Skeletal age assessment: a comparison of 3 methods.

INTRODUCTION: The aim of this study was to evaluate the applicability of 3 methods of skeletal age assessment. METHODS: The skeletal assessment methods of Greulich and Pyle (GP), Tanner et al (TW3), and Eklöf and Ringertz (ER) were used to analyze the dorsopalmar hand-wrist radiographs of 360 Brazilian children and adolescents (180 boys, 180 girls; ages, 7-15 years). The standard error of the mean and confidence intervals of the 3 assessment methods as well as the mean chronologic ages of both sexes and the age ranges studied were calculated. RESULTS: Skeletal age means obtained with the GP and TW3 methods were close to chronologic age for both sexes. The ER method tended to overestimate skeletal age for the lower age groups, to correspond for the intermediate age groups, and to underestimate for the higher age groups in both sexes. The confidence interval confirmed that these data did not represent a statistically significant difference between chronologic and assessed skeletal ages; this means there is a high relationship between the studied sample data and the 3 standard methods. Determinate correction factors (regression equation) make each method more useful for the studied population. CONCLUSIONS: Although all methods reliably assessed age, correction factors are recommended for better adaptability to the studied population.

Computed tomography of the TMJ in diagnosis of ankylosis: two case reports.

Ankylosis of the temporomandibular joint is characterized by restriction or limitation of mandibular movement. It presents as a classic symptom a limited range of motion on opening. Radiographically, ankylosis presents features that facilitate the diagnosis. However, its visualization is not clear in most of the cases involving conventional radiographic techniques. With the evolution of radiographic techniques, computed tomography (CT) became an important examination in the diagnosis of the ankylosis of temporomandibular joint. Due to the increasing use of the CT and its importance in the diagnosis of this disease, the aim of this paper is to present and describe tomographic images of ankylosis of this joint by presenting two clinical cases, using several slices as axial, coronal, and three-dimensional reformatted images.

Sensitometric comparisons of Insight and Ektaspeed Plus films: effects of chemical developer depletion.

The aim of this study was to compare the sensitometric properties of Insight and Ektaspeed Plus radiographic films manually and automatically processed using fresh and depleted chemical solutions. Ten sets of each type of film were obtained (1 set = 5 films), 5 sets being manually processed and 5 sets being automatically processed. A total of 100 films (50 Ektaspeed Plus and 50 Insight film) were exposed and developed. The first two sets of each film type were developed in fresh chemicals (one set per each type of processing), on the first day of the experiment. The other sets were processed in the same progressively depleted solutions once a week until the end of experiment, which was completed within 4 weeks. Characteristic curves were constructed to compare the sensitometric properties of the films: contrast, latitude and speed. Processing solution depletion had different effects on manually and automatically developed films, which was confirmed by the changes in the form of the characteristic curves in the third week of the automatic processing and fourth week of the manual processing. Ektaspeed Plus showed 11% reduction in contrast values for manual processing and 53% for automatic processing, while Insight contrast values showed a reduction of 25% and 59%, respectively. Insight film, however, showed lesser loss of speed and lesser increase of latitude than Ektaspeed Plus. In conclusion, chemical depletion in automatic film processing was faster than in manual developing. In depleted chemicals, both types of films had an increase in latitude values and a decrease in speed and contrast. Insight was more resistant than Ektaspeed Plus to decrease in speed and latitude when processed using older chemicals, whereas contrast in Ektaspeed Plus was comparatively more stable.

Task-specific enhancement filters in storage phosphor images from the Vistascan system for detection of proximal caries lesions of known size.

