Hand-wrist Bone Research Articles

Relationship between hand and wrist bone age assessment method and application to male children

Objective: To explore the interrelationship among three simplified hand and wrist bone age assessment methods and to establish corresponding bone ages for each substage in male children. Methods: This retrospective case series study included 169 left hand and wrist X-rays from 152 male children who underwent bone age assessments at the Pediatric Orthopedics and Pediatrics Departments,Beijing Jishuitan Hospital,Capital Medical University from January 2019 to December 2023. The age at the time of X-ray was (13.7±2.0) years (range:9.1 to 17.9 years). Reasons for bone age assessment included evaluating the progress of adolescent idiopathic scoliosis in 36 cases, predicting limb length discrepancies in 28 cases, and predicting the height of healthy adolescents in 88 cases. Bone age was first graded using the Chinese hand-wrist bone age assessment method. Three simplified hand and wrist bone age assessment methods were then applied:Sanders simplified skeletal maturity staging system(Sanders stage), the distal radius and ulna classification (DRU), and e thumb ossification composite index (TOCI). Somers'delta correlation test was used to analyze the relationship among the results of the three simplified methods. The bone age and standard deviation for each sub-stage were calculated, and gender differences in bone age for the same sub-stage were compared with previous study. Results: The DRU, TOCI and Sanders stages showed a strong correlation when assessing bone age in male children, with Somers'delta correlation coefficients ranging from 0.881 to 0.876 (all P<0.01). The sub-stages with the smallest standard deviations (shorter duration) in each of the three classifications can serve as a quick reference for determining precise bone age, included proximal thumb epiphysis covered, without sesamoid (12.0 years);proximal thumb epiphysis covered with sesamoid or distal radial covered (13.0 years), early capping of the thumb epiphysis, radial epiphysis medial side capping(13.5 years), all phalangeal epiphyses capping (14.0 years), distal phalangeal physes beginning to close (14.5 years), all distal phalangeal physes closed (15.0 years), middle or proximal phalangeal physes beginning to close (15.5 years), all digital epiphyses closed (16.5 years), and nearly complete distal radius fusion with a notch (17.5 years). On average, the bone ages of males were 2 years behind those of females in the same substage. Conclusions: The DRU, TOCI, and Sanders stages can be applied to male children, and it is showed good correlation between them. The subtypes with shorter duration can be used as a quick assessment method to determine the bone age.

The accuracy of Cameriere methods in Turkish children: chronological age estimation using developing teeth and carpals and epiphyses of the ulna and radius.

The aim of the present study was to develop a specific formula by measuring the developing teeth, carpal bones, and epiphyses of the ulna and radius to determine the chronological age in Turkish children. The left developing permanent mandibular teeth were evaluated, and the number of teeth with closed apex was recorded. The distance between the inner sides of open apex/apices was measured by using the ImageJ program and divided by the tooth length. The sum of the normalized open apices was also calculated. The carpal area (Ca), covering the epiphyses of ulna and radius and the carpal bones, was measured on the X-rays of left hand. The areas of each carpal bone and epiphyses of the ulna and radius were measured, and these measurements were added together to obtain the bone area (Bo). The Bo/Ca ratio between the total area of carpal bones and the carpal area was calculated to normalize the measurements. The accuracy of the equations formulated by Cameriere was evaluated, and a new regression equation was developed accordingly. The new formula showed no statistically significant difference between the chronological and the estimated age for females, males, and total sample. The new formula, which hit the age with 72.80% accuracy, was more successful in predicting chronological age than other adjusted regression equations. The new regression model, created for the Turkish children by using both developing teeth and hand-wrist bones, was considerably successful in estimating the chronological age.

Evaluation of Cervical Vertebral Maturation Angular Measurements as a Tool to Assess Skeletal Maturity: A Radiological Study.

