Assessment of skeletal age in Orthodontics (2).pptx

This presentation outlines various methods of Skeletal Age Assessment in Orthodontics

1. ASSESSMENT OF SKELETAL AGE ( cont …) Dr. SAIF ALAM JR-I

2. CONTENTS

3. CERVICAL VERTEBRA MATURATION INDEX Hassel and Farman (1995) found that the shapes of the cervical vertebrae were found to differ with different levels of skeletal development​

4. MODIFIED STAGES OF CERVICAL VERTEBRAL MATURATION -Mcnamara, Bacetti and Franchi (2005) The six stages are defined as follows: Cervical stage 1 (CS1) : The lower borders of all the three vertebrae (C2-C4) are flat. The bodies of both C3 and growth C4 are trapezoid in shape (the superior border of the vertebral body is tapered from posterior to anterior). The peak in mandibular growth will occur on an average two years after this stage. Cervical stage 2 (CS2) : A concavity is present at the lower border of C2. The bodies of both C3 and C4 are still trapezoid in shape. The peak in mandibular growth will occur, on an average within one year after this stage. Class III treatment with maxillary expansion and protraction is effective in the maxilla only when it is performed before the peak (CS1 or CS2), whereas it is effective in the mandible during both prepubertal between and pubertal stages.

5. Cervical stage 3 (CS3) : Concavities at the lower border of both C2 and C3 are present. The bodies of C3 and C4 may be either trapezoid or rectangular horizontal in shape. Stage CS3 represents the ideal stage to begin functional jaw orthopedics, as the peak in mandibular growth will occur within the year or after this stage. CS3 is also the appropriate age for treatment of vertical malocclusion, because peak in mandibular growth occurs during this stage. Cervical stage 4 (CS4) : Concavities at the lower borders al of C2, C3, and C4 are now present. The bodies of both C3 and C4 are rectangular and horizontal in shape. The peak in mandibular growth has occurred within one or two years before this stage.

6. Cervical stage 5 (CS5) : The concavities at the lower borders of C2, C3, and C4 still are present. At least one of the bodies of C3 and C4 is square in shape. The peak in mandibular growth ends at least one year before this stage. Cervical stage 6 (CS6) : The concavities at the lower borders of C2, C3, and C4 still are evident. At least one of the bodies of C3 and C4 is rectangular and vertical in shape. The peak in mandibular growth end at least two years before this stage

7. Mandibular Canine Calcification As An Indicator For Skeletal Maturation

8. DEVELOPMENT OF MANDIBULAR THIRD MOLAR AS AN INDICATOR OF SKELETAL MATURATION

9. After comparing the stages of formation of lower third molar with hand wrist radiographs, the following points were concluded: At the stage PP2 , the lower third molar showed complete crown mineralization in majority of the subjects. At DP3 U stage , the lower third molar crown was still incomplete in some subjects, but it had already attained full root length in others. At stage RU , the crown was completed only in one-third of the subjects and rarely had the root developed in one third, and the root had reached full length in the rest. At MP3 cap , the lower third molar crown formation was complete in majority of the subjects.

10. FRONTAL SINUS The study was performed on 53 adolescent boys, and the frontal sinus size development was assessed on lateral head films. The accuracy of the prediction procedure was tested by comparing the prediction stage with the longitudinal growth data for body height of the subjects.

11. Method Two head films from each subject were analyzed on a 1- or 2-year interval basis. Two prediction intervals of 1 (T1) and 2 years (T2) were formed. The radiographs were selected without any knowledge of the child's somatic maturity stage.

12. Frontal sinus growth velocity at puberty is closely related to body height growth velocity.  Frontal sinus growth shows a well-defined pubertal peak ( Sp ), which on the average, occurs 1.4 years after the pubertal body height peak (Bp).   In male subjects, the average age at frontal sinus peak is 15.1 years.  In a 1-year observation interval, a peak growth velocity in the frontal sinus of at least 1.3 mm/yr. is attained by 84% of the subjects. In a 2-year observation interval, a peak growth velocity in the frontal sinus of at least 1.2 mm/yr. is attained by 70% of the subjects.

