Every dentist should understand

craniofacial growth!

Why?

difficult to understand
conditions seen in adults
without understanding the
developmental process that
caused them
When working with children,
it is important to distinguish
normal variation from effects
of abnormal or pathologic
processes.
Growth - refers to a change in
size or number

this change can have a

positive or negative phase

growth is mainly an
anatomic phenomenon
Development - an increase in the
degree of organisation/ a change
in proportion or increase in
complexity

carries an overtone of
specialisation leading to a loss
of potential

development is physiologic
and behavioural
growth pattern

In studies of growth, the

concept of pattern is an
important one.

1. Pattern - reflects
proportionality of a complex
set of proportions rather than a
single proportional
relationships at a point in time
Pattern in growth represents
proportionality in a very complex way

it refers to the change in these

proportional relationships over time

e.g. physical arrangement of the body is

a pattern of spatially proportioned parts
over time
There is a higher level of
pattern, “the pattern of
growth”

The pattern of growth –

refers to the changes in these
spatial proportions over time
Cephalocaudal gradient of growth -
axis of increased growth extending
from the head towards the feet

2. Another aspect of normal growth

pattern, - not all tissue systems of the
body grow at the same rate

muscular and skeletal elements

grow faster than cns as shown by
relative decrease in head size
in growth pattern, we see that
not all tissues systems of the
body grow at the same rate

The different tissues systems

that grow at different rates are
concentrated in various parts
of the body
compare skull of newborn infant with
that of an adult:

infant has a relatively larger cranium

and a much smaller face

The face grows out from under the

cranium following the cephalocaudal
gradient, so the mandible, being
farther away from from the brain,
will tend to grow more and later than
the maxilla which is closer.
 3. Predictability – is another
important aspect of pattern.
•
patterns are predictable, they repeat
( patterns of tiles on the floor or
clothes)

difference between a growth pattern

and a geometric pattern is the
addition of a time dimension

A change in a growth pattern would

show in some alteration in the
expected changes in body
proportions
 Variability
A second important concept in the
study of growth is Variability

People do not all grow at the same

rate.

clinically we have to determine if an

individual is at the extreme of
normal variation or falls outside the
normal range

it is more useful to think in terms of

deviations from the usual pattern
and to express variability
quantitatively(growth charts)
 Variability

‘Normal variability’ is derived from

large scale studies of groups of children

growth charts are used to determine

whether growth is normal or abnormal

a child above the 97 percentile should

receive special study and attention
before being classified as an extreme of
the normal population
 Variability
Growth charts are used to
follow a child over time and
evaluate if there are
unexpected changes in growth
patterns (pattern implies
predictability)

this means a child’s growth

should plot along the same
percentile line at all ages
 Timing

variability in growth arises in

various ways:

normal variation

abnormal influences-
serious illness

timing effects
 Timing variability
Variation in timing occurs
because the same event
happens for different
individuals at different times
or

the biologic clocks of

different individuals are set
differently

this variation is very evident

during adolescence.
some kids grow very fast and
mature early, completing their
growth quickly

others grow and develop

slowly and appear to be
behind, but given time, they
can catch up and even surpass
the fast growers
timing variation is seen more
clearly in girls with onset of
menarche as an indication of
sexual maturity

sexual maturation is
accompanied by a growth
spurt
Age is normally measured
chronologically, as amount of time
since birth

Biologically it can be measured in

terms of progress toward
developmental markers or stages

using developmental markers reduces

timing variability and makes this
approach useful in evaluating a
persons growth status
The End!