Basic Concepts of Growth

and Development

Moderator: Dr. Sumitra

Presented by: N. Shweta
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Definition
Major themes in development
Factors affecting growth
Growth:
Nature
Pattern
Variability
Timing
Methods to study growth
Genetic influences on growth
Evaluation of physical growth
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 Growth

Todd: Growth is an increase in size

Moyer: Quantitative aspect of biologic development per unit of time

Moss: Change in any morphological parameter which is

measurable

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 DEVELOPMENT

Todd: Development is the progress towards maturity

Moyer: All the naturally occurring unidirectional changes

in the life of an individual from it’s existence as a single
cell to its elaboration as a multifunctional unit

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Growth Differentiation Transformation

DEVELOPMENT

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Differentiation: It is the change from generalised cells or
tissues to more specialized kind during development.
Differentiation is change in quality or kind

Translocation: It is the change in position

Maturation: It is a term used to express the qualitative changes

which occur with ageing
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 Major themes in
development

Changing complexity Shifts from competent

to fixative

Ubiquity of genetic
Shifts from dependent
control modulated by
to independent
the environment

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Compensatory growth

 Compensatory growth is the growth of a structure or a complex

of structures that occurs in response to environmentally,
functionally, and biomechanically mediated events

 The growth is secondary in nature

 This is a process by which morphological adaptation takes

place

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Hereditary Family size and birth order

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Illness

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Race

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Climate and seasonal effects

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Physique

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Psychological disturbance

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Socioeconomic status

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Dimensional or
auxetic growth Multiplicative growth Accretionary growth

Hypertrophy Hyperplasia Secretion of extra

cellular matrix 19
Interstitial growth

• Occurs at all points within the tissue

• Eg: Soft tissue and cartilage

Appositional growth

• Takes place only on the surface of

the tissue

• Eg: Bone and cartilage 20

 Cartilage

Primary cartilage Secondary cartilage

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Secondary cartilage:

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 Bone

Non Cellular

Cellular Non Lamellar

Lamellar
Vascular

Non Vascular

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Primary vascular bone

 Coarse
Cancellous bone
 Fine

Bundle bone

Chrondroid bone
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Mechanism of bone formation:

Endochondral ossification 25
Intramembranous ossification:

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 Mechanisms of bone growth

Modelling Remodelling

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Remodelling

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Types:
Biomechanical Haversian
remodeling remodeling

Pathologic Growth
remodeling remodeling

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Factors affecting bone remodeling

Parathyroid hormone

Mechanical factors:
Vitamin D metabolites Wolff’s law

Growth factors

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Translation Transformation

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Drift

Depositing
surface

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Displacement:

 Primary displacement

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 Secondary displacement

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Growth of Craniofacial Complex

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Cranial Vault

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Cranial base

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Maxilla

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Diagrammatic representation of
surface remodeling and
translation by growth of
adjacent structures. It is similar
to the growth of maxilla

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Mandible:

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The Expanding V Principle:

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Enlow’s Counterpart principle:

a- Anterior Cranial Base

b- Spheno-occipital
Complex
c- Nasomaxillary Complex
d- Mandible

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Growth centre

Cranial vault Cranial base Maxilla Mandible

- Synchondroses - -

Growth site

Cranial vault Cranial base Maxilla Mandible

Sutures Synchondroses Sutures and Condyle,
surfaces and sutures surfaces ramus and
other surfaces
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Cephalocaudal gradient of growth

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Scammon’s growth curve:

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Variability

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Concepts of Normality:

Statistical

Evolutionary

Functional

Aesthetic

Clinical
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Growth spurts
Female Male

Infantile or 3 Years 3 Years

Childhood
growth spurt
Mixed 6-7 Years 7-9 Years
dentition or
juvenile
growth spurt
Pre pubertal or 11-12 Years 14-15 Years
Adolescent
growth spurt 65
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 Types of growth data

Ratings
Opinion Observations and Quantitative
rankings measurements

Direct data Indirect data Derived data

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 Methods of gathering growth data

• Craniometry
Measurement approaches • Anthropometry
• Cephalometric radiographs
• Three dimensional imaging

• Vital staining
• Implant radiography Experimental approaches

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Craniometry

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Anthropometry

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Cephalometric radiographs

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Three dimensional imaging:

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3D photography:

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Vital staining

Dyes used:

Alizarin
Tetracycline
Trypan blue
Lead acetate

Radioactive tracers

Technetium 99
Calcium 45 74
Implant radiography:

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Implants are inserted in four
regions
of the mandible: (1) One in the
midline of the
symphysis; two under the first or
second
premolar or first molar, the right
side; (3) one
on the external aspect of the
ramus, right side,
(4) one under the second premolar,
left side.
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Implants are inserted in four zones in the maxilla. (1) Before
eruption of the permanent incisors, one on each side of the hard
palate, behind the deciduous canines; (2) after eruption of
permanent incisors, one on each side of the median suture,
under the anterior nasal spine; (3-4) two on each side in the
zygomatic process of the maxilla. 77
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Analysis and evaluation of growth data

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 Various centres for study of growth and development

Records were obtained annually on the three-year-old

Burlington growth children; at ages 9, 12, 14, 16, 20 years on the original
centre for six-year-old children and at 12 and 20 years on the
original 12-year-old children. This resulted in an original
craniofacial growth sample of 1258 children representing approximately 90%
at the University of of the Burlington children in these age groups. There are
also records, at various ages, of 111 siblings of the
Toronto original study group and 312 parents. Complete
orthodontic records were taken for all children consisting
of 6 Cephalometric radiographs, containing: 1 PA; 2
oblique (45 deg.); 1 lat. in occlusion; 1 lat. with open bite;
Dr. Robert Moyers 1 lat. in rest position (enlargement 9.84%); 1 hand-wrist;
(1952) Dental models; Height and weight; history containing:
diagnosis, habits, childhood diseases, ethnic background;
TA notation if applicable; details of any orthodontic
treatment given at the BGC; and photographs.
 • Founded by Robert E Moyers (1964)

• Early in his career in Ann Arbor, Moyers

Centre for Human became involved with the University of
Michigan Elementary and Secondary School
Growth and Growth Study, adding cephalometric and
Development, hand-wrist film data to the data gathered
University of annually from the students in the University’s
“laboratory school” located within the
Michigan, Ann School of Education. This extensive database
Arbor has served as a research source for many
scholars at Michigan and for those who have
come from around the world to study and
conduct research at the University of
Michigan.
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 • The Bolton-Brush Centre houses more than 200,000
radiographs of the head (lateral and frontal views) and
the major joints of the body (shoulder, elbow,
wrist/hand, pelvis, knee, and ankle/foot).

• Radiographic data was supplemented by handwritten

Bolton-Brush Growth notes regarding nutritional, dental and medical health
Study Centre, Ohio status, and disease history. Batteries of psychological
and mental tests were also given yearly as part of the
Brush Inquiry. Active data gathering for the Brush
Inquiry stopped in 1942 while the Bolton Study
Dr. Holly Brodbent continued gathering data until 1959. Over the years,
1929 radiographs were taken of the same individuals on an
annual basis for the purpose of determining how the
body grows.

• There were over 6,000 research subjects with over

2,800 of those subjects participating in both studies.
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Am J Orthod
Dentofacial Orthop
2015;148:922-38)

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Differential Impact of Msx1 and Msx2 Homeogenes on Mouse
Maxillofacial Skeleton
Cells Tissues Organs 2009;189:126–132,DOI: 10.1159/000154271

• Msx homeobox genes are expressed very early and are implicated in multiple
signalling process
• The aim of the study was to compare the patterns of expression of Msx 1 and Msx
2 genes and the experiment was done on heterozygous mice
• The results were confirmed by quantitative RT-PCR
• Msx 1 gene was expressed in the basal bone during postnatal growth
• Msx 2 was expressed strongly in alveolar bone and was also seen in growth plate
cartilages
• The osteoblasts and osteoclasts are also involved in the Msx molecular pathway
and helps to understand growth related oro- facial dysmorphologies

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Epigenetic influence of KAT6B and HDAC4 in the development
of skeletal malocclusion
Am J Orthod Dentofacial Orthop 2013;144:568-76

• Two enzymes known to change gene expressions through histone modification,

chromatin modifying histone acyltransferase KAT6B and deacetylase HD4C4, to
determine their association with musculoskeletal variation in jaw deformation
malocclusion
• Samples were obtained from masseter muscles on subjects undergoing
orthognathic surgery and the muscles were characterized for fibre type properties
by immunohistochemistry and total rna was isolated for gene expression
• Gene expression for fast isoforms of myosins and contractile proteins for KAT6B
and HD4C4 were increased several fold in masseter muscles of patients with
deep bite and class 3 patients
• This data supports the reports on epigenetic regulation in determination of
skeletal muscle phenotype and bone growth
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Major Gene and Multifactorial Inheritance of Mandibular
Prognathism
American Journal of Medical Genetics Part A 146A:71–77 (2008)

• Mandibular prognathism shows familial aggregation.

