Other investigators have stated that the appearance of the hook of hamate and the pisiform bone is also a good indicator of the onset of puberty. The beginning of ossification of adductor sesamoid has been advocated by some authors as a reliable indicator of the onset of puberty. On the other hand, skeletal maturation staging from the radiographic analysis is a widely used approach to predict the timing of pubertal growth, to estimate growth velocity, and to estimate the proportion of growth remaining. In orthodontic treatment planning, knowledge of facial growth velocity, and percentage of facial growth remains as a very important factor for effective growth modification interventions. Hägg and Taranger studied pubertal growth from the stages of ossification of the middle phalanx of the third finger of the hand (MP 3 stages). Furthermore, the changes in the epiphysis of the middle phalanx of the third finger (MP3) follow an orderly sequence. The Atlas of Greulich and Pyle is the most frequently used method to evaluate skeletal age from hand-wrist radiographs. The hand-wrist radiograph is commonly used for skeletal developmental assessment. However, these methods do not give a precise prediction of how much growth left. Therefore, analysis of the cervical spine or of the frontal sinus on lateral cephalographs was recommended as an alternative method. The use of hand-wrist radiographs to examine skeletal maturity has been criticized as the patient is exposed to additional radiation. The most preferred method is the use of hand-wrist radiographs. It was reported that the evaluation of skeletal maturation with the help of radiographs is considered to be the more reliable approach. Growth prediction can be estimated utilizing physiological parameters which include the peak of the growth velocity in standing height, pubertal markers, dental development, and radiological finding of skeletal maturation. The development of these bones from the appearance of calcification centers to epiphyseal plate's closure occurs throughout the entire postnatal growth period and therefore provides a useful means of assessing skeletal maturity. The idea of using hand and wrist radiograph for determining the skeletal age is that the skeleton in hand and wrist region is made of several small bones 27 small bones, distal ends of long bones radius and ulna. The bone age is of great help to the orthodontist in coordinating the orthodontic therapy with the growth process. The hand and wrist radiograph help in estimating the skeletal age of bone for determining the physical maturation status of the child. Further, variations of dental and skeletal ages from known chronological age indicate changes in the standard growth pattern. The relationship among the chronological, dental, and skeletal ages is important in diagnosis and treatment. Several methods have been developed to assess the dental age according to the degree of calcification observed in permanent teeth. Dental age estimation is based on the rate of development and calcification of tooth buds and the progressive sequence of their eruption in the oral cavity. Thus, biological age or physiological age was considered. Hence, chronological age cannot be considered as a reliable indicator for the evaluation of the maturity status of a child. The chronological age of a child may be accelerated of decelerated due to the individual variation of the timing of pubertal growth spurt. The radiographic assessment of the bone provides a valuable criterion of an individual's osseous maturation and is referred as the skeletal age. The appearance and union of the different skeletal centers of ossification follows a pattern and schedule from birth to maturity. Skeletal age is an indicator of physiological development and is distinct from the chronological age. However, skeletal age has been considered the most reliable method to assess the developmental status. The developmental stage of a child can be determined from several parameters such as height, weight, chronological age, secondary sexual characteristics, skeletal age, and dental age. This atlas serves to compare and indicate the skeletal age of the patient. Greulich and Pyle have published atlas of hand and wrist radiographs of normal healthy children from birth to adulthood, at every 3-month interval. Most of the information concerning growth are obtained from cephalography and hand and wrist radiograph. The orthodontist deals with growing children and nongrowing adults.
0 kommentar(er)
