Duration of pubertal peak in skeletal class I /certified fixed orthodontic courses by Indian dental academy


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Duration of pubertal peak in skeletal class I /certified fixed orthodontic courses by Indian dental academy

  1. 1. DURATION OF PUBERTAL PEAK IN SKELETAL CLASS - I INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. INTRODUCTION  Human growth and development are not uniform at various developing maturational stages.  Onset of puberty varies with sex, population and environment. www.indiandentalacademy.com
  4. 4. Indicators to determine growth potential in adolescents:  body height  body weight  menarche  sexual maturation charecteristics  chronological age  dental devolopment  skeletal devolopment www.indiandentalacademy.com
  5. 5.  Hand wrist radiographs have been used widely as a reliable analysis to establish skeletal age.  Unfortunately, the hand-wrist method requires additional radiation exposure when used in orthodontic treatment planning. www.indiandentalacademy.com
  6. 6.  In 1972 Lamparski created the first standards of cervical vertebral maturation as related to chronological age and to skeletal maturation as observed on hand-wrist radiographs.  O’Reilly and Yanniell in 1988, Franchi et al in 2000, and Baccetti et al in 2005 demonstrated that the greatest increase in mandibular length occurred during the pubertal growth spurt and that this could be assessed during the interval between CS3 and CS4. www.indiandentalacademy.com
  7. 7.  The literature provides indications about the duration of the pubertal peak – Class I occlusions, Class III malocclusion.  This study evaluates the duration of the pubertal growth spurt in subjects with Class III malocclusion vs subjects with normal occlusion by using a reliable indicator of skeletal maturity (CVM method). www.indiandentalacademy.com
  8. 8. Inclusion criteria:  Cephalograms of good quality.  Caucasian ancestry.  No previous orthodontic treatment.  No congenitally missing or extracted teeth.  No systematic diseases that could have affected general development www.indiandentalacademy.com
  9. 9.  Skeletal Class I or III, with the diagnosis based on the A-N-Pog angle by Bjork analysis (Class I= -0.50 < A-NPog < 40; Class III = A-N-Pog < -0.5)  Vertical skeletal relationship (NL/ML angle by Bjork analysis) ranging from 190 to 330  Skeletal stages CS3 or CS4 based on the CVM method. www.indiandentalacademy.com
  10. 10. MATERIALS AND METHOD  The lateral cephalograms of 900 orthodontically untreated subjects, ages 8 through 18 years, were analyzed.  The CVM stage on each radiograph was assessed according to the method of Baccetti et al, and skeletal class was assessed according to Bjork’s cephalometric analysis www.indiandentalacademy.com
  11. 11.  The lateral cephalograms were analyzed on a conventional viewing screen and traced on acetate by the two observers.  The measurements were made with mutual agreement between the two operators. www.indiandentalacademy.com
  12. 12. The final sample consisted of 218 subjects 93- female 125- male subjects CS3 - 113 cephalograms: 67 Class I subjects : 28 –female 39 - male 46 Class III subjects : 27 - female 19 - male www.indiandentalacademy.com
  13. 13. OR  CS4 - 105 cephalograms : 56 Class I subjects : 34 – female 22 – male 40 Class III subjects : 36 female 13 male www.indiandentalacademy.com
  14. 14. STATISTICAL ANALYSIS The variable ‘‘age’’ was tested with the Shapiro-Wilks test to confirm normal distribution and Levene’s analysis of variance exploratory test for confirmation of homogeneity.  No statistical significance was assessed.  Student T-tests for independent samples (P < .05) were used to compare the age intervals between CS3 and CS4 in the Class I vs Class III subjects as www.indiandentalacademy.com
  15. 15. RESULTS  No statistically significant differences in the duration of the CS3–CS4 interval were observed between genders. No.of.r ecords maloccl Cervica usion l stage min max Std. deviati on Std. error Mean age 67 Class I CS 3 9yr 1mon 13yr 10mon 1yr 1mon 2mon 11yr 4mon 56 Class I CS4 9yr 6mon 15yr 1yr 5mon 2mon 12yr 3mon 46 Class III CS3 9yr 3mon 13yr 9mon 1yr 0mon 2mon 11yr 5mon 49 Class III 11yr 3mon 15yr 3mon 1yr 0mon 2mon 12yr 9mon CS4 www.indiandentalacademy.com
  16. 16.  Average Duration of the Pubertal Peak Interval in the Skeletal Disharmony malocclusio CS3 n CS4 CS3-CS4 Class I 11yr 4mon 12yr 3mon 11+/- 2mon Class III 11yr 5mon 12yr 9mon 16+/-1.5mon www.indiandentalacademy.com
  17. 17.  The CS3–CS4 age interval was significantly longer (P < .001) in Class III subjects than in Class I subjects  The effect size was larger than two, which means that the average effect was much greater than the inter individual variability expressed by the average standard deviation. www.indiandentalacademy.com
  18. 18. skeletal Class I and Class III malocclusions. The significant difference in duration of the pubertal peak between Class I and Class III groups is approximately 5 months (P < .001). www.indiandentalacademy.com
  19. 19. DISCUSSION  This study obtains information about the duration of the pubertal peak in untreated persons with Class III skeletal relationships when compared to those with normal skeletal relationships.  Reyes et al reported that, in those with a Class III malocclusion, the largest ‘‘increase’’ in mandibular length occurred - 1 year later in both sexes with Class III skeletal relationships than it did in those with Class I relationships. www.indiandentalacademy.com
  20. 20.  In the current investigation the average chronological age at onset of the pubertal peak was similar for both skeletal Class I and Class III subjects  Average chronological age was 11 years 5 months  However, the pubertal growth spurt interval ended earlier for skeletal Class I subjects (average age of 12 years 3 months) than in skeletal Class III subjects (average age of 12 years 9 months). www.indiandentalacademy.com
