Evaluation of cortical bone density at the infrazygomatic crest area in adolescents via CBCT and its correlation with cervical vertebral maturation

Evaluation of cortical bone density at the infrazygomatic crest area in adolescents via CBCT and its correlation with cervical vertebral maturation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of cortical bone density at the infrazygomatic crest area in adolescents via CBCT and its correlation with cervical vertebral maturation Yuanhao Peng, Ting Yu, Yixin Zhang, Huiyue Wang, Dongmei Lv, Xin Xiong, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7485548/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background In orthodontic treatment, microimplants provide critical anchorage, with cortical bone density being vital for implant stability. The infrazygomatic crest is a common implantation site, but adolescents exhibit significant variability in bone density due to individual growth differences. Cervical vertebral maturation (CVM) is a reliable indicator of skeletal growth, yet its correlation with infrazygomatic crest cortical bone density remains underexplored. This study aimed to evaluate cortical bone density at the infrazygomatic crest area in adolescents and assess its correlation with CVM to guide clinical microimplants placement. Methods Cone beam computed tomography data from 80 adolescents (20 per CVM stage Cvs3 to Cvs6) were analyzed. Images were reconstructed to establish the maxillary occlusal plane as horizontal and the mesiobuccal root apex of the left maxillary first molar as baseline. Cortical bone density was measured on the buccal cortex at heights of 13 mm, 15 mm, and 17 mm above baseline, across six mesiodistal layers from the second premolar to second molar region. Results Cortical bone density ranged from 656 ± 136 Hounsfield Units (HU) to 1244 ± 134 HU. Significant increases in cortical bone density occurred between Cvs4 and Cvs5 stages (from 656–1000 HU to 796–1172 HU; p < 0.01). Cortical bone density generally decreased distally and increased apically across most sites and stages. Spearman's rank correlation analysis revealed strong positive correlations between cortical bone density at all 18 measurement sites and CVM (correlation coefficients r = 0.555–0.731; p < 0.001). Conclusions Cortical bone density at the adolescent infrazygomatic crest significantly increases with advancing CVM, with a pronounced rise between Cvs4 and Cvs5 stages. Regarding cortical bone density, all layers of the infrazygomatic crest area in adolescents at the Cvs3 to Cvs6 stages are suitable for microimplants insertion. For adolescents at Cvs3 and Cvs4 stages, selecting anterior layers is recommended to access higher cortical bone density values. CBCT Cervical vertebral maturation Infrazygomatic crest Cortical bone density Microimplants Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Orthodontic treatment relies heavily on controlled anchorage for successful outcomes. Microimplants have become indispensable tools due to their excellent anchorage control, biocompatibility, and minimally invasive nature. 1 The infrazygomatic crest (IZC), formed by the downward extension of the zygomatic process intoalveolar bone of the molars, provides substantial bone mass and is a preferred site for microimplants placement. 2 , 3 Microimplants at this area enable various biomechanics including anterior tooth retraction, total arch distalization, and posterior tooth intrusion. 4 – 6 However, achieving optimal primary stability at the IZC area in adolescents remains challenging. Cortical bone density, a key determinant of microimplant success, 7 – 10 exhibits significant inter-individual variability in this population due to heterogeneous skeletal maturation. Although clinical guidelines recommend microimplants placement between the maxillary second premolar and first molar in adolescents, 11 the IZC is anatomically defined as a mesiodistally oriented bony structure that inherently offers multiple clinically viable implantation sites beyond these conventional boundaries. Moreover, clinical scenarios frequently involve microimplants failures—such as inadequate biomechanical effects or loosening—that necessitate reassessment and selection of alternative implantation sites. Adolescents make up the majority of orthodontic patients, and this developmental stage is an ideal time for correcting malocclusions. 12 Consequently, tinvestigating bone quality at the IZC area in this cohort carries substantial clinical and research significance. However, adolescents exhibit considerable individual variability in their growth and development, with peers of the same chronological age potentially being at different stages of maturation. 13 , 14 Skeletal maturation, a key metric for evaluating individual growth and developmental status, encompasses factors such as body height, the maturation of the hand and wrist, and cervical vertebral maturation (CVM). 13 , 15 Among these, CVM is particularly closely associated with jawbone growth and is frequently utilized in orthodontic treatment to predict craniofacial growth in adolescents. Previous studies on IZC area bone density predominantly focused on adult populations or chronological age grouping, neglecting individual skeletal maturation variability in adolescents. This study addresses the gap by correlating cortical bone density with cervical vertebral maturation, providing developmental-stage-specific guidance for microimplants placement. Therefore, the present study employs Cone Beam Computed Tomography (CBCT) to investigate the cortical bone density and its variations at the IZC area across adolescents of differing CVM. Furthermore, the study aims to explore the correlation between cortical bone density at this area and CVM, thereby providing valuable insights for the application of microimplants in adolescent patients. Materials and methods This study was conducted in accordance with the ethical guidelines of the Affiliated Stomatological Hospital of Southwest Medical University (Approval No. 20211214003). Written informed consent was obtained from all participants and their legal guardians. Based on the cervical vertebral maturation (CVM) method proposed by Franchi, 16 80 adolescent patients with CVM stages of Cvs3, Cvs4, Cvs5, and Cvs6 were selected randomly from those who visited the Orthodontic Department of the Affiliated Stomatological Hospital of Southwest Medical University between 2020 and 2021. Twenty patients were included in each group, with equal gender distribution. Adolescents with Cvs1 or Cvs2 stages were excluded due to being in the primary or mixed dentition phase, during which microimplants anchorage are rarely used in orthodontic treatment. The inclusion criteria were as follows: patients under 18 years of age, normal craniofacial development, complete permanent dentition (excluding third molars); no severe crowding in the upper posterior teeth (crowding < 5 mm); no periodontal disease or alveolar bone resorption; no history of trauma or surgery to the upper or lower jaws, cervical spine, or previous orthodontic treatment, and no history of dental trauma; no systemic diseases. Cone beam computed tomography (CBCT) data for each of the 80 subjects were obtained using a scanner (KODAK 9500, Carestream Health, USA) with 88 kVp, 10 mA, 0.2 mm voxel size, a exposure time of 10.8 seconds, and a field of view of 20.6 * 18 cm. The data were then imported into Mimics Medical 21.0 software (Materialise, Belgium) for three-dimensional reconstruction, the maxillary anatomical occlusal plane was reconstructed into the horizontal plane (Fig. 1 , A), and the sagittal plane was reconstructed parallel to the left posterior dental arch (Fig. 1 , B). Finally, cortical bone density on the buccal side of the IZC area was measured in the coronal plane (Fig. 1 , C). The measurement range encompassed six layers from the distal of the left maxillary second premolar to the mesiobuccal region of the second molar. The base line was set at the level of the mesiobuccal apex of the left maxillary first molar (Fig. 2 ). Cortical bone density was measured at 13 mm, 15 mm, and 17 mm above the base line on each of the six layers, resulting in a total of 18 measurement sites. These sites were labeled as 1,13; 1,15; 1,17; ...; 6,13; 6,15; and 6,17. The measurement area was consistently 0.3 mm 2 , equidistant from the edges of the inner and outer cortical bones, and the average bone density within this area was taken as the measurement value (Fig. 3 ). Due to the fact that the majority of patients in the Cvs3 group and four patients in the Cvs4 group had an unerupted or partially erupted left maxillary second molar, only the first to four layers were measured for all patients in the Cvs3 group and the four specific patients in the Cvs4 group. To ensure intra-examiner reproducibility, the same researcher conducted measurements on all target subjects. Two weeks after the initial measurements, 20 samples were randomly selected for reassessment. The same researcher performed repeated measurements on these samples, with consistency evaluated using the Intraclass Correlation Coefficient (ICC). Results demonstrated excellent measurement reliability (ICC > 0.90). Statistical analysis Data were presented as mean and standard deviation. Normality of the measurements was assessed using the Shapiro - Wilk test, confirming a normal distribution. Student's t-test revealed no statistically significant differences in cortical bone density at the IZC area between male and female adolescents, prompting the combination of data from both genders for subsequent analyses. To evaluate variability, one-way analysis of variance (ANOVA) was employed to compare cortical bone density: 1) across different layers at identical heights within the same group, 2) across different heights at identical layers within the same group, and 3) at identical measurement sites across different groups; pairwise comparisons were conducted using the LSD post-hoc test. Spearman's rank correlation analysis was applied to examine the relationship between cortical bone density and CVM. All statistical analyses were performed using IBM SPSS Statistics version 26, with a p-value less than 0.05 denoting statistical significance. Results Adolescent cortical bone density at the IZC area exhibited a quantifiable range of 656 ± 136 to 1244 ± 134 HU across Cvs3 to Cvs6 maturation stages (Table 1 ). Spatial analysis revealed distinct density gradients in both mesiodistal and vertical dimensions. At consistent measurement heights, statistically significant interlayer variations emerged in all groups ( p < 0.05), except at the 13 mm height in Cvs3 group. Density demonstrated a progressive distal reduction at equivalent heights, with peak values localized at the first layer for Cvs3 – Cvs5 groups and the third layer for Cvs6 group (Table 1 ). Vertical assessment showed increasing density from occlusal to apical regions. across all groups, with peak density values consistently localized at the 17 mm level. Statistically significant height-dependent variations were