Bone Age Assessment from Lateral Cephalograms Using Deep Learning Algorithms in the Indian Population

Purpose: The assessment of bone age has applications in a wide variety of fields: from orthodontics to immigration. The traditional non?automated methods are time?consuming and subject to inter? and intra?observer variability. This is the first study of its kind done on the Indian population. In this study, we analyse different pre?processing techniques and architectures to determine the degree of maturation (i.e. cervical vertebral maturation [CVM]) from cephalometric radiographs using machine learning algorithms. Methods: Cephalometric radiographs—labelled with the correct CVM stage using Baccetti et al. method—from 383 individuals aged between 10 and 36 years were used in the study. Data expansion and in?place data augmentation were used to handle high data imbalances. Different pre?processing techniques like Sobel filters and canny edge detectors were employed. Several deep learning convolutional neural network (CNN) architectures along with numerous pre?trained models like ResNet?50 and VGG?19 were analysed for their efficacy on the dataset. Results: Models with 6 and 8 convolutional layers trained on 64 × 64–size grayscale images trained the fastest and achieved the highest accuracy of 94%. Pre?trained ResNet?50 with the first 49 layers frozen and VGG?19 with 10 layers frozen to training had remarkable performances on the dataset with accuracies of 91% and 89%, respectively. Conclusions: Custom deep CNN models with 6–8 layers on 64 × 64–sized greyscale images were successfully used to achieve high accuracies to classify the majority classes. This study is a launchpad in the development of an automated method for bone age assessment from lateral cephalograms for clinical purposes.

Relación del crecimiento sagital de los maxilares y el índice de maduración cervical / Relationship between the sagittal growth of the maxillary and the cervical maturation index

Resumen El crecimiento del maxilar se manifiesta de manera diferente respecto a la mandíbula, la cual se caracteriza por un desarrollo sagital más tardío. El objetivo de esta investigación fue asociar el crecimiento sagital del maxilar superior e inferior con el índice de maduración cervical en radiografías cefálicas laterales de pacientes entre 8 a 20 años de la ciudad de Cuenca, Ecuador. Se realizó una investigación con enfoque cuantitativo de tipo descriptivo, correlacional y de corte transversal retrospectivo, con una base de datos de 10.586 radiografías cefálicas laterales. Se observó que el pico de crecimiento inicia alrededor de los 9 años en las mujeres y en los hombres a los 11 años, y este culmina a los 13 años en el sexo femenino y entre los 14 y 17 años en el sexo masculino. Además, se determinó una correlación baja ente el crecimiento sagital del maxilar superior y los estadios de maduración vertebral (r=0,338) así como con el maxilar inferior (r= 0,357). Finalmente, se concluyó que el crecimiento del maxilar superior se produce en los primeros estadios de maduración cervical, mientras que en el maxilar inferior el crecimiento longitudinal se produce a partir del estadio III de maduración cervical.

Abstract The growth of the maxilla manifests itself differently from the mandible, which is characterized by a later sagittal development. The objective of the research was to associate the sagittal growth of the upper and lower jaw and the cervical maturation index in lateral cephalic radiographs of patients between 8 and 20 years of age from the city of Cuenca. A descriptive, correlational and retrospective cross-sectional quantitative approach was conducted with a database of 10,586 lateral cephalic radiographs. It was observed that the peak of growth begins around 9 years of age in women and at 11 years in men, and culminates at age 13 in females, and between 14 and 17 years in males. In addition, a low correlation was determined between the sagittal growth of the upper jaw and the stages of vertebral maturation (r = 0.338) as well as with the lower jaw (r = 0.357). Finally, it was concluded that the growth of the upper jaw occurs in the first stages of cervical maturation, while in the lower jaw, longitudinal growth occurs from stage III of cervical maturation.

