Dental and Skeletal Maturity Indicators for Timing Orthodontic Treatment in Growing Children: A Narrative Review

The effect of functional orthodontic treatment depends on the child’s growth phase, for which chronological age is a poor guide. This narrative review summarises radiographic dental and skeletal maturity indicators used in paediatric orthodontics and their relationship. The Demirjian method overestimates chronological age by about 0.5–0.7 years, whereas the Willems method is more accurate in most populations; in several Balkan samples the Demirjian bias exceeded one year. Such accuracy in estimating age, however, does not indicate usefulness for locating the growth peak. Hand–wrist radiography indicates the pubertal growth spurt well but requires additional radiation. The cervical vertebral maturation (CVM) method uses a lateral cephalogram already justified for diagnosis, but its reproducibility is lowest around the pubertal peak, and its accuracy in identifying an imminent peak is limited. Dental and skeletal maturity indicators are moderately to strongly correlated, but this association, mostly from cross-sectional studies, does not allow the growth peak to be predicted in the individual child; dental stages reliably identify only the pre-pubertal phase. As a clinical proposal requiring validation, a stepwise assessment is suggested: dental age as supporting information, the CVM stage as the main skeletal indicator, and hand–wrist radiography only for uncertain stages that would change management.