Academic literature on the topic 'Skeletal age assessment: Cameriere's method'

ABSTRACT Aim The purpose of this study was to evaluate whether the open apex measurements of the lower teeth can be used for prediction of the pubertal growth spurt. Materials and methods The study group consisted of 150 males and 142 females ranging in age from 10 to 16 years. A total of 292 panoramic and 292 hand-wrist radiographs were obtained and analyzed. The skeletal maturity was determined according to the skeletal maturity indicators (SMIs) developed by Fishman. The open apices measurements of the left lower teeth were made according to the method described by Cameriere. Results The Spearman rank order correlation coefficient revealed a relationship between the skeletal maturity stages and the open apex measurements. These correlations ranged from 0.577 for the lower second premolar to 0.830 for the lower canine. The measurement of the left lower canine showed the highest correlation, so its relationship with the SMIs was further investigated. The measurements of 6.07 (or greater) indicated to SMI4, and 2.485 (or lesser) indicated to SMI7. Conclusion The skeletal maturity well related to the measurements of the open apices of the lower teeth. Lower canine open apex measurements could be used as an indicator of the SMI4 and SMI7. Clinical significance The measurements of the open apices of the left lower canines from panoramic radiographs may be clinically useful as an indicator of the beginning and the ending of the pubertal growth period. How to cite this article Issa YN, Burhan AS, Nawaya FR, Massouh LG. Assessment of the Pubertal Growth Period using the Open Apices of the Lower Teeth. J Contemp Dent Pract 2017;18(1):16-22.

Bone age assessment defined as the measure of skeletal development is most often used in pediatrics and forensics to estimate the true age of a person. It is usually done by comparing the left hand X-ray of a person with the hand radiographs in the standard atlas or based on local regions of interests (ROI) that include epiphyseal regions of the phalanges (14 ROI’s).Both these assessments were labour intensive, prone to discrepancies and can only be used to estimate the age till 18. Hence there is a need to develop automated method to assess the bone age by exploiting the appropriate features. This paper attempts to identify a procedure in recognizing the respective bone that belongs to male or female with its corresponding age. The automated procedure comprises of segmentation of metacarpals using area based statistics followed by typical feature extraction. Nine features are extracted for the experimental study. A back propagation neural network is then applied to classify whether the given sample refers to male or female bone. It is observed from the simulation results that the proposed procedure is found to be less computation burden and the results are found to be comparable with the existing work reported in the literature.

Aims Using 90% of final height as a benchmark, we sought to develop a quick, quantitative and reproducible method of estimating skeletal maturity based on topographical changes in the distal femoral physis. Patients and Methods Serial radiographs of the distal femoral physis three years prior to, during, and two years following the chronological age associated with 90% of final height were analyzed in 81 healthy children. The distance from the tip of the central peak of the distal femoral physis to a line drawn across the physis was normalized to the physeal width. Results A total of 389 radiographs of the distal femur with corresponding Greulich and Pyle bone ages and known chronological ages were measured. Children reached 90% of final height at a mean age of 11.3 years (sd 0.8) for girls and 13.2 years (sd 0.6) for boys. Linear regression analysis showed higher correlation coefficent in predicting the true age at 90% of final height using chronological age + gender + central peak value (R2 = 0.900) than chronological age + gender (R2 = 0.879) and Greulich and Pyle bone age + gender (R2 = 0.878). Conclusion Chronological age + gender + central peak value provides more accurate prediction of 90% of final height compared with chronological age + gender and Greulich and Pyle bone age + gender. Cite this article: Bone Joint J 2018;100-B:1106–11.