Skeletal maturation pattern among Down Syndrome individuals in Benin, City. Nigeria

Background: The assessment of skeletal maturity is important in the timing of orthodontic treatment especially in the modification of dento-facial growth. The use of cervical vertebrae as a method of assessment of skeletal maturity has rarely been used among Down Syndrome. Objective: To assess skeletal maturity among individuals with Down Syndrome using the cervical vertebrae maturation stages. Methods: The study was conducted among 21 Down Syndrome with mean ages of 11.70  1.83 years (males) and 13.64  1.75 years (female); and 21 control individuals with mean ages of 12.00  2.00 years (male), and 13.50  1.90 years (female). The independent t-test and chi-square test were used to determine significant differences among the continuous (age) and categorical variables (cervical vertebrae maturation stages) respectively when matched with gender and chronological age. Fischer exact test was used when an expected frequency presentation was <5. A p-value of < 0.05 was set as statistically significant. Results: Down Syndrome males had delayed maturation at 11 years but accelerated at 12 with early attainment of maturity at 15 years. Down Syndrome female had a delay tendency in skeletal maturation from 11­15 years of age. Overall, Down Syndrome had a 1.242 probability of either having a delay or advancement in skeletal maturation which was not statistically significant. Conclusively, the skeletal maturation pattern between Down syndrome patients and normal individuals was not statistically different. Conclusion: The average timing for commencement of orthodontic treatment especially growth modification for normal individuals can be applied for individuals with Down Syndrome as this present study did not show any statistically significant difference in their overall skeletal maturation.

Identification of bone-specific alkaline phosphatase in saliva and its correlation with skeletal age

Bone-specific alkaline phosphatase (B-ALP), a product of osteoblasts, is a bone formation marker whose serum levels fluctuate with puberty and adolescence. Aims: This study aims to assess B-ALP levels in saliva and correlate it with different skeletal maturity stages of hand-wrist radiographs using Hagg and Taranger method. Settings and Design: Observational study and cross-sectional design. Subjects and Methods: Total sample comprised of 90 individuals, right hand-wrist radiographs, and 2 ml unstimulated whole saliva samples taken from each patient on the same day. The hand-wrist radiographs were traced and staged into 5 subgroups (18 individuals each) according to Hagg and Taranger method. Statistical Analysis Used: One-way analysis of variance (ANOVA) and Tukey's multiple post hoc test. Results: The comparison of salivary B-ALP values between the different skeletal subgroups using one-way ANOVA depicted statistically significant results (P = 0.0003). Pairwise comparison using Tukey's multiple post hoc procedures showed that salivary B-ALP levels were comparatively higher in subgroup 3 and that the difference between subgroups 1 and 3 (P = 0.0109) and subgroups 3 and 5 (P = 0.0014) was statistically significant. Conclusion: B-ALP could be successfully identified and quantitatively estimated in saliva and showed significant correlation with different skeletal age subgroups as determined by Hagg and Taranger method.

Correlation between craniofacial growth and upper and lower body heights in subjects with Class I occlusion

ABSTRACT Objective: To correlate skeletal age, standing height, upper and lower body lengths, and selected craniofacial growth features in a sample of growing individuals, and to model craniofacial growth using multivariate regression. Methods: This was a retrospective cross-sectional study with 447 African black boys and girls, between the ages 8 and 16 years, who attended the dental clinic at one hospital. The skeletal maturational age was determined from hand-wrist radiographs using the Greulich and Pyle atlas. Craniofacial measurements representing maxillary length (Ar-ANS), mandibular length (Ar-Gn), and lower facial height (ANS-Me) were calculated from lateral cephalograms in habitual occlusion. Body lengths were clinically measured in centimeters. Results: Moderate correlations (r=0.42 to 0.68) were observed between skeletal age and the three selected craniofacial measurements. Statistically significant correlations were also found between the craniofacial measurements and both upper and lower body lengths. The mandibular length had a stronger correlation with the upper body length than with the lower body length. Multiple regression analyses to determine maxillary and mandibular lengths suggested that sex, upper and lower body lengths might be used to determine maxillary length; while skeletal age, upper and lower body lengths might help determine mandibular length. Conclusions: Based on the relatively strong correlation between upper body length and mandibular length, further research in this area may warrant its use as a predictor for mandibular growth modification timing.

