Hand-wrist Radiographs Research Articles

ENG

The continuous movement of people across borders has resulted in an increase in children who are unable to prove their age when challenged by authorities. The use of the left hand-wrist radiograph for age estimation, especially in younger children has been shown to be an effective method of assessing skeletal age. This study looks at a population of Roma children aged between 1 year and 9 years of age and examines the relationship between the appearance of the ossification centres of the hand-wrist and the age of the child with a view to understanding which of these ossification centres is most predictive of age. The radiographs of 388 children (214 boys, 174 girls) were examined and each ossification centre scored on their appearance in the radiograph. Discriminant function analysis was undertaken on the results to understand the relationship between the appearance of each ossification centre and chronological age. The results showed that there were a number of ossification centres which could be considered to be more predictive of age for both boys and girls including the ossification centres of the distal ulna, the scaphoid and the 5 th distal phalanx.

Evaluating the agreement of skeletal age assessment based on hand-wrist and cervical vertebrae radiography

The aim of this study was to examine the agreement of skeletal age assessment based on hand-wrist radiographs with cephalogram-based cervical vertebrae evaluation. To circumvent bias and loss of information from staging, a quantitative approach was applied to determine morphologic changes. We analyzed 730 sets of radiographs (cephalogram and hand-wrist) of untreated subjects (352 boys, 378 girls; age range, 6-18 years) from a growth study, each sex as a separate sample. Skeletal age was determined on the hand-wrist radiographs according to the method of Greulich and Pyle. Morphometric changes of the vertebral bodies C2 through C4 were measured (concavity, anterior height, and angle) and tested for correlations with the method of Greulich and Pyle. All correlating variables were included in a multiple linear regression to generate a calculated skeletal age. To establish the agreement between the method of Greulich and Pyle and calculated skeletal age, Bland-Altman plots were made, limits of agreement were identified, and cross-tables (before and after peak height velocity) were computed. Similarly, the agreement between the method of Greulich and Pyle and each subject's chronologic age was estimated for comparison. Concavity of C2, C3, and C4; anterior height of C3 and C4; and the angle of C3 correlated with skeletal age highly significantly (P<0.0001) in both sexes, and calculated skeletal age was established based on a linear regression. The agreement between the method of Greulich and Pyle and calculated skeletal age was modest (limits of agreement: boys, ±3.5 years; girls, ±3.3 years) and substantially weaker than the agreement between the method of Greulich and Pyle and chronologic age (limits of agreement: boys,+2.1 to -1.7 years; girls,+2.2 to -1.2 years). Similarly, calculated skeletal age resulted in considerably more false predictions of peak height velocity (boys, 18.9%; girls, 12.9%) than did chronologic age (boys, 7.1%; girls, 7.4%). Morphometric assessment of age-dependent changes in the cervical spine offers no advantage over chronologic age, in either assessing skeletal age or predicting the pubertal growth spurt.

Age prediction formulae from radiographic assessment of skeletal maturation at the knee in an Irish population

Age estimation in living subjects is primarily achieved through assessment of a hand–wrist radiograph and comparison with a standard reference atlas. Recently, maturation of other regions of the skeleton has also been assessed in an attempt to refine the age estimates. The current study presents a method to predict bone age directly from the knee in a modern Irish sample. Ten maturity indicators (A–J) at the knee were examined from radiographs of 221 subjects (137 males; 84 females). Each indicator was assigned a maturity score. Scores for indicators A–G, H–J and A–J, respectively, were totalled to provide a cumulative maturity score for change in morphology of the epiphyses (AG), epiphyseal union (HJ) and the combination of both (AJ). Linear regression equations to predict age from the maturity scores (AG, HJ, AJ) were constructed for males and females. For males, equation-AJ demonstrated the greatest predictive capability (R2=0.775) while for females equation-HJ had the strongest capacity for prediction (R2=0.815). When equation-AJ for males and equation-HJ for females were applied to the current sample, the predicted age of 90% of subjects was within ±1.5 years of actual age for male subjects and within +2.0 to −1.9 years of actual age for female subjects. The regression formulae and associated charts represent the most contemporary method of age prediction currently available for an Irish population, and provide a further technique which can contribute to a multifactorial approach to age estimation in non-adults.

