Growth and
Development(1)
Dr. Alaa Abdelgadir Ahmed
BDS(UOfK)MSC(UOfK)
Definition of Growth
Growth usually refers to an increase in size -(Todd).
Growth may be defined as the normal change in
amount of living substance – Moyers
Definition of Development
Development IS maturational process involving progressive
differentiation at the cellular and tissue levels.
Development refers to all naturally occurring progressive, sequential
and 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 is a progress towards maturity.
As can be understood from the above definitions, growth and
development are complementary to each other.
Scammon's curves
Picture shows the curves for growth of the
four major tissue systems of the body:
growth of the neural tissues is nearly
complete by 6 or 7 years of age
general body tissues, including muscle,
bone, and viscera, show an S-shaped
curve, with a slowing of growth during
childhood and an acceleration at puberty.
lymphoid tissues proliferate far beyond
the adult amount in late childhood, and
then undergo involution at the same time
that growth of the genital tissues
accelerates rapidly.
Changes in proportions of the head
and face during growth
the infant has a relatively much
larger cranium and a much smaller
face
after the age of 6 years, there is little
further growth of the cranium
because the brain has nearly
reached its adult size
the facial skeleton grows much
longer and thus in the adult forms a
much larger proportion of the skull
than in the child.
when the facial growth pattern is viewed against the
perspective of the cephalocaudal gradient, the
mandible, being farther away from the brain, tends
to grow more and longer than the maxilla, which is
closer.
Mechanics of growth
At the cellular level, there are only three possibilities for growth:
Hypertrophy is an increase in the size of individual cells
hyperplasia is an increase in the number of the cells
Secretion of extracellular material, which contribute to an increase in size
independent of the number or size of the cells themselves.
All three of these processes occur in skeletal growth.
Hyperplasia is a prominent feature.
Hypertrophy occurs in a number of special circumstances but
is a less important mechanism.
Although tissues throughout the body secrete extracellular
material, this phenomenon is particularly important in the
growth of the skeletal system, where extracellular material
later mineralizes
The fact that the extracellular material of the skeleton becomes
mineralized leads to an important distinction between growth of the
soft tissues of the body and the hard or calcified tissues.
Growth of soft tissues is called interstitial growth and it occurs at all
points within the tissue.
In contrast, when mineralization takes place, interstitial growth
becomes impossible
Growth of the bone is possible:
by direct or surface apposition- formation of
new cells occurs in the periosteum, and
extracellular material, secreted there, is mineralized
and becomes new bone
from sutures
from cartilage
Ossification
The bone growth mechanisms are primarily two:
a) Endochondral which is the primary means of ossification in the
entire body which is the chief mode of ossification within the
craniofacial complex.
Endochondral ossification – In this variety of ossification, bone forms
by replacing cartilage. This cartilage acts as an intermediary.
Mesenchyme – Cartilage cells Hypertrophy and calcification
Invasion by Degeneration of cartilage cells.
Osteogenic tissues Replacement by bone
.
Endochondral bones in the skull and facial regions are:
- Synchondrosis at the cranial base.
- Nasal septal cartilage.
- Condylar cartilage.
b) Intramembranous bone formation
This differs from endochondral ossification in that there is no
cartilaginous intermediary and bone formation can directly proceed
from mesenchymal tissue.
This is the :
Predominant mode of ossification in the skull
(cranial vault).
- Periosteal bone is always intramembranous.
- Occurs in areas of tension. .
The important regions of intramembranous
ossification within the cranial complex are:
Cranial vault.
Bones in the facial complex; ex: zygoma.
Maxilla.
Mandible, except the condyle.
Bone growth mechanisms
a) Remodelling : A process involving deposition and
resorption occurring on the opposite ends.
b) Displacement
i. Primary due to enlargement of the bone itself.
ii. Secondary due to enlargement of adjacent bones.
c) Rotation – diagonally placed areas of deposition and
resorption.
d) Remodelling and displacement combination occurring
together are the basic mechanisms in the enlargement
and movement of bone.
Study of growth
1)Measurement approach
a) Craniometry – Basic of anthropology
Precise measurements on dry skulls.
However, data is always cross sectional.
b) Anthropometry – Measurements of skeletal
variables in living individuals as well; based on
various skeletal landmarks.
c) Cephalometry – Important clinically to the
orthodontist in order to evaluate a patients skeletal
( and soft tissue) growth at a given period of time.
2)Experimental Approaches
a)Vital Staining
in which dyes(e.g alizarin) that stain mineralizing tissues are
injected into an animal. These dyes remain in the bones and
teeth and can be detected later after sacrifice of the animal.
B)Implant Radiography
In this technique, inert metal pins are placed in bones
anywhere in the skeleton, including the face and jaws. These
metal pins are well tolerated by the skeleton, become
permanently incorporated into the bone without causing any
problems, and are easily visualized on a cephalograms.
Clinical Implications
a) Head form as the basis for malocclusion.
b) Planning of therapy.
i) To evaluate the causative of the abnormality.
ii) To time the individual and accordingly plan the mode of
therapy.
d) Predict efficacy of therapy.
The craniofacial complex can be divided into four
areas :
the cranial vault, the bones that cover the upper and
outer surface of the brain
the cranial base, the bony floor under the brain, which
also is the dividing line between the cranium and the
face
the nasomaxillary complex, made up of the nose,
maxilla, and associated small bones
the mandible