RESUMO Objetivo: correlacionar a idade esquelética, a estatura, as alturas corporais superior e inferior, e algumas características específicas do crescimento craniofacial, em uma amostra de indivíduos em crescimento, e delinear o crescimento craniofacial usando regressão multivariada. Métodos: esse estudo transversal retrospectivo foi feito com 447 meninos e meninas negros africanos, com idades entre 8 e 16 anos, atendidos na clínica odontológica de um hospital. A maturação esquelética, em anos, foi determinada a partir de radiografias de mão e punho, usando o atlas de Greulich e Pyle. As medidas craniofaciais representando o comprimento maxilar (Ar-ENA), o comprimento mandibular (Ar-Gn) e a altura facial anterior inferior (ENA-Me) foram calculadas a partir de cefalogramas laterais em oclusão habitual. Os comprimentos corporais foram medidos clinicamente, em centímetros. Resultados: correlações moderadas (r = 0,42 a 0,68) foram observadas entre a idade esquelética e as três medidas craniofaciais selecionadas. Também foram encontradas correlações estatisticamente significativas entre as medidas craniofaciais e as alturas corporais superior e inferior. O comprimento mandibular teve uma correlação mais forte com a altura corporal superior do que com a inferior. As análises de regressão múltipla para determinar os comprimentos maxilar e mandibular sugeriram que o sexo e as alturas corporais superior e inferior podem ser usados para determinar o comprimento maxilar, enquanto a idade esquelética e as alturas corporais superior e inferior podem ajudar a determinar o comprimento mandibular. Conclusões: com base na correlação relativamente forte entre a altura corporal superior e comprimento mandibular, pesquisas adicionais nessa área poderiam justificar seu uso como indicador para o período de modificação do crescimento mandibular.

Skeletal Maturity of the Hand and Wrist in Bania Girls in Punjab Assessed by the TW2 Method.

Background: Chronological age of the child is a poor indicator of his/her maturity status especially during adolescence. Skeletal age derived from hand and wrist is well established as a method of estimating physical maturity and particularly valuable at about time of puberty when the greatest number of variations in maturation are found among children of same chronological age. Methods: The investigation was carried out cross- sectionally on the menstruating 200 bania girls from Punjab. Skeletal maturity was assessed by Tanner-Whitehouse-2 method (20 bone score) by taking hand wrist radiographs of left hand as advocated by Tanner. Results: The mean skeletal age is 11.625± .2252 at mean chronological age of 11.181± .1337 (20B) and mean skeletal age is 12.092± .8036 at mean chronological age of 12.013± .2736. Delay is seen in skeletal age than chronological age at 13 and 14 years. The differences between skeletal ages and chronological ages are statistically significant at p < .05 at 11 years and 13 years. Discussion: Bania girls showed advancement of skeletal age over chronological age at 11 and 12 years while Chinese girls showed advanced skeletal age at 12 and 13 years and well off Chandigarh girls showed advanced skeletal age at 12 years of age. Conclusion: The ages at which skeletal age preceded the chronological age occurred much earlier in bania girls than well off Chandigarh girls and Chinese girls. As all ratings were done by the first author with higher reliability and without information on age. All these factors suggest that sample is representative of bania girls from Punjab and the observations on the skeletal maturation are reliable.

Reliability of the frontal sinus index as a maturity indicator.

Aim: The aim of this study was to compare the reliability of frontal sinus as a skeletal maturity indicator in males and females. Setting and Sample Population: Lateral cephalograms of 75 males and 75 females, both in preand post-pubertal stages of development as determined by Middle phalanx of the third finger (MP3) radiographs. Materials and Methods: Lateral cephalograms were analyzed for frontal sinus maturity. Maximum height, maximum width and height to width ratio of the sinus were calculated. The mean height to width ratio of the sinus at respective MP3 stages were tabulated and subjected to statistical analysis to determine the correlation. Correlation at different MP3 stages between males and females was also determined. Results: Statistically significant differences were observed between the mean values of F and FG along with F and I stage in males, significant difference between the values of FG stage among males and females were also observed. Conclusion: Based on statistical and direct comparison of raw data, study concludes that frontal sinus is not reliable as a sole criterion for prediction of skeletal maturity.

