SlideShare une entreprise Scribd logo
1  sur  18
Hand Wrist Radiographs
&
Maturity Indicators
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com






Understanding of growth events is of primary
importance in orthodontics.
Individual variations regarding timing, velocity
of growth.
To assess growth, prediction of amount of
growth left SKELETAL MATURITY
INDICATORS are used.

www.indiandentalacademy.com
Skeletal Maturity
“a measure of how far the bones of an area have
progressed towards maturity, not in size, but in
shape and in their relative positions one to
another, as visualized in a radiograph”.

Hand Wrist Radiograph
Cervical Vertebrae
www.indiandentalacademy.com
Why study maturity indicators ?
Exact status of growth ( magnitude & direction )
For treatment planning.
…potential vector of facial development…
…growth potential left..
….onset of treatment timing…
…type of effective treatment… Functional appliance,
orthodontic fixed treatment, Orthognathic surgery.
....treatment prognosis.
www.indiandentalacademy.com
“Chronologic age is not a reliable developmental
yardstick , as it is not necessarily correlated with
the maturational age of the patient”

www.indiandentalacademy.com


Key to successful treatment
of growth .



To take advantage of growth we must have an
idea of its magnitude, direction & timing.



Timing
Knowledge of skeletal maturity
indicators is important.
www.indiandentalacademy.com

Utilization
Handwrist radiograph
Numerous small bones which show a predictable
sequence of ossification from birth to maturity
Ossification of the bones of hand and wrist is
standard for skeletal development.
Calculation of skeletal age
Ossification and development of bones form a
chronology of skeletal development

www.indiandentalacademy.com
Components of hand and wrist

Phalanges
Metacarpals
Carpals
www.indiandentalacademy.com


Adductor sesamoid – Small nodular bone
present in region of thumb.



To obtain an estimate of timing of adolescent
growth spurt

www.indiandentalacademy.com
www.indiandentalacademy.com
Stages of ossification of phalanges

capping

www.indiandentalacademy.com

fusion
Fishman Skeletal Maturity
Assessment (1982)
11 Skeletal Maturity Indicators
4 stages of bone maturation
6 anatomical sites

www.indiandentalacademy.com
www.indiandentalacademy.com
A) WIDTH OF EPIPHYSIS EQUALS DIAPHYSIS
1. PP3 =
2. MP3 =
3. MP5 =
B) OSSIFICATION
4. Adductor sesamoid of thumb
P
ubertal growth spurt

(Acceleration)
C) CAPPING
5. DP3 cap
6. MP3 cap
7. MP5 cap
D) FUSION
8. DP3
9. PP3
10. MP3 11. Radius
www.indiandentalacademy.com
Adolescent period of development
Accelerating Growth (SMI 1 to 3)
Peak velocity of growth (SMI 4 to 7)
Decelerating growth (SMI 8 to11).

Childhood

Adolescence

www.indiandentalacademy.com
www.indiandentalacademy.com
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com

Contenu connexe

Plus de Indian dental academy

Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  Indian dental academy
 
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
 
Diagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental coursesDiagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
 
Properties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic coursesProperties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
 
Use of modified tooth forms in complete denture occlusion / dental implant...
Use of modified  tooth forms  in  complete denture occlusion / dental implant...Use of modified  tooth forms  in  complete denture occlusion / dental implant...
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
 
Dental luting cements / oral surgery courses  
Dental   luting cements / oral surgery courses  Dental   luting cements / oral surgery courses  
Dental luting cements / oral surgery courses  Indian dental academy
 
Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  Indian dental academy
 
Dental casting investment materials/endodontic courses
Dental casting investment materials/endodontic coursesDental casting investment materials/endodontic courses
Dental casting investment materials/endodontic coursesIndian dental academy
 
Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  Indian dental academy
 
Dental ceramics/prosthodontic courses
Dental ceramics/prosthodontic coursesDental ceramics/prosthodontic courses
Dental ceramics/prosthodontic coursesIndian dental academy
 
Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  Indian dental academy
 
Dental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry coursesDental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry coursesIndian dental academy
 
Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  Indian dental academy
 
Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...
Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...
Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...Indian dental academy
 
Dentin bonding agents final/cosmetic dentistry courses
Dentin bonding agents final/cosmetic dentistry coursesDentin bonding agents final/cosmetic dentistry courses
Dentin bonding agents final/cosmetic dentistry coursesIndian dental academy
 
Dentofacial perspective / dental courses
Dentofacial perspective  / dental coursesDentofacial perspective  / dental courses
Dentofacial perspective / dental coursesIndian dental academy
 
Dentofacial perspective /prosthodontic courses
Dentofacial perspective  /prosthodontic coursesDentofacial perspective  /prosthodontic courses
Dentofacial perspective /prosthodontic coursesIndian dental academy
 
Denture adhesives and cleansers/ oral surgery courses  
Denture adhesives and cleansers/ oral surgery courses  Denture adhesives and cleansers/ oral surgery courses  
Denture adhesives and cleansers/ oral surgery courses  Indian dental academy
 
Denture base and teeth /orthodontic courses by Indian dental academy 
Denture base and teeth /orthodontic courses by Indian dental academy Denture base and teeth /orthodontic courses by Indian dental academy 
Denture base and teeth /orthodontic courses by Indian dental academy Indian dental academy
 
Denture base considerations (2)/certified fixed orthodontic courses by Indian...
Denture base considerations (2)/certified fixed orthodontic courses by Indian...Denture base considerations (2)/certified fixed orthodontic courses by Indian...
Denture base considerations (2)/certified fixed orthodontic courses by Indian...Indian dental academy
 

Plus de Indian dental academy (20)

Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  
 
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
 
Diagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental coursesDiagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental courses
 
Properties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic coursesProperties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic courses
 
Use of modified tooth forms in complete denture occlusion / dental implant...
Use of modified  tooth forms  in  complete denture occlusion / dental implant...Use of modified  tooth forms  in  complete denture occlusion / dental implant...
Use of modified tooth forms in complete denture occlusion / dental implant...
 
Dental luting cements / oral surgery courses  
Dental   luting cements / oral surgery courses  Dental   luting cements / oral surgery courses  
Dental luting cements / oral surgery courses  
 
Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  
 
Dental casting investment materials/endodontic courses
Dental casting investment materials/endodontic coursesDental casting investment materials/endodontic courses
Dental casting investment materials/endodontic courses
 
Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  
 
Dental ceramics/prosthodontic courses
Dental ceramics/prosthodontic coursesDental ceramics/prosthodontic courses
Dental ceramics/prosthodontic courses
 
Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  
 
Dental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry coursesDental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry courses
 
Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  
 
Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...
Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...
Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...
 
Dentin bonding agents final/cosmetic dentistry courses
Dentin bonding agents final/cosmetic dentistry coursesDentin bonding agents final/cosmetic dentistry courses
Dentin bonding agents final/cosmetic dentistry courses
 
Dentofacial perspective / dental courses
Dentofacial perspective  / dental coursesDentofacial perspective  / dental courses
Dentofacial perspective / dental courses
 
Dentofacial perspective /prosthodontic courses
Dentofacial perspective  /prosthodontic coursesDentofacial perspective  /prosthodontic courses
Dentofacial perspective /prosthodontic courses
 
Denture adhesives and cleansers/ oral surgery courses  
Denture adhesives and cleansers/ oral surgery courses  Denture adhesives and cleansers/ oral surgery courses  
Denture adhesives and cleansers/ oral surgery courses  
 
Denture base and teeth /orthodontic courses by Indian dental academy 
Denture base and teeth /orthodontic courses by Indian dental academy Denture base and teeth /orthodontic courses by Indian dental academy 
Denture base and teeth /orthodontic courses by Indian dental academy 
 
Denture base considerations (2)/certified fixed orthodontic courses by Indian...
Denture base considerations (2)/certified fixed orthodontic courses by Indian...Denture base considerations (2)/certified fixed orthodontic courses by Indian...
Denture base considerations (2)/certified fixed orthodontic courses by Indian...
 