  21. 21.  Therefore, the pubertal peak for Class I subjects lasted 11 months whereas in subjects with Class III malocclusion it lasted for a longer period (16 months)  The increased mandibular length in Class III persons at the pubertal growth spurt25 could be linked to the longer duration of the pubertal peak in these subjects. www.indiandentalacademy.com
  22. 22. CONCLUSION  The average time of onset of pubertal peak in both Class I and Class III subjects is similar: 11 years and 5 months.  In Class I subjects, the interval between CS3 and CS4 (duration of pubertal peak) lasts 11 months, whereas it lasts 16 months in skeletal Class III malocclusion. www.indiandentalacademy.com
  23. 23.  The greater increase in mandibular length in Class III subjects compared to that in Class I subjects during puberty might be associated with the longer duration of the pubertal peak in Class III subjects www.indiandentalacademy.com
  24. 24. REFERENCE ARTICLES www.indiandentalacademy.com
  25. 25.  This study deals with the growth changes of japanease face associated with mandibular prognathism during 3yrs after the pubertal peak.  This investigation was based on serial lateral Cephalometric roentgenograms of prognathic normal females, respectively. www.indiandentalacademy.com
  26. 26.  Maturational stages of the pubertal growth were determined individually by the ossification events taken from hand-wrist radiographs.  Acc. To Grave and others, peak stages of pubertal growth spurt was determined to occur shortly before the appearance of the epiphyseal capping on its diaphysis at the distal phalanges of fingers and radius. www.indiandentalacademy.com
  27. 27. METHOD  3 groups were taken.each consisted of 3yr interval set of lateral head films, which were taken at the ages of 15 and 18 for male and 14 &17 for female subjects.  Normal group exhibited excellent or mild class I malocclusion. This was control group in the study. www.indiandentalacademy.com
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  32. 32.  Results indicate that the morphological characteristics of the mandibular prognathism, which are established before the pubertal growth peak, are strongly maintained during the period studied.  Mandibular prognathism seems to show a manner of growth change fairly similar to that of the normal after the pubertal growth peak. www.indiandentalacademy.com
  33. 33. An Improved Version of the Cervical Vertebral Maturation (CVM) Method for the Assessment of Mandibular Growth  Tiziano Baccetti, DDS, PhDa; Lorenzo Franchi, DDS, PhDa; James A. McNamara Jr, DDS, PhDb Angle Orthodontist, Vol 72, No 4, 2002 www.indiandentalacademy.com
  34. 34.  The morphology of the bodies of the second (odontoid process, C2), third (C3), and fourth (C4) cervical vertebrae were analyzed in six consecutive cephalometric observations (T1 through T6) of 30 orthodontically untreated subjects.  Observations for each subject consisted of two consecutive cephalograms comprising the interval of maximum mandibular growth (as assessed by means of the maximum increment in total mandibular length, Co-Gn), together with two earlier consecutive cephalograms and two later consecutive cephalograms. www.indiandentalacademy.com
  35. 35.  The construction of the new version of the CVM method was based on the results of both ANOVA for repeated measures with post-hoc Scheffe´’s test (P< .05) and discriminant analysis.  The new CVM method presents with five maturational stages (Cervical Vertebral Maturation Stage [CVMS] I through CVMS V, instead of Cvs 1 through Cvs 6 in the former CVM method). www.indiandentalacademy.com
  36. 36.  The peak in mandibular growth occurs between CVMS II and CVMS III, and it has not been reached without the attainment of both CVMS I and CVMS II. CVMS V is recorded at least two years after the peak.  The advantages of the new version of the CVM method are that mandibular skeletal maturity can be appraised on a single cephalogram and through the analysis of only the second, third, and fourth cervical vertebrae, which usually are visible even when a protective radiation collar is worn. www.indiandentalacademy.com
  38. 38.  This study was to determine the validity of cervical vertebrae radiographic assessment to predict skeletal maturation.  Left hand-wrist and lateral cephalometric radiographs of 958 Spanish children from age of 5-18 yr were measured.  Classification of Grave and Brown was used to assess the maturation. www.indiandentalacademy.com
  39. 39.  Lateral cephalograms were evaluated using the stages described by Lamparski and Hassel and Farman.  A new method to evaluate the cervical maturation by studying the changes in the concavity of the lower border , height, and shape of vertebral body was created. www.indiandentalacademy.com
  40. 40.  A good correlation was found between hand-wrist skeletal maturation and vertebral maturation assess by Hassel and Farmal classification.  Though it was significantly better for females.  Lower correlation was found when Lamparski classification was compared with hand-wrist skeletal maturation. www.indiandentalacademy.com
  41. 41.  Concavity tended to have a highest correlation with hand-wrist maturation.  Correlation coefficients were calculated to establish the relationship between skeletal maturation values obtained by the three classifications of vertebral, skeletal maturation measured at the wrist.  All coefficient values obtained were statistically significant (P<0.001). www.indiandentalacademy.com
  42. 42.  Results suggest that new methodto determine skeletal maturation was reliable.  The morphological vertebral parameter best able to estimate the maturation is the concavity of the lower border of the body. www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com