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Skeletal maturity /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
0091-9248678078

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  • 1. Skeletal Maturity indicators INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. Introduction  Adolescence  It is the transitional period b/w juvenile stage and adulthood during which the secondary sexual characteristics appear, the adolescent growth spurt takes place, fertility is attained, and profound physiologic changes occur.(PROFFIT) - Important period - Treatment planning & outcome of treatment Growth potential –important during Adolescence and preadolescence www.indiandentalacademy.com
  • 3.  Chronological age is a poor indicator of specific stages of maturation  BIOLOGICAL AGE -determined from skeletal, dental, morphologic age and onset of puberty  Individual variation in timing, duration and the velocity of growth, skeletal age assessment essential  Skeletal maturation refers to the degree of ossification in bone – closely related to sexual maturity www.indiandentalacademy.com
  • 4.  During growth every bone goes through a series of changes seen radiographically  Sequence relatively consistent for a given bone  The timing of changes varies – according to biological clock  statural growth acceleration precedes facial growth acceleration by 6-12 months www.indiandentalacademy.com
  • 5.  Developmental status of the child judged by : i. peak height velocity ii. menarche in case of girls iii. voice change in boys iv. dental development v. skeletal ossification  The orthodontist – has to work with growth  Assessment of skeletal age is important to know whether any growth remains in individual and what percentage of growth can be expected. www.indiandentalacademy.com
  • 6. Growth spurts A spurt is defined as growth acceleration up to a maximum where the annual increment of growth exceeded the previous one by at least 0.7mm -Erkstrom. www.indiandentalacademy.com
  • 7. Normal growth spurts  infantile spurt – 3years  juvenile spurt – 7-8 years females, 8-10 years males.  Pubertal spurt – 10-13 years females, 13-15 years males.  Growth spurts – acceleration phase and deceleration phase. Growth modulation www.indiandentalacademy.com
  • 8.  The pubertal growth spurt most important for the orthodontist : as this spurt shows the maximum growth changes (WOODSIDE)   According to ‘PROFFIT’ juvenile growth spurt in girls may be as large, or even greater than the pubertal growth spurt. growth modulation – mixed dentition (girls) early permanent dentition (boys) www.indiandentalacademy.com
  • 9. Best indicator for the pubertal growth spurt is the attainment of the peak height velocity The clinician prefers to start the treatment during the acceleration phase  Earlier in girls www.indiandentalacademy.com
  • 10. WOODSIDE www.indiandentalacademy.com
  • 11. Skeletal maturity indicators  Hand and wrist radiographs,  Cervical vertebrae  Mid palatal suture  Corpus index  Tooth mineralization www.indiandentalacademy.com
  • 12. Hand and wrist radiographs  Chronological age- not sufficient for assessing the developmental stage and the somatic maturity of the patient  Assessment of the skeletal age is made with the help of hand radiographs which can be considered as biological clock www.indiandentalacademy.com
  • 13.  Standard method for the evaluation of the skeletal age  Easily identifiable maturity indicators  Reliable  Serves source of maturation process as a useful diagnostic aid www.indiandentalacademy.com
  • 14.  Roentgen -1895  Rowland – 1896 growing bone as maturity indicator –first H&W radiograph.  Proyr. Rotch and Crampton -1900 tabulated indicators of hand and wrist.  Carter – 1926 study on carpal bones of children.  Hellman - 1928 studied the ossification of the epiphyseal cartilages of hand.  Todd and Stuart– 1929 – data on hand wrist radiographs.  Greulich and Pyle -1936 studied the calcification of carpal sesamoid www.indiandentalacademy.com
