description on growth spurts and different growth spurts

2. PRE PUBERTAL
GROWTH SPURT
D R . S I N U J AYA P R A K A S H
2 N D Y R P O S T G R A D U AT E
D E P T O F P E D O D O N T I C S

3. CONTENTS
• Introduction
• Definition
• Developmental growth period
• Methods of studying growth
• Conclusion
• reference

4. DEFINITION FOR GROWTH

5. DEFINITION FOR DEVELOPMENT

6. NEGATIVE GROWTH
• Generally we equate growth with enlargement but
there are instances in which growth results in decrease
in size
• Eg.thymus gland

7. DIFFERENCE BETWEEN GROWTH AND
DEVELOPMENT
• Growth is anatomic phenomenon and quantitative in nature
• development is basically physiologic phenomenon and qualitative in
nature
• development= growth+ differentiation+ translocation
( PROFIT)

8. • Growth is a dynamic process with a stable pattern of changes result
in increase in physical size and mass during its course of
development.
growth is a three fold process “
self multiplication,
differentiation,
organization”
A fourth dimension is : TIME

9. DEVELOPMENTAL GROWTH PERIOD
• A) Prenatal life (about 10 IU months).
1) Period of ovum : conception to 2 weeks.
2) Period of embryo : 2 – 8 weeks.
3) Period of fetus : 2 to 10 IU months.
B) Birth.
• C) Postnatal life.
• I. Infancy: (birth to about 1 year)
• a) Neonatal period : birth, 1 to 2 weeks.
• b) Infancy proper : 2 weeks to 1 year.
II. childhood
a) Early childhood (preschool) 1 – 6 years.
Developmental growth periods

10. • b) Middle childhood (grade school) 6 to 9 or 10 years.
• c) Late childhood or Prepubertal period (junior high school)
• Girls : 9 or 10 to 12 or15 years. Boys : 9 or 10 to 13 or 16 years.
• III. Puberty :
• a) Girls mean about 13 years
• b) Boys mean about 14 years.
• IV.Adolescence :
• a) Girls : 13 – 18 years
• b) Boys : 14 – 20 years.
• V. Maturity: 18 or 20 to about 60 years
• VI. Senility: beginning at about 60 years

11. METHODS OF STUDYING GROWTH
Experimental
approach
Measurement
approach

12. METHODS OF GATHERING GROWTH
DATA
Longitudinal study
Cross sectional
study
Semi longitudinal
study

13. EXPERIMENTAL APPROACH
• uses experiments in which growth is manipulated in
some way.
• implies that the subject of the experiment is available
for study in some detail and the detailed study may
be destructive.
• Animals may be sacrificed for experimental purpose.

14. Vital staining-
Uses dyes that stain mineralizing tissues (occasionally soft
tissues) are injected into an animal, these dyes remain in the
bones and teeth and can be detected later after sacrifice of the
animal.
This method was originated by the great English anatomist
Hunter in the 18th century.
• alizarin red
• Tetracycline
• Trypon blue
• Lead acetate

15. AUTORADIOGRAPHY:
• It is a technique in which a film emulsion is placed over a
thin section of tissue containing radioactive isotope, and
then is exposed in the dark by radiation.
• The location of radiation in the film indicates the site of
growth.
• Commonly used autoradiographic labels are:
A. 3 H thymidine.
B. 3 H proline.
C. Bromodeoxyuridine

16. Radioisotopes :
• often used as in vivo markers .
• When injected into the body they get incorporated
the developing bone.
• They can be detected by means of Geiger counter.
E.g., 1. Technetium 99 2. Calcium 45

17. Implant radiology:
• In this technique, inert metal pins generally made of titanium
are placed in growing bones of the skeleton, including the
and jaws
• These metal pins are well tolerated by the skeleton and
become permanently incorporated into the bone.
• These serve as reference points to study the amount,
and manner of growth.

18. MEASUREMENT APPROACH
• Technique for measuring living animals and humans
methods
1.Craniometr
y
2.Anthropom
etry
3.Cephalome
try
3
dimensional

19. Craniometry:
• The first of the measurement approaches of anthropology.
• Based on measurements of skulls found among human skeletal remains.
• Advantage: precise measurements can be made on dry skulls.
• Disadvantage: study can be only cross sectional

20. Anthropometry:
In anthropometry, various landmarks established in studies of dry skulls are measured in
living individuals simply by using soft tissue points over lying these bony landmarks.
Measurements obtained would be of different results because the soft tissue thickness
overlying both landmarks.
Advantages: longitudinal , growth of an individual can be followed over a period of time
with repeated measurements

21. Cephalometry:
• Is a standardized radiographic technique in craniofacial region.
• Introduced by Broadbent in 1931.
• importance not only in the study of growth, but also in clinical evaluation of orthodontic
patients.
Advantages:
• 1. Allows direct measurement of skeletal dimensions, as the bone can be seen through
the soft tissue covering in a radiograph.
Disadvantages:
• 1.Two-dimensional representation of a three-dimensional structure.
• 2.The technique depends on precisely orienting the head before making a radiograph,
with equally precise control of magnification.
• 3.Even with precise head positioning, not all measurements are possible

22. Three-dimensional imaging:
• New information now is being obtained with the application of three-dimensional
imaging techniques.
• Computed axial tomography (CT) allows 3-D reconstructions of the cranium and face.
This method has been applied for several years to plan surgical treatment for patients
with facial deformities. Example of a 3D imaging for hemifacial microsomia

23. LONGITUDINAL STUDY
• These are made of measurements on same person or group at regular
intervals through time
• Advantages
• Temporary problems are smoothed with time
• Variablilty in development within a group is put in proper perspective
• Serial comparison makes study of specific developmental pattern of
individual possible
Disadvantages
Time consuming
Expensive
Sample loss

24. CROSS SECTIONAL STUDY
• Measurements made of different samples or individuals and studied
at different periods
ADVANTAGES
1.Quicker.
2.Less expensive.
3. Statistical treatment of data is easier.
4.Studies can be readily repeated.
5.Method can be used in archeological data.
DISADVANTAGES
1.Variation in development among individuals within the sample
cannot be studied.

25. SEMI LONGITUDINAL STUDY
Longitudinal and cross sectional studies can be
combined to seek the advantages of both.
In this way one might compress 15 years of study
into 3 years of gathering growth data

26. FACTORS AFFECTING PHYSICAL
GROWTH
• Hereditary
• Nutrition
• Illness
• Race
• Socio economic status