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

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

ASSESMENT OF GROWTH AND
DEVELOPMENT IN ORTHODONTICS
.
INDIAN DENTAL ACADEMY
Leader in continuing dental education

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

• 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

An accurate estimate
of the patients
state of devolopment
is essential in
planning orthodontic
treatment.

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

This seminar is a
presentation of many
factors which effect
growth & which can
guide the
orthodontist in
determining the
foregoing.

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.

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.

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.

1. CHRONOLOGIC AGE
2. BONE AGE
3. PHYSIOLOGIC AGE
4. DENTAL AGE
5. MENTAL AGE

CHRONOLOGIC AGE
The age expressed in years and months;

BONE AGE
The stage of development of bone as
adjudged by radiography, in contrast to
chronologic age.

PHYSIOLOGIC AGE
Age estimated in terms of function.

ASSESMENT OF GROWTH AND
DEVELOPMENT IN ORTHODONTICS.
• Why do we assess growth?
• How to assess growth clinically?

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

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

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

The Human Head Shape
Brachycephalic Dolichocephalic
• short and wide • tall and narrow

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.

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. www.indiandentalacademy.com

Soft Tissue Profile
Convex straight concave
retrognathic orthognathic prognathic

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

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

• Growth Assessment
• Bone formation and growth control
• Growth of cranial complex

Was the first to present a detailed
analysis of human growth

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

GROWTH STANDARDS
A single examinaton
of a growing child
is not a reliable
method of
determining the rate
& direction of
growth &
development.

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.

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.

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

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.

• Terminology
– Growth
– Development
• Pattern, Variability, and Timing

Growth is a
physicochemical
process of living
matter by which
an organism
becomes larger

HUXLEY:self multiplication of
living substance.
KROGMAN: increase in size, change
in proportion,& progressive
complexity

Development may be
defined as the
sequence of changes
from cell
fertilization to
maturity. It
relates to cell
division, growth,
differentiation &
maturity.

HOW TO ASSES GROWTH CLINICALLY ?

GIRLS
BOYS

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.

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.

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.

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.

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.

Acne, which is considered a common
part of puberty.

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.

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.

What Can the Charts Tell Us About Child's Growth?

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.

GROWTH TRENDS

• Type A growth trend
• Type B growth trend
• Type C growth trend

Type A growth trend

Type B growth trend

Type c growth trend

Type A Type B Type C

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.

GROWTH
normal growth for any individual
organism is growth which follows the
estabilished type for the species.

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.

Pattern vs.. Variability
• Normal growth pattern
ex) Changes in overall body proportions
Cephalocaudal gradient of growth

Pattern
vs.
Variability
Scammon’s Curve

Pattern vs. Variability
Boys GirlsGrowth Curves

Variability
• Racial and ethnic differences
• Gender
• Sickness
• nutrition
• Timing factor -Late/early maturers
• Problems with growth (hormones or
genetics)

Timing Variation
• Early, average, and late matuerers
• Chronological age vs. Developmental age

R
U
S
L P
T
T
C
M
M M M M
P
P
P
P
P
P
P
P
P

%%%

• April, 1895.

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.

Hägg and Taranger
• MP3-F stage (onset or
start of the curve of
pubertal growth spurt);
epiphysis is as wide as
metaphysis.

• 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.

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.

• MP3-H stage
(deceleration part of
the curve of
pubertal growth
spurt); fusion of
epiphysis and
metaphysis has
begun.

• MP3-I stage (end of
pubertal growth
spurt); fusion of
epiphysis and
metaphysis is
completed.

STAGES OF CERVICAL VERTEBRAL MATURATION.
( Hassel Farman)

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.

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.

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.

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.

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.

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.

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.

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

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.

Stage three (puberal
onset):
- Beginning calcification
of ulnar sesamoid.
- Increased width of
epiphysis of (PP2)
- Increased calcification
of hamate hook & pisiform.

Stage four (puberal):
1. Calcified ulnar
sesamoid.
2. Capping of shaft
of middle phalanx
of third digit by
its epiphysis(MP3

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.

Stage six
(Growth completion)
1. No remaining
growth sites.

• 1998 AJO-DO), Volume 1980 Jan (79 -
91): Tooth mineralization as an indicator of
the pubertal growth spurt - Chertkow

SKELETAL GROWTH

• 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.

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

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