Download analysis of skeletal maturation by evaluation of cervical vertebrae

DISSERTATION – SYNOPSIS
Dr. PRIYA SARA THOMAS
POST GRADUATE STUDENT
DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY
A.B.SHETTY MEMORIAL INSTITUTE OF DENTAL SCIENCES
DERALAKATTE,
MANGALORE .
Rajiv Gandhi University of Health Sciences
Bangalore, Karnataka.
Performa for Registration of Subjects for Dissertation
1
Name of the candidate and address
(in block letter)
DR. PRIYA SARA THOMAS
DEPARTMENT OF ORAL MEDICINE AND
RADIOLOGY,
A.B. SHETTY MEMORIAL INSTITUTE OF
DENTAL SCIENCES,
DERALAKATTE,
MANGALORE – 575018
KARNATAKA, INDIA.
2
Name of the institution
A.B. SHETTY MEMORIAL INSTITUTE OF
DENTAL SCIENCES.
DERALAKATTE,
MANGALORE – 575018
KARNATAKA, INDIA.
3
Course of the study and subject
MASTER OF DENTAL SURGERY
ORAL MEDICINE AND RADIOLOGY
4
Date of admission to course
31 MAY, 2008
TITLE OF THE TOPIC:
5
ANALYSIS OF SKELETAL MATURATION BY EVALUATION OF CERVICAL
VERTEBRAE – A RADIOGRAPHIC STUDY
6.
Brief resume of the intended work
6.1 Need for the study
The diagnosis, treatment, prognosis and stability of the orthodontic results
have become more precise with the development of contemporary
orthodontics. The determination of the growth peak contributes to the
elimination of probable interferences with the use of appliances and proper
techniques, guiding and favouring dentoskeletal relations. The decisions as to
the use of functional appliances, the orthodontic treatment with or without
extractions, and the time of the orthognathic surgery are specially based on
considerations as to the present stage of skeletal maturation of the patient.
Prepubertal growth period is the best time to start orthopedic treatment for
skeletal malocclusions. Besides the chronological age, there are many
biological parameters which can determine the stage of the subject in the
growth curve like the dental age, circumpubertal age, the relationship of
height-weight and skeletal age. The skeletal age represents the most reliable
means and the most utilized method.
The purpose of this study is to determine the feasibility and reproducibility of
determining the skeletal maturation using the lateral cephalogram for routine
dental application.
6.2 REVIEW OF THE LITERATURE
A study was done to determine skeletal maturation by morphological
evaluation of the cervical vertebrae in 100 cephalograms. Inter and intra
operator variability was assessed. The analysis showed that this method
was reproducible for assessing the individual’s growth curve.¹
A study was designed to determine the validity of cervical vertebrae
radiographic assessment to predict skeletal maturation. Lamparski’s and
Hassel and Farman’s criteria were compared against a New method put
forth by Roman et al. The best morphological vertebral parameter to
estimate the maturation was found to be the concavity of the lower border
of the body.²
A study was done on 11 groups of 10 males and 10 females (220 subjects)
aged from 8 – 18 years. Lateral profiles of second, third and fourth cervical
vertebrae were assessed. Inter and intra operator error was assessed. The
study revealed that it was possible to develop a reliable ranking of patients
according to the future adolescent growth potential.³
A study designed to investigate the relationship between chronologic age
and maturation of cervical vertebrae showed significant results for the
sexes combined and for the male / female subjects. The reproducibility of
all the assessments were good with high correlation values.4
An improved version of cervical vertebral maturation method for detection
of mandibular growth was studied in 30 orthodontically untreated subjects.
