GROWTH AND DEVELOPMENT

presented by:Dr. Vandana Kararia

Definitions Acc. To Dorlands Medical Dictionary Growth .a normal process of increase in size of an organism as a result of accretion of tissue similar to that originally present.

Absolute growth an expression of actual increase in size. Accretionary growth. Increase in size resulting from increase in number of special cells by mitotic division. Allometric growth growth of different organs or parts of an organism at different rates. Appositional growth by addition at the periphery Differential growthcomparison of increase in size of dissimilar parts

Heterogeneous growth of such nature, that when plotted logarithmically gives straight lines. Histiotypic growth uncontrolled growth of cells as in tissue culture. Interstitial growth growth occurring in interior of already formed parts. Multiplicative growth increase in size by mitosis, cell size same. Organotypic growth controlled normal growth in organs. Isometric growth growth of different parts at same rate. Relative growth expression of comparison of increase in size of similar parts

DEVELOPMENT Process of growth and differentiation. Arrested unsaturation prior to normal. Cognitive development of intelligence, cognitive thought. Mosaic development of embryo in a fixed unalterable way, local regions being independent portions of a mosaic whole. Psychosexual sexuality affected by biological, cultural and emotional influences. Psychosocial personality, social attitudes.

Prenatal .before birth Postnatal after birth. Regulative development of embryo, determination of various organs and parts being gradually attained through the action of inductors.

As per Glossary of Orthodontic terms:growth age related increase in size or mass involving changes in amount of living substance. Growth is the quantitative aspect of biological development and is measured in units of increase per units of time. Enlargement of living matter with growth may be direct result of cellular division or the indirect product of biologic activity.

Growth centre: a location at which independent(genetically controlled) growth occurs as opposed to a growth site, which is merely a location at which growth occurs. All growth centers are also growth sites but not reverse. Growth factors ..highly specific serum polypeptides that are directly and specifically involved in stimulating cell division or differentiation. Growth potential amount of growth yet to occur. Growth prediction estimation of amount and direction of growth of the bones of craniofacial skeleton and the overlying soft tissues.

Def. growth is a physicochemical process by which an organism increases in size due to the interaction of genetic, congenital, environmental, sexual, metabolic and nutritive factors. Development .change towards maturity. E.g. change from fertilized ovum to full fledged organism due to the multiplicity of factors including self multiplication, histodifferentiation and morphodifferentiation.

Process of increase in size: Auxetic . Increase in size of cells e.g. hypertrophy. Multiplication hyperplasia. Accretionary.. Combination of all.

Skeleton Bone Cartilage

endochondral . Cartilage bone membranous nidus mesenchymal cells collagen fibres After formation of bone Apposition, Resorption( periosteal, endosteal)

Control of growth processes First, the growth of all bones having cartilage growth plates was presumed to be regulated entirely by the intrinsic genetic programming within the cartilage cells. Intramembranous bone growth has a different control. Such bones have an osteogenic process that is more sensitive to biomechanical stresses and strain

Thus growth control involves graded feedback chains from systemic to local tissue, cellular or molecular level. The variable stresses presumably trigger selective genetic expression or induce direct physiological changes to provide control.

Contributory factors:Vascular interruption Nerve severance Temperature changes Alteration in pH & Oxygen tension Other factors include Neurotropic effect-not exactly nerve but cytoplasmic streaming, neurohormonal Piezoeffect Activity of inductor substances

Piezoelectric effect Muscle action I Minute deformation in bone I Bioelectric changes I Triggering of osteoblast/ osteoclast action

I (first messenger stimulus) Surface receptor I Activation of membrane bound adenyl cyclase I ATP------------------ cAMP( secondary messenger) I Synthesis of specific enzymes Also mobilization of Calcium from mitochondria I Membrane permeability alters I Controls the flux of other materials (ground substance, fibers, enzymes etc.)

BONE GROWTH Osteoblast take up aa , glucose, sulfate I Utilize glycoprotein & collagen I Tropocollagen & hydroxyapatite synthesized by organelles I Matrix is laid down Alkaline glycerophosphate cause bone formation Acid phosphatase cause bone resorption Citric acid cycle & Glycolytic enzymes provide energy.

OSTEOCLAST I( First messenger is PTH/ bioelectric signal) Activates adenyl cyclasse I Increased cytoplasmic cAMP I Increased permeability of lysosomal membrane I Resorption of organic & inorganic substance by acid hydrolases, lactates, citrates

CARTILAGE Distinctive structural features It has a stiff but not hard intercellular matrix rich in chondroitin sulfate associated with noncollagenous protein which is very hydrophilic. The matrix is non calcified. It is non vascular It can grow both interstitially and appositionally. It has an enclosing vascular membrane but it can survive without one. It is uniquely pressure tolerant.

