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INDIAN DENTAL ACADEMY
Leader in continuing dental education
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Introduction:




One of the objective for treating skeletal
discrepancies, is to take advantage of the
patients growth ...
Introduction:




As a results many investigators have attempted ,
to predict the duration ,magnitude, direction and
tim...
Introduction:






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Chronological age is often not sufficient for assessing
the developmental stage and somatic matu...
Introduction:






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Dental age has been based on two different methods of
assessment.
1. Tooth eruption age.
2. Toot...
BIOLOGICAL AGE
AND
HAND WRIST RADIO GRAPH


Orthodontic treatment progresses more quickly
during growth spurts.
Generally...
HAND-WRIST RADIO GRAPHIC
EVALUATION
After Roentgen demonstrate his new radiographic discovery in 1895 Ronaldo, in 1896,
in...
TOPOGRAPHIC ANATOMY OF THE
SKELETON OF THE HAND

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TOPOGRAPHIC ANATOMY
OF
THE SKELETON OF THE HAND

www.indiandentalacademy.com
TOPOGRAPHIC ANATOMY OF THE
SKELETON OF THE HAND
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1. Epiphysis of the thumb.
2. Epiphysi...
TOPOGRAPHIC ANATOMY OF THE
SKELETON OF THE HAND
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18.
19.
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22.
23.
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25.
26.
27.
28.
2...
Hand-wrist radiographs
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Atlas
Sesamoid bone(Flory,Bjork,Chapman)
Julian Singer (1980)
Fishman(1982)
Hagg & T...
Hand-wrist radiograph:

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Hand-wrist radiograph:

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Hand-wrist radiograph:

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SKELETAL MATURATION
ASSESSMENT
.
LEONARD S.FISHMAN 1982 outlined four stages of bone maturation found
at six anatomical si...
Fishman’s skeletal maturity indicators

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Hagg





and

Taranger skeletal maturity indicators

They described a method in which skeletal development
is assessed ...
Hagg

and

Taranger

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BIOLOGICAL AGE



HAND WRIST RADIO
GRAPH
AND

Growth stages of the fingers are assessed according to
the relationship bet...
MP3 STAGES

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BIOLOGICAL AGE AND HAND WRIST RADIO
GRAPH
There are nine developmental stages.
1.First stage of maturation :(PP2= stage)
T...
BIOLOGICAL AGE
GRAPH

AND

HAND WRIST RADIO

4. Fourth stage :(S-and H2-stage)
S-stage: First mineralization of the ulnar ...
BIOLOGICAL AGE
GRAPH

AND

HAND WRIST RADIO

3. Third stage:(Pisi-,H1-,and R= stage)
This stage of development can be iden...
BIOLOGICAL AGE
GRAPH

AND

HAND WRIST RADIO

5. Fifth stage:( MP3cap–,PP1cap-,and Rcap-stage)
During this stage ,the diaph...
BIOLOGICAL AGE
GRAPH

AND

HAND WRIST RADIO

6. Sixth stage :(DP3u-stage)
Visible union of the epiphysis and diaphysis at ...
BIOLOGICAL AGE
GRAPH
7.

AND

HAND WRIST RADIO

Seventh stage:(PP3u-stage)
Visible union of the epiphysis and diaphysis at...
BIOLOGICAL AGE
GRAPH

AND

HAND WRIST RADIO

8. Eighth stage :(MP3u-stage)
Visible union of the epiphysis and diaphysis at...
BIOLOGICAL AGE
GRAPH

AND

HAND WRIST RADIO

9. Ninth stage:(Ru-stage)
Complete union of the epiphysis and diaphysis of th...
Growth period
1.

2.

3.

4.

5.

6.

7.

8.

9.

