Skeletal maturity /certified fixed orthodontic courses by Indian dental academy

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Skeletal maturity /certified fixed orthodontic courses by Indian dental academy

  1. 1. Skeletal Maturity indicators INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 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. 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. 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. 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. 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. 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. 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. 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. 10. WOODSIDE www.indiandentalacademy.com
  11. 11. Skeletal maturity indicators  Hand and wrist radiographs,  Cervical vertebrae  Mid palatal suture  Corpus index  Tooth mineralization www.indiandentalacademy.com
  12. 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. 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. 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. 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. 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. 17. Hand & wrist radiograph www.indiandentalacademy.com
  18. 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. 19.  Most commonly used, comprising of 28 – 30 separate centers of bone growth and maturation www.indiandentalacademy.com
  20. 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. 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. 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. 23. Stages of ossification www.indiandentalacademy.com
  24. 24. First stage:  PP2 = stage  Occurs 3yrs before prepubertal growth spurt www.indiandentalacademy.com
  25. 25. Second stage:  MP3 = stage www.indiandentalacademy.com
  26. 26. Third stage:  Three ossification areas  Pisi-,H1-,and R = stage www.indiandentalacademy.com
  27. 27. Fourth stage:  S- and H2 stage  Reach shortly before or at the beginning of the pubertal growth spurt www.indiandentalacademy.com
  28. 28. Fifth stage:  MP3 cap, PP1 cap and R cap stage  Marks the peak of pubertal growth spurt www.indiandentalacademy.com
  29. 29. Sixth stage  DP3 U stage – constitues the end of pubertal growth www.indiandentalacademy.com
  30. 30. Seventh stage  PP3 U stage www.indiandentalacademy.com
  31. 31. Eighth stage  MP3 U stage www.indiandentalacademy.com
  32. 32. Ninth stage : R u stage  Ossification of all the hand bones is completed and skeletal growth is finished. www.indiandentalacademy.com
  33. 33. Average values of ages(Schopf) 1978 www.indiandentalacademy.com
  34. 34. Growth rhythm curveBJORK www.indiandentalacademy.com
  35. 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. 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. 37. 11 discrete adolescent SMIs System of SMA -organized -relatively simple www.indiandentalacademy.com
  38. 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. 39. Four stages of maturation www.indiandentalacademy.com
  40. 40. Capping occurs in the transition Fusion follows capping. www.indiandentalacademy.com
  41. 41. 11 Skeletal maturity indicators www.indiandentalacademy.com
  42. 42. www.indiandentalacademy.com
  43. 43.  With this approach key stages are checked first.  Adductor sesamoid- whether seen or not. www.indiandentalacademy.com
  44. 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. 45. Measurements & evaulation  Maxillary and mandibular measurements made  S-A & Ar-A – maxilla  S-Gn & Ar-Gn -mandible www.indiandentalacademy.com
  46. 46. Cronological age values for adolescent skeletal maturity indicators www.indiandentalacademy.com
  47. 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. 48. SMI level -6,50% of adolescent growth www.indiandentalacademy.com
  49. 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. 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. 51.  After peak growth, velocities diminished more rapidly in females than in males www.indiandentalacademy.com
  52. 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. 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. 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. 55.  Stage 3( pubertal onset)  Beginning of calcification of ulnar sesamoid  Increased ossification of pisiform & hook of hamate www.indiandentalacademy.com
  56. 56.  Stage 4(pubertal)  Calcified ulnar sesamoid  Capping of shaft of middle phalanx of third digit by its epiphysis-MP3cap. www.indiandentalacademy.com
  57. 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. 58.  Stage 6(growth completion)  No remaining growth sites www.indiandentalacademy.com
  59. 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. 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. 61.  Stage 2 (prepubertal)- mandibular growth in girls reached peak  Late growth of the mandible should be considered www.indiandentalacademy.com
  62. 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. 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. 64. d www.indiandentalacademy.com
  65. 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. 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. 67. www.indiandentalacademy.com