Skeletal Maturity Indicators - Simplified Method For Clinical Reference.

The stage of Skeletal Maturation of an individual is essential for assessing the growth potential of an individual. This helps in formulating Diagnosis and Treatment Planning which may affect the final prognosis of the orthodontic treatment. The course of orthodontic treatment often depends upon the intensity of facial growth. Thus the knowledge of the timing of these growth velocity variations in craniofacial complex is important in clinical orthodontics. There are different methods of assessing skeletal maturity for orthodontic treatment purpose. The main source is Hand Wrist X-rays, Cephalograms and Radiographs for assessing the status of dental development. Review of Literature reveals a wide data on this aspect related to methods and the correlation between different methods. Most of them are academically oriented. The purpose of this article is to present a simplified method for clinical reference during treatment.

Digital radiograph of the middle phalanx of the third finger (MP3) region as a tool for skeletal maturity assessment.

Objective: To evaluate the reliability of the digital radiograph of the middle phalanx of the third finger (MP3) in skeletal maturity assessment Study Design: Fifty children (24 girls and 26 boys) belonging to the circumpubertal age-group were selected for the study. Two radiographs - lateral cephalogram and digital radiograph of the MP3 region - were taken in each child. Age assessment was based on the changes in shape of the cervical vertebrae and the epiphysis of the middle phalanx of the third finger of the left hand. The radiographs were assessed by three examiners. The inter- and intraexaminer variability were determined by the Wilcoxon rank sign test and the Kruskal-Wallis test and were found to be nonsignificant. Examiner 3 showed the best intraexaminer agreement and was selected to evaluate the radiographs for the entire study. Results: The correlation determined between the MP3 stages and cervical vertebrae maturity index (CVMI) stages, the peak-wise distribution of the MP3 stages, and the correlation between the MP3 stages and the chronological age were found to be highly significant. Conclusions: Digital radiograph of the MP3 region is definitely a simple, reliable, cost-effective, and time-saving technique for the assessment of skeletal maturity.

Maduración ósea y estado nutricional antropométrico en niños, niñas y adolescentes con síndrome nefrótico / Bone maturation and anthropometric nutritional status in children and adolescents with nephrotic syndrome

Los glucocorticoides, comúnmente utilizados en el tratamiento del síndrome nefrótico, pudieran interferir en elcrecimiento y desarrollo del niño. La maduración ósea (MO) por el método Tanner- Whitehouse II (TW I2) constituye un indicador para evaluar el desarrollo somático. Analizar el comportamiento de la MO con relación al estado nutricional antropométrico y a las características clínico – patológicas en niños, niñas y adolescentes con Síndrome Nefrótico. Estudio transversal, exploratorio, descriptivo y correlacional. Se evaluaron 28 pacientes (11 niñas, 17 varones) entre 2 y 16 años con síndrome nefrótico, que acudieronentre agosto y octubre de 2008 a la consulta de nefrología del Hospital Pediátrico Dr. Elías Toro, cuyos padres autorizaron las medicionesde peso y talla y la realización de una radiografía de mano y muñeca izquierdas para edad ósea TW2. Se utilizaron la prueba de ANOVAsimple, t de Student y coeficiente de correlación de Pearson, con nivel de significación estadística de p <0,05. Predominó el género masculino(60,7%). Dos pacientes tuvieron un índice de masa corporal en exceso y ninguno con déficit. Predominó la edadósea normal (85,7%), adelantada en tres niños (10,7%) y retardada en uno. Se observó una relación inversa entre el número de recaídas y el porcentaje de maduración ósea alcanzada en los pacientes masculinos con corticoresistencia (p < 0,05). Este estudio reveló diferencias en el comportamiento de la maduración ósea, según el género y la condición de corticoresistencia