absent in both Cvs3 and Cvs4 groups at most measurement layers ( p > 0.05). Conversely, significant inter-height differences were observed at the majority of measurement layers for Cvs5 and Cvs6 groups ( p < 0.05, Table 1 ). Intergroup comparisons revealed statistically significant differences in cortical bone density across all 18 measurement sites among the four groups ( p 0.05) with exceptions at sites 4,15 and 4,17, the Cvs4 and Cvs5 groups exhibited significant differences at all 18 sites ( p < 0.01). Conversely, comparisons between Cvs5 and Cvs6 groups indicated non-significant differences at half of the measurement sites (Table 2 , Fig. 4 ). Spearman's rank correlation analysis demonstrated statistically significant positive correlations between cortical bone density and maturation advancement across all 18 measurement sites ( p < 0.001). Correlation coefficients ranged from 0.555 to 0.731, with 15 sites exhibiting values between 0.6 and 0.79, and 3 sites displaying values between 0.4 and 0.59 (Table 3 ). Table 1 Cortical bone density at the infrazygomatic crest area of Cvs3 to Cvs6 adolescents (HU) CVM stages Measure height Layer p value 1 2 3 4 5 6 Cvs3 (n = 20) 13 mm 777 ± 154 774 ± 127 757 ± 133 667 ± 137 \ \ 0.052 15 mm 844 ± 135 830 ± 159 772 ± 147 707 ± 148 \ \ 0.021 * 17 mm 930 ± 170 914 ± 134 832 ± 164 741 ± 153 \ \ < 0.001 ** p value 0.013 * 0.012 * 0.263 0.297 \ \ Cvs4 (n = 20) 13 mm 861 ± 168 837 ± 140 792 ± 146 750 ± 140 705 ± 139 656 ± 136 < 0.001 ** 15 mm 912 ± 166 890 ± 147 854 ± 159 814 ± 162 736 ± 174 691 ± 160 < 0.001 ** 17 mm 1000 ± 143 958 ± 145 899 ± 164 860 ± 179 802 ± 190 736 ± 151 < 0.001 ** p value 0.031 * 0.042 * 0.117 0.118 0.208 0.262 Cvs5 (n = 20) 13 mm 998 ± 131 993 ± 136 976 ± 127 922 ± 97 876 ± 111 796 ± 136 < 0.001 ** 15 mm 1108 ± 136 1081 ± 141 1060 ± 131 991 ± 154 937 ± 123 852 ± 141 < 0.001 ** 17 mm 1172 ± 136 1126 ± 131 1077 ± 137 1035 ± 150 994 ± 157 910 ± 133 < 0.001 ** p value 0.001 ** 0.016 * 0.061 0.084 0.049 * 0.047 * Cvs6 (n = 20) 13 mm 1096 ± 122 1085 ± 149 1061 ± 113 1016 ± 161 981 ± 146 875 ± 131 < 0.001 ** 15 mm 1165 ± 169 1154 ± 137 1124 ± 148 1095 ± 150 1034 ± 122 941 ± 138 < 0.001 ** 17 mm 1235 ± 164 1215 ± 149 1244 ± 134 1157 ± 178 1079 ± 134 998 ± 127 < 0.001 ** p value 0.025 * 0.027 * < 0.001 ** 0.034 * 0.086 0.021 * * Significant at P < 0.05; ** Significant at P < 0.01. Table 2 Comparison of cortical bone density at the infrazygomatic crest area of Cvs3 to Cvs6 adolescents sites CVM stage Cortical bone density (HU) p value LSD 1,13 Cvs3 777 ± 158 < 0.001 ** Cvs3<Cvs4, P = 0.078 Cvs4 861 ± 173 Cvs4<Cvs5, P = 0.005 ** Cvs5 998 ± 134 Cvs5<Cvs6, P = 0.042 * Cvs6 1096 ± 125 1,15 Cvs3 844 ± 139 < 0.001 ** Cvs3<Cvs4, P = 0.177 Cvs4 912 ± 170 Cvs4<Cvs5, P < 0.001 ** Cvs5 1108 ± 142 Cvs5<Cvs6, P = 0.259 Cvs6 1165 ± 173 1,17 Cvs3 930 ± 175 < 0.001 ** Cvs3<Cvs4, P = 0.164 Cvs4 1000 ± 146 Cvs4<Cvs5, P = 0.001 ** Cvs5 1172 ± 140 Cvs5<Cvs6, P = 0.208 Cvs6 1235 ± 168 2,13 Cvs3 774 ± 130 < 0.001 ** Cvs3<Cvs4, P = 0.163 Cvs4 837 ± 143 Cvs4<Cvs5, P = 0.001 ** Cvs5 993 ± 145 Cvs5<Cvs6, P = 0.046 * Cvs6 1085 ± 152 2,15 Cvs3 830 ± 164 < 0.001 ** Cvs3<Cvs4, P = 0.213 Cvs4 890 ± 151 Cvs4<Cvs5, P < 0.001 ** Cvs5 1081 ± 144 Cvs5<Cvs6, P = 0.128 Cvs6 1154 ± 141 2,17 Cvs3 914 ± 138 < 0.001 ** Cvs3<Cvs4, P = 0.345 Cvs4 958 ± 149 Cvs4<Cvs5, P < 0.001 ** Cvs5 1126 ± 142 Cvs5<Cvs6, P = 0.055 Cvs6 1215 ± 153 3,13 Cvs3 757 ± 136 < 0.001 ** Cvs3<Cvs4, P = 0.403 Cvs4 792 ± 150 Cvs4<Cvs5, P < 0.001 ** Cvs5 976 ± 135 Cvs5<Cvs6, P = 0.050 * Cvs6 1061 ± 116 3,15 Cvs3 772 ± 150 < 0.001 ** Cvs3<Cvs4, P = 0.098 Cvs4 854 ± 163 Cvs4<Cvs5, P < 0.001 ** Cvs5 1060 ± 149 Cvs5<Cvs6, P = 0.191 Cvs6 1124 ± 152 3,17 Cvs3 832 ± 168 < 0.001 ** Cvs3<Cvs4, P = 0.177 Cvs4 899 ± 168 Cvs4<Cvs5, P < 0.001 ** Cvs5 1077 ± 139 Cvs5<Cvs6, P = 0.001 ** Cvs6 1244 ± 137 4,13 Cvs3 667 ± 141 < 0.001 ** Cvs3<Cvs4, P = 0.066 Cvs4 750 ± 144 Cvs4<Cvs5, P < 0.001 ** Cvs5 922 ± 111 Cvs5<Cvs6, P = 0.040 * Cvs6 1016 ± 165 4,15 Cvs3 707 ± 152 < 0.001 ** Cvs3<Cvs4, P = 0.040 * Cvs4 814 ± 167 Cvs4<Cvs5, P = 0.001 ** Cvs5 991 ± 175 Cvs5<Cvs6, P = 0.046 * Cvs6 1095 ± 154 4,17 Cvs3 741 ± 157 < 0.001 ** Cvs3<Cvs4, P = 0.036 * Cvs4 860 ± 184 Cvs4<Cvs5, P = 0.002 ** Cvs5 1035 ± 179 Cvs5<Cvs6, P = 0.031 * Cvs6 1157 ± 182 5,13 Cvs4 705 ± 143 < 0.001 ** Cvs4<Cvs5, P < 0.001 ** Cvs5 876 ± 144 Cvs5<Cvs6, P = 0.026 * Cvs6 981 ± 149 5,15 Cvs4 736 ± 178 < 0.001 ** Cvs4<Cvs5, P < 0.001 ** Cvs5 937 ± 129 Cvs5<Cvs6, P = 0.040 * Cvs6 1034 ± 125 5,17 Cvs4 802 ± 195 < 0.001 ** Cvs4<Cvs5, P = 0.001 ** Cvs5 994 ± 168 Cvs5<Cvs6, P = 0.113 Cvs6 1079 ± 137 6,13 Cvs4 656 ± 140 < 0.001 ** Cvs4<Cvs5, P = 0.002 ** Cvs5 796 ± 141 Cvs5<Cvs6, P = 0.076 Cvs6 875 ± 134 6,15 Cvs4 691 ± 165 < 0.001 ** Cvs4<Cvs5, P = 0.001 ** Cvs5 852 ± 147 Cvs5<Cvs6, P = 0.067 Cvs6 941 ± 142 6,17 Cvs4 736 ± 155 < 0.001 ** Cvs4<Cvs5, P < 0.001 ** Cvs5 910 ± 137 Cvs5<Cvs6, P = 0.052 Cvs6 998 ± 130 * Significant at P < 0.05; ** Significant at P < 0.01. Table 3 Spearman's rank correlation analysis between cortical bone density of the infrazygomatic crest area and cervical vertebral maturation in adolescents Site Correlation Coefficient (ρ) p value 1,13 0.651 < 0.001 ** 1,15 0.663 < 0.001 ** 1,17 0.621 < 0.001 ** 2,13 0.643 < 0.001 ** 2,15 0.660 < 0.001 ** 2,17 0.625 < 0.001 ** 3,13 0.687 < 0.001 ** 3,15 0.680 < 0.001 ** 3,17 0.731 < 0.001 ** 4,13 0.698 <0.001 ** 4,15 0.694 <0.001 ** 4,17 0.698 <0.001 ** 5,13 0.664 <0.001 ** 5,15 0.688 <0.001 ** 5,17 0.581 <0.001 ** 6,13 0.555 <0.001 ** 6,15 0.598 <0.001 ** 6,17 0.620 <0.001 ** * Significant at P < 0.05; ** Significant at P < 0.01. Discussion The infrazygomatic crest (IZC) represents a key extraalveolar site for microimplants placement, where devices do not impede adjacent tooth movement, enhancing clinical utility. The primary stability of microimplants relies predominantly on mechanical retention with surrounding bone tissue rather than osseointegration. 17 Substantial evidence confirms cortical bone as the primary stress concentration zone for microimplants, providing critical mechanical retention. 18 , 19 Consequently, cortical bone thickness and density are closely associated with microimplants stability, with density being particularly pivotal for long-term success. 8 Bone mineral density quantifies skeletal mineral content and strength, yet existing IZC research emphasizes cortical thickness over density. Specifically, studies investigating cortical bone density in adolescents within this area remain limited. Furthermore, existing literature is limited by its approach to cohort construction, which typically assigns adolescents to a specific age or a wide spectrum of ages, failing to adequately account for the individual growth and developmental variability among adolescents. Factors such as ethnicity, genetic predisposition, hormonal levels, and environmental influences significantly impact the growth and development of the adolescent maxillofacial complex. 13 , 20 , 21 Notably, chronological age alone is an insufficient proxy for accurately reflecting the growth and developmental status of an individual. 22 In contrast, the cervical spine undergoes systematic and predictable morphological changes during development, with cervical vertebral maturation (CVM) being intricately linked to both systemic and craniofacial growth. This metric has proven to be a reliable and effective predictor of craniofacial growth during puberty, with its precision and reproducibility having been extensively corroborated in the scientific literature. 15 , 23 , 24 Therefore, our study utilized CVM as the criterion for grouping, and conducted a measurement and analysis of cortical bone density at the IZC area of adolescents with different CVM stages. Previous studies have consistently demonstrated no statistically significant difference in the bone quality between the left and right sides at the IZC area. 25 – 27 To minimize the complexity of the study, the focus was restricted to the left IZC area in the selected subjects. Anatomically, the IZC area is bounded superiorly by the maxillary sinus floor and medially by molar roots. To avoid root damage during microimplant placement, Liou et al. 11 recommend implantation 14–16 mm above the maxillary occlusal plane. In clinical practice, microimplants are generally placed at or above the mucogingival junction in this area. 28 , 29 The crown height of the maxillary molars is approximately 8.1 mm, 30 and the height of the attached gingiva is about 4–5 mm. 31 Du et al. validated 13 mm, 15 mm, and 17 mm heights above the maxillary occlusal plane as appropriate measurement levels for assessing cortical bone density at the IZC area. 32 Accordingly, this study adopted identical height parameters to analyze IZC cortical bone density variations. The results demonstrated that cortical bone density increased with greater vertical height, consistent with our hypothesis that bone density escalates as the measurement site moves from the alveolar crest toward the basal bone. In the mesiodistal direction, cortical bone density exhibited a gradient decrease from mesial to distal sites, a pattern aligning with the findings of Chen et al. 33 Regarding gender factors, most previous studies indicate that there are no statistically significant differences in cortical bone density at the IZC area or the buccal cortical bone of the posterior maxillary basal bone between adult males and females. 34 – 36 Notably, Avdagic et al. 37 demonstrated that males achieve peak bone density later than females, which may plausibly explain why some studies observed significantly higher cortical bone density in females at the IZC area or posterior maxillary basal regions compared to males. This difference may be related to variations in the study populations. 33 , 38 In the present study, cortical bone density showed no statistically significant sex - based differences across 18 measurement sites in adolescents. This finding may be explained by the homogeneity of skeletal maturation stages among participants, as all adolescents in each subgroup were at comparable phases of growth and development. In vitro studies have demonstrated that higher cortical bone density correlates with enhanced microimplants stability. 39 , 40 Kim et al. 7 experimentally inserted microimplants into artificial bone blocks with varying densities, observing that specimens with denser cortical bone exhibited greater maximum insertion torque, higher maximum removal torque, greater horizontal resistance, and reduced micromotion. Conversely, clinical evidence suggests that excessively high bone density may compromise clinical outcomes. Elevated bone density increases insertion torque and generates excessive stress during placement. Motoyoshi et al. 41 analyzed 87 microimplants placed in the posterior dentition, revealing significantly higher success rates for devices with insertion torques of 8–10 N·cm compared to those below 8 N·cm or exceeding 10 N·cm. Similarly, Suzuki et al. 42 reported optimal stability when insertion torque was maintained within 5–10 N·cm, with failure rates escalating beyond this range. Notably, Deguchi et al. 43 demonstrated through animal experiments that microimplants placed into the denser mandibular bone exhibited less cortical bone formation around the screw head during healing compared to those in the maxilla. These findings may be attributed to biomechanical overload. Excessive bone density can induce microdamage to surrounding bone tissue during implantation due to elevated stress concentrations and frictional heat generation. Such mechanical and thermal insults may lead to localized ischemia, delayed healing, and ultimately compromised stability. 