GROWTH AND DEVELOPMENT

BASIC PRINCIPLES

Contents Introduction
Knowledge about normal growth and how it occurs is essential so that one can distinguish any deviation. To know about the timing of growth so that one can Work with growth.

DEFINITIONS Growth
Growth refers to increase in size - Todd Growth usually refers to an increase in size and number Proffit Quantitative aspect of biologic development per unit of time- Moyers Change in any morphological parameter which is measurable - Moss

Development
Development is a progress towards maturity Todd All the naturally occurring unidirectional changes in the life of an individual from its existence as a single cell to its elaboration as a multifunctional unit terminating in deathMoyers

Growth is largely an anatomic phenomenon and quantitative in nature. Development is a physiologic and behavioral phenomenon and qualitative in nature. The two processes depend on each other and under the influence of the morphogenetic pattern, the three fold process- self multiplication, differentiation, organization growth and development occurs, time being the fourth dimension.

Morphogenesis
A biologic process having an underlying control at the cellular and tissue levels. Morphogenesis works towards a state of balance among all growing parts.

Normal features of growth and development

Pattern -Differential Growth -cephalocaudal gradient of growth - predictability Variability - concept of normality Timing

PATTERN
Pattern in growth represents proportionality of a subject in relation to its various sizes.It refers not just to proportionality at a point of time but to changes in these proportional relationships over time

DIFFERENTIAL GROWTH
Different tissues grow at different rates and at different times. Scammons curve of growth. -Richard Scammon

SCAMMONS CURVE OF GROWTH LYMPHOID NEURAL GENERAL GENITAL CEPHALOCAUDAL GRADIENT OF GROWTH Changes , part of normal growth pattern reflect Cephalocaudal gradient of growth It means there is an axis of increased growth from the head towards the feet. CEPHALOCAUDAL GRADIENT OF GROWTH

Predictability
Predictability of growth pattern is a specific kind of proportionality that exists at a particular time and progresses towards another, at the next time frame with slight variations. Change in growth pattern indicates some alteration in the expected changes in body proportions.

Variability
It indicates the degree of difference between two growing individuals. Since no two individuals grow alike, it is important to identify if an individual is at the extreme of normal variation or outside the range.

Normality
Normality refers to that which is usually expected, is ordinarily seen or typical Moyers Normality may not necessarily be ideal so rather than categorizing as normal or abnormal one can think of deviations from the normal pattern One way to evaluate normality is using growth charts. Used to determine if growth is normal in 2 ways-location of the individual relative to the group.

- follow a childs growth to evaluate any unexpected changes.

Timing
One of the factors for variability in growth. Timing variations arise because biologic clock of different individuals is set differently. Timing-largely genetically controlled. -sex related differences -physical differences -environmental

Variation in growth and development because of timing are evident in human adolescence. Plotting change in weight or height shows the pattern of growth. The distance and velocity graphs can be plotted and compared.

Growth spurts
Periods of growth acceleration Due to physiological alteration in hormonal secretion Timing-sex linked Normal spurts are Infantile spurt at 3 years age Juvenile spurt 6-7 years (females); 8-10 years (males) Pubertal spurt 11-12 years(females); 14-15 years (males)

Pubertal growth spurt: Important period for orthodontic treatment. -Initiated in the brain-secretion of releasing factors, pituitary gonadotropins.PTH,Vit D,Calcitonin.G.H.-Somatotropin,Testosterone, Estrogen.
-Timing -2 years earlier in girls.

-Affected by genetic and environmental factors.

Cross sectional studies

Involves gathering data from different samples.
ADVANTAGES repeating Quicker Less costly

DISADVANTAGES Variation amongst individuals cannot be studied

Methods of studying growth

Measurement approach
craniometry anthropometry cephalometric radiography

Experimental approach
vital staining autoradiography radioisotopes implant radiography

SITES OF IMPLANT PLACEMENT Maxilla:

Mandible Anterior aspect of symphysis, in the midline below the root tips. 2 pins on the right side of the mandibular body. One under the first premolar & the other below the second premolar or first molar. One pin on the external aspect of right ramus in level with the occlusal surface of molars.

Nature of skeletal growth

Hyperplasia Hypertrophy Secretion of extracellular matter

Mechanism of growth in soft tissues

In soft tissues growth occurs mainly by a combination of two mechanisms namely: --Hyperplasia-increase in the number of cells. --Hypertrophy-increase in size of cells. Secretion of extracellular material also contributes to growthbut different from hard tissue growth as it does not mineralize. Hyperplasia is the main mechanism hypertrophy occurring secondarily. Interstitial growth-growth occurring at all points in a tissue. Also occurs in uncalcified cartilage.

Types of growth in hard tissues

Two mechanisms Endochondral bone formation: Process of converting cartilage into bone Intramembranous bone formation: Process of bone formation from undifferentiated mesenchymal tissue.
Steps in bone formation

Undifferentiated connective tissue undergoes series of changes. Some cells develop into osteoblasts. Osteoblasts produce osteoid tissue. Cells and blood vessels are encased. Osteocytes are formed Osteoid tissue continues to be produced by membrane cells. Osteoid calcifies. Essential membrane covers bone.

Endochondral ossification
It is the conversion of hyaline cartilage prototype models into bone. Interstitial growth or expansion capability of cartilage allows directed prototype cartilage growth which is then replaced by endochondral bone.
Steps in bone formation

Hypertrophy of chondrocytes and matrix calcifies Cells degenerate Invasion of blood vessels and connective tissue cells. Osteoblasts differentiate and produce osteoid tissue. Osteogenic tissues replace degenerating cartilage. osteoblastic tissue calcifies.

Intramembranous ossification
frontal,parietal,zygomatic,maxilla,nasal,palatine, lacrimal,vomer.

Endochondral ossification ethmoid,inferior nasal chonchae Both occipital,temporal,mandible,sphenoid.

Mechanisms of bone growth

Deposition and resorption Growth fields Modelling Remodelling Growth movements Drift Displacement Rotations

Deposition and resorption

Bone sides which face the direction of growth are subject to deposition (+) and those opposite to it undergo resorption(-) Bone produced by covering membrane is periosteal bone.Bone produced by lining membrane is endosteal bone.Both comprise half of the cortical bone tissue.

Growth fields
Inside and outside of every bone is covered by growth fields which control the bone growth. Spread along the bone in a mosaic pattern. They are both resorptive and depository types.

Provides two growth functions: 1)Enlargement of any given Bone 2)Remodelling of any given bone

Growth sites
Growth fields having special role in the growth of the particular bone are called growth sites e.g. mandibular condyle, maxillary tuberosity, synchondrosis of the basicranium, sutures and the alveolar process.

Growth centers

Special areas which are believed to control the overall growth of the bone e.g.mandibular condyle,sutures. They are special growth sites.eg.epiphyseal plate of long bone.these supoosed to behave an intrinsic growth potential.

Modelling
It involves independent sites of resorption and deposition that change the shape and size of a bone.

Remodelling
Bone shaping involves resorption and deposition on the opposite sides of the bone.

Growth movements
Cortical drift
It occurs towards the depository surface by a combination of resorption and deposition on opposing surfaces simultaneously.

Displacement
Primary displacement occurs in conjunction with the bones own growth. Secondary displacement occurs due to growth of adjacent bone/s.

Rotation
Occurs when rate of resoprtion and deposition are unequal.

Theories of growth control

Genetic theory Sutural dominance theory Cartilaginous theory Functional matrix theory Servosystem theory

Importance of Growth and Development to Orthodontist