13. Prediction Procedure

14. Mahmood HT, Shaikh A, Fida M. Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity. American Journal of Orthodontics and Dentofacial Orthopedics . 2016 Oct 1;150(4):637-42.

15. Method A cross-sectional study was performed on the pre-treatment lateral cephalograms of 252 subjects aged 8 to 21 years. The sample was divided into 6 groups based on the cervical vertebral maturation stages. The frontal sinus index was calculated by dividing the frontal sinus height and width, and the cervical stages were evaluated on the same radiograph. Mahmood HT, Shaikh A, Fida M. Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity. American Journal of Orthodontics and Dentofacial Orthopedics . 2016 Oct 1;150(4):637-42.

16. SH - the highest point on the frontal sinus; SL - the lowest point on the frontal sinus; A - line joining SH and SL denoting maximum frontal sinus height; SPP - posterior point on the frontal sinus; SAP - anterior point on the frontal sinus; B - line joining SPP and SAP denoting the maximum frontal sinus width perpendicular to line A; S - anatomic centre of sella turcia ; N - deepest point in the midline at the frontonasal suture. Mahmood HT, Shaikh A, Fida M. Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity. American Journal of Orthodontics and Dentofacial Orthopedics . 2016 Oct 1;150(4):637-42.

17. Results: The height and width of the frontal sinus were significantly larger in the male subjects than in the females. A significant association was found between the frontal sinus height and width and cervical stages in both sexes. However, the changes in the frontal sinus index across the different cervical stages were found to be significant in male subjects only. A weak negative correlation was found between the sinus index and the cervical stages in male subjects, whereas no correlation was found in female subjects. Conclusions: The frontal sinus index cannot be used to identify the prepubertal, pubertal, and post-pubertal stages of the adolescent growth spurt. Therefore, it cannot be used as a reliable maturity indicator. Mahmood HT, Shaikh A, Fida M. Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity. American Journal of Orthodontics and Dentofacial Orthopedics . 2016 Oct 1;150(4):637-42.

18. Singer CP, Mamandras AH, Hunter WS. The depth of the mandibular antegonial notch as an indicator of mandibular growth potential. American Journal of Orthodontics and Dentofacial Orthopedics . 1987 Feb 1;91(2):117-24.

19. Singer CP, Mamandras AH, Hunter WS. The depth of the mandibular antegonial notch as an indicator of mandibular growth potential. American Journal of Orthodontics and Dentofacial Orthopedics . 1987 Feb 1;91(2):117-24. Materials and Method Two groups were selected, each comprising of 25 orthodontically treated patients (13 girls and 12 boys). Sample selection was based on the depth of the mandibular antegonial notch as viewed on each subject's pre-treatment lateral cephalogram. The deep notch (DN) group (average age, 12.3 years) included all subjects with a notch depth of 3 mm or greater. The shallow notch (SN) group (average age, 11.5 years) contained a similar number of cases with a notch depth of l mm or less. The mean time interval examined was 4.3 years for DN cases and 3.7 years for SN cases. Nongrowing patients and patients with a Class III malocclusion were excluded from the study.

20. Singer CP, Mamandras AH, Hunter WS. The depth of the mandibular antegonial notch as an indicator of mandibular growth potential. American Journal of Orthodontics and Dentofacial Orthopedics . 1987 Feb 1;91(2):117-24.

21. Singer CP, Mamandras AH, Hunter WS. The depth of the mandibular antegonial notch as an indicator of mandibular growth potential. American Journal of Orthodontics and Dentofacial Orthopedics . 1987 Feb 1;91(2):117-24. Findings Mandible The mandible of DN subjects was more retrusively positioned relative to the anterior cranial base. The DN mean value for SNB was 2.8° less; SNPg was 3.9° less than the SN averages. The articular angle in the DN group was 6.2° larger than the corresponding SN mean value. Maxilla M axilla was 2.1 ° more retrusively positioned relative to the anterior cranial base in DN cases. A retrusive maxilla helped compensate for the effects of a retrusive mandible in the DN cases. Cranial base The average value for the saddle angle ( Ar -S-N) was 2.9° smaller in the DN group as compared to the SN group. No statistical differences were found between the two groups for the linear size of the cranial base.