  • 15.  1959 – Atlas form  Flory 1936 – beginning of calcification of the carpal sesamoid – determine the period immediately before puberty  Bambha 1961-facial spurt occurred little later than the body height spurt  Hunter 1966- carpel bones-most satisfactory for determining skeletal maturation  Bjork 1972 – divided the maturation process of bones of the hand b/w 9 – 17yr into 8 developmental stages  Grave & Brown 1976 – skeletal age determined with the help of 6 ossification centers www.indiandentalacademy.com
  • 16.  Leonard.s.Fishman 1982 developed a system for evaluation of SMI’s in the hand & wrist.  Hagg & Taranger 1982 – correlated maturity indicators to the pubertal growth spurt. www.indiandentalacademy.com
  • 17. Hand & wrist radiograph www.indiandentalacademy.com
  • 18. Indications for hand & wrist radiographs  Prior to rapid maxillary expansion  When maxillomandibular changes are indicated  Marked discrepancy b/w chronologic and dental age  Orthodontic patients requiring orthognathic surgery between 16 &20 yrs of age. www.indiandentalacademy.com
  • 19.  Most commonly used, comprising of 28 – 30 separate centers of bone growth and maturation www.indiandentalacademy.com
  • 20. Anatomy of skeleton of the hand Distal ends of long bones Carpals Metacarpals Phalanges Carpel bones: I. Trapezium II. Trapezoid III. Capitate IV. Hamate V. Hamular processof the hamate VI. Triquetral VII.Pisiform VIII.Lunate IX. Scaphoid www.indiandentalacademy.com
  • 21. Atlas method of Greulich & Pyle  Radiograph is compared with a standard series of films, representative of normal children at different chronological ages and for each sex. www.indiandentalacademy.com
  • 22. Bjork, Grave & Browns method (1976 ) 9 developmental stages  Area of ossification events Area of phalanges Carpel bones Radius  This method describes the relationship b/w the epiphyses and the diaphysis in 3 stages www.indiandentalacademy.com
  • 23. Stages of ossification www.indiandentalacademy.com
  • 24. First stage:  PP2 = stage  Occurs 3yrs before prepubertal growth spurt www.indiandentalacademy.com
  • 25. Second stage:  MP3 = stage www.indiandentalacademy.com
  • 26. Third stage:  Three ossification areas  Pisi-,H1-,and R = stage www.indiandentalacademy.com
  • 27. Fourth stage:  S- and H2 stage  Reach shortly before or at the beginning of the pubertal growth spurt www.indiandentalacademy.com
  • 28. Fifth stage:  MP3 cap, PP1 cap and R cap stage  Marks the peak of pubertal growth spurt www.indiandentalacademy.com
  • 29. Sixth stage  DP3 U stage – constitues the end of pubertal growth www.indiandentalacademy.com
  • 30. Seventh stage  PP3 U stage www.indiandentalacademy.com
  • 31. Eighth stage  MP3 U stage www.indiandentalacademy.com
  • 32. Ninth stage : R u stage  Ossification of all the hand bones is completed and skeletal growth is finished. www.indiandentalacademy.com
  • 33. Average values of ages(Schopf) 1978 www.indiandentalacademy.com
  • 34. Growth rhythm curveBJORK www.indiandentalacademy.com
  • 35. A clinically oriented method based on hand &wrist films leonard Fishman angle orthodontist 1982 A system for the evaulation of skeletal maturity from H&W radiographs is developed & presented with complete details for implementation in clinical practice. www.indiandentalacademy.com
  • 36. SMA This system uses; - Only four stages of maturation - Six anatomic sites located on the thumb, third finger, fifth finger radius. www.indiandentalacademy.com
  • 37. 11 discrete adolescent SMIs System of SMA -organized -relatively simple www.indiandentalacademy.com
  • 38. widening of epiphysis relative to its diaphysis - First appears as a small center of ossification centrally located in the diaphysis. - when developed to the width of diaphysis Applicable as a SMI www.indiandentalacademy.com
