Clinical implications of growth & development
- 1. Clinical Implications of Growth and Development PROF (Dr.) SAIBEL FARISHTA
- 2. Growth Spurts Changes in Inter- canine width Growth Timing Direction Rotation
- 3. Growth Spurts Growth does not take place in a steady manner, there are certain periods where there is a sudden increase in growth,which is called Growth Spurt. These growth spurts are sex linked. The greatest increment are actually at the 3 year age level. The second peak is from 6 to 7 years.
- 4. Appearance of Growth Spurts MALE FEMALE First Peak 3 years 3 years Second Peak 7 to 9 years 6 to 7 years Third Peak 14 to 15 years 11 to 12 years
- 5. Clinical implications A knowledge of growth spurt is essential for successful treatment planning in orthodontics. This helps to decide the timing of orthodontic treatment, i,e whether to start the treatment at the time of peak growth or after the active growth is completed.
- 6. These are obvious for orthopedic correction of maxillo-mandibular relationships. Malocclusions requiring surgical correction can be undertaken after the growth spurt is completed. Malocclusion of dental arches can be treated taking advantage of growth spurts during the active growth period.
- 7. Arch expansion and rapid skeletal expansion can be undertaken during periods of maximum growth. Growth Spurt period is the best time for Interceptive Orthodontic procedure. 1) Class II malocclusion with mandibular retrognathism can be managed by Activator therapy.
- 8. 2) Class II malocclusion with maxillary prognathism can be corrected by the use of Headgear. 3) Class III malocclusion with mandibular prognathism can be corrected by Chin Cap and Head gear.
- 9. Change in Inter-Canine width In the mandibular dentition, mandibular inter-canine width is relatively complete by 9-10 years of age in both boys and girls. In cases of maxilla, the inter-canine width is almost complete by about 12 years of age in girls and by about 18 years of age in boys.
- 10. Clinical Implications The final horizontal increments in the mandible, particularly in males causes a forward movement of mandibular base with its teeth. This basal change eliminates any flush terminal plane tendencies that have persisted beyond the mixed dentition. However, the forward bodily mandibular thrust is unmatched by comparable maxillary horizontal growth changes. Hence, the maxillary inter canine dimension serves as a “Safety Valve” for the basal discrepancy.
- 11. Growth Timing Woodside (1969), in his study of the Burlington group demonstrated different periods of growth spurts in an individual. The greatest increments of growth are actually at the 3 years of age level. The second peak is from 6 to 7 years in girls and 7 to 9 years in boys. The third peak is 11 to 12 years in girls and 14 to 15 years in boys.
- 12. Infancy and Early Childhood During this period there is a rapid growth of the brain case which gets completed by the age of 6 years, after which extra oral orthopedic forces can be used to our advantage. Here, the growth of the face is faster in depth.
- 13. Rapid growth is exhibited during this period (i,e 4-6 years). Growth modification using functional appliances for jaw discrepancies should be successful at this stage. Unfortunately, relapse occurs because of continued growth in the original disproportionate pattern due to a phenomenon known as “Predominance of Morphogenetic pattern”.
- 14. If children are treated early, they need further treatment during the mixed dentition and again in the early permanent dentition to maintain the correction. For this reason, expect for the most severe problems growth modification therapy for skeletal discrepancies is best attempted until the pre adolescent years when growth modification results are more stable.
- 15. Juvenile period Studies of Woodside (1974) have shown a predominant period of “Juvenile Acceleration” that occurs 1-2 years before the adolescent growth spurt, more particular in girls. This juvenile acceleration can equal or exceed the jaw growth that accompanies the secondary sexual maturation. If the treatment is delayed too long in girls we may miss this juvenile spurt.
- 16. Adolescent Period Major events of dentofacial development, overall facial growth and differential growth of jaws occur during this period. It is an accepted fact that all children begin to grow at puberty. It is only that different children reach puberty at different times.
- 17. During the adolescent growth spurt, growth modification and definitive treatment can be combined and the results are said to be stable unlike the deciduous dentition period. In boys, generally puberty begins later and extends for a long period which is 5 years in boys as compared to 3 ½ years in girls.
- 18. Typical treatment plan for jaw discrepancies. Stage one – During mixed dentition stage, focus on correcting skeletal problem,(i,e during 1-3 years before the peak of the adolescent growth spurt). Stage Two - Comprehensive fixed appliance treatment during the early permanent dentition for stability.
- 19. Direction of Growth While the face as a whole grows downward and forward, there are times when growth is predominantly in one direction or the other. Growth direction can change autonomously or can be changed by means of mechanical appliances.
- 20. Factors affecting the direction of growth Muscle dysfunction. - Excessive muscle contractions - Decrease in the muscle activity Habits. - Thumb or Finger Sucking - Tongue Thrust - Mouth Breathing
- 21. Clinical Significance of Growth Rotation In forward rotation of the jaw the fulcruming point is located at the incisors. In patients where the incisor contact is stable the overbite remains unchanged. In unstable cases, the fulcruming point is located further back along the occlusal plane, resulting in deepening of the bite.
- 22. This deterioration of the occlusion is not pronounced during puberty when growth intensity is at its greatest, but continues throughout the growth periods. Therefore, deep bite should be treated early and the occlusion supported throughout the growth period. Retention should be maintained until the mandibular growth is completed.
- 23. In patients with vertical growth and posterior rotation of mandible,the center of growth rotation is located near the mandibular condyles. Here, early interception is needed to maximize the dentoalveolar compensation. In cases where extractions are necessary, treatment should be postponed until after puberty.
- 24. THANK YOU