  68. 68. Method of analysis  Adolescent growth studied by graphic analysis 320yrs  PHV  Onset www.indiandentalacademy.com
  69. 69.  Dental development was assessd by dental emergence stages ( DES)  Stages devised by Bjork + 2 new stages DESM3 & DESM5 www.indiandentalacademy.com
  70. 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. 71. Ulnar sesamoid 2 stages www.indiandentalacademy.com
  72. 72. Distal phalanx of third finger (DP3)  Stage I www.indiandentalacademy.com
  73. 73. Middle phalanx of the third finger(MP3) 5 stages www.indiandentalacademy.com
  74. 74. Distal epiphysis of radius 3 stages www.indiandentalacademy.com
  75. 75. Pubertal developement  Assesed from 10-18 years  Menarche in girls  Voice change in boys www.indiandentalacademy.com
  76. 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. 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. 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. 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. 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. 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. 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. 83. Fishmans method www.indiandentalacademy.com
  84. 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. 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. 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. 87. Stages of ossification www.indiandentalacademy.com
  88. 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. 89. Stage E4 www.indiandentalacademy.com
  90. 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. 91.  Mandibular growth may still continue in more severe skeletal discrepancy-ANB > -6 www.indiandentalacademy.com
  92. 92. Pre treatment case I www.indiandentalacademy.com
  93. 93. www.indiandentalacademy.com
  94. 94. www.indiandentalacademy.com
  95. 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. 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. 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. 98. 11 Skeletal maturity indicators www.indiandentalacademy.com
  99. 99. Results  Six categories of CV maturation defined www.indiandentalacademy.com
  100. 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. 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. 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. 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. 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. 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. 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. 107. RESULTS www.indiandentalacademy.com
  108. 108. RESULTS www.indiandentalacademy.com
  109. 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. 110. www.indiandentalacademy.com
  111. 111. MP3-F & CVMI 1 www.indiandentalacademy.com
  112. 112. MP3-FG & CVMI 2 www.indiandentalacademy.com
  113. 113. MP3-G 7CVMI 3 www.indiandentalacademy.com
  114. 114. MP3-H &CVMI 4 www.indiandentalacademy.com
  115. 115. MP3-HI &CVMI 5 www.indiandentalacademy.com
  116. 116. MP3-I & CVMI-6 www.indiandentalacademy.com
  117. 117. Results www.indiandentalacademy.com
  118. 118. conclusions  Modified MP3 stages using periapical Xray film can be an accurate & simple growth indicator. www.indiandentalacademy.com
  119. 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. 120. www.indiandentalacademy.com
  121. 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. 122. www.indiandentalacademy.com
  123. 123. www.indiandentalacademy.com
  124. 124. www.indiandentalacademy.com
  125. 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. 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. 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. 128.  Max. & mandibular canines,1&2 premolars & mandibular second molars  Appearace of sesamod,MP3cap & calcification of hook of hamate. www.indiandentalacademy.com
  129. 129. Dental formation stages(Demirjian) www.indiandentalacademy.com
  130. 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. 131. www.indiandentalacademy.com
  132. 132. Conclusion  Completion of root formation of mand canine,prior to apical closure Maturity indicator www.indiandentalacademy.com
  133. 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. 134. Materials & methods  Sample 60 pts - 30 males & 30 females(9 to 16 yrs) www.indiandentalacademy.com
  135. 135. Measurements www.indiandentalacademy.com
  136. 136. Transverse slicing section(TSS)  MEASUREMENTS  BCT  LCT  LBT  MCH  MCD  Corpus indexMCH/MCD www.indiandentalacademy.com
  137. 137. RESULTS www.indiandentalacademy.com
  138. 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. 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. 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. 141. Frontal sinus measurements www.indiandentalacademy.com
  142. 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. 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. 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. 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. 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. 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. 148. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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