Sensitivity and Specificity of Mandibular Third Molar Calcification at Chronological Age and Hand Wrist Maturation Stage to Discriminate Between Female and Male at Pubertal Growth Period

Abstract

Background: The mandibular third molar is the last tooth that is not completely developed by the time pubertal growth has been finished. Maturation of the mandibular third molar is one of the physiological maturation indicators that can be used to determine the stage of pubertal growth. Objective: The aim of the study was to determine the sensitivity and specificity of mandibular third molar calcification at chronological age and hand wrist maturation stage to discriminate between female and male at pubertal growth period. Methods: It is a retrospective study with a cross-sectional approach using panoramic and hand-wrist digital radiographs of 279 females and 144 males, age 8-17 years, with a total of 423 panoramic radiographs and 423 hand-wrist radiographs. Statistical analysis was performed using Excel Mega Stat. ANOVA to analyze the differences between mandibular third molar calcification at chronological age and hand-wrist maturation stage, and t-test was used to analyze the differences between females and males. Spearman rank correlation was used for the analysis of the correlation between mandibular third molar calcification with chronological age and hand-wrist maturation stage; sensitivity and specificity were used to discriminate the pubertal growth period between mandibular third molar calcification and hand-wrist maturation stage. Results: There were significant differences found in mandibular third molar crown maturation stage B and C, but no significant difference was observed between mandibular third molar stage A, D, E, F, G and H, between females and males. The highest percentage of mandibular third molar crown formation in females was observed at stage D (6.68%) at MP3u, and in males, it was observed at stage D (8.83%) at SMI-4. The highest percentage of root formation in females was stage E (8.24%) at the SMI-10 stage, and males stage F (4.86%) at MP3u. The correlation was observed between mandibular third molar calcification with hand-wrist, females 0.22 and males 0.43, and chronological age 0.60 for females and 0.69 for males. The highest sensitivity of mandibular third molar calcification of 97.0% was observed in female at SMI-4 of hand-wrist maturation with specificity of 100%, while in male, a sensitivity of 94.5% was observed at SMI-2 stage with a specificity of 99.99%. Conclusion: There were significant differences found in mandibular third molar calcification between females and males except for stage B and stage C; weak correlation was observed between mandibular third molar calcification and hand-wrist, and moderate correlation was observed with chronological age. The sensitivity and specificity in females and males indicate that mandibular third molar calcification is only useful for diagnosing the pre-pubertal growth phase.