Skeletal maturity indicators/endodontic courses

Skeletal Maturity Indicators -Skeletal Maturity Indicators -
Hand Wrist RadiographsHand Wrist Radiographs
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ContentsContents
 IntroductionIntroduction
 Topographic Anatomy of the skeleton of handTopographic Anatomy of the skeleton of hand
 HistoryHistory
 Indications of Hand Wrist RadiographsIndications of Hand Wrist Radiographs
 Atlas method by Greulich and Pyle in 1959Atlas method by Greulich and Pyle in 1959
 Bjork ,Grave and Brown method in 1976Bjork ,Grave and Brown method in 1976
 Julian singer’s method in 1980Julian singer’s method in 1980
 Fishman’s skeletal maturity indicators in 1982Fishman’s skeletal maturity indicators in 1982
 Hagg and Taranger method in 1982Hagg and Taranger method in 1982
 SummarySummary
 ReferencesReferences www.indiandentalacademy.comwww.indiandentalacademy.com

IntroductionIntroduction
Ricketts (1955)Ricketts (1955)
““To take advantage of growth we mustTo take advantage of growth we must
have some idea, first, of its amount, andhave some idea, first, of its amount, and
second of its direction.”second of its direction.”22

Topographic Anatomy ofTopographic Anatomy of
Skeleton of HandSkeleton of Hand11

HistoryHistory 22
The first recorded hand-wrist film wasThe first recorded hand-wrist film was
published by Sydney Rowland of London inpublished by Sydney Rowland of London in
April, 1896.April, 1896.
Pryor (1925)
He tabulated the time of appearance of bones
of the hand, time of union of the epiphyses,
and sex differences in skeletal development.

 Hellman, 1928, reported a study of ossification of the
epiphyses.
 60 females between 10 yrs 3 months- 12 yrs 3
months.
 He found that the greatest increment to bones of the
hand preceded the greatest increase in height of the
body by one year.
 Baldwin, 1928, was the first to measure carpal bones
for the determination of degree of development.
 JOSEPH C. KONIE (1964) :Comparative Value Of X-
rays Of The Spheno occipital Synchondrosis And Of
The Wrist For Skeletal Age Assessment 10

IndicationsIndications 11

Methods Of Assessing Skeletal AgeMethods Of Assessing Skeletal Age
using Hand Wrist Radiographusing Hand Wrist Radiograph
 Atlas method by Greulich and Pyle in 1959Atlas method by Greulich and Pyle in 1959
 Bjork ,Grave and Brown method in 1976Bjork ,Grave and Brown method in 1976
 Julian singer’s method in 1980Julian singer’s method in 1980
 Fishman’s skeletal maturity indicators in 1982Fishman’s skeletal maturity indicators in 1982
 Hagg and Taranger method in 1982Hagg and Taranger method in 1982

Greulich and Pyle Method (1959)Greulich and Pyle Method (1959)
 T. Wingate Todd (1929) at the Brush Foundation ofT. Wingate Todd (1929) at the Brush Foundation of
Western Reserve University, Cleveland.Western Reserve University, Cleveland.
 1937, selected Cleveland children who had excellent
health backgrounds as determined by physicians.
 3 months to 16 years in girls
 3 months to 19 years in boys.
 “Atlas of Skeletal Maturation of the Hand” by Todd
 “Radiographic Atlas of Skeletal Maturation of the Hand
& wrist” by W.W Greulich & S.I Pyle

Bjork , Grave And Brown MethodBjork , Grave And Brown Method
(1976)(1976)11
Appropriate chronological age for each ofAppropriate chronological age for each of
the stages was given bythe stages was given by SchopfSchopf in 1978in 1978
9 to 17 years of age.9 to 17 years of age.

3 stages3 stages
First stage Capping
stage
Third stage

First stage: PP2= -stageFirst stage: PP2= -stage
males = 10.6yrs & females = 8.1 yrsmales = 10.6yrs & females = 8.1 yrs
 3 years before the peak.3 years before the peak.