The purpose of the present research was to evaluate the comparison between the Skeletal Maturation phases of Fishman's hand-wrist skeletal maturation index (SMI) and cervical vertebral maturation angle (CVMA). Assessment and comparison of Skeletal Maturation utilizing the hand-wrist bone radiograph by Fishman's system of skeletal maturation indicator (SMI), cervical vertebra maturation stages (CVMS), and lateral cephalogram by cervical vertebral maturation angle (CVMA) conducted on 150 subjects (75 male and 75 female). Chi-square was used to reveal the significance of study parameters on a categorical scale between SMI, CVMS, CVMA, and multiple regression analysis conducted to envisage the connotation of the dependent variable. Multiple regression analysis models exhibited 61.9% of the variance for CVMA with autonomous variables. In multiple regression analysis, there is no substantial association (P > 0.05) between age and CVMA. The correlation of SMI and CVMA values utilizing Pearson's correlation coefficient for males and females presented positive association with R value of 0.801 for males and 0.834 for females and a P value of < 0.001. As compared to other maturity indicators like hand and wrist, cervical vertebral angular measurements were reliable enough for assessing the degree of skeletal maturation.

Bone-specific median age of hand-wrist maturation from Sudan

Background Maturation of bones in the hand–wrist region varies among individuals of the same age and among world groups. Although some studies from Africa report differences to other ethnic groups, the lack of detailed bone-specific maturity data prevents meaningful comparisons. Aim The aim of this study was to describe bone-specific maturity for developing hand–wrist bones in individuals in Khartoum, Sudan. Subjects and methods The sample was selected from healthy patients attending a dental hospital in Khartoum with known age and ancestry (males = 280, females = 330; aged between 3 and 25 years). Bones were assessed from radiographs of the left hand and wrist after the Greulich and Pyle Atlas (1959). Median ages of attainment for bone stages were calculated using probit analysis for each stage in males and females separately. Results Maturity data for stages of the phalanges, metacarpals, carpals and radius and ulna in males and females are presented. Median ages in females were earlier compared to males for all stages. These results are largely earlier than previously published findings or where these could be calculated. Conclusion These results of individual maturity stages of phalanges, metacarpals, carpals and the distal epiphyses of the radius and ulna are useful to assess maturity in growing individuals from Sudan.

Research on bone age estimation of adolescents and children by using the fourth cervical vertebra

Traditionally, hand-wrist bone fragments are significantly related to the peak period of growth and development, which is the best index to judge bone age. However, some scholars hold that although the X-ray exposure to wrist is very small, it increases the exposure after all. Therefore, it is proposed to judge the stage and degree of growth and development by cervical vertebra images in lateral cephalogram. Clinical measurement of cervical vertebral bone age is mainly used to judge whether the craniofacial bone is in the peak growth period and predict the growth potential of mandible, so as to determine the appropriate treatment time and treatment mode. This paper mainly reviews the application of cervical vertebral bone age in orthodontic clinic from the above two aspects.

Assessment of maturation indicators in individuals with different skeletal malocclusion.

The aim of this study was to comparatively evaluate hand-wrist bones, cervical vertebrae and tooth development stages according to skeletal classification. The orthodontic initial records of 297patients were used and separated into three groups according to the skeletal malocclusion. Three groups including 99people each were sampled representing malocclusions with Angle classesI, II and III, respectively. The panoramic, cephalometric and hand-wrist radiographs of all patients included in this study were used to compare dental and skeletal maturation indicators. Calcification of teeth was rated according to the system of Demirjian. To evaluate the stage of skeletal maturation hand-wrist radiographs were analyzed according to the Grave and Brown method. Also, Hassel and the Farman method was used to classifying vertebral developmental stages. Spearman rank correlation tests, as well as Fisher exact χ2 tests with r×c tables, were used for the comparison of categorical variables. Hand-wrist, vertebral and dental development stages showed astatistically significant relationship (p < 0.01) for both genders and in all malocclusions. The association between the different maturation indicators used in this study and the type of malocclusion was also statistically significant for both genders. It was observed that the peak period of skeletal maturation according to the hand-wrist radiograph findings correlated with the cervical vertebrae stage C3 in girls (63.2%) and C2-C3 in boys (43.5-43.5%). The weakest correlation was seen between the dental development stages and the skeletal developmental stages in the classII group (r = 0.443-0.220 [girls]; r = 0.604-0.410 [boys]). The use of the dental development stage as areliable indicator of maturation was limited. According to the Demirjian method, the calcification stage of the second molar might indicate that the individual is in the pubertal peak period.