PP2

MP3

Pisi

S

MP3

Ru

H2

PP3
u

MP3

H1

DP3
u

15.
0
13.
0

15.
...
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Cervical vertebrae maturation indicators
The first seven vertebrae in the spinal column constitute
the cervical spine. The...
Cervical vertebrae maturation indicators
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The standard method of evaluating skeletal maturity has
been to us...
Cervical vertebrae maturation indicators
The use of cervical vertebrae to determine skeletal
maturity was
suggested by Lam...
Cervical vertebrae maturation indicators
-Lamparski

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Six stages of cervical vertebral maturation wer...
Cervical vertebrae maturation indicators

Cvs1

cvs2

cvs3

cvs4

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cvs6
Cervical vertebrae maturation indicators

STAGES

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Cervical vertebrae maturation indicators

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Cervical vertebrae maturation indicators

STAGES

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Cervical vertebrae maturation indicators
1. Initiaton:
• Inferior borders of 2nd 3rd and 4th cervical
vertebrae are flat a...
Cervical vertebrae maturation indicators
2. Acceleration:
• Concavities on the inferior borders of
second and third verteb...
Cervical vertebrae maturation indicators
3. Transition :
• Distinct concavities are shown on the
inferior borders of secon...
Cervical vertebrae maturation indicators
4. Deceleration stage:
• Distinct concavities can observed on
the inferior border...
Cervical vertebrae maturation indicators
5. Maturation stage:
• Marked concavities are observed
on the inferior borders of...
Cervical vertebrae maturation indicators
6. Completion:
• Deep concavities are observed on
the second, third and fourth ce...
Assessment of skeletal
maturation
The 5 distinct stages of MP3 as
described by HAGG & TARANGER (1980),
and 6 th stage (bet...
COMPARISON BETWEEN
MP3-F & INITIATION STAGE
MP3-F STAGE

INITIATION STAGE

It represents the onset or the start 1.C2, C3 a...
COMPARISON BETWEEN
MP3-FG & ACCELERATION STAGE
MP3-FG STAGE

ACCELERATION STAGE

It represents the acceleration part of 1....
COMPARISON BETWEEN
MP3-G & TRANSITION STAGE
MP3-G STAGE

TRANSITION STAGE

It represents the point of maximum
pubertal gro...
COMPARISON BETWEEN
MP3-H & DECELERATION STAGE
MP3-H STAGE

DECELERATION STAGE

It represents the deceleration part of 1.Di...
COMPARISON BETWEEN
MP3-HI & MATURATION STAGE
MP3-HI STAGE

MATURATION STAGE

It represents the maturation part of
the curv...
COMPARISON BETWEEN
MP3-I & COMPLETION STAGE
MP3-I STAGE

COMPLETION STAGE

It represents the end of pubertal

1. Deep conc...
Comparison
of
MP3 and CVMI

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Correlation of hand-wrist
and

cervical vertebral maturation stages
A comparative evaluation of hand-wrist and cervical ve...
Correlation of hand-wrist
and

cervical vertebral maturation stages
Hand –wrist

Cervical
vertebral stages

Pubertal growt...
STAGES OF TOOTH CALCIFICATION-NOLLA(1960)
10.Root apex completed.
9.Root almost completed,open apex.
8.Two thirds of root ...
Dental age determination according to the stage of mineralization
Demirjian et al., in 1973 divided tooth mineralization i...
Scores of different dental formation stages

The table was made for the left mandibular quadrant.
www.indiandentalacademy....
Conversion chart for dental age determination,calculated
according to the score-system of dental formation

The overall fi...
DENTAL FORMATION STAGES
D-H OF MANDIBULAR CANINE

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Tooth mineralization as an indicator of the pubertal
growth spurt

Diagrammatic appearance of stages C to H of tooth
devel...
OPG:

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Mandibular growth changes
&
Maturation of cervical vertebrae
Maria T o’Reilly & Gary J Yanniello conducted a study on
rela...
Clinical significance:
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1. Treatment involving modification of skeletal growth seems to demand
as much ...
LATERAL CEPHALOGRAM:

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LATERAL CEPHALOGRAM:

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LATERAL CEPHALOGRAM:

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LATERAL CEPHALOGRAM:

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LATERAL CEPHALOGRAM:

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Leader in continuing dental education
www.indiandentalacademy.com

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skeletal maturity indicators /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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Transcript of "skeletal maturity indicators /certified fixed orthodontic courses by Indian dental academy "

