Biological indicators of skeletal maturity refer mainly to somatic changes at puberty, thus emphasizing the known interaction between the development of craniofacial structures and the modifications in the adjacent structures. Somatic maturity is recognized by the annual growth increments in height or weight. The changes of secondary sex characteristics, voice changes in boys and menarche in girls, are characterized as sexual maturity. The usefulness of these two maturity indicators has limited value for the immediate clinical judgment of a patient's maturity stage because these indicators can be applied only after the serial recording of height or the inception of puberty. 1The technique for assessing skeletal maturity consists of visual inspection of the developing bones -their initial appearance and their subsequent ossification-related changes in shape and size. Various areas of the skeleton have been used: the foot, the ankle, the hip, the elbow, the hand-wrist, and the cervical vertebrae. 2There are some limitations in the interpretation of skeletal maturity from hand-wrist radiographs.The ossification sequence and timing of skeletal maturity within the hand-wrist area show polymorphism and sexual dimorphism, which can limit the clinical predictive use of this method. Moreover, there are concerns about the extra radiation exposure resulting from use of this method, and its use must be questioned if other comparable methods of assessment are available. Finally, events in the hand and wrist are indicators of the peak and the end of the pubertal growth spurt, but these events do not signal the onset of the pubertal growth spurt. 3,4 In 1972, Lamparski offered standards of cervical vertebral maturation for boys and girls. Hassel and Farman detailed these cervical vertebra maturation indexessuggesting six stages for cervical vertebral maturation and found a high correlation between cervical vertebral and hand-wrist maturationand stated that the cervical vertebral analysis can be used in the assessment of skeletal maturity 5 . Baccetti et al (2005) has modified their method to six stages based on