OBJECTIVE: The aim was to compare original 8-bit images from the Vistascan storage phosphor plate system with images enhanced with specific filters for detection of proximal caries lesions and, further, to analyze the mutual sensitivity of the filtered images for different lesion sizes. STUDY DESIGN: One hundred sixty approximal noncavitated surfaces were radiographed using the Vistascan storage phosphor plate system. Original and enhanced (Fine, Caries1, and Caries2 filters) images were assessed by 6 observers who recorded the presence/absence of proximal carious lesions. Microscopy served to detect and measure true lesion size. RESULTS: One hundred one surfaces were sound, and 59 had lesions. The sensitivity of the Fine filter images was significantly higher than the Caries1 and Caries2 filter modalities (P < .005). The original images did not differ significantly from the Caries1 and Caries2 modalities. Both the Fine filter and the original images had a significantly higher specificity than the Caries2 modality (P < .005). The overall accuracies for the Fine filter and the original images were significantly higher than for the Caries2 modality (P < .005). The Fine filter images also had higher accuracy than the Caries1 modality (P < .05). The mutual sensitivity of the filters varied little with lesion size. CONCLUSION: Fine filter may be a promising enhancement tool for images used for detection of shallow carious lesion, because it showed less observer variability. The task-specific enhancement filters, Caries1 and Caries2, were less accurate than the original and Fine filter images and cannot be recommended for detection of the lesion sizes included in this study.

Dental maturity as an indicator of chronological age: radiographic assessment of dental age in a Brazilian population.

OBJECTIVE: The purpose of this investigation was to evaluate the applicability of the methods proposed by Nolla and by Nicodemo and colleagues for assessing dental age and its correlation to chronological age. METHODS: Panoramic radiographs of 360 patients from the city of Fortaleza (CE, Brazil) aged 7-15 years were used to assess the associations between dental and chronological age. Data were submitted to statistical analysis using the BioEstat 2.0 (2000) software. Student-Neuman-Keuls test was performed and Pearson's correlation coefficients were calculated at 5% significance level. RESULTS: When the Nolla method was applied, the mean difference between true and estimated age for males and females was underestimated. The use of the method proposed by Nicodemo and colleagues also resulted in underestimation, although it was more evident in male subjects. The correlation coefficients between chronological age and estimated dental age were high, with mean values ranging between 0.87 and 0.91 for males and between 0.84 and 0.93 for females. CONCLUSION: Although both methods proved to be reliable in estimating age, the use of correction factors is recommended.

Comparison of TW2 and TW3 skeletal age differences in a Brazilian population.

OBJECTIVE: The aim of this study was to determine the differences between the skeletal ages estimated by TW2 and TW3 methods through their RUS and Carpal systems. MATERIAL AND METHODS: A sample of two hundred and forty hand and wrist radiographs of male and female Brazilian children aged 84-199 months was evaluated by five observers. The Dunnet test was performed for statistical analysis. RESULTS: Results showed higher skeletal ages estimated by TW2RUS than TW3RUS and Carpal for both genders. For girls a statistically significant difference (p<0.05) was observed between TW2RUS and TW3RUS over the entire age range. For boys this difference was observed from 108 months onwards. In general RUS skeletal ages were higher than the chronological age and Carpal skeletal ages for both genders. The overestimation of chronological age was smaller for TW3RUS than for TW2RUS, and this last system showed a statistically significant difference regarding chronological age over the entire age range for girls, whereas for boys this difference was seen from 132 months onwards. For girls TW3 RUS and Carpal showed a significant difference regarding chronological age in the oldest age groups; in boys TW3RUS did not show a significant difference regarding chronological age. For Carpal, these results were more variable. CONCLUSION: It seems reasonable to recommend the use of the TW3 system for the studied Brazilian population.

Dental maturity as an indicator of chronological age: radiographic assessment of dental age in a brazilian population

OBJECTIVE: The purpose of this investigation was to evaluate the applicability of the methods proposed by Nolla and by Nicodemo and colleagues for assessing dental age and its correlation to chronological age. METHODS: Panoramic radiographs of 360 patients from the city of Fortaleza (CE, Brazil) aged 7-15 years were used to assess the associations between dental and chronological age. Data were submitted to statistical analysis using the BioEstat 2.0 (2000) software. Student-Neuman-Keuls test was performed and Pearson's correlation coefficients were calculated at 5 percent significance level. RESULTS: When the Nolla method was applied, the mean difference between true and estimated age for males and females was underestimated. The use of the method proposed by Nicodemo and colleagues also resulted in underestimation, although it was more evident in male subjects. The correlation coefficients between chronological age and estimated dental age were high, with mean values ranging between 0.87 and 0.91 for males and between 0.84 and 0.93 for females. CONCLUSION: Although both methods proved to be reliable in estimating age, the use of correction factors is recommended.

