Department of Oral Medicine and Radiology

DISSERTATION – SYNOPSIS

DR. SHABIL MOHAMED MUSTAFA

POST GRADUATE STUDENT

DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY

K.V.G. DENTAL COLLEGE & HOSPITAL

KURUNJIBAGH, SULLIA – 574327

DAKSHINA KANNADA

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / : / DR. SHABIL MOHAMED MUSTAFA
POST GRADUATE STUDENT,
DEPT OF ORAL MEDICINE AND RADIOLOGY
K.V.G DENTAL COLLEGE & HOSPITAL,
KURUNJIBAGH, SULLIA – 574 327
2. /

NAME OF THE INSTITUTION

/ : / K.V.G. DENTAL COLLEGE & HOSPITAL,
KURUNJIBAGH, SULLIA – 574 327.
3. / COURSE OF THE STUDY AND SUBJECT / : / MASTERS IN ORAL MEDICINE AND RADIOLOGY
4. / DATE OF ADMISSION TO COURSE / : / 30TH MAY 2O11
5. / TITLE OF THE TOPIC / : / EVALUATION OF DENTAL MATURITY AND SKELETAL MATURITY USING DIGITAL PANORAMIC RADIOGRAPH AND DIGITAL CEPHALOGRAM.
6. / BRIEF RESUME OF THE INTENDED STUDY
6.1 NEED FOR THE STUDY
Radiographs are effective tools in assessing the stages of bone maturation in dentistry. Assessment of stage of maturation is an important parameter in the treatment planning in orthodontics, pedodontics and for orthognathic surgery. Maturational status whether the pubertal growth spurt of the patient has been reached or completed will considerably influence treatment planning in orthodontics.1 Moreover it helps in interdisciplinary health teams to assess the patients with various types of endocrine and developmental disorders. Its utility is well established for syndrome identification.
The degree of skeletal development is a reflection of degree of physiological maturation of a subject .2 Skeletal age is as important as chronological age in evaluating an adolescent’s physical development. Certain skeletal developmental stage of the hand wrist and lateral cephalogram helps in evaluating skeletal age.
Cervical vertebrae analysis can be used to evaluate skeletal maturity. It has the advantages of simplicity, objectivity and repeatability since cephalograms are used routinely. Vertebral analysis is as valid as the hand wrist radiographs. It has the advantage of reducing the radiation exposure of growing subject.3
Dental maturity can be determined by stages of tooth eruption or stages of tooth formation. Tooth formation is proposed as more reliable criterion for determining dental maturation .4 Dental developmental stages can be easily recognized using panoramic radiographs. Periapical or panoramic radiographs are commonly used in dental practice.
If a correlation can be found out between tooth calcification stages, cervical vertebral maturation and hand wrist maturity, panoramic imaging can be used as the primary imaging modality for assessing maturity.
6.2  REVIEW OF THE LITERATURE
A study was conducted in 302 Chinese individuals (134 boys and 168 girls) to find out correlation between cervical vertebral maturity and dental maturity.5 Digital panoramic radiographs and lateral skull cephalograms were taken. Results indicate tooth calcification stages significantly correlated with cervical vertebral maturation stages. Development of mandibular second molar in female and mandibular canine in male had the strongest correlation.
Another study was conducted among Thai individuals ;139 male
subjects and 222 female subjects to evaluate relationships between dental calcification
stages and skeletal maturity indicators .1 According to this study there was interrelationship
between dental and skeletal development.
A study was conducted among 500 Turkish subjects to investigate relationship between stages of calcification of various teeth and skeletal maturity stages .2 The study indicated that in children of Turkish origin the completion of root formation of canine and premolar may be used as maturity indicators of pubertal growth spurt.
Relationship between mandibular canine calcification stages and skeletal maturity was evaluated among 200 boys and 215 girls using hand wrist radiographs and panoramic radiographs .6 The study was concluded as canine calcification could serve as a useful tool evaluating children skeletal maturation.
