Maturation of the Middle Phalanx of the Third Finger: A Comparative Study between Right and Left Hand

Duration of stages of the Middle Phalanx Maturation method in a contemporary population: A 6-year longitudinal analysis

OBJECTIVE

To determine the duration and age at the beginning of each stage corresponding to the circumpubertal period in the Middle Phalanx Maturation method (MPM) and to assess the differences between males and females.

MATERIALS AND METHODS

Sets of X-rays of the middle phalanx of the third finger taken at 6-month intervals were analysed for 246 skeletal Class I subjects (102 females and 144 males) between 9 and 15 years of age. After staging, the duration of each stage was derived from chronological ages, and the difference between males and females for both duration and age at the beginning of each stage was investigated.

RESULTS

The median duration for MPS2 and MPS3 was 1 year for both sexes, while MPS4 showed a median duration of 1 year in females and 9 months in males, with no significant differences between the sexes. Mean age at the beginning of MPS2 was 10y11m for females and 11y11m for males; for MPS3, it was 11y8m for females and 13y1m for males; for MPS4, it was 12y9m for females and 13y11m for males; for MPS5, it was 13y4m for females and 14y3m for males. The differences between the sexes were statistically significant for all the stages (P < .001).

CONCLUSIONS

This study confirms, with relevant sample size, the median duration of 1 year for each MPM stage from MPS2 to MPS4. Despite the distinctive interindividual variability, the interquartile range is 6 months or less for all but one interval, confirming the soundness of the results.

Bone Age Evaluated With Conventional Ultrasound: The Inter-Side Difference

OBJECTIVE

To confirm the inter-side difference of bone age evaluated with conventional ultrasound.

METHODS

In this prospective study, patients aged between 3 and 15 years with referral for bone age evaluation from the pediatric outpatient and inpatient department in our general medical institute were enrolled from March to October 2021. Bone ages from left and right side were evaluated with ultrasound using a summed ossification ratio of radius, ulna, and femur in all patients. For comparison, radiographic bone ages were assessed with X-ray films of the left hand and wrist.

RESULTS

A total of 192 patients were enrolled into the study, including 95 boys (10.5 years [3.2-14.6 years]) and 97 girls (8.7 years [3.7-15.4 years]). In the girls, the ossification ratio of the right radius was greater than the left (P = .030) and the ultrasonic bone age from the right side was more advanced than the left (P = .007). The differences of the left and right ultrasonic bone age were -0.66 to 0.61 years in the boys and -0.89 to 0.67 years in the girls. The differences of right ultrasonic bone age and radiographic bone age were -0.77 to 1.01 years in the boys and -1.12 to 1.14 years in the girls. The differences of left ultrasonic bone age and radiographic bone age were -0.73 to 0.91 years in the boys and -1.16 to 0.90 years in the girls.

CONCLUSIONS

Clinically important difference can be obtained from the left and right side when assessed bone age with the ossification ratio of bones by ultrasound, especially in girls. Both sides should be evaluated in clinical work.

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.

Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient

INTRODUCTION

Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry.

OBJECTIVE

The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME.

METHODS

This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient.

RESULTS

NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area.

CONCLUSIONS

NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.

Gait and posture analysis in patients with maxillary transverse discrepancy, before and after RPE

AIM

The purpose of this study was to evaluate the effects of the rapid palatal expansion (RPE) on posture and gait analysis in subjects with maxillary transverse discrepancies.

MATERIAL AND METHODS

Forty-one patients between 6 and 12 years were divided into 3 groups: 10 control subjects (Cs), 16 patients with unilateral posterior crossbite (CbMono), 15 patients with maxillary transverse discrepancy and no crossbite (Nocb). Every subject underwent gait analysis and posturographic examination in order to evaluate the presence of balance alterations before (T0) and after (T4) RPE application. The examinations were performed through a six-cameras stereophotogrammetric system (60-120Hz, BTS S.p.A.) synchronized with two force plates (FP4060, Bertec Corp.). Romberg test was performed on a force plate, and the statokinesiogram and joint kinematics were evaluated. One-way Anova was performed among the variables after evidence of normal distribution (Levene's test for equality of variances) and Kruskal-Wallis test (P<0.05), in order to compare the three groups of subjects. While paired t-test was performed, or Kruskal-Wallis test, instead when comparing pre- and post-RPE application within the same group of subjects (P<0.05). Tamane T2 or Bonferroni correction was applied where needed.

RESULTS

The posturographic analysis reveal significant differences across the 3 population: 95% power frequency in medio-lateral and antero-posterior direction in T0, median frequency in medio-lateral direction in T0, mean power frequency in medio-lateral direction in T0. Significant differences were also registered in the three-dimensional joints kinematics variables, mainly between Cs and Cbmono in T0 and T4 and between Cbmono and Nocb in T4.

CONCLUSIONS

A detectable correlation between dental occlusion and body posture is shown in this study that confirms another benefit of the RPE. This was mainly revealed in the dynamic posture where modifications at the mandibular level affect the whole body.