Telerradiografias obtidas em posição natural da cabeça alteram as grandezas cefalométricas? / Are there cephalometric measurements alterations using natural head position?

OBJETIVO: o objetivo deste estudo foi comparar a real variação entre as medidas cefalométricas realizadas em telerradiografias laterais de um mesmo indivíduo, obtidas em posição natural da cabeça (PNC) e na técnica padrão, onde o plano de Frankfurt foi posicionado paralelamente ao solo. Foi realizada a análise facial, comparando as medidas de postura, perfil facial e medidas ântero-posteriores. METODOLOGIA: a amostra foi composta por 50 telerradiografias laterais de indivíduos brasileiros, sendo 25 do gênero feminino e 25 do gênero masculino, com idade média de 21 anos. As medidas cefalométricas avaliadas foram divididas em três campos: 4 medidas de postura, 3 medidas de perfil e 9 medidas ântero-posteriores das bases ósseas. RESULTADOS E CONCLUSÃO: para as medidas de postura, não foram encontradas diferenças significativas no grupo feminino, sendo que no grupo masculino foram encontradas diferenças significativas para os planos SN, Frankfurt, e Mandibular em relação à linha vertical verdadeira. Para as medidas ântero-posteriores e de perfil facial, não houve diferenças para ambos os grupos. Houve correlação do plano SN/V (Sela-Násio/Linha vertical verdadeira) com o plano palatino e Plano Horizontal de Frankfurt nas radiografias padrão e PNC, com exceção do grupo masculino nas telerradiografias laterais padrão. Não houve correlação entre o plano da base do crânio SN/V com o plano mandibular em nenhuma das duas posições.

AIM: the aim of this study was to quantify the real variation of cephalometric measurements obtained from lateral cephalometric radiographs using a natural head posture (NHP) and a conventional technique, positioning Frankfurt Horizontal Plane parallel to the horizontal. A facial analysis was performed in order to compare postural measurements, facial profile and antero-posterior measurements. METHODS: fifty lateral cephalometric radiographs from 25 females and 25 males composed the sample, mean aged 21 years. The cephalometric measurements were divided into three groups: 4 postural measurements, 3 profile measurements, and 9 antero-posterior measurements. RESULTS AND CONCLUSION: no statistically significant differences were found for females, while males showed statistically significant differences for sella-nasion (SN), Frankfurt, and mandibular planes in relation to true vertical line (T). For antero-posterior and facial profile measurements, no statistically significant differences were found in both groups. A correlation of the SN/V (sella-nasion/true vertical line) plane with the palatal and Frankfurt planes was found for both techniques, except when conventional lateral cephalometric radiographs were taken from males. No correlation was found between the SN/V base of the skull plane and the mandibular plane in both positions.

Análise comparativa da maturação óssea determinada pelo método de Grave-Brown entre imagens convencionais e digitalizadas / Comparative analysis of bone maturation determined by Grave-Brown method in conventional and digitalized images

OBJETIVO: o presente estudo teve como objetivo comparar os estágios de maturação óssea estimados pelo método de Grave-Brown em radiografias de mão e punho convencionais e digitalizadas. METODOLOGIA: a amostra foi composta por 129 radiografias de mão e punho de indivíduos brasileiros do gênero feminino, com idades cronológicas entre 84 e 199 meses. As radiografias foram digitalizadas e posteriormente analisadas por cinco observadores. RESULTADOS E CONCLUSÃO: os resultados mostraram que não houve diferença estatisticamente significante entre os estágios de maturação óssea estimados, tanto nas imagens radiográficas convencionais como nas digitalizadas. Verificou-se ainda a reprodutibilidade dos observadores, sendo o valor de Kappa de 0,86 para as imagens convencionais e de 0,87 para as imagens digitalizadas. Recomenda-se a utilização de imagens digitalizadas como uma alternativa à imagem convencional para estimar a maturação óssea em radiografias de mão e punho.

