ASSESSMENT OF

PHYSICAL GROWTH

Sai Rohith
I MDS
 Contents

• Biological assessment
• Anatomic assessment
• Physiologic assessment
• Histologic assessment
• Radiaological assessment (SMI)
• Photography
• Radiography (Superimposition)
 Introduction
As with all practitioners in health arts, an
Orthodontists primary objective is to describe and
diagnose malocclusion.

The diagnosis can dictate the treatment objectives

and mechanotherapy for a particular patient.

The ability to predict patient’s facial growth early

in life would enable the clinician to establish a correct
diagnosis and identify the appropriate treatment.
 METHODS OF ASSESSMENT
 Direct measurements:
 Osteometry
 Vital staining
 Implant markers
 Histologic method
 Indirect measurements:
 Photographs
 Models
 Radiographs
 Indirect measurments in combination:
 X-ray + Implants
 X-ray + Metaphyseal bands
 Autoradiograhs
 3D Facial measurements:
 Stereophotogrammetry
 Sassomis Physioprint
 Contour Photography
 MEASUREMENT APPROACHES
 Craniometry
 Anthropometry
 Animal Experiments : 1.Vital Staining
2.Histology
3.Split line Technique
4.Implants
 Radioactive Tracers
 Auto Radiographs
 Cephalometric Roentgenography
 Photocephalometry
 Computerised Cephalometry
 Contour photography

 Silhouette method

 Study models

 Facial masks
Craniometry :

• Measurement of skulls found among human skeletal

remains with which the science of physical
anthropology began.
• Advantage : Precise measurements

can be made on dry skulls.

• Disadvantage : Can only be cross sectional study. Same
individual can be measured at only one point in time.
Anthropometry:
• Measure skeletal dimensions on living individuals.

• Camphor, Morton, Broca.

• Longitudinal data

• John Hunter - first to apply anthropometry using

mandible.
• Advantage : Can be made on either a dried skull or a
living individual.
• Disadvantages : Results would be different because
of the soft tissue thickness overlying both landmarks
on dried skull or a living individual.
Animal experiments:
 Vital staining :
• Introduced by John Hunter.
• Injection of dyes into the animal.
• Dyes remain in the bones and the teeth, and can be
detected later after sacrificing the animal.
• Alizarin was found by Belchier (1936) , the active
agent is still used for vital staining.
• Reacts strongly with calcium at sites where bone
calcification is occurring.
• However not possible in the humans.
Histology:
• Direct measurements - Optical superimposition.
• Indirect measurement - Micro photographs.
• Site , Direction and Pattern of bone growth.
• Osteoclasts – Bone resorption
• Osteoblasts – Bone deposition
Split line technique:
 Benninghoff (1925) - Superficial trabecular bone
pattern.
 Bones are decalcified , penetrated with needle.
 Indian ink diffuses to fix fine trabecular bone pattern.
Implants:
• Duhamel (1742) – Silver stylets.
• Hunter (1770) – Lead shots in Tibia of pigs.
• Grans Robinson, Sarnath - Silver amalgam
implants.
• Bjork - Tantalum pins & wires are used and serial x-
rays taken.
• Au, Ag, Amalgam, SS, Vitalium, Tantalum – (pins,
clips, pegs, screws, plates, wires)
• 1st dental study – Humphery (1864) – Pig mandible
wire loops around Ramus.
- Resorption in anterior border
- Deposition in posterior border
• Indirect studies – Using x-rays.
• Growth pattern of the jaws.
• Advantages: No interference with diet, Non invasive.
New bone formation & resorption can be measured.
• Disadvantages: only Sum total is demonstrated .
Intervening changes not revealed.
Radioactive tracers:

• Radio phosphorous, Radio Sodium, Radio Calcium,

Strontium, Radio Fluoride, Radio Chloride, Iodine,
Carbon, Plutonium, Americanum, Gallium.

• Incorporated into tissue as a sort of vital stain.

• IV injection of isotope.

• Detected by weak radiation it emits.

Autoradiographs:

• Placing tissue of an animal injected with radioactive

substance close to a photographic emulsion.
• Exposed to radiation in dark.
• Location of radiation indicates where growth is
occurring.
Roentgenographs:
• Superimposition of successive x-rays.

• Krogman & Sassouni(1957) - measurments from

bone & soft tissue landmarks on radiographic images.
• 1922 – Paccini - Teleradiographic image.

• 1912 – Tandler – used x-ray film in Anthropometry.

• Serial hand wrist x-rays to detect growth changes.

Cephalometric roeotgenography:
• 1931- Broadbent & Hoffrath

• Krogman, Savara, Meridth, Popovitch, Bjork &

Woodside - Longitudinal studies

• Stable anatomic base for superimposing.

• Rate ,amount & relative direction of bone growth.

• Distinguish horizontal & vertical growth patterns.

• Advantages: Direct measurement of bony skeletal

dimensions, soft tissue covering.
• Disadvantage - 2D representation of a 3D structure

• Does not reveal sites or mode of growth.

• PA Ceph projection - Moorees, Moyers Chierici &

Faber.
• For Clinical evaluation of Treatment planning.
Photo cephalometry:

• Superimposition of co-ordinated head films with

photographs.

