Asessment of growth and development in orthodontics /certified fixed orthodontic courses by Indian dental academy


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Asessment of growth and development in orthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. 1. Introduction 2. Growth and development 3. ASSESMENT OF GROWTH AND DEVELOPMENT IN ORTHODONTICS. 4. Growth timing in orthodontics 5. Various means of assessing growth 6. Conclusion 7. References
  4. 4. • Growth standards • Somatogenetic & morphogenetic growth • Outline of physical growth & devolopment • The concept of normalty & growth • Increments of growth • Devolopment • Skeletal maturation • Influence of disease on growth • Relative values of growth criteria • Clinical appraisal of growth • Height & weight in relation to physical maturity
  5. 5. An accurate estimate of the patients state of devolopment is essential in planning orthodontic treatment.
  6. 6. The orthodontist must attempt to determine how much more growth to expect for the individual child & whether the general present & past health experience of child indicate that he can expect future growth to be normal or abnormal
  7. 7. This seminar is a presentation of many factors which effect growth & which can guide the orthodontist in determining the foregoing.
  8. 8. Clinical significance: 1. Treatment involving modification of skeletal growth seems to demand as much as information as possible about patient’s growth potential. 2. Orthodontic appliances such as the mandibular protraction appliance, Frankel,Bionator, Twin block.
  9. 9. Clinical significance: 3.In cases where patient require orthopedic changes using head gears and protraction masks activator. 4.Prior to rapid maxillary expansion. 5.In patients with marked discrepancy between dental and chronological age.
  10. 10. Clinical significance: 6. Orthodontic patients requiring orthognathic surgery if under taken during growth period. 7. When maxillo mandibular changes are indicated in the treatment of class III cases, skeletal class II cases or skeletal open bites.
  12. 12. CHRONOLOGIC AGE The age expressed in years and months;
  13. 13. BONE AGE The stage of development of bone as adjudged by radiography, in contrast to chronologic age.
  14. 14. PHYSIOLOGIC AGE Age estimated in terms of function.
  15. 15. ASSESMENT OF GROWTH AND DEVELOPMENT IN ORTHODONTICS. • Why do we assess growth? • How to assess growth clinically?
  16. 16. Why do we assess growth? • To determine optimum time for treatment (growth modification and surgery) • to determine the amount of growth left • to determine type of growth
  17. 17. How to assess growth clinically? 1. Hand wrist x-ray 2 . sexual maturity: onset of menarche in girls, voice changes and facial hair in boys 3. lateral cephalogram tracings: superimpositions
  18. 18. Other indicators of growth • Ask parents how much the child grew last year (height and shoe size) • look at parent’s phenotype: tall or short
  19. 19. The Human Head Shape Brachycephalic Dolichocephalic • short and wide • tall and narrow
  20. 20. Reasons for Describing Head and Face Shape The growth direction of the face and jaws is different in each type of head and/or face.
  21. 21. Reasons for Describing Head and Face Shape “Brachy” tends to grow horizontally; “dolicho” tends to grow vertically. Knowing the general pattern of growth and the expected direction can be helpful in orthodontic diagnosis and treatment planning.
  22. 22. Soft Tissue Profile Convex straight concave retrognathic orthognathic prognathic
  23. 23. Soft Tissue Changes with Growth Boy growing normally Black - 10 yo red - 14 yo • Soft tissue profile tends to flatten with growth • Nose and chin growth at teenage years may change facial appearance
  24. 24. Theories of Growth Control • Determinants of the growth control – Bone – Cartilage – The soft tissue matrix in which the skeletal elements are embedded - 60’s “Functional Matrix Theory” by Moss • Level of control: Sites vs. Centers
  25. 25. • Growth Assessment • Bone formation and growth control • Growth of cranial complex
  26. 26. Was the first to present a detailed analysis of human growth
  27. 27. HELLMAN He was principally responsible for the recognition of the role of growth & development in bringing about changes in facial proportions , the role of different rates of growth in different parts of face, & their influence on orthodontic therapy
  28. 28. GROWTH STANDARDS A single examinaton of a growing child is not a reliable method of determining the rate & direction of growth & development.
  29. 29. GROWTH STANDARDS The amount and rate of developmental progress over a period of time is of more significance in measuring growth than the physical status on a given occasion.
  30. 30. GROWTH STANDARDS By taking measurements of the same child at regular intervals the amount of growth that may have occurred in the various segments during a given time interval can be determined.