  1. 1. www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Introduction:   One of the objective for treating skeletal discrepancies, is to take advantage of the patients growth spurt, which help to achieve optimal results,within the short period of time. Evaluation of individual biologic time table and identification of period of accelerated growth is essential for clinical decisions, regarding growth modulation procedures for skeletal discrepancies, extraction versus non extraction options,use of extra oral orthopaedic forces and planning for www.indiandentalacademy.com orthognathic surgery for skeletal malocclusions.
  4. 4. Introduction:   As a results many investigators have attempted , to predict the duration ,magnitude, direction and timing of the adolescent growth changes. The developmental status of a child is usually assessed in relation to events that take place during progress of growth. Thus chronological age, sexual maturational characteristics , dental development (dental age), height and weight measurements and skeletal age are some of the biological indicators that have been used to www.indiandentalacademy.com identify stages of growth.
  5. 5. Introduction:     Chronological age is often not sufficient for assessing the developmental stage and somatic maturity of the patient,so that the biological age has to be determined. The biological age is determined from the skeletal, dental and morphologic age and onset of puberty. Patient chronological age is defined as the time period from the birth to till date. Morphologic age is based on the height . A child’s height can be compared with those of his same age group and other age groups to determine where he stands in relation to others. Height is useful as a maturity indicator from late infancy to early adulthood. www.indiandentalacademy.com
  6. 6. Introduction:     Dental age has been based on two different methods of assessment. 1. Tooth eruption age. 2. Tooth mineralization stage. Sexual age refers to development of secondary sexual characteristics. This type of indicator is useful only for adolescent growth. Skeletal age Assessment is often made with the help of hand - wrist radiograph which can be considered the ‘Biological clock ’. Nine developmental stages are there according BJork(1972), Grave and Brown (1976).The ossification events are localized in the area of the phalanges, carpal bones and radius. www.indiandentalacademy.com
  7. 7. BIOLOGICAL AGE AND HAND WRIST RADIO GRAPH  Orthodontic treatment progresses more quickly during growth spurts. Generally children experience a pattern of fast growth, followed by a slow growth in late childhood and then accelerated and peak growth in adolescence. Because children begin this sequence of growth at different ages, chronological age is a poor indicator of a child’s development. Hand-wrist radiograph is a useful tool for identifying a child’s skeletal development. www.indiandentalacademy.com
  8. 8. HAND-WRIST RADIO GRAPHIC EVALUATION After Roentgen demonstrate his new radiographic discovery in 1895 Ronaldo, in 1896, introduced the idea of using the comparative size and shape of the radiographic shadows of growing bones as indicators of rate of growth and maturity. In early 1900s, Pryor, Rotch and Crampton began tabulating indicators of maturity on sequential radiographs of the growing hand and wrist. Hellman published his observations on the ossification of epiphysial cartilage of the hand in 1928. Todd compiled hand –wrist data that was further elaborated on by Greulich and Pyle in atlas form. In 1936 Flory indicated that beginning of calcification of the carpal sesamoid was a good guide to determine the period immediately before puberty. The appearance of the adductor sesamoid has been highly correlated to peak height velocity and start of adolescent growth spurt. Fishman developed a system of hand wrist skeletal maturation indicators using four stages of bone maturation at six anatomic sites on the hand and the wrist. Hagg and Taranger created a method using the hand wrist radiograph to correlate certain maturity indicators to the pubertal growth spurt. www.indiandentalacademy.com
  9. 9. TOPOGRAPHIC ANATOMY OF THE SKELETON OF THE HAND www.indiandentalacademy.com