Aim of the Study. To assess whether skeletal age can be determined from left-hand magnetic resonance imaging (MRI) using the Greulich & Pyle (G&P). Method. The study includes 80 patients identified from an endocrine clinic, two males and two females from each of 5 age groups (<5, 5 to 7, 8 to 10, 11 to 13, and 14 to 16 years). Skeletal age as determined from an open MRI scanner and radiographs performed on the same day was compared for each child. Two observers assess the skeletal age from radiographs and MRI images independently. After a period of at least three weeks, observers determined the skeletal age of all patients independently. All of the images were in different and random orders, on both of the assessment occasions. The agreement was assessed using the interclass correlation coefficient and Bland Altman plots. Problem Statement. The recurrent use of left-hand radiography in children with chronic conditions might result in the patient being exposed to the same image several times throughout the course of their lives. Use of radiation-free methods such as magnetic resonance imaging (MRI) may be able to assist in reducing the risks associated with radiation exposure, if done properly. Results. Patients’ age ranged from 3 to 16 years, in which the mean of the chronological age was 9.3 years (±2.9) and 9.8 years (±2.7) in girls and boys, respectively. The interrater agreement for skeletal age determination was 0.984 for radiographs and 0.976 for MRI scans. Using the G&P technique, for Observer 1, intraobserver agreement for radiographs and DXA was 0.993 and 0.983, respectively, and 0.995 and 0.994, respectively, for Observer 2. Plotting the rater readings against the line of equality shows no significant differences between readings acquired from radiographs and MRI scans. Conclusion. For the study contribution, it is possible to employ open compact MRI to determine the skeletal age of a person. Our results showed that left-hand MRI scans were of better quality than the radiographs.

Accurate assessment of skeletal maturity is important clinically. Skeletal age assessment is usually based on features encoded in ossification centers. Therefore, it is critical to design a mechanism to capture as much as possible characteristics of features. We have observed that given a feature, there exist stages of the skeletal age such that the variation pattern of the feature differs in these stages. Based on this observation, we propose a Bayesian cut fitting to describe features in response to the skeletal age. With our approach, appropriate positions for stage separation are determined automatically by a Bayesian approach, and a model is used to fit the variation of a feature within each stage. Our experimental results show that the proposed method surpasses the traditional fitting using only one line or one curve not only in the efficiency and accuracy of fitting but also in global and local feature characterization.

ABSTRACT Objectives To evaluate the frequency of abnormal progression that could ultimately affect the reliability of the skeletal maturity index (SMI) and the cervical vertebral maturation (CVM) method that are most commonly used analyses for skeletal age assessment. Materials and Methods A retrospective design was used to compare 299 hand-wrist radiographs with 299 lateral skull radiographs regarding the number of abnormalities in the proposed sequence of maturation in the SMI and CVM methods. Results A significantly greater number of abnormalities occurred in the sequence of CVM progression compared with SMI (P &lt; .001). Sex and age did not have an effect. Conclusions Skeletal age assessment based on SMI is more accurate than CVM regarding the progressive sequence of stages.

Objectives: To compare Demirjian Dental scoring method with Greulich-Pyle (GP) Skeletal method of age estimation in pubertal children. Materials and Methods: Sample of the study included 267 male healthy subjects of 11-16 years of age group.. Demirjian Scoring system was utilized to evaluate the orthopantomograms to assess their Dental age and the Hand-Wrist radiographs were analyzed to calculate the skeletal age by utilizing GP atlas. Chronological age was obtained from the date of birth of the subject .Both methods were compared with one another and with the chronological age. It was a cross-sectional study and only healthy male subjects without any clinical abnormalities were included in the study. Results: A total of 267 male subjects of 11-16 years of age group were assessed by Demirjian and Greulich Pyle Methods. Both were compared with Chronological Age. Data obtained was statistically analyzed and the Student “t” test was applied in the study population. The mean difference between Chronolgical age and dental age was 0.69years and that of chronological age and skeletal age was 0.87 years. It was observed from dental age assessment that it does not differ much from the skeletal age. Conclusion: It was concluded that Demirjian method of Age Estimation is more precise than Greulich Pyle method of Age Estimation. Furthermore both methods can be used selectively in Medicolegal cases to access bone age which can be easily correlated to chronological age.

Background and purpose — Skeletal maturity is a crucial parameter when calculating remaining growth in children. We compared 3 different methods, 2 manual and 1 automated, in the radiological assessment of bone age with respect to precision and systematic difference. Material and methods — 66 simultaneous examinations of the left hand and left elbow from children treated for leg-length discrepancies were randomly selected for skeletal age assessment. The radiographs were anonymized and assessed twice with at least 3 weeks’ interval according to the Greulich and Pyle (GP) and Sauvegrain (SG) methods by 5 radiologists with different levels of experience. The hand radiographs were also assessed for GP bone age by use of the automated BoneXpert (BX) method for comparison. Results — The inter-observer intraclass correlation coefficient (ICC) was 0.96 for the GP and 0.98 for the SG method. The inter- and intra-observer standard error of the measurement (SEm) was 0.41 and 0.32 years for the GP method and 0.27 and 0.21 years for the SG method with a significant difference (p < 0.001) between the methods and between the experienced and the less experienced radiologists for both methods (p = 0.003 and p < 0.001). In 25% of the assessments the discrepancy between the GP and the SG methodwas > 1 year. There was no systematic difference comparing either manual method with the automatic BX method. Interpretation — With respect to the precision of skeletal age determination, we recommend using the SG method or preferably the automated BX method based on GP assessments in the calculation of remaining growth.

