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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




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
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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

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
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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