Comparative analysis between dental, skeletal and chronological age

The purpose of this study was to determine if skeletal age, dental age and chronological age agreed in 41 subjects. The orthodontist not only needs to know the patient's chronological age, but also he must know what percentage of growth can be expected in one or two years treatment time. This information is obtained by assessing the skeletal age with hand-wrist radiographs, but there are other aids of diagnosis such as the panoramic X-ray on which dental age can be assessed, so that the clinician has two aids for a more comprehensive diagnosis. Unfortunately although these methods are widely commented in Literature in the clinical practice they are not considered that much. In order to evaluate the skeletal age, we used Fishman's method in the hand-wrist radiograph and to assess dental age, Dermirjian's method in the panoramic X-ray was used. t test was used to determine the significant differences between the variables and it was applied to a test of analysis of variance (ANOVA). The results suggest exist statistically significant differences between the skeletal age and the dental age, between the dental age and the chronological age, as well as between the skeletal age and the chronological age. In correlation terms it is only observed very little correlation between the chronological age and the dental age.

Análisis comparativo entre la edad ósea, edad dental y edad cronológica

The purpose of this study was to determine if skeletal age, dental age and chronological age agreed in 41 subjects. The orthodontist not only needs to know the patient’s chronological age, but also he must know what percentage of growth can be expected in one or two years treatment time. This information is obtained by assessing the skeletal age with hand-wrist radiographs, but there are other aids of diagnosis such as the panoramic X-ray on which dental age can be assessed, so that the clinician has two aids for a more comprehensive diagnosis. Unfortunately although these methods are widely commented in Literature in the clinical practice they are not considered that much. In order to evaluate the skeletal age, we used Fishman’s method in the hand-wrist radiograph and to assess dental age, Dermirjian’s method in the panoramic X-ray was used. t test was used to determine the significant differences between the variables and it was applied to a test of analysis of variance (ANOVA). The results suggest exist statistically significant differences between the skeletal age and the dental age, between the dental age and the chronological age, as well as between the skeletal age and the chronological age. In correlation terms it is only observed very little correlation between the chronological age and the dental age.

Nonsyndromic brachydactyly type D and type E mapped to 7p15 in healthy children and adults from the Jirel ethnic group in eastern Nepal.

There is phenotypic overlap between Brachydactyly Type D (BDD) and Brachydactyly Type E (BDE) that suggests a possible common underlying etiology. We seek to understand the genetic underpinnings of, and relationship between, these skeletal anomalies. The Jirel ethnic group of eastern Nepal participates in various genetic epidemiologic studies, including those in which hand-wrist radiographs have been taken to examine skeletal development. Nearly 2,130 individuals (969 males; 1,161 females) were phenotyped for BDD/BDE. Of these, 1,722 individuals (773 males; 949 females) were genotyped for 371 STR markers spanning the autosomal genome. Variance components-based linkage analysis was used to conduct a genome-wide linkage scan for QTL influencing the BDD/BDE phenotype. BDD was present in 3.55%, and BDE was present in 0.39%, of the study sample. Because of the phenotypic overlap between two traits, affecteds of either type were considered as affected by a single combined phenotype (BDD/BDE) having a prevalence of 3.94%. The additive genetic heritability of BDD/BDE was highly significant (h(2) ± SE = 0.89 ± 0.13; P = 1.7 × 10(-11) ). Significant linkage of BDD/BDE was found to markers on chromosome 7p21-7p14 (peak LOD score = 3.74 at 7p15 between markers D7S493 and D7S516). Possible positional candidate genes in the one-lod support interval of this QTL include TWIST and the HOXA1-A13 cluster. This is the first study to report significant linkage results for BDD/BDE using a large extended pedigree, and the first to suggest that mutations in TWIST and/or the HOXA1-A13 cluster may contribute to these specific skeletal anomalies.

