Dental maturity vs. skeletal maturity: a cross-sectional comparison of mandibular canine development, CVMI, and salivary ALP activity in 8-15-year-old children.

Radiographic assessments of pubertal growth (e.g., hand-wrist films, CVMI) are subjective and involve ionizing radiation. Total salivary alkaline phosphatase (ALP) offers a non-invasive alternative. To compare mandibular canine development with skeletal maturity indicators-CVMI and salivary ALP, cross-sectional study of 210 participants (8-15 years) was performed. Unstimulated saliva was analyzed for total ALP via kinetic spectrophotometry. CVMI (I-VI) and Demirjian Index (DI; F-H) were scored from routine radiographs under blinded consensus. Group differences used ANOVA with effect sizes, and associations used Fisher's exact with effect size. Mean age was 12.4 years (SD 1.68). ALP differed across CVMI stages (F(5,204) = 22.7, p < 0.001; η2 = 0.36, large), peaking at CVMI II (23.67 ± 6.92 U/L) and declining thereafter; key standardized contrasts were large (e.g., III > VI g = 4.58, II > VI g = 3.64; Tukey-adjusted p < 0.001). ALP did not vary across DI (F(2,207) = 0.59, p = 0.554; η2 = 0.006, trivial). CVMI-DI association was small (Fisher p = 0.179; Cramér's V = 0.06). Total salivary ALP aligns strongly with skeletal maturation and may serve as a practical adjunct for growth assessment, whereas single-tooth DI shows limited concordance with skeletal stage or ALP.