Performance of an artificial intelligence system for bone age assessment in Tibet.

To investigate whether bone age (BA) of children living in Tibet Highland could be accurately assessed using a fully automated artificial intelligence (AI) system. Left hand radiographs of 385 children (300 Tibetan and 85 immigrant Han) aged 4-18 years who presented to the largest medical center of Tibet between September 2013 and November 2019 were consecutively collected. From these radiographs, BA was determined using the Greulich and Pyle (GP) method by experts in a consensus manner; furthermore, BA was estimated by a previously reported artificial intelligence (AI) BA system based on Han children from southern China. The performance of the AI system was compared with that of experts by using statistical analysis. Compared with the experts' results, the accuracy of the AI system for Tibetan and Han children within 1 year was 84.67 and 89.41%, respectively, and its mean absolute difference (MAD) was 0.65 and 0.56 years, respectively. The discrepancy in hand-wrist bone maturation was the main cause of low accuracy of the system in the 4- to 6-year-old group. The AI BA system developed for Han Chinese children living in flat regions could enable to assess BA accurately in Tibet where medical resources are limited. AI-based BA system may serve as an effective and efficient solution to assess BA in Tibet.

Assessment of bone age by cervical vertebral dimensions in lateral cephalometric radiographs

Aim and Objectives: For determining the skeletal/bone age from hand-wrist radiographs, Greulich and Pyle’s Atlas and Tanner–Whitehouse 3 (TW3) methods are considered as reliable methods, but there are concerns of extra radiation dose. The cervical vertebral bone age (CVBA) by measurements of the vertebral body of third (C3) and fourth (C4) is a relatively new method of objectively evaluating the skeletal maturation. The aim of this study was to estimate bone age by measuring 3rd and 4th cervical vertebral (C3, C4) dimensions. Materials and Methods: Lateral cephalometric and hand-wrist radiographs of 40 male and 46 female subjects (08–16 years of age) who had attended Government Dental College Srinagar for treatment were taken and measurements of C3 and C4 was done by using NNT Dicom version 7.0.0.0 software. Hand-wrist bone age was determined using Pyle and Greulich Atlas. Stepwise multiple regression analysis demonstrated the correlation between the measurements. Results: Anterior height of the third cervical vertebrae (AH3) in males had the strongest correlation with hand-wrist bone age (r=1.o, p3 was 10.733. The highest correlation coefficient in females was observed between H3 and the estimated bone age from Greulich’s Atlas (r=0.896, p3 was 10.43. The bone age was calculated by multiple regression model: Bone age in males = 0.809×AH3+ 2.896. Adjusted R2 was 0.153 (p3+ 2.752. Adjusted R2 was 0.245 (p Conclusions: Lateral cephalometric radiographs might be an alternative to the hand-wrist radiography for bone age estimation. Therefore, analysis of cervical vertebrae by replacing hand-wrist method additional radiograph could be avoided. Keywords: Cervical vertebral bone age, Lateral cephalometric radiographs, Hand-wrist radiographs.