Glucocorticoids, commonly used in the treatment of nephrotic syndrome could interfere in children’s growth and development. Skeletal maturity determined by Tanner-Whitehouse II method (TW2) constitutes an indicator of bone maturation. To analyze the behavior of bone age (BA) related to anthropometric nutritional status and to clinical and pathological characteristics of children and adolescents with nephrotic syndrome. This is a cross-sectional, exploratory, descriptive andcorrelational study. Twenty eight patients (11 girls, 17 boys) diagnosed with nephrotic syndrome that attended the nephrology outpatient clinic of the Pediatric Hospital Dr. Elías Toro, from August to October 2008. Weight and height were measured using international techniques, and a left hand and wrist X-ray was evaluated by the TW2-method. ANOVA, t-Student test and Pearson correlation coefficient were calculated with a significance level of p< 0.05. Results: boys predominated (60.7%). Body mass index was abovenormal in 2 patients and normal in the rest. BA was normal in 24 children (85.7%), advanced in three (10.7%) and delayed in one. An inverse relationship was found between the number of relapses and the percentage of maturity reached in steroid resistant male patients (p < 0.05). This study shows a probable difference in the behavior of BA, according to gender steroid resistance

The Longitudinal Sagittal Growth Changes of Maxilla and Mandible According to Quantitative Cervical Vertebral Maturation / 华中科技大学学报（医学）（英德文版）

To investigate the longitudinal sagittal growth changes of maxilla and mandible according to the quantitative cervical vertebral maturation (QCVM) for adolescents with normal occlusion,mixed longitudinal data were used.The samples included 87 adolescents aged from 8 to 18 y old with normal occlusion (32 males,55 females) selected from 901 candidates.Sequential lateral cephalograms and hand-wrist films were taken once a year,lasting for 6 y.The longitudinal sagittal growth changes of maxilla and mandible according to QCVM were measured.There were some significant differences between maxilla and mandible according to QCVM.The sagittal growth change of maxilla showed a trend towards high velocity→decelerating velocity→completing velocity from QCVM stage Ⅰ to stage Ⅳ.The sagittal growth change of mandible showed a trend towards accelerating velocity→high velocity→decelerating velocity→completing velocity from QCVM stage Ⅰ to stage IV.With sagittal relationship,growth magnitude was almost the same between maxilla and mandible at QCVM stage Ⅰ.At stage Ⅱ the growth of mandible exceeded that of maxilla and growth in mandible continued at stages Ⅲ and Ⅳ,while the maxilla ceased to grow.Growth magnitude was greater and the growth duration was longer with male mandible.It is concluded that the longitudinal sagittal growth changes of maxilla and mandible on the basis of QCVM is of value in the orthodontic practice.

Correlación entre los niveles plasmáticos de hormona luteinizante (LH) y hormona folículo-estimulante (FSH) y el estadio de maduración esquelética en un grupo de niños de Medellín, Colombia / Correlation between plasma levels of luteinizing (LH) and folliclestimulating hormones (FSH) and the state of skeletal maturation in a group of children from Medellin, Colombia

Con el fin de evaluar la asociación entre la madurez ósea y los cambios en los niveles de las gonadotrofinas durante las etapas iniciales de la pubertad, se correlacionaron los niveles séricos de las hormonas luteinizante (LH) y folículo-estimulante (FSH) con el estado de maduración esquelética (evaluado por el método de Greulich y Pyle), la edad, el peso, la talla y la madurez sexual (según la clasificación de Tanner y con el empleo del orquidómetro de Prader) en una población sana de la ciudad de Medellín, Colombia.El estudio de tipo prospectivo observacional, conformado por 16 varones y 15 niñas, entre 8 y 12 años de edad, evaluó seis veces a la misma cohorte durante un período de 30 meses empleando muestras sanguíneas para los niveles hormonales y radiografías de las estructuras óseas carpofalángicas; se incluyeron quienes completaron seis muestras sanguíneas y seis estudios radiológicos.Una vez registradas las diferencias clínicas de los estados Tanner de madurez sexual, los varones con ganancia progresiva de peso mostraron tendencia hacia mayores concentraciones de FSH y discreto avance de la edad esquelética, en tanto que, para los dos sexos, el cambio en los valores de LH se correlacionó mejor con la progresión de la edad esquelética independientemente de otras variables.

