Why is it essential to describe maturational age in terms of
                             both maturational stage and maturational level?



                Every progressive maturational stage, as depicted by selected
                    skeletal maturity indicators (SMIs), represents an increasing
                    percentage amount of total skeletal growth completed.  Variations
                    in the maturational level (advanced vs. average vs. delayed) 
                    represent significant differences in the percentages of total
                    growth completed at the same maturational stage.

                   This is demonstrated in the following chart depicting downward 
                    and forward growth of the the mandible (S-Gn)
at a few selected 
                    maturational stages.  


          2           91.50               88.83              88.66              87.75

           4           92.37               92.20              91.82              90.91

           6           93.17               92.84              92.75              92.64

                    advanced                 average                average                delayed

    The combination of fourteen (14) maturational levels and twenty-three (23)
     maturational stages represents a comprehensive data base for each sex.
     Variations in the percentages of total maxillary and mandibular growth   
     also vary relative to the maturational stage and maturational level.  On the
     basis of this complex set of longitudinal data, estimations of future maxillary 
     and mandibular growth can be individualized and estimated.   

     In regard to the timing of growth, every progressive maturational stage,  
     as depicted by selected skeletal maturity indicators (SMIs) viewed on the
     hand-wrist x-rays, represents an decrease in the future time required to
     achieve adult termination of growth.  Variations in the maturational level   
     (advanced vs. average vs. delayed) represent significant differences in
     the time periods between the maturational stages.

     This is demonstrated in the following chart depicting chronologic age 
     values at a few selected maturational stages.           


       1               9.157                          10.230                         11.302         

        3               9.914                          10.872                         11.831       

        7             11.369                          12.512                         13.655         
advanced       B- average      C- average       D- delayed






         Variations in maturational level (advanced vs. average vs. delayed)
           also directly influence the timing of growth termination ( SMI 11 ).

    selected reference: Fishman, LS. Maturational patterns and prediction during
                                                adolescence. Angle Orthod 1987;57:178-193

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