44 Preoperative evaluation of cortical bone density in the target implantation area is therefore critical. Misch et al. 45 established a classification system for bone density based on CT Hounsfield units (HU), defining five categories: D1 (> 1250 HU), D2 (850–1250 HU), D3 (350–850 HU), D4 (150–350 HU), and D5 (< 150 HU). Chugh et al. 46 proposed that D1 - D3 bone types are suitable for microimplants placement, whereas D4 bone is contraindicated due to unacceptably high failure rates exceeding 35%. In contrast, Truhlar et al. 47 reported higher success rates for implants placed in D2 or D3 bone compared to D1 bone. This paradox may stem from the biomechanical limitations of D1 bone: despite its high density, the absence of trabecular bone and limited vascular supply (primarily dependent on periosteal nutrition) impairs post-drilling bone remodeling. Conversely, D2 and D3 bone provide optimal vascularity and moderate density, facilitating early-stage osseous healing to sustain implant stability. 45 Park et al. 48 quantified buccal cortical bone density in the posterior maxilla and IZC areas as 810–940 HU and 1100 HU, respectively. These measurements correspond to D2 and D3 classifications, further validating these sites as favorable zones for microimplants placement. The measurement results of this study demonstrated cortical bone density at the IZC area of Cvs3 - Cvs6 adolescents ranged from 656 to 1244 HU (Table 1 ), classified as D2/D3 bone. Specifically, in the Cvs5 and Cvs6 adolescents, all measurement sites (except for site 6,13 in Cvs5) exhibited cortical bone density > 850 HU, corresponding to D2 bone. In contrast, in the Cvs3 and Cvs4 adolescents, except for a few sites in the anterior layers, most sites demonstrated cortical bone density < 850 HU, corresponding to D3 bone. These data confirm that cortical bone density across all infrazygomatic crest layers in Cvs3 - Cvs6 adolescents is clinically suitable for microimplants placement. However, for Cvs3 and Cvs4 patients, prioritization of anterior implantation sites is recommended to leverage the biomechanical advantage of higher cortical bone density. Approximately 80% of peak bone mass accrues by age 20 37 , with 25% accumulating during the peri-pubertal growth spurt. 49 Craniofacial development and jawbone density progression tightly couples with systemic growth. 38 , 50 , 51 Our Spearman's rank correlation analysis corroborates this, revealing significant positive correlations between IZC cortical bone density and CVM at all 18 sites (p < 0.001, Table 3 ). Fifteen sites (83%) showed strong correlations (r = 0.6–0.79), and three sites (17%) moderate correlations (r = 0.4–0.59). Crucially, pairwise comparisons indicated pronounced density increases between Cvs4 - Cvs5 (p 0.05 at most sites, Fig. 4 ). We hypothesize this Cvs4 - Cvs5 acceleration relates to complete second molar eruption, introducing sustained occlusal loading. Per Moss’ functional matrix hypothesis, 52 skeletal adaptation responds secondarily to biomechanical stimuli; increased masticatory forces likely induce localized IZC cortical remodeling, elevating density and thickness. Conclusion Cortical bone density at all measurement sites positively correlates with cervical vertebral maturation, confirming that Cortical bone density progressively increases throughout adolescence alongside skeletal maturation. A significant increase in cortical bone density at the IZC area occurs during the Cvs4 – Cvs5 transition, whereas comparatively smaller increases characterize the Cvs3 – Cvs4 and Cvs5 – Cvs6 periods. Regarding cortical bone density, all measurement layers at the IZC area in Cvs3 – Cvs6 adolescents are suitable for microimplants placement. For adolescents at Cvs3 and Cvs4 stages, anterior layers should be prioritized to access higher cortical bone density . Declarations Ethics approval and consent to participate All procedures were performed in accordance with the Declaration of Helsinki and the protocol was approved by the Ethics Committee of the Affiliated Stomatological Hospital of Southwest Medical University (Approval No. 20211214003). Informed consent was obtained from all subjects and/or their legal guardian. Clinical trial number Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests Funding This work was supported by the Luzhou Science and Technology Program (No. 2023JYJ055) and the Youth Innovation Program of Sichuan Medical Association (No. Q2024075). Author Contribution YHP and TY (co-first authors): devised the study concept, involved in study planning, contributed in analysis, revised the draft critically and wrote the main manuscript text. YXZ and HYW: contributed in data gathering and preparimg Tables 1-3. DML: prepared Figures 1-4. XX and QC: supervised the writing of the article, reviewed the manuscript, and provided critical revisions. All authors reviewed and approved the final version of the manuscript. Acknowledgements Not applicable. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Umalkar SS, Jadhav VV, Paul P, Reche A. Mod Anchorage Syst Orthod Cureus. 2022;14(11):e31476. Chugh T, Ganeshkar SV, Revankar AV, Jain AK. Quantitative assessment of interradicular bone density in the maxilla and mandible: implications in clinical orthodontics. Prog Orthod. 2013;14(1):38. Farnsworth D, Rossouw PE, Ceen RF, Buschang PH. Cortical bone thickness at common miniscrew implant placement sites. Am J Orthod Dentofac Orthop. 2011;139(4):495–503. 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Bone thickness of the infrazygomatic crest area in skeletal Class III growing patients: A computed tomographic study. Imaging Sci Dent. 2013;43(4):261–6. Liu H, Wu X, Yang L, Ding Y. Safe zones for miniscrews in maxillary dentition distalization assessed with cone-beam computed tomography. Am J Orthod Dentofac Orthop. 2017;151(3):500–6. El-Dawlatly MM, Abou-El-Ezz AM, El-Sharaby FA, Mostafa YA. Zygomatic mini-implant for Class II correction in growing patients. J Orofac Orthop. 2014;75(3):213–25. Hikita Y, Yamaguchi T, Tomita D, Adel M, Nakawaki T, Katayama K, Maki K, Kimura R. Growth hormone receptor gene is related to root length and tooth length in human teeth. Angle Orthod. 2018;88(5):575–81. Ono A, Motoyoshi M, Shimizu N. Cortical bone thickness in the buccal posterior region for orthodontic mini-implants. Int J Oral Maxillofac Surg. 2008;37(4):334–40. Du B, Zhu J, Li L, Fan T, Tan J, Li J. Bone depth and thickness of different infrazygomatic crest miniscrew insertion paths between the first and second maxillary molars for distal tooth movement: A 3-dimensional assessment. Am J Orthod Dentofac Orthop. 2021;160(1):113–23. Chen X, Jiang X, Chen S. Site selection of micro-implant anchorages in the infrazygomatic crest in adult orthodontic patients. Hua Xi Kou Qiang Yi Xue Za Zhi. 2024;42(2):207–13. English, Chinese. Wang YQ, Chi JW, Liu YF, Feng F, Wu H, Liu W. Analysis of cortical density in zygomatic alveolar ridge of different vertical facial types. Shanghai Kou Qiang Yi Xue. 2019;28(6):652–6. Chinese. Arvind Tr P, Jain RK. Computed tomography assessment of maxillary bone density for orthodontic mini-implant placement with respect to vertical growth patterns. J Orthod. 2021;48(4):392–402. Hasani M, Afzoon S, Karandish M, Parastar M. Three-dimensional evaluation of the cortical and cancellous bone density and thickness for miniscrew insertion: a CBCT study of interradicular area of adults with different facial growth pattern. BMC Oral Health. 2023;23(1):753. Avdagić SC, Barić IC, Keser I, Cecić I, Satalić Z, Bobić J, Gomzi M. Differences in peak bone density between male and female students. Arh Hig Rada Toksikol. 2009;60(1):79–86. Ohiomoba H, Sonis A, Yansane A, Friedland B. Quantitative evaluation of maxillary alveolar cortical bone thickness and density using computed tomography imaging. Am J Orthod Dentofac Orthop. 2017;151(1):82–91. Migliorati M, Benedicenti S, Signori A, Drago S, Barberis F, Tournier H, Silvestrini-Biavati A. Miniscrew design and bone characteristics: an experimental study of primary stability. Am J Orthod Dentofac Orthop. 2012;142(2):228–34. Bourassa C, Hosein YK, Pollmann SI, Galil K, Bohay RN, Holdsworth DW, Tassi A. In-vitro comparison of different palatal sites for orthodontic miniscrew insertion: Effect of bone quality and quantity on primary stability. Am J Orthod Dentofac Orthop. 2018;154(6):809–19. Motoyoshi M, Yoshida T, Ono A, Shimizu N. Effect of cortical bone thickness and implant placement torque on stability of orthodontic mini-implants. Int J Oral Maxillofac Implants. 2007 Sep-Oct;22(5):779–84. Suzuki M, Deguchi T, Watanabe H, Seiryu M, Iikubo M, Sasano T, Fujiyama K, Takano-Yamamoto T. Evaluation of optimal length and insertion torque for miniscrews. Am J Orthod Dentofac Orthop. 2013;144(2):251–9. Deguchi T, Yabuuchi T, Hasegawa M, Garetto LP, Roberts WE, Takano-Yamamoto T. Histomorphometric evaluation of cortical bone thickness surrounding miniscrew for orthodontic anchorage. Clin Implant Dent Relat Res. 2011;13(3):197–205. Chang HP, Tseng YC. Miniscrew implant applications in contemporary orthodontics. Kaohsiung J Med Sci. 2014;30(3):111–5. Misch CE. Density of bone: effect on treatment plans, surgical approach, healing, and progressive boen loading. Int J Oral Implantol. 1990;6(2):23–31. Chugh T, Jain AK, Jaiswal RK, Mehrotra P, Mehrotra R. Bone density and its importance in orthodontics. J Oral Biol Craniofac Res. 2013 May-Aug;3(2):92–7. Truhlar RS, Morris HF, Ochi S, Winkler S. Second-stage failures related to bone quality in patients receiving endosseous dental implants: DICRG Interim Report No. 7. Dental Implant Clinical Research Group. Implant Dent. 1994 Winter;3(4):252-5. Park HS, Lee YJ, Jeong SH, Kwon TG. Density of the alveolar and basal bones of the maxilla and the mandible. Am J Orthod Dentofac Orthop. 2008;133(1):30–7. Golden NH, Abrams SA. Committee on Nutrition. Optimizing bone health in children and adolescents. Pediatrics. 2014;134(4):e1229–43. Chen L, Lin J, Xu T, Long X. The longitudinal sagittal growth changes of maxilla and mandible according to quantitative cervical vertebral maturation. J Huazhong Univ Sci Technolog Med Sci. 2009;29(2):251–6. Cassetta M, Sofan AA, Altieri F, Barbato E. Evaluation of alveolar cortical bone thickness and density for orthodontic mini-implant placement. J Clin Exp Dent. 2013;5(5):e245–52. Moss ML. The functional matrix hypothesis revisited. 1. The role of mechanotransduction. Am J Orthod Dentofac Orthop. 