  10. 10. TOPOGRAPHIC ANATOMY OF THE SKELETON OF THE HAND www.indiandentalacademy.com
  11. 11. TOPOGRAPHIC ANATOMY OF THE SKELETON OF THE HAND                  1. Epiphysis of the thumb. 2. Epiphysis of the proximal phalanx of the thumb. 3. Sesamoid of the adductor brevis muscle at the metacarpophalangeal joint of the thumb. 4. Epiphysis of the distal phalanx of the index finger. 5. Epiphysis of the middle phalanx of the index finger. 6. Epiphysis of the proximal phalanx of the index finger. 7. Epiphysis of the distal phalanx of the middle finger. 8. Epiphysis of the middle phalanx of the middle finger. 9. Epiphysis of the proximal phalanx of the middle finger. 10. Epiphysis of the distal phalanx of the ring finger. 11. Epiphysis of the middle phalanx of the ring finger. 12. Epiphysis of the proximal phalanx of the ring finger. 13. Epiphysis of the distal phalanx of the little finger. 14. Epiphysis of the middle phalanx of the little finger. 15. Epiphysis of the proximal phalanx of the little finger. 16. Epiphysis of the metacarpal bone. www.indiandentalacademy.com 17. Epiphysis of the second metacarpal bone.
  12. 12. TOPOGRAPHIC ANATOMY OF THE SKELETON OF THE HAND               18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. Epiphysis of the third metacarpal bone. Epiphysis of the fourth metacarpal bone. Epiphysis of the fifth metacarpal bone. Trapezium. Trapezoid bone. Capitate bone. Hamate bone. Hamular process of the hamate bone. Triquetral bone. Pisiform bone. Lunate bone. Scaphoid bone. Distal epiphysis of the radius. Distal epiphysis of the ulna. www.indiandentalacademy.com
  13. 13. Hand-wrist radiographs        Atlas Sesamoid bone(Flory,Bjork,Chapman) Julian Singer (1980) Fishman(1982) Hagg & Taranger(1982) Leite &O’Reilly(1985) Abdel Kader(1998) www.indiandentalacademy.com
  14. 14. Hand-wrist radiograph: www.indiandentalacademy.com
  15. 15. Hand-wrist radiograph: www.indiandentalacademy.com
  16. 16. Hand-wrist radiograph: www.indiandentalacademy.com
  17. 17. SKELETAL MATURATION ASSESSMENT . LEONARD S.FISHMAN 1982 outlined four stages of bone maturation found at six anatomical sites located on the thumb, third finger, fifth finger and radius. Eleven skeletal maturity indicators are found in these six anatomic sites. Epiphysis as wide as diaphysis 1.Third finger-proximal phalanx 2.Third finger-middle phalanx 3.Fifth finger-middle phalanx Ossification 4.Adductor sesamoid of thumb Capping of epiphysis 5.Third finger distal- phalanx 6.Third finger middle -phalanx 7.Fifth finger middle-phalanx Fusion of epiphysis and diaphysis 8.Third finger distal -phalanx 9.Third finger proximal- phalanx 10.Third finger middle- phalanx 11.Radius www.indiandentalacademy.com
  18. 18. Fishman’s skeletal maturity indicators www.indiandentalacademy.com
  19. 19. Hagg   and Taranger skeletal maturity indicators They described a method in which skeletal development is assessed by ossification of the ulnar sesamoid of the metacarpophalangeal joint of the first finger (S) and certain specified stages of three epiphyseal bones; the middle and distal phalanges of the third finger (MP3 and DP3) and the distal epiphysis of the radius (R ). All the four bones to be used as indicators of the skeletal development were choosen according to Bjork. Eight of the ten indicators were already defined by others. In order to obtain maturation indicators of shorter duration, two new epiphyseal stages were defined. One stage in the middle phalanx of the third finger,denoted MP3-FG,and one stage in the distal end of the radius,denoted R-IJ. Sesamoid: sesamoid is usually attained during the acceleration period ofwww.indiandentalacademy.com spurt(onset of the pubertal growth
  20. 20. Hagg and Taranger www.indiandentalacademy.com
  21. 21. BIOLOGICAL AGE  HAND WRIST RADIO GRAPH AND Growth stages of the fingers are assessed according to the relationship between the epiphysis and diaphysis.     There are three stages of ossification of the phalanges. FIRST STAGE: Epiphysis shows the same width as the diaphysis. SECOND STAGE:(CAPPING STAGE) The epiphysis surrounds the diaphysis like a cap. THIRD STAGE:(U-STAGE) www.indiandentalacademy.com
  22. 22. MP3 STAGES www.indiandentalacademy.com