In order to analyze the association between skeletal maturation and the changes in the levels of gonadotrophinsduring the initial stages of puberty, serum levels of luteinizing (LH) and follicle-stimulating hormones (FSH) were correlated with the state of skeletal maturation (determined by the method of Greulich and Pyle), and with the age, weight, height and sexual maturity (according to the classification of Tanner and using Prader´s orchidometer) in a healthy population of Medellin, Colombia. Our report includes 16 boys and 15 girls, ranging in age from 8 to 12 years, who completed a total of six blood specimens for hormone levels determination, and six radiographic studies of the carpo-phalangeal bone structures. The study lasted 30 months. Boys with progressive weight gain showed a trend towards higher concentrations of FSH and a discrete advance in skeletal age. On the other hand, in both girls and boys, changes in the LH values were betterassociated with the progression of skeletal age with no influence of other variables.

Clinical Application of CHN Bone Age / 医疗卫生装备

CHN (the standards of skeletal maturity of hand and wrist for Chinese) is becoming more and more important in rencent years. At present, CHN bone age is applied in forecasting body height, menophania date, infantile endocrine diseases, judicial identification, orthopedics and so on. The clinical application of CHN bone age is introducted. In addition, the existing problems and future trends of bone age are pointed out.

The effect of treatment timing on maxillary protraction treatment response: A comparison of prepubertal and pubertal patients / 대한치과교정학회지

Treatment timing is a very important factor to consider in treating skeletal Class III patients by means of maxillary protraction. According to the literature maxillary protraction should be carried out at an early age before puberty. However, no scientific data were presented to support this statement and recent studies supported by statistical data showed disagreement concerning the optimum treatment time of maxillary protraction. Therefore, there is no agreement about the optimum treatment time of maxillary protraction. In this study hand-wrist X-rays were taken from 119 patients and subjects were grouped into prepubertal and pubertal group according to their skeletal maturity. Pretreatment and posttreatment lateral cephalometric X-rays were taken and treatment effects were compared. The average treatment time was 6.5 months for the prepubertal group and 6.1 months for the pubertal group. The obtained results were as follows; 1. The amount of maxillary forward movement was the same for prepubertal and pubertal group. 2. The amount of maxillary downward movement was the same for prepubertal and pubertal group. 3. The amount of mandibular downward and backward rotational movement was the same for prepubertal and pubertal group. 4. Dental effects were the same for prepubertal and pubertal group.

The relationship between menarche and the ossification stages of the phalanx of the first and third finger / 대한치과교정학회지

Among many maturation indicators of growing patients, menarche and skeletal maturity are useful to assess growth and development, and the changes of the first and third finger are relatively important in hand-wrist X-rays. The objective of this study was to evaluate the relationship between menarche and the changes of the phalanx of the first and third finger and compare skeletal maturation among different malocclusion types. The sample used in this study was 29 Class I, 27 Class II and 27 Class III females whose hand-wrist X-rays had been taken with 6 month interval before the appearance of ulnar sesamoid ossification till the phalanges of the fingers were almost fused. The results were as follows. 1. There was no skeletal maturity difference among malocclusion types. 2. There was no difference in the mean chronologic age of menarche among different malocclusion types and that was 12.30+/-0.98 years. 3. The ulnar sesamoid was observed at 10.35+/-1.01 years, and on distal phalanx of the first finger, epiphyseal capping appeared at 11.26+/-1.04 years and fusion at 13.12+/-1.06 years. The epiphyseal capping on middle phalanx of the third finger was observed at 11.57+/-1.02 years and fusion at 13.72+/-1.04 years. 4. The timing of menarche occurred around the same time as the fusion process of distal phalanx of the first finger(p<0.001, r=0.82) and the initiation of fusion of middle phalanx of the third finger(p<0.001, r=0.78). Therefore, we can give the aid when we evaluate the growth and development of growing females seeing the changes at phalanx of the first and finger.

