Comparative evaluation of skeletal maturity using Middle Phalanx of the third Finger (MP3) , Cervical Vertebral Maturation (CVM) , and Insulin Like Growth Factor 1 ( IGF 1) : An In-Vivo Study

**AIM:**To evaluate the reliability of IGF-1 for assessing skeletal maturity by comparing IGF-1 levels with MP3 stages and cervical vertebral stages.

OBJECTIVES:

·       To investigate whether blood IGF-1 levels are a reliable predictor of skeletal maturity.

·       To find out a correlation of IGF-1 with stages of cervical vertebral maturation (CVM).

·       To find out a correlation of IGF-1 with stages of the middle phalanx of the third finger (MP3).

Materials:

In this study, following armamentarium will be required:

·       Lateral cephalogram

·       Middle phalanx of middle finger radiograph

·       Insulin like growth factor 1 test in serum

METHODOLOGY

Lateral cephalogram, MP3 radiographs on intraoral periapical films will be obtained for each patient whose growth modification is required and on the same day blood samples will be collected. Serum is separated from the blood samples and are labelled with a patient code (without any mention of patient details such as name, age, sex) and are properly sealed and stored in thermocol box with ice pack (kept between 2 degrees Celsius – 8 degrees Celsius) and will be sent to the laboratory for chemiluminescence immunoassay for determination of IGF-1 levels by a fully automated, two-site chemiluminescent immunoassay. Lateral cephalograms will be taken in natural head position. All the radiographs will be exposed at 80 KVP, 9mA for 1.25 seconds with Ortho pantomography machine of model Kodak CS8000C. The cervical staging technique as described by Baccetti et al will be  used to stage the cervical vertebrae.The intra oral periapical film will be used for radiograph of the middle phalanx of the third finger (MP3) of the right hand. This will be done by placing the hand palm downward on a flat non metallic surface. The middle phalanx of the right middle finger will be placed such that it lied at the center of the x-ray film. The cone of the standard dental x-ray machine (60 KVP and 7mA) will be positioned in light contact with the middle phalanx perpendicular to the dental x-ray film. The exposure time will be set to 0.25 seconds with Ortho pantomography machine of model Kodak CS8000C. For interpretation of MP3 radiograph method introduced by Rajagopal and Kansal will be used.