Determination of Pubertal Growth Plot Using Hand-wrist and Cervical Vertebrae Maturation Indices, Dental Calcification, Peak Height Velocity, and Menarche

Endah Mardiati1, *, Ira Komara2, Himawan Halim3, Ani Melani Maskoen4
1 Department of Orthodontics, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
2 Department of Periodontics, Faculty of Dentistry, Universitas Padjadjara, Bandung, Indonesia
3 Department of Orthodontics, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
4 Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Indonesia

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© 2021 Mardiati et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Orthodontics, Faculty of Dentistry, Universitas Padjadjaran, Indonesia; Tel: +62-222504985; E-mail:



Pubertal growth stages are important periods in orthodontic treatment with functional appliances and orthognathic surgery. Pubertal growth prediction, which determines the amount of growth that has taken place and estimates the remaining growth, can influence diagnosis, treatment goals, treatment plans, and orthodontic treatment outcomes, especially in cases requiring growth intensity or growth completion. Determination of pubertal growth stages is more accurate when performed using physiological maturation indicators than chronological age. There are several maturation indices that can be used to predict the pubertal growth stage, such as hand-wrist maturation, cervical vertebrae maturation index (CVMS), dental calcification, peak height velocity of body height (PHV), and menarche in females. The aim of this study was to identify the differences and correlation between hand-wrist, CVMS maturation stages, peak height velocity (PHV), canine and M2 calcification stages, and menarche age (of female subjects). The study also aimed to describe the pubertal growth curve plot of female and male subjects.

Materials and Methods:

This is a retrospective study with a cross-sectional approach, which included 279 females and 144 males aged 8-17 years. Subjects had digital lateral cephalograms, hand-wrist, and panoramic radiographs. The hand-wrist maturation stage was analyzed using the Fishman method, CVMS using Baccetti et al.’s method, and the stages of dental maturation were assessed using Demirjian and Goldstein method. PHV was measured from standing height using a wall-mounted plastic stadiometer, while menarche was analyzed through interviews. Statistical analysis by ANOVA, post hoc analysis, and Spearman’s rank correlation coefficient were determined with Excel Mega Stat.


There were significant differences between females and males in CVMS and hand-wrist (P< 0.05) except for radius union (Ru). No significant differences in canine and M2 calcification between females and males were observed. PHV females increased by 7.89 cm at 11-12 years, while males increased by 9.9 cm at 13-14 years. Menarche occurred at the age of 12.2 years on average, with the oldest being 14.7 years and the youngest being 9.6 years. The correlation between females’ and males’ hand-wrist and CVMS was very high. The lowest correlation in females was between menarche and CVMS and in males, it was between PHV and canine.


Maturation stages of hand-wrist, CVMS, and PHV females were earlier than males. Pubertal growth curves plot of females tended to skew to the left, demonstrating that the time from the beginning to the peak of pubertal growth is shorter than that from the peak to the end of pubertal growth, while pubertal growth curves plot of males tended to skew to the right, demonstrating that the time from the beginning to the peak of pubertal growth is longer than that from the peak to the end of pubertal growth.

Keywords: CVMS, Dental calcification, Hand-wrist, Menarche, PHV, Pubertal growth plot.