hey this is dr. Amanda here with straight smile solutions and today we're gonna be talking about
hand risk x-rays and orthodontics why do we need them how can we use them why are they useful and
should we get them so so many things to talk about now I use these all the time why well
basically in a nutshell sometimes you need to know about growth it doesn't matter if you're
an orthodontist a general dentist a pediatric dentist a pediatrician you need to know about
growth need to know if your patient is done growing still growing about to grow about to
reach peak growth potential I mean even sometimes coaches like to know this information I know they
do so this is really useful information hey hey I've got kids they want to know this information
guess what I can get out my magic crystal ball and be a Miss Cleo and I can tell you are you far
away from puberty or your growth spurt are you and getting their clothes are you about to max out or
are you done growing and I can find all this out from a hand wrist x-ray sweet is not off awesome
now for orthodontics it's particularly important because sometimes we're into tying the time or
certain type of treatment whether we're trying to time certain type of treatment to correct
a bite problem or just timing braces in general like harness the growth or thinking are we gonna
have any more growth is this or should we change a treatment plan that maybe doesn't factor in growth
or people we're thinking about doing orthognathic surgery so many reasons we need to know this for
ortho and I think sometimes there's a lot of ways that people can find out about growth of course
sometimes people just say oh the child is 12 they must be growing well not necessarily because girls
can have their peak growth spurt from age 8 to age 14 boys can have their peak growth spurt from age
10 to 8 17 so there's some big windows in there so that age doesn't necessarily have anything to
do with it chronological age the dental growth or dental age doesn't have anything to do with
it you could have a girl that only lost 8 teeth and they could be done growing so sometimes it
has nothing to do with one another and parents don't necessarily get this okay so so many things
to think about and if you do this not only are you going to be more successful in explaining
the value of the treatment plan to the patient and the parent but your timing and your outcomes
are going to be better because you're making more educated and wise decisions so that's why
I recommend doing this now how do you do this you can do this on any set play if you already have a
supplementary x-ray machine it's really easy you don't have to play with it a little bit but it's
basically on the same plate okay I'm assuming you can do it on a CB CT I haven't tried it but
pretty cool stuff what do you need to know well I'm taking my analysis this is like a modified
analysis because what's out there is so flippin confusing for most people and I know how to do
the other version but it's more information than I need and it gets confusing when I try to teach
other people how to do it so I've made it like way simpler here so this is my version straight smile
solutions version of a hand wrist analysis okay so copyright Night 2019 so this is based on the
research and the atlas of garlic and pile 1959 this is just standard stuff okay I just tried
to break it down and make it more simple okay so what we're gonna do is we're only going to look
at three points I need to know some basic anatomy first okay now in the phalanges or finger bones
okay when you're growing you have an epiphysis okay which is like the end of the bone and the
diathesis which is basically in between is the growth plate okay so the diaphysis is like the
little bone here and the epiphysis is right here okay so these are separate as you're growing and
when you finish growing they fuse together okay so that's what you need to know you need to know the
difference between a diaphysis and epiphysis you need to localize them okay the other bone that I
want you to know about is called a sesamoid bone the sesamoid bone is a little bone and looks like
that and that's exactly where it's gonna be and that presents at a certain time in growth okay so
it's not in a young child it's only in a pubertal child you'll start to get one little dot in your
thumb okay the last spot so I said only three spots middle phalanges of the middle finger so
middle middle just this spot right here okay the sesamoid bone and the wrist bone the radius here
again epiphysis and diathesis these two and is there a space in between them that's it that's
all I want you to know three spots middle middle sesamoid and radius bone okay three things on any
x-ray and then you can use it from there so there's six stages that I break it down into
you got your pre-puberty pre-puberty three years before peak puberty that means like for a girl
three years before you're gonna get your period three years and a boy before they're gonna their
voice is gonna change and they're gonna stop growing okay puberty is just starting puberty
is peaking puberty is almost done and puberty is done okay so that's our my six different steps
and this is like super important because if I want the time treatment for ortho I don't necessarily
want the pre-puberty time or even the years before peak puberty I kind of want it like right here for
the most part okay or here but ideally I'm trying to aim for right in-between here for most ortho
growth modification things okay so like I said you can't go by the chronological age so we're
gonna look at those three points middle middle look for the SS my boat and look at the fusion
of this bone right here easy all right so pre puberty what are we looking for in pre-puberty
in pre-puberty your epiphysis and diathesis are not fused in your middle middle sorry it's covered
up right here okay and actually your diathesis let me do this right sorry your epiphysis sorry
your diocese is smaller than the epiphysis still okay so you can see here see that it's smaller
than the epiphysis okay so there's a little line in between and it's still smaller okay that's
pre-puberty button on middle middle so right now I can tell you on this we'll see it in a second this
x-ray is actually right here so see it middle middle on either finger diathesis epiphysis not
the same size and they're not fused okay so this child is totally pre-pubertal not even happening
within the next three years okay so most likely this child is five six something like that maybe
seven okay so we look at the other landmarks that we talked about is their assessment bone nope and
is views No okay three spots so that's great what else three years before peak puberty the
epiphysis and the diaphysis are equal in size but not fused okay so that's the kind of Bingbing Ming
growth is coming so that's kind of where I want to start timeing stuff okay puberty is like actively
starting that's when the sesamoid bone shows up that little dot on the thumb oh no we gotta get a
move on now it showed up you know puberty is like peaking whoa red alert it's peaking okay so when
it's peaking and I probably don't have the best example of this here but you'll see the epiphysis
and the diathesis kind of starting to fuse together and make him like a cap okay it looks
like a hat so like the ends are kind of touching but in the middle there's still a space that is
like peeking okay that's peeking and puberty is almost done that's when the you already have the
sesamoid but the fingers are fused now the middle middle is fused okay but the radius is not fused
yet okay some see the radius is not fused there's still a space so let's see the example of an adult
this is an adult hand I can work my way backward radius is totally fused right something we know
this is this is a completely an adult sesamoid bone is right there total fusion right no capping
no space on middle male that's it it's that easy I hope you loved it I know I did I'm excited to
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