Skeletal maturity indicators in orthodontics: A comprehensive review

Accurate evaluation of an individual’s growth status plays a pivotal role in orthodontic diagnosis and treatment planning. Relying solely on chronological age can be misleading due to considerable variations in biological maturation among individuals. This review explores the key indicators that are used to assess skeletal maturity, which help clinicians determine the optimal timing for growth modification therapies. Among these are radiographic methods such as hand-wrist radiography and Cervical Vertebral Maturation (CVM), which remain the gold standard in routine practice. Additionally, the review examines the relevance of dental calcification stages, frontal sinus maturation, mid palatal suture calcification, foot calcification and emerging biochemical markers. The clinical applicability, strengths, and limitations of each method are discussed in detail. Understanding and integrating these tools into clinical orthodontics can greatly enhance treatment planning, outcomes and predictability.