• Various genetic models are described and it is assumed to a multifactorial and a
polygenic trait
• The aim was to examine specific genetic models of familial transmission of this
trait
• 2562 individuals from 55 families were chosen.
• Analysis showed more affected females than males.
• Pedigrees suggest autosomal dominant inheritance with incomplete penetrance.
Major gene that influences the expression of mandible prognathism with signs of
mendelian inheritance and multifactorial components

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The ADAMTS1 Gene Is Associated with Familial Mandibular
Prognathism: Journal of Dental Research2015, Vol. 94(9) 1196–1201

• The goal of this study was to identify candidate genes or genomic regions
directly associated with mandibular prognathism development, by
employing whole genome sequencing.
• A large Chinese family was recruited, composed of 9 affected and 12
unaffected individuals, and the inheritance pattern of this family tends to
be autosomal dominant.
• A single-nucleotide missense mutation in the ADAMTS1 gene (c. 742I>T)
was found to segregate in the family, given that the affected individuals
must be heterozygous for the mutation.
• Final results suggested that 2 single-nucleotide polymorphisms (rs2738,
rs229038) of ADAMTS1 were significantly associated with mandibular
prognathism.

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Heritability of malocclusion: Influence of genetics in
malocclusion- Twin study-British journal of orthodontics/vol.26/1999/195-203

• Horowitz et al studied adult monozygotic and dizygotic twins using

lateral cephalogram. The statistics derived from the data indicated that
there was highly significant hereditary variation in anterior cranial
base, mandibular body length and lower facial height.

• Studies concluded that although genetic factors appear to govern the

basic skeletal form and size, environmental factors have much
influence on bony elements and they both combine to achieve
harmonious or disharmonious head and face.

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Genetics of Craniosynostosis: Genes, Syndromes, Mutations and
Genotype-Phenotype Correlations
Craniofacial sutures- Development, disease and treatment, Frontiers of oral biology, volume 12

• Interaction between epithelial and mesenchymal cells is vital to the normal development of
the craniofacial skeleton. The critical involvement of fibroblast growth factor receptor
(FGFR) signalling system in these interactions has been highlighted by the discovery that a
set of congenital craniosynostosis syndromes– Apert, Pfeiffer, Crouzon and Jackson-Weiss –
are caused by mutations in FGFR genes.

• The affected children show premature fusion of sutures that separate the calvarial and facial
bones and these may be accompanied by limb as well as sporadic visceral and neural
anomalies

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Temporomandibular joint formation requires two distinct
hedgehog-dependent steps
www.pnas.org/cgi/doi/10.1073/pnas.1000188107

• The condyle is an important growth site in the mandible with similarities to the growth
plate of the long bones, and it displays four distinct zones: a fibrous cell layer, a
progenitor cell layer, a zone of flattened chondrocytes, and a zone of hypertrophic
chondrocytes.

• One key gene previously noted to be expressed during and function within the growth
plate of the condylar cartilage is Indian hedgehog (Ihh) (20–22). Ihh has been studied
extensively during endochondral ossification of the long bones, where it plays several
distinct roles.

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Evaluation of physical growth:

 Why assess?

 Questions to be asked

 General growth standards

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References:
1. Contemporary Orthodontics, William R profit, 5th edition

2. The Human Face, Donald H Enlow

3. Handbook of Orthodontics, Robert E Moyers, 4th edition

4. Essentials of Facial Growth, Donald H Enlow, Mark G Hans

5. Introduction to Craniofacial Biology, David S Carlson

6. Orthodontic Principles and Practice, T. M . Graber

7. Orban’s Oral Histology and Embryology, 14th edition

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8. www.pnas.org/cgi/doi/10.1073/pnas.1000188107
9. Craniofacial sutures- Development, disease and treatment, Frontiers of oral
biology, volume 12
10. Journal of Dental Research2015, Vol. 94(9) 1196–1201

11. American Journal of Medical Genetics Part A 146A:71–77 (2008)

12. Am J Orthod Dentofacial Orthop 2013;144:568-76

13. Cells Tissues Organs 2009;189:126–132,DOI: 10.1159/000154271

14. Am J Orthod Dentofacial Orthop 2015;148:922-38)

15. Am. J. PHYS. ANIHROP., 29: 243-254.

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Life is change; for when you are through changing, you are through.
- Bruce Barton

Thank you

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