Correlations between dental and skeletal maturity / 대한치과교정학회지

To investigate the developmental stages of dental and skeletal maturation by ages and the correlations among dental maturity, skeletal maturity of cervical vertebrae, and that of hand-and-wrist, the author used the cephalograms, orthopantomograms, and hand-and-wrist radiograms of 1055 patients (male 458, female 597) aged 7 to 29 years old. In the cephalograms, the skeletal maturity stages of each bone were mainly assessed by Hassel and Farman's cervical vertebrae maturation indicators (CVMI) method. In the orthopantomograms, the dental maturity stages of each tooth were mainly assessed by Nolla's tooth calcification stages method. In the hand-and-wrist radiograms, the skeletal maturity stages of each bone were mainly assessed by Fishman's skeletal maturity indicators (SMI) method. The results were as follows. 1. There was a high correlation among dental maturity, skeletal maturity of cervical vertbrae, and that of hand-and-wrist in the both sexes (p0.8) between skeletal maturity of hand-and-wrist and maturity of upper and lower canine, first premolar, and second premolar. 4. There was high a correlation(r=0.8) between skeletal maturity of cervical vertebrae and maturity of upper canine. 5. By the age, dental maturity, skeletal maturity of cervical vertebrae, and that of hand-and-wrist were obtained in the both sexes. In summary, dental maturity, skeletal maturity of cervical vertebrae, and that of hand-and-wrist are of sufficient diagnostic worth as an index to predict adolescent growth

A longitudinal study on the skeletal maturity of the hand and wrist among various malocclusion groups (I) / 대한치과교정학회지

Growth and development evaluation of patients with growth potential is of great importance for orthodontic treatment planning. Timing of orthodontic intervention greatly depends on one`s developmental status, thus if there is a difference in skeletal maturation among malocclusion types different treatment timing should be applied. The objective of this study was to evaluate and compare skeletal maturation among different malocclusion types. The samples used in this study was 38 ClassI. 36 ClassII and 33 ClassIII females aging from 8 to 10 years. Handwrist X-rays were taken with 6 month interval till 12-13 years of age. The results were as follows. 1. There was no skeletal maturity difference among different malocclusion types. 2. The hamular process of hamate was observed at 9.16+/-0.72 years, pisiform bone at 9.13+/-0.71 years and the ulnar sesamoid at 10.34+/-0.84 years. 3. The timing of epiphyseal capping on the third finger was 10.96+/-0.80 years for distal phalanx and 11.27+/-0.87 years for middle phalanx, 11.12+/-0.86 years for proximal phalanx of the first finger, 11.21+/-0.82 years for radius and 11.62+/-0.85 years for middle phalanx of the fifth finger. 4. The appearance of pisiform bone showed high correlation with appearance of hamular process of hamate(r=0.91), and ulnar sesamoid bone appearance showed high correlation with advanced ossification of hamular process(r=0.86). Timing of epiphyseal capping among different parts showed high correlation(r=0.80-0.90). 5. The shape of middle phalanx of the fifth finger showed the highest variability (20.6%).

Evaluation of the skeletal maturity using the cervical vertebrae and hand-wrist rakiographs / 대한치과교정학회지

