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Skeletal Age
Assessment
Presented by:
Dr. Gaurav Acharya
2nd year PG Resident
Department of Orthodontics and Dentofacial O...
Growth
Prediction
Chronological
Age
Dental
Development
Growth
Charts
Secondary
Sexual
Characteristics
Skeletal
Development
Skeletal
Age
Assessment
Hand wrist
radiograph
Cervical
vertebra
Frontal
Sinus
Midpalatal
suture
Hand wrist Radiograph
 Most standardized method
 Shows predictable and scheduled
pattern of appearance, ossification
& u...
Hand wrist Radiograph
Sequence of Ossification
First to Ossify→
Capitate
Last to Ossify→
Sesamoid
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: Birth to 10 mont...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 10 months to 2 y...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 10 months to 2 y...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 10 months to 2 y...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 10 months to 2 y...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 2 years to 7 yea...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 7 years to 13 ye...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 13 years to 15 y...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 13 years to 15 y...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 13 years to 15 y...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 13 years to 15 y...
Hand wrist Radiograph
 Infancy
 Toddlers
 Pre-puberty
 Puberty
 Late Puberty
 Post-puberty
Females: 15 years to 17 y...
Hand wrist Radiograph
Different methods of assessing
1. Atlas of Greulich and Pyle (1959)
2. Bjork Method (1972)
3. Fishma...
Hand wrist Radiograph
Atlas of Greulich and Pyle (1959)
Hand wrist Radiograph
Atlas of Greulich and Pyle (1959)
Hand wrist Radiograph
Atlas of Greulich and Pyle (1959)
Hand wrist Radiograph
Atlas of Greulich and Pyle (1959)
Hand wrist Radiograph
Fishman Method (1982)
Cervical Vertebra
 Suggested by Lamparski in 1972.
 Possible with routinely taken lateral
cephalograms
Cervical Vertebra
 Variables analyzed:
1. Concavity at lower border of C2, C3 & C4
2. Shape of the body of C3 and C4
 Tr...
Cervical Vertebra
 Hassel & Farman1 suggested 6 stages of
cervical vertebral maturation
1- Brent Hassel and Allan Farman....
Cervical Vetebra
Initiation
Acceleration
Transition
Decceleration
Maturation
Completion
C2
C3
C4
Cervical Vertebrae
Co- relation of Hand wrist & Cervical Vertebra
maturation Stages1
1- Garcia fernandez. The cervical ver...
Frontal Sinus
 Study done by Ruf and Pancherz in 19961
1- Sabine Ruf, Hans Pancherz. Frontal Sinus Development as an indi...
Frontal Sinus
 Radiographs taken at yearly intervals.
 Average yearly growth velocity (millimeters per year) of
the fron...
Frontal Sinus
 From longitudinal growth data of the subjects, the
average yearly body height growth velocity
(millimeters...
Frontal Sinus
 Frontal sinus growth
velocity at puberty is
closely related to body
height growth velocity.
 Frontal sinu...
Midpalatine Suture1
 Amount of approximation of the midpalatal suture
compared with stages of ossification of the hand-
w...
Midpalatine Suture
 Key landmarks -
 Point A→ most anterior point of premaxilla
 Point B→ most posterior point on the p...
Midpalatine Suture
• A-P (total dimension of the suture)
• A-B (anterior dimension of the suture)
• B-P (posterior dimensi...
Midpalatine Suture
Results
 Increase in sutural approximation
as SMI stages progressed.
 SMI 1&2- decreased sutural
appr...
Midpalatine Suture
Conclusion:
 Best to accomplish ME-before SMI 9.
 Ideal time- SMI 1- 4
Less orthopedic force required...
Conclusion
 Chronological age of an individual is often not
sufficient to assess the development age and somatic
maturity...
References
 Vicente Gilsanz, Osman Ratib. Bone Age : A Digital Atlas of
Skeletal Maturity, Springer publication 2005
 Gr...
Thank You…
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Skeletal age assessment

