Year : 2006 | Volume
: 24 | Issue : 3 | Page : 127--135
Comparative evaluation of hand wrist radiographs with cervical vertebrae for skeletal maturation in 10-12 years old children
M Kamal, Ragini, S Goyal
Department of Orthodontics, D. A. V. Dental College, Yamuna Nagar, Haryana, India
Tulsi Lok and Sons, Outer Quilla Road, Shant Mai Chowk, Rohtak - 124 001, Haryana
A comparative evaluation of hand wrist and cervical vertebrae was done to know the validity of cervical vertebrae as maturity indicators. A sample of 50 subjects (25 females and 25 males) in the age group of 10-12 years were selected on criteria of normal occlusion and the result showed that cervical vertebrae can be used with the same confidence as hand wrist radiographs to evaluate skeletal maturity, thus avoiding the need for an additional radiograph.
|How to cite this article:|
Kamal M, Ragini, Goyal S. Comparative evaluation of hand wrist radiographs with cervical vertebrae for skeletal maturation in 10-12 years old children.J Indian Soc Pedod Prev Dent 2006;24:127-135
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Kamal M, Ragini, Goyal S. Comparative evaluation of hand wrist radiographs with cervical vertebrae for skeletal maturation in 10-12 years old children. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2021 Oct 27 ];24:127-135
Available from: https://www.jisppd.com/text.asp?2006/24/3/127/27901
Skeletal age refers to the degree of development of ossification of the bone. Because of individual variations in timing, duration and velocity of growth, skeletal age assessment is essential and helpful in formulating viable orthodontic treatment plans. During growth every bone goes through a series of changes that can be seen radiologically. The sequence of change is relatively constant for a given bone in every person but the timing of the changes varies because each person has his or her own biological clock.
The hand wrist radiograph is considered to be the most standardized method of skeletal assessment. Assessment of skeletal maturation using hand wrist radiograph as an index based upon time and sequence of appearance of carpal bones and certain ossification events has been reported by many investigators.
Fishman developed a system of skeletal maturation assessment based on four stages of maturation at six anatomic sites located on thumb, third finger, fifth finger and radius. He described 11 adolescent skeletal maturation indicators on the six sites predicting the entire period of adolescence and reported the percentage of growth completed corresponding to each maturity indicator.
Hassel and Farman developed cervical vertebrae as maturity indicators by assessing the lateral profile changes of second, third and fourth vertebrae. The cervical vertebrae maturity indicators were evaluated against skeletal maturation index established from hand wrist radiograph by Fishman. The method has the advantage of eliminating the need for an additional radiographic exposure since the vertebrae are already recorded in the lateral cephalogram taken as a pretreatment record.
Materials and Methods
This study was conducted in the Department of Orthodontics at D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana.
The sample consisted of 50 subjects (25 females and 25 males) in the age range of 10-12 years. The children were selected from schools located in urban areas of Yamuna Nagar.
The samples were selected on the following criteria:
a) Angle's Class I molar relationship
b) Normal occlusion with zero to minimum crowding / spacing (0-2 mm)
c) No history of extraction
d) No history of any orthodontic treatment
e) No history of any badly decayed / filled tooth
f) Pleasant soft tissue profile
Protocol and method
Selected subjects were clinically examined and the following points were recorded:
Age and date of birth: The age considered was his or her chronological age in completed years, without taking the months into consideration.Sex: As males and females attain puberty at different times in life, the total samples were differentiated into males and females.
Sample size of 50 children (25 males and 25 females) were selectedRadiographs-hand wrist, lateral cephalogramMatte acetate tracing paperLead pencil-4HRadiograph viewer
Grouping of sample was done as below.
Lateral cephalograms were taken on Gendex Orthoralix 9200 at 70 Kvp, 6 mA, with exposure time of 0.80 s using Kodak Diagnostic film (T-mat), green base of size 8 in. ´ 10 in. Distance from X-ray source to the subject's midsagittal plane was fixed at 5 feet.
Patient positioning procedure
Radiograph was taken with the Frankfurt horizontal plane parallel to floor.Teeth in centric occlusion.Lips at repose or relaxed position.
Hand wrist radiographs
Hand wrist radiographs of left hand were taken using SRS/SRD-300 at 50 Kvp, 6 ma, with exposure time of 0.60 s using Nieue plus blue base films of size 8 in. ´ 10 in. The distance between the hand and the X-ray source was kept 100 cm.