The aim of this retrospective study was to evaluate the correlation between the midpalatal suture maturation and skeletal maturation in growing children aged 7 - 15 years and predict the maturational stages of the midpalatal suture corresponding to skeletal maturity assessed by the skeletal maturation indicators (SMI) and middle phalanx of the third finger (MP3) stages. The group of this retrospective study was consisted of randomly selected 132 male and 135 female in age from 7 - 15 years. The maturation of the midpalatal suture was evaluated by using images from cone-beam computed tomography (CBCT) while the skeletal age was assessed by hand-wrist radiography. CBCT images and hand-wrist radiographs used in this study were obtained from all subjects for orthodontic diagnosis before orthodontic treatment. The maturational stages of the midpalatal suture showed strong correlations with both SMI and MP3 stages. The correlation between the midpalatal suture maturation and SMI (Spearman’s correlation coefficient, ϒ_S = 0.905, <i>p</i> < 0.05) was slightly greater than that of MP3 stages (ϒ_S = 0.830, <i>p</i> < 0.05). There was a positive significant correlation between the midpalatal suture maturation and chronological age (ϒ_S = 0.868,<i>p</i> < 0.05). CBCT for evaluation of the midpalatal suture maturational stages may be unnecessary in every pediatric patients because SMI and MP3 stages were both replaceable useful methods for assessing maturation of the midpalatal suture before orthopedic treatment. In this retrospective study, the diagnostic reliability of the SMI method for estimating midpalatal suture maturation showed better reliability than the MP3 method.

Age-at-death assessment is a crucial step in the identification process of skeletal human remains. Nonetheless, in adult individuals this task is particularly difficult to achieve with reasonable accuracy due to high variability in the senescence processes. To improve the accuracy of age-at-estimation, in this work we propose a new method based on a multifactorial macroscopic analysis and deep random neural network models. A sample of 500 identified skeletons was used to establish a reference dataset (age-at-death: 19–101 years old, 250 males and 250 females). A total of 64 skeletal traits are covered in the proposed macroscopic technique. Age-at-death estimation is tackled from a function approximation perspective and a regression approach is used to infer both point and prediction interval estimates. Based on cross-validation and computational experiments, our results demonstrate that age estimation from skeletal remains can be accurately (~6 years mean absolute error) inferred across the entire adult age span and informative estimates and prediction intervals can be obtained for the elderly population. A novel software tool, DRNNAGE, was made available to the community.