Residents' journal review

Residents' journal review

Bone age assessment using cephalometric photographs

SummaryBackground:The assessment of bone age comprises the basic element of orthodontic diagnostics as it enables the recognition of deviations from normal growth, determines the choice of treatment, helps determine the appropriate moment to begin treatment, establish prognosis and plan a retention strategy. In order to make an assessment of skeletal maturity possible in a single examination, radiological methods were adopted. The following characteristics are evaluated on a radiograph: the appearance, size and shape of ossification centers, the width and the shape of growth cartilage and the degree of fusion between diaphyses and epiphyses. In order to assess the maturity of bones, hand-wrist radiographs were introduced in the second decade of the 20th century. Bone age assessment of bone age could also be made based on an analysis of a morphological maturity of cervical vertebrae utilizing cephalometric radiographs.Objective:The objective of the study was to evaluate the correspondence between bone age assessments made from hand-wrist radiographs and those from cephalometric radiographs.Material/Methods:In order to fulfill the objectives, hand-wrist radiographs as well as cephalometric radiographs of 30 patients (15 girls and 15 boys) between 10 and 17 years of age were collected. Bone age of hand, wrist and cervical spine was assessed. Bone age on hand-wrist radiographs was evaluated using the Björk method, whereas cephalometric radiographs were analyzed by the Baccetti et al. method.Results:A strong and statistically highly significant (r=0.98; p<0.00001) Pearson’s correlation was found between bone age assessed from hand-wrist radiographs using Björk’s method and bone age assessed from cephalometric radiographs using the method by Baccetti et al.Conclusions:The analysis of cervical vertebrae in cephalometric radiographs appears to be the most desirable method of bone age assessment. Performing the analysis on routinely taken cephalograms eliminates the need for additional exposure to X-ray radiation and shortens the duration of examination.

To establish the validity of dental age assessment using Nolla′s method on comparing with skeletal age assessed by hand-wrist radiographs

Background: Skeletal age assessment by hand-wrist radiographs has been found to correlate significantly with the growth status of an individual, but has a known drawback in the form of extra-radiograph and high dose of radiation exposure in comparison to periapical X-rays used commonly in dentistry. Aims and Objectives: The purpose of the study was to assess skeletal age using hand-wrist radiographs and to find the correlation amongst the skeletal, dental, and chronological ages. Materials and Methods : Ninety Indian healthy children in the age group 9-13 years, comprising equal number of males and females, were included in the study. The children were radiographed for hand-wrist of the right hand and intraoral periapical X-ray for right permanent maxillary and mandibular canine. Results: There was high correlation between skeletal maturation indicator and canine calcification stages for both male and female children (0.635, 0.891). Conclusion: Females were more advanced in skeletal maturation than males. Chronological age showed inconsistent correlation with dental and skeletal ages. It was concluded that canine calcification stages can also be used for assessing skeletal maturity.

The relationship between dental age, bone age and chronological age in underweight children

Background and Objective:The knowledge of bone age and dental age is of great importance for pediatrician and pediatric dentist. It is essential for a pediatric dentist to formulate treatment plan and it is a source of complementary information for pediatrician. There are few studies, which showed the relationship between dental age, bone age and chronological age in underweight children. Therefore, objective of this study was to determine and compare dental age, bone age and chronological age in underweight children.Materials and Methods:100 underweight children between the age group of 18-14 years were selected. Chronological age was assessed by recording date of birth. Dental age assessment was done using orthopantamogram following the method described by Demirjian. Bone age assessment was carried out using hand wrist radiograph following Bjork, Grave and Brown′s method.Results:Dental age and Bone age was delayed compared to chronological age in both sexes. The correlation between chronological age, dental age and bone age were all positive in males.Interpretation and Conclusion:The data supports the concept that dental age and bone age delay is a significant feature in underweight children. It is important to consider dental age and bone age as variables for diagnosing underweight children. To support our findings further a well-designed, controlled as well as longitudinal studies with a larger sample size is required.

Reliability of panoramic radiography in chronological age estimation

Introduction:There has been a strong relationship between the growth rate of bone and teeth, which can be utilized for the purpose of age identification of an individual.Aims and Objective:The present study was designed to determine the relationship between the dental age, the age from dental panoramic radiography, skeletal age, and chronological age.Materials and Methods:The study included 270 individuals, averaging between 17 years and 25 years of age from out-patient department of New Horizon Dental College and Hospital, Sakri, Bilaspur, Chhattisgarh, India, for third molar surgery. Panoramic and hand wrist radiographs were taken, the films were digitally processed for visualization of the wisdom teeth. The confirmations of ages were repeated again at an interval of 4 weeks by a radiologist. The extracted wisdom teeth were placed in 10% formalin and were examined by one dental surgeon to estimate the age on the basis of root formation. Student's t-test was adopted for statistical analysis and probability (P value) was calculated.Conclusion:Estimating the age of an individual was accurate by examining extracted third molar. Age estimation through panoramic radiography was highly accurate in upper right quadrant (mean = 0.72 and P = 0.077).