1997;112(1):8–11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Dec, 2025 Reviews received at journal 05 Dec, 2025 Reviewers agreed at journal 30 Nov, 2025 Reviewers agreed at journal 29 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviews received at journal 24 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers invited by journal 17 Sep, 2025 Editor invited by journal 04 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Submission checks completed at journal 03 Sep, 2025 First submitted to journal 29 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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07:10:58","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164838,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7485548/v1/9da13b294f7dc1257799e6b0.html"},{"id":92474303,"identity":"69dd48a6-7705-4702-8faa-451494e4d506","added_by":"auto","created_at":"2025-09-30 07:11:03","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":277243,"visible":true,"origin":"","legend":"\u003cp\u003eThree-dimensional reconstruction of maxillary left infrazygomatic crest area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e: Horizontal plane;\u003cstrong\u003e B\u003c/strong\u003e: Sagittal plane; \u003cstrong\u003eC\u003c/strong\u003e: Coronal plane.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7485548/v1/d08728fcde02e8fb0692e6cf.jpeg"},{"id":92475963,"identity":"384ff462-6393-46fe-b6b0-428413799f89","added_by":"auto","created_at":"2025-09-30 07:18:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":107115,"visible":true,"origin":"","legend":"\u003cp\u003eSix measurement layers at the infrazygomatic crest area.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7485548/v1/65bfa9c4696fe97bba254c65.png"},{"id":92474302,"identity":"6f4caf38-8e2e-4f86-95e8-ca7ce9e56885","added_by":"auto","created_at":"2025-09-30 07:11:01","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":258148,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurements of cortical bone density at the infrazygomatic crest area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e: Cortical bone density at 13 mm above the base line; \u003cstrong\u003eB\u003c/strong\u003e: Cortical bone density at 15 mm above the base line; \u003cstrong\u003eC\u003c/strong\u003e: Cortical bone density at 17 mm above the base line.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7485548/v1/1825ee67135c49c951dc58e8.jpeg"},{"id":92474293,"identity":"cda4e78d-147b-48ad-9cfe-463da7d6f0a0","added_by":"auto","created_at":"2025-09-30 07:10:58","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":341613,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of cortical bone density at the infrazygomatic crest area of Cvs3 to Cvs6 adolescents. \u003cstrong\u003eA\u003c/strong\u003e: cortical bone density of 13 mm\u0026nbsp;above\u0026nbsp;the baseline; \u003cstrong\u003eB\u003c/strong\u003e: cortical bone density of 15\u0026nbsp;mm\u0026nbsp;above\u0026nbsp;the baseline; \u003cstrong\u003eC\u003c/strong\u003e: cortical bone density of 17\u0026nbsp;mm\u0026nbsp;above\u0026nbsp;the baseline.\u0026nbsp;\u003csup\u003e*\u003c/sup\u003eSignificant at \u003cem\u003eP \u003c/em\u003e\u0026lt; 0.05; \u003csup\u003e**\u003c/sup\u003eSignificant at \u003cem\u003eP \u003c/em\u003e\u0026lt; 0.01.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7485548/v1/d24a27e827042e86a665c726.jpeg"},{"id":92475966,"identity":"ee82b5ad-bc05-4b4c-8593-a0c7c5a1d7fd","added_by":"auto","created_at":"2025-09-30 07:19:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1874276,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7485548/v1/ffdd6582-ea0b-4551-be61-7aeefca12ea5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of cortical bone density at the infrazygomatic crest area in adolescents via CBCT and its correlation with cervical vertebral maturation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOrthodontic treatment relies heavily on controlled anchorage for successful outcomes. Microimplants have become indispensable tools due to their excellent anchorage control, biocompatibility, and minimally invasive nature.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe infrazygomatic crest (IZC), formed by the downward extension of the zygomatic process intoalveolar bone of the molars, provides substantial bone mass and is a preferred site for microimplants placement.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Microimplants at this area enable various biomechanics including anterior tooth retraction, total arch distalization, and posterior tooth intrusion.\u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHowever, achieving optimal primary stability at the IZC area in adolescents remains challenging. Cortical bone density, a key determinant of microimplant success,\u003csup\u003e\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e exhibits significant inter-individual variability in this population due to heterogeneous skeletal maturation. Although clinical guidelines recommend microimplants placement between the maxillary second premolar and first molar in adolescents,\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e the IZC is anatomically defined as a mesiodistally oriented bony structure that inherently offers multiple clinically viable implantation sites beyond these conventional boundaries. Moreover, clinical scenarios frequently involve microimplants failures\u0026mdash;such as inadequate biomechanical effects or loosening\u0026mdash;that necessitate reassessment and selection of alternative implantation sites.\u003c/p\u003e\u003cp\u003eAdolescents make up the majority of orthodontic patients, and this developmental stage is an ideal time for correcting malocclusions.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Consequently, tinvestigating bone quality at the IZC area in this cohort carries substantial clinical and research significance. However, adolescents exhibit considerable individual variability in their growth and development, with peers of the same chronological age potentially being at different stages of maturation.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Skeletal maturation, a key metric for evaluating individual growth and developmental status, encompasses factors such as body height, the maturation of the hand and wrist, and cervical vertebral maturation (CVM).\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Among these, CVM is particularly closely associated with jawbone growth and is frequently utilized in orthodontic treatment to predict craniofacial growth in adolescents. Previous studies on IZC area bone density predominantly focused on adult populations or chronological age grouping, neglecting individual skeletal maturation variability in adolescents. This study addresses the gap by correlating cortical bone density with cervical vertebral maturation, providing developmental-stage-specific guidance for microimplants placement. Therefore, the present study employs Cone Beam Computed Tomography (CBCT) to investigate the cortical bone density and its variations at the IZC area across adolescents of differing CVM. Furthermore, the study aims to explore the correlation between cortical bone density at this area and CVM, thereby providing valuable insights for the application of microimplants in adolescent patients.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e This study was conducted in accordance with the ethical guidelines of the Affiliated Stomatological Hospital of Southwest Medical University (Approval No. 20211214003). Written informed consent was obtained from all participants and their legal guardians. Based on the cervical vertebral maturation (CVM) method proposed by Franchi,\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e 80 adolescent patients with CVM stages of Cvs3, Cvs4, Cvs5, and Cvs6 were selected randomly from those who visited the Orthodontic Department of the Affiliated Stomatological Hospital of Southwest Medical University between 2020 and 2021. Twenty patients were included in each group, with equal gender distribution. Adolescents with Cvs1 or Cvs2 stages were excluded due to being in the primary or mixed dentition phase, during which microimplants anchorage are rarely used in orthodontic treatment. The inclusion criteria were as follows: patients under 18 years of age, normal craniofacial development, complete permanent dentition (excluding third molars); no severe crowding in the upper posterior teeth (crowding\u0026thinsp;\u0026lt;\u0026thinsp;5 mm); no periodontal disease or alveolar bone resorption; no history of trauma or surgery to the upper or lower jaws, cervical spine, or previous orthodontic treatment, and no history of dental trauma; no systemic diseases.\u003c/p\u003e\u003cp\u003eCone beam computed tomography (CBCT) data for each of the 80 subjects were obtained using a scanner (KODAK 9500, Carestream Health, USA) with 88 kVp, 10 mA, 0.2 mm voxel size, a exposure time of 10.8 seconds, and a field of view of 20.6 * 18 cm. The data were then imported into Mimics Medical 21.0 software (Materialise, Belgium) for three-dimensional reconstruction, the maxillary anatomical occlusal plane was reconstructed into the horizontal plane (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, A), and the sagittal plane was reconstructed parallel to the left posterior dental arch (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, B). Finally, cortical bone density on the buccal side of the IZC area was measured in the coronal plane (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, C).\u003c/p\u003e\u003cp\u003eThe measurement range encompassed six layers from the distal of the left maxillary second premolar to the mesiobuccal region of the second molar. The base line was set at the level of the mesiobuccal apex of the left maxillary first molar (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCortical bone density was measured at 13 mm, 15 mm, and 17 mm above the base line on each of the six layers, resulting in a total of 18 measurement sites. These sites were labeled as 1,13; 1,15; 1,17; ...; 6,13; 6,15; and 6,17. The measurement area was consistently 0.3 mm\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, equidistant from the edges of the inner and outer cortical bones, and the average bone density within this area was taken as the measurement value (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Due to the fact that the majority of patients in the Cvs3 group and four patients in the Cvs4 group had an unerupted or partially erupted left maxillary second molar, only the first to four layers were measured for all patients in the Cvs3 group and the four specific patients in the Cvs4 group. To ensure intra-examiner reproducibility, the same researcher conducted measurements on all target subjects. Two weeks after the initial measurements, 20 samples were randomly selected for reassessment. The same researcher performed repeated measurements on these samples, with consistency evaluated using the Intraclass Correlation Coefficient (ICC). Results demonstrated excellent measurement reliability (ICC\u0026thinsp;\u0026gt;\u0026thinsp;0.90).