  31. 31. GROWTH STANDARDS Standards of growth & development are cross sectional averages of children from diverse groups and of varied levels of health – rather than of ideals of achievements. They are not invariable norms applicable to individual children
  32. 32. SOMATOGENETIC & MORPHOGENITIC GROWTH • Somatogenetic growth, body growth, is controlled by the target glands, the thyroid, adrenals, and the gonads. • Morphogenetic growth refers to differentiation of cells & tissues in the early embryo which results in establishing the form & structure of the various organs & parts of the body. This is controlled by the hypophysis and anterior lobe of pitutary.
  33. 33. • Terminology – Growth – Development • Pattern, Variability, and Timing
  34. 34. Growth is a physicochemical process of living matter by which an organism becomes larger
  35. 35. HUXLEY:self multiplication of living substance. KROGMAN: increase in size, change in proportion,& progressive complexity
  36. 36. Development may be defined as the sequence of changes from cell fertilization to maturity. It relates to cell division, growth, differentiation & maturity.
  37. 37.
  39. 39. GIRLS BOYS
  40. 40. For a Boy Puberty for a boy usually starts with enlargement of the testicles and sprouting of pubic hair, followed by a growth spurt between ages 10 and 16 - on average 1 to 2 years later than when girls start. His arms, legs, hands, and feet also grow faster than the rest of his body.
  41. 41. His body shape will begin to change as his shoulders broaden and he gains weight and muscle. And that first crack in the voice is a sign that his voice is changing and will become deeper.
  42. 42. For a Girl Puberty generally starts earlier for a girl, some time between 8 and 13 years of age. For most girls, the first evidence of puberty is breast development and the growth of pubic hair.
  43. 43. These first signs of puberty are followed 1 or 2 years later by a growth spurt. Her body will begin to build up fat, and she will take on the contours of a woman as her hips get wider and her breasts enlarge.
  44. 44. The culminating event will be the arrival of menarche, her first period. Girls usually get their first period between the ages of 9 and 16.
  45. 45. Acne, which is considered a common part of puberty.
  46. 46.
  47. 47.
  48. 48. Doctors use growth charts to compare a child's measurements with those of other children his age. This helps the doctors determine whether a child's growth is adequate. Boys and girls are plotted on different charts because their growth rates and patterns differ.
  49. 49. For both boys and girls there are two sets of standard charts: one for infants ages 0 to 36 months and another for children ages 2 to 18 years. The charts are a series of percentile curves that show the distribution of growth measurements of children from across the country.
  50. 50. What Can the Charts Tell Us About Child's Growth?
  51. 51. What Can the Charts Tell Us About Child's Growth? Although growth charts are valuable tools, both doctors and parents must be careful not to focus too much on any one reading. Instead, the numbers should be viewed as a trend. Any measurement, taken out of context of the others, might give you the wrong impression of your child's growth. For example, a child's height measurement might place him at the 5th percentile, but this usually doesn't indicate a growth problem if his subsequent measurements continue to track along that percentile curve (as might be the case for a child who has inherited "short genes" from his parents). If the doctor and parents fixate on that one measurement, however, they might wrongly worry about the child's growth.
  53. 53. • Type A growth trend • Type B growth trend • Type C growth trend
  54. 54. Type A growth trend
  55. 55. Type B growth trend
  56. 56. Type c growth trend
  57. 57. Type A Type B Type C
  58. 58. CONCEPT OF NORMALITY & GROWTH Normality & variation: The need for orthodontic treatment arises primarily because of morphologic, spatial & functional deviation of teeth & jaws beyond the limits of normality.
  59. 59. CONCEPT OF NORMALITY & GROWTH normal growth for any individual organism is growth which follows the estabilished type for the species.
  60. 60. CONCEPT OF NORMALITY & GROWTH Normal growth is not the average of a number of individuals but a wide range in which healthy individuals vary in specific charecteristics but maintain their common identity.
  61. 61. Pattern vs.. Variability • Normal growth pattern ex) Changes in overall body proportions Cephalocaudal gradient of growth
  62. 62. Pattern vs. Variability Scammon’s Curve
  63. 63. Pattern vs. Variability Boys GirlsGrowth Curves
  64. 64. Variability • Racial and ethnic differences • Gender • Sickness • nutrition • Timing factor -Late/early maturers • Problems with growth (hormones or genetics)
  65. 65. Timing Variation • Early, average, and late matuerers • Chronological age vs. Developmental age
  66. 66.
  67. 67. R U S L P T T C M M M M M P P P P P P P P P
  68. 68. %%%
  69. 69.
