DIFFERENT METHODS OF GROWTH ASSESSMENT AND ITS PREDICTION.

1. DIFFERENT METHODS OF
GROWTH ASSESSMENT AND
ITS PREDICTION
JAYAHARINI A.C

2. -ACC.TO TODD - GROWTH REFERS TO INCREASE IN SIZE.
-ACC. TO PROFFIT - GROWTH REFERS TO INCREASE IN SIZE
AND NUMBER
-ACC. TO HUXLEY -GROWTH ISSELF-MULTIPLICATION OF
LIVING SUBSTANCE.
-ACC. TO MOSS -GROWTH IS DEFINED AS CHANGE IN ANY
MORPHOLOGICAL PARAMETER WHICH IS MEASUREABLE
-ACC. TO KROGMANN -GROWTH IS THE INCREASE IN SIZE,
CHANGE IN PROPORTION AND PROGRESSIVE MATURITY.
GROWTH - DEFINITIONS

3. WHY ASSESS
GROWTH?

4. 1. Amount of growth
2. Direction (including rotation)
of growth
3. Timing of growth

5. . CHRONOLOGICAL AGE
. DENTAL AGE
. MORPHOLOGICAL AGE
. SEXUAL AGE
. SKELETAL AGE
BIOLOGIC
MATURITY INDICATOERS

6. DIFFERENT METHODS OF
ASSESSING GROWTH
CLINICAL
RADIOGRAPHICAL

7. CLINICAL
Body height
Sexual characteristic
Chronological
age
Dental eruption

8. RADIOGRAPHICAL
Skeletal Maturity Dental Maturity
Using OPGHand –Wrist
Radiograph
Cervical Vertebra
Maturity

9. HAND
WRIST RADIOGRAPH

10. 1. Before the use of RME
2. Treatment planning of class II and III cases
when
functional appliance is an option
3. Severe discrepancy between dental and
chronological age.
4. Help to predict future skeletal maturation rate
and status
5. To predict pubertal growth spurt
6. To predict the skeletal age of patient whose
growth is affected by infection, trauma etc.
INDICATION

11. GROWTH OF EPIPHYSIS

12. DIFFERENT METHODS OF
SMI USING HAND WRIST
RADIOGRAPH
1. Fisherman skeletal maturation indicator
2. Bjork, Grave and Brown
3.Hagg and Taranger method
4.Atlas of Greulich and Pyle

13. Fisherman skeletal maturation
indicator

14. Stage 1..width of Epiphysis
equal that
of Diaphysis i.e. E=D
1. Middle finger proximal
phalanx…PP3
2. Middle finger middle
phalanx…MP3
3. Little finger middle
phalanx..MP5
Stage II. Adductor
sesamoid of thumb..S
4. Centre of ossification medial to
the junction
of the epiphysis and diaphysis of
the proximal
phalanx of the thumb

15. Stage III. Capping
5. Middle finger distal phalanx
DP3
6. Middle finger middle phalanx
MP3
7. Little finger middle phalanx
MP5
Stage IV. FUSION
8. Middle finger distal phalanx
DP3
9. Middle finger proximal phalanx
PP3
10. Middle finger middle phalanx
MP3
11. Radius

16. SMI MALES FEMALES
1 11.3 10.2
2 11.9 10.7
3 12.1 10.8
4 12.3 11.0
5 13.0 11.7
6 13.7 11.9
7 14.4 12.5
8 15.1 13.2
9 15.4 13.9
10 16.1 14.8
11 17.2 16.5

17. What is the
use?

18. 11- GRADE SCHEME OF FISHERMAN

19. Cervical Vertebra Maturation
Indicator
- Assessment of completion of active growth
- To identify clinically the adequate time for
intervention in subjects who need surgery
- For prediction of growth spurt
- Predicting the correct direction of growth
INDICATION

21. 1. Initiation.
- Very significant amount of adolescent growth
expected
- C2, C3, and C4 inferior vertebral body borders are
flat.
- Superior vertebral borders are tapered posterior
to anterior i.e. trapezoids
2. Acceleration.
- Significant amount of adolescent growth
expected.
- Concavities developing in lower borders of C2
and C3.
- Lower border of C4 vertebral body is flat.
- C3 and C4 are more trapezoid in shape

22. 3. Transition .
- Moderate amount of adolescent growth
expected
- Distinct concavities seen in lower borders ofC2
and C3.
- C4 developing concavity in lower border of
vertebral body.
- C3 and C4 are rectangular in shape.
4. Deceleration.
- Small amount of adolescent growth expected
- Distinct concavities in lower borders of C2,
C3,and C4.
- C3 and C4 are nearly square in shape.

23. 5. Maturation.
- Insignificant amount of adolescent growth
expected.
- Accentuated concavities on inferior borders
of C2, C3, and C4.
- C3 and C4 are square in shape.
6. Completion.
- Adolescent growth is completed.
- Deep concavities are present on inferior
borders of C2,C3, and C4.
- C3 and C4 heights are greater than widths.

25. DENTAL MATURITY
1. Calcification e.g. Demirjian et al
2. Measurement of the crown height, apex width, and root
length of the teeth observed in radiographs. Mornstad et al.
3. Time of eruption; Gustafson and Koch
Methods of assessing dental age

26. DEMIRJIAN TECHNIQUE
STAGE A.
In both uniradicular and multiradicular
teeth, a beginning of calcification is seen at
the superior level of the crypt in the form of an
inverted cone or cones. The is no fusion of
these calcified points
STAGE B.
fusion of the calcified points to give a regular
outlined occlusal surfacecified points

27. STAGE C.
a. enamel formation is complete at the occlusal
surface. Its extension and convergence towards the
cervical region is seen.
b. the beginning of dentinal deposit is seen
c. the outline of the pulp chamber has a curved
shape at the occlusal border
Stage D.
a. the crown formation is completed down to the CEJ
b. the superior border of the pulp chamber in the uniradicular teeth
has a definite curved form, being concave towards the cervical region.
The projection horns if present, gives an outline like an umbrella top.
In molars the pulp chamber has a trapezoidal form.
c. beginning of root formation is seen in the form of a spicule.

28. STAGE E.
UNIRADICULAR TEETH:
a. the walls of the pulp chamber now form straight lines
whose continuity is broken by the presence of the pulp horn,
which is larger than in the previous stage.
b. the root length is less than the crown height
MOLARS.
a. initial formation of the radicular bifurcation is seen in the
form of either a calcified points or a semi-lunar shape
b. the root length is still less than the crown height

29. STAGE F.
UNIRADICULAR TEETH:
a. the walls of the pulp chamber now forma more or less
isosceles triangle. The apex ends in a funnel shape
b. the root length is equal to or greater than the crown
height
MOLARS.
a. the calcified region of the bifurcation has developed
further down from its semi-lunar stage to give the roots a
more definite and distinct outline with funnel shaped
endings
b. the root length is equal to or greater than the
crown height

30. STAGE H.
a. the apical end of the root canal is
completely closed(distal root in molars).
b. the periodontal membrane has a uniform
width around the root and the apex
STAGE G.
The walls of the root canal are now parallel
and its apical end is still partially
opened(distal root in molars)

31. Self weighted score for dental stages

33. CONCLUSION
Understanding the development patterns of
every growing patient is one of the prerequisites
for successful orthodontic treatment. Many
treatment modalities will yield a better result in
less time if properly correlated with the facial
growth patterns that are associated with the
patient. Growth related appliances such as
functional appliances can yield excellent result if
properly timed.