Hand Wrist Radiographs & Maturity Indicators www.indiandentalacademy.com
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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.
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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�
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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
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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
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Stages of ossification of phalanges
capping
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fusion
Fishman Skeletal Maturity Assessment (1982) 11 Skeletal Maturity Indicators 4 stages of bone maturation 6 anatomical sites
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A) WIDTH OF EPIPHYSIS EQUALS DIAPHYSIS 1. PP3 = 2. MP3 = 3. MP5 = B) OSSIFICATION 4. Adductor sesamoid of thumb Pubertal 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
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