Second stage: MP3= -stageSecond stage: MP3= -stage
males 12.0 yrs & females 8.1 yrsmales 12.0 yrs & females 8.1 yrs

Stage three: Pisi-, H1-, and R= - stageStage three: Pisi-, H1-, and R= - stage
males 12.6 yrs & females 9.6 yrsmales 12.6 yrs & females 9.6 yrs

Fourth stage: S- and H2-stageFourth stage: S- and H2-stage
Age:- males 13 yrs & females 10.6 yrsAge:- males 13 yrs & females 10.6 yrs
 shortly before or at the beginning of the pubertal growthshortly before or at the beginning of the pubertal growth
spurt.spurt.

Fifth stage: MP3Fifth stage: MP3capcap-, PP1-, PP1capcap- and R- and Rcapcap--
stagestage Age :- males 14 yrs & femalesAge :- males 14 yrs & females
11 yrs.11 yrs.
This stage of ossification marks the peak of the pubertal growth spurt.This stage of ossification marks the peak of the pubertal growth spurt.

Sixth stage: DP3Sixth stage: DP3uu-stage-stage
males 15 yrs & females 13yrsmales 15 yrs & females 13yrs
 This stage of development constitutes the end of pubertal growthThis stage of development constitutes the end of pubertal growth

Seventh stage: PP3Seventh stage: PP3uu-stage-stage
male 15.9y & female13.3y,male 15.9y & female13.3y,

Eighth stage: MP3Eighth stage: MP3uu-stage-stage
males 15.9y & females 13.9y.males 15.9y & females 13.9y.

Ninth stage: RNinth stage: Ruu-stage-stage
males 18.5y & females 16.0ymales 18.5y & females 16.0y

Singer’s method of AssessmentSinger’s method of Assessment
(1980)(1980)22

Stage 1 (Early)Stage 1 (Early)

Stage 2 (Pre-pubertal)Stage 2 (Pre-pubertal)
Clinical significance www.indiandentalacademy.comwww.indiandentalacademy.com

Stage 3 (Pubertal onset)Stage 3 (Pubertal onset)

Stage 4 (Pubertal)Stage 4 (Pubertal)

Stage 5 (Pubertal deceleration)Stage 5 (Pubertal deceleration)

Stage 6 (Growth completion)Stage 6 (Growth completion)

Fishman’s Skeletal Maturity IndicatorsFishman’s Skeletal Maturity Indicators
(SMI) (1982)(SMI) (1982)

Fishman method –Eleven SMIsFishman method –Eleven SMIs
Width of Epiphysis equal to DiaphysisWidth of Epiphysis equal to Diaphysis
3 yrs before PGS

 OssificationOssification (beginning)(beginning)
 Capping of Epiphysis (Capping of Epiphysis ( peak)peak)

 Fusion of Epiphysis and DiaphysisFusion of Epiphysis and Diaphysis

Maturation Assessment by HaggMaturation Assessment by Hagg
and Taranger (1982)and Taranger (1982)

 MATERIALS AND METHODSMATERIALS AND METHODS
 212 children from birth to adulthood in a212 children from birth to adulthood in a
Swedish urban communitySwedish urban community
 At the last programmed annual examination, atAt the last programmed annual examination, at
18 years, 160 (75.5 percent) of the 212 original18 years, 160 (75.5 percent) of the 212 original
subjects participated.subjects participated.
 At a follow-up examination at 20 to 22 years,At a follow-up examination at 20 to 22 years,
148 subjects (69.8 percent) were investigated.148 subjects (69.8 percent) were investigated.

 RESULTSRESULTS
 The pubertal growth spurtThe pubertal growth spurt
ONSETONSET 10.010.0 12.112.1
ENDEND 14.814.8 17.117.1
PHVPHV 1212 14.114.1
FEMALES MALES

SesamoidSesamoid
 S was usually (girlsS was usually (girls
86 percent, boys 9286 percent, boys 92
percent) attainedpercent) attained
during theduring the
acceleration period ofacceleration period of
the pubertal growththe pubertal growth
spurt (ONSET-PHV).spurt (ONSET-PHV).

