skeletal maturity indicators in orthodontics 1 / fixed orthodontic courses by indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Material
&method
Sample of 11 groups of 10 males &10 females (20) aged from 10 –
18 yrs
radiograph used : lt hand wrist
lat ceph
Method : Fishman method
Lat ceph taken to assess :
a)
Dens of c2
b)
Body of c2 c3
c)
Curvature on inferior border of c2 , c3, c4
d)
Intervertebral spacing
These records were used to assess cervical vertebrae maturation
indices


Anatomy of vertebrae


Ossification


CVMI 2


CVMI 3


CVMI 4


CVMI 5


CVMI 6


Smi grouping







cvmi grouping

1 &2
3&4
5&6
7 &8
9 &10
11

1
2
3
4
5
6


Cervical vertebrae as maturational indicators

PETRICA FERNANDEZ
JCO (1998)


Adv : a )

no need for extra radiograph

b) detection of abnormalities

Disadv :

A) subtle changes not appreciated
b) postural variation
c) radiation protection


Dental age determination
Demirjian et al 1973 .
Should not rely on last stage of tooth formation
9 stages of dental development have been described
:


Scores given


The calculation is made using a point evaluation system


Tooth mineralization & pubertal growth spurt
a study by Seymour Chertkow
Relation between the state of maturation of
maxillary canine & lower premolars & 2nd molars &
known skeletal. Indicators like :




Hook of hamate
Sessmoid
Epiphysis of middle phalanx of 3rd finger


Results

Completion of root formation of mandibular canine
prior to apical closure was related to other
maturational indicators in white children
In black children apical closure had already occurred
No sex difference


Relationship between mand canine
calcification stages & skeletal maturity
BUSCHANG, COUTHINO , MIRANDA
Correlation of skeletal. &canine maturity was tested
RESULTS :
AT STAGE F :

do not show sessmoid
MP3 , PP5 epiphysis = diaphysis

G : presence of sesmoid
DP3 , MP3 , PP5 CAP


H : apical closure ,

fusion of epiphysis with diaphysis

CONCLUSION :

before PHV I

1 ) initiation of spurt – stage F
2 ) G coincides with eruption of canine 1 yr
in boys and 5 months before in
girls


Lower 3rd molar development in relation to
skeletal maturity and chronological Age
ENGSTROM & SAGNE

•

IN 60 % PP2 stage - initial crown mineralization

•

80% MP3 STAGE - crown formation complete & root formation begins
indicates pubertal growth spurt

•

70 % DP3u stage – formation of half root length – deceleration phase

•

AT RU STAGE - 1/3 RD CROWN COMPLETED
1/3 rd –1/2 root developed
1/3 rd root reached full length
rd
Lower 3 molar developed earlier in boys

•


-

Maturation evaluation of ossification of mid
palatal suture
Revello & Fishman (1994)
purpose
materials and methods :
a) occlusal & hand wrist
b) 84 pt .( 39 m , 45 f )

Results :



significant correlation
Variation exists in the way the suture closes

Location of points


During early stages of maturation :
- little or no midpalatal approximation
-9 % fusion at smi3
- ant portion of suture is widely open

As maturation progresses
- approximation increases
- 25 % fusion at smi3

During late maturation
- inc . Rate of ossification
- smi 11 only 50 % suture ossified
- no significant sex difference

conclusion

Frontal sinus &mandibular growth
prediction
Rossow , Lambard , Harris
Skeletal growth patterns of 103 subjects with cl 1& 3
malocclusions were analyzed as advocated
by Ricketts

Surface area of frontal sinus was assessed by
summagraphics decoder linked to microcomputer


Assessment of growth impetus using mp3 maturation
& its correlation with cvmi & dental age
I. Iso (2003 ) – Ks Negi , Y. sharma
PURPOSE :
compare changes in middle phalanx of 3rd
finger , cervical vertebrae & developmental
stages of max. rt canine during skeletal
Maturation
160 children (80 +80)


Conclusion :


sexual dimorphism



highly significant correlation between cvmi & mp3



Canine maturation has inconsistent correlation


Correlation between CVMI & MP3


Cervical vertebral maturation as predictor of
adolescent growth spurt

KEITH
GRAVE
,GRANTTOWN
STEND

AUS ORTH J ,
(2003)


Mandibular growth as related to cervical
vertebral maturation & body height
FRANCHI , BACETTI , MACNAMARA
(AJO 2000)

Material & method :
24 individuals (15 f , 9 m ), lat ceph taken


DENTOFACIAL ORTHOPEDICS IN
RELATION TO SOMATIC MATURATION
HANS PANCHEVZ & HAGG
AJO ( 1985 )
 mandibular treatment changes was related to somatic
maturation in cases with cl 2 mal treated for 7 mnths

 somatic maturity assessed by recording standing ht
 treatment period were correlated with phv
RESULTS : 1) sagital condylar growth more in peak


Tooth mineralization &pubertal growth spurt
Richard smith
Stage of tooth

Hook of hamate

Epiphysis of
mp3

inference

1

Root length = or >crown Incomplete
length
calcification

Epiphysis =
diaphysis

Growth spurt
not started

2

Walls of root canal
parallel open apex

Completely calcified

increase

3

Apex closed

calcified

Mp3 cap

Shortly before
beginning
pubertal growth
spurt
Pubertal
growth spurt


conclusion
Growth factor is a critical variable in orthodontic treatment
Using treatment element of timing of maximum growth in conjunction
with knowledge of magnitude &direction one can readily transform
orthodontic profession from mere tooth positioning to one

involving face

forming


Thank you
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