“…21 Pubertal growth spurt usually occurs in girls between 9 and 12 years old and boys aged 11 to 13 years. 20 Thus, orthodontists can treat this malocclusion at three different development stages: (a) Pre-pubertal; (b) During pubertal growth spurt, in order to produce both dentoalveolar and skeletal changes; or (c) Adulthood, when growth has ceased. It is crucial that clinicians learn to distinguish between these stages as it has a bearing on the choice of therapy to which the patient will be subjected, when referred to an expert.…”