Association of maxillary dental developmental abnormality with precocious puberty: a case-control study

BackgroundDental studies of precocious puberty have focused on examination of jaw and dentition growth. The aim of the study was to analyze the relationship between precocious puberty and maxillary dental developmental abnormalities (DDAs).MethodsThis retrospective study was conducted on the Korean patients in whom dental panoramic and hand-wrist radiographs had been taken before they were 15 years of age. The maxillary DDAs were assessed as mesiodens, congenital missing teeth, peg-shape lateral incisors, or impacted teeth. The chronological ages of the control group members were within the normal range of the hand-wrist bone age. Others with a peak luteinizing hormone of ≥ 5 and < 5 IU/L were allocated to central precocious puberty (CPP) and peripheral precocious puberty (PPP), respectively.ResultsOf the enrolled 270 patients, 195, 52, and 23 were allocated to the control, CPP, and PPP groups, respectively. The maxillary DDAs were significantly more prevalent in the CPP group than in the other groups. Among those with maxillary DDA, the mesiodens predominated. Age- and sex-adjusted multivariate analysis revealed maxillary DDA (odds ratio, 3.36; 95% CI, 1.60-7.05) and especially mesiodens (odds ratio, 5.52; CI, 2.29-13.28) to be significantly associated with CPP.ConclusionsMaxillary DDAs were significantly more prevalent in the CPP group than in the PPP or control groups. Among the many types of maxillary DDAs, mesiodens was significantly associated with CPP and may be considered a predictor of the development of CPP.

Correlation between Chronological Age, Cervical Vertebral Maturation and Fishman’s Skeletal Maturity Indicators in Central India Population

Introduction: Skeletal maturity indicators are very important indicators when diagnosing and panning the treatment in growing population. Cervical Vertebrae Method (CVM) and Fishman’s Skeletal Maturity Indicators are two commonly used methods for the diagnosis and treatment planning. The aim of the study was to investigate the correlation between cervical vertebral maturation (CVM)and Fishman’s hand-wrist skeletal maturity indicator and chronological age by including subjects within the range of circumpubertal growth spurt in Central India.&#x0D; Materials &amp; Method: One Twenty Five contemporary hand-wrist and lateral cephalometric radiographs from population of Central India were randomly selected and analyzed. All subjects were within the circumpubertal period i.e. female subjects were between 10 and 15 years of age, and the male subjects were between 12 and 17 years of age. The hand-wrist bone analysis was evaluated using the method developed by Fishman whereas cervical vertebra bone analysis was evaluated using the method developed by Baccetti and co-workers. These two methods and chronological age were correlated using the Spearman rank correlation analysis.&#x0D; Result: CVM was significantly correlated with hand-wrist maturation (r=0.8868). However low correlation was found between the CVM and chronological age( r =0.7139) and little correlation was found between the HWM and chronological age ( r =0.6892).&#x0D; Conclusion: CVM is a valid indicator of skeletal growth during the circumpubertal growth period and has a high correlation with the HWM for the Central India population. However chronological age is not suitable to measure skeletal maturity as shown by the low correlations found between the chronological age and both CVM and HWM.

The relationship between frontal sinus morphology and skeletal maturation.

The aim of this study is to evaluate the relationship between frontal sinus morphology and hand-wrist bone maturation by using postero-anterior (PA) cephalometric radiographs. The study sample consisted of 220 patients divided into 11 groups based on the hand-wrist radiographs. The right and left maximum height, width and area of the frontal sinus parameters were measured in PA cephalometric radiographs of 220 subjects aged 8-18 years. The hand-wrist skeletal maturation stages were evaluated on the hand-wrist radiographs using the method of Fishman. The Kendall tau-b values were analysed to evaluate the correlation between the hand-wrist skeletal maturation stages and the frontal sinus parameters. The right and left frontal sinus areas and widths were found to be larger in males than in females (p < 0.05). In males, a significant difference was observed in all frontal sinus parameters in different maturation stages (p < 0.001), while a statistically significant correlation was found in females between the left frontal sinus area, right frontal sinus height, right frontal sinus width and different maturation stages (p < 0.05). The relationship between frontal sinus dimensions obtained from PA cephalometric radiographs and hand-wrist maturation stages suggests that frontal sinuses can be used in determining growth and development.

Carpals and epiphyses of radius and ulna as age indicators using longitudinal data: a Bayesian approach.