Dernier

Paris 2024 Olympic Geographies - an activity
Paris 2024 Olympic Geographies - an activityParis 2024 Olympic Geographies - an activity
Paris 2024 Olympic Geographies - an activityGeoBlogs
 
Class 11th Physics NEET formula sheet pdf
Class 11th Physics NEET formula sheet pdfClass 11th Physics NEET formula sheet pdf
Class 11th Physics NEET formula sheet pdfAyushMahapatra5
 
Beyond the EU: DORA and NIS 2 Directive's Global Impact
Beyond the EU: DORA and NIS 2 Directive's Global ImpactBeyond the EU: DORA and NIS 2 Directive's Global Impact
Beyond the EU: DORA and NIS 2 Directive's Global ImpactPECB
 
Kisan Call Centre - To harness potential of ICT in Agriculture by answer farm...
Kisan Call Centre - To harness potential of ICT in Agriculture by answer farm...Kisan Call Centre - To harness potential of ICT in Agriculture by answer farm...
Kisan Call Centre - To harness potential of ICT in Agriculture by answer farm...Krashi Coaching
 
9548086042 for call girls in Indira Nagar with room service
9548086042  for call girls in Indira Nagar  with room service9548086042  for call girls in Indira Nagar  with room service
9548086042 for call girls in Indira Nagar with room servicediscovermytutordmt
 
Sanyam Choudhary Chemistry practical.pdf
Sanyam Choudhary Chemistry practical.pdfSanyam Choudhary Chemistry practical.pdf
Sanyam Choudhary Chemistry practical.pdfsanyamsingh5019
 
The Most Excellent Way | 1 Corinthians 13
The Most Excellent Way | 1 Corinthians 13The Most Excellent Way | 1 Corinthians 13
The Most Excellent Way | 1 Corinthians 13Steve Thomason
 
Measures of Dispersion and Variability: Range, QD, AD and SD
Measures of Dispersion and Variability: Range, QD, AD and SDMeasures of Dispersion and Variability: Range, QD, AD and SD
Measures of Dispersion and Variability: Range, QD, AD and SDThiyagu K
 
APM Welcome, APM North West Network Conference, Synergies Across Sectors
APM Welcome, APM North West Network Conference, Synergies Across SectorsAPM Welcome, APM North West Network Conference, Synergies Across Sectors
APM Welcome, APM North West Network Conference, Synergies Across SectorsAssociation for Project Management
 
Call Girls in Dwarka Mor Delhi Contact Us 9654467111
Call Girls in Dwarka Mor Delhi Contact Us 9654467111Call Girls in Dwarka Mor Delhi Contact Us 9654467111
Call Girls in Dwarka Mor Delhi Contact Us 9654467111Sapana Sha
 
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...EduSkills OECD
 
Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...
Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...
Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...fonyou31
 
Q4-W6-Restating Informational Text Grade 3
Q4-W6-Restating Informational Text Grade 3Q4-W6-Restating Informational Text Grade 3
Q4-W6-Restating Informational Text Grade 3JemimahLaneBuaron
 
Key note speaker Neum_Admir Softic_ENG.pdf
Key note speaker Neum_Admir Softic_ENG.pdfKey note speaker Neum_Admir Softic_ENG.pdf
Key note speaker Neum_Admir Softic_ENG.pdfAdmir Softic
 
Software Engineering Methodologies (overview)
Software Engineering Methodologies (overview)Software Engineering Methodologies (overview)
Software Engineering Methodologies (overview)eniolaolutunde
 
1029-Danh muc Sach Giao Khoa khoi 6.pdf
1029-Danh muc Sach Giao Khoa khoi  6.pdf1029-Danh muc Sach Giao Khoa khoi  6.pdf
1029-Danh muc Sach Giao Khoa khoi 6.pdfQucHHunhnh
 