Fundamental Functions 1. Since the matrix is noncalcified it can afford to be nonvascular. Nutrients and wastes can directly diffuse to and from cells. 2. It is pressure tolerant as it is non vascular. The turgid matrix protects the cells within. 3. It can function without membrane as being non calcified diffusion is easy and surface vessels are not required. 4. It is adaptable to sites involving pressure eg. Articular surfaces,surface of epiphyseal plates.

5. It can grow in areas where membrane is absent eg. Articular surfaces, synchondroses, epiphseal plates. 6. since the matrix is non calcified cell divisions can take place

Mesenchymal cells Precartilage perichondrium Cells secrete matrix Get embedded ( Chondrocytes which are elliptical) (appositional growth) Cytoplasm accumulates glycogen and lipids Cells become rounded, get separated by matrix Redivide (Interstitial growth)

BONE It is hard and has a calcified non expandable matrix. Osteogenic capacity is thus provided by covering vascular membrane and is appositional type. It is a traction adapted tissue as vaso-occlusion takes place in pressure and thus chondrogenesis takes place rather than osteogenesis.

Intramembranous bone formation Mesenchymal cells Osteoblast Fibrous bone matrixOsteoid ( later becomes mineralized) Blood vessels are retained and matrix enclosed cells become osteocytes. Further undiff cells form osteoblast and rest divide to accommodate enlarging trabaculae.

Endochondral ossification Cartilagenous primordium Primary center of ossification Bone grows longitudinally and circumferentially (epipysis has cart., which continues to grow) It is replaced by bone (perichondrium is now periosteum)

It lays intramembranous subperiosteal bone Secondary ossification centers appear and form bony epiphysis ( Epiphyseal cart remains) Special sec cart develops in articular cart. Epiphseal plate proliferates and gets replaced by endochondral bone Central cancellous bone is also raplaced

BONE TYPES Fine cancellous bone tissue- fastest growing & porous, found in fetal skeleton, callus formation Coarse cancellous bone- has irregular large spaces with red and yellow marrow. Also called as spongy bone made of trabaculae or thin bony plates. Found in epiphysis and in cortex of flat bones as diploes. Non lamellar bone irregular and jumbled osteocytes, no stratification, c/a woven bone, rapid or moderate growth

Lamellar bone- aligned collagen fibers in layers, stratification seen, high strength, slow growing Primary vascular bone- seen in child skeleton, endosteal areas. 2 types primary- outside and inside cortex Secondary- cortical reconstruction in primary leads to haversian systemconcentric rings around vessels. Non-vascular boneseen in some species plexiform bone- massive cortical deposit in short time. bundle bone-contains parallel bundles of collagen fibers. chondroid bone-seen at rapidly growing crest of alveolar ridges or at the growing tubercle where a muscle is attached. Turns to nonlamellar bone later.

Osteocyte has a life span of 7 years. There is a cylinder like area of physiologic tissue dependence around each vascular channel. The areas distant from vessels undergo necrolysis as the canaliculi too get plugged with calcium. The cells in this area die and empty lacunae are seen. Haversian bone is secondary that replaces the primary cortex. Biochemical remodeling involves exchange of minerals and ions between bone and blood.

Growth remodeling carries out relocation of bones parts as it grows. Haversian remodeling is the internal reconstruction within the cortex. Resorption canals develop by osteoclastic activity and there is removal of primary tissue cylinder. New bone is then laid from outside to inside. Haversian systems are a feature of older skeleton and with time microcracks may be seen. It is also involved in reattachment of muscles on growing and remodeling skeleton.

GROWTH MOVEMENTS

Cortical Drift

Remodelling

Cortical drift

Surface moving towards the direction of growth is depository Surface facing opposite is resorptive. A reversal line is a region of crossover from resorptive to depository. An interplay of both may cause rotation of structures.

Displacement

Primary- the process of physical carrying is taking place in conjunction with a bones own enlargement. Secondary- the movement of bone in response to the adjoining structural growth creating a cumulative domino effect.

Certain assumed fallacies

The cranial base is truly stable and unchanging. Fixed points indeed actually exist. Sella and Nasion are actually not zero growth points. The exception is ear ossicles. Forward and downward picture of facial enlargement represents the actual mode of facial growth.

Study Acquisition of knowledge by investigation Collection of data Analysis of data Presentation Explanation

Source of data

Census Registration of vital events Hospital records & other health records
Survey of population Health interview survey (opinion) Health examination survey Health record survey

mailed question survey