Skeletal maturity indicators provide information about an individual's biological age and maturation status, which is important for orthodontic diagnosis and treatment planning. Hand-wrist radiographs show the ossification and fusion of bones and can assess skeletal maturity using several methods, most notably the Atlas method of Greulich and Pyle or the 9-stage Bjork, Grave, and Brown method. Understanding a patient's skeletal maturity stage helps orthodontists determine prognosis, select appropriate treatment modalities, and predict the timing of growth spurts.

1. Skeletal Maturity Indicator
Dr. Shweta Kolhe
BDS, MDS(Orthodontist)

2. • Skeletal age is considered as the most reliable method as it is
closely related to physical growth
• The timing of changes vary as each individual has his/her own
“Biological Clock”
• Maturation status have influence on: diagnosis, treatment goals,
treatment planning, eventual outcome of treatment, decisions
regarding use of extra oral traction forces, functional appliance,
extraction versus non-extraction treatment or orthognathic
surgery.
Introduction

3. Biological Age
Chronological age Sexual Age
Maturity Indicators
Morphological age
Dental age
Circumpubertal age
Skeletal age 1. Hand - Wrist Radiographs
2. Cervical Vertebrae
3. Different stages of tooth
development.

4. Hand and wrist radiographs
• The hand - wrist region is made up of
numerous small bones.
• Show a predictable & scheduled pattern of
appearance, ossification & union from birth
to maturity.
• Methods to asses skeletal maturity :
1. Atlas Method By Greuich & Pyle.
2. Bjork, Grave & Brown Method
3. Fishman’s Skeletal Maturity Indicator.
4. Hagg & Taranger Method.

5. Indications Of Hand And Wrist Radiographs:
• Useful in patients exhibit major discrepancy
between dental and chronological age.
• Before start of treatment of skeletal malocclusion.
• To assess skeletal age whose growth is affected by
infection, neoplastic or traumatic condition.
• Predict future skeletal maturation rate and status.
• To predict the pubertal growth spurt.
• Indicated in patient with orthognathic surgery.
• For research purpose.

6. Anatomy Of Hand - Wrist

7. Phalanges
Phalanges ossify in 3 stages :
• STAGE 1: The epiphysis and
diaphysis are equal.
• STAGE 2: The epiphysis caps
the diaphysis by surrounding
it like a cap.
• STAGW 3: Fusion occurs
between the epiphysis and
diaphysis.

8. 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.

9. Width of Epiphysis =
Diaphysis
PP2
Stage 1- 3 year before peck of
pubertal growth spurt.
MP3
Stage 2 – Prior to the beginning of
puberta growth spurts
♂ - 10.6 yrs. ♀ - 8.1 yrs. ♂ - 12 yrs. ♀ - 8.1 yrs.
Bjork, Grave & Brown Method (1972)
• 9 STAGES
• Width of Epiphysis = Diaphysis

10. Pisi – stage:
Visible ossification
Pisiform Bone.
H1 – stage: Ossification
of Hamular Process of
Hamet
R – stage Epiphysis
= Diaphysis of
Radius
♂ - 12.6 yrs.
♀ - 9.6 yrs.
Stage 3

11. S – stage: First mineralization
of Sisamoid Bone
H2 – stage: Progressive Ossification
of Hamular Process of Hamet
♂ - 13 yrs.
♀ - 10.6 yrs.
Beginning of
pubertal
growth spurts
Stage 4

12. Capping of Epiphysis
PP1cap - stage MP3cap - stage
♂ - 14 yrs. ♀ - 11 yrs. Peak of the Pubertal growth
Rcap - stage
Stage 5

13. Union of Epiphysis
♂ - 15 yrs. ♀ - 13 yrs.
• Union of epiphysis and
diaphysis at the distal phalanx
of middle finger
• End of pubertal growth.
DP3u - stage
Stage 6

14. • ♂ - 15.9 yrs. ♀ - 13.3 yrs.
• Union of epiphysis and
diaphysis at the proximal
phalanx of middle finger
• Seen 1 year after growth
spurts
PP3u - stage
Stage 7

15. • ♂ - 15.9 yrs. ♀ - 13.9 yrs.
• Union of epiphysis and
diaphysis at the middle
phalanx of the middle
finger
MP3u - stage
Stage 8

16. • ♂ - 18.5 yrs. ♀ - 16 yrs.
• Complete union of epiphysis
and diaphysis of the radius
• Skeletal growth is finished
Ru - stage
Stage 9

18. 1st – 3rd Stage 4th & 5th Stage 6th – 9th Stage
Corresponds to 3 years
before the peak pubertal
growth period. Prognosis
is good if growth
modification is planned
Residual growth potential
–fixed functional
appliances can be
planned
Union stage –no chance
for functional appliance
therapy