MP3-FMP3-F (start of pubertal growth spurt)(start of pubertal growth spurt)

MP3-FGMP3-FG (acceleration of PGS)(acceleration of PGS)

MP3-GMP3-G (maximum point of PGS)(maximum point of PGS)

MP3-HMP3-H (Deceleration of PGS)(Deceleration of PGS)

MP3-IMP3-I (End of PGS)(End of PGS)

DP3-IDP3-I

RadiusRadius

A Comparison of Modified MP3 Stages and theA Comparison of Modified MP3 Stages and the
Cervical Vertebrae as Growth IndicatorsCervical Vertebrae as Growth Indicators
R. RAJAGOPAL, SUDHANSHU KANSALR. RAJAGOPAL, SUDHANSHU KANSAL
(2002)(2002)55
six stages of cervical vertebrae maturationsix stages of cervical vertebrae maturation
indices (CVMI), as described by Hasselindices (CVMI), as described by Hassel
and Farmanand Farman

CVMI-1 & MP3-F
80-100% pubertal
growth remaining

CVMI-2 & MP3-FG
65-85% pubertal
growth remaining

CVMI-3 & MP3-G
25-65% pubertal
growth remaining

CVMI-5 & MP3-
HI
CVMI-4 & MP3-H
10-25% pubertal
growth remaining

CVMI-5 & MP3-HI
5-10%

CVMI-6 & MP3-I

Assessment of growth Impetus using MP3 maturationAssessment of growth Impetus using MP3 maturation
& its correlation with CVMI & dental age. (2003)& its correlation with CVMI & dental age. (2003)77
D.N.Kapoor ; K.S.Negi ; V.P.Sharma ; P.TandonD.N.Kapoor ; K.S.Negi ; V.P.Sharma ; P.Tandon
 This study was done to find the reliability of MP3 stagesThis study was done to find the reliability of MP3 stages
for assessing skeletal maturity by correlating it withfor assessing skeletal maturity by correlating it with
CVMI stages & the developmental stages of maxillaryCVMI stages & the developmental stages of maxillary
canine.canine.
 The radiographs of 160 patients (80 males & 80 females)The radiographs of 160 patients (80 males & 80 females)
of age group 8-16 yrs to assess the MP3 stage & theof age group 8-16 yrs to assess the MP3 stage & the
development stage of maxillary right canine using dentaldevelopment stage of maxillary right canine using dental
x-ray film & the CVMI stage using lateral cephalogram.x-ray film & the CVMI stage using lateral cephalogram.
 They concluded that the developmental stages of theThey concluded that the developmental stages of the
MP3 can be used as a reliable SMI for assessment ofMP3 can be used as a reliable SMI for assessment of
skeletal maturation.skeletal maturation.

A Comparison of Hand-Wrist Bone & CervicalA Comparison of Hand-Wrist Bone & Cervical
Vertebral Analysis in Measuring Skeletal Maturation.Vertebral Analysis in Measuring Skeletal Maturation.
( 2006)( 2006) 66
Paola Gandini; Maria Macini; Federico AndreaniPaola Gandini; Maria Macini; Federico Andreani
 He did a study to compare skeletal maturation asHe did a study to compare skeletal maturation as
measured by hand- wrist bone analysis & by cervicalmeasured by hand- wrist bone analysis & by cervical
vertebral analysis.vertebral analysis.
 Hand wrist bone analysis & cephalometric cervicalHand wrist bone analysis & cephalometric cervical
vertebral analysis of 30 pts (14 males & 16 females;vertebral analysis of 30 pts (14 males & 16 females;
7-18 yrs of age)7-18 yrs of age)
 Concluded that vertebral analysis on a lateralConcluded that vertebral analysis on a lateral
cephalogram is as valid as the hand-wrist bonecephalogram is as valid as the hand-wrist bone
analysis with the advantage of reducing the radiationanalysis with the advantage of reducing the radiation
exposure of growing subjects.exposure of growing subjects.

