Maturational age is defined in terms of both the maturational
stage and the maturational level of the patient. This approach
is different from other existing systems of maturational evaluation
and is considered essential if timing and amounts of future growth
can be more reliably estimated.
The maturational stage refers to the point of development that
been reached by the patient relative to the eventual attainment of
adulthood. Maturational stages are referred to in terms of
skeletal maturity indicators or SMIs that are identified from
inspection of the patient's hand-wrist x-ray. The 23 SMIs
currently utilized in the System of Skeletal Maturation
Assessment cover the mid to late childhood and adolescent
periods of development.
Identification of skeletal maturity indicators (SMIs) on the
hand-wrist x-rays involves an organized inspection of bony
ossification events. These include the initial developmental
appearance of selected bones and the maturational progression of
epiphyseal-diaphyseal fusion of selected bones.
Maturational level refers to the relationship between the
chronologic age relative to the existing stage (SMI) of maturation.
Two or more individuals can demonstrate the same SMI at varying
chronologic ages. In other words, an individual can be
maturationally advanced, average or delayed. The System of
Skeletal Maturation Assessment employs 14 subgroups of
maturational levels. The identification of an individual's level of
maturation is extremely significant as it reflects variations in
developmental timing and amounts of skeletal growth.
An individual's specific level of maturation can be determined and
selected references: Fishman LS Radiographic evaluation of skeletal maturation: A
clinically oriented study based on hand-wrist films. Angle Orthod
Subtelny JD Early Orthodontic Treatment. Quintessence Pub., 2000
Fishman LS, Chapter 13
Barakat R, Fishman LS. Indicators of skeletal maturational development
during infancy and childhood (senior research). Rochester, NY:
Eastman Dental Center, 1995.
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