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The 'Maturational Patient Report' supplied by GrowthTek clearly
assists and guides the clinician in formulating a well-timed treatment
plan. It is very important not to rely on chronologic age in
determining the best time to initiate facial surgery whether it be
for the maxilla and/or the mandible.
Although the surgeon and orthodontist usually prefer to delay surgery
until all facial growth is completed, an individualized maturational
analysis often reveals a developmental pattern that allows for earlier
intervention. This often is desirable for psychological reasons. For
instance, advanced maturers tend to become 'burnt out' relative to
future amounts of incremental skeletal growth. On the other hand,
delayed maturers tend to 'catch up' by continuing to grow incremental
amounts over a longer period of time. The uniqueness of the individual
can be evaluated on this basis resulting in a more rational approach
to the timing of surgery. GrowthTek provides this information.
The following example is of an individual who demonstrates a skeletal
disharmony associated with excessive vertical growth of the lower
face, upper facial retrusion, lower facial protrusion, Class III molar
relationship, anterior dental cross-bite relationship, concave facial
CentroGraphic Analysis (CGA) was utilized to evaluate the facial form
Fishman LS Individualized evaluation of facial form JODO 1997
(Subtelny, JD Early Orthodontic Treatment, Chapter 13, 2000)
The following chart
illustrates nine different developmental scenarios
for the male patient relative to maturational age. The first three
patients ( A,B,C ) all demonstrated on their pretreatment hand-wrist
x-rays the same maturational stage of SMI 6, a period of very high
maxillary and mandibular growth velocity. All three patients
demonstrated different maturational levels, Patient A being
advanced, Patient B being average and Patient C being delayed. The
second series of three patients ( D,E,F) also demonstrated the same
respective maturational levels, but demonstrated maturational stages
of 10, a developmental period associated with deceleration of growth.
The remaining three patients ( G,H,I ) also demonstrated the same
respective maturational levels but demonstrated very late adolescent
maturational stages of 10++. The respective pretreatment chronologic
ages and maxillary ( S-A ) and mandibular ( S-Gn ) measurements
'Patient Maturational Reports' were completed for all nine patients.
Within each of the three subgroups of advanced, average and delayed
maturers, 24 mo. estimations were made of expected maxillary and
mandibular growth. It becomes evident that a significant difference
can exist between advanced, average and delayed maturers even if
they commonly share the same maturational stage prior to treatment.
It is not uncommon to demonstrate insignificant amounts of future
growth in an advanced maturer, often providing the basis for chrono-
logically early surgical intervention. The reverse of this can also
be seen whereby surgical intervention needs to be delayed until a
late chronologic age is achieved. GrowthTek evaluates all of these
maturational factors and provides the clinician with clear guidelines
for diagnosis and treatment planning.
Note: Fishman, LS Maturational patterns and prediction during adolescence.
Angle Orthod. 1987
Note: Please refer to the other questions in this 'Clinical Applications'
section of this web site for specific clinical information regarding
maturational timing of treatment. Also refer to the 'Background
Information' section of this web site for additional information.
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