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this is basic growth and development chapter for undergraduate orthodontics
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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 chemist’s 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. Huxley
“The self multiplication of living substance.”
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 generallyassociated 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 POINTSDevelopment = 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 PHYSICALGROWTH
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 AFFECTING PHYSICAL GROWTH
2.Nutrition.
The effects of malnutrition are reversible to a certain extent as children have fine recuperative powers.
FACTORS AFFECTING PHYSICAL GROWTH
2.Nutrition.
Catch-up growthIf 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 illnessordinarily cannot be shown to havemuch effect on physical growth.
Prolonged and debilitating illnesshowever can have a marked effect onall 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 andfavorable socio-economic conditionsshow earlier onset of growth events.
They also grow to a larger size thanchildren 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 alarge population can be shown to occurwith 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 toaffect 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 prolongedduration can hence markedly retardgrowth.
FACTORS AFFECTING PHYSICAL GROWTH
10.ExerciseExercises 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 GROWTH1.Concept of normality
Normal refers to that which is usually expected, is ordinarily seen or is typical.
CONCEPTS OF GROWTH1.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 GROWTH1.Concept of normality
Normal refers to a range Another aspect of cranio facial growth is that normality changes with age.
CONCEPTS OF GROWTH2.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 GROWTH2.Rhythm of growth
This growth rhythm is most clearly seen in stature or body height.
CONCEPTS OF GROWTH2.Rhythm of growth
The first "wave" of growth is seen in both sexes from birth to the fifth or sixth year
CONCEPTS OF GROWTH2.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 GROWTH2.Rhythm of growth
Both sexes another period of accelerated growth
corresponding to adolescence
Girls 14th and 16th yearBoys 16th or 18th year.
CONCEPTS OF GROWTH3.Growth Spurt
Sudden increase in growth is termed
"growth spurt".
CONCEPTS OF GROWTH3.Growth Spurt
"Growth Spurt".Periods when
a sudden acceleration of growth occurs.
CONCEPTS OF GROWTH3.Growth Spurt
physiological alteration inhormonal secretion
cause for Growth Spurts
CONCEPTS OF GROWTH3.Growth Spurt
TIMINGS OF GROWTH SPURTS.a. Just before birth b. One year after birthc. Mixed dentition growth spurtBoys : 8-11 yearsGirls : 7-9 yearsd. Pre-Pubertal growth spurtBoys : 14 - 16 yearsGirls : 11-13 years
CONCEPTS OF GROWTH3.Growth Spurt
Growth modificationby means ofFunctional and orthodontic appliances Elicit better response during growth spurts.
CONCEPTS OF GROWTH4.Differential growth
Different organs growat different rates
to a different amount&
at different times.
CONCEPTS OF GROWTH4.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 curvetonsils, adenoids, appendix, intestines, and spleenpre-adolescent maximum, followed byregression to adult value
1. Lymphoid curveLymphoid 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 GROWTH2. Cephalo-caudal gradient of growth
An axis of increased growth extending from head towards the feet
CONCEPTS OF GROWTH2. Cephalo-caudal gradient of growth
A comparison of the body proportion Between pre-natal and post-natal lifereveals Post-natal growth of regions of the body that are away fromthe HYPOPHYSIS is more.
CONCEPTS OF GROWTHCephalo-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 GATHERINGGROWTH 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
E.g. Height, Weight,Skeletal maturation & ossification
Compared with standards
II.Experimental approaches -Bimetric tests
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