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData were presented as mean and standard deviation. Normality of the measurements was assessed using the Shapiro\u003cb\u003e-\u003c/b\u003eWilk test, confirming a normal distribution. Student's t-test revealed no statistically significant differences in cortical bone density at the IZC area between male and female adolescents, prompting the combination of data from both genders for subsequent analyses. To evaluate variability, one-way analysis of variance (ANOVA) was employed to compare cortical bone density: 1) across different layers at identical heights within the same group, 2) across different heights at identical layers within the same group, and 3) at identical measurement sites across different groups; pairwise comparisons were conducted using the LSD post-hoc test. Spearman's rank correlation analysis was applied to examine the relationship between cortical bone density and CVM. All statistical analyses were performed using IBM SPSS Statistics version 26, with a p-value less than 0.05 denoting statistical significance.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAdolescent cortical bone density at the IZC area exhibited a quantifiable range of 656\u0026thinsp;\u0026plusmn;\u0026thinsp;136 to 1244\u0026thinsp;\u0026plusmn;\u0026thinsp;134 HU across Cvs3 to Cvs6 maturation stages (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Spatial analysis revealed distinct density gradients in both mesiodistal and vertical dimensions. At consistent measurement heights, statistically significant interlayer variations emerged in all groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), except at the 13 mm height in Cvs3 group. Density demonstrated a progressive distal reduction at equivalent heights, with peak values localized at the first layer for Cvs3 \u0026ndash; Cvs5 groups and the third layer for Cvs6 group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVertical assessment showed increasing density from occlusal to apical regions. across all groups, with peak density values consistently localized at the 17 mm level. Statistically significant height-dependent variations were absent in both Cvs3 and Cvs4 groups at most measurement layers (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Conversely, significant inter-height differences were observed at the majority of measurement layers for Cvs5 and Cvs6 groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIntergroup comparisons revealed statistically significant differences in cortical bone density across all 18 measurement sites among the four groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Pairwise analysis demonstrated that while the Cvs3 and Cvs4 groups showed comparable density values at 16 measurement sites (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) with exceptions at sites 4,15 and 4,17, the Cvs4 and Cvs5 groups exhibited significant differences at all 18 sites (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Conversely, comparisons between Cvs5 and Cvs6 groups indicated non-significant differences at half of the measurement sites (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSpearman's rank correlation analysis demonstrated statistically significant positive correlations between cortical bone density and maturation advancement across all 18 measurement sites (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Correlation coefficients ranged from 0.555 to 0.731, with 15 sites exhibiting values between 0.6 and 0.79, and 3 sites displaying values between 0.4 and 0.59 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCortical bone density at the infrazygomatic crest area of Cvs3 to Cvs6 adolescents (HU)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCVM stages\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMeasure height\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e\u003cp\u003eLayer\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCvs3 (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e777\u0026thinsp;\u0026plusmn;\u0026thinsp;154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e774\u0026thinsp;\u0026plusmn;\u0026thinsp;127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e757\u0026thinsp;\u0026plusmn;\u0026thinsp;133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e667\u0026thinsp;\u0026plusmn;\u0026thinsp;137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\\\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\\\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e844\u0026thinsp;\u0026plusmn;\u0026thinsp;135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e830\u0026thinsp;\u0026plusmn;\u0026thinsp;159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e772\u0026thinsp;\u0026plusmn;\u0026thinsp;147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e707\u0026thinsp;\u0026plusmn;\u0026thinsp;148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\\\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\\\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.021\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e930\u0026thinsp;\u0026plusmn;\u0026thinsp;170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e914\u0026thinsp;\u0026plusmn;\u0026thinsp;134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e832\u0026thinsp;\u0026plusmn;\u0026thinsp;164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e741\u0026thinsp;\u0026plusmn;\u0026thinsp;153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\\\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\\\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.013\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.012\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\\\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\\\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCvs4 (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e861\u0026thinsp;\u0026plusmn;\u0026thinsp;168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e837\u0026thinsp;\u0026plusmn;\u0026thinsp;140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e792\u0026thinsp;\u0026plusmn;\u0026thinsp;146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e750\u0026thinsp;\u0026plusmn;\u0026thinsp;140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e705\u0026thinsp;\u0026plusmn;\u0026thinsp;139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e656\u0026thinsp;\u0026plusmn;\u0026thinsp;136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e912\u0026thinsp;\u0026plusmn;\u0026thinsp;166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e890\u0026thinsp;\u0026plusmn;\u0026thinsp;147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e854\u0026thinsp;\u0026plusmn;\u0026thinsp;159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e814\u0026thinsp;\u0026plusmn;\u0026thinsp;162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e736\u0026thinsp;\u0026plusmn;\u0026thinsp;174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e691\u0026thinsp;\u0026plusmn;\u0026thinsp;160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1000\u0026thinsp;\u0026plusmn;\u0026thinsp;143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e958\u0026thinsp;\u0026plusmn;\u0026thinsp;145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e899\u0026thinsp;\u0026plusmn;\u0026thinsp;164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e860\u0026thinsp;\u0026plusmn;\u0026thinsp;179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e802\u0026thinsp;\u0026plusmn;\u0026thinsp;190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e736\u0026thinsp;\u0026plusmn;\u0026thinsp;151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.031\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.042\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCvs5 (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e998\u0026thinsp;\u0026plusmn;\u0026thinsp;131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e993\u0026thinsp;\u0026plusmn;\u0026thinsp;136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e976\u0026thinsp;\u0026plusmn;\u0026thinsp;127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e922\u0026thinsp;\u0026plusmn;\u0026thinsp;97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e876\u0026thinsp;\u0026plusmn;\u0026thinsp;111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e796\u0026thinsp;\u0026plusmn;\u0026thinsp;136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1108\u0026thinsp;\u0026plusmn;\u0026thinsp;136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1081\u0026thinsp;\u0026plusmn;\u0026thinsp;141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1060\u0026thinsp;\u0026plusmn;\u0026thinsp;131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e991\u0026thinsp;\u0026plusmn;\u0026thinsp;154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e937\u0026thinsp;\u0026plusmn;\u0026thinsp;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e852\u0026thinsp;\u0026plusmn;\u0026thinsp;141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1172\u0026thinsp;\u0026plusmn;\u0026thinsp;136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1126\u0026thinsp;\u0026plusmn;\u0026thinsp;131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1077\u0026thinsp;\u0026plusmn;\u0026thinsp;137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1035\u0026thinsp;\u0026plusmn;\u0026thinsp;150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e994\u0026thinsp;\u0026plusmn;\u0026thinsp;157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e910\u0026thinsp;\u0026plusmn;\u0026thinsp;133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.016\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.049\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.047\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCvs6 (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1096\u0026thinsp;\u0026plusmn;\u0026thinsp;122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1085\u0026thinsp;\u0026plusmn;\u0026thinsp;149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1061\u0026thinsp;\u0026plusmn;\u0026thinsp;113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1016\u0026thinsp;\u0026plusmn;\u0026thinsp;161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e981\u0026thinsp;\u0026plusmn;\u0026thinsp;146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e875\u0026thinsp;\u0026plusmn;\u0026thinsp;131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1165\u0026thinsp;\u0026plusmn;\u0026thinsp;169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1154\u0026thinsp;\u0026plusmn;\u0026thinsp;137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1124\u0026thinsp;\u0026plusmn;\u0026thinsp;148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1095\u0026thinsp;\u0026plusmn;\u0026thinsp;150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1034\u0026thinsp;\u0026plusmn;\u0026thinsp;122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e941\u0026thinsp;\u0026plusmn;\u0026thinsp;138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1235\u0026thinsp;\u0026plusmn;\u0026thinsp;164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1215\u0026thinsp;\u0026plusmn;\u0026thinsp;149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1244\u0026thinsp;\u0026plusmn;\u0026thinsp;134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1157\u0026thinsp;\u0026plusmn;\u0026thinsp;178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1079\u0026thinsp;\u0026plusmn;\u0026thinsp;134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e998\u0026thinsp;\u0026plusmn;\u0026thinsp;127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.025\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.027\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.034\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.021\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eSignificant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; \u003csup\u003e**\u003c/sup\u003eSignificant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of