• Photo images on skin of patient - accurately

superimposed on corresponding markers in a
cephalogram.

• Advantagee: Soft tissues can be seen.

Computerised cephalometrics:

• 1970 in U.S.A

• Computer is fed with all data regarding norms &

standards of all analysis.
• Less time consuming.

• Increased reliability by double digitization.

• Easy storage of information.

 Contour photography:

• Cobb (1972), Lovesy

(1974), Robertson (1976)
• Light sectioning technique.
• Equal width grids projected
on face producing contour
pattern.
• Convex telecentric lenses
are placed in paths of
projected beams & of
recording camera.
Silhouette’s method:
• Light projected on patient from a predetermined
distance.
• Shadow on a smooth , fixed screen.
• Lontitudinal study.
Study models:
• Duplication with plaster, thiokol, hydrocolloid,
stone.
• Permanent records, longtitudinal studies possible.
• Model analysis done & growth changes measured.

Facial masks:
• Impression of face taken at regular intervals.
• Standard measurements – Zygoma-zygoma,
Gonion-Gonion.
 Skeletal Indicators Of Maturity
Types:
1. Frontal sinus
2. Radius ossification
3. Sesamoid bone
4. Mp3
5. Cervical vertebrae maturity index
6. IGF-I
7. Lower canine calcification
8. Lower 3rd molar calcification
9. Mid palatal suture
10.Hand-wrist radiographs - Fishman index.
Radiographic method (non-invasive):
• IOPA
• Lateral cephalogram
• Hand wrist radiograph
• Orthopantomogram
• Occlusal view – Maxilla

Non radiographic method (invasive)

• Blood spot insulin - like growth factor (IGF-I)
testing.
 RECENT ADVANCES
• NMR spectroscopy

• Computer aided tomography

• Computer laser scan systems

• Laser

• Digigraph

• Finite element analysis

• Antegonial notch for growth prediction

Nmr spectroscopy:
 New method of obtaining 3D cross sectional pictures
of thin slices of human head - using resonance of
hydrogen nuclei.
 Radio tracers of P, Na, Mg - growth studies on non
invasive plane.
Computer aided tomography:
• Image of the subject is processed by a computer ,

assessing cranio facial growth and numerical

investigations regarding growth.

• CAT or CT

• CBCT
Computer laser scan systems:

 Regular cephalostat for taking

cephalograms with specialised
coated films.
 He & Ne Lasers - used to
activate.
 Delineate hard & soft tissues.
 Laser :
• Rapid 3D for facial
morphology study
• Scan face in 6 seconds,
gives image in 4 min.
• Advantages: Contact free,
data memory, rapidity
• Disadvantage: Costly
Digigraph:
 Sonic digitizing probe.

 Pressing button – sound elicited & land mark

recorded by microphone array.

 Dolphin imaging systems (California, USA).

• Ceph measurements recorded by
microphone array in X-Y-Z co-ordinate.
• Calculating time between sonic wave
emission & detection.
Finite element analysis:
• In 1985, Melvin moss ,introduced a method to analyse
a cephalogram.
• Generate a mathematical matrix of transformation
related to both size & shape
• Finite element for analysis of serial, lateral
cephalometric radiographs
• Useful tool for morphometric analysis in craniofacial
biology
 By reducing the structure to a group of appropriately
connected small elements of known mechanical
behaviour, the response of entire structure to loading
can be estimated.
Antegonial notch for growth prediction:
• Singer , Mamandras & Hunter.

• Presence of prominent antegonial notch-arrested growth

of mandibular condyles.

Apposition Resorption
• Forward rotating - Symphysis Angle
• Backward rotating - Angle Symphysis
• So deep antegonial notch – Backward rotating mandible.
 CONCLUSION
• Dynamics of growth is a complex process .

• The Orthodontist, if he is to evaluate properly the

role he plays in correcting malocclusion ,must have
the opportunity to examine the conditions over which
he has the least control, namely growth &
development during correction of malocclusion.
• With the use of the recent techniques available
accurate information about growth can be obtained.
 References
1. Profitt WR, Fields HW, Sarver DM.
Contemporary Orthodontics: Mosby – Elsevier
publications, Fourth edition, 2007.
2. Graber LW , Vanarsdall RL, Vig KWL.
Orthodontics: Current Principles and Techniques.
3. Thomas Rakosi, Irmtrud Jonas, Thomas
M.Graber. An atlas and manual of cephalometric
radiography.
4. Inderbir Singh.Textbook of human histology:
5. Stuart C. White, Michael J. Pharoah.The Dental
Radiology.
6. W.D.Leivesley (1983) The Reliability of Contour
Photography for Facial Measurements, British Journal
of Orthodontics, 10:1, 34-37.
7. Bernard G. Sarnath – Growth pattern of mandible – AJO
DO 1986 pg:221-233.
8. Leivesly – Reliability of Contour Photography for facial
measurements- BJO 1983, pg:34-37.
9. Nute & Moss – 3D facial growth studied by optical
scanning – JO 2000 vol 27,pg:31-38.
10. Kolodziej,southard – Evaluation of Ante gonial notch
depth for growth prediction – AJO DO
2002,121,pg:357-363.