The aim of this study is to develop a new formula for age estimation in a longitudinal study of a sample from the radiological collection of wrist bones of growing infants, children, and adolescents recorded at the Burlington Growth Centre. A sample of 82 individuals (43 boys and 39 girls), aged between 3 and 16years, were analyzed with a total of 623 X-rays of left hand-wrist bones by measuring the area of carpal bones and epiphyses of the ulna and radius (Bo) and carpal area (Ca). The intra-class correlation coefficient (ICC) and its 95% confidence interval were used to evaluate intra-observer agreement. Hierarchical Bayesian calibration has been adopted to exceed the bias deriving from the classical regression approach used for age estimation in forensic disciplines, since it tends to overestimate or underestimate the age of the individuals. Calibration distributions of the dataset obtained by the evaluation of BoCa (the ratio of Bo and Ca) suggested mean absolute errors (MAE) of 1.07 and 1.34years in boys and girls, respectively. The mean interquartile range (MIQR) was 1.7 and 2.42years in boys and girls, respectively. The respective bias of the estimates was βERR = - 0.025 and - 0.074. Furthermore, a correspondence between different BoCa values and estimated age with its standard deviation (SD) was calculated for boys and girls, respectively. In conclusion, the Bayesian calibration method appears to be suitable for assessing both age and its distribution in subadults, according to hand-wrist maturity. Furthermore, it can easily incorporate other age predictors, obtaining a distribution of the subjects with multivariate predictors.

Assessment of correlation between dental calcification stages and skeletal maturity indicators.

Introduction:Assessment of age is a critical step in the identification of an individual in forensic cases. The hand–wrist radiographic evaluation and tooth development is also a useful measure of maturity because it represents a series of recognizable changes that occur in the same sequence from an initial event to a constant end point.Aim of the Study:To investigate the relationship of dental calcification stages and skeletal maturity indicators as assessed by the hand–wrist bone radiograph.Objectives:(1) Correlation of dental calcification stages and skeletal maturation. Information for decision-making in treatment plan in growing patients.Materials and Methods:A cross-sectional pilot study was performed using orthopantomograph (OPG) and hand–wrist radiographs of fifty children (25 males and 25 females) with age ranging from 8 to 14 years. The hand–wrist radiographs and OPG were analyzed using Fishman's Skeletal Maturity Index and the Demirjian's system, respectively. SPSS software version 19 (IBM) was used in the calculation of all statistical analyses.Results:Correlation coefficient ranged from 0.61 to 0.83 for males and from 0.81 to 0.86 for females. The canine stage F for both sexes coincided with the MP3 stage, which is indicative of the onset of a period of accelerating growth.Conclusion:The findings of this pilot study indicated that tooth calcification stages might be clinically used as a maturity indicator of the pubertal growth period.

Hand Wrist Bone Identification Using Quadrant Ballon Snake

In this research, hand wrist bone Identification for human forensic is discussed. Hand wrist bone is one of the effective methods used in the forensic science for age identification. There are four techniques used in this research: cropping image, preprocessing, Quadrant Ballon Snake and identification. The first step is to crop an image on metaphysis and epiphysis bone. The second step is preprocessing using morphology and edge detection. The third step is to apply Quadrant Ballon Snake to segment hand wrist bone. The last step is to use ratio metaphysis and epiphysis to identify a person. The performance segmentation for assessment hand wrist bone showed an average age identification 91%, bone age metaphysis 95% and bone age epiphysis 95%. The experiments resulted in the fact that Quadrant Ballon Snake method is able to find and improve the segmentation of hand wrist bone images accurately. This indicates that this method is effective for segmenting hand wrist bone.

