A simple method of growth prediction

Growth IndicatorsGrowth Indicators
www.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTIONINTRODUCTION
In orthodontics the assessment ofIn orthodontics the assessment of
 skeletal ageskeletal age andand
 pubertal growth spurtpubertal growth spurt (in particular)(in particular)
are of prime importance inare of prime importance in
1.1. DiagnosisDiagnosis
2.2. treatment planningtreatment planning
3.3. Retention.Retention.

INDICATIONS FOR GROWTHINDICATIONS FOR GROWTH
STATUSSTATUS
1.1. When maxillomandibular changes areWhen maxillomandibular changes are
indicated in the treatment ofindicated in the treatment of
a.a. Skeletal Class III cases,Skeletal Class III cases,
b.b. Skeletal Class II cases orSkeletal Class II cases or
c.c. Skeletal open bitesSkeletal open bites
2.2. In patients with marked discrepancyIn patients with marked discrepancy
between dental and chronological agebetween dental and chronological age
3.3. Patients requiring orthognathic surgery ifPatients requiring orthognathic surgery if
undertaken between 16-20 years of ageundertaken between 16-20 years of age
4.4. Prior to rapid maxillary expansionPrior to rapid maxillary expansion
(Transverse Plane)

BIOLOGICAL AGEBIOLOGICAL AGE
 DENTAL AGE (CANINE, 3DENTAL AGE (CANINE, 3RDRD
MOLAR)MOLAR)
 CHRONOLOGICAL AGECHRONOLOGICAL AGE
 ONSET OF PUBERTYONSET OF PUBERTY
 SKELETAL AGESKELETAL AGE
Hand wrist radiographHand wrist radiograph
Cervical vertebraeCervical vertebrae
Frontal sinusFrontal sinus
PHV etc.PHV etc.

GROWTH RHYTHMGROWTH RHYTHM
 Pubertal growth spurts are genderPubertal growth spurts are gender
dependent and vary in their relation to thedependent and vary in their relation to the
chronological agechronological age
 Average valuesAverage values
• Girls 10-12 yrsGirls 10-12 yrs
• Boys 12-14 yrsBoys 12-14 yrs
 A disturbance of growth rhythm isA disturbance of growth rhythm is
considered if a difference of +/- 2 yrsconsidered if a difference of +/- 2 yrs
exists between chronological and biologicexists between chronological and biologic
ageage

Skeletal ageSkeletal age
 We all know that long bones growWe all know that long bones grow
at the ends calledat the ends called epiphysisepiphysis..
 The newly formed bone startsThe newly formed bone starts
getting mineralized at thegetting mineralized at the
metaphysismetaphysis and the most maturedand the most matured
bone is seen at thebone is seen at the diaphysisdiaphysis..
 The epiphysis initially forms as aThe epiphysis initially forms as a
cartilage tissue which latercartilage tissue which later ossifiesossifies
andand fusesfuses with the metaphysis aswith the metaphysis as
it matures.it matures.

HAND RADIOGRAPHHAND RADIOGRAPH

Acc JULIAN SINGERAcc JULIAN SINGER
Stage 1 EARLYStage 1 EARLY
a) Abcence ofa) Abcence of
PissiformPissiform
b) Abcence of Hookb) Abcence of Hook
of the hamateof the hamate
c) Epiphysis ofc) Epiphysis of
proximal phalanxproximal phalanx
of second digitof second digit
(pp2) narrower(pp2) narrower
than its shaftthan its shaft

Stage II PREPUBERTALStage II PREPUBERTAL
a)a) Proximal phalanx ofProximal phalanx of
second digit (pp2)second digit (pp2)
and its Epiphysisand its Epiphysis
are in equal in widthare in equal in width
b)b) Initial ossification ofInitial ossification of
Hook of the hamateHook of the hamate
& Pissiform& Pissiform

Stage III PUBERAL ONSETStage III PUBERAL ONSET
 Beginning calcificationBeginning calcification
ofof Ulnar sesamoid
 Increased width ofIncreased width of
epiphysis of PP2epiphysis of PP2
 Increased calcificationIncreased calcification
Hook of the hamate &Hook of the hamate &
PissiformPissiform

Stage IVStage IV PUBERALPUBERAL
 Calcified UlnarCalcified Ulnar
sesamoidsesamoid
 Mp3 cappingMp3 capping
(capping of shaft of(capping of shaft of
middle phalanx ofmiddle phalanx of
33rdrd
digit by itsdigit by its
epidhysis)epidhysis)

Stage VStage V PUBERALPUBERAL
DECELARATIONDECELARATION
 Ulnar sesamoidUlnar sesamoid
FullyCalcifiedFullyCalcified
 Dp3 UDp3 U
 All Phalanges andAll Phalanges and
carpals fully calcifiedcarpals fully calcified
 Epiphysis of radiusEpiphysis of radius
and ulna not fullyand ulna not fully
calcifiedcalcified

Stage V Growth CompletionStage V Growth Completion
•No remaining
growth

MP3MP3
STAGINGSTAGING

MP3 STAGE IMP3 STAGE I
(ONSET)(ONSET)

MP3 STAGE IIMP3 STAGE II
(ACCELERATION)(ACCELERATION)

MP3 STAGE IIIMP3 STAGE III
(PEAK)(PEAK)

MP3 STAGE IVMP3 STAGE IV
(DECELLERATION)(DECELLERATION)

MP3 STAGE VMP3 STAGE V
(END)(END)

AdvantagesAdvantages
 The procedure is very simple andThe procedure is very simple and
easy.easy.
 Focus is on a single skeletal maturityFocus is on a single skeletal maturity
indicator.indicator.
 Enhanced image clarity.Enhanced image clarity.
 Drastically decreases radiationDrastically decreases radiation
exposure.exposure.
 Cost effective solution to circumventCost effective solution to circumvent
hand wrist radiographs.hand wrist radiographs.
 Practical feasibility for the generalPractical feasibility for the general
dental practitioner.dental practitioner.www.indiandentalacademy.comwww.indiandentalacademy.com

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A simple method of growth prediction

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A simple method of growth prediction