GROWTH – PRINCIPLES

AND CONCEPTS
Dr.Pranali P Agawane
Department of orthodontics and
dentofacial orthopaedics
Terna dental college
content
 Definations
 Growth:pattern,variability,timing
 Growth spurts
 Growth field,site and centre
 Nature of skeletal growth
 Growth movements
 Osteogenesis
 Primary and secondary cartilage
 V principle
 Surface principles
 Growth equivalent concept
 Method of studying physical growth
DEFINATION OF GROWTH
 The self multiplication of living substance
(J.S.Huxley)
 Increase in size,change in proportion and
progresive complexity (Krogman)
 An increase in size (Todd)
 Entire series of sequential anatomic and
physiological changes taking place from the
beginning of prenatal life to senelity (Meridith)
 Quantitative aspect of biological
development per unit time (Moyers)
 Change in morphological parametre
which is measurable (Moss)
DEFINATION OF DEVELOPMENT
 According to TODD
Development is progress towards maturity .
 According to PROFFIT
Development cannotes an increase degree
of organisation often with unfortunate
consequences for the natural environment.
 According to MOYERS
All the naturally occuring unidirectional
changes in the life of an individual from its
existance as a single cell to its elaboration as
a multifunctional unit terminating in a death
 According to WEBSTER
Development is defined as going through
natural growth , diffrentiation or evolution by
succesive changes .
 According to ENLOW
Facial growth and development is a morphogenic
process working towards a composite state of
aggregate structural and functional balance
among all the multiple ,regional growing and
changing hard and soft tissue parts .
 Growth and development though closely
related but are not synonymous
 Growth- anatomic phenomenon
Development - physiological and
behavioural

PROFFIT
 A thorough background for craniofacial
growth is necessary for every dentist
 To distinguish normal variation from the
effects of abnormal and pathologcal
process.
 To manipulate facial growth for the
benefit of the patient
Growth
 Pattern
 Variability
 Timing

 -PROFFIT
PATTERN
 Pattern in growth also represents
proportionality, but in a still more
complex way.
 It refers not just to a set of proportional
relationships at a point in time, but to the
change in these proportional
relationships over time.
 The physical arrangement of the
human body at any one time is a pattern
of specially proportioned parts.
 Important aspect of pattern is its
predictability i.e pattern repeats. The
only difference between the geometric
pattern and growth pattern is time
dimension
CEPHALO-CAUDAL GRADIENT OF
GROWTH
SCAMMON’S GRPWTH SPURT
VARIABILITY
 It decide whether an individual is merely
at the extreme of the normal variation or
falls outside the normal range.
 Rather than categorizing people as
normal or abnormal, express variability
quantitatively.
 One way to do this is to evaluate a given
child relative to peers on a standard
growth chart.
TIMING
 A final major concept in physical growth
and development is that of timing
 Variation in timing arises because the
same event happens for different
individuals at different times-or,viewed
differently,
 The biologic clocks of different
individuals
are set differently.
Growth spurts
 Growth does not take place uniformly at
all times
 There seems to be period when sudden
acceleration of growth occurs.
 This sudden increase in growth is
termed growth spurts .

