GROWTH CENTRES & GROWTH SITES

Contents:

1. Introduction
2. Growth Centres
3. Growth Sites
4. Evidence based
5. References

Introduction:

Ossification -The process of bone formation by deposition of calcium in the fetal hyaline
cartilage.
Centres of Ossification
Types of Ossification:
Endochondral Ossification
Cartilage is formed first from the mesenchymal tissue which later on ossify to form the bone.
Steps in Intramembranous Ossification
Steps in Endochondral Ossification
Zones of the Epiphyseal Growth Plate
1. Zone of Reserve cartilage
2. Zone of Proliferation
3. Zone of Maturation and hypertrophy
4. Zone of Calcification
5. Zone of Ossification
Difference Between Intramembranous and Endochondral Ossification:
Growth Centre & Growth Site
Baume had coined these two terminologies.
Growth centers are places of endochondral ossification with tissue separating force,
contributing to the increase in skeletal mass.
Growth site has been defined as a region of periosteal or sutural bone formation and
modeling resorption adaptive to environmental influences.
Profitt defines
Growth site - a location at which growth occurs.
Growth Center - is a location at which independent (genetically controlled) growth occurs.
All growth centers are also sites, whereas all growth sites are not centers
Growth Centre
Cranial Base Synchondroses
Ossification of Synchondrosis:
1. Intersphenoidal synchondrosis – before birth.
2. Intra- ethamoidal synchondrosis – before birth.
3. Intraoccipital synchondrosis – before 5 years of age.
4. Sphenoethmoidal synchondrosis – around 6 years of age.
 5. Sphenoccipital or Basiooccipital synchondrosis – at 12-13 years for female, and in
male at 14-15 years and is complete by 17-18 years.
Histological structures of synchondrosis:
 Morphologically, synchondrosis is similar to the long bone growth plate.
 Except that growth at the synchondrosis is not unipolar but bipolar.
 Synchondrosis can be regarded as two growth plates positioned back to back.
 So that they share a common zone of actively proliferating chondroblasts or the ‘rest
zone’.
1. Zone of Vascular erosion and invasion.
2. Zone of matrix calcification.
3. Zone of matrix production or matrixogenic zone.
4. Zone of cellular proliferation.
5. Central zone or resting zone.
The different zones of the synchondrosis mirror each other such that there is cartilage
in the centre and bone at each end.
Relevance of Cranial Base Synchondrosis in Orthodontics:
Cranial base synchondroses play a critical role in the growth and development of the
craniofacial skeleton. Their relevance in orthodontics lies in their impact on cranial and
facial proportions, skeletal relationships, and treatment planning.
Spheno-occipital synchondrosis:
Skeletal and Dental Malocclusions:
Altered growth at cranial base synchondroses can lead to:
 Skeletal discrepancies, such as Class II (retrognathic mandible) or Class III
(prognathic mandible) malocclusions.
 Changes in the cranial base angle, which influences the anteroposterior relationships
between the maxilla and mandible.
 These discrepancies are critical in diagnosing and planning orthodontic or orthopedic
interventions.
Growth Prediction and Timing of Treatment
Understanding synchondrosis growth patterns aids in:
 Predicting the timing and magnitude of craniofacial growth.
 Deciding the optimal timing for orthodontic or orthopedic treatments, such as
growth modification using functional appliances.
For example, active growth at the spheno-occipital synchondrosis can impact the timing of
Class II & III corrections.
Nasal septum Cartilage
 Nasal septal cartilage plays a significant role in maxillary growth.
 Nasal cartilage has innate growth potential and serves as a primary growth centre.
 The nasal septum cartilage serves as a "pacemaker" for midfacial growth.
Relevance of Nasal Septal Cartilage in Orthodontics
Influence on Maxillary Position
Proper development leads to balanced facial proportions, while abnormal growth can cause
issues such as midfacial hypoplasia.
  Abnormal growth can lead to underdevelopment of the midface.
 Results in a retracted maxilla and flat facial profile.
Growth Sites
Sutures of the Cranial Vault:
Sutures are fibrous joints between the bones of the skull, providing flexibility during growth
and development.

Examples:
1. Coronal suture: Between the frontal and parietal bones.
2. Sagittal suture: Between the two parietal bones.
3. Lambdoid suture: Between the parietal and occipital bones.
Sutural Growth:
Scott and Dixon (1978) have summarized
the craniofacial sutures system as follows:
 Coronal suture promote longitudinal growth of the skull.
 Sagittal suture is responsible for growth in width of the cerebral and facial skull.
 Lambdoid suture:Growth from the suture affects mainly the back of skull.
 Craniofacial and maxillofacial suture system contribute to forcing the middle face
downwards and forwards.
Clinical relevance:
Premature fusion of cranial sutures (craniosynostosis) can disrupt normal skull growth,
leading to facial deformities.

Mid-Palatal Suture
Five maturation stages based on histological and radiographic evaluation: proposed by
Angelieri et al. (2013)
Relevance in Orthodontics
 Determines the effectiveness of rapid palatal expansion (RPE) in treating maxillary
transverse deficiencies.
 RPE is more effective before complete fusion, after which surgically assisted
expansion is required.
 Crucial for planning orthodontic and orthopedic treatments in growing patients.

Foot and Shoe Mechanism

Alveolar Process Growth: The alveolar process forms the supporting structure for teeth.

Growth Association: Tooth eruption stimulates bone growth at the alveolar region.

Microcellular Changes: Activity of osteoblasts and osteoclasts leads to bone formation

Mechanism: Bone apposition occurs as the tooth moves through the alveolar bone,
guiding the surrounding alveolar process to grow.
Orthodontic Implications:
Tooth Movement: Controlled bone remodelling facilitates orthodontic adjustments.
Growth Modulation: Functional appliances influence alveolar adaptation.
Tooth Loss: Absence of teeth reduces alveolar growth, leading to resorption.
Age-Related Considerations:
 Peak growth during mixed dentition phase.
Remodeling continues in adults, responding to functional demands.
Clinical Significance:
Guides:

Timing of orthodontic interventions.

Application of forces for desired outcomes.

Management of space maintenance or tooth replacement.

References: Enlow & Hans (1996). Essentials of Facial Growth 2. Proffit et al. (2019).
Contemporary Orthodontics 3. Bishara (2001). Textbook of Orthodontics 4. Frost
(1994). Wolff's Law and Bone Adaptation

Condylar Cartilage:

Secondary Cartilage:
Develops from mesenchymal tissue (not from primary cartilaginous skeleton).
Associated with membrane bones, distinct from primary cartilage like Meckel's cartilage.
Formation and Structure:
Not articular cartilage or an epiphyseal growth plate.
Grows appositionally, with mesenchymal cells from the intermediate layer becoming
chondroblasts.
Structure of condyle
Fibrous layer: Outer dense connective tissue.
Proliferation zone: Undifferentiated connective tissue cells.
Hyaline cartilage zone: Chondroblasts and hypertrophied cells.
Endochondral ossification zone: Cartilage resorbed and replaced by trabecular bone.