The film in a cassette, was placed on the table with its long axis parallel to the long axis of hand in pronation.Patient stood with his / her left forearm resting on the film placed on the table with fingers slightly separated and the axis of the hand wrist and forearm in a straight line.The center of the tube was half way between the tips of the fingers and distal end of the radius.
Radiographs were exposed and developed using the standard developer and fixer in a dark room by the same operator to eliminate errors. Any radiograph that had poor contrast was discarded.
Since relative measurement and not absolute measurement is used in the study, magnification is of minimal concern.
Method of tracing the films
The radiographic films were covered on one side with the matte acetate tracing paper.The tracings of the films were done using 4H lead pencil.All the phalanges of the fingers and thumb were drawn along with the carpals, metacarpals and outline of the radius and ulnar bone in the hand wrist radiographs.In the lateral cephalograms, three parts of the cervical vertebrae were traced; these entities include the dens odontoid process - C2, body of the third cervical vertebrae - C3 and the body of the fourth cervical vertebrae - C4.
Elimination of error
The tracings were evaluated by an independent evaluator to evaluate interoperator error.
SMI gives the percentage of adolescent growth completed as shown below.
Cervical vertebrae development was evaluated from the lateral cephalogram according to Hassel and Farman's method (1995) as shown in the chart given below.
Percentage of growth remaining by Hassel and Farman
After the evaluation of cervical vertebrae, the lateral cephalogram was paired with its respective hand wrist radiograph of the same patient.
Cervical vertebrae maturation index (CVMI) indicate percentage of growth remaining and is common for males and females.
Comparison and correlation
Each CVMI is designated equivalent to two skeletal maturation indicators (SMI) levels. Percentage of growth completed according to SMI was taken to evaluate the growth status in males and females [Figure 1][Figure 2][Figure 3][Figure 4][Figure 5].
Observation and Results
The following results were drawn from the statistical analysis.
The [Table 1] shows the mean, minimum, maximum and standard deviation values of the variables - Age, CVMI score, SMI score and growth. The minimum value of chronological age is 10 years and maximum is 12 years with a mean of 11.34 years and standard deviation is 0.7453. The minimum value for CVMI score is 1 and maximum is 5 with a mean of 2.1000 and standard deviation of 1.0152. The minimum value of SMI score is 1 and maximum is 10 with a mean of 3.7200 and standard deviation of 2.0607. The minimum value of percentage of growth completed according to SMI is 0% and maximum value is 96.14% with a mean of 28.0311 and standard deviation of 22.9451.
The [Table 2]a shows that on evaluation of 50 subjects by both the evaluators, i.e., evaluator A and evaluator B, 44 subjects were showing positive correlation between the SMI and CVMI scores, whereas 6 subjects were not showing a positive correlation between SMI and CVMI scores. Forty-three subjects were in agreement with evaluator A and evaluator B, but 1 case was different for both the evaluators, for which Kappa Test was applied to calculate the percentage of agreement between the two evaluators.
Correlation is significant at ' P ' P ' value turns out to be 0.000, which shows that correlation is significant at ' P ' P ' value of 0.000, which is statistically significant at ' P ' P ' P ' value of 0.000, which is statistically significant at ' P ' P ' P ' value of 0.000, which is statistically significant at ' P ' Wide variation in chronological age for different maturity levels suggests that chronological age is a poor indicator of maturity. Skeletal maturity indicators provide a more valid basis than chronological age for growth status of individuals.Females are ahead of males at all levels of skeletal maturity, indicating early age of maturational development for females.Females tend to achieve higher percentage of their growth than males, especially during the age of 11-12 years. At 10 years of age, there is very less variation in the percentage of growth completed in males and females.Cervical vertebrae developmental changes are same for males and females but females develop the changes earlier.Skeletal maturity indicators are less reliable for females as compared to males during the 12th year of age.Maturation indicators of brief duration are more informative than those of longer duration.Skeletal maturation being a continuous process is categorized by distinct events in continuum; so it is difficult to differentiate borderline cases.There is no significant difference between the two techniques of evaluation. This shows that cervical vertebrae can be used with the same confidence as the hand wrist radiographs to evaluate skeletal maturity, thus avoiding the need for an additional radiograph.
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