  23. 23. BIOLOGICAL AGE AND HAND WRIST RADIO GRAPH There are nine developmental stages. 1.First stage of maturation :(PP2= stage) The epiphysis of the proximal phalanx of the index finger has the same width as the diaphysis. This stage occurs approximately 3 years before the peak of the pubertal growth spurt. 2.second stage :(MP3=stage) Epiphysis of the middle phalanx of the middle finger is of the same width as the diaphysis. www.indiandentalacademy.com
  24. 24. BIOLOGICAL AGE GRAPH AND HAND WRIST RADIO 4. Fourth stage :(S-and H2-stage) S-stage: First mineralization of the ulnar sesamoid bone of the metacarpophalangeal joint of the thumb. H2-stage: Progressive ossification of the hamular process of the hamatum. The fourth stage is reached shortly before or at the beginning of the pubertal growth spurt. www.indiandentalacademy.com
  25. 25. BIOLOGICAL AGE GRAPH AND HAND WRIST RADIO 3. Third stage:(Pisi-,H1-,and R= stage) This stage of development can be identified by three distinct ossification areas. These show individual variations but appear at the same time during the process of the maturation. Pisi-stage: Visible ossification of the pisiforme. H1-stage : Ossification of the hamular process of the hamatum. R-stage : Same width of epiphysis and diaphysis of the radius. www.indiandentalacademy.com
  26. 26. BIOLOGICAL AGE GRAPH AND HAND WRIST RADIO 5. Fifth stage:( MP3cap–,PP1cap-,and Rcap-stage) During this stage ,the diaphysis covered by the cap shaped epiphysis. MP3cap–stage: The process begins at the middle phalanx of the third finger. PP1cap-stage : At the proximal phalanx of the thumb. Rcap-stage : At the radius. This stage of ossification marks the peak of the pubertal growth spurt. www.indiandentalacademy.com
  27. 27. BIOLOGICAL AGE GRAPH AND HAND WRIST RADIO 6. Sixth stage :(DP3u-stage) Visible union of the epiphysis and diaphysis at the distal phalanx of the middle finger. This stage of development constitutes the end of the puberal growth. www.indiandentalacademy.com
  28. 28. BIOLOGICAL AGE GRAPH 7. AND HAND WRIST RADIO Seventh stage:(PP3u-stage) Visible union of the epiphysis and diaphysis at the proximal phalanx of the little finger. www.indiandentalacademy.com
  29. 29. BIOLOGICAL AGE GRAPH AND HAND WRIST RADIO 8. Eighth stage :(MP3u-stage) Visible union of the epiphysis and diaphysis at the middle phalanx of the middle finger is clearly seen. www.indiandentalacademy.com
  30. 30. BIOLOGICAL AGE GRAPH AND HAND WRIST RADIO 9. Ninth stage:(Ru-stage) Complete union of the epiphysis and diaphysis of the radius. The ossification of all the hand bones is completed and skeletal growth is completed. www.indiandentalacademy.com
  31. 31. Growth period 1. 2. 3. 4. 5. 6. 7. 8. 9. PP2 MP3 Pisi S MP3 Ru H2 PP3 u MP3 H1 DP3 u 15. 0 13. 0 15. 9 13. 3 15. 9 13. 9 R= cap R u cap PP1 males females 10. 6 8.1 12. 2 8.1 12. 6 9.6 13. 0 10. 6 cap 14. 0 11. 0 www.indiandentalacademy.com 18. 5 16. 0
  32. 32. www.indiandentalacademy.com
  33. 33. Cervical vertebrae maturation indicators The first seven vertebrae in the spinal column constitute the cervical spine. The first two, the atlas and the axis are quite unique, the third through the seventh have great similarity. Maturational changes can be observed from birth to full maturity. Vertebral growth takes place from the cartilagenous layer on the superior and inferior surface of each vertebrae. Secondary ossification nuclei on the tips of the bifid spinous processes and transverses appear during puberty. Secondary ossification nuclei unite with the spinous processes when vertebral growth is complete. After completion of endochondral ossification, growth of the vertebral body takes place by periosteal apposition. It appears to take place only at the front and sides. Todd and Pyle , Lanier and Taylor made measurements from lateral www.indiandentalacademy.com radiographs of the lower cervical vertebrae. Lamparski