22. Singer CP, Mamandras AH, Hunter WS. The depth of the mandibular antegonial notch as an indicator of mandibular growth potential. American Journal of Orthodontics and Dentofacial Orthopedics . 1987 Feb 1;91(2):117-24. Treatment Considerations The results of this study clearly demonstrated decreased mandibular growth in DN subjects as compared with SN subjects, even though the DN group had a combined active treatment and retention period that was 7 months longer in duration than the SN group. Furthermore, DN subjects required the extraction of dental units with three times the frequency of their SN counterparts in order to achieve a successful orthodontic result. The extraoral traction needs of DN children were primarily fulfilled with high-pull and straight-pull headgear. SN children wore low-pull headgear exclusively. Thus, patients exhibiting deep antegonial notching of the mandible may require longer and more comprehensive orthodontic treatment than SN patients.

23. Singer CP, Mamandras AH, Hunter WS. The depth of the mandibular antegonial notch as an indicator of mandibular growth potential. American Journal of Orthodontics and Dentofacial Orthopedics . 1987 Feb 1;91(2):117-24. Conclusion Deep notch subjects had a more retrusive mandible with a shorter corpus, less ramus height, and a greater gonial angle than did shallow notch subjects. The mandibular growth direction in deep notch patients, as measured by the facial axis and the mandibular plane angle, was more vertically directed than for shallow notch patients. The deep notch subjects had longer total facial height and longer lower facial height than did the shallow notch subjects. The deep notch subjects had a smaller saddle angle than did the shallow notch subjects. The deep notch sample experienced less mandibular growth during the study period examined as e videnced by (a) a smaller increase in total mandibular length, (b) corpus length, and (c) less displacement of the chin in a forward direction as compared to the shallow notch sample. Notch depth increased in the deep notch group, while it decreased slightly in the shallow notch group during the study period. Deep notch patients required a longer duration of orthodontic treatment than did shallow notch patients.

24. Tripathi T, Gupta P, Rai P, Sharma J, Gupta VK, Singh N. Osteocalcin and serum insulin-like growth factor-1 as biochemical skeletal maturity indicators. Progress in Orthodontics. 2017 Dec;18:1-8.

25. Methods:- A cross-sectional study was done on 150 subjects (75-M, 75-F) in the age groups of 8-20 years and segregated into 6 CVMI stages. Serum osteocalcin and IGF-1 were estimated by ELISA. RESULTS:- Peak serum IGF-1 levels were obtained at CVMI stages 4 and 3 for males and females, respectively, with insignificant difference between stages 3 and 4 in females. Peak serum osteocalcin levels were found at stage 5 and 3 for males and females with insignificant difference from other stages except stages 5 and 6 in males. CONCLUSION:- Osteocalcin followed IGF-1 across all CVMI stages but showed insignificant interstage differences. Tripathi T, Gupta P, Rai P, Sharma J, Gupta VK, Singh N. Osteocalcin and serum insulin-like growth factor-1 as biochemical skeletal maturity indicators. Progress in Orthodontics. 2017 Dec;18:1-8.

26. Masoud M, Masoud I, Kent Jr RL, Gowharji N, Cohen LE. Assessing skeletal maturity by using blood spot insulin-like growth factor I (IGF-I) testing. American journal of orthodontics and dentofacial orthopedics . 2008 Aug 1;134(2):209-16.

27. Masoud M, Masoud I, Kent Jr RL, Gowharji N, Cohen LE. Assessing skeletal maturity by using blood spot insulin-like growth factor I (IGF-I) testing. American journal of orthodontics and dentofacial orthopedics . 2008 Aug 1;134(2):209-16. METHODS: They measured mean blood IGF-1 levels in a cross-sectional study of 83 patients (44-F, 39-M) on recall to begin orthodontic treatment, in active treatment, or in post-treatment follow-up. RESULTS: Mean bloodspot IGF-1 levels were significantly higher in late pubertal stages than in pre-pubertal, early pubertal, and post-pubertal stages. CONCLUSION: Blood spot IGF-1 could be used as a skeletal maturity indicator and might be useful in detecting residual mandibular growth in young adults.

28. REFERENCES

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