بسم هللا الرمحن الرحمي
GROWTH AND DEVELOPMENT
DR.hala mohammed
OUTLINES
▪ Growth and development.
▪ Growth concepts .
▪ Growth theories.
Why do we study growth & development?
1-To know the developmental stage.
2-To notice deviation from normal development.
3-intercept \prevent some dental problems.
4- To be able to treat patients with the common
craniofacial anomalies such as cleft lip and/or palate.
Growth
Development
▪ Growth: increase in size or number.
▪ Development: increase in complexity and
specialization.
▪ Growth is an anatomic phenomenon while
development is physiologic and behavioral.
Factors affecting physical growth
1. Heredity.
2. Nutrition.
3.Illness.
4. Race.
5. Socio-economic factor.
6. Family size and birth order.
7.Climate and seasonal changes.
8. Exercise.
Some Concepts of Growth
Normality;
1- Normal refers to range.
2-Normality changes with age.
Rhythm of growth; not a steady and uniform.
Growth spurts; sudden acceleration of growth occur.
Differential growth; different organs grows at different rates.
Growth stages
• Prenatal period::-
conception to birth
• Neonate:
Birth to 1 month
• Infancy
1 month to 1 year
• Early Childhood
• Toddler
1-3 years
• Preschool
3-6 years
• Middle Childhood
School age:
• 6 to 10 yrs girls.
• 6 to 12 years boys .
• Late Childhood
Adolescent:
• 10-18 years girls
13-20 years boys
Basic concepts of growth
❑ Pattern.
❑ Variability.
❑ Timing.
Basic concept of growth
1. Pattern:
❑ Change in the proportionality over time.
❑ Allow predictability.
❖Examples
✓ Cephalocaudal gradient of growth.
✓ Scammon’s curve of growth.
Cephalocaudal gradient of growth
▪ .” This simply means that there is an axis of increased growth extending from
the head toward the feet.
Cephalocaudal gradient of growth
▪ In fetal life, at about the third month of intrauterine
development, the head is almost 50% of the total body
length. The cranium is large relative to the face and
represents more than half the total head. In contrast,
the limbs are still rudimentary and the trunk is
underdeveloped.
Cephalocaudal gradient of growth
▪ At birth, the trunk and limbs have grown faster than the
head and face, so that the proportion of the head about
30%.
▪ The legs represent about one-third of the total body
length.
▪ More growth of the lower limbs than the upper limbs .
▪ In the adult the head is about 12% .
▪ The legs represent about half of the body length and
more growth of the lower limbs than the upper limbs .
Cephalocaudal gradient of growth
Scammons curve of growth
• General growth including muscles, bone and viscera, 40- 45% of it is
formed at birth, 70% is formed by age 7 years, then it shows a slight
decrease during childhood and acceleration during puberty.
Scammons curve of growth
• Growth of the genital tissues accelerates rapidly after the late childhood.
Scammons curve of growth
• Lymphoid tissues proliferates rapidly in the late childhood & reached
up to 200%.
• By the age of 18 it undergoes involution into adult size.
Scammons curve of growth
• The neural cells are largely attained by the first six months of life, with
approximately 75% of the total brain size attained at 2 years and almost
completed by age 5-6 years.
Basic concept of growth
2. Variability:
❑ Individuals are not alike in the way that they
grow.
❑ It can be difficult but clinically very important to
decide whether an individual is merely at the
extreme of the normal variation or falls outside
the normal range
Basic concept of growth
3. Timing:
❑ The same event happens for different
individuals at different times.
❑ So variability in growth arises in several ways:
✓ From normal variation.
✓ From influences outside the normal experience
(e.g. serious illness).
✓ From timing effects.
Methods for Studying Physical Growth
❑ Measurement Approaches.
❑ Experimental Approaches.
▪ Measurement Approaches:
1. Craniometry.
2. Anthropometry.
3. Cephalometric Radiology.
4. Three-Dimensional Imaging.
Methods for Studying Physical Growth
1. Craniometry:
❑ Measurement are made directly on the
human skull.
Methods for Studying Physical Growth
2. Anthropometry:
❑ Measurements are made directly on living
individuals.