cortical bone density at the infrazygomatic crest area of Cvs3 to Cvs6 adolescents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esites\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCVM stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCortical bone density (HU)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLSD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e777\u0026thinsp;\u0026plusmn;\u0026thinsp;158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e861\u0026thinsp;\u0026plusmn;\u0026thinsp;173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e998\u0026thinsp;\u0026plusmn;\u0026thinsp;134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.042\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1096\u0026thinsp;\u0026plusmn;\u0026thinsp;125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e844\u0026thinsp;\u0026plusmn;\u0026thinsp;139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e912\u0026thinsp;\u0026plusmn;\u0026thinsp;170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1108\u0026thinsp;\u0026plusmn;\u0026thinsp;142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.259\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1165\u0026thinsp;\u0026plusmn;\u0026thinsp;173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e930\u0026thinsp;\u0026plusmn;\u0026thinsp;175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1000\u0026thinsp;\u0026plusmn;\u0026thinsp;146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1172\u0026thinsp;\u0026plusmn;\u0026thinsp;140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.208\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1235\u0026thinsp;\u0026plusmn;\u0026thinsp;168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e2,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e774\u0026thinsp;\u0026plusmn;\u0026thinsp;130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.163\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e837\u0026thinsp;\u0026plusmn;\u0026thinsp;143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e993\u0026thinsp;\u0026plusmn;\u0026thinsp;145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1085\u0026thinsp;\u0026plusmn;\u0026thinsp;152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e2,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e830\u0026thinsp;\u0026plusmn;\u0026thinsp;164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.213\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e890\u0026thinsp;\u0026plusmn;\u0026thinsp;151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1081\u0026thinsp;\u0026plusmn;\u0026thinsp;144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1154\u0026thinsp;\u0026plusmn;\u0026thinsp;141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e2,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e914\u0026thinsp;\u0026plusmn;\u0026thinsp;138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.345\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e958\u0026thinsp;\u0026plusmn;\u0026thinsp;149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1126\u0026thinsp;\u0026plusmn;\u0026thinsp;142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1215\u0026thinsp;\u0026plusmn;\u0026thinsp;153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e3,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e757\u0026thinsp;\u0026plusmn;\u0026thinsp;136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.403\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e792\u0026thinsp;\u0026plusmn;\u0026thinsp;150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e976\u0026thinsp;\u0026plusmn;\u0026thinsp;135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.050\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1061\u0026thinsp;\u0026plusmn;\u0026thinsp;116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e3,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e772\u0026thinsp;\u0026plusmn;\u0026thinsp;150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e854\u0026thinsp;\u0026plusmn;\u0026thinsp;163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1060\u0026thinsp;\u0026plusmn;\u0026thinsp;149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.191\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1124\u0026thinsp;\u0026plusmn;\u0026thinsp;152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e3,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e832\u0026thinsp;\u0026plusmn;\u0026thinsp;168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e899\u0026thinsp;\u0026plusmn;\u0026thinsp;168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1077\u0026thinsp;\u0026plusmn;\u0026thinsp;139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1244\u0026thinsp;\u0026plusmn;\u0026thinsp;137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e4,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e667\u0026thinsp;\u0026plusmn;\u0026thinsp;141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.066\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e750\u0026thinsp;\u0026plusmn;\u0026thinsp;144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e922\u0026thinsp;\u0026plusmn;\u0026thinsp;111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1016\u0026thinsp;\u0026plusmn;\u0026thinsp;165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e4,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e707\u0026thinsp;\u0026plusmn;\u0026thinsp;152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e814\u0026thinsp;\u0026plusmn;\u0026thinsp;167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e991\u0026thinsp;\u0026plusmn;\u0026thinsp;175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1095\u0026thinsp;\u0026plusmn;\u0026thinsp;154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e4,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e741\u0026thinsp;\u0026plusmn;\u0026thinsp;157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs3\u0026lt;Cvs4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e860\u0026thinsp;\u0026plusmn;\u0026thinsp;184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1035\u0026thinsp;\u0026plusmn;\u0026thinsp;179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1157\u0026thinsp;\u0026plusmn;\u0026thinsp;182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e5,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e705\u0026thinsp;\u0026plusmn;\u0026thinsp;143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e876\u0026thinsp;\u0026plusmn;\u0026thinsp;144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e981\u0026thinsp;\u0026plusmn;\u0026thinsp;149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e5,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e736\u0026thinsp;\u0026plusmn;\u0026thinsp;178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e937\u0026thinsp;\u0026plusmn;\u0026thinsp;129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1034\u0026thinsp;\u0026plusmn;\u0026thinsp;125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e5,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e802\u0026thinsp;\u0026plusmn;\u0026thinsp;195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e994\u0026thinsp;\u0026plusmn;\u0026thinsp;168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.113\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1079\u0026thinsp;\u0026plusmn;\u0026thinsp;137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e6,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e656\u0026thinsp;\u0026plusmn;\u0026thinsp;140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e796\u0026thinsp;\u0026plusmn;\u0026thinsp;141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e875\u0026thinsp;\u0026plusmn;\u0026thinsp;134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e6,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e691\u0026thinsp;\u0026plusmn;\u0026thinsp;165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e852\u0026thinsp;\u0026plusmn;\u0026thinsp;147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e941\u0026thinsp;\u0026plusmn;\u0026thinsp;142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e6,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e736\u0026thinsp;\u0026plusmn;\u0026thinsp;155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs4\u0026lt;Cvs5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e910\u0026thinsp;\u0026plusmn;\u0026thinsp;137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCvs5\u0026lt;Cvs6, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.052\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCvs6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e998\u0026thinsp;\u0026plusmn;\u0026thinsp;130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eSignificant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; \u003csup\u003e**\u003c/sup\u003eSignificant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSpearman's rank correlation analysis between cortical bone density of the infrazygomatic crest area and cervical vertebral maturation in adolescents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSite\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrelation Coefficient (ρ)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.651\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.660\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.625\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.687\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.680\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.694\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.664\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.581\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.598\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.620\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eSignificant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; \u003csup\u003e**\u003c/sup\u003eSignificant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe infrazygomatic crest (IZC) represents a key extraalveolar site for microimplants placement, where devices do not impede adjacent tooth movement, enhancing clinical utility. The primary stability of microimplants relies predominantly on mechanical retention with surrounding bone tissue rather than osseointegration.