BRITISH BIOMEDICAL BULLETIN

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Hussain Chalkoo 1, Farooq Ahmad Naikoo 1 and Mirzada Bilal Ahmad* 2 1 Department of Oral Medicine and Radiology Government Dental College Srinagar, India 2 Dental surgeon (MDS Oral Medicine and

2016 Keywords: Chronological age, Dental age, Hand-wrist, Skeletal age., Nolla s Method, Skeltal maturity indicators.

1 Journal Home Page BRITISH BIOMEDICAL BULLETIN Original Article Dental Age Assessment Using Nolla s Method and Skeletal Age Assessment by Hand Wrist Radiograph Among Kashmiri Children- A Comparative Study Altaf Hussain Chalkoo 1, Farooq Ahmad Naikoo 1 and Mirzada Bilal Ahmad* 2 1 Department of Oral Medicine and Radiology Government Dental College Srinagar, India 2 Dental surgeon (MDS Oral Medicine and Radiology Kashmir health services), India A R T I C L E I N F O A B S T R A C T Received Dec. 20 Received in revised form 28 Dec. 20 Accepted 16 Feb Keywords: Chronological age, Dental age, Hand-wrist, Skeletal age., Nolla s Method, Skeltal maturity indicators. Corresponding author: Dental surgeon (MDS Oral Medicine and Radiology Kashmir health services), India address: drmirzada.bilal@gmail.com Aims and objectives: The Main Purpose of the study was to assess the skeletal age using skeletal maturity indicator and dental age using Nolla s method and their correlation with each other. Materials and Methods: The study was conducted on 120 healthy children in the age group of 8 13 years, comprising equal number of males and females. The children were radio graphed for hand-wrist of the right & left hand and intraoral periapical X-ray for right permanent maxillary and mandibular canine. Results: A high correlation was observed between skeletal age and dental age by Nolla s calcification stages for both male and female children of growing age (p value >0.790, 0.64). But Chronological age showed inconsistent correlation with dental and skeletal ages. It was concluded that canine calcification stages given by Nolla s can also be used for assessing skeletal maturity. Statistical analysis: The quantitative data was analyzed by using one way analysis of variance technique. For comparison of three methods least significant difference post hoc test was used. Conclusion: Nolla s method of age estimation can be used as a substitute method for skeletal age determination in age group of 8-13 years. Introduction Age estimation in children is an important question in forensic medicine, pediatric endocrinology, and in orthodontic treatment 1. The developmental status of a child can be assessed from various parameters such as height, weight, chronological age, secondary sexual characteristics, skeletal age, and dental age 2. Generally chronologic age is considered poor indicator for estimating the degree of skeletal maturity due to significant individual growth variations among children of the same or calendar age group 3. The hand wrist radiograph has been one of the most popular biological indicator used to assess skeletal development, however

2 routine use of hand wrist radiograph has been recently questioned due to ethical issues. Additionally radiation exposure is the primary concern 4. Tooth formation is suitable for estimation of age because it is continuous, progressive process that can be followed radiographically from the crypt stage to the closure of root apex. Also tooth development is uniform and is less influenced by external factors such as malnutrition, diseases and mental stress. If strong association exists between skeletal maturity and dental calcification stages the stages of dental calcification can be used as a first level diagnostic tool to estimate the timing of the pubertal growth spurt. Materials and methods The present study was conducted on randomly selected healthy children of 120, who visited to our Department Oral Medicine and Radiology. Among the subjects 60 were males (50%) & 60 were females (50%). The age ranged from 9-13 years in case of males & 8-12 years in case of females (TABLE 1). All the subjects were divided into groups. Informal Consent was taken from all the patients and their parents for diagnostic radiographic examination. Further ethical clearance was sought from the institutional ethical committee before conducting the study. Inclusion criteria Subjects who were moderately built and were of growing age with no deformities in oro-facial region. Subjects who will consent for radiologic examination. Exclusion criteria History of trauma or surgery in the dento-facial region. The subjects with muscular dystrophy, congenital abnormalities affecting growth and development, or traumatic injuries of hand wrist and jaws. Hand-wrist radiograph was taken by placing the left hand-wrist on the cassette of 8 inches with fingers slightly separated. X-ray tube and target film distance was kept at 90 cm. The parameters used were 7 ma current, 70 kvp of power and exposure time of 0.5s. Intraoral periapical radiograph of right maxillary & mandibular canine was taken using bisecting angle technique with Kodak film of size 31 41mm. The film was exposed to 70 kvp of voltage and 7mA current with exposure time of 0.6sec with dental X ray unit (ERGON-XHF Italy). Radiographs of each patient were taken on same day. A brief history of each patient including name, age, sex, date of birth, residence, name of school were taken followed by radiographic examination. Results The data was analyzed by using one way analysis of variance technique. For comparison of three methods least significant difference post hoc test was used. The mean difference was considered to be statistically significant at p The norms for maturation of canines for girls and boys respectively are shown at table 2 and 3. Comparison of chronologic age with skeletal age assessed according to Radiographic Atlas of Greulich and Pyle and age according to calcification stages of maxillary and mandibular right canine are shown in Table 4. Comparison between skeletal age and age by Nolla s method of maxillary and mandibular right canine was statistically obtained as shown in table 5. Discussion The study of morphological pattern of teeth on dental X ray of children is more reliable than most other methods and is

