Alkaline Phosphatase Activity in Serum as Indicator for Skeletal Maturity in Assamese Population - An Ex-Vivo Study

Determination of peak growth velocity is fundamental in effectuating the greatest impact of functional/orthopedic appliances with concomitant reduction in the demands made on changes in tooth position and to predict post treatment occlusal stability. Along with clinical and radiological techniques, isolation and characterization of various systemic and local factors, aka biochemical markers have a significant role in the growth process in that they provide the sight to tap their potential to be used as skeletal maturity indicators. A biomarker is a naturally occurring molecule, gene, or characteristic by which a particular physiological or pathological process can be identified. Compound estimations of biomarkers have been carried out in blood, serum, urine, gingival crevicular fluid, saliva, etc., for the prediction of growth and skeletal maturity in the field of orthodontics in order to facilitate better growth estimation. The present study assesses the level of enzyme alkaline phosphatase (ALP) in serum and its variations corresponding to growth and development as a skeletal maturity indicator. In a normal child, growth and development throughout childhood till adolescence imply increased growth velocity, manifesting mainly in height and weight. This increase in skeletal development is contributed to by increased proliferation of osteoblasts. This, in turn, raises secretion of ALP, evidently causing its rise in serum levels. The present study aims to compare the serum ALP level with the radiographic method of cervical vertebral maturation stages (CVMI) given by Hassel and Farman in the young Assamese population.

Hospital-based cross-sectional study in the age group of 7-21 years with a sample size of 50 Assamese individuals.

After taking written informed consent from the participants, they were grouped into 6 categories by obtaining the lateral cephalometric radiograph corresponding to Hassel and Farman's CVMI stages. 5 ml of blood was drawn from the median cubital vein and gently transferred into vacutainers (clotted vial), then allowed to stand for 30 min and centrifuged at 3000 rpm in the Remi R 8C centrifuge machine. The serum was separated, and serum ALP was estimated following the method: The International Federation of Clinical Chemistry (IFCC) method for measuring serum ALP activity (IFCC-DGKCh) by a kinetic rate method using a 2-amino-2-methyl-1-propanol (AMP) buffer.

In both males and females, an increase in mean serum ALP level from CVMI Stage 1 to Stage 2 was observed. After that, the levels gradually become lower from Stage 2 to Stage 6.

The present study effectively projects serum ALP as a reliable biochemical marker for growth estimation, useful in orthodontic treatment planning. An extensive study on a larger scale could be carried out to further substantiate the same.