A Practical Method For Determining Pubertal Growth Spurt

ORIGINAL ARTICLE

A practical method for determining pubertal growth spurt
Törün Özer,a Jalen Devecioglu Kama,b and Senem Yigit Özerc ˘ ˘ Diyarbakir, Turkey Introduction: It is important to evaluate skeletal maturation in orthodontic treatment. Hand-wrist and cervical maturation stages have been shown to be correlated with skeletal growth changes during puberty. The cervical vertebrae have 6maturation phases, whereas the medial phalange of the third finger has 5 stages; a modified version has 6 stages. The purpose of this study was to determine the correlation of the cervical vertebrae maturation index with the modified medial phalange index. Methods: Lateral cephalometric and left-hand medial phalange radiographs of 150 males between the ages of 9 and 19 who were referred fororthodontic treatment were examined. Results: The 6 modified medial phalange stages were found to correlate with the 6 cervical vertebral maturation stages. Conclusions: Because cervical vertebrae stage is a reliable maturation indicator, the medial phalange of the third finger can be used instead to assess a subject’s skeletal maturation. (Am J Orthod Dentofacial Orthop 2006;130:131.e1-131.e6)

hebiologic aspects of facial growth are fundamentally important in dentofacial orthopedics. Cephalometric studies indicate that the facial growth rate is not constant throughout the development period. The beginning, intensity, onset, and duration of the pubertal peak of facial growth have great variations among patients.1,2 Chronological age, dental development, body weight, height, menarche, and voiceand breast changes have been shown to be unreliable and impractical for estimating the pubertal growth spurt.1-4 Hand-wrist and cervical vertebae maturation (CVM) stages have been shown to be correlated with skeletal growth changes during puberty.1-6 A number of studies have found close correlations between changes in bone morphology, density, and epiphyseal-diaphyseal stages and the pubertalgrowth spurt.1-4 Although most studies used the entire hand and wrist region, the third finger has also been used. The usefulness of the cervical vertebrae in estimating pubertal growth has also been the topic of some studies.7-9 The use of the cervical vertebrae has the advantage of not requiring an additional radiograph. Studies of the CVM stages have shown correlation with the hand-wrist stagesof maturation, which thus provide a
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practical means for estimating facial and mandibular growth. Regardless of the method— hand-wrist, third finger, or cervical vertebrae—they all require longitudinal follow-up for accuracy. Knowing the stage does not allow a clinician to determine the timing of maturation with sufficient accuracy. This is particularly important for girls because theyhave shorter pubertal spurts and complete their growth earlier than do boys. Hägg and Taranger1 used the medial phalanges of the third finger (MP3) to determine the pubertal growth spurt. They primarily used the developmental changes in the epiphyseal region of the third finger. Rajagopal and Kansal10 added an additional bone stage to the method of Hägg and Taranger1: the MP3-HI, which occurs betweenMP3-H and MP3-I and reflects changes in the metaphyseal region of the third finger. The purpose of this study was to determine the correlation of the 6 CVM stages of Küçükkeles et al7 ¸ with the 6 modified MP3 stages of Hägg and Taranger1 and Rajagopal and Kansal.10
SUBJECTS AND METHODS

Assistant professor, Faculty of Dentistry, Department of Orthodontics, University of Dicle, Diyarbakir,Turkey. b Professor, Faculty of Dentistry, Department of Orthodontics, University of Dicle, Diyarbakir, Turkey. c Department of Endodontics, Oral Health Center, Diyarbakir, Turkey. Reprint requests to: Törün Özer, Faculty of Dentistry, Department of Orthodontics, University of Dicle, 21280 Diyarbakir, Turkey; e-mail, torun@dicle.edu.tr. Submitted, October 2005; revised and accepted, January 2006....