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1. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. Methods
1 . Comparison method
:
a) visual comparison
b)rating of individual bone using a
biologically weighted scoring system by Tanner
et al
2. Evaluation of development of the pt. to
his own growth potential in order to assess
peak growth .

3. Most commonly used methods are :




Bjork , Grave and Brown
Singers method
Fishmans smi
Hagg and Taranger

4.  GREULICH AND PYLE METHOD (1950):


Early approaches
Practical difficulty
 TANNER AND WHITE HOUSE METHOD
-
:
individual bone technique
- assigns a numerical score , ranging from 0 – 100 to 8 or 9
stages of development of each of 20 bones
-
this method gives an advanced rating

5. Bjork (1972) , Grave and Brown ( 1976)
9 developmental stages in
maturation process of bones of
hand between 8 – 18 yrs
There are 3 stages of
ossification



First stage ( = )
Second stage ( = cap )
Third stage ( = u )

7. PP2 STAGE

8. MP3 STAGE

9. PISI H-1
R= STAGE

10. S H-2 STAGE

11. MP3 PPI R CAP

12. DP3u stage

13. PP3u stage

14. MP3u stage

15. Ru stage

16. Correlation table b /t ossification stages of hand and
bones and skeletal ages for period between 8 – 18
yrs ( schopf 1978 )

17. Singers method
by Julian singer (1980 )
enables the clinician to rapidly and with some degree
of reliability helps to determine the maturational
status of the pt .

18. STA
GE
1
2
3
4
5
6
Pisiform
and
hamate
-
pp2
sesmoid Mp3
cap
narrow
-
-
-
Initial
equal
-
-
-
-
-
prese
nt
-
increase increas
d
ed
calcified
begins
calcified
calcified
Dp3
calcified
Calcified

19. Hagg and Taranger
212 Swedish children from birth to adulthood were
studied
Data on :




Standing height
Tooth emergence
Pubertal development
Radiograph of rt hand wrist was obtained
- ulnar sesmoid
- mp3 and dp3
- distal epiphysis of radius

20. sesamoid :
attained during acceleration period of pubertal gr. Spurt

21. Third finger middle phalanx

22. In a study done by Rajkumar
and Sudhanshu kansal (jco
2002 ) – a comparision of
modified MP3 & cvmi as
growth indicators - they
introducud a new stage MP3 – HI STAGE

23. Third finger distal phalanx
Dp3 – I :fusion of epiphysis
and metaphysis is completed
Attained during
deacceleration period I.e end
of PHV

24. Radius

25. girls

26. boys

27. Dental development
Was assessed by dental emergence stages(DES)
tooth is considered emerged if any part of crown is visible
DENTAL EMERGENCE STAGES :
teeth ant to molars
DES 1
DES 2
DES 3
DES 4
1 –7 incisors
all incisors
1 – 2 canines
all canines &premolars

28. Molar teeth :
DES 1
DES 2
DES 3
DES 4
DES 5
DES 6
1- 3 molars
all 1st molars
1-3 2nd molars
all 2nd molars
1 – 3 3rd molars
all 3rd molars

31. PUBERTAL DEVELOPMENT
WAS ASSESSED FR. 10 – 18 YRS


Occurrence of menarche in girls
Voice changes in boys
RESULTS
on average , pubertal spurt began at 10 and 12 yrs and
ended at 14.8 &17.1 yrs in girls and boys
respectively
Phv occurred 2 yrs after onset -12 yrs in girls
& 14.1 yrs in boys

32. Skeletal development and pubertal growth spurt
Dental dev. $ pubertal gr. Spurt
Pubertal dev. $ pubertal growth spurt
CONCLUSION : the peak and end determined and
not the beginning

33. Fishmans skeletal maturity
indicators
Proposed by Leonard s. Fishman in 1982
Anatomical sites
Uses 4 stages of maturation

37. Hand wrist observation scheme

41. Limitation of hand wrist radiograph
Variation
Sex variation
Anatomical and morphologic variability
Difference in development
Margin of error
Observer variation
Correlated
clinically

42. Skeletal maturation evaluation using cervical
vertebrae
By Hassel & Farman (1995)


primary objective ??
Lamparski studied changes in shape and size

44. Thank you
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