Middle phalanx maturation of the third finger (MPM) method in the evaluation of skeletal age in a growing orthodontic patient

Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation

Aim

Growth measurement has always been essential to identify the best time to employ orthopedic or orthodontic appliances. Optimal timing for orthodontic treatment is strictly linked to the identification of periods of craniofacial growth when treatment is more effective.The aim of this study was to compare two different methods, middle phalanx maturation (MPM) and cervical vertebrae maturation (CVM), used to evaluate the stage of facial growth.

Materials and methods

The research data was collected from July 2018 to April 2019 at the Dental Clinic of the San Gerardo Hospital in Monza. The study included a sample of 98 patients-46 males and 52 females. For each patient, a latero-lateral teleradiography of the skull and an X-ray on the middle finger of the right hand were obtained.The statistical analysis of the comparison of the stages of skeletal maturation obtained by the MPM and CVM methods was performed using the correlation coefficient for ranks of Spearman.

Results

A descriptive statistical analysis of the entire sample of 98 patients was performed (mean age of 12.2 years and median of 12.2 years). The average age of females in every single stage of MPM was significantly lower than the average age of males. Of the total sample, 87 patients (88.8%) showed complete agreement between the two methods.

Conclusion

The results obtained from the statistical analysis of this study allowed us to confirm a satisfactory agreement between the two methods.The intermediate phalanx method is a valid and alternative indicator to CVM for the identification of the puberty growth peak. We can, therefore, consider the MPM method a valid indicator of skeletal maturity.

How to cite this article

Mirabelli L, Bianco E, Pigato G, et al. Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation. Int J Clin Pediatr Dent 2023;16(2):327-332.

The Third Finger Middle Phalanx Maturation (MPM) Method to Assess Timing of Functional Treatment for Skeletal Class II Malocclusion: Report of Three Cases

A deficient mandibular growth on the sagittal plane is the most frequent diagnostic finding in dentoskeletal Class II malocclusion. Evidence indicated that functional treatment for such malocclusion is efficient only if performed during the pubertal growth spurt, as identified through radiographical growth indicators. With the aim of reducing the radiation to the patients and to follow longitudinally individual growth phases, the use of the sole third finger middle phalanx maturation (MPM), as a 5-stage method, has been proposed. Herein, three clinical cases of skeletal Class II malocclusion in growing patients treated by removable functional appliances (with or without full-fixed appliance treatment) are reported. Timing of intervention was strictly planned according to the MPM method, and skeletal effects have been recorded up to 21 months of follow-up. In all the cases, noteworthy skeletal effects have been achieved in terms of mandibular elongation, with relevant occlusal and aesthetic outcomes. It has also been showed that results are stable or slightly improved after functional treatment. These results would be achieved irrespective of the appliance used and support the use of the MPM method in everyday clinical practice.

Assessment of Skeletal Age Using Hand-Wrist Radiographs following Bjork System

The knowledge of the skeletal maturation and the stage of the growth of the patients seeking orthodontic treatment are of great value in planning efficient orthodontic therapy. However, different craniofacial structures of patient show variation in growth potential. The routine use of hand-wrist radiograph for growth prediction exposes the patient to extra radiation. Cervical vertebrae in the lateral cephalograph have been recommended as an alternative method. The pubertal growth spurt is a vital period in the orthodontic treatment and should be kept in mind when planning orthodontic treatment in growing children. One of the main objectives of taking hand and wrist radiograph is to determine the amount of growth and get used of it in patients with skeletal discrepancy during adolescence. Further, this will help in the selection of the appliances required, the course of the treatment and the retention after active orthodontic therapy.