❑ Advantage: it possible to follow the growth of
an individual directly, making the same
measurements repeatedly at different times
(i.e. longitudinal data can be obtained).
❑ Disadvantage: less accurate because the soft
tissue introduces variation.
Methods for Studying Physical Growth
3. Cephalometric Radiology:
❑ Measurements are made on
standardized radiograph.
❑ Advantage: combine the advantages of
craniometry and anthropometry.
❑ Disadvantage:
a. radiation exposure.
b. it produces a two-dimensional (2-D)
representation of a three dimensional (3-
D) structure.
Methods for Studying Physical Growth
4. Three-Dimensional Imaging:
❑ Measurement are made on 3D images
like CT, CBCT and MRI
❑ Advantage: combine the advantages of
craniometry and anthropometry and
produce 3D image.
❑ Disadvantage:
a. More expensive
b. higher radiation exposure with CT and
CBCT. MRI only shows the soft tissues.
Methods for Studying Physical Growth
▪ Experimental Approaches
❑ Vital Staining.
❑ Implant studies.
❑ Radioactive isotope.
Growth Spurt
❑ Sudden acceleration in growth.
❑ Thought to be due to hormonal secretion.
❑ Timing of growth spurts:
A. just before birth.
B. one year after birth.
C. mixed dentition growth spurt (Girls 7-9 year, Boys 8-
11 year).
D. pre-pubertal growth spurt (Girls 11-13 year, Boys 12-
14 year).
Growth site Vs Growth center
❑ Growth site:
▪ A site of growth is merely a location at which growth
occurs.
❑ Growth center:
▪ A center is a location at which independent (genetically
controlled) growth occurs.
❖ All centers of growth also are sites, but the reverse is
not true.
BONE FORMATION AND GROWTH
Theories of bone growth
1- Sutural theory.
2- Cartilaginous theory.
3- Functional matrix theory.
The major difference in the theories is the location
at which genetic control is expressed.
1. Sutural theory
❑ Bone, like other tissues, is the primary determinant of
its own growth.
❑ The sutures between the membranous bones of the
cranium and jaws were considered growth centers.
❑ Evidence against this theory:
✓ When an area of the suture between two facial bones is
transplanted to another location the tissue does not
continue to grow. This indicate a lack of innate growth
potential.
✓ Growth at sutures will respond to outside influences like
compression or tension.
✓ Growth do occur even if there is a clear sutural defect (e.g.
cleft palate patients).
2. Cartilaginous theory
Cartilage is the primary determinant of skeletal growth,
while bone responds secondarily and passively.
The fact that, for many bones, cartilage grow while bone
merely replaces it make this theory attractive for the bones
of the jaws.
✓ Base of the skull ➔ Synchondrosis.
✓ Maxilla➔ Nasal septal cartilage.
✓ Mandible ➔ condyle.
2. Cartilaginous theory
❑ Evidence supporting this theory
✓ In most bones in the body cartilage grow while bone
merely replaces it.
✓ When cartilage from the base of the skull and the nasal
septal cartilage was transplanted to a different area it
continue to grow which indicate an innate growth
potential.
✓ When cartilage was removed, growth retardation occurred.
▪ Transplantation experiments and removal experiments
on the condyle showed no support to the idea that the
cartilage of the mandibular condyle is an important
center.
3. Functional matrix theory (by Melvin Moss)
▪ “The origin, form, position, growth and
maintenance of all skeletal tissue and organs are
always secondary, compensatory, and necessary
responses to chronologically and morphologically
prior events or processes that occurs in their
related non skeletal tissues, organs and functional
spaces”.
3. Functional matrix theory
❑ If neither bone nor cartilage was the determinant for
growth of the craniofacial skeleton, it would appear
that the control would have to lie in the adjacent soft
tissues.
❑ This theory imply that the soft tissue matrix in which
the skeletal elements are embedded is the primary
determinant of growth, and both bone and cartilage
are secondary followers.
3. Functional matrix theory
❖ According to this theory:
❑The size of the cranium match the size of the brain.
❑ The size of the eye determined the size of the
orbital cavity.
❑ The size of the oral cavity and nasal cavity
determined the size of maxilla and mandible.
References
Thank You