Interactive Powerpoint_How to Master effective communication
Interactive Powerpoint_How to Master effective communicationInteractive Powerpoint_How to Master effective communication
Interactive Powerpoint_How to Master effective communicationnomboosow
 
fourth grading exam for kindergarten in writing
fourth grading exam for kindergarten in writingfourth grading exam for kindergarten in writing
fourth grading exam for kindergarten in writingTeacherCyreneCayanan
 

Dernier (20)

Paris 2024 Olympic Geographies - an activity
Paris 2024 Olympic Geographies - an activityParis 2024 Olympic Geographies - an activity
Paris 2024 Olympic Geographies - an activity
 
Class 11th Physics NEET formula sheet pdf
Class 11th Physics NEET formula sheet pdfClass 11th Physics NEET formula sheet pdf
Class 11th Physics NEET formula sheet pdf
 
Beyond the EU: DORA and NIS 2 Directive's Global Impact
Beyond the EU: DORA and NIS 2 Directive's Global ImpactBeyond the EU: DORA and NIS 2 Directive's Global Impact
Beyond the EU: DORA and NIS 2 Directive's Global Impact
 
Kisan Call Centre - To harness potential of ICT in Agriculture by answer farm...
Kisan Call Centre - To harness potential of ICT in Agriculture by answer farm...Kisan Call Centre - To harness potential of ICT in Agriculture by answer farm...
Kisan Call Centre - To harness potential of ICT in Agriculture by answer farm...
 
9548086042 for call girls in Indira Nagar with room service
9548086042  for call girls in Indira Nagar  with room service9548086042  for call girls in Indira Nagar  with room service
9548086042 for call girls in Indira Nagar with room service
 
Sanyam Choudhary Chemistry practical.pdf
Sanyam Choudhary Chemistry practical.pdfSanyam Choudhary Chemistry practical.pdf
Sanyam Choudhary Chemistry practical.pdf
 
The Most Excellent Way | 1 Corinthians 13
The Most Excellent Way | 1 Corinthians 13The Most Excellent Way | 1 Corinthians 13
The Most Excellent Way | 1 Corinthians 13
 
Measures of Dispersion and Variability: Range, QD, AD and SD
Measures of Dispersion and Variability: Range, QD, AD and SDMeasures of Dispersion and Variability: Range, QD, AD and SD
Measures of Dispersion and Variability: Range, QD, AD and SD
 
APM Welcome, APM North West Network Conference, Synergies Across Sectors
APM Welcome, APM North West Network Conference, Synergies Across SectorsAPM Welcome, APM North West Network Conference, Synergies Across Sectors
APM Welcome, APM North West Network Conference, Synergies Across Sectors
 
Call Girls in Dwarka Mor Delhi Contact Us 9654467111
Call Girls in Dwarka Mor Delhi Contact Us 9654467111Call Girls in Dwarka Mor Delhi Contact Us 9654467111
Call Girls in Dwarka Mor Delhi Contact Us 9654467111
 
INDIA QUIZ 2024 RLAC DELHI UNIVERSITY.pptx
INDIA QUIZ 2024 RLAC DELHI UNIVERSITY.pptxINDIA QUIZ 2024 RLAC DELHI UNIVERSITY.pptx
INDIA QUIZ 2024 RLAC DELHI UNIVERSITY.pptx
 
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
 
Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...
Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...
Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...
 