La stima dell’età rappresenta un’area di ricerca piuttosto recente nelle scienze forensi e, in quanto tale, gravata da rilevanti criticità quali l’assenza di consenso e di uniformità delle procedure, la molteplicità dei metodi la cui affidabilità varia in base alla etnia e al sesso. Su queste basi, il progetto di ricerca è stato sviluppato individuando tre linee di ricerca aventi ad oggetto: 1) gli aspetti normativi sulla stima dell’età in minori stranieri non accompagnati (MSNA), 2) le problematiche etiche e deontologiche correlate all’utilizzo di metodiche radiografiche per lo studio dell’odontogenesi, 3) la verifica sperimentale dell’affidabilità predittiva dei metodi che studiano radiograficamente marcatori dell’età scheletrica (metodo Bo/Ca) e di quella dentale (valutazione dello sviluppo del terzo molare - I3M). Sono stati esaminati ben 12 protocolli operativi adottati sul territorio italiano. La comparazione degli stessi ha mostrato un quadro molto disomogeneo sia in relazione alla composizione del team di specialisti cui è affidato il compito di accertare l’età dei MSNA, sia con riferimento alle modalità accertative mediante le quali dovrebbe svolgersi la procedura valutativa. È risultato minoritario l’indirizzo di taluni protocolli di affidare il coordinamento del team multi-specialistico ad un medico legale con competenze antropologico-forensi, così come l’adozione di metodiche radiologiche autorizzate solo in caso di persistenti e fondati dubbi sull’età. E questo nonostante in letteratura scientifica è documentata una elevata capacità predittiva delle metodiche radiografiche, specie se effettuate da personale esperto e addestrato come quello di provenienza medico legale. L’applicazione del Principialismo etico (autonomia, beneficenza, non maleficenza, giustizia) alle metodiche radiografiche di Demirjian e I3M per lo studio degli indicatori dell’età dentaria a scopo forense, ha evidenziato come questi metodi non debbano essere considerati aprioristicamente non etici, perchè invasivi e non giustificati da alcuna indicazione terapeutica. Al contrario, la elevata affidabilità di queste metodiche, il rischio pressoché irrilevante correlato alla esposizione a radiazioni ionizzanti e, soprattutto, gli importanti benefici conseguenti alla definizione dell’età biologica, necessari alla stessa identificazione personale dell’individuo, portano a ritenere del tutto vantaggiosa la procedura accertativa quale premessa ineludibile per la tutela dei diritti del minore. L’accuratezza del metodo I3M in popolazione di diversa etnia è stata valutata attraverso una revisione narrativa della letteratura di 22 articoli, per un totale di 12.286 OPT appartenenti a 21 diverse nazionalità. L’I3M ha mostrato una sensibilità complessiva compresa tra il 51.8% e il 93.4% e una specificità compresa tra l’86.2% ed il 100%. La proporzione di individui correttamente classificati è risultata compresa tra il 74% e il 95%. Sulla base di questo studio retrospettivo, l’I3M risulta essere un metodo affidabile in ambito forense, in grado di fornire con grande accuratezza i margini di errore correlati al sesso ed alla provenienza geografica, requisito imprescindibile per una stima forense dell’età biologica. L’attività di ricerca inerente il metodo Bo/Ca è stata espletata in due diverse fasi. Nella prima fase, si è verificata l’efficacia predittiva del metodo su un campione sudafricano di 563 subadulti (179 neri e 384 bianchi, 320 femmine e 243 maschi), di età compresa tra 6 e 16 anni. L’errore standard di stima ha indicato un errore di 1.19 anni nei maschi e 1.09 anni nelle femmine con un range compreso tra 0.84 (femmine di 12 anni) e 3.09 (maschi di 16 anni). L’analisi della varianza non ha mostrato significative differenze tra età scheletrica ed età cronologica tra i neri ed i bianchi. La differenza tra età scheletrica ed età cronologica è risultata inferiore ad un anno e la sottostima più significativa è stata riscontrata negli individui appartenenti alla fascia di età compresa tra i 14 ed i 16 anni. Nella seconda fase, si è effettuata un’analisi comparativa tra il metodo Bo/Ca ed il metodo TW2 su un campione di 224 subadulti sudafricani (110 neri e 114 bianchi, 111 femmine e 113 maschi), di età compresa tra 6 e 16 anni. Bo/Ca e TW2 hanno correttamente classificato sia gli individui bianchi (- 0,08 e 0,18 anni rispettivamente) che gli individui neri (- 0,07 e - 0,20 anni), sia maschi (- 0,19 e 0,19 anni) che femmine (- 0,03 e - 0,21 anni). Il metodo Bo/Ca è però risultato essere meno influenzato dall'etnia o dal sesso rispetto al metodo TW2 mostrando però una maggiore imprecisione nei subadulti di età ≥ 13 anni.
Age estimation in living individuals represents a fairly recent applied research area for forensic sciences. For this reason, there are critical issues that need to be improve such as the lack of consensus and uniformity regarding the procedures as well as the different methods whose reliability varies according to ethnicity and sex. On this basis, the research project was developed by identifying three areas of research: the regulatory aspects on age estimation in unaccompanied foreign minors (UM); ethical and deontological issues in age estimation performed with radiological techniques for the evaluation of dental development; the experimental verification of the effectiveness of radiographic methods for the skeletal age (Bo/Ca method) and dental age (third molar maturity index - I3M) assessment. Twelve different protocols adopted in Italy were examined. The comparison between the protocols showed a non-homogenous system both in relation to the composition of the team and the methods by which the age assessment of UM should be carried out. In only some protocols the coordination of the multi-specialist team is assigned to a forensic pathologist with anthropological-forensic skills. The use of radiological methods is allowed only when there are substantiated doubts concerning the age. However, the scientific literature shows a high predictive capacity of radiographic methods, especially if performed by an experienced and trained forensic expert. In this regard, a couple of radiological methods like the Demirjian and the I3M for the assessment of dental age have been compared with reference to the ethical paradigms of Principialism (autonomy, beneficence, non-maleficence, justice). They have been considered unethical, just because intrusive due to radiological exposure not justified by a medical benefit. On the contrary, the age estimation process performed using these methods is advantageous because of the high effectiveness of these methods, the very low radiation exposure and the child rights related to a fair age assessment. To evaluate the accuracy of the I3M method in different ethnic populations has been performed a critical literature review of 22 scientific articles, representing data from panoramic radiographs of 12.286 individuals from 21 countries. I3M has shown an overall sensitivity ranging from 51.8% to 93.4% and a specificity ranging from 86.2% to 100%. The proportion of correctly classified individuals ranged from 74% to 95%. I3M can be considered a suitable method for estimating adulthood in forensic settings, because it provides with great accuracy the margin of error of living subjects according to sex and ethnicity. Regarding the skeletal maturity, the Bo/Ca method has been the issue of a research activity carried out in two different phases. In the first phase, Bo/Ca method was applied in a sample of 563 South African subadults (179 Black and 384 White, 320 girls and 243 boys), aged between 6 and 16 years. The Standard Error of Estimate was 1.19 years and 1.09 years in boys and girls, respectively, ranging from 0.84 years in 12 year old girls to 3.09 years in 16 year old boys. A one-way analysis of the variance showed no statistically significant difference in skeletal age and chronological age between Blacks and Whites. The difference between skeletal age and chronological age was less than a year and the most significant underestimation was found in the participant belonging to the age group of 14 to 16 years. In the second phase, a comparative skeletal age assessment using the Bo/Ca and TW2 methods in a South African sample of 224 individuals (110 Black and 114 White, 111 females and 113 males) aged between 6 and 16 years, was performed. Bo/Ca and TW2 correctly classified individuals both in White (- 0.08 and 0.18 yrs respectively) and Black (- 0.07 and – 0.20 yrs, respectively) as well as in males (- 0.19 and 0.19 yrs, respectively) and females (- 0.03 and - 0.21 yrs, respectively). Bo/Ca method seems to be less influenced by ancestry and biological sex in respect to TW2. Bo/Ca method seems to be less influenced by ancestry and biological sex in respect to TW2 and both methods showed greater inaccuracy in subadults aged 13 yrs or older compared with younger.