AIM: the purpose of the present study was to compare the skeletal maturation stages estimated using the method of Grave-Brown in conventional and digitalized hand and wrist x-rays. METHODS: the sample was composed by 129 hand and wrist radiographs of Brazilian girls, with chronological ages between 84 and 199 months. The radiographs were digitalized and analyzed by five observers. RESULTS AND CONCLUSION: the results showed no statistically significant difference between the skeletal maturation stages estimated in the conventional or the digitalized images by Grave-Browns method. The reproducibility of the observers was also verified, the value of Kappa was 0.86 for the conventional images and 0.87 for the digitalized images. Therefore digitalized images are a reliable alternative for skeletal maturation estimation.

Sensitometric comparisons of Insight and Ektaspeed Plus films: effects of chemical developer depletion

O objetivo do presente estudo foi comparar as propriedades sensitométricas dos filmes Insight e Ektaspeed Plus processados manual e automaticamente em soluções novas e degradadas. Foram expostas 10 séries de cada tipo de filme (1 série = 5 filmes), sendo 5 séries processadas manualmente e 5, automaticamente. As primeiras duas séries de cada filme foram processadas em líquidos novos (uma série para cada tipo de processamento) e as demais foram processadas nas mesmas soluções progressivamente degradadas, uma vez por semana, até a conclusão do experimento dentro de 4 semanas. Curvas características foram construídas a fim de se comparar as propriedades sensitométricas dos filmes: contraste, latitude e sensibilidade. A degradação das soluções apresentou comportamentos distintos entre os tipos de processamento, o que pôde ser visto pelo padrão das curvas características que apresentaram modificações em sua forma, na terceira semana no processamento automático e na quarta semana no processamento manual. O filme Ektaspeed Plus apresentou uma redução de 11% nos seus valores de contraste no processamento manual e 53% no automático, já o Insight, 25% e 59%, respectivamente. O filme Insight, no entanto, apresentou uma menor perda de sensibilidade e um menor aumento de latitude. Concluiu-se que a degradação é mais rápida no processamento automático do que no manual. Em soluções degradadas, ambos os filmes apresentaram aumento de latitude e redução de contraste e sensibilidade. O Insight foi mais resistente em relação à latitude e sensibilidade, mas quanto ao contraste, o Ektaspeed Plus se apresentou mais estável.

Comparison of TW2 and TW3 skeletal age differences in a Brazilian population

OBJECTIVE: The aim of this study was to determine the differences between the skeletal ages estimated by TW2 and TW3 methods through their RUS and Carpal systems. MATERIAL AND METHODS: A sample of two hundred and forty hand and wrist radiographs of male and female Brazilian children aged 84-199 months was evaluated by five observers. The Dunnet test was performed for statistical analysis. RESULTS: Results showed higher skeletal ages estimated by TW2RUS than TW3RUS and Carpal for both genders. For girls a statistically significant difference (p<0.05) was observed between TW2RUS and TW3RUS over the entire age range. For boys this difference was observed from 108 months onwards. In general RUS skeletal ages were higher than the chronological age and Carpal skeletal ages for both genders. The overestimation of chronological age was smaller for TW3RUS than for TW2RUS, and this last system showed a statistically significant difference regarding chronological age over the entire age range for girls, whereas for boys this difference was seen from 132 months onwards. For girls TW3 RUS and Carpal showed a significant difference regarding chronological age in the oldest age groups; in boys TW3RUS did not show a significant difference regarding chronological age. For Carpal, these results were more variable. CONCLUSION: It seems reasonable to recommend the use of the TW3 system for the studied Brazilian population.