Q4-W6-Restating Informational Text Grade 3
Q4-W6-Restating Informational Text Grade 3Q4-W6-Restating Informational Text Grade 3
Q4-W6-Restating Informational Text Grade 3
 
Key note speaker Neum_Admir Softic_ENG.pdf
Key note speaker Neum_Admir Softic_ENG.pdfKey note speaker Neum_Admir Softic_ENG.pdf
Key note speaker Neum_Admir Softic_ENG.pdf
 
Software Engineering Methodologies (overview)
Software Engineering Methodologies (overview)Software Engineering Methodologies (overview)
Software Engineering Methodologies (overview)
 
1029-Danh muc Sach Giao Khoa khoi 6.pdf
1029-Danh muc Sach Giao Khoa khoi  6.pdf1029-Danh muc Sach Giao Khoa khoi  6.pdf
1029-Danh muc Sach Giao Khoa khoi 6.pdf
 
Mattingly "AI & Prompt Design: The Basics of Prompt Design"
Mattingly "AI & Prompt Design: The Basics of Prompt Design"Mattingly "AI & Prompt Design: The Basics of Prompt Design"
Mattingly "AI & Prompt Design: The Basics of Prompt Design"
 
Interactive Powerpoint_How to Master effective communication
Interactive Powerpoint_How to Master effective communicationInteractive Powerpoint_How to Master effective communication
Interactive Powerpoint_How to Master effective communication
 
fourth grading exam for kindergarten in writing
fourth grading exam for kindergarten in writingfourth grading exam for kindergarten in writing
fourth grading exam for kindergarten in writing
 

Hand wrist radiographs /certified fixed orthodontic courses by Indian dental academy

  • 1. Hand Wrist Radiographs & Maturity Indicators www.indiandentalacademy.com
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 3.    Understanding of growth events is of primary importance in orthodontics. Individual variations regarding timing, velocity of growth. To assess growth, prediction of amount of growth left SKELETAL MATURITY INDICATORS are used. www.indiandentalacademy.com
  • 4. Skeletal Maturity “a measure of how far the bones of an area have progressed towards maturity, not in size, but in shape and in their relative positions one to another, as visualized in a radiograph”. Hand Wrist Radiograph Cervical Vertebrae www.indiandentalacademy.com
  • 5. Why study maturity indicators ? Exact status of growth ( magnitude & direction ) For treatment planning. …potential vector of facial development… …growth potential left.. ….onset of treatment timing… …type of effective treatment… Functional appliance, orthodontic fixed treatment, Orthognathic surgery. ....treatment prognosis. www.indiandentalacademy.com
  • 6. “Chronologic age is not a reliable developmental yardstick , as it is not necessarily correlated with the maturational age of the patient” www.indiandentalacademy.com
  • 7.  Key to successful treatment of growth .  To take advantage of growth we must have an idea of its magnitude, direction & timing.  Timing Knowledge of skeletal maturity indicators is important. www.indiandentalacademy.com Utilization
  • 8. Handwrist radiograph Numerous small bones which show a predictable sequence of ossification from birth to maturity Ossification of the bones of hand and wrist is standard for skeletal development. Calculation of skeletal age Ossification and development of bones form a chronology of skeletal development www.indiandentalacademy.com
  • 9. Components of hand and wrist Phalanges Metacarpals Carpals www.indiandentalacademy.com
  • 10.  Adductor sesamoid – Small nodular bone present in region of thumb.  To obtain an estimate of timing of adolescent growth spurt www.indiandentalacademy.com
  • 12. Stages of ossification of phalanges capping www.indiandentalacademy.com fusion
  • 13. Fishman Skeletal Maturity Assessment (1982) 11 Skeletal Maturity Indicators 4 stages of bone maturation 6 anatomical sites www.indiandentalacademy.com
  • 15. A) WIDTH OF EPIPHYSIS EQUALS DIAPHYSIS 1. PP3 = 2. MP3 = 3. MP5 = B) OSSIFICATION 4. Adductor sesamoid of thumb P ubertal growth spurt (Acceleration) C) CAPPING 5. DP3 cap 6. MP3 cap 7. MP5 cap D) FUSION 8. DP3 9. PP3 10. MP3 11. Radius www.indiandentalacademy.com
  • 16. Adolescent period of development Accelerating Growth (SMI 1 to 3) Peak velocity of growth (SMI 4 to 7) Decelerating growth (SMI 8 to11). Childhood Adolescence www.indiandentalacademy.com
  • 18. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com