A practical formula for determining growth

We aimed to establish a practical method to evaluate skeletal age using cervical vertebrae. The study consisted of hand-wrist and cephalometric radiographs of 324 subjects (167 girls, 157 boys; age range, 7.3-17.2 years). Skeletal ages of the subjects were calculated from hand-wrist radiographs, and cervical vertebral bodies were measured using cephalometric radiographs. A single formula based on C3 and C4 vertebral body heights with different coefficients for each gender was derived using ridge regression analysis. The correlation coefficients for vertebral and hand-wrist bone age were 0.825 and 0.856 for girls and boys, respectively. The correlations among vertebral bone age and C3 and C4 vertebral body heights were also found to be significant. The intraclass correlation (ICC) score was found to be 0.914, which shows high consistency between the two measurements of the same investigator for each C3 and C4 vertebral body height result. The formula derived for evaluating skeletal age in cephalometric radiographs is reliable and can be applied to both girl and boy subjects for legal requirements or therapeutic needs of age estimation.

Skeletal age estimation in a contemporary Western Australian population using the Tanner–Whitehouse method

Various age estimation techniques have been utilised in Australia to evaluate the age of individuals who do not have documentation to determine legal majority/culpability. These age estimation techniques rely on the assessment of skeletal development as visualised in radiographs, CT scans, MRI or ultrasound modalities, and subsequent comparison to reference standards. These standards are not always population specific and are thus known to be less accurate when applied outside of the original reference sample, leading to potential ethical implications. Therefore, the present study aims to: (i) explore the variation in developmental trajectories between the established Tanner–Whitehouse (TW) age estimation standards and a Western Australian population; and (ii) develop specific hand-wrist age estimation standards for the latter population.The present study examines digital anterior–posterior hand-wrist radiographs of 360 individuals 0 to 24.9 years of age, equally represented by sex. Each radiograph was assessed using the RUS, Carpal and 20-bone methods of Tanner et al. The standard error of the estimate (SEE) was calculated for each method (range: ♀ SEE ±0.4–11.5 years; ♂ SEE ±0.9–10.1 years). The most accurate method was TW3 RUS for females and the TW2 Carpal system for males. The 50th centile skeletal maturity scores for each year age group were plotted against average chronological age to produce polynomial regression standards with a demonstrated accuracy of (♀ SEE ±0.09–3.46 years; ♂ SEE ±0.02–3.42 years) for females and males, respectively. The standards presented here can be used in future forensic investigations that require age estimation of hand-wrist bones in a Western Australian population, however, they are not appropriate for establishing age of majority (18 years), as skeletal maturity was attained on average earlier than 15 years of age in both sexes for all three systems examined.

A new formula for assessing skeletal age in growing infants and children by measuring carpals and epiphyses of radio and ulna

The aim of this study is to develop a specific formula for the purpose of assessing skeletal age in a sample of Italian growing infants and children by measuring carpals and epiphyses of radio and ulna. A sample of 332 X-rays of left hand-wrist bones (130 boys and 202 girls), aged between 1 and 16 years, was analyzed retrospectively. Analysis of covariance (ANCOVA) was applied to study how sex affects the growth of the ratio Bo/Ca in the boys and girls groups. The regression model, describing age as a linear function of sex and the Bo/Ca ratio for the new Italian sample, yielded the following formula: Age = −1.7702 + 1.0088 g + 14.8166 (Bo/Ca). This model explained 83.5% of total variance (R2 = 0.835). The median of the absolute values of residuals (observed age minus predicted age) was −0.38, with a quartile deviation of 2.01 and a standard error of estimate of 1.54. A second sample test of 204 Italian children (108 girls and 96 boys), aged between 1 and 16 years, was used to evaluate the accuracy of the specific regression model. A sample paired t-test was used to analyze the mean differences between the skeletal and chronological age. The mean error for girls is 0.00 and the estimated age is slightly underestimated in boys with a mean error of −0.30 years. The standard deviations are 0.70 years for girls and 0.78 years for boys. The obtained results indicate that there is a high relationship between estimated and chronological ages.

Maturation Disparity between Hand-Wrist Bones in a Chinese Sample of Normal Children: An Analysis Based on Automatic BoneXpert and Manual Greulich and Pyle Atlas Assessment.