  70. 70. • April, 1895.
  71. 71. THE MIDDLE PHALANX OF THE THIRD FINGER Hägg and Taranger noted that the stages of ossification of the middle phalanx of the third finger of the hand (MP3 stages) follow the pubertal growth spurt. • -------------------------------- The MP3 stages are five stages representing the different stages of the pubertal growth spurt from onset to end.
  72. 72. Hägg and Taranger • MP3-F stage (onset or start of the curve of pubertal growth spurt); epiphysis is as wide as metaphysis.
  73. 73. • MP3-FG stage (acceleration part of the curve of pubertal growth spurt); epiphysis is as wide as the metaphysis and there is a distinct medial and/or lateral border of the epiphysis forming a line of demarcation at right angle to the distal border.
  74. 74. MP3-G stage (peak-PTV, the point of maximum pubertal growth spurt); sides of the epiphysis have thickened and cap its metaphysis forming a sharp edge distally at one or both sides.
  75. 75. • MP3-H stage (deceleration part of the curve of pubertal growth spurt); fusion of epiphysis and metaphysis has begun.
  76. 76. • MP3-I stage (end of pubertal growth spurt); fusion of epiphysis and metaphysis is completed.
  78. 78. Six categories of cervical vertebrae skeletal maturation could be defined, 1) INITIATION 4) DECELARATION 2) ACCELARATION 5) MATURATION 3) TRANSITION 6) COMPLETION and the following observations were made for each category.
  79. 79. INITIATION: All inferior borders of the bodies are flat. The superior borders are strongly tapered from posterior to anterior. • 80% to 100% of adolescent growth was expected.
  80. 80. ACCELARATION A concavity has developed in the inferior border of the 2nd vertebra. The anterior vertical heights of the bodies have increased. • 65% to 85% of adolescent growth expected.
  81. 81. TRANSITION. Distinct concavities were seen in the inferior borders of C2 and C3. A concavity was beginning to develop in the inferior border of C4. 25% to 65% of adolescent growth expected.
  82. 82. DECELERATION. Distinct concavities were seen in the inferior borders of C2, C3, and C4. The vertebral bodies of C3 and C4 were becoming more square in shape. 10% to 25% of adolescent growth expected.
  83. 83. MATURATION. More accentuated concavities were seen in the inferior borders of C2,C3,and C4. The bodies of C3 and C4 were nearly square to square in shape. Final maturation of the vertebrae took place during this stage, with 5% to 10% of adolescent growth expected.
  84. 84. COMPLETION. Deep concavities were seen in the inferior borders of C2, C3, and C4. The bodies of C3 and C4 were square or were greater in vertical dimension than in horizontal dimension. Growth was considered to be complete at this stage. Little or no adolescent growth was expected.
  85. 85. HAND WRIST RADIOGRAPH Julian Singer Stage one (Early): 1. Absence of pisiform 2. Absence of hook of hamate 3. Epiphysis of proximal phalanx of second digit (PP2) narrower than its shaft R U S L P T T C M M M M M P P P P P P P P P
  86. 86. Stage two (prepuberal): 1. Proximal phalanx of second digit and its epiphysis are equal in width. 2. Initial ossification of hook of hammate. 3. Initial ossification of the pisiform.
  87. 87. Stage three (puberal onset): - Beginning calcification of ulnar sesamoid. - Increased width of epiphysis of (PP2) - Increased calcification of hamate hook & pisiform.
  88. 88. Stage four (puberal): 1. Calcified ulnar sesamoid. 2. Capping of shaft of middle phalanx of third digit by its epiphysis(MP3
  89. 89. Stage five (puberal Decelaration): 1. Ulnar sesamoid fully calcified 2. Calcification of epiphysis of distal phalanx of third digit with its shaft (DP3U). 3. all phalanges and carpals fully calcified. 4. Epiphysis of radius and ulna not fully calcified with respective shafts.
  90. 90. Stage six (Growth completion) 1. No remaining growth sites.
  91. 91. • 1998 AJO-DO), Volume 1980 Jan (79 - 91): Tooth mineralization as an indicator of the pubertal growth spurt - Chertkow
  93. 93. • Q. Why is the growth spurt at puberty so important in orthodontics? • A. This is the time when most of the development of the face occurs. Treatment during this time allows the orthodontist to favorably influence the facial profile in a growing child. Once growth of the facial bones in complete, correction of skeletal discrepancies usually requires surgery.
  94. 94.
  95. 95. SUPERIMPOSITIONS Thank you For more details please visit