In clinical orthodontics, it is significant to understand the stage of growth in a growing patient. In order to assess the skeletal maturity of the patients, the hand-wrist radiograph and the cervical vertebrae (Cervical Vertebrae Maturation Indicators: CVNII) was evaluated from the lateral cephalograph and the skeletal maturity determined from the hand-wrist X-ray, (Skeletal Maurity Indicators: SMI) taken on the same day in the same patients, and its interrelationship examined to come up with the following results: 1. The skeletal maturity evaluated from the hand-wrist radiograph and the maturation of the cervical vertebrae from the lateral cephalograph showed a significant interrelationship with each other. 2. In the evaluation of the skeletal maturity using the SNIT and CVMI, the CVMI 1 showed a siginificant correlation with SMI 1, 2, the CVMI 2 with SNIT 3, 4, CVMI 3 with SMI 6, 7, CVMI 4 with SMI 7, 8, CVMI 5 with 9, 10 and CVNII 6 with SMI 11. 3. When the morphological changes in the 2nd and 3rd cervical vertebrae were separately observed, it was seldom that the concavity appeared in the lower border of the 2nd cervical vertebra and at the same time not appear in the 3rd cervical vertebra (CVMI 2 : 10.38 %, CVMI 3 : 6.56 %) 4. In each of the skeletal maturation stage evaluated from the hand-wrist and the cervical vertebrae, the average age and its standard deviation in male and female patients appeared to have large differences among individuals. Skeletal maturation seemed to appear earlier for the girls than for the boys, and its termination 24 months faster for girls.

A study on menarche and skeletal maturity among various malocclusion groups / 대한치과교정학회지

In order to correct a maxillofacial-skeletal disharmony successfully and achieve a favorable facial profile, orthodontic treatment must begin at pubertal growth spurt. Therefore predicting the pubertal growth pattern and evaluating the growth potential is very important For an orthodontist, estimating skeletal maturity in relation to one's personal growth spurt is essential and it must be considered into the treatment. The objective of this study was to find out whether there was a difference in menacheal age among different malocclusion groups and to evaluate the skeletal maturity at menarche. The subjects were 64 Class I malocclusion patients, 51 Class 1I patients and 38 Class III patients. Skeletal maturity was estimated from handwrist radiographs of these patients. Handwrist radiographs were taken between 3 months before and after the menarche. The results were as follows. 1. The mean chronologic age of menarche was 12.50+/-1.01 years. 2. For the Class I malocclusion group the mean age cf menarche was 12.36+/-1.04 years, for Class II 12.81+/-1,03 years and for Class III 12.32+/-0.82 years. According to these results Class II malocclusion patients started mensturation later than Class I and. Class III malocclusion patients. 3. No difference was found considering the skeletal maturity at menarche among the malocclusion groups. 4. The skeletal maturity index at menarche was SMI 7 for 45.10%, SMI 8 for 27.25%, SW 9 for 10.46%, SMI 6 for 7.84%, SMI 10 for 7.84% and SMI 5 for 1.31% patients. 5. Statistically there was a significant correlation between skeletal maturity estimated by handwrist radiographs and menacheal age( P<0.05, r-0.25430).

Study on estimating skeletal maturity of hand-wrist using multiple regression model / 대한치과교정학회지

The evaluation of growth potency can be done with many physiologic indicators. It has well known that skeletal maturity has a close relation with both sexual maturity and somatic maturity, but the correlation between skeletal maturity and dental maturity was believed to be less certain. But, recent studies show that specific teeth. including lower canines, present close correlations with skeletal maturity, So, in this study, we studide hand-wrist X-ray films and orthopantomagrams of 387 Korean boys and girls aged from 7 to 15; the purpose was to determine skeletal and dental maturity, and to find out a new method to estimate individual skeletal maturity using multiple-regression model, without the help of hand-wrist X-ray film. As a result of this study, followings were observed. 1. The following multiple-regression model can estimate skeletal maturity index (SMI) with 84% accuracy, and regression coefficient of chronologic age, sex and lower canine show statistical significance. SMI = 0.60 x chronolngic age - 1.67 x sex** + 0.88 x lower canine* - 0.55 x lower 2nd molar* - 10.3 * : mean age corresponding each developing atage, ** : male = 1, female = 0 2. The followering multiple-regression model can estimate skeletal age with 87% of accuracy, and regression coefficient of chronologic age, sex and lower canine show statistical significance. Skeletal age = 0.75 x chronolngic age - 0.55 x sex** + 0.71 x lower canine* - 0.09 x lower 2nd molar* - 5.77 * : mean age corresponding each developing atage, ** : male = 1, femal = 0