Introduction:
The orthodontist treats both children who are growing up and adults. A child's skeletal age, dental age, height, weight, chronological age, secondary sexual traits, and other factors can all be used to define their developmental stage. On the other hand, skeletal age has been thought to be the most accurate way to determine the developmental stage. The majority of data about growth comes from hand and wrist radiographs as well as cephalography. One of the primary goals of collecting hand and wrist radiographs is to assess the pace of growth and to monitor bone discrepancies during adolescence. Additionally, this will support the choice of necessary appliances, treatment plans, and retention following active orthodontic treatments.
Why Hand and Wrist Radiography Is Important?
The child's physical maturation level can be ascertained by assessing the skeletal age of the bone using the hand and wrist radiograph. To coordinate orthodontic treatment with the process of growing, the orthodontist greatly benefits from knowing the age of the bones. The hand and wrist radiograph is intended to determine the patient's skeletal age since the hand and wrist region's skeleton is composed of multiple small bones, including the distal ends of the long bones radius and ulna, as well as 27 other small bones. Since these bones develop throughout the whole postnatal growth period from the emergence of calcification centers to the closing of the epiphyseal plate—they offer a helpful method for determining skeletal maturity.
These bones exhibit an orderly and predictable ossification, union, and appearance sequence. Thus, one of the best places to research growth is this one. Changes in the growing skeleton that are visible and analyzed on the standardized radiograph serve as the basis for assessing skeletal maturity from hand and wrist radiographs. The left hand and wrist are utilized traditionally. The hand and wrist are positioned flat on the X-ray plate with the fingers slightly apart.
What Are the Other Factors that Help Determine the Skeleton Age?
Physiological criteria, such as pubertal markers, dental development, height, and radiographic findings of skeletal maturation, can be used to determine growth. According to a report, using radiographs to assess skeletal maturation is seen to be a more dependable method. Using hand-wrist radiography is the recommended approach. The increased radiation that hand-wrist radiographs expose patients to led to criticism of their use in examining skeletal development.
As an alternative, an examination of the cervical spine on lateral cephalographs was advised. These techniques, however, are unable to provide an accurate estimate of the remaining growth. A hand-wrist radiograph is frequently used to evaluate the development of the skeleton. The approach most commonly used to determine bone age from hand-wrist radiographs is the Atlas of Greulich and Pyle. This atlas consists of wrist and hand radiographs of healthy, normal children taken at three-month intervals from infancy to maturity. This atlas compares and displays the patient's skeletal age.
What Are the Components of Hand and Wrist Bones Seen in Radiographs?
The following components of the hand and wrist bones are the distal ends of the forearm's long bones (ulna and radius), carpals, metacarpals, and phalanges.
The following are the key parts of the hand and wrist:
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The radiocarpal joint (a connection between the radius and navicular bones).
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The carpometacarpal joint (the connection between the first metacarpal bones and the trapezium).
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The initial metacarpophalangeal joint.
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Thumb's interphalangeal joint.
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Proximal interphalangeal joint.
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Middle interphalangeal joint.
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Distal interphalangeal joint.
Diaphysis and epiphysis comprise each phalange (small bones that make up the fingers). The term "epiphysis" refers to the broader region at both ends of the bone. The hollow, tubular shaft that connects the two ends of the bone is called the diaphysis. Children's epiphysis and diaphysis develop differently in terms of the order in which the maturational events occur and when they occur. The maturational events include width, ossification, capping, and fusing. Conversely, the developmental stage significantly impacts orthodontic diagnostic and treatment planning.
Based on whether the sesamoid bone is visible in the image, the following steps in Bjork's method of measuring skeletal age using hand-wrist radiographs should be taken in order to determine the skeletal maturity stage in the image.
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The initial step is to search for the fusion of the third finger's diaphysis and epiphysis at the distal site and the sesamoid bone.
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If the sesamoid bone is not there, measure the proximal phalanx's width (epiphysis and metaphysis) at the second finger (PP2). If they are the same, then evaluate the middle (epiphysis and metaphysis) of the third finger (MP3). The individual is in the (MP3) stage if they are identical, but when they are not, they are in the (PP2) stage.
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The third phase involves examining the third finger at the distal site to determine whether or not there is fusion if the sesamoid bone (S) is present.
Radiographic examination of the hands and wrists can provide an accurate image of bone age (skeletal age). The hand and wrist were chosen because they are technically straightforward for making radiographs and because it is easy to identify the various developmental phases and ossification sites, which will provide precise skeletal age in comparison to chronological age.
What Methods Are Used to Assess Skeletal Age Using Hand Wrist Radiograph?
Several techniques that explain how to use hand and wrist radiographs for skeletal age evaluation are as follows:
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Gruelich-Pyle (G.P) Method - The process involves trying to match an individual child's hand-wrist X-ray as closely as possible to a set of standard X-ray plates that represent increasing skeletal maturity at particular calendar ages.
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Tanner and Whitehouse (TW) Method - In this method, every bone under evaluation is contrasted with a reference group of bones at various developmental stages. Based on the patient's sex and level of maturity, a score is given to each bone. Following the scoring of each bone, a total score is produced by summing the individual bone scores, which are then displayed on a graph to show the relationship between the bone age and the chronological age.
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Gilsanz and Ratibin (GR) Atlas - This atlas offers idealized, age- and sex-specific pictures of skeletal development by integrating the essential morphological characteristics of ossification in the hand and wrist bones.
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Automatic Skeletal Bone Age Assessment - Computer-assisted evaluations, such as automatic skeletal age assessment, can shorten the time needed to review the image and improve the analysis's accuracy.
Conclusion:
One of the most accurate ways to determine developmental age is to analyze skeleton age. Pediatric endocrinologists and pediatric orthopedic surgeons need accurate developmental age estimation to select the most appropriate course of treatment for a child patient. Furthermore, proper age determination is crucial for forensics as well. Consequently, a variety of bone age assessment techniques, particularly hand-wrist radiography, are beneficial to medical science. Numerous techniques for evaluating hand-wrist radiographs have been developed; automated systems are the most recent.