Another study was conducted to compare skeletal maturation as measured by hand wrist bone analysis and by cervical vertebral analysis of 30 patients (14males and 16 females) .3 Hand wrist bone analysis was evaluated by Bjork index, where as the cervical vertebrae analysis was assessed by cervical vertebral maturation stage method. Study was concluded as vertebral analysis on a lateral cephalogram is as valid as the hand wrist bone analysis with the advantage of reducing the radiation exposure on the growing subject.
6.3 AIM & OBJECTIVES OF THE STUDY
AIM
§  To assess the usefulness of panoramic radiograph as a effective tool for estimation of growth.
§  Evaluation of different stages of dental maturity using digital panoramic radiograph.
§  Comparison of different stages of dental maturity with skeletal. maturity as determined by cervical vertebrae and hand wrist region.
.
OBJECTIVES
1.  To compare the dental maturity assessed by calcification of mandibular canine, first and second premolar, second molars using digital panoramic radiographs and skeletal maturity assessed by cervical vertebral maturation stages using lateral cephalograms and hand wrist radiographs.
2.  To ascertain the importance of tooth calcification stages as a maturity indicator assessed by the digital panoramic radiograph.
MATERIALS & METHODS :
7.1 SOURCE OF THE DATA:
60 children of the age group 8-16 years will be included in the study. Subjects will be selected from patients coming to the KVG Dental College and Hospital, Sullia who seek interventional treatment. Informed consent will be obtained from the subjects and parents.
7.2 METHODS OF COLLECTION OF DATA:
Dental maturity assessment
Dental maturity will be assessed according to the calcification stages of individual teeth
given by Demirijan etal .7
The developmental stages of the left mandibular permanent canines, first and second
premolars, and second molars will be rated on an 8-stage scale from A to H:
A.  Cusp tips are calcified but have not yet fused.
B.  Calcified cusps are united so a outlined occlusal surface is well defined.
C.  Enamel formation is complete at the occlusal surface, and dentin formation has commenced. The pulp chamber is curved, and no pulp horn is visible.
D.  Crown formation is complete to the level of the cementoenamel junction. Root formation has commenced. The pulp horns are beginning to differentiate, but the walls of the pulp chamber remain curved.
E.  The root length remains shorter than the crown height. The walls of the pulp chamber are straight, and the pulp horns are more differentiated than in the stage. In molars radicular bifurcation has to calcify.
F.  The walls of the pulp chamber form an isosceles triangle, and the root length is equal to or greater than the crown height. In molars, the bifurcation has developed sufficiently to give the roots a distinct form.
G.  The walls of the root canal are parallel, but the apical end is partially open. In molars, only the distal root is rated.
H.  The root apex is completely closed (distal root in molars). The periodontal membrane surrounding the root and apex is uniform in width throughout.
Skeletal maturity assessment
Skeletal maturity will be evaluated by the Cervical vertebra maturation method by
Baccetti T. 8
According to the CVM method, the morphology of the bodies of the second (C2), third
(C3), and fourth (C4) cervical vertebrae are rated on a 6-level scale from cervical stage
CS 1 to CS6
·  CS1: The lower borders of all 3 vertebrae (C2-C4) are flat. The bodies of both C3 and C4 are trapezoid in shape.
·  CS2: A concavity is present at the lower border of C2.The bodies of both C3 and C4 are still trapezoid in shape.
·  CS3: Concavities at the lower borders of both C2 and C3 are present. The bodies of C3 and C4 may be either trapezoid or rectangular-horizontal in shape. The growth peak occurs the year after this stage.
·  CS4: Concavities at the lower borders of C2, C3, and C4 are present. The bodies of both C3 and C4 are rectangular-horizontal.
·  CS5: At least 1 of the bodies of C3 and C4 is square.If not square, the body of the other cervical vertebra is rectangular-horizontal.
·  CS6: At least 1 of the bodies of C3 and C4 is rectangular-vertical in shape.
Skeletal maturity evaluated by hand wrist radiographs
Each hand-wrist radiograph will be assigned a skeletal age by comparing it with the
standard plates designed by Greulich and Pyle 10 ( Radiographic Atlas of Skeletal
