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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2010  |  Volume : 28  |  Issue : 2  |  Page : 95-99

Assessment of skeletal age using MP 3 and hand-wrist radiographs and its correlation with dental and chronological ages in children

1 Senior Lecturer, Department of Pedodontics & Preventive Dentistry, JCD Dental College, Sirsa, India
2 Professor & Head, Department of Pedodontics & Preventive Dentistry, Government Dental College & Hospital, Patiala, India
3 Director-Principal, Guru Nanak Dev Dental College & Research Institute, Sunam, India

Date of Web Publication24-Jul-2010

Correspondence Address:
M Bala
B-X/539, St. No. 2, Patel Nagar, K.C. Road, Barnala-148 101 (Pb.)
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.66746

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The purpose of the study was to assess skeletal age using MP 3 and hand-wrist radiographs and to find the correlation amongst the skeletal, dental and chronological ages. One hundred and sixty North-Indian healthy children in the age group 8-14 years, comprising equal number of males and females were included in the study. The children were radiographed for middle phalanx of third finger (MP 3 ) and hand-wrist of the right hand and intra oral periapical X-ray for right permanent maxillary canine. Skeletal age was assessed from MP 3 and hand-wrist radiographs according to the standards of Greulich and Pyle. The dental age was assessed from IOPA radiographs of right permanent maxillary canine based on Nolla's calcification stages. Skeletal age from MP 3 and hand-wrist radiographs shows high correlation in all the age groups for both sexes. Females were advanced in skeletal maturation than males. Skeletal age showed high correlation with dental age in 12-14 years age group. Chronological age showed inconsistent correlation with dental and skeletal ages.

Keywords: Dental age, MP 3 , skeletal age

How to cite this article:
Bala M, Pathak A, Jain R L. Assessment of skeletal age using MP 3 and hand-wrist radiographs and its correlation with dental and chronological ages in children. J Indian Soc Pedod Prev Dent 2010;28:95-9

How to cite this URL:
Bala M, Pathak A, Jain R L. Assessment of skeletal age using MP 3 and hand-wrist radiographs and its correlation with dental and chronological ages in children. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2023 Feb 1];28:95-9. Available from: http://www.jisppd.com/text.asp?2010/28/2/95/66746

   Introduction Top

Growing individuals not only differ in the timing of the maturational events, but also in the sequence of these events. Development status can have considerable influence on diagnosis and treatment planning. The developmental status of a child can be accessed from various parameters such as height, weight, chronological age, secondary sexual characteristics, skeletal age and dental age.[1] Skeletal age has been considered the most reliable method to assess the developmental status.[2],[3],[4]

The hand-wrist radiograph is commonly used for skeletal developmental assessment. [4],[5],[6] The most frequently used method to evaluate skeletal age from hand-wrist radiographs is the  Atlas More Details of Greulich and Pyle. [6],[7],[8] Also, the changes in the epipyhsis of middle phalanx of the third finger (MP 3 ) follow an orderly sequence. Hagg and Taranger studied pubertal growth from the stages of ossification of the middle phalanx of the third finger of the hand (MP 3 stages). [9]

Dental age estimation is based upon the rate of development and calcification of tooth buds and the progressive sequence of their eruption in the oral cavity. Several methods have been developed to assess the dental age according to the degree of calcification observed in permanent teeth.[8] One such widely used method is that given by Nolla.[10]

The relationship amongst the chronological, dental and skeletal ages is important in diagnosis and treatment. Variations of dental and skeletal ages from known chronological age indicate changes in the standard growth pattern.

   Materials and Methods Top

The present study was conducted on 160 North-Indian healthy children in the age group 8-14 years. An equal number of male and female children were selected. The children were selected from the outpatient department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Patiala, and various schools.

Healthy children were selected according to Indian weight standards developed by Aggarwal et al.[11] The normal variation range in weight was taken between 3rd and 97th percentile curves for a particular age. Children having weight out of this range were not included in the study.

   Method Top

A brief history of each child including name, age, sex, date of birth, name of the school and address was recorded. Consent was obtained from the parents and school teachers.

The study included:

  1. Radiographs of hand-wrist of the right hand using 8" Χ 10" films
  2. Radiographs of middle phalanx of third finger (MP 3 ) of right hand using 31 Χ 41 mm IOPA films
  3. Intraoral periapical radiographs of right permanent maxillary canine using 31 Χ 41 mm IOPA films.
All the radiographs were taken on the same day.

Skeletal age from MP 3 and hand-wrist radiographs was assigned according to the standards given in the "Radiographic Atlas of Greulich and Pyle".[3]

Intraoral periapical radiographs of maxillary permanent right canine were assessed for dental age according to Nolla's[10] calcification stages [Figure 1].

Nolla's developmental stages

The Nolla's developmental stages are given below.

stage 10: apical end of root completed

stage 9: root almost complete; open apex

stage 8: two third of root completed

stage 7: one third of root completed

stage 6: crown completed

stage 5: crown almost completed

stage 4: two third of crown completed

stage 3: one third of crown completed

stage 2: initial calcification

stage 1: presence of crypt

stage 0: absence of crypt

The chronological age was determined from the actual date of birth either stated by parents or as given in school records.

Data were compiled and statistical analysis was done.

   Results Top

[Table 1] and [Table 2] show the mean values of chronological, dental and skeletal ages (from MP 3 and hand-wrist) in males and females, respectively.

Skeletal age from MP 3 and hand-wrist radiographs for males and females in different age groups showed highly significant correlation [Table 3]. Females are skeletally advanced than males [Figure 2] and [Figure 3].