Reliability of Nolla′s dental age assessment method for Lucknow population

Tooth formation is widely used to assess dental maturity and predict the age of growing children. Skeletal age assessment by hand-wrist radiographs has been found to correlate significantly with the growth status of an individual, but has a known drawback in the form of extra radiograph and high dose of radiation exposure in comparison to periapical X-rays used commonly in dentistry. The purpose of this study was to assess the reliability of dental age and to find its comparison with chronological age. Dental maturity was studied from the intraoral periapical radiographs of 90 children aged 9-13 years in Lucknow population with 45 males (age range 10-13 years) and 45 females (age range 9-12 years), and the reliability of dental age estimation using Nolla's method was investigated. The children were radiographed for intraoral periapical X-ray of right permanent maxillary and mandibular canines. Chronological age was obtained from the date of birth of the children. Correlation between the dental age and chronological age was analyzed using the paired t-test. Slightly higher mean was recorded in the estimated age (dental age) compared to actual age (chronological age). Females were more advanced in dental maturation than males. Chronological age showed inconsistent correlation with dental age. It was concluded that canine calcification stages can also be used for assessing skeletal maturity.

Objective Evaluation of Cervical Vertebral Bone Age— Its Reliability in Comparison with Hand-Wrist Bone Age: By TW3 Method

The aim of this study was to establish the validity of a new method for evaluating skeletal maturation by assessing the 3rd and 4th cervical vertebrae seen in the cephalometric radiograph. This study consisted of a sample of 50 patients in the age group of 8 to 14 years of age. Chronologically, they were divided into six groups, based on the age consisting of a minimum of six to a maximum of 10 subjects. All the patients included in the study were females. The selected subjects were clinically examined and then age and date of birth of the patient in years and months was noted. Then lateral cephalograms and hand-wrist radiographs of the patient were taken on the same day with good clarity and contrast. The results suggested that cervical vertebral bone age on cephalometric radiographs calculated with this method is as reliable at estimating bone age as is the Tanner-Whitehouse 3 (TW3) method on hand-wrist radiographs. By determining the cervical vertebral bone age, skeletal maturity can be evaluated in a detailed and objective manner with cephalometric radiographs. The ability to accurately appraise skeletal maturity from cervical vertebral maturation, without the need for additional radiographs, has the potential to improve orthodontic diagnostic and therapeutic decisions. The technique's simplicity and ease of use should encourage this method as a frst level diagnostic tool to assess skeletal maturation. Clinical signifcance: This study revealed that the timing and sequence of ossifcation of the bones in hand and wrist and cervical vertebrae were able to relate the skeletal development of the various skeletal maturity indicators to a child's development. This method provided a mean with which one can determine the skeletal maturity of a person and thereby determine whether the possibility of potential growth existed.

To Establish the Validity of Dental Age Assessment using Nolla’s Method on Comparing with Skeletal Age assessed by Hand-Wrist Radiographs

To Establish the Validity of Dental Age Assessment using Nolla’s Method on Comparing with Skeletal Age assessed by Hand-Wrist Radiographs

Estimation and comparison of dental, skeletal and chronologic age in Bangalore south school going children

Precise evaluation of the developmental stages of a child is an integral part of both diagnosis and treatment planning of pediatric patients and also essential in forensic medicine and dentistry. As human growth shows considerable variation in chronological age, physiological maturity is preferred over chronological age in the estimation of person's exact age. Two hundred and fifty children consisting of 124 girls and 126 boys were selected randomly from the age group of 6-15 years. They were divided into 10 groups based on their age. The chronological age was determined by their date of birth as per the school records. An orthopantomogram and left hand-wrist radiographs was taken for each child to assess the dental age through Demirjian's method and skeletal age through the atlas of Greulich and Pyle's method respectively. The dental age showed a significant correlation (P<0.05) with chronological age in group 1 and 5 in males and group 3 and 7 females, whereas skeletal age showed a significant correlation with chronological age in group 3, 5, 9, and 10 in males and 1, 2, 5, 9, and 10 years in females. Demirjian's method of dental age estimation and Greulich and Pyle's method of skeletal age estimation showed accuracy only in certain age groups in the school children of Bangalore.