Skeletal age assessment, Skeletal maturity indicator, Hand wrist radiograph

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Skeletal age assessment

  1. 1. Skeletal Age Assessment Presented by: Dr. Gaurav Acharya 2nd year PG Resident Department of Orthodontics and Dentofacial Orthopedics Peoples Dental College and Hospital, Kathmandu
  2. 2. Growth Prediction Chronological Age Dental Development Growth Charts Secondary Sexual Characteristics Skeletal Development
  3. 3. Skeletal Age Assessment Hand wrist radiograph Cervical vertebra Frontal Sinus Midpalatal suture
  4. 4. Hand wrist Radiograph  Most standardized method  Shows predictable and scheduled pattern of appearance, ossification & union.
  5. 5. Hand wrist Radiograph Sequence of Ossification First to Ossify→ Capitate Last to Ossify→ Sesamoid
  6. 6. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty
  7. 7. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: Birth to 10 months Males: Birth to 14 months Hamate Capitate
  8. 8. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 10 months to 2 years Males: 14 months to 3 years
  9. 9. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 10 months to 2 years Males: 14 months to 3 years
  10. 10. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 10 months to 2 years Males: 14 months to 3 years
  11. 11. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 10 months to 2 years Males: 14 months to 3 years
  12. 12. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 2 years to 7 years Males: 3 years to 9 years
  13. 13. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 7 years to 13 years Males: 9 years to 14 years
  14. 14. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 13 years to 15 years Males: 14 years to 16 years
  15. 15. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 13 years to 15 years Males: 14 years to 16 years
  16. 16. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 13 years to 15 years Males: 14 years to 16 years
  17. 17. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 13 years to 15 years Males: 14 years to 16 years
  18. 18. Hand wrist Radiograph  Infancy  Toddlers  Pre-puberty  Puberty  Late Puberty  Post-puberty Females: 15 years to 17 years Males: 17 years to 19 years
  19. 19. Hand wrist Radiograph Different methods of assessing 1. Atlas of Greulich and Pyle (1959) 2. Bjork Method (1972) 3. Fishman Method (1982) 4. Hagg and Taranger (1982)
  20. 20. Hand wrist Radiograph Atlas of Greulich and Pyle (1959)
  21. 21. Hand wrist Radiograph Atlas of Greulich and Pyle (1959)
  22. 22. Hand wrist Radiograph Atlas of Greulich and Pyle (1959)
  23. 23. Hand wrist Radiograph Atlas of Greulich and Pyle (1959)
  24. 24. Hand wrist Radiograph Fishman Method (1982)
  25. 25. Cervical Vertebra  Suggested by Lamparski in 1972.  Possible with routinely taken lateral cephalograms
  26. 26. Cervical Vertebra  Variables analyzed: 1. Concavity at lower border of C2, C3 & C4 2. Shape of the body of C3 and C4  Trapezoid : least mature  Rectangular horizontal  Squared  Rectangular vertical : in adult life
  27. 27. Cervical Vertebra  Hassel & Farman1 suggested 6 stages of cervical vertebral maturation 1- Brent Hassel and Allan Farman. Skeletal maturation evaluation using cervical vertebrae, AJODO 1995:107:58-66 1. Initiation 2. Acceleration 3. Transition 4. Decceleration 5. Maturation 6. Completion
  28. 28. Cervical Vetebra Initiation Acceleration Transition Decceleration Maturation Completion C2 C3 C4
  29. 29. Cervical Vertebrae Co- relation of Hand wrist & Cervical Vertebra maturation Stages1 1- Garcia fernandez. The cervical vertebrae as maturational indicators, JCO APRIL 1998
  30. 30. Frontal Sinus  Study done by Ruf and Pancherz in 19961 1- Sabine Ruf, Hans Pancherz. Frontal Sinus Development as an indicator for somatic maturity at puberty?, AJODO 1996;110:476-82
  31. 31. Frontal Sinus  Radiographs taken at yearly intervals.  Average yearly growth velocity (millimeters per year) of the frontal sinus was calculated
  32. 32. Frontal Sinus  From longitudinal growth data of the subjects, the average yearly body height growth velocity (millimeters per year) was calculated
  33. 33. Frontal Sinus  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 1.5 yr after body ht. peak
  34. 34. Midpalatine Suture1  Amount of approximation of the midpalatal suture compared with stages of ossification of the hand- wrist according to the Fishman’s system 1- Bernal Revalo, Fishman. Maturational evaluation of ossification of the mid palatal suture, AJO MARCH 1994
  35. 35. Midpalatine Suture  Key landmarks -  Point A→ most anterior point of premaxilla  Point B→ most posterior point on the posterior wall of the incisive foramen  Point P→ Point on the line tangent to the posterior walls of the greater palatine foramen
  36. 36. Midpalatine Suture • A-P (total dimension of the suture) • A-B (anterior dimension of the suture) • B-P (posterior dimension of the suture) • Percentage of osseous development were recorded
  37. 37. Midpalatine Suture Results  Increase in sutural approximation as SMI stages progressed.  SMI 1&2- decreased sutural approx.  After SMI 9- significant increase in the sutural approx.  No significant difference b/n sexes.
  38. 38. Midpalatine Suture Conclusion:  Best to accomplish ME-before SMI 9.  Ideal time- SMI 1- 4 Less orthopedic force required.  Mid palatal approx. occurs more posteriorly.
  39. 39. Conclusion  Chronological age of an individual is often not sufficient to assess the development age and somatic maturity of the patient  Skeletal age derived from Hand-wrist radiograph and cervical vertebra radiograph provide a reliable and efficient means of assessment.  Frontal sinus & midpalatine sutute evaluation are the new approaches for the skeletal maturity assessment
  40. 40. References  Vicente Gilsanz, Osman Ratib. Bone Age : A Digital Atlas of Skeletal Maturity, Springer publication 2005  Greulich-Pyle Hand &Wrist Atlas  Brent Hassel and Allan Farman. Skeletal maturation evaluation using cervical vertebrae, AJODO 1995:107:58-66  Sabine Ruf, Hans Pancherz. Frontal Sinus Development as an indicator for somatic maturity at puberty?, AJODO 1996;110:476-82  Heinrich Wehrbein and Faruk Yildizhan. Mid-palatal suture in young adults. European Journal of Orthodontics 23 (2001) 105— 114  Garcia fernandez. The cervical vertebrae as maturational indicators, JCO APRIL 1998
  41. 41. Thank You…

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