Review Article
Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies
Table 1
Description of the stages of the hand and wrist maturation (HWM) method according to Fishman [
35].
| Stage description | Attainment |
| SMI 1: third finger proximal phalanx, epiphysis as wide as metaphysis | Before the standing height and mandibular growth peaks (prepubertal) | SMI 2: third finger middle phalanx, epiphysis as wide as metaphysis | SMI 3: fifth finger middle phalanx, epiphysis as wide as metaphysis | SMI 4: thumb, appearance of adductor sesamoid |
| SMI 5: third finger distal phalanx, epiphysis showing capping towards the metaphysis | Generally, at coincidence of the standing height and mandibular growth peaks (pubertal) | SMI 6: third finger middle phalanx, epiphysis showing capping towards the metaphysis | SMI 7: fifth finger middle phalanx, epiphysis showing capping towards the metaphysis |
| SMI 8: third finger distal phalanx, fusion of epiphysis and diaphysis | After the standing height and mandibular growth peaks (postpubertal) | SMI 9: third finger proximal phalanx, fusion of epiphysis and diaphysis | SMI 10: third finger middle phalanx, fusion of epiphysis and diaphysis | SMI 11: radius, fusion of epiphysis and diaphysis |
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The method is also referred to as skeletal maturity assessment (SMA). SMI, skeletal maturity indicator.
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