OBJETIVO: O objetivo deste estudo foi determinar as diferenças entre as idades esqueletais estimadas pelos métodos TW2 e TW3, usando os sistemas RUS e Carpal. MATERIAL E MÉTODOS: Uma amostra de 240 radiografias de mão e punho de crianças brasileiras de ambos os sexos com idade cronológica entre 84 e 199 meses foram avaliadas por cinco observadores. Para análise estatística dos dados foi aplicado o Teste de Dunnet. RESULTADOS: Os resultados demonstraram que as idades esqueletais estimadas pelo método TW2RUS foram mais avançadas que aquelas estimadas pelos métodos TW3RUS e Carpal, para ambos os sexos. Para o sexo feminino, uma diferença estatisticamente significante (p<0,05) foi observada entre os métodos TW2RUS e TW3RUS em todas as faixas etárias estudadas. No sexo masculino, essa diferença foi observada a partir de 108 meses em diante. Em geral, idades esqueletais estimadas pelo método RUS são maiores que a idade cronológica e também maiores que a idade esqueletal estimada pelo método Carpal em ambos os sexos. A superestimativa da idade cronológica é menor quando se aplica o método TW3RUS do que ao se utilizar o método TW2RUS, e esse último sistema mostrou uma diferença estatisticamente significante em relação a idade cronológica em todas as faixas etárias das meninas, enquanto para os meninos isso foi observado apenas a partir dos 132 meses em diante. No sexo feminino, houve uma diferença significante em relação a idade cronológica no grupo mais velho quando se comparou TW3RUS e Carpal; o que não foi observado no sexo masculino. No método Carpal os resultados foram mais variados. CONCLUSÃO: Diante dos resultados, os autores consideraram mais razoável a utilização do método TW3 para a estimativa da idade esqueletal em pacientes brasileiros.

Comparison of TW2 and TW3 skeletal age differences in a Brazilian population%Estudo comparativo das idades ósseas estimadas pelos métodos TW2 e TW3 numa população brasileira

OBJETIVO: O objetivo deste estudo foi determinar as diferenças entre as idades esqueletais estimadas pelos métodos TW2 e TW3, usando os sistemas RUS e Carpal. MATERIAL E MÉTODOS: Uma amostra de 240 radiografias de mão e punho de crianças brasileiras de ambos os sexos com idade cronológica entre 84 e 199 meses foram avaliadas por cinco observadores. Para análise estatística dos dados foi aplicado o Teste de Dunnet. RESULTADOS: Os resultados demonstraram que as idades esqueletais estimadas pelo método TW2RUS foram mais avançadas que aquelas estimadas pelos métodos TW3RUS e Carpal, para ambos os sexos. Para o sexo feminino, uma diferença estatisticamente significante (p<0,05) foi observada entre os métodos TW2RUS e TW3RUS em todas as faixas etárias estudadas. No sexo masculino, essa diferença foi observada a partir de 108 meses em diante. Em geral, idades esqueletais estimadas pelo método RUS são maiores que a idade cronológica e também maiores que a idade esqueletal estimada pelo método Carpal em ambos os sexos. A superestimativa da idade cronológica é menor quando se aplica o método TW3RUS do que ao se utilizar o método TW2RUS, e esse último sistema mostrou uma diferença estatisticamente significante em relação a idade cronológica em todas as faixas etárias das meninas, enquanto para os meninos isso foi observado apenas a partir dos 132 meses em diante. No sexo feminino, houve uma diferença significante em relação a idade cronológica no grupo mais velho quando se comparou TW3RUS e Carpal; o que não foi observado no sexo masculino. No método Carpal os resultados foram mais variados. CONCLUSÃO: Diante dos resultados, os autores consideraram mais razoável a utilização do método TW3 para a estimativa da idade esqueletal em pacientes brasileiros