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1. Growth Indicators
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. INTRODUCTION
In orthodontics the assessment of

skeletal age and

pubertal growth spurt (in particular)
are of prime importance in
1.
2.
3.
Diagnosis
treatment planning
Retention.
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3. INDICATIONS FOR GROWTH
STATUS
1.
When maxillomandibular changes are
indicated in the treatment of
a.
b.
c.
2.
3.
4.
Skeletal
Skeletal
Skeletal
Class III cases,
Class II cases or
open bites
In patients with marked discrepancy
between dental and chronological age
Patients requiring orthognathic surgery if
undertaken between 16-20 years of age
Prior to rapid maxillary expansion
(Transverse Plane)
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4. BIOLOGICAL AGE




DENTAL AGE (CANINE, 3RD MOLAR)
CHRONOLOGICAL AGE
ONSET OF PUBERTY
SKELETAL AGE
Hand wrist radiograph
Cervical vertebrae
Frontal sinus
PHV etc.
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5. GROWTH RHYTHM


Pubertal growth spurts are gender
dependent and vary in their relation to the
chronological age
Average values
• Girls 10-12 yrs
• Boys 12-14 yrs

A disturbance of growth rhythm is
considered if a difference of +/- 2 yrs
exists between chronological and biologic
age
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6. Skeletal age



We all know that long bones grow
at the ends called epiphysis.
The newly formed bone starts
getting
mineralized
at
the
metaphysis and the most matured
bone is seen at the diaphysis.
The epiphysis initially forms as a
cartilage tissue which later ossifies
and fuses with the metaphysis as
it matures.
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7. HAND RADIOGRAPH
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8. Acc JULIAN SINGER
Stage 1 EARLY
a) Abcence of
Pissiform
b) Abcence of Hook
of the hamate
c) Epiphysis of
proximal phalanx
of second digit
(pp2) narrower
than its shaft
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9. Stage II PREPUBERTAL
a) Proximal phalanx of
second digit (pp2)
and its Epiphysis
are in equal in width
b) Initial ossification of
Hook of the hamate
& Pissiform
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10. Stage III PUBERAL ONSET



Beginning calcification
of Ulnar sesamoid
Increased width of
epiphysis of PP2
Increased calcification
Hook of the hamate &
Pissiform
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11. Stage IV PUBERAL
Calcified Ulnar
sesamoid
 Mp3 capping
(capping of shaft of
middle phalanx of
3rd digit by its
epidhysis)

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12. Stage V PUBERAL
DECELARATION




Ulnar sesamoid
FullyCalcified
Dp3 U
All Phalanges and
carpals fully calcified
Epiphysis of radius
and ulna not fully
calcified
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13. Stage V Growth Completion
•No remaining
growth
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14. MP3
STAGING
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15. MP3 STAGE I
(ONSET)
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16. MP3 STAGE II
(ACCELERATION)
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17. MP3 STAGE III
(PEAK)
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18. MP3 STAGE IV
(DECELLERATION)
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19. MP3 STAGE V
(END)
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20. Advantages






The procedure is very simple and
easy.
Focus is on a single skeletal maturity
indicator.
Enhanced image clarity.
Drastically decreases radiation
exposure.
Cost effective solution to circumvent
hand wrist radiographs.
Practical feasibility for the general
dental practitioner.
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21. THA K Y
N OU
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