Abstract
INTRODUCTION: Evaluating skeletal maturity is essential for determining the appropriate timing of orthopedic and orthodontic therapies. Noninvasive approaches to skeletal maturity assessment are increasingly being researched for their clinical applicability. MATERIALS AND METHODS: This study included 110 participants (53 males, 57 females) aged 7-23 years. Lateral cephalograms classified subjects into five cervical vertebral maturation stages (CVMS) with 22 participants in each group. Salivary alkaline phosphatase (ALP) activity and total protein concentration were measured. Pearson correlation determined the relationship between chronological age and CVMS, while ANOVA compared ALP activity and protein concentrations across groups. Multinomial regression analyzed the predictive ability of ALP activity, protein concentration, and chronological age for CVMS. RESULTS: Salivary ALP activity differed significantly across CVMS groups (P = 0.001), with the highest levels in CVMS I and significantly higher values in males than females (P = 0.027). Total protein concentration also showed a highly significant difference across CVMS groups (P = 0.001), with the highest concentration in CVMS III. Combined protein concentration and chronological age were the most accurate predictors of CVMS (99.1%), followed by ALP activity and age (96.4%). Chronological age alone had 84.5% predictive accuracy, while ALP activity alone was the least predictive (67.3%). CONCLUSIONS: Chronological age combined with salivary biomarkers, such as ALP activity and protein concentration, enhances the noninvasive evaluation of skeletal maturity.