Intern Seminar Presentation
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Transcript Intern Seminar Presentation
Introduction
Malocclusion has a high prevalence
among populations
(Josefsson et al. 2007)
(Chew et al.2006)
The need for orthodontic treatment
among Saudi children is 60%
(Al Emran et al. 1990)
Introduction
In general,
class II is more prevalent
than class III
(Danaie et al, 2006)
(McLain et al, 1985)
Introduction
Bimaxillary protrusion and class III
malocclusion prevalence is more in
Saudi population than in western
communities
(Jones WB, 1987)
Introduction
Skeletal discrepancies,
what is the cause?
Introduction
The reason of skeletal discrepancies
is the different growth potentials of
different bones of the craniofacial
complex
(Riedel, 1952)
Introduction
Orthopedic intervention is commonly
used to affect the growth potential of
skeletal components
(Proffit et al, 1998)
(Vig et al, 2000)
Introduction
The pubertal growth spurt is typically
used to modify the growth of the
related structures
( DiBiase A, 2002)
( Arvystas MG, 1998)
Introduction
How can we detect the
“pubertal growth spurt”
Introduction
The chronological age is a poor
indicator of skeletal development
(Fishman LS, 1979)
Introduction
Many diagnostic tools were
developed to aid in detection of the
growth spurt
Introduction
Hand & wrist radiographs is the
most commonly used and the most
reliable tool
(Bjork, 1972)
(Grave, 1994)
(Hagg et al, 1980)
Introduction
Dental development was widely
investigated as a potential predictor
of skeletal maturity
(Sierra, 1987)
(Anderson et al, 1975)
(Green, 1961)
Introduction
Dental maturity is either assessed
by the tooth eruption stages or tooth
calcification stages
Tooth calicification stages are more
reliable
(Nolla, 1960)
(Hotz, 1959)
Introduction
The relationship between dental
maturity and chronological age has
been investigated in different
populations
(Green, 1961)
(Uysal et al, 2004)
(Krailassiri et al, 2002)
Introduction
The ability to assess skeletal
maturity by the dental development
stages using the OPG has many
advantages
Dental development stages is easy
to identify
No need for additional exposure for
H&W x-ray
Introduction
The relationship between skeletal
maturity and chronological age for
Saudi male children has been
recently established
(Al Hadlag et al, 2007)
Introduction
The aims:
1- to establish the dental age for a
group of Saudi male children
Introduction
The aims:
2- to establish the relationship
between dental, skeletal, and
chronological ages in the study
sample
Introduction
The aims:
3- to find the best dental maturity
indicator of the skeletal maturity
stage in the study sample
Materials & Methods
The study is a cross sectional
descriptive study
148 OPG 148 H&W radiographs
were obtained from the records of
patients attending Collage of
Dentistry, KSU
Materials & Methods
Criteria:
1- Saudi males with age ranges from 9
to 15 years
2- Free of any serious illness
3- With normal growth and
development
Materials & Methods
Criteria:
4- With no abnormal dental condition,
e.g. impaction, transposition and
congenitally missing teeth
5- With no previous history of trauma
or disease to the face and the handwrist region
Materials & Methods
Criteria:
6- With no history of orthodontic
treatment
Materials & Methods
Dental maturity:
From the OPG
Using Demirjian method
Materials & Methods
Demirjian method:
7 left mandibular teeth were used
Each tooth was given a letter
from A to H
Depending on its calcification stage
Materials & Methods
Demirjian method:
Then each tooth was given a score
The total score of the teeth is
converted into an age
Materials & Methods
A
cusp tips are calcified
B
calcified cusps are united
C
enamel formation is complete , dentin deposition has
commeneced
D
crown formation is complete to the CEJ
E
the walls of the pulp chamber are straight, root length
is less than crown hight, also radicular bifurcation is visible
F
the root length is equal to or greater than crown height,
the apex has a funnel shape
G
walls of the root canal are parellel but apex is partially
open
H
apex is completely closed , PDL space is uniform
around root apex
Materials & Methods
Skeletal maturity stages:
From the Hand & Wrist
Using the Fishman’s method
6 stages were used
Materials & Methods
Fishman’s method
PP2: the epiphysis of the proximal phalanx of the second
finger equals its diaphysis
MP3: the epiphysis of the middle phalanx of the third
finger equals its diaphysis
S stage: the first mineralization of the ulnar sesamoid
bone
MP3cap: the epiphysis the middle phalanx of the third
finger caps its diaphysis
DP3u: complete epiphyseal union of the distal phalanx of
the third finger
MP3u: complete epiphyseal union the middle phalanx of
the third finger
A pre-PP2 stage was assigned to any subject who has
not reached PP2 stage.
Materials & Methods
Skeletal age:
“Greulich and Pyle’s Radiographic
Atlas of Skeletal Development of the
Hand and Wrist”
Materials & Methods
One examiner took the dental
assessments
The other took the skeletal
assessments
Chronological age was taken by
referring to records
Materials & Methods
Results
Intra-examiner Reliability
Spearman-Brown
correlation
Dental assessment
(average)
Skeletal age
assessment
Skeletal maturity
assessment
0.935
0.981
0.995
Results
Sample distribution according to age
Mean age = 11.92 ± 1.49
No. of cases according to age
40
36
30
31
29
24
20
16
10
7
5
Std. Dev = 1.49
Mean = 11.9
N = 148.00
0
9.0
10.0
11.0
12.0
Age
13.0
14.0
15.0
Results
Comparison between skeletal and chronological ages
Age Group
9 yrs
10 yrs
11 yrs
12 yrs
13 yrs
14 yrs
15 yrs
Total
Skeletal age
N
5
24
31
36
29
16
7
148
9.000
9.167
10.532
11.681
12.707
13.719
15.357
11.537
Std. Dev.
0.707
1.544
1.402
1.364
0.882
1.366
1.406
2.118
A-S
0.000
0.833
0.468
0.319
0.293
0.281
-0.357
0.382
P value
1.000
0.015*
0.073
0.169
0.084
0.423
0.526
0.001*
Mean
Results
Comparison between dental and chronological ages
Age Group
9 yrs
10 yrs
11 yrs
12 yrs
13 yrs
14 yrs
15 yrs
Total
Dental age
N
Mean
Std. Dev.
A-D
P value
5
24
31
36
29
16
7
148
10.18
10.158
10.632
12.028
13.020
14.750
15.843
12.039
0.646
1.050
1.078
1.272
1.782
2.010
1.705
2.176
-1.180
-0.158
0.368
-0.028
-0.020
-0.750
-0.843
-0.120
0.015*
0.468
0.067
0.896
0.951
0.156
0.239
0.315
Results
Investigation of the relation between skeletal and dental
maturity markers
Skeletal Maturity stage
Spearman's rho
Sig. (2-tailed)
N
C
Incisor
.156
.059
148
L
incisor
.415
.000
148
Canine
.679
.000
148
1s t PM
.729
.000
148
2nd PM
.700
.000
148
1s t M
.512
.000
148
2nd M
.720
.000
148
16
15
14
Age
13
12
11
10
9
8
N=
26
22
51
21
20
2
6
Pre-PP2
PP2
MP3
S
MP3cap
DP3u
MP3u
Skeletal Maturity
Challenges
No saudi literature
3000 records yielded only 130 pairs
DOB documentation is neglected
Lack of digitalization of records
We lacked previous knowledge
about this issue