  • 39. Four stages of maturation www.indiandentalacademy.com
  • 40. Capping occurs in the transition Fusion follows capping. www.indiandentalacademy.com
  • 41. 11 Skeletal maturity indicators www.indiandentalacademy.com
  • 42. www.indiandentalacademy.com
  • 43.  With this approach key stages are checked first.  Adductor sesamoid- whether seen or not. www.indiandentalacademy.com
  • 44. Materials and methods  Longitudinal and cross sectional data  170 females &164 males-longitudinal gp.  Lateral cephalograms& hand wrist radiographs  1040 radiographs-cross-sectional sample www.indiandentalacademy.com
  • 45. Measurements & evaulation  Maxillary and mandibular measurements made  S-A & Ar-A – maxilla  S-Gn & Ar-Gn -mandible www.indiandentalacademy.com
  • 46. Cronological age values for adolescent skeletal maturity indicators www.indiandentalacademy.com
  • 47. Results  The sex difference in time was approx.1yr at maturity levels 1 & 2  2 yrs at SMI levels 7 &8  Decreased to 1.3 yr at SMI level 11 www.indiandentalacademy.com
  • 48. SMI level -6,50% of adolescent growth www.indiandentalacademy.com
  • 49. Summary  Growth patterns including growth rates for statural height and face were studied  Skeletal maturation age as measured with SMI – more valid basis than cronological age for grouping individuals  Alterations in maturational developments are directly related to growth velocity www.indiandentalacademy.com
  • 50.  Facial growth as measured in max. and mand. – close direct association between variations in the rate of growth  Females tended to achieve a higher percentage of their total statural growth than males during early adolescence  Female showed greater growth velocities and earlier maturation in stature and in max.  Mandibular velocities highest in the males www.indiandentalacademy.com
  • 51.  After peak growth, velocities diminished more rapidly in females than in males www.indiandentalacademy.com
  • 52. Physiological timing of Orthodontic treatment Julian Singer Oct.1979,AO. To take advantage of growth when the major growth increments are likely to occur Purpose of the paper 1.To enable the clinician to rapidly and with some degree of reliability utilize the hand and wrist film to determine the maturation status. www.indiandentalacademy.com
  • 53. 6 stages of hand & wrist developement Stage 1(early) Absence of pisiform, Hook of hamate. Epiphysis of proximal phalanx Of second digit narrower than Its shaft www.indiandentalacademy.com
  • 54. Stage 2(prepubertal) -Initial ossification of pisiform & Hook of hamate. -Proximal phalanx of second digit And its epiphysis are equal in width www.indiandentalacademy.com
  • 55.  Stage 3( pubertal onset)  Beginning of calcification of ulnar sesamoid  Increased ossification of pisiform & hook of hamate www.indiandentalacademy.com
  • 56.  Stage 4(pubertal)  Calcified ulnar sesamoid  Capping of shaft of middle phalanx of third digit by its epiphysis-MP3cap. www.indiandentalacademy.com
  • 57.  Stage 5(pubertal decelaration)  Ulnar sesamoid fully calcified  DP3u stage  All phalanges and carpals fully calcified  Epiphyses of radius and ulna not fully calcified with respect to shafts www.indiandentalacademy.com
  • 58.  Stage 6(growth completion)  No remaining growth sites www.indiandentalacademy.com
  • 59. Summary  As quoted by Singer  Maximum mand growth-before appearance of S.  Pileski et al - Stages 3 or 4 frequently mentioned for onset of treatment - The peak of growth velocity may have passed www.indiandentalacademy.com
  • 60.  Armstrong- tissue response most rapid in mixed dentition stage  Judicious use of hand and wrist film to assess the developemental status – effective correction in short period of time(prepubertal) www.indiandentalacademy.com