Introduction: Physical activity (PA) performed at recommended levels is associated with mul-tiple health benefits. However, as indicated by the available studies, the volume of habitual physical activity of children continuously decreases. Aim: The aim of the study was to assess the relationships between physical activity per-formed by school-age population and indicators of motor performance and body composition. Methods: The research group consisted of 144 students of the primary school assigned into groups according to the years of study (first, fifth and eighth-year students). The amount of physical activity was examined through a non-direct method, using Fels PAQ, recording four scores, namely sport index, leisure index, work (chore) index and total score. Body composition was tested using a direct segmental multi-frequency bioelectric impedance analysis (DSM-BIA). Motor performance was assessed in four categories. Endurance and strength endurance were assessed using Jacik’s motor test; strength abilities were measured using a hand grip test; speed abilities were tested in linear sprints at 5 and 10 meters and in the test of speed with changes of direction at 4 x 10 m and, finally, explosive strength was assessed from results of the countermovement jump (CMJ), squat jump (SJ) and 10-second repeated jumps tests. The strength of association between the selected factors was determined from the results using the Spearman’s rank correlation analysis. Results: The amount of physical activity was mainly associated with the indicators of active body mass (fat free mass, skeletal muscle mass) in all age categories. Low association was found in the parameters of adipose tissue (body fat percentage, visceral fat level). When assessing the strength of association between the characteristics of motor performance and physical activity performed, we observed various courses of associations, based on which it is not possible to determine the tendency. When assessing the relationship between the amount of physical activity and motor performance of students regardless of age, we found medium association only with indicators of strength abilities (hand grip test) and characteris-tics of speed abilities. Conclusions: The results are not explicit but they point to some tendencies in relationships between habitual physical performance and body composition indicators. With respect to mo-tor performance, it is not possible to consider these results decisive; therefore, further data collection and more accurate assessment of relationships are necessary.