An Evaluation of Skeletal Maturation by Hand-Wrist Bone Analysis and Cervical Vertebral Analysis: A Comparitive Study

Objective: To evaluate the reproducibility of the concordance between skeletal maturity index stages of hand-wrist radiograph (Fishman) and cervical vertebral maturity index stages of lateral cephalogram (Hassel and Farman). Materials and methods: A radiographic hand-wrist bone analysis and cephalometric cervical-vertebral analysis of 48 patients (24 males and 24 females; 7–18 years of age) were examined. The hand-wrist bone analysis was evaluated by the Fishman index, whereas the cervical vertebral analysis was assessed by the Hassel and Farman (CVMI) method. These measurements were then compared with the hand-wrist bone analysis, and the results were statistically analyzed by the Cohen  concordance index. Results: The Cohen  index obtained (mean ± SD) was 0.70 ± 0.02, which is in the good range of agreement. The results also show a correlation of CVMI I with Fishman stages 1-2, CVMI II with Fishman stages 3-4, CVM III with Fishman stages 4-5, CVMI IV with Fishman stages 6- 7,CVMI V with Fishman stages 9-10 and CVMI VI with Fishman stage 11.

A methodology to measure cervical vertebral bone maturation in a sample from low-income children

This study evaluated the applicability of the regression method for determining vertebral age developed by Caldas et al. (2007) by testing this method in children from low-income families of the rural zone. The sample comprised cephalometric and hand-wrist radiographs of 76 boys and 64 girls aged 7.0 to 14.9 years living in a medium-sized city in the desert region of the northeastern region of Brazil, with an HDI of 0.678. C3 and C4 vertebrae were traced and measured on cephalometric radiographs to estimate the bone age. The average age, average hand-wrist age and average error estimated for girls and boys were, respectively, 10.62 and 10.44 years, 11.28 and 10.57 years, and 1.42 and 1.18 years. Based on these results, the formula proposed by Caldas et al. (2007) was not applicable to the studied population, and new multiple regression models were developed to obtain the children's vertebral bone age accurately.

Longitudinal comparison of skeletal age determined by the Greulich and Pyle method and chronologic age in normally growing children, and clinical interpretations for orthodontics

Coinciding treatment with periods of accelerated skeletal growth and maturation might be advantageous in clinical practice. Better understanding of the concordance between skeletal and chronologic ages during the period that children frequently receive orthodontic treatment is needed. The literature on skeletal age determination from hand-wrist radiographs lacks reports based on longitudinal data, creating lacunae in the understanding of the magnitudes and variations of differences between skeletal and chronologic ages. The aims of this research were to comprehensively analyze the concordance between skeletal and chronologic ages determined by using the Greulich and Pyle method at different ages in the preadolescent and adolescent periods, and to determine any age- and sex-related differences in the concordance. By using the Greulich and Pyle method, skeletal age determinations were made from 572 hand-wrist radiographs of 68 white children with normal facial growth, selected from the records of the Burlington Growth Centre, spanning the growth period from 9 to 18 years. Skeletal age and chronologic age differences for each sex were analyzed by using paired t tests and Wilcoxon signed rank tests at yearly intervals. Differences over the longitudinal duration were examined by using the mixed model approach. The limits of agreement were determined by using the Bland-Altman method. In each yearly chronologic age group, differences were clinically categorized based on the proximity of the skeletal and chronologic ages. Overall, a slightly greater proportion of the total skeletal age determinations made in girls (41.9%) were within 0.5 year of their chronologic age, compared with 38% in boys. The largest proportions of subjects having skeletal age-chronologic age differences within 0.5 year were in the 10-year age group in girls (64.5%) and the 13-year age group in boys (64.7%). Mean skeletal age-chronologic age differences were significantly larger in the 13- to 16-year age groups in girls and in the 16- and 17-year age groups in boys, but the differences were not statistically significant at other ages. Several patterns of variations were identified in the direction of differences when individual plots were examined. This longitudinal analysis of differences between skeletal and chronologic ages showed wide ranges and distributions of differences at each yearly age group during the growth period from 9 to 18 years, even when mean differences were small. Variations in the magnitude and direction of differences observed at different ages highlighted the variability in skeletal maturation among normally growing young people. Overall, the differences in skeletal and chronologic ages were positively related to age, with little effect of sex or its interaction with age.

