BONE MATURATION INDICATORS IN CRANIOFACIAL GROWTH

SANTAMARIA MJr, FARIA GD, VEDOVELLO SAS, DEGAN VV, VEDOVELLO FILHO M

MS PROGRAM OF ORTHODONTICS – UNIARARAS – ARARAS/SP – BRAZIL

Objective: The purpose of the present study was to evaluate the

correlation among frontal sinus pneumatization, cervical vertebrae

morphology and carpal radiographs in determining peak pubertal

growth. Methods: Carpal radiographs and lateral teleradiographs of 123

patients (62 female and 61 male) aged 8-16 were evaluated, in order to

determine bone age, and check the stage patient’s peak growth.

Cervical vertebrae morphological changes were analyzed using lateral

teleradiographs, as well as frontal sinus height and width changes. The

data obtained were submitted to statistical analysis, using the Pearson’s

Linear Correlation Coefficient and the Spearman’s Correlation

Coefficient, to determine the level of relationship among the variables

(p<0,05). Results: Results showed a highly significant correlation

between the bone age, obtained through the carpal radiographs, and

the morphological changes of the cervical vertebrae (r=0,7898). Despite

being lower, all the other correlations were statistically significant:

frontal sinus height and bone age (r=0,4449); frontal sinus width and

bone age (r=0,3105). Conclusion: The use of the frontal sinus as an

indicator of skeletal maturity can be used associated with other bone

maturation indicators in order to be safer and more reliable.

The knowledge of facial and general growth, as well as the pubertal

growth phase is extremely important for the optimization of most

orthodontic treatments (Chapman, 1972; Häag and Taranger, 1982). It is

known that the evaluation of carpal radiographs, as an indicator of the

peak pubertal growth observed by the bone maturity, is the most

studied, used and widespread method in Dentistry. However, studies

have been developed in order to provide alternatives for professionals in

lateral teleradiographs use in order to determine bone age, reducing

therefore the radiation dose the patient is exposed during orthodontic

evaluation (Santos et al., 1998).

Evaluate correlation of skeletal maturity through carpal radiographs

and morphological changes of cervical vertebrae and changes in

height and width of the frontal sinus.

The determination of the bone age through the evaluation of carpal

radiograph was the most reliable method, although the evaluation of the

cervical vertebrae and the frontal sinus dimensions are important

alternative methods and can be safer if used together.

Abstract

Introduction

Results

Conclusion

Material and Methods

Purposes

Carpal radiographs and lateral teleradiographs of 123 patients, 62

girls and 61 boys, aged between 8 and 16, with mixed or permanent

teeth, were examined.

Data were submitted to statistical analysis, in which the average,

standard deviation, variation coefficient, minimum and maximum values

for each variable were obtained.

TABLE 1 – Growth phase measures with the chronological and bone ages, height

and width of the frontal sinus, in the girls.

FIGURE 1: Carpal radiographs were evaluated through the inspectional

method, recommended by Greulich and Pyle (1959).

FIGURE 2: The vertebrae C2, C3 and C4 morphology was visually

evaluated by the researcher in order to identify the development stage

according to the Hassel and Farman’s method (1995).

Skeletal Age

Cervical Vertebrae

FIGURE 3: Frontal sinus dimensions were determined in lateral

teleradiographs, according to the method described by Ruf and Pencherz

(1997).

This method enumerates six maturity stages based on the

morphological change of the cervical vertebrae called Cervical Vertebrae

Maturity Indicators: Initiation, Acceleration, Transition, Slowdown, Maturity

and Completion.

Frontal Sinus

N Chronol. Age Bone Age FS – Height FS – Width

Average SD Average SD Average SD Average SD

Pre-peak 4 9,4 1,6 8,8 0,0 24,0 11,9 7,1 1,7

Peak 39 10,8 1,2 11,5 1,2 26,9 5,7 9,9 2,6

Post-peak 19 13,8 1,2 15,4 1,1 29,5 8,7 9,4 2,5

TABLE 2 – Growth phase measures, with the chronological and bone ages, height

and width of the frontal sinus, in the boys.

N Chronol. Age Bone Age FS – Height FS - Width

Average SD Average SD Average SD Average SD

Pre-peak 22 9,7 1,2 10,0 1,4 22,2 6,2 8,7 2,1

Peak 36 12,3 1,5 13,3 0,8 29,6 7,0 10,8 2,2

Post-peak 3 14,6 0,9 18,0 1,0 35,7 1,4 13,4 2,5

GRAPHICS – Dispersion graphics of frontal sinus height, width and bone age.

TABLE 3 – Correlations (Pearson* and Spearman**), for the bone age, cervical

vertebrae and frontal sinus dimension.

Cervical Frontal Sinus Height Frontal Sinus Width

Bone Age 0,7898 (**) 0,4449 (*) 0,3105 (*)

Chapman SM. Ossification of the adductor sesamoid and the adolescent growth spurt. Angle Orthodontist. 1972,41(3):236 - 244.

Häag U, Taranger J. Maturation indicators and the pubertal growth spurt. Am J Orthodont. 1982, 82(4): 299 – 309.

Santos SCBN, Almeida RR, Henriques JFC, Bertoz FA. Avaliação de um método de determinação do estágio de maturação

esquelética utilizando as vétebras cervicais presentes nas telerradiografias em norma lateral. Revista Dental Press de Ortodontia e

Ortopedia Facial. 1998, 3(3): 67 – 77.

Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2ed. Stanford: Stanford University Press,

1959.

Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop.1995,107(1):58-66.

Ruf S, Pancherz H. Development of the frontal sinus in relation to somatic and skeletal maturity. A cephalometric roentgenographic

study at puberty. European Journal Orthodontics. 1996, 18: 491 – 497.

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