Development of the Hand and Wrist ).
According to the method described by Fishman and modified by Krailassiri S,
Anuwongnukroh N, Dechkunakorn S , the following selected ossification events will be
determined to evaluate the stage of skeletal maturation.9
·  MP3: the middle phalanx of the third finger, the epiphysis equals its diaphysis.
·  S stage: the first mineralization of the ulnar sesamoid bone.
·  MP3cap: the middle phalanx of the third finger, the epiphysis caps its diaphysis.
·  DP3u: the distal phalanx of the third finger, complete epiphyseal union.
·  MP3u: the middle phalanx of the third finger, complete epiphyseal union.
INCLUSION CRITERIA:
·  Subjects falling in the age group of 8-16.
·  The subjects have normal dentition.
·  Subjects and parents who gives consent for the study.
EXCLUSION CRITERIA:
·  Image deformity affecting the estimation of tooth development and skeletal maturity stages.
·  Hypodontia .
·  Gross pathology .
·  Missing mandibular permanent teeth .
·  Subjects who have history of medical or surgical disease that could affect the presence and development of mandibular permanent teeth.
·  The subjects who had undergone orthodontic treatment .
·  The subjects who had previous history of trauma or injury to the face & hand and
wrist regions.
MATERIALS REQUIRED:
Digital panoramic radiograph machine with skull unit.
EVALUATION
All digital radiographs will be viewed on the same computer. Stages of tooth formation, cervical vertebra development, and hand wrist radiographs of each subject will be assessed separately by 2 trained observers with neither the knowledge of neither age nor gender of the patient.
STATISTICAL ANALYSIS
The results will be statistically evaluated using Spearman rank-order correlation coefficient and student unpaired‘t’ test.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED IN PATIENTS OR OTHER HUMANS
Yes. Patient will be exposed to panoramic radiograph, lateral cephalogram, and hand wrist radiograph. The informed consent will be taken from patients and parents
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION
The ethical clearance certificate from our institution has to be obtained.
8. / LIST OF REFERENCES :
1.  Krailassiri S, Anuwongnukroh N, Dechkunakorn S. Relationship between dental calcification stages and skeletal maturity indicators in Thai individuals. Angle Orthod 2002;72:155-66.
2.  Uysal T, Sari Z, Ramoglu SI, Basciftci FA. Relationships between dental and skeletal maturity in Turkish subjects. AngleOrthod 2004;74:657-64.
3.  Gandini P, Mancini M, Andreani F. A comparison of hand-wrist bone and cervical vertebral analyses in measuring skeletal maturation. Angle Orthod 2006;76:984-9.
4.  Demirjian A, Buschang H, Tanguy R, Patterson DK. Interrelationships among measures of somatic, skeletal, dental, and sexual maturity. Am J Orthod 1985;88:433-8.
5.  Jianwei Chen, Haikun Hu, Jing Guo, Zeping Liu, Renkai Liu, Fan Li, and Shujuan Zou, Chengdu. Correlation between dental maturity and cervical vertebral maturity
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:777-783
6.  Coutinho S, Buschang PH, Miranda F. Between mandibular canine calcification stages and skeletal maturity. Am J Orthod Dentofac Orthop 1993;104:262-8.
7.  Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973;45:211-27
8.  Baccetti T, Franchi L, McNamara JA Jr. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod 2002;72:316-23.
9.  Fishman LS. Radiographic evaluation of skeletal maturation. AngleOrthod. 1982;52:88–112
10.  Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development
of the Hand and Wrist. 2nd ed. Stanford, Calif: Stanford University Press; 1959.
9. / SIGNATURE OF CANDIDATE
10. /

REMARKS OF THE GUIDE

11. / NAME AND DESIGNATION OF
11.1 GUIDE / DR. RAJ A.C, M.D.S
PROFESSOR
DEPARTMENT OF ORAL MEDICINE & RADIOLOGY,
K.V.G DENTAL COLLEGE AND HOSPITAL, KURUNJIBAGH, SULLIA, D.K -574327
11.2 SIGNATURE
11.3 HEAD OF THE DEPARTMENT / DR. JAYAPRASAD ANEKAR, M.D.S.
PROFESSOR AND HOD
DEPARTMENT OF ORAL MEDICINE & RADIOLOGY
K.V.G DENTAL COLLEGE AND HOSPITAL, KURUNJIBAGH, SULLIA, D.K -574327
11.4 SIGNATURE
12. /

PRINCIPAL

/ DR. MOKSHA NAYAK, M.D.S.
PRINCIPAL
K.V.G. DENTAL COLLEGE AND HOSPITAL, KURUNJIBAGH, SULLIA.
12.1 REMARK
12.2 SIGNATURE