Comparative determination of skeletal maturity by hand–wrist radiograph, cephalometric radiograph and cone beam computed tomography



The purpose of this study is to assess the stages of skeletal maturity in cone beam computed tomography (CBCT), hand–wrist radiography (HWR) and cephalometric radiography (CR) techniques of orthodontic patients, and associate skeletal maturity stages with chronological age, in a Turkish subpopulation.


Hand–wrist radiographs, cephalometric radiographs and CBCT of 105 patients were evaluated. For evaluation of HWR, the “Hand Bone Age A Digital Atlas of Skeletal Maturity” of Vicente Gilsanz and Osman Ratib (2005) was used. Skeletal maturation in the cephalometric radiographs and sagittal sections of cervical vertebrae obtained by CBCT were evaluated with Hassel and Farman’s method (1995). All results were re-evaluated 3 weeks later to assess intra-observer reliability.


Intra-observer reliability coefficients of the skeletal maturity stages in HWR, CR, and CBCT were 0.912, 0.595, 0.756 respectively (p < 0.05). Spearman’s correlation coefficient value between skeletal developmental stages in in HWR, CR, and CBCT was found to be 0.785, 0.875, and 0.791, respectively (p < 0.05).


Results of this study reveal that the determination of the skeletal development status with analysis of cervical vertebrae using cephalometric radiographs and CBCT is as reliable method as the evaluation of the hand–wrist radiographs and is compatible with chronological age in a subgroup of the Turkish population. When assessing the skeletal development stages of patients, both CBCT and CR can be used validly, so no extra hand–wrist radiography is required. This information is important for the prevention of increased radiation doses in patients.

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Correspondence to Alperen Tekın.

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Tekın, A., Cesur Aydın, K. Comparative determination of skeletal maturity by hand–wrist radiograph, cephalometric radiograph and cone beam computed tomography. Oral Radiol 36, 327–336 (2020).

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  • Cephalometric radiograph
  • Chronological age
  • Cone beam computed tomography
  • Hand–wrist radiograph
  • Skeletal age
  • Skeletal maturation