  • 61.  Stage 2 (prepubertal)- mandibular growth in girls reached peak  Late growth of the mandible should be considered www.indiandentalacademy.com
  • 62. Conclusions  Hand and wrist film can be used as an indicator of the maturational status of Orthodontic pt.  6 stages advocated as guidelines for t/t timing  Stage 2- important prepubertal period during which Cl.II correction could be effectively achieved  Stage 5-period of residual growth during which post t/t changes could occur www.indiandentalacademy.com
  • 63. Maturation indicators and the pubertal growth spurt Urban Hagg, John Taranger AJO Oct 1992. Pubertal growth spurt and maturation of a sample of 212 swedishchildren were analysed - 90 girls &122 boys. Factors studied 1.Definition of pubertal growth spurt,age at the beginning ,peak and end of the pubertal growth spurt. www.indiandentalacademy.com
  • 64. d www.indiandentalacademy.com
  • 65. 2. Age at the attainment of specified maturation level indicators 3.The association betn the specified maturation level and pubertal growth spurt By comparing with standard for age and sex - Average - Accelerated - Retarded www.indiandentalacademy.com
  • 66. Method  Subjects examined once a year according to planned schedule - Data on standing height - Tooth emergence - Pubertal development - Radiograph of the right hand and wrist Menarche – 10 years + every 3 months Voice change – 10 years + annual voice assessment www.indiandentalacademy.com
  • 67. www.indiandentalacademy.com
  • 68. Method of analysis  Adolescent growth studied by graphic analysis 320yrs  PHV  Onset www.indiandentalacademy.com
  • 69.  Dental development was assessd by dental emergence stages ( DES)  Stages devised by Bjork + 2 new stages DESM3 & DESM5 www.indiandentalacademy.com
  • 70. Skeletal development- in the hand and wrist – analysed by annual radiographs-6-18 yrs  Four bones - as indicators of skeletal development  UlnarSesamoid  Middle phalanx of the third finger  Distal phalanx of third finger  Distal epiphysis of radius www.indiandentalacademy.com
  • 71. Ulnar sesamoid 2 stages www.indiandentalacademy.com
  • 72. Distal phalanx of third finger (DP3)  Stage I www.indiandentalacademy.com
  • 73. Middle phalanx of the third finger(MP3) 5 stages www.indiandentalacademy.com
  • 74. Distal epiphysis of radius 3 stages www.indiandentalacademy.com
  • 75. Pubertal developement  Assesed from 10-18 years  Menarche in girls  Voice change in boys www.indiandentalacademy.com
  • 76. Results 1. Pubertal growth spurt  Large differences in the ages and growth events.  Onset 10 & 12.1 yr,END at 14.8 &17.1 yr.  PHV 2 yrs after onset in both sexes. www.indiandentalacademy.com
  • 77. Dental development and pubertal growth spurt  Weak corelation  Clinical interest  DES2 attained or passed by all subjects at onset  DES3 attained or passed by all subjects at PHV  DES4 attained before end by all boys and At End by all girls  DESM3 attained or passed by all boys at PHV  DESM4 attained or passed by all boys before and by all girls at end www.indiandentalacademy.com
  • 78. Skeletal development and pubertal growth spurt  Skeletal  Onset  PHV  End development at more advanced in girls more advanced in girls more advanced in boys www.indiandentalacademy.com
  • 79. Clinically important findings  S- attained during acceleration period of pubertal growth spurt  MP3 – F – attained before onset by 40%  MP3FG – 1 yr before or at PHV by 90%  MP3G- at or one yr after PHV by 90%  MP3H after PHV but before end by all boys and 90% girls  MP3I before or at end in all subjects www.indiandentalacademy.com
  • 80. Distal third phalanx  DP3I – during the deceleration period of pubertal growth spurt  RADIUS  R.I- 1 yr before or at end by about 80% of girls and 90% of boys  RIJ & RJ not attained before END by any subject www.indiandentalacademy.com