-PROFFIT
 Timing of growth spurt
 A)just before birth
 B)one year after birth
 C)mixed dentition growth spurt
boys : 8- 11 years
girls : 7-9 years
 Prepubertal growth spurts
boys : 14-16 years
girls : 11-13 years
Significance of growth spurts
 Growth modification by means
Functional appliances and orthodontic
appliances
 surgical correction of maxilla and
mandible after the cessation of growth
spurts
Terminologies related to growth
 Growth field :outer and inner surface of
bone are blanked by mosaic like pattern
of soft tissue ,cartilage and periosteum .
 Growth field is responsible for bone
enlargement and consist of remodelling
and displacement .
Growth site
 Some growth field have traditionally
signeled out for special attention .
 These special growth sites includes the
sutures of face and cranium ,maxillary
tuberosity and alveolar bone .
 These sites does not carry out the entire
growth process but all inner and outer
surfaces of given bone also actively
participate in the overall growth
Growth centre
 Growth centre having intrinsic growth
potential ,tissue separating force, and
essentially endochondral in type. –
Baume
 Cartilage by the virtue of its interstitial
growth ,turgidity and resistance to
deforming forces can separate growing
bone at sutures just as brain or eye ball
can –Scott,1967
 But according to Enlow ,
 It is now believed that such centres do
not control the growth process ,as they
are not master process .
 No part is developmentally
independentant and self contained ;this
is fundamental and very important
principle of growth.
THE NATURE OF SKELETAL
GROWTH
 At cellular level
1. hypertrophy: Increase in the size of
individual cells.
2.hyperplasia: Increase in the number of
the cells.
3. the cells to secrete extracellular
material,thus contributing to an increase in size
independent of the number or size of the cells
themselves.
PROFFIT
SOFT TISSUE GROWTH
 Soft tissue growth
 combination of hyperplasia and
hypertrophy.
 Interstitial growth, which simply means that
it occurs at all points within the tissue.
 Secretion of extracellular
 Interstitial growth is characteristic of nearly
all soft tissues

-PROFFIT
 SURFACE APPOSITION:
Formation of new cells occurs in the
periosteum, and extracellular material
secreted there is mineralized and becomes
new bone.
 Interstitial growth is a prominent aspect
of overall skeletal growth.
-PROFFIT
Endosteal and periosteal bone growth
 Approximately half the cortical plate of
the facial and cranial bones is formed by
the periosteum, and the other half by
the endosteum.
 The same cortex is composed of
periosteal and endosteal bone layers
which are separated by reversal lines.
 The reversal line represents the
interface between endosteally and
periosteally produced by one layers.
Remodelling
 Differential Growth activity involving
simultaneous deposition and resorption
of all inner and outer surfaces of bone.
 There are 4 kinds of remodelling in bone tissue
1. Biochemical remodeling- deposition and
removal of ions
2.Secondary reconstruction of bone by
haversian system-Rebuilding of cancellous
trabaculae.

3.Remodeling following disease and trauma

4.Growth Remodeling
-ENLOW
GROWTH MOVEMENTS
 Drift
 A combination of bone deposition and
resorption resulting in a growth
movement towards the depositing
surface .
 Displacement:
It is the movement of a whole bone as a
unit .
 displacement can be of two types:

 Primary displacement.
 secondary displacement.
 Primary displacement:
 Bone gets displaced as a result of it’s
own growth.
 The respective direction of growth
and movement is always opposite.

-Bhalaji
 Secondary displacement:

Bone gets displaced as a result of growth

and enlargement of an adjusent bone
Osteogenesis
 Osteogenesis – The process of bone
formation.
 Two types:
 1.Endochondral bone formation.
 2.Intramembranous bone formation.
Endochondral bone formation
 Bone formation is preceded by formation of
a cartilageneous model that is subsequent
replaced by bone.

mesenchymal cells become

condended at the site of bone formation

Chondroblast
 Lay down hyaline cartilage

perichondrium contains osteogenic cells

Intercellular substance surrounds the

cartilage cells becomes calified
Death of cartilage cells leads to formation
of empty spaces(primary areolae)

Secondary areolae
(due to eating away of calcified matrix)

Osteogenic cells of perichondriun becmes

osteoblast
Osteoblasts lay down osteoid ,which
later becomes calcified to form lamella

another layer of osteoid is sectreated

and this goes on and on
Intramembranous bone formation
 Bone is led down directly on fibrous
membrane

Mesenchymal cells becomes aggregated

Lay down collagen fibres

Mesenchymal cells enlarge and form

osteoblast
Secret osteoid around the collagen matrix

Osteoblasts deposite calcium into osteiod

(conversion of osteoid into bone lamella)

New layer of osteoid get secreated and get

calcified
 Cartilage
 Cartilage is solid connective tissue that
is to a certain extent pliable making it
reselient.