This was particularly useful when skeletal maturity had to be assessed on a
single cephalogram.5
A study was done using cephalometric radiographs of 176 girls to measure
cervical vertebral bodies. The results suggested that cervical vertebral bone
age reflects skeletal maturity since it approximates bone age which is
considered to be the most reliable method for evaluating skeletal maturity.6
A study designed to analyze the validity of 6 stages of cervical vertebral
maturation revealed that it was appropriate as a biologic indicator for
skeletal maturity and for the appraisal of mandibular skeletal maturity in
individual patients on the basis of a single cephalometric observation.7
A study suggested that cervical vertebral measurements maybe useful to
evaluate the mandibular growth potential. An equation was determined to
obtain the mandibular length increments on the basis of the measurements
in the third and fourth cervical vertebral bodies.8
A study conducted on 3 subjects of similar backgrounds, ages, dental and
medical health showed that skeletal maturation accounts for a significant
portion of the variation in cephalofacial structure between children.9
6.3 AIMS & OBJECTIVES
1. To analyse the skeletal maturity by morphologically evaluating the
cervical vertebrae in a lateral cephalogram which is a routine
diagnostic aid.
2. To assess the reliability of using only the lateral cephalogram
prior to undertaking any treatment procedure.
3. To ascertain reproducibility in evaluating cervical vertebrae
by assessing intra / inter examiner variability.
7
MATERIALS AND METHODS
7.1 SOURCE OF DATA :
180 Cephalograms of patients reporting from 2009 - 2010 to the
Department of Oral Medicine and Maxillofacial Radiology, A.B
Shetty Memorial Institute of Dental Sciences, Mangalore.
INCLUSION CRITERIA:
1. Patients from 6 to 18 years of age
2. Cephalometric radiographs with high clarity and good contrast
3. Patients with no systemic diseases
4. No previous orthodontic treatment
EXCLUSION CRITERIA:
1. Patients with any deformities to the spine
2. Patients with developmental abnormalities
7.2 METHODS OF COLLECTION OF DATA AND
ANALYSIS
Informed consent will be obtained from the patients included in the
study.
Equipments Used In The Study
PLANMECA – Proline Ceph 2002
Lead apron
8x10 inch cassette
8x10 inch Kodak films
Calibration Device
Acetate paper (matte)
Lead pencil
Viewbox
Method of Analysis using Cervical Vertebra
1. Cervical vertebral stages will be determined by a new method
proposed by Paloma San Roman et al which has been found to be as
accurate as Hassel and Farman’s method and superior to Lamparski’s
classification.
2. The concavity of the lower border of the vertebrae, the height and
the shape of the vertebrae will be studied.
CONCAVITY OF THE LOWER BORDER OF THE
VERTEBRAE
Considered to be present when there is a distance of more than 1
mm between the middle of the lower border of the vertebral body and
a line traced from the postero-inferior angle to the antero-inferior
angle of the vertebral body.
According to the concavity, six stages will be defined.
STAGE 1: All the vertebrae have a flat lower border
STAGE 2: A concavity is present in the C2 lower border
STAGE 3: A concavity is present in the C3 lower border
STAGE 4: C2, C3 concavity increases and a concavity is
present in C 4,5,6
STAGE 5: Concavity increases in all the vertebrae
STAGE 6: Deep concavity is present in all the vertebrae and
the inferior angles are rounded
VERTEBRAL BODY HEIGHT
The height and width will be calculated at the middle of the
body. The lower border will be considered to be the line traced from
the postero-inferior angle to the antero-inferior angle of the vertebral
body.
Four stages will be defined.
STAGE 1: Height is less than 80 % of the width
STAGE 2: Height is between 80 – 99 % of the width
STAGE 3: Height and width are equal
STAGE 4: Height is greater than width
SHAPE OF THE VERTEBRAL BODY
The shape will be determined as being either wedge shaped,
rectangular shaped, nearly squared, squared or rectangular bodies with
height greater than width.
Six stages will be defined.
STAGE 1: Upper border of C3 is tapered from the posterior to
the anterior and wedge shaped
STAGE 2: Wedge shaped C3 and nearly rectangular shaped
C4 with absence of supero-anterior angles
STAGE 3: Rectangular shaped bodies
STAGE 4: Nearly squared shaped bodies
STAGE 5: Squared bodies
STAGE 6: Rectangular bodies with height greater than width
The cephalograms will then be evaluated by three examiners. The
examiners will be trained and tested before starting evaluation of the
radiographs. The intra examiner and inter examiner variability will
then be assessed.
