BDS [Orthodontics] course

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