  34. 34. Cervical vertebrae maturation indicators      The standard method of evaluating skeletal maturity has been to use a hand- wrist x-ray to compare the bones of an individual’s hand with those in published atlases. To avoid taking an additional x-ray,some researchers sought to relate maturation with dental and skeletal features other than the bones in the hand and wrist. The use of cervical vertebrae to determine skeletal maturity is not new. In 1972, Lamparski concluded that the cervical vertebrae ,as seen on the routine lateral cephalograms , were as statistically and clinically reliable in assessing skeletal age as the hand-wrist technique. He found that the cervical vertebral indicators were the same for females and males, but that females developed the changes earlier. www.indiandentalacademy.com
  35. 35. Cervical vertebrae maturation indicators The use of cervical vertebrae to determine skeletal maturity was suggested by Lamparski in 1972. He concluded that the cervical vertebrae, as seen on routine lateral cephalograms,were as statistically and clinically reliable in assessing skeletal age as the hand-wrist technique. He found that the cervical vertebral indicators were the same for the females and males, but that females developed the changes earlier. www.indiandentalacademy.com
  36. 36. Cervical vertebrae maturation indicators -Lamparski         Six stages of cervical vertebral maturation were described. Stage 1: All inferior borders of the bodies are flat. The superior borders are strongly tapered from posterior to anterior. Stage 2: A concavity has developed in the inferior border of the second vertebrae.the anterior vertical heights of the bodies have increased. Stage 3:A concavity has developed in the inferior border of the third vertebra. The other inferior borders are still flat. Stage 4: All bodies are now rectangular in shape. The concavity of the third vertebra has increased, and a distinct concavity has developed on the fourth vertebra. Concavities on 5 and 6 are just beginning to form . Stage 5: The bodies have become nearly square in shape and the space between the bodies are visibly smaller.concavities are well defined on all six bodies. Stage 6: All bodies have increased in vertical height and are www.indiandentalacademy.com
  37. 37. Cervical vertebrae maturation indicators Cvs1 cvs2 cvs3 cvs4 www.indiandentalacademy.com cvs6
  38. 38. Cervical vertebrae maturation indicators STAGES www.indiandentalacademy.com
  39. 39. Cervical vertebrae maturation indicators www.indiandentalacademy.com
  40. 40. Cervical vertebrae maturation indicators STAGES www.indiandentalacademy.com
  41. 41. Cervical vertebrae maturation indicators 1. Initiaton: • Inferior borders of 2nd 3rd and 4th cervical vertebrae are flat at this stage. • The third and fourth vertebrae are wedge shaped and the superior vertebral borders are tapered from posterior to anterior. • 100% of pubertal growth remains. • Very significant amount of adolescent growth expected. www.indiandentalacademy.com
  42. 42. Cervical vertebrae maturation indicators 2. Acceleration: • Concavities on the inferior borders of second and third vertebrae begin to develop. • Inferior border of fourth vertebrae remains flat. • Vertebral bodies of third and fourth are nearly rectangular in shape. • 65-85% of pubertal growth remains. www.indiandentalacademy.com
  43. 43. Cervical vertebrae maturation indicators 3. Transition : • Distinct concavities are shown on the inferior borders of second and third vertebrae. • A concavity begins to develop on the inferior border of fourth vertebrae. • Vertebral bodies of third and fourth are rectangular in shape. • 25-65% of pubertal growth remains. www.indiandentalacademy.com
  44. 44. Cervical vertebrae maturation indicators 4. Deceleration stage: • Distinct concavities can observed on the inferior borders of second third and fourth cervical vertebrae. • Vertebral bodies of third and fourth begin to be more square in shape. • 10-25% of pubertal growth remains. www.indiandentalacademy.com
  45. 45. Cervical vertebrae maturation indicators 5. Maturation stage: • Marked concavities are observed on the inferior borders of second, third and fourth cervical vertebrae. • Vertebral bodies of third and fourth are almost square in shape. • 5-10% of pubertal growth remains. www.indiandentalacademy.com
  46. 46. Cervical vertebrae maturation indicators 6. Completion: • Deep concavities are observed on the second, third and fourth cervical vertebrae. • Vertebral bodies are greater vertically than horizontally. • Pubertal growth has been completed. www.indiandentalacademy.com
