Maturation of the Middle Phalanx of the Third Finger: A Comparative Study between Right and Left Hand

Objectives: Recently a classification of patient's skeletal age based on the phalanx maturation, The Middle Phalanx Maturation of the third finger (MPM) method, was suggested. The aim of this study is to evaluate if there is a difference in MPM between the right and left hand. Study design: Two hundred fifty-four patients were obtained from the Complex Operating Unit of Orthodontics of Padua University Hospital. The total sample size has been selected by appropriate statistical calculations resulting in 130 patients. It was decided to further double the sample size of a previous study to ensure a robust statistical analysis. Radiographs of the right and left were obtained using the MPM method. Stages were compared using the right hand as a reference. The statistical analysis (Fisher exact test) was performed for the entire sample and related to gender in order to compare the right and the left hand stages. Results: In MPS2, 6 out 49 (12.2%) males and 7 out 27 females (25.9%) showed MPS3 in the left hand (p-value < 0.05). In all other stages, a total agreement (100%) was found. Conclusion: The authors confirm the use of the right hand as reference. In patients with MPS2 an additional radiograph on the left hand can be taken in order to increase the diagnostic accuracy. In all other stages other radiographs are not needed as a total agreement between the right and left hand was found.

skeletal age, orthodontics, middle phalanx maturation

1. Melsen B. Palatal growth studied on human autopsy material. A histologic microradiographic study. Am J Orthod; 68(1):42–54. 1975.

2. Persson M, Thilander B. Palatal suture closure in man from 15 to 35 years of age. Am. J. Orthod;72(1):42–52. 1977.

3. Baccetti T, Franchi L, McNamara JA. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod; 2(4):316–23. 2002.

4. Gu Y, McNamara JA. Mandibular growth changes and cervical vertebral maturation. a cephalometric implant study. Angle Orthod; 77(6):947–53. 2007.

5. Ruf S.;Optimal time for treatment with the Herbst appliance];Orthod Fr;77(1):163–7. 2006.

6. Franchi L, Baccetti T, De Toffol L, Polimeni A, Cozza P; Phases of the dentition for the assessment of skeletal maturity: a diagnostic performance study. Am J. Orthod Dentofacial Orthop;133(3):395–400.2008.

7. Perinetti G, Westphalen GH, Biasotto M, Salgarello S, Contardo L. The diagnostic performance of dental maturity for identification of the circumpubertal growth phases: a meta-analysis. Prog. Orthod; 14:8. 2013.

8. Perinetti G, Caprioglio A, Contardo L. Visual assessment of the cervical vertebral maturation stages: A study of diagnostic accuracy and repeatability. Angle Orthod; 84(6):951–6. 2014.

9. Fishman LS. Radiographic evaluation of skeletal maturation. A clinically oriented method based on hand-wrist films. Angle Orthod; 52(2):88–112. 1982.

10. Perinetti G, Perillo L, Franchi L, Di Lenarda R, Contardo L. Maturation of the middle phalanx of the third finger and cervical vertebrae: a comparative and diagnostic agreement study. Orthod Craniofac. Res; 17(4):270–9. 2014.

11. Safer AN, Homel P, Chung DD. Lateral comparisons using Fishman’s skeletal maturation assessment. Angle Orthod; 85(3):408–12. 2015.

12. Sizonenko PC. Normal sexual maturation. Pediatrician ; 14(4):191–201. 1987.

13. Perinetti G, Primožič J, Franchi L, Contardo L; Treatment Effects of Removable Functional Appliances in Pre-Pubertal and Pubertal Class II Patients: A Systematic Review and Meta-Analysis of Controlled Studies. PLoS One 2015;10(10):e0141198.

14. Franchi L, Baccetti T, McNamara JA. Mandibular growth as related to cervical vertebral maturation and body height. Am J Orthod Dentofacial Orthop;118(3):335–40. 2000.

15. Soegiharto BM, Moles DR, Cunningham SJ. Discriminatory ability of the skeletal maturation index and the cervical vertebrae maturation index in detecting peak pubertal growth in Indonesian and white subjects with receiver operating characteristics analysis. Am J Orthod Dentofac Orthop; 134(2):227–37. 2008.

16. Perinetti G, Baccetti T, Contardo L, Lenarda R Di. Gingival crevicular fluid alkaline phosphatase activity as a non-invasive biomarker of skeletal maturation. Orthod Craniofac. Res.;(6). 2011.

17. Masoud M, Masoud I, Kent RL, Gowharji N, Cohen LE. Assessing skeletal maturity by using blood spot insulin-like growth factor I (IGF-I) testing. Am J Orthod Dentofac Orthop; 134(2):209–16. 2008.

18. Kronenberg HM. PTHrP and skeletal development. Ann NY Acad Sci;068(1):1–13. 2006.

19. Ohba S, Chung U. PTHrP Action on Skeletal Development: A Key for the Controlled Growth of Endochondral Bones. Clin Rev Bone Miner; Metab;12(3):130–41. 2014.

20. Sharmada BK, Pai SS, Alle RS, Pai VS, Santosh A. Insulin-like Growth Factor I as a Skeletal Maturity Indicator. J Indian Orthod Soc; 48(4):370- 374. 2014.

21. Isaacson K, Thom AR. Orthodontic radiography guidelines. Am J Orthod. Dentofac Orthop; 147(3):295–6. 2015.

22. Santiago RC, de Miranda Costa LF, Vitral RW, Fraga MR, Bolognese AM, Maia LC. Cervical vertebral maturation as a biologic indicator of skeletal maturity. Angle Orthod; 82:1123–1131. 2012.

23. Zhao XG, Lin J, Jiang JH, Wang Q, Ng SH. Validity and reliability of a method for assessment of cervical vertebral maturation. Angle Orthod; 2012;82:229–234.