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Substantial evidence confirms cortical bone as the primary stress concentration zone for microimplants, providing critical mechanical retention.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Consequently, cortical bone thickness and density are closely associated with microimplants stability, with density being particularly pivotal for long-term success.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eBone mineral density quantifies skeletal mineral content and strength, yet existing IZC research emphasizes cortical thickness over density. Specifically, studies investigating cortical bone density in adolescents within this area remain limited. Furthermore, existing literature is limited by its approach to cohort construction, which typically assigns adolescents to a specific age or a wide spectrum of ages, failing to adequately account for the individual growth and developmental variability among adolescents. Factors such as ethnicity, genetic predisposition, hormonal levels, and environmental influences significantly impact the growth and development of the adolescent maxillofacial complex.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Notably, chronological age alone is an insufficient proxy for accurately reflecting the growth and developmental status of an individual.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e In contrast, the cervical spine undergoes systematic and predictable morphological changes during development, with cervical vertebral maturation (CVM) being intricately linked to both systemic and craniofacial growth. This metric has proven to be a reliable and effective predictor of craniofacial growth during puberty, with its precision and reproducibility having been extensively corroborated in the scientific literature.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Therefore, our study utilized CVM as the criterion for grouping, and conducted a measurement and analysis of cortical bone density at the IZC area of adolescents with different CVM stages. Previous studies have consistently demonstrated no statistically significant difference in the bone quality between the left and right sides at the IZC area.\u003csup\u003e\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e To minimize the complexity of the study, the focus was restricted to the left IZC area in the selected subjects.\u003c/p\u003e\u003cp\u003eAnatomically, the IZC area is bounded superiorly by the maxillary sinus floor and medially by molar roots. To avoid root damage during microimplant placement, Liou et al.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e recommend implantation 14\u0026ndash;16 mm above the maxillary occlusal plane. In clinical practice, microimplants are generally placed at or above the mucogingival junction in this area.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e The crown height of the maxillary molars is approximately 8.1 mm,\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e and the height of the attached gingiva is about 4\u0026ndash;5 mm.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Du et al. validated 13 mm, 15 mm, and 17 mm heights above the maxillary occlusal plane as appropriate measurement levels for assessing cortical bone density at the IZC area.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Accordingly, this study adopted identical height parameters to analyze IZC cortical bone density variations. The results demonstrated that cortical bone density increased with greater vertical height, consistent with our hypothesis that bone density escalates as the measurement site moves from the alveolar crest toward the basal bone. In the mesiodistal direction, cortical bone density exhibited a gradient decrease from mesial to distal sites, a pattern aligning with the findings of Chen et al.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eRegarding gender factors, most previous studies indicate that there are no statistically significant differences in cortical bone density at the IZC area or the buccal cortical bone of the posterior maxillary basal bone between adult males and females.\u003csup\u003e\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Notably, Avdagic et al.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e demonstrated that males achieve peak bone density later than females, which may plausibly explain why some studies observed significantly higher cortical bone density in females at the IZC area or posterior maxillary basal regions compared to males. This difference may be related to variations in the study populations.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e In the present study, cortical bone density showed no statistically significant sex\u003cb\u003e-\u003c/b\u003ebased differences across 18 measurement sites in adolescents. This finding may be explained by the homogeneity of skeletal maturation stages among participants, as all adolescents in each subgroup were at comparable phases of growth and development.\u003c/p\u003e\u003cp\u003eIn vitro studies have demonstrated that higher cortical bone density correlates with enhanced microimplants stability.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e Kim et al.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e experimentally inserted microimplants into artificial bone blocks with varying densities, observing that specimens with denser cortical bone exhibited greater maximum insertion torque, higher maximum removal torque, greater horizontal resistance, and reduced micromotion. Conversely, clinical evidence suggests that excessively high bone density may compromise clinical outcomes. Elevated bone density increases insertion torque and generates excessive stress during placement. Motoyoshi et al.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e analyzed 87 microimplants placed in the posterior dentition, revealing significantly higher success rates for devices with insertion torques of 8\u0026ndash;10 N\u0026middot;cm compared to those below 8 N\u0026middot;cm or exceeding 10 N\u0026middot;cm. Similarly, Suzuki et al.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e reported optimal stability when insertion torque was maintained within 5\u0026ndash;10 N\u0026middot;cm, with failure rates escalating beyond this range. Notably, Deguchi et al.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e demonstrated through animal experiments that microimplants placed into the denser mandibular bone exhibited less cortical bone formation around the screw head during healing compared to those in the maxilla. These findings may be attributed to biomechanical overload. Excessive bone density can induce microdamage to surrounding bone tissue during implantation due to elevated stress concentrations and frictional heat generation. Such mechanical and thermal insults may lead to localized ischemia, delayed healing, and ultimately compromised stability.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003ePreoperative evaluation of cortical bone density in the target implantation area is therefore critical. Misch et al.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e established a classification system for bone density based on CT Hounsfield units (HU), defining five categories: D1 (\u0026gt;\u0026thinsp;1250 HU), D2 (850\u0026ndash;1250 HU), D3 (350\u0026ndash;850 HU), D4 (150\u0026ndash;350 HU), and D5 (\u0026lt;\u0026thinsp;150 HU). Chugh et al.\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e proposed that D1 - D3 bone types are suitable for microimplants placement, whereas D4 bone is contraindicated due to unacceptably high failure rates exceeding 35%. In contrast, Truhlar et al.\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e reported higher success rates for implants placed in D2 or D3 bone compared to D1 bone. This paradox may stem from the biomechanical limitations of D1 bone: despite its high density, the absence of trabecular bone and limited vascular supply (primarily dependent on periosteal nutrition) impairs post-drilling bone remodeling. Conversely, D2 and D3 bone provide optimal vascularity and moderate density, facilitating early-stage osseous healing to sustain implant stability.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e Park et al.\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e quantified buccal cortical bone density in the posterior maxilla and IZC areas as 810\u0026ndash;940 HU and 1100 HU, respectively. These measurements correspond to D2 and D3 classifications, further validating these sites as favorable zones for microimplants placement.\u003c/p\u003e\u003cp\u003eThe measurement results of this study demonstrated cortical bone density at the IZC area of Cvs3 \u003cb\u003e-\u003c/b\u003e Cvs6 adolescents ranged from 656 to 1244 HU (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), classified as D2/D3 bone. Specifically, in the Cvs5 and Cvs6 adolescents, all measurement sites (except for site 6,13 in Cvs5) exhibited cortical bone density\u0026thinsp;\u0026gt;\u0026thinsp;850 HU, corresponding to D2 bone. In contrast, in the Cvs3 and Cvs4 adolescents, except for a few sites in the anterior layers, most sites demonstrated cortical bone density\u0026thinsp;\u0026lt;\u0026thinsp;850 HU, corresponding to D3 bone. These data confirm that cortical bone density across all infrazygomatic crest layers in Cvs3 \u003cb\u003e-\u003c/b\u003e Cvs6 adolescents is clinically suitable for microimplants placement. However, for Cvs3 and Cvs4 patients, prioritization of anterior implantation sites is recommended to leverage the biomechanical advantage of higher cortical bone density.\u003c/p\u003e\u003cp\u003eApproximately 80% of peak bone mass accrues by age 20\u003csup\u003e37\u003c/sup\u003e, with 25% accumulating during the peri-pubertal growth spurt.\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e Craniofacial development and jawbone density progression tightly couples with systemic growth.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e,\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e Our Spearman's rank correlation analysis corroborates this, revealing significant positive correlations between IZC cortical bone density and CVM at all 18 sites (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Fifteen sites (83%) showed strong correlations (r\u0026thinsp;=\u0026thinsp;0.6\u0026ndash;0.79), and three sites (17%) moderate correlations (r\u0026thinsp;=\u0026thinsp;0.4\u0026ndash;0.59).\u003c/p\u003e\u003cp\u003eCrucially, pairwise comparisons indicated pronounced density increases between Cvs4 \u003cb\u003e-\u003c/b\u003e Cvs5 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 at all sites), contrasting with nonsignificant changes in Cvs3 \u003cb\u003e-\u003c/b\u003e Cvs4 and Cvs5 \u003cb\u003e-\u003c/b\u003e Cvs6 transitions (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 at most sites, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). We hypothesize this Cvs4 \u003cb\u003e-\u003c/b\u003e Cvs5 acceleration relates to complete second molar eruption, introducing sustained occlusal loading. Per Moss\u0026rsquo; functional matrix hypothesis,\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e skeletal adaptation responds secondarily to biomechanical stimuli; increased masticatory forces likely induce localized IZC cortical remodeling, elevating density and thickness.