Predictive Value of Dental Maturity for a Positive Gonadotropin-Releasing Hormone Stimulation Test Result in Girls with Precocious Puberty

Abstract

Dental maturity is associated with skeletal maturity, which is advanced in girls with central precocious puberty (CPP). We investigated the performance of dental maturity as a screening method for CPP using mandibular second premolar and molar calcification stages, assessed the associated anthropometric and laboratory factors, and evaluated pubertal response predictors using the gonadotropin-releasing hormone stimulation test (GnRHST) in prepubertal and pubertal girls. A prospective case-control study was conducted in girls, aged 7.0–8.9 years, classified into pubertal (peak luteinizing hormone [LH] after GnRHST ≥ 5 IU/L), prepubertal (peak LH < 5 IU/L), and control groups. Auxological and biochemical tests, panoramic radiographs, and GnRHSTs in participants with breast development were conducted. Dental maturity was assessed using the Demirjian index (DI). We included 103 girls (pubertal, 40; prepubertal, 19; control, 44). Chronological age (CA) was not significantly different between groups. Bone age (BA) and BA advancement was higher in the pubertal and prepubertal groups. Increased DI values at the mandibular second premolar and molar were significantly associated with CA, BA, BA advancement, height standard deviation score (SDS), peak LH after GnRHST, and insulin-like growth factor-I (IGF-I) (all P < 0.05). Moreover, odds ratio (OR) of the mandibular second premolar and molar (a DI value of ≥ E) for predicting a positive response to GnRHST was 8.7 (95% confidence intervals [CI], 2.9–26.1) and 5.2 (95% CI, 2.2–12.7), respectively. Dental maturity was a strong predictor for diagnosing CPP. Determining dental maturity in girls with suspected precocious puberty might help determine the performance of GnRHSTs.

Evaluation of characteristics of the craniofacial complex and dental maturity in girls with central precocious puberty

“…Previous studies have reported an association between dental maturity and chronological and bone age. 14,15 The findings of this study showed that a higher tooth formation stage, regardless of the tooth type, was strongly associated with higher chronological and bone age. In this study, the vertical growth of the craniofacial complex, such as lower and total anterior facial heights, was proportional to chronological age, but anteroposterior mandibular growth, ie, total mandibular length and dental maturity of all mandibular teeth, was positively related to the presence or absence of CPP and bone age.…”

Development of Prediction Models Using Machine Learning Algorithms for Girls with Suspected Central Precocious Puberty: Retrospective Study

“…Suh et al [10] found that accelerated growth rate, advanced bone age, and increased basal gonadotropin and insulin-like growth factor-I (IGF-I) levels were correlated with CPP. Traditional statistical analysis including t test and binary logistic regression were used to select factors correlated with the GnRH test [11-14]. Although remarkable progress has been made in these studies, there is a long way to go for their application in clinics due to the low sensitivity or specificity of tests.…”

Evaluation of cephalometric characteristics and skeletal maturation of the cervical vertebrae and hand-wrist in girls with central precocious puberty

“…In a previous study, dental maturation was investigated as a predictive indicator of CPP. 17 However, in another study, girls with CPP showed faster dental maturation, an overgrown maxilla, a horizontal mandibular growth pattern, and vertical excess in the face. 7 In this study, although the differences between the two groups were subtle and clinically insignificant, we demonstrated that girls with CPP exhibited greater posterior facial height and smaller mandibular plane angle than the control group, in linear and angular measurements derived from lateral cephalograms.…”