ConclusionConclusion
Orthodontic treatment of most dentofacialOrthodontic treatment of most dentofacial
problems will be affected by concurrent growthproblems will be affected by concurrent growth
regardless of appliance mechanicsregardless of appliance mechanics
But neither chronological age nor the level ofBut neither chronological age nor the level of
dental development demonstrate sufficientdental development demonstrate sufficient
correlation with individual maturationalcorrelation with individual maturational
development to provide an adequate basis fordevelopment to provide an adequate basis for
the timing of therapythe timing of therapy

REFERENCESREFERENCES
1.1. Thomas Rakosi :Orthodontic Diagnosis : Ist Edition pg no.Thomas Rakosi :Orthodontic Diagnosis : Ist Edition pg no.
118- 122.118- 122.
2.2. Julian Singer : Physiologic timing of Orthodontic treatmentJulian Singer : Physiologic timing of Orthodontic treatment
Angle Orthodontist : 1980 : Vol. 50, No.4 . Pg no. 322-333.Angle Orthodontist : 1980 : Vol. 50, No.4 . Pg no. 322-333.
3.3. Leonard S. Fishman : Radiographic evaluation of SkeletalLeonard S. Fishman : Radiographic evaluation of Skeletal
Maturation- A clinically oriented method based on Hand-Maturation- A clinically oriented method based on Hand-
Wrist Films : Angle Orthodontist :1982 Vol. 52, No.2. pgWrist Films : Angle Orthodontist :1982 Vol. 52, No.2. pg
no. 88-112no. 88-112
4.4. Urban Hagg & John Taranger : Maturation Indicators &Urban Hagg & John Taranger : Maturation Indicators &
pubertal growth spurt. AJO-DO 1982 : Vol 82 No 4. pg no.pubertal growth spurt. AJO-DO 1982 : Vol 82 No 4. pg no.
299-309.299-309.
5.5. R. Rajagopal & S. Kansal : A comparison of Modified MP3R. Rajagopal & S. Kansal : A comparison of Modified MP3
stages & the Cervical Vertebrae as growth indicators. JCOstages & the Cervical Vertebrae as growth indicators. JCO
2002 : Vol. 36. No. 7 . Pg no. 398-4062002 : Vol. 36. No. 7 . Pg no. 398-406

6. Paola Gandini; Marata Mancini & Federico Andreani : A6. Paola Gandini; Marata Mancini & Federico Andreani : A
comparison of Hand-Wrist Bone & Cervical Vertebralcomparison of Hand-Wrist Bone & Cervical Vertebral
Analyses in Measuring Skeletal Maturation. AngleAnalyses in Measuring Skeletal Maturation. Angle
Orthodontist 2006. Vol. 76, No. 6. pg no. 984-989.Orthodontist 2006. Vol. 76, No. 6. pg no. 984-989.
7. D.N.Kapoor ; K.S.Negi ; V.P.Sharma ; P.Tandon :7. D.N.Kapoor ; K.S.Negi ; V.P.Sharma ; P.Tandon :
Assessment of growth impetus MP3 maturation & itsAssessment of growth impetus MP3 maturation & its
correlation with CVMI & dental age. JIOS 2003; 36; pg no.correlation with CVMI & dental age. JIOS 2003; 36; pg no.
204-213.204-213.
8. Torun Ozer, Jalen Deveciouglu Kama & Senem. A Practical8. Torun Ozer, Jalen Deveciouglu Kama & Senem. A Practical
Method for Determining Pubertal Growth Spurt AJO-DOMethod for Determining Pubertal Growth Spurt AJO-DO
2006;130:131.e1-131.e62006;130:131.e1-131.e6
9. Carlos Flores Mir, Corr Burgess, Mitchell. Correlation of9. Carlos Flores Mir, Corr Burgess, Mitchell. Correlation of
Skeletal Maturation stages determined by CervicalSkeletal Maturation stages determined by Cervical
Vertebrae & Hand wrist Evaluations. Angle OrthodontistVertebrae & Hand wrist Evaluations. Angle Orthodontist
2006;76:1-52006;76:1-5
10. Joseph C. Konie Comparative Value of X-Rays of the10. Joseph C. Konie Comparative Value of X-Rays of the
Spheno-occipital Synchondrosis & of hand wrist for skeletalSpheno-occipital Synchondrosis & of hand wrist for skeletal
assessment of age Angle Orthodontist ,1964:34(4):303-313.assessment of age Angle Orthodontist ,1964:34(4):303-313.

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