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 descriptionAttainment

SMI 1: third finger proximal phalanx, epiphysis as wide as metaphysisBefore 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 metaphysisGenerally, 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 diaphysisAfter 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

The method is also referred to as skeletal maturity assessment (SMA). SMI, skeletal maturity indicator.