ObjectiveTo assess the maturation disparity of hand-wrist bones using the BoneXpert system and Greulich and Pyle (GP) atlas in a sample of normal children from China.Materials and MethodsOur study included 229 boys and 168 girls aged 2–14 years. The bones in the hand and wrist were divided into five groups: distal radius and ulna, metacarpals, proximal phalanges, middle phalanges and distal phalanges. Bone age (BA) was assessed separately using the automatic BoneXpert and GP atlas by two raters. Differences in the BA between the most advanced and retarded individual bones and bone groups were analyzed.ResultsIn 75.8% of children assessed with the BoneXpert and 59.4% of children assessed with the GP atlas, the BA difference between the most advanced and most retarded individual bones exceeded 2.0 years. The BA mean differences between the most advanced and most retarded individual bones were 2.58 and 2.25 years for the BoneXpert and GP atlas methods, respectively. Furthermore, for both methods, the middle phalanges were the most advanced group. The most retarded group was metacarpals for BoneXpert, while metacarpals and the distal radius and ulna were the most retarded groups according to the GP atlas. Overall, the BAs of the proximal and distal phalanges were closer to the chronological ages than those of the other bone groups.ConclusionObvious and regular maturation disparities are common in normal children. Overall, the BAs of the proximal and distal phalanges are more useful for BA estimation than those of the other bone groups.

Correlation between cervical and hand-wrist analysis for skeletal maturation in Mexican boys and girls of the children's General Hospital of Mexico «Federico Gomez»

Hand-wrist radiographs have been used to determine the variations of skeletal maturation by many researchers. The morphology of cervical vertebrae has been used to assess skeletal maturation and its possible relationship with facial growth. The aim of the following article was to determine the correlation between the growth stages in the cervical and hand-wrist bone maturation analysis in Mexican boys and girls ages 9 to 16 years at the Children’s Hospital of Mexico «Federico Gomez» during 2011. Methodology: Lateral headfilms and hand-wrist radiographs from 194 files of the Orthodontics Department of the Children’s Hospital of Mexico «Federico Gomez» were examined. The exclusion criteria were: patients with craniofacial syndromes, growth disorders and metabolic disorders that affected growth. The values obtained for skeletal maturation from both analysis were analyzed through the SPSS v.17.0 (Statistical Package for the Social Sciences) software using the Spearman test to study the correlation between the two analyses. Results: A high correlation (0.89) was found between the Fishman’s hand-wrist analysis and the Lamparski cervical analysis. It was also found that the largest correlation by age was at the age of 9 (0.94). The smallest correlation by age was at 16 years old (0.68). The average age was 12.7 years. Conclusions: Lateral headfilms are a valuable auxiliary to predict the growth spurt. In some cases, it may not be necessary to obtain a hand- wrist radiograph since the information of the vertebrae might be sufficient to determine the skeletal maturation stage. Key words: Skeletal maturation, growth, cervical and hand-wrist analyses.

Third-molar mineralization and eruption correlated to chronologic age in Turkish children and adolescents

The number of criminal cases involving Turkish juveniles has increased in recent years. To date, there is no method for chronological age estimation according to third-molar mineralization in Western Turkish children and adolescents. The aim of this study was to investigate the mandibular third molar development according to the eight stages (A–H) of the Demirjian method and to compare third-molar development according to gender and age with previous data. The digital orthopantomograms of 1120 white Turkish children (406 boys, mean age 15.17 ± 3.80 years, and 714 girls, mean age 16.83 ± 3.59 years) aged 7 to 22 years, from the Western Anatolia region were retrospectively reviewed. The Turkish population reached stage H at a mean age of 20 years in both genders. Dental mineralization in Western Turkish children was delayed at stages D–G but advanced at stage H compared with that in Turkish children in other regions. Third molar root development can reliably estimate the mean age and age range for a juvenile of unknown chronological age, especially compared with the standard deviation obtained using other techniques for calculating the skeletal age of the hand-wrist or long bones.