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCortical bone density at all measurement sites positively correlates with cervical vertebral maturation, confirming that Cortical bone density progressively increases throughout adolescence alongside skeletal maturation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eA significant increase in cortical bone density at the IZC area occurs during the Cvs4 \u0026ndash; Cvs5 transition, whereas comparatively smaller increases characterize the Cvs3 \u0026ndash; Cvs4 and Cvs5 \u0026ndash; Cvs6 periods.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRegarding cortical bone density, all measurement layers at the IZC area in Cvs3 \u0026ndash; Cvs6 adolescents are suitable for microimplants placement. For adolescents at Cvs3 and Cvs4 stages, anterior layers should be prioritized to access higher cortical bone density .\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e All procedures were performed in accordance with the Declaration of Helsinki and the protocol was approved by the Ethics Committee of the Affiliated Stomatological Hospital of Southwest Medical University (Approval No. 20211214003). Informed consent was obtained from all subjects and/or their legal guardian.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis work was supported by the Luzhou Science and Technology Program (No. 2023JYJ055) and the Youth Innovation Program of Sichuan Medical Association (No. Q2024075).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYHP and TY (co-first authors): devised the study concept, involved in study planning, contributed in analysis, revised the draft critically and wrote the main manuscript text. YXZ and HYW: contributed in data gathering and preparimg Tables 1-3. DML: prepared Figures 1-4. XX and QC: supervised the writing of the article, reviewed the manuscript, and provided critical revisions. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUmalkar SS, Jadhav VV, Paul P, Reche A. Mod Anchorage Syst Orthod Cureus. 2022;14(11):e31476.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChugh T, Ganeshkar SV, Revankar AV, Jain AK. Quantitative assessment of interradicular bone density in the maxilla and mandible: implications in clinical orthodontics. Prog Orthod. 2013;14(1):38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFarnsworth D, Rossouw PE, Ceen RF, Buschang PH. Cortical bone thickness at common miniscrew implant placement sites. Am J Orthod Dentofac Orthop. 2011;139(4):495\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosa WGN, de Almeida-Pedrin RR, Oltramari PVP, de Castro Conti ACF, Poleti TMFF, Shroff B, de Almeida MR. Total arch maxillary distalization using infrazygomatic crest miniscrews in the treatment of Class II malocclusion: a prospective study. Angle Orthod. 2023;93(1):41\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGopal H, Das SK, Barik AK, Mishra M, Rath SK, Samal R, Sharma G. Success rate of infrazygomatic crest mini-implants used for en-masse retraction of maxillary anterior teeth in first premolar extraction cases: A three-dimensional comparative prospective clinical trial between adolescents and young adults. 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Comparison of Infrazygomatic Crest Dimension Above Mesiobuccal Roots of Maxillary Molars in South Indian Subjects: A Retrospective Cone Beam Computed Tomography Study. J Indian Orthodontic Soc. 2023 2023-01-01;57(2):70\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee HS, Choi HM, Choi DS, Jang I, Cha BK. Bone thickness of the infrazygomatic crest area in skeletal Class III growing patients: A computed tomographic study. Imaging Sci Dent. 2013;43(4):261\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu H, Wu X, Yang L, Ding Y. Safe zones for miniscrews in maxillary dentition distalization assessed with cone-beam computed tomography. Am J Orthod Dentofac Orthop. 2017;151(3):500\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Dawlatly MM, Abou-El-Ezz AM, El-Sharaby FA, Mostafa YA. Zygomatic mini-implant for Class II correction in growing patients. J Orofac Orthop. 2014;75(3):213\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHikita Y, Yamaguchi T, Tomita D, Adel M, Nakawaki T, Katayama K, Maki K, Kimura R. Growth hormone receptor gene is related to root length and tooth length in human teeth. Angle Orthod. 2018;88(5):575\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOno A, Motoyoshi M, Shimizu N. Cortical bone thickness in the buccal posterior region for orthodontic mini-implants. Int J Oral Maxillofac Surg. 2008;37(4):334\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDu B, Zhu J, Li L, Fan T, Tan J, Li J. Bone depth and thickness of different infrazygomatic crest miniscrew insertion paths between the first and second maxillary molars for distal tooth movement: A 3-dimensional assessment. Am J Orthod Dentofac Orthop. 2021;160(1):113\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen X, Jiang X, Chen S. Site selection of micro-implant anchorages in the infrazygomatic crest in adult orthodontic patients. Hua Xi Kou Qiang Yi Xue Za Zhi. 2024;42(2):207\u0026ndash;13. English, Chinese.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang YQ, Chi JW, Liu YF, Feng F, Wu H, Liu W. Analysis of cortical density in zygomatic alveolar ridge of different vertical facial types. Shanghai Kou Qiang Yi Xue. 2019;28(6):652\u0026ndash;6. Chinese.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArvind Tr P, Jain RK. Computed tomography assessment of maxillary bone density for orthodontic mini-implant placement with respect to vertical growth patterns. J Orthod. 2021;48(4):392\u0026ndash;402.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHasani M, Afzoon S, Karandish M, Parastar M. 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The longitudinal sagittal growth changes of maxilla and mandible according to quantitative cervical vertebral maturation. J Huazhong Univ Sci Technolog Med Sci. 2009;29(2):251\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCassetta M, Sofan AA, Altieri F, Barbato E. Evaluation of alveolar cortical bone thickness and density for orthodontic mini-implant placement. J Clin Exp Dent. 2013;5(5):e245\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoss ML. The functional matrix hypothesis revisited. 1. The role of mechanotransduction. Am J Orthod Dentofac Orthop. 1997;112(1):8\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CBCT, Cervical vertebral maturation, Infrazygomatic crest, Cortical bone density, Microimplants","lastPublishedDoi":"10.21203/rs.3.rs-7485548/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7485548/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn orthodontic treatment, microimplants provide critical anchorage, with cortical bone density being vital for implant stability. The infrazygomatic crest is a common implantation site, but adolescents exhibit significant variability in bone density due to individual growth differences. Cervical vertebral maturation (CVM) is a reliable indicator of skeletal growth, yet its correlation with infrazygomatic crest cortical bone density remains underexplored. This study aimed to evaluate cortical bone density at the infrazygomatic crest area in adolescents and assess its correlation with CVM to guide clinical microimplants placement.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eCone beam computed tomography data from 80 adolescents (20 per CVM stage Cvs3 to Cvs6) were analyzed. Images were reconstructed to establish the maxillary occlusal plane as horizontal and the mesiobuccal root apex of the left maxillary first molar as baseline. Cortical bone density was measured on the buccal cortex at heights of 13 mm, 15 mm, and 17 mm above baseline, across six mesiodistal layers from the second premolar to second molar region.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCortical bone density ranged from 656\u0026thinsp;\u0026plusmn;\u0026thinsp;136 Hounsfield Units (HU) to 1244\u0026thinsp;\u0026plusmn;\u0026thinsp;134 HU. Significant increases in cortical bone density occurred between Cvs4 and Cvs5 stages (from 656\u0026ndash;1000 HU to 796\u0026ndash;1172 HU; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Cortical bone density generally decreased distally and increased apically across most sites and stages. Spearman's rank correlation analysis revealed strong positive correlations between cortical bone density at all 18 measurement sites and CVM (correlation coefficients r\u0026thinsp;=\u0026thinsp;0.555\u0026ndash;0.731; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eCortical bone density at the adolescent infrazygomatic crest significantly increases with advancing CVM, with a pronounced rise between Cvs4 and Cvs5 stages. Regarding cortical bone density, all layers of the infrazygomatic crest area in adolescents at the Cvs3 to Cvs6 stages are suitable for microimplants insertion. For adolescents at Cvs3 and Cvs4 stages, selecting anterior layers is recommended to access higher cortical bone density values.\u003c/p\u003e","manuscriptTitle":"Evaluation of cortical bone density at the infrazygomatic crest area in adolescents via CBCT and its correlation with cervical vertebral maturation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 07:10:52","doi":"10.21203/rs.3.rs-7485548/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-19T08:56:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-06T01:36:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142635761564245599101320649445520210636","date":"2025-11-30T14:43:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51502891116518660619087778967694070312","date":"2025-11-30T04:09:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143501821859354677182314800045744070081","date":"2025-11-06T13:18:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253956873761851785931383938784855559987","date":"2025-09-24T18:22:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-24T15:25:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85927552302037013141592714302293803515","date":"2025-09-18T09:38:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T01:52:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-04T13:55:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T04:51:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-03T04:49:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-08-29T06:32:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88177c88-46f0-43be-914e-f288adf9e409","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T10:09:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 07:10:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7485548","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7485548","identity":"rs-7485548","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}