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Hand Wrist Radiograph in Orthodontics

StraightSmile Solutions® uses a variation from the Hand Wrist Radiograph from The Atlas of Greulich and Pyle (1959)

Why is Growth Prediction Important in Orthodontics?


*To understand the potential direction of facial development

* To predict growth potential left

* Too stage the onset of treatment timing prior to treatment in a Class II or III Skeletal malocclusion patient

* To select the most effective treatment plan

* To clarify a major discrepancy between dental age and chronological age

* To time Orthognathic surgery

What Data Can be Used for Growth Prediction in Orthodontics?


* Growth Charts

* Secondary Characteristics

* Skeletal Development

* Chronological Age

* Dental Development

Anatomy Markers:


To keep it simple, we recommend just focusing on 3 bones:

1. The Epiphysis and Diaphysis of the Middle Phalanges in the 3rd Finger.

They are small bones forming the fingers. They are three in number in each finger, except the thumb, which has only two phalanges. They ossify in three stages. The Diaphysis is the middle section of a bone. The Epiphysis refers to the ends of a bone.

2. The Sesamoid Bone

The Sesamoid bone is a “Dot-Shaped” bone in the thumb

3. The Radius

The wrist bone.



The middle finger, middle phalanges has a diaphysis that is smaller than the epiphysis

3 Years Before Peak Puberty:

The epiphysis and diaphysis of the middle finger and middle phalanges are equal

Puberty is Starting:

The sesamoid bone presents in the thumb.

Puberty is Peaking:

The epiphysis of the middle phalanges of the middle finger caps the diaphysis by surrounding like a cap.

Puberty is Almost Complete

Fusion occurs between the epiphysis and diaphysis of the middle phalanges of the middle finger in absence of the fused radius bone.

Puberty is Completed

The complete union of epiphysis and diaphysis of the radius. This is the last bone to ossify.

The ossification of all the hand bones is completed and skeletal growth is finished.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway, and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information view our services here. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.