GROWTH &

DEVELOPMENT
 THE PRACTICE OF
ORTHODONTICS HAS TWO
BASIC REQUIREMENTS
1. Intimate knowledge of the anatomy
and growth of the head
2. Master the techniques for regulating
tooth position
As orthodontists we should have the concepts of when, where,
why and how the facial growth occurs. The role the genetic and
environmental factors in influencing facial growth

it is necessary to have a thorough understanding of both the

pattern of normal growth and the mechanisms that underlie it and
deviations from normal pattern. it is important to distinguish
normal variation from the effects of abnormal or pathologic
processes

How the face changes from its embryologic form through

childhood, adolescence and adulthood.

Understanding of how and where the growth occurs, direction of

growth , how much growth potential is remaining and when the
growth will express itself.,

How the above factors can be modified by the operator for the
benefit of the patient and to achieve the optimal results in the
potential of each individual person.
This facetious formulation
by Krogman illustrates the
complex nature of the
biologic process we are to
discuss in this chapter
Growth was conceived by an anatomist. born
to a biologist, delivered by a physician,left on
a chemists doorstep,and adopted by a
physiologist. At an early age she eloped with
a statistician, divorced him. for a
psychologist, and is now being wooed,
alternately and concurrently,by an
endocrinologist a pediatrician, a physical
anthropologist, an educationalist, a
biochemist, a physicist, mathematician, an
orthodontist, a eugenicist & theChildren's
Bureau
 Definitions related to Growth
J.S. The self multiplication of living substance.
Huxley

Krogman Increase in size, change in proportion and

progressive complexity.

Todd An increase in size.

Meridith- Entire series of sequential anatomic and physiologic
changes taking place from the beginning of prenatal
life to senility.
Moyers Quantitative aspect of biologic development per
unit of time.

Moss Change in any morphological parameter which is

measurable
profit Growth refers to an increase in size/number
Generally growth is irreversible. It is partially
true as in the in the case of increase in the
length of the body.

Growth may be reversible as seen in the case

of increase in weight of the body .

Though growth is generally associated with an

increase in size and unidirectional , yet some
conditions involving regression are also
considered to take place during growth. For
example, the atrophy of the thymus gland
Though growth is
generally
associated with an
increase in size, yet
some conditions
involving regression
are also considered to
take place during
growth.
E.g.The atrophy of
the thymus gland.
DEVELOPMENT GROWTH IS OFTEN USED AS A SYNONYMOUS
FOR DEVELOPMENT. BIOLOGICALLY DEVELOPMENT IS A
PROCESS OF CONTINUOUS CHANGES OCCURRING IN A
PREDETERMINED DIRECTION. Thus it encompasses the normal
sequential events between fertilization and death.

Todd Development, according to Todd, is progress

towards maturity.
Profit Development is in complexity

Moyers According to Moyers, development refers to 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
death.
 Development
Development refers to 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
death.
 Differentiation
Differentiation is the change from a generalized cell or
tissue to one that is more specialized. Thus differentiation
is a change in quality or kind.

According to Todd' growth and development relies on the

other and under the influence of morphogenetic pattern;
the threefold process works its miracles; self-multiplication,
differentiation, organization-each according to its own kind!
A fourth dimension is time.
 KEY POINTS
Development = Growth +
differentiation +
translocation.
 KEY POINTS
Development is characterized by
changes in complexity, a shift to
fixation of function, and more
independence, all of which is
under genetic control, yet modified
by the environment
The changes associated with aging
i.e.,degeneration and senility are
considered by some as a part of
maturation, while others consider It
as part of development.
 KEY POINTS
9. "Normal" refers to the
expected or typical but is
misused as a goal of
treatment or when
confused with the ideal.
 KEY POINTS
10. Growth is evaluated
in chincal practice to
assess the status of the
patient, recognize any
pathologic deviations, and
plan treatment.
 Differentiation
Differentiation is the
change from a generalized
cell or tissue to one that is
more specialized. Thus
differentiation is a change
in quality or kind.
The stabilization of the
adult stage brought about
by the growth &
development is called
Maturation
FACTORS AFFECTING
PHYSICAL
GROWTH
 FACTORS AFFECTING
PHYSICAL GROWTH
1. Heredity.
2. Nutrition.
3. Illness.
4. Race
5. Socio- economic factors
 FACTORS AFFECTING
PHYSICAL GROWTH
6. Family size and birth order
7. Secular trends
8. Climatic and seasonal effects
9. Psychological disturbances
10.Exercise
 FACTORS AFFECTING
PHYSICAL GROWTH
1. Heredity.
The size of parts,Rate of growth and the
Onset of growth.
The genes hence play a major role in the
overall growth of a person.