  47. 47. Assessment of skeletal maturation The 5 distinct stages of MP3 as described by HAGG & TARANGER (1980), and 6 th stage (between MP3-H and MP3-I which is called as MP3-HI stage) which was introduced by our prof. Dr.Raja gopal and Dr. Kansal were to be evaluated and compared with six stages of cervical vertebrae which were described by HASSEL & FARMAN(1995). www.indiandentalacademy.com
  48. 48. COMPARISON BETWEEN MP3-F & INITIATION STAGE MP3-F STAGE INITIATION STAGE It represents the onset or the start 1.C2, C3 and C4 inferior vertebral of the curve of pubertal growth body borders are flat. spurt. 2.Superior vertebral borders are FEATURES: tapered from posterior to Epiphysis is as wide as metaphysis. anterior. (Wedge shape). 3.100% of pubertal growth remains. www.indiandentalacademy.com
  49. 49. COMPARISON BETWEEN MP3-FG & ACCELERATION STAGE MP3-FG STAGE ACCELERATION STAGE It represents the acceleration part of 1.Concavities developing in lower the curve of pubertal growth bordres of C 2 & C 3 . spurt. 2.Lower border of c4 vertebral body FEATURES: is flat. 1.Epiphysis is as wide as metaphysis 3.c3 & c4 are more rectangular in shape. 2.There is a distinct medial and or lateral border of the epiphysis forming a line of demarcation at 4.65-85 % of pubertal growth remains. right angle to the distal border. www.indiandentalacademy.com
  50. 50. COMPARISON BETWEEN MP3-G & TRANSITION STAGE MP3-G STAGE TRANSITION STAGE It represents the point of maximum pubertal growth spurt. FEATURES: Sides of epiphysis have thickened and cap its metaphysis forming a sharp edge distally at one or both sides. 1.Distinct concavities in lower borders of c2 and c3 are seen. 2.Developing concavity in lower border of body of c4 is seen. 3.c3 and c4 are rectangular in shape. 4.25-65% of pubertal growth remains. www.indiandentalacademy.com
  51. 51. COMPARISON BETWEEN MP3-H & DECELERATION STAGE MP3-H STAGE DECELERATION STAGE It represents the deceleration part of 1.Distinct concavities in the lower the Curve of pubertal growth bordrs of c2,c3 and c4 are seen. spurt. 2.c3 and c4 are nearly square in FEATURES: shape. Fusion of epiphysis and metaphysis has begun. 3.10-25% of pubertal growth remains. www.indiandentalacademy.com
  52. 52. COMPARISON BETWEEN MP3-HI & MATURATION STAGE MP3-HI STAGE MATURATION STAGE It represents the maturation part of the curve of pubertal growth spurt. FEATURES: 1.Superior surface of the epiphysis shows a smooth concavity. 2.Metaphysis shows a smooth convex surface almost fitting into the reciprocal concavity of epiphysis. 1. Accentuated concavities of inferior vertebral body borders of c2,c3,and c4 are seen. 2. c3 and c4 are square in shape. 3. 5-10% of pubertal growth remains. 3.Radiolucent gap between epiphysis and metaphysis is insignificant. www.indiandentalacademy.com
  53. 53. COMPARISON BETWEEN MP3-I & COMPLETION STAGE MP3-I STAGE COMPLETION STAGE It represents the end of pubertal 1. Deep concavities present on growth Spurt. FEATURES: 1.Fusion of epiphysis and metaphysis is completed. inferior vertebral body borders of c2,c3 and c4. 2. c3 and c4 heights are greater than widths. 3. Pubertal growth has been completed. www.indiandentalacademy.com
  54. 54. Comparison of MP3 and CVMI www.indiandentalacademy.com
  55. 55. Correlation of hand-wrist and cervical vertebral maturation stages A comparative evaluation of hand-wrist and cervical vertebrae was done in our department by Prof.Dr.shyamala and Dr.Akshay gupta to find out the validity of the cervical vertebrae as maturation marker. The following conclusions were drawn: 1. Wide variation in chronological age for different maturity levels suggests that chronological age is a poor indicator of maturity. Skeletal maturity indicators provide a more valid basis than chronological age for grouping of individuals. 2. Females are ahead of males at all levels of skeletal maturity., indicating early age of maturation for female group. 3. Females tend to achieve a higher percentage of their total growth than male especially during mid-adolescence. Early and late adolescence show less variation in percentage of growth completed . 4. cervical vertebrae can be used as an alternative method for evaluation of skeletal maturity, with the same confidence as hand www.indiandentalacademy.com wrist radiographs.