STATISTICAL ANALYSIS
Evaluation of the intra and inter examiner variability will be
computed using Cronbach’s alpha ( SPSS software package )
7.3 Does the study require any investigations or
interventions to be conducted on patients or other
humans or animals ? If so, please describe briefly
The study requires taking a lateral cephalogram of the
patients.
7.4 Has ethical clearance been obtained from your
institution in case of 7.3?
Ethical clearance has been obtained & enclosed.
8
LIST OF REFERENCES
1. Almada Santos et al. Skeletal maturation analysis by morphological
evaluation of cervical vertebrae.J CLIN PEDIATR DENT 2006;30(3):
265-270
2.
Roman P.S et al. Skeletal maturation determined by cervical
vertebrae development. EUR J OF ORTHOD 2002; 24: 303-311
3.
Hassel B, Farman AG. Skeletal maturation evaluation using cervical
vertebrae. AM J ORTHOD DENTOFACIAL ORTHOP 1995;107:58-66
4.
Ulysal T et al. Chronologic age and skeletal maturation of the
cervical vertebrae and hand wrist: Is there a relationship? AM J ORTHOD
DENTOFACIAL ORTHOP 2006;130:622-8
5.
Baccetti T, Franchi L, McNamara JA Jr. An improved version of the
cervical vertebral maturation method for the assessment of mandibular
growth. ANGLE ORTHOD 2002;72:316-23
6.
Mito.T et al. Cervical vertebral bone age in girls. AM J ORTHOD
DENTOFACIAL ORTHOP 2002; 122: 380-5
7.
Franchi L et al. Mandibular growth as related to cervical vertebral
maturation and body height. AM J ORTHOD DENTOFACIAL ORTHOP
2000; 118: 335-40
8.
Chen F et al. A new method of predicting mandibular length
increment on the basis of cervical vertebrae. THE ANGLE
ORTHODONTIST 2004; 74(5): 630-4
9.
Johnston et al. Skeletal maturation and Cephalofacial development.
THE ANGLE ORTHODONTIST 1965; 35(1): 1-11
10. .
O’Reilly MT, Yannielo GJ. Mandibular growth changes and
maturation of cervical vertebrae: A longitudinal cephalometric study.
ANGLE ORTHOD 1988;58:179-84
9.
Signature of the candidate
10.
Remarks of the guide
11.
Name and designation( in block
letters) of
11.1 Guide
PROF(DR.) G. SUBHAS BABU
PROFESSOR AND HEAD OF THE
DEPARTMENT
DEPARTMENT OF ORAL
MEDICINE & MAXILLOFACIAL
RADIOLOGY
A.B. S.M.I.D.S
DERALAKATTE, MANGALORE
11.2 Signature
11.3 Co-Guide
PROF(DR.) U.S KRISHNA
NAYAK
DEAN (ACADEMICS)
PROFESSOR AND HEAD OF THE
DEPARTMENT
DEPARTMENT OF
ORTHODONTICS
A.B. S.M.I.D.S.
DERALAKATTE, MANGALORE
11.4 Signature
Co-guide
DR . SHRIKRISHNA
ASSOCIATE PROFESSOR
DEPT. OF RADIOLOGY
K.S HEGDE MEDICAL ACADEMY
DERALAKATTE, MANGALORE
Signature
11.5 Head of the department
PROF(DR).G. SUBHAS BABU
PROFESSOR AND HEAD OF THE
DEPARTMENT
DEPARTMENT OF ORAL
MEDICINE & MAXILLOFACIAL
RADIOLOGY
A.B. S.M.I.D.S.
DERALAKATTE, MANGALORE
11.6 Signature
12
12.1 Remarks of the chairman and
principal
12.2 Signature
PROF (DR.) B.RAJENDRA
PRASAD
PRINCIPAL AND DEAN
A.B.S.M.I.D.S
DERALAKATTE, MANGALORE.