Studies were done on twins

 FACTORS AFFECTING
PHYSICAL GROWTH
2. Nutrition.
Malnutrition may affect all aspects of
growth including size of parts, body
proportions, quality and texture of
tissues, and onset of growth events.
 FACTORS 2. Nutrition.
AFFECTING
PHYSICAL
GROWTH
The effects of malnutrition
are reversible to a certain
extent as children have
fine recuperative powers.
 FACTORS 2. Nutrition.
AFFECTING
PHYSICAL
GROWTH
Catch-up growth
If the adverse effects are
not too severe, the growth
process accelerates when
proper nutrition is
provided.
 FACTORS AFFECTING
PHYSICAL GROWTH
3. Illness.
The usual minor childhood illness
ordinarily cannot be shown to have
much effect on physical growth.

Prolonged and debilitating illness

however can have a marked effect on
all aspects of growth.
 FACTORS AFFECTING
PHYSICAL GROWTH
4. Race
Differences in growth among
different races can be attributed to
other Nutritional and environmental
factors,
 FACTORS AFFECTING
PHYSICAL GROWTH
5. Socio- economic factors
Children brought up in affluent and
favorable socio-economic conditions
show earlier onset of growth events.

They also grow to a larger size than

children living in unfavorable socio-
economic environment.
 FACTORS AFFECTING
PHYSICAL GROWTH
6. Family size and birth order
First born babies tend to weigh less at
birth and have smaller stature but higher
I. Q.

The smaller the family size, the better

would be the nutrition and other
favorable conditions.
 FACTORS AFFECTING
PHYSICAL GROWTH
7. Secular trends
Changes in size and maturation in a
large population can be shown to occur
with time.

e.g :15 old boys are approximately 5

inches taller than the same age group 50
years back.
 FACTORS AFFECTING
PHYSICAL GROWTH
7. Secular trends
It could possibly be due to changes in
socio-economic conditions and food
habits.
 FACTORS AFFECTING
PHYSICAL GROWTH
8. Climatic and seasonal effects
Seasonal variation have been shown to
affect adipose tissue content and the
weight of new born babies.

Climatic changes seem to have little

direct effect on rate of growth.
 FACTORS AFFECTING
PHYSICAL GROWTH
9. Psychological disturbances
Children experiencing stressful
conditions display an inhibition of
growth hormone secretion.

Psychological disturbances of prolonged

duration can hence markedly retard
growth.
 FACTORS AFFECTING
PHYSICAL GROWTH
10.Exercise
Exercises are essential for a healthy body,
Strenuous and regular exercises have not
been associated with more favorable growth.
Certain aspects of growth such as
development of some motor skills and
increase in muscle mass is found to be
influenced by exercise.
BASIC TENETS OF GROWTH

PATTERN
VARIABILITY
TIMING
 CONCEPTS OF GROWTH
1.Concept of normality
Normal refers to that which is usually
expected, is ordinarily seen or is typical.
 CONCEPTS OF GROWTH
1.Concept of normality
The concept of normality must not be
equated with that of the ideal. While
ideal denotes the central tendency for
the group.
 CONCEPTS OF GROWTH
1.Concept of normality
Normal refers to a range Another aspect
of cranio facial growth is that normality
changes with age.
 CONCEPTS OF GROWTH
2. Rhythm of growth

Hooton
Human growth is not a steady & uniform
process wherein all parts of die body enlarge
at the same rate & the increments of one year
arc equal to that of the proceeding
or succeeding year."
 CONCEPTS OF GROWTH
2. Rhythm of growth

This growth rhythm is

most clearly seen in
stature or body height.
 CONCEPTS OF GROWTH
2. Rhythm of growth

The first "wave" of growth is seen

in both sexes from birth to the fifth or
sixth year
CONCEPTS OF GROWTH
2. Rhythm of growth

It is most intense and rapid

during the first 2 years.