  • 81. Pubertal development and the pubertal growth spurt  Close association  Girls – menarche – 1.1 yr after PHV  Boys – PV 0.2 yr before PHV MV 0.9 yr after PHV  All girls – menarche at the end  All boys – male voice during pubertal growth spurt. www.indiandentalacademy.com
  • 82. Summary  Bjork ,Grave & Browns method S & H2 stagebeginning of pubertal spurt.  MP3cap,PP1cap & Rcap stage- peak of pubertal spurt.  DP3u stage-end of pubertal spurt. www.indiandentalacademy.com
  • 83. Fishmans method www.indiandentalacademy.com
  • 84. Hagg &Taranger method  F-onset of the curve of pubertal growth spurt  FG-acceleration part of the curve of pubertal growth spurt.  G- peak of the curve.  H-deceleration part of the curve of pubertal growth spurt  I-end of the pubertal growth spurt. www.indiandentalacademy.com
  • 85. Ossification of the distal phalanx of the first digit as a maturity indicator for initiation of orthodontic treatment of class III malocclusion in Japanese women Shigemi Goto, et al., AJO Nov 1996 Japanese female patients Purpose: stage of skeletal maturation of the first digit of the distal phalanx as an indicator of the residual growth potential in patients with mild to moderate class III malocclusions www.indiandentalacademy.com
  • 86.  Ossification of the epiphyses of the distal phalanx – occurs from 1-3 yrs after the pubertal growth peak.  Closely associated with declining growth rate of mandibular condyles  Indication for initiation of orthodontic treatment in subjects with mild to moderate class III malocclusion www.indiandentalacademy.com
  • 87. Stages of ossification www.indiandentalacademy.com
  • 88. Results:  Complete fusion of the distal phalanx occurs after 90% of the total growth in length of the cranial base and the maxillary and mandibular lengths is over  Minimal craniofacial growth was left after the stage particularly in females. www.indiandentalacademy.com
  • 89. Stage E4 www.indiandentalacademy.com
  • 90. Conclusions  Determination of the stage of skeletal maturation of the distal phalanx of the first digit may provide quick and useful clinical method for assessing the residual growth potential  Helpful in patients whose continued mandibular growth could be detrimental to the stability of t/t result www.indiandentalacademy.com
  • 91.  Mandibular growth may still continue in more severe skeletal discrepancy-ANB > -6 www.indiandentalacademy.com
  • 92. Pre treatment case I www.indiandentalacademy.com
  • 93. www.indiandentalacademy.com
  • 94. www.indiandentalacademy.com
  • 95. Cervical vertebrae  Lamparski-1972 O reilly & Yanniello(1988)-used CVMA  Hassel &Farman(1995)-skelatal maturity can be evaluated at any given time using CVMI.  Garcia Fernandez(1998)- mexican population.  Raja Gopal & Kansal(2002)- found a high correlation bn six MP3 stages & six stages of CV maturation. www.indiandentalacademy.com
  • 96. Skeletal maturation evaluation using cervical vertebrae-AJO 1995 BRENT HASSEL& FARMAN Bolton brush growth centre Cervical vertebrae maturation index – 2,3 & 4 cervical vertebrae Sample: 220 subjects 8- 18 yrs Anomalies were checked for. Fractures Ankylosis Infections www.indiandentalacademy.com
  • 97. Method  Fishmans system- H & W radiograph  Lateral ceph. & H&W radiograph Dens(odontoid process) Body of C3 Body of C4 www.indiandentalacademy.com
  • 98. 11 Skeletal maturity indicators www.indiandentalacademy.com
  • 99. Results  Six categories of CV maturation defined www.indiandentalacademy.com
  • 100. CATEGORY 1(initiation)  Corresponds  80-100% to SMI 1&2. of growth expected  Inferior borders of C2,C3 & C4 were flat  Vertebrae  Tapered wedge shaped from post. to Ant. www.indiandentalacademy.com
  • 101. CATEGORY 2 (acceleration)  Corresponds to SMI 3&4  65-85% of growth expected  Inferior borders of C2,C3- concavities developing  Inf. Border C4 flat  C3 &C4 bodies rectangular www.indiandentalacademy.com
  • 102. 3 (transition)  Corresponds toSMI 5& 6  25-65% GROWTH EXPECTED  Distinct concavities-C3&C4  Concavity begins to developC4  C3 &C4 rectangular. www.indiandentalacademy.com
  • 103. CATEGORY4(DECELERATION)  Corresponds to SMI 7&8.  10-25% growth expected  Distinct concavities- C2, C3&C4.  C3&C4-becoming square in shape. www.indiandentalacademy.com
  • 104. CATEGORY 5(maturation)  Corresponds  5-10% to SMI 9 & 10 growth expected.  Accentuated concavities-C2,C3 &C4.  C3 &C4 almost square in shape. www.indiandentalacademy.com
  • 105. CATEGORY 6 (COMPLETION)  Corresponds  Adolescent  Deep toSMI 11 growth complete concavities-C2, C3 &C4.  Vertebral bodies greater vertically than horizontally. www.indiandentalacademy.com
  • 106. The cervical vertebrae as maturational indicators GARCIA FERNANDEZ JCO APRIL 1998  Mexican population  Sample-113 patients  H& W-FISHMAN  Cervical vertebraeHASSEL &FARMAN www.indiandentalacademy.com
  • 107. RESULTS www.indiandentalacademy.com
  • 108. RESULTS www.indiandentalacademy.com
  • 109. A comparision of modified MP3stages &the cervical vertebrae as maturity indicators RAJAGOPAL and KANSAL JCO JULY 2002 Aim :determine whether the 6 modified MP3 stages could be correlated with the 6 stages of CVMI’s. Materials 75 males &75 females– Age-9-17yrs Lateral cephalograms & periapical radiographs www.indiandentalacademy.com
  • 110. www.indiandentalacademy.com
  • 111. MP3-F & CVMI 1 www.indiandentalacademy.com
  • 112. MP3-FG & CVMI 2 www.indiandentalacademy.com
  • 113. MP3-G 7CVMI 3 www.indiandentalacademy.com
  • 114. MP3-H &CVMI 4 www.indiandentalacademy.com
  • 115. MP3-HI &CVMI 5 www.indiandentalacademy.com
  • 116. MP3-I & CVMI-6 www.indiandentalacademy.com
  • 117. Results www.indiandentalacademy.com
  • 118. conclusions  Modified MP3 stages using periapical Xray film can be an accurate & simple growth indicator. www.indiandentalacademy.com
  • 119. Maturational evaluation of ossification of the mid palatal suture BERNAL REVALO,FISHMAN AJO MARCH 1994 PURPOSE:positive correlation b/n adolescent maturation development and the approximation of the mid palatal suture. Method- H&W radiographs – Fishman’s method Occlusal radiographs-Approx. of mid palatal suture. Sample 39 males & 45 females- 8-18 yrs www.indiandentalacademy.com
  • 120. www.indiandentalacademy.com
  • 121. Results  Increase in sutural approx. as SMI stages progressed.  SMI 1&2(PP3&MP3=)- decreased sutural approx.  After SMI 9(PP5u)- significant increase in the sutural approx.  No significant difference b/n sexes. www.indiandentalacademy.com
  • 122. www.indiandentalacademy.com
  • 123. www.indiandentalacademy.com
  • 124. www.indiandentalacademy.com
  • 125. Results  Significant correlation b/n maturational development & beginning of ossification.  At SMI 3(MP5) only 8% fused.  At SMI 9(PP3u) –approx. 25% of fusion.  At SMI 11(Rf)- 50% of fusion. www.indiandentalacademy.com
  • 126. Conclusion  Best to accomplish ME-before SMI 9.  Ideal time- SMI 1- 4  Less orthopedic force required.  Mid palatal approx. occurs more posteriorly. www.indiandentalacademy.com
  • 127. Tooth mineralization as an indicator of the pubertal growth spurt CHERTKOW AJO 1980  AIM:To investigate the relationship b/n stages of mineralization of various teeth & other maturational indicators of pubertal growth spurt.  Method &materials197 patients  Panoramic radiographs  H & W radiographs www.indiandentalacademy.com
  • 128.  Max. & mandibular canines,1&2 premolars & mandibular second molars  Appearace of sesamod,MP3cap & calcification of hook of hamate. www.indiandentalacademy.com
  • 129. Dental formation stages(Demirjian) www.indiandentalacademy.com
  • 130. Results  Uniformity of development of mand. canine  No sexual dimorphism.  Marked racial differences.  Mand. Canine – calcification pattern similar in boys & girls.  Definite relationship b/n development of mandibular canine & other indicators of pubertal growth spurt.  Caucasian population- stage G coincided with other maturity indicators. www.indiandentalacademy.com
  • 131. www.indiandentalacademy.com
  • 132. Conclusion  Completion of root formation of mand canine,prior to apical closure Maturity indicator www.indiandentalacademy.com
  • 133. Mandibular skeletal maturity assessment Santosh C Verghese J M Jayraj U S Krishna Nayak Jios June 2003 Purpose : Deduce a simpler method of estimating the skeletal maturity of mandible using corpus index obtained from transverse slicing section of the mandible - Correlating values of the corpus index to cervical maturation stages www.indiandentalacademy.com
  • 134. Materials & methods  Sample 60 pts - 30 males & 30 females(9 to 16 yrs) www.indiandentalacademy.com
  • 135. Measurements www.indiandentalacademy.com
  • 136. Transverse slicing section(TSS)  MEASUREMENTS  BCT  LCT  LBT  MCH  MCD  Corpus indexMCH/MCD www.indiandentalacademy.com
  • 137. RESULTS www.indiandentalacademy.com
  • 138. RESULTS  Corpus index scoring of 1.8 – pubertal growth potential of 65 to 85 %  Scoring of 2.03 – pubertal growth potential of 25-65%  Scoring of 2.15 – 10-25% pubertal growth  Scoring of 2.35 – 5-10% pubertal growth  Scoring of 2.5- completion of pubertal growth www.indiandentalacademy.com
  • 139. Conclusion  Orthopedic t/t can be accomplished - pt shows a corpus index of 1.8  2.05 – fixed functional orthopedic t/t  2.17 – orthopedic appliances minimal skeletal & more of dental changes www.indiandentalacademy.com
  • 140. Frontal sinus development as an indicator of somatic maturity at puberty Pancherz &Sabine Ruf AJO NOV 1996  To evaluate the possibility of predicting the stage of somatic maturity by analyzing frontal sinus growth.  Sample size-53 boys  Method: analysis of lateral headfilms. -2 lateral headfilms-1yr or 2yrs -2 prediction intervals T1&T2 www.indiandentalacademy.com
  • 141. Frontal sinus measurements www.indiandentalacademy.com
  • 142. Previous study results  Frontal sinus growth velocity at puberty is closely related to body height growth velocity  Frontal sinus growth shows a well defined pubertal peak(Sp) which on the average occurs 1.5 yr after body ht. peak  In males – average age at frontal sinus peak is 15.1 yrs www.indiandentalacademy.com
  • 143. Previous study results 1 yr interval,peak growth velocity T11.3mm/yr.  2 yr interval,peak growth velocity T21.5mm/yr. www.indiandentalacademy.com
  • 144. Prediction procedure  If SV greater than T value (T1or T2)frontal sinus peak was reached during prediction interval & Bp 1.4 yr before.  If SV less than T value – prepeak or postpeak ? Chronological age used  If <15.1 yrs Sp not been reached Bp not reached or occured less than 1.4 yr before www.indiandentalacademy.com
  • 145. Prediction procedure > 15.1 yrs Sp has occurred and Bp also occurred more than 1.4 yr before the beginning www.indiandentalacademy.com
  • 146. Accuracy of prediction  If only prediction was whether the pubertal growth maximum has passed the precision of the method was high-90%.  If incidence of body ht. peak was to be predicted – accuracy was much lower55.5%(1yr) & 57.7% (2yrs). www.indiandentalacademy.com
  • 147. References       Hassel B, Farman A G.”Skeletal maturation evaluation using cervical vertebrae” Am J Orthod,1995; 107:58-61 Julian Singer “ Physiologic timing of orthondic treatment”. Angle Orthod, 1980;50:320-333. Hagg U,Taranger J “ Maturational indicators and the pubertal growth spurt”. Am J Orthod, 1982; 88:299-309 Revelo B,Fishman LS,” Maturational evaluation of ossification of midpalatal suture”. Am J Orthod,1994;105:288-292 Ruf S,Pancherz,” Frontal sinus development as an indicator for somatic maturity at puberty”. Am J Orthod ; 1996; 110: 476-82 Fishman L S,” Radiographic evaluation of skeletal maturation”. Angle Orthod ; 1982; 52:89-111 www.indiandentalacademy.com
  • 148. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com