram according to the method given by Baccetti et al. , [Figure 4]. The morphology of the three cervical vertebrae (C2, C3, C4) on the cephalograms was evaluated by visual inspection. The principal investigator and coinvestgator performed the assessment independently. The percentage of inter-examiner agreement was 97.14%. Two sets of variables were analyzed: (1) presence of a concavity at the lower border of the body of C2, C3, and C4; and (2) shape of the body of C3 and C4: The shape of C3 and C4 recorded in the present study is summarized as trapezoid, rectangular horizontal, squared, rectangular vertical.
The subjects were divided into prepeak (CS1 and CS2), peak (CS3 and CS4), and postpeak (CS5 and CS6) groups according to Kucculess et al.  to establish the eruption of maxillary canine in various puberty stages.
The distributions of the CVM stages in the subjects showing eruption of the maxillary canines were evaluated. A statistical analysis of prevalence rates (z test) showed differences in the prevalence of canine eruption in all the groups according to skeletal maturation.
| Results|| |
The ages of the seventy subjects in the final phase of canine eruption ranged from 9 to 13 years. The distribution of the CVM stages was as follows: CS1, 14 (11.67%); CS2, 32 (26.67%); CS3, 33 (27.5%); CS4, 35 (29.16%); CS5, 2 (1.67%); and CS6, 4 (3.33%). The subjects were divided in three groups, the prepeak group comprised 46 subjects (38.33%), the peak group had 68 subjects (56.67%), and the postpeak group comprised of 6 subjects (5%) [Table 1]. The differences in prevalence rates between prepeak, peak and postpeak were statistically significant.
| Discussion|| |
The present study was undertaken to establish the correlation between the physiologic eruption of the maxillary permanent canine and the skeletal maturity, as evaluated by the CVM method. The age-wise distribution of subjects ranged from 9 to 13 years, thus confirming the individual variability of the canine eruption with respect to age.
Dentoalveolar events have been correlated with skeletal maturation, assessed with hand-wrist and CVM methods by various authors. Hägg and Taranger  assessed hand-wrist radiographs of Swedish children and reported that the eruption of the permanent canines and the premolars had been attained in all subjects as by the late pubertal growth spurt. Recently, Bacceti et al.  assessed lateral cephalograms from a large group of Italian children and found that the eruption of the permanent maxillary canine had occurred in all subjects at any stage in skeletal maturation (CS1-CS4), before the end of the pubertal growth spurt. The present study confirmed that the eruption of the permanent maxillary canine was most commonly found in the Peak stage of puberty (56.67%) followed by Pre-peak Stage (38.33%) and Post-peak Stage (5%) respectively and the differences were statistically significant.
Therefore, the present study confirms the findings of Hägg and Taranger , in establishing the fact that in majority of subjects (95%) the canine erupts in the dental arch by the puberty at its peak. In remaining subjects (5%), physiologic eruption of the maxillary canines was found to take place after pubertal growth spurt. The present study reaffirmed that the lack of eruption of the permanent maxillary canine after post-pubertal stage (CS5 and CS6) can be regarded as delayed eruption. The difference in prevalence rates between pre-peak peak and post-peak groups were found statistically significant.
Thus, the analysis of skeletal maturity can assist in the diagnosis of tooth eruption disturbances especially when the bilateral intraosseous position of the maxillary canines is associated with generalized retardation of tooth emergence and also in subjects with retarded eruption of one maxillary canine associated with the early emergence of the contralateral one. Likewise, the findings can be helpful for the determination of the expected appearance in the dental arch of displaced maxillary canines after interceptive procedures to improve the rate of successful eruption of this tooth. ,,
| Conclusion|| |
The present study focused on the relationship between the eruption of permanent maxillary canine and skeletal maturity, by using CVMI as biological indicator of skeletal maturity and subsequently with stage of puberty. It led to the conclusion that eruption of the permanent maxillary canine can occur at any stage in CVM till end of the puberty (CS1-CS6). Thus, an absence of maxillary canine during or after postpeak stage of puberty (CS5 or CS6) suggests delayed eruption and/or possible canine impaction.
| References|| |
|1.||Bishara SE. Impacted maxillary canines: a review. Am J Orthod Dentofacial Orthop 1992;101:159-71. |
|2.||Shah RM, Boyd MA, Vakil TF. Studies of permanent tooth anomalies in 7,886 Canadian individuals impacted teeth. J Can Dent Assoc 1978;44:262. |
|3.||Tsai HH. Eruption process of upper permanent canine. J Clin Pediatr Dent 2001;25:175-9. |
|4.||Ayudin U, Yilmaz HH, Yildirim D. Incidence of canine impaction and transmigration in a subject population, Dentomaxillofac Radiol 2004;33:164-9. |
|5.||Rayne J. The unerupted maxillary canine. Dent Pract Dent Rec 1969;19:194-204. |
|6.||Power SM, Short MB. An investigation into the response of palatally displaced canines to the removal of deciduous canines and an assessment of factors contributing to favourable eruption. Br J Orthod 1993;20:217-23. |
|7.||Erikson S, Kurol J. Resorption of incisors after ectopic eruption of maxillary canines; a CT study. Angle Orthod 2000;70:415-23. |
|8.||Hume V. Range of normalcy in the eruption of permanent teeth. J Dent Child 1949;16:11-5. |
|9.||Becker A, Chaushu S. Dental age in maxillary canine ectopia. Am J Orthod Dentofacial Orthop 2000;117:657-62. |
|10.||Björk A, Helm S. Dental age in maxillary pubertal growth in body height. Angle Orthod 1967;37:134-43. |
|11.||Hägg U, Taranger J. Dental emergence stages and the pubertal growth spurt. Acta Odontol Scand 1981;39:298-306. |
|12.||Baccetti T, Franchi L, De Lisa S, Giuntini V. Eruption of the maxillary canines in relation to skeletal maturity. Am J Orthod Dentofacial Orthop 2008;133:748-51. |
|13.||Baccetti T, Franchi L, McNamara JA Jr. The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Semin Orthod 2005;11:119-29. |
|14.||Kucukkeles N, Acar A, Biren S, Arun T. Comparisons between cervical vertebrae and hand wrist maturation for assessment of skeletal maturity. J Clin Pediatr Dent 1999; 24(1):47-52. |
|15.||Ericson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Eur J Orthod 1988;10:283-95. |
|16.||Leonardi M, Armi P, Franchi L, Baccetti T. Two interceptive approaches to palatally displaced canines: A prospective longitudinal study. Angle Orthod 2004;74:581-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]