Leonard S. Fishman

Chronological versus skeletal age, an evaluation of craniofacial growth.

Skeletal and chronologic ages of both female and male populations were compared relative to the degree of concurrence between the two age-indices at the various age levels. Maxillary and mandibular cephalometric measurements were similarly compared for both sex groups. Individuals comparisons of facial changes were made relative to their respective chronologic and skeletal ages. The significance of a skeletal vs. chronologic age discrepancy and its relationship to the timing of facial growth was demonstrated. Clinical implications were discussed.

Maturational Patterns and Prediction During Adolescence

A mixed longitudinal study of Skeletal Maturation Indicators (SMI) from the hand-wrist radiograph as a means for evaluating maturational status.

Timing of cervical headgear treatment based on skeletal maturation

Forty-one patients with clinically diagnosed Class II, Division I malocclusions with midface prognathism were treated with Kloehn-type cervical headgear. All cases included both longitudinal series of lateral cephalometric radiographs and hand-wrist films taken before, during, and after treatment. Skeletal and dental changes were related to specific maturational periods and compared with their related chronologic age to evaluate optimum timing for maximum treatment response. As determined by this study, timing of cervical headgear treatment on the basis of skeletal maturation is a more statistically significant means of obtaining the maximum desirable orthopedic effect than chronologic age. More favorable results were demonstrated during maturational periods that were associated with a higher degree of incremental growth velocity.

Facial growth during adolescence in early, average and late maturers

The relative stage of maturity of a child may be determined by comparing the childs hand-wrist radiograph to known standards of skeletal development. Hand-wrist radiographs of 70 adolescents were used to categorize the individuals by skeletal maturation into early, average and late maturation groups using the Fishman SMA method of assessment. The rates of mandibular and maxillary growth relative to the last stages of the pubertal growth spurt were measured. Statistical evaluation of the data was performed using an analysis of variance. The magnitude of change in growth increments of the mandible was greater in the late maturers than in the early or average maturers. Incremental differences in growth between the maxilla and mandible during the last stages of puberty were noted, with the mandible growing significantly more than the maxilla.

Individualized evaluation of facial form

The purpose of this study was to establish a nonnumeric graphic approach to the evaluation of facial form. By using a centroid-based pattern of orientation, skeletal, dental, and soft-tissue morphologic characteristics can be identified that more reliably represent the uniqueness of the person and are not dependent on nonrepresentative group-based numerical standards. The CentroGraphic Analysis (CGA) cephalomorphically demonstrates vertical and horizontal balance or disharmony in skeletal, dental, and soft-tissue form and position. The Facial Centroid Axis (FCA) provides a relatively stable reference plane that can be used for longitudinal cephalomorphic superimposition.

Dental and skeletal relationships to attritional occlusion.

Dental attrition has been investigated in depth. Besides alterations in arch length due to attrition, skeletal and intra-arch differences were discovered. It is felt that these findings do have value in helping us realize that present-day concepts of proper occlusion cannot necessarily be applied to dentitions that existed at another time. A more thorough knowledge of occlusions exhibiting dental attrition provides information that is helpful in understanding more fully the nature of tooth eruption and associated dental arch occlusion and the interrelationships of these factors with supporting skeletal structures.

Dentoskeletal changes following mini-implant molar intrusion in anterior open bite patients

OBJECTIVE To evaluate skeletal and dental changes after intrusion of the maxillary molars in subjects with anterior open bite. MATERIALS AND METHODS This retrospective cephalometric study evaluated skeletal and dental changes resulting from the use of maxillary orthodontic mini-implants in 31 consecutively treated patients. Radiographs were taken at the start and end of maxillary molar intrusion to evaluate the associated changes. Statistical analysis was performed using a one-sample t-test. RESULTS The mean treatment observation time was 1.31 years (SD  =  2.03). The maxillary first molars (P  =  0.0026) and second molars (P  =  0.039) were intruded. However, the mandibular first molars (P  =  0.0004) and second molars (P  =  0.003) erupted in adolescent patients. Both the maxillary and mandibular first molars inclined distally (P  =  0.025 and P  =  0.044, respectively). The mandibular plane angle decreased (P  =  0.036), lower facial height decreased (P  =  0.002), and the occlusal plane angle increased (P  =  0.009). The overbite increased (P < .0001). The ANB angle decreased (P < .0001). Mandibular dental and skeletal changes were more apparent in adolescents, while adults tended toward maxillary changes. CONCLUSIONS Vertical traction from orthodontic mini-implants reduces the maxillary posterior dentoalveolar height, thereby assisting orthodontic closure of anterior open bite. However, simultaneous eruption or extrusion of the mandibular molars should be controlled. Adolescent patients tend to demonstrate more favorable effects of mandibular autorotation than do adults.