Physiologic Markers: Height and weight have limited predictive value for future growth rates.
Pubertal Markers: Voice deepening (males) and menarche/breast development (females) are accurate but not applicable in dental clinics.
Chronological Age: Girls (11.13 years) and boys (13.15 years) are convenient but do not correlate well with skeletal maturation.
Dental Age: Panoramic X-rays show a weak correlation with puberty.
Biological Skeletal Age (Most Accurate):
Skeletal Maturation Index (SMI): Uses adductor sesamoid via left-hand radiographs.
Cervical Vertebral Maturation Index (CVMI): Uses lateral cephalometric X-rays; CVMI 2 corresponds to SMI stage 4.
Concepts of Craniofacial Growth
Cortical Drift: Bone deposition occurs in the direction of growth, with resorption on the opposite side.
Mosaic Pattern: Outside and inside bone surfaces undergo continuous deposition and resorption.
Bone Composition: Facial and cranial bones derive half their cortical bone from endosteal and half from periosteal sources.
Functional Matrix Theory: Growth is controlled by the soft tissue matrix (e.g., mouth breathing leads to facial elongation).
Growth Centers: High-rate growth areas include facial and cranial sutures, mandibular condyle, maxillary tuberosity, alveolar bone, and cranial base synchondroses (spheno-occipital, spheno-ethmoidal, intersphenoidal, and intra-occipital).
Relocation and Remodeling: Relocation is the sequential movement of bone components in the direction of growth. Remodeling involves reshaping and resizing (e.g., mandibular ramus relocation and maxillary nasal chamber enlargement).
Primary Displacement: Physical movement of the whole bone as it grows and remodels (e.g., nasomaxillary complex).
Secondary Displacement: Movement of a whole bone caused by the enlargement of a nearby bone.