  56. 56. Correlation of hand-wrist and cervical vertebral maturation stages Hand –wrist Cervical vertebral stages Pubertal growth remaining 1-2 Initiation 85-100% 3-4 Acceleration 65-85% 5-6 Transition 25-65% 7-8 Deceleration 10-25% 9-10 Maturation 5-10% 11 completion 0% SMI www.indiandentalacademy.com
  57. 57. STAGES OF TOOTH CALCIFICATION-NOLLA(1960) 10.Root apex completed. 9.Root almost completed,open apex. 8.Two thirds of root completed. 7.One third of root completed. 6.Crown completed. 5.Crown almost completed. 4.Two thirds of crown completed. 3.One third of root completed. 2.Initial calcification. 1.Crypt present. 0.Crypt absent. www.indiandentalacademy.com
  58. 58. Dental age determination according to the stage of mineralization Demirjian et al., in 1973 divided tooth mineralization into nine stages. o. Tooth germ without signs of calcification. A. Calcificaion of single occlusal points without fusion of different calcification. B. Fusion of mineralization points. The contour of the occlusal surface is recognizable. C. Calcification of the crown is complete; beginning of dentin deposits. D. Crown formation is complete up to the cemento enamel junction. E. Root length shorter than crown height. F. Root length larger than crown height. G. Root formation finished. Apical foramen still open. H. Apical foramen is closed. www.indiandentalacademy.com Single rooted tooth Multi rooted tooth
  59. 59. Scores of different dental formation stages The table was made for the left mandibular quadrant. www.indiandentalacademy.com
  60. 60. Conversion chart for dental age determination,calculated according to the score-system of dental formation The overall figure for assessment of dental age is obtained by adding www.indiandentalacademy.com together the separate values for 7 teeth in the lower left quadrant.
  61. 61. DENTAL FORMATION STAGES D-H OF MANDIBULAR CANINE www.indiandentalacademy.com
  62. 62. Tooth mineralization as an indicator of the pubertal growth spurt Diagrammatic appearance of stages C to H of tooth development for uni and multi radicular teeth. www.indiandentalacademy.com
  63. 63. OPG: www.indiandentalacademy.com
  64. 64. Mandibular growth changes & Maturation of cervical vertebrae Maria T o’Reilly & Gary J Yanniello conducted a study on relationship of cervical vertebral maturation and mandibular growth changes using lateral cephalometric radiographs in females age group of 9-15 years. They found that cervical vertebral stages of maturation are related to mandibular growth changes during puberty. An analysis of variance for repeated measurements and Scheffee’s tests reveal significant increase between stages 1 and 2, 2 and 3 and 3 and 4 for mandibular length; between 1 and 2 and 2 and 3 for corpus length; and between 1 and 2 for ramus height.On the average, stages1 through 3 occurred prior to peak velocity, with 2 and 3 in the year preceeding peak growth velocity. www.indiandentalacademy.com
  65. 65. Clinical significance:        1. Treatment involving modification of skeletal growth seems to demand as much as information as possible about patient’s growth potential. 2. Orthodontic appliances such as the mandibular protraction appliance, Herbst appliance, Frankel, Bionator, Twin block and activator. 3. In cases where patient require orthopedic changes using head gears and protraction masks. 4. Prior to rapid maxillary expansion. 5. In patients with marked discrepancy between dental and chronological age. 6. Orthodontic patients requiring orthognathic surgery if under taken during growth period. 7. When maxillo mandibular changes are indicated in the treatment of class III cases, skeletal class II cases or skeletal open bites. www.indiandentalacademy.com
  66. 66. LATERAL CEPHALOGRAM: www.indiandentalacademy.com
  67. 67. LATERAL CEPHALOGRAM: www.indiandentalacademy.com
  68. 68. LATERAL CEPHALOGRAM: www.indiandentalacademy.com
  69. 69. LATERAL CEPHALOGRAM: www.indiandentalacademy.com
  70. 70. LATERAL CEPHALOGRAM: www.indiandentalacademy.com
  71. 71. Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com

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