Growth assessment/prediction
Importance of growth prediction
• Maximum skeletal response can be achieved at specific growth
stage.
• Growth can be promoted when it is rapidly occuring.
• Growth can be restrained/ redirected during active period.
• Growth modification can eliminate the need of orthognathic surgery.
• Orthognathic surgery can be performed when active growth period is
completed.
Methods
Hx and Examination
Investigations
Lateral cephalogram Cervical vertebral maturation stages
Hand-wrist radiograph
OPG tooth mineralization stages
Hormone levels in blood
Cervical Vertebral Maturation stages
• Methods
▫ Baccetti
▫ Hassel and Farmen
Baccetti method
• 6 stages
• Presence of concavities at the inferior border of C-2, 3, 4.
• Shape changes in C-3, C-4
CS-1
• Flat inferior border of C2,3,4
• Maximum skeletal growth of the midface occur.
• Maxillary advancement can be performed in this
stage.
CS-2
• Concavity at the inferior border of C2
• Flat inferior surfaces of C3,4
• Peak mandibular growth will occur ONE year after
the start of this stage.
CS-3
• Concavity at the inferior border of C2,3
• Flat inferior border of C4
• Start of Peak mandibular growth
• Functional appliance therapy for skeletal Cl II
can be initiated in this stage
CS-4
• Concavity at the inferior border of C2,3, 4
• Shape of C3,4 Rectangular Horizontal
• Decrease in sagittal growth velocity
• Significant vertical growth occur
CS-5
• Deep notches at the inferior border of C2,3,4
• Shape of C3,4 more squarish
• Most of Craniofacial growth is completed
• Placement of endosseus implants for missing
teeth can be performed.
CS-6
• Deep concavities at C2, 3, 4
• Shape of C3,4 at least one has vertical
rectangular morphology.
• Any individual with >20years of age should be
considered in CS-6 stage.
• Growth of Craniofacial region is completed
• Orthognathic surgery can be planned in this stage.
Hand-Wrist Radiograph
• Fishman’s skeletal maturity indicators
• Appearance of sesamoid bone
▫ start of growth spurt
• Fusion of epiphysis with diaphysis
▫ Distal, medial and proximal phalanx of 3rd
finger
▫ End of growth spurt
▫ Fusion of radius epiphysis with
diaphysis growth completion
Tooth developmental Stages
• Mandibular canine
• Root development
▫ <1/2 start of growth spurt
▫ Apical closure end of growth spurt
• Mandibular 2nd molar
▫ Root development upto bifurcation area start of growth spurt.
Other investigations
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Hormone levels in blood
GH
IGF-I (insulin-like growth factor)
Sex hormones
▫ Testosterone
▫ Estrogen