3 commonly used to determine age in humans. The identification of the skeletal maturation level provides very useful means of identifying specific points along the progressive path of adolescent growth. In this study there was no significant difference between chronological age & skeletal age assessed by Radiographic Atlas of Greulich and Pyle in case of females. However in case of males there was statistically significant difference (<0.05) between chronologic age and skeletal age except in the age group of Also there was no significant difference between chronological age and age by canine calcification stages of right maxillary and mandibular canine in case of females. The mean difference between chronologic age and age by right mandibular and maxillary canine in case of males was found to be statistically significant (p<0.05). Luterstein 5, Chertkow 6, Chertkow and Fatti 7, Sierra 8 and Coutinho et al 9 Ali Bagherpour have suggested a high co relationship between canine calcification and skeletal maturity indicators. The present study also found a similar trend with p value of 0.62, 0.79 for maxillary and mandibular canines respectively for females and p of 0.69 and 0.64 respectively for maxillary and mandibular canine for males. In our study females were ahead in skeletal maturation than males in all the age groups. This is supported by Hagg and Taranger 11, Koshy and Tandon 12, Prabhakar et al 13. The technique has the advantages of being simple, using low patient radiation dose, and exhibiting high degree of clarity of the radiographs. The equipment required is available in most dental centers. No significant differences were found between dental age, skeletal age, and chronological age in this sample. Therefore, chronological age can be regarded as an acceptable indicator of the skeletal maturity and dental development. 14 A skeletal age could be assessed by time-tested hand-wrist radiographs or by canine calcification stages on periapical radiographs; the latter is easier and cheaper to procure than hand-wrist X rays. Assessment of the maturation is of utmost importance in certain orthodontic protocols like, for myofunctional therapy, before starting with rapid maxillary expansion, and for timing of ortho-surgical procedures (surgery for mandibular setback should be carried out only after mandibular growth has completed).however the study was carried on small sample on to further validate the result of this study, it should be carried out on larger sample size and varied age group. Conclusion It can be concluded from this study that skeletal age closely correlates with dental age by Nolla s canine calcification stages of maxilla and mandible skeletal maturation is ahead in females than males. Besides the technique is cost efficient as compared to other methods of age estimation and is readily available across all dental clinics. Acknowledgement We are highly oblidged to Mr. Ashraf and Mr Fayaz Dental X-ray Technicians who helped a lot during the conduct of study. We are extremely grateful to our patients without whom this study could not have been possible. References 1. Roberto Cameriere, Luigi Ferrante, Mariano Cingolani. Int J Legal Med (2006)120: Bala M, Pathak A, Jain RL. Assessment of skeletal age using MP3 and hand wrist radiograph and its correlation with dental Age and chronological ages in children. J Indian Soc Pedod Prev Dent 20; 28:95-9.

4 3. Al-Hadlaq et al Saudi dental journal, volume 19, no 1, January April Eddie Hsiang- Hua Lai, Jen-peiLiu, Jenny, Zwei-Chieng Chang, Shih-jawTsai, Chungchen Jane Yao, Mu-Hsiung Chen, Yi-Jan Chen, Chun Pin Lin.Radiographic assessment of skeletal maturation stages for orthodontic patients: Hand wrist bone or Cervical vertebrae. J Formus Med Assoc 2008 Vol 7 No Luterstein. A cross sectional study in dental development and skeletal age. J Am Dent Assoc 1961; 62: Chertkow, S. Tooth mineralization as an indicator of the pubertal growth spurt. Am J Orthod : Chertkow, S. and P. Fatti. The relationship between tooth mineralization and early evidence of the ulnar sesamoid. Angle Orthod : Sierra AM. Assessment of dental and skeletal maturity: A new approach. Angle Orthod 1987; 57: Coutinho, S., P. H. Buschang, and F. Miranda. Relationship between mandibular canine calcification stages and skeletal maturity. Am J Orthod : Hand skeletal maturity and its correlation with mandibular dental development. J Clin Exp Dent Jul; 6(3): e275 e Hagg U, Taranger J. Maturation indicators and the pubertal growth spurt. Am J Orthod 1982; 82: Koshy S, Tandon S. Dental age assessment: The applicability of Demirjian s method in South Indian children. Forensic Sci Int 1998; 94: Prabhakar AR, Panda AK, Raju OS. Applicability of Demirjian s method of age assessment in children of Davangere. J Indian Soc Pedod Prev Dent 2002; 20: Al-Hadlaq, Adel, Hashim, Hayder, Al- Dosari, Mohammed, Al-Hamad, Ali. interrelationship between dental maturity, skeletal maturity and chronological age in saudi male children; Egyptian Dental Journal: 2008; 54(1). S. no Table 1: Age gender and number wise distribution of subjects Group 1 (Male subjects) Group 2 (Female subjects) Age(years) No. of subjects Age(years) No. of subjects Total 60 60

5 Table 2: Norms for maturation of permanent teeth for girls Age(years) Mandibular teeth (growth stage) Mandibular right canine Maxillary teeth (growth stage) Maxillary right canine Table 3: Norms for maturation of permanent teeth for boys Age(years) Mandibular teeth (growth stage) Mandibular right canine Maxillary teeth (growth stage) Maxillary right canine

6 Table 4: Comparison of chronologic age with skeletal age and dental age by Nolla s method Age group(in years) Chronologic age Skeletal age Age by right maxillary canine Age by right mandibular canine p-value Males a b bc bd 0.049* a b bc bd 0.025* a ac bc ac a b bc bd 0.002* Females *Significant at 5% (p<0.05) level of significance. Values with different superscript within the rows differ significantly. Table 5: Comparison of Skeletal age with Nolla s method Females Males mean±sd p-value mean±sd p-value Skeletal age.061± ±1.160 Age by maxillary right Canine 9.950± ± Age by mandibular right Canine.00± ±

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