Reliability of growth prediction with hand-wrist radiographs

The aim of this study was to investigate the validity of hand-wrist radiographic analysis in estimating the amount of remaining craniofacial growth. The material compromised cephalograms of 22 males and 27 females with a Class I malocclusion. The median age of the females at the beginning (T1) was 11 years 10 months and of the males 12 years 6 months and at the end (T2) of treatment 14 years 7 months and 15 years 3 months, respectively. Statural height was measured and a lateral cephalogram was obtained for every patient at T1 and T2. A hand-wrist radiograph was taken only at T1. The cephalograms were scanned and analyzed. Relative dimensional growth changes in statural height as well as of the length of the cranial base (N-S), the maxilla (Ptm-A), and the dimensions of the mandible (Co-Gn, Go-Gn, and Co-Gn) from T1 to T2 were determined and statistically compared (Pearson's correlation coefficients) with the growth prediction assessed with the help of hand-wrist radiographs according to Greulich and Pyle. The results showed a highly significant correlation between statural growth increases and growth prediction assessed from the hand-wrist radiographs (females: r = 0.68; males: r = 0.7). Concerning craniofacial structures, the increase in mandibular corpus showed the highest correlation with growth prediction (females: r = 0.21; males: r = 0.52), but this association would not allow a reliable growth prediction. There was no significant correlation between growth increases of the cranial base, the maxilla, the ramus, and the effective length of the mandible and growth prediction assessed with the help of hand-wrist radiographs. As each patient has an individual growth pattern and different craniofacial structures show individual growth potential, it is questionable if quantitative craniofacial growth prediction with the help of hand-wrist radiographs is reliable. However, in an individual case for the assessment of the timing of the growth process, a hand-wrist radiograph can contribute to treatment planning.