 Function:
 Cartilage nutrition.
 Appositional growth and regeneration.
 Primary cartilage

 Derivatives of primordial cartilage

 Chondroblasts divide and synthesis intercellular
matrix
 The dividing chondroblasts are surrounded by
cartilageneous matrix .
 Cells arrenged in columnar fashion.
 Not influenced by environmental factors
 Growth is interstitial
 Considered to be genetic pacemaker of growth.
 Secondary cartilage

 Forms membranus bone

 No intercellular matrix
 Not surrounded by cartilagenous matrix
 Cells are arrenged in hapazard manner .
 Affected by external influences which will
stimulus growth
 Only peripheral growth takes place
 Contribute only regional adaptive growth.
 V PRINCIPLE
 A most useful and basic concept in facial
growth
 INNER SIDE OF V: Deposition
 OUTER SIDE OF V: Resorption
 The direction of movement is toward the
wide end of the V.
Expanding V principle—vertical
expansion.
The ‘V’ principle—horizontal expansion.
 It will cause:

 Enlargement of overall size of V-shaped

area

 Movement of the entire “V” structure

toward its wide end
SURFACE PRINCIPLE
 Bone sides which facing the direction of
the growth are subject to deposition
 And those opposed to the direction of
growth undergo resorption.
 The direction of growth is not the same
for all areas of the bone as each region
of a structure has its own specific growth
pattern.
 As individual parts of the bone grow in
different directions
 Half of the deposition process - on the
outer cortical plate (periosteal bone
formation).
 The other half of the of bone deposition-
on the inner cortical surface (endosteal
bone formation).
Growth equivalent concept (Enlow
counterpart principle)

 According to Enlow, the growth activity

in one region is invariably accompanied
by complementary growth in other
regions. This complementary activity is
essential for maintaining functional and
esthetic balance.
 Imbalance leads to protrusion or
retrusion
Methods of studying physical growth

 Craniometry
 Anthropometry
 Anthropometry
 Three-Dimensional Imaging.
Craniometry
 craniometry, based on measurements of
skulls found among human skeletal
remains.
 From such skeletal material, it has been
possible to get some idea of their
pattern of growth by comparing one skull
with another.
 Precise measurements can be made on
dry skulls.
Anthropometry
 It is also possible to measure skeletal
dimensions on living individuals.
 Various landmarks established in studies of
dry skulls are measured in living individuals
simply by using soft tissue
 Although the soft tissue introduces variation.
 Farkas'anthropometric studies have provided
valuable new data for human facial
proportions and their changes over time.
Cephalometric Radiology.
 Combine the advantages of craniometry
and anthropometry.
 Direct measurement of bony skeletal
dimensions.
 Superimposing a tracing or digital model
of a later cephalogram on an earlier one.
 Disadvantage:two-dimensional
representation of three-dimensional
structure.
Three-Dimensional Imaging.
 Computed axial tomography (CAT or iust
CT):
-3-D reconstructions of the cranium and face.
-Surgical treatment for patients with facial
deformities.
 Magnetic resonance imaging(MRI):
USE:Analysis of the growth changes
produced by functional appliance.
 ADVANTAGE:No radiation exposure
EXPERIMENTAL APPROACHES
 Vital Staining
 Dyes that stain mineralizing tissues( or
occasionallys, oft tissues) are injected into an
animal.
 These dyes remain in the bones and teeth
and can be detected.
 The active agent was a dye called alizarine.
 The gamma-emitting isotope ee-Tc can be
used to detect areas of rapid bone growth
and diagnosis of localized growth problems.
Implant Radiography
 Inert metal pins are placed in bones
anywhere in the skeleton.
 Precise evaluation of dentofacial growth
in humans using Implant cephalogram.
Reference
 Contemporary orthodontics -PROFFIT
 Essentials of facial growth –ENLOW
AND HANS
 Textbook of craniofacial growth –
SHRIDHAR PREMKUMAR
 BHALAJI
THANK YOU