There follows a slower increase

terminating in
Boys -10th to 12th year
Girls -no later than 10th year.
CONCEPTS OF GROWTH
2. Rhythm of growth

Both sexes
another period of accelerated growth
corresponding to adolescence

Girls 14th and 16th year

Boys 16th or 18th year.
CONCEPTS OF GROWTH
3. Growth Spurt

Sudden increase in growth

is termed
"growth spurt".
CONCEPTS OF GROWTH
3. Growth Spurt

"Growth Spurt".
Periods when
a sudden acceleration
of growth occurs.
CONCEPTS OF GROWTH
3. Growth Spurt

physiological alteration in
hormonal secretion

cause for Growth Spurts

CONCEPTS OF GROWTH
3. Growth Spurt
TIMINGS OF GROWTH SPURTS.
a. Just before birth
b. One year after birth
c. Mixed dentition growth spurt
Boys : 8-11 years
Girls : 7-9 years
d. Pre-Pubertal growth spurt
Boys : 14 - 16 years
Girls : 11-13 years
CONCEPTS OF GROWTH
3. Growth Spurt

Growth modification
by means of
Functional and
orthodontic appliances
Elicit better response
during growth spurts.
CONCEPTS OF GROWTH
4. Differential growth

Different organs grow

at different rates
to a different amount
&
at different times.
 CONCEPTS OF GROWTH
4. Differential growth

1. Scammon's curve of growth

2. Cephalo-caudal gradient of growth

1. General or Somatic
curve height, weight,
skeleton, muscles
2. Genital slow in the pre-
pubertal period rapid at
adolescence
3. Neural curve brain,
skull, eyes, ears development
earlier than any other tissues
or organs no adolescent spurt
4. Lymphoid curve
tonsils, adenoids, appendix,
intestines, and spleen
pre-adolescent maximum,
followed by
regression to adult value
1. Lymphoid curve
Lymphoid tissue
proliferates
rapidly in late
childhood and
reaches almost
200% of adult size
An adaptation to protect
children from infection
By 18 years LYMPHOID
tissue undergoes
involution to reach adult
size.
2. Neural curve
Neural tissue grows very
rapidly and reaches
adult size by 6-7
years.
Very little growth of
neural tissue occurs
after 6-7 years.
3. General or
Somatic curve
Consists of the
muscles, bones and
other organs.
These tissues exhibit
an "S" shaped
curve with rapid
growth up to 2-3
years
followed by a slow
phase of growth
between 3-10 years.
After the 10th year, a
rapid phase of
growth occurs
terminating by the
18 - 20th year
4. Genital slow in the pre-
pubertal period rapid at
adolescence
 CONCEPTS OF GROWTH
2. Cephalo-caudal gradient of growth

An axis of
increased growth
extending from
head towards
the feet
 CONCEPTS OF GROWTH
2. Cephalo-caudal gradient of growth

A comparison of the
body proportion
Between pre-natal and
post-natal life
reveals Post-natal growth
of regions of the
body that are away from
the HYPOPHYSIS is more.
 CONCEPTS OF GROWTH
Cephalo-caudal gradient of growth
A. 3rd month of intra-uterine life :The head
takes up 50% of the total body length.
B. At birth:the trunk and the limbs have
grown more than the head, thereby
reducing the head to about 30% of body
length.
C. The growth continues with a progressive
reduction in the relative size of the head to
about 12% in the adult
METHODS OF GATHERING
GROWTH DATA
a.Longitudinal Studies
b.Cross sectional studies
c.Semi - longitudinal
studies
METHODS OF STUDYING
GROWTH

I.Measurement
approaches
II.Experimental
approaches
METHODS OF STUDYING
GROWTH

I.Measurement
approaches
Living individuals
METHODS OF STUDYING
GROWTH
I.Measurement
approaches
METHODS OF STUDYING
GROWTH

II.Experimental approaches -
Bimetric tests
E.g. Height, Weight,Skeletal
maturation & ossification
Compared with standards
II.Experimental
approaches
Bimetric tests
E.g.Skeletal
maturation &
ossification
II.Experimental approaches
2.vital staining

accidentally noted
that bones of
animals who had
eaten madder plants
were stained red.
II.Experimental approaches
2.vital staining

dye in the madder

plant, ALIZARIN
was identified and
used for bone
research.
II.Experimental approaches
2.vital staining

site of growth,
the direction,
duration and amount of growth
II.Experimental approaches
2.vital staining

Other dyes used

a)Acid Alizarin Blue
b)Trypon blue
c)Lead acetate
d)Tetracycline
II.Experimental approaches
3.Radioisotopes

a)Technetium 33
b)Calcium 45
c)Potassium 32
II.Experimental approaches
4.Implants

Areas
where
implants
were used