New model for cervical vertebral bone age estimation in boys

The objective of this study was to test the validity of a newly developed statistical model in establishing the cervical vertebral bone age in growing children. The sample of the study consisted of lateral cephalometric and hand-wrist radiographs of 122 Saudi male children. Subjects were divided based on their chronological age into six groups: 10–15years. The metric dimensions of the vertebral body of the third and fourth cervical vertebrae were measured from the lateral cephalometric radiographs and a statistical model was developed through a stepwise multiple regression analysis to calculate the cervical vertebral bone age. The validity of the statistical model was assessed against the bone age and skeletal age determined from the hand-wrist radiographs using the Tanner–Whitehouse 3 method and the Greulich and Pyle atlas method. No significant (P<0.05) difference and high correlation were found between the calculated cervical vertebral bone age and the bone/skeletal age established by the hand-wrist methods. No significant (P<0.05) difference and high correlation were demonstrated between the calculated cervical vertebral bone age and the chronological age. The results of this study indicate that the established statistical formula for cervical vertebral bone age calculation is useful in determining the skeletal maturation in growing children as the other well-established hand-wrist methods.

소아청소년기 정상 교합 아동에서 경추골 및 수완부골 성숙도에 대한 하악골 성장의 연관성

교정치료에는 치아를 움직이는 치열교정치료와 골격적인 이동을 도모하는 악정형 치료가 있다. 소아청소년기 아동에서 특히 악정형 치료를 위해서는 골 성숙도와 성장 잠재력의 평가가 매우 중요하다. 본 연구의 목적은 6~13세 정상 교합 아동을 대상으로 측모 두부 규격 방사선사진과 수완부골 방사선사진을 촬영하여 발달 단계를 평가하고 하악골 성장량을 비교한 것으로 다음과 같은 연구결과를 얻었다. SMI와 CVM은 유의한 상관관계를 나타냈다(p < 0.05). 수완부골 성숙도가 증가할수록 Ar-Go, Co-Go, N-Go, S-Gn, N-Me, Co-Gn, Go-Me, Go-Gn이 증가하였고, 경추골 성숙도가 증가할수록 Ar-Go, Co-Go, N-Go, S-Gn, N-Me, Co-Gn, Go-Me, Go-Gn이 증가하였다. 또한 Ar-Go, Co-Go, N-Go, S-Gn, N-Me, Co-Gn, Go-Me, Go-Gn은 경추 및 수완부골 성숙도와 각각 유의한 상관성을 보였다(p < 0.05). 이상의 결과로 하악골 성장은 경추 및 수완부골 성숙도와 유의한 상관성이 있음을 알게 되었다. There are orthodontic treatment which involves tooth movements and orthopedic treatment which involves skeletal movement. In childhood and adolescence, especially for the treatment of orthopedic treatment, the evaluation of bone maturity and growth potential is very important. The purpose of this study is to assess the developmental stage and to compare the amount of mandibular growth with cephalometric radiographs and hand-wrist radiograph in 6 to 13-year-old children with normal occlusion. The results are as follows : SMI and CVM showed a significant correlation (p < 0.05). Ar-Go, Co-Go, N-Go, S-Gn, N-Me, Co-Gn, Go-Me, Go-Gn increased with increasing maturity of hand-wrist and Ar-Go, Co-Go, N-Go, S-Gn, N-Me, Co-Gn, Go-Me, Go-Gn increased with increasing maturity of cervical vertebrae maturation. Also Ar-Go, Co-Go, N-Go, S-Gn, N-Me, Co-Gn, Go-Me, Go-Gn showed a significant correlation with each of the cervical vertebrae maturation stages and hand-wrist maturation stages (p < 0.05). These results suggested that mandibular growth had a significant correlation with cervical vertebrae maturation stages and hand-wrist maturation stages.