Skeletal Maturity PDF

SKELETAL MATURITY The basis for skeletal age assessment by radiograph is that the different ossification centers appear and mature at different times. The order, rate, time of appearance and progress of ossification in the various ossification centers occur in predictable sequence. Method...

SKELETAL MATURITY The basis for skeletal age assessment by radiograph is that the different ossification centers appear and mature at different times. The order, rate, time of appearance and progress of ossification in the various ossification centers occur in predictable sequence. Methods that are available to assess the skeletal maturity of an individual: 1) Hand- wrist radiograph- most widely accepted method 2) Evaluation of skeletal maturation using cervical vertebrae. 3) Assessment of maturity by clinical and radiographic examination of different stages of tooth development. Hand-wrist region is made up of numerous small bones. These bones show a predictable and scheduled pattern of appearance, ossification and union from birth to maturity. Determine the skeletal maturation status of that individual. Methods to assess the skeletal maturity using Hand-wrist radiograph: A. Atlas methods by Greulich and Pyle B. Bjork, Grave and Brown method C. Fishman’s Skeletal maturity Indicators D. Hagg and Taranger Method Anatomy of hand and wrist 1) Distal ends of long bones of forearm. The distal ends of radius and ulna (long bones of the forearm, form the first group of bones. ulna- medial aspect radius- distal aspect 2) Carpals- eight small bones- irregularly shaped arrange in two rows (proximal and distal row) 3) Metacarpals- 5 miniature long bones forming the skeletal framework of the palm of the hand. numbered 1-5 from the thumb to little finger (ossifies) 4) Phalanges- small bones forming the finger Three in number in each finger, except thumb, which has only 2 phalanges. Proximal, Middle (absent in thumb), distal phalanges 3 stages of ossification  Stage 1- epiphysis and diaphysis are equal Stage 2- The epiphysis caps the diaphysis by surrounding it like a cap Stage 3- fusion occurs between the epiphysis and diaphysis 5) Sesamoid bone is a small nodular bone most open present embedded in tendons in the region of the thumb Greulich and Pyle method Bjork, Grave and Brown method- divided skeletal development into 9 stages Stage 1 (male 10.6 y, female 8.1 y)- epiphysis and diaphysis of the proximal phalanx of index finger are equal; occurs approximately three years before the peaks of pubertal growth spurt. Stage 2 (male 12.0 y, female 8.1y)- epiphysis and diaphysis of the middle phalanx of the middle finger are equal; noticed prior to the beginning pubertal growth spurt. Stage 3 (males 12.6 y, female 9.6 y) – presence of 3 areas of ossification. The hamular process of the hamate exhibits ossification Ossification of pisiform The epiphysis and diaphysis of radius are equal Stage 4 (male 13.0 y, female 10.6 y) this stage marks the beginning of the pubertal growth spurt Initial mineralization of the ulnar sesamoid of the thumb Increased ossification of the hamular process of the hamate bone Stage 5 – peak 0f pubertal growth spurt. Capping of diaphysis by the epiphysis is seen in: Middle phalanx of third finger Proximal phalanx of the thumb Radius Stage 6 (male 15 y, female 15 y)- signifies the end of pubertal growth spurt. Union between epiphysis and diaphysis of the distal phalanx the middle finger Stage 7 (male15.9y, female 13.3 y) Union of epiphysis and diaphysis of the proximal phalanx the little finger occurs Stage 8 (male 15.9 y. female 13.9 y) fusion between epiphysis and diaphysis of the middle phalanx the middle finger. Stage 9 (male 18.5 y, female 16.0 y) Last stage and end of skeletal growth Fusion of epiphysis and diaphysis of the radius REFERENCE: S. I. Bhalajhi (2015), Orthodontics The Arts and Sciences: Arya (MED) Publishing House, 6th ed.