The knowledge of the skeletal maturation and the stage of the growth of the patients seeking orthodontic treatment are of great value in planning efficient orthodontic therapy. Cervical vertebrae in the lateral cephalograpm have been recommended as an alternative method. The pubertal growth spurt is a vital period in the orthodontic treatment and should be kept in mind when planning orthodontic treatment in growing children. One of the main objectives of taking hand and wrist radiograph is to determine the amount of growth and this will help in the selection of the appliances required, the course of the treatment and the retention after active orthodontic therapy. This article reviews some methods of skeletal age assessment using hand wrist radiographs.