Skeletal age (from MP 3 and hand-wrist) and dental age showed statistically significant correlation in patients of 12-14 years of age of both the sexes [Table 4] and [Table 5]. Males and females did not differ significantly in dental development [Figure 4].

Skeletal and dental ages did not show significant correlation with chronological age [Table 6],[Table 7],[Table 8]

   Discussion Top

Malnutrition can have an adverse effect on the dental and skeletal maturation. To minimize these effects, healthy children were selected according to Indian weight standards given by Aggarwal et al.[11]

In this study, females were ahead in skeletal maturation than males in all the age groups. This is supported by Magnusson,[6] Hagg and Taranger,[9] Castellanous et al.,[7] Koshy and Tandon,[6] Prabhakar et al.,[8] Hunter,[12] Fishman[5] and Sharma et al.[4]

Results of the present study show insignificant difference in dental development in males and females. The study was supported by Nolla.[10]

In this study a highly significant correlation ( P < 0.01) was obtained between MP 3 and hand-wrist in all age groups of males and females. Kucukkeles[13] indicated that cervical vertebrae maturation indices (CVMI) and hand-wrist skeletal maturation were significantly related. Rajagopal and Kansal[1] and Sharma et al.[4] showed high correlation of MP 3 and CVMI stages. Thus, MP 3 can substitute hand-wrist radiographs for skeletal maturity evaluation. MP 3 radiographs are taken on standard IOPA X-ray film. The technique has the advantages of being simple, using low patient radiation dose and exhibiting high degree of clarity of the radiographs. The equipment required is available in most dental clinics.

Canine maturation shows close association with MP 3 and hand-wrist in the age group 12-14 years in this study. Our finding is in agreement with Sharma et al.[4] who found that maxillary canine maturation is closely associated with MP 3 and CVMI stages in the age group 12-16 years.

For both the sexes, skeletal age (from MP 3 and hand-wrist) and dental age do not show high correlation with chronological age in all the age groups in this study. This indicates that the chronological age has no sufficient correlation with individual maturational development. Similar findings have been reported by Singer,[14] Demirjian et al.,[15] Prabhakar et al.,[8] Moorrees et al.[16] and Sharma et al.[4]

The findings in this study reveal that there is highly significant correlation of MP 3 stages with hand-wrist; however, an inconsistent relationship was observed with dental age and chronological age. This suggests that MP 3 radiographs can be used for assessment of skeletal age as hand-wrist radiographs. Dental and chronological ages are poor indicators of development status.

   References Top

1.Rajagopal R, Kansal S. A comparison of modified MP 3 stages and the cervical vertebrae as growth indicators. J Clin Orthod 2002;36:398-406.  Back to cited text no. 1      
2.Fishman LS. Maturational patterns and prediction during adolescence. Angle Orthod 1987;57:178-93.  Back to cited text no. 2      
3.Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. In: Todd TW, editor. Brush Foundation Study of Human Growth and Development initiated. California: Stanford University, Standford University Press; 1950.  Back to cited text no. 3      
4.Sharma VP, Tondon P, Negi KS. Assessment of growth impetus with MP 3 and its correlation with CVMI and dental age. A Thesis. Department of Orthodontics, KGMC, Lucknow, April 2002.  Back to cited text no. 4      
5.Fishman LS. Radoigarphic evaluation of skeletal maturation: A clinically oriented method based on hand wrist films. Angle Orthod 1982;52:88-112.  Back to cited text no. 5      
6.Koshy S, Tandon S. Dental age assessment: The applicability of Demirjian's method in South Indian children. Forensic Sci Int 1998;94:73-85.  Back to cited text no. 6      
7.Jimιnez-Castellanos J, Carmona A, Catalina-Herrera CJ, Viρuales M. Skeletal maturation of wrist and hand ossification centers in normal spanish boys and girls: a study using the Greulich Pyle method. Acta Anat (Basel) 1996;155:206-11.  Back to cited text no. 7      
8.Prabhakar AR, Panda AK, Raju OS. Applicablity of Demirjian's method of age assessment in children of Davangere. J Indian Soc Pedod Prev Dent 2002;20:54-62.  Back to cited text no. 8  [PUBMED]    
9.Hδgg U, Taranger J. Maturation indicators and the pubertal growth spurt. Am J Orthod 1982;82:299-309.  Back to cited text no. 9      
10.Nolla CM. The development of permanent teeth. JDC 1960;27:254-66. J Dent Child  Back to cited text no. 10      
11.Ghai OP. Text book of Essential Pediatrics. 5 th ed. Vol. 6. 1996.   Back to cited text no. 11      
12.Hunter CJ. The correlation of facial growth with body height and skeletal maturation at adolescence. Angle Orthod 1966;36:44-54.  Back to cited text no. 12      
13.Kucukkeles N, Acar A, Biren S, Arun T. Comparisons between cervical vertebrae and hand-wrist maturation for the assessment of skeletal maturity. J Clin Pediatr Dent 1999;24:47-52.  Back to cited text no. 13      
14.Singer J. Physiologic timing of orthodontic treatment. Angle Orthod 1980;50:322-33.  Back to cited text no. 14      
15.Demirjian A, Buschang PH, Tanguay R, Patterson DK. Inter-relationships among measures of somatic, skeletal, dental and sexual maturity. Am J Orthod 1985;88:433-8.  Back to cited text no. 15      
16.Moorrees CF, Fanning EA, Hunt EE Jr. Age variation of formation stages for ten permanent teeth. J Dent Res 1963;42:1490-502.  Back to cited text no. 16      


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]

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