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1. Hand Wrist Radiographs
&
Maturity Indicators
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2. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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3. 


Understanding of growth events is of primary
importance in orthodontics.
Individual variations regarding timing, velocity
of growth.
To assess growth, prediction of amount of
growth left SKELETAL MATURITY
INDICATORS are used.
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4. Skeletal Maturity
“a measure of how far the bones of an area have
progressed towards maturity, not in size, but in
shape and in their relative positions one to
another, as visualized in a radiograph”.
Hand Wrist Radiograph
Cervical Vertebrae
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5. Why study maturity indicators ?
Exact status of growth ( magnitude & direction )
For treatment planning.
…potential vector of facial development…
…growth potential left..
….onset of treatment timing…
…type of effective treatment… Functional appliance,
orthodontic fixed treatment, Orthognathic surgery.
....treatment prognosis.
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6. “Chronologic age is not a reliable developmental
yardstick , as it is not necessarily correlated with
the maturational age of the patient”
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7. 
Key to successful treatment
of growth .

To take advantage of growth we must have an
idea of its magnitude, direction & timing.

Timing
Knowledge of skeletal maturity
indicators is important.
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Utilization

8. Handwrist radiograph
Numerous small bones which show a predictable
sequence of ossification from birth to maturity
Ossification of the bones of hand and wrist is
standard for skeletal development.
Calculation of skeletal age
Ossification and development of bones form a
chronology of skeletal development
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9. Components of hand and wrist
Phalanges
Metacarpals
Carpals
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10. 
Adductor sesamoid – Small nodular bone
present in region of thumb.

To obtain an estimate of timing of adolescent
growth spurt
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12. Stages of ossification of phalanges
capping
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fusion

13. Fishman Skeletal Maturity
Assessment (1982)
11 Skeletal Maturity Indicators
4 stages of bone maturation
6 anatomical sites
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15. A) WIDTH OF EPIPHYSIS EQUALS DIAPHYSIS
1. PP3 =
2. MP3 =
3. MP5 =
B) OSSIFICATION
4. Adductor sesamoid of thumb
P
ubertal growth spurt
(Acceleration)
C) CAPPING
5. DP3 cap
6. MP3 cap
7. MP5 cap
D) FUSION
8. DP3
9. PP3
10. MP3 11. Radius
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16. Adolescent period of development
Accelerating Growth (SMI 1 to 3)
Peak velocity of growth (SMI 4 to 7)
Decelerating growth (SMI 8 to11).
Childhood
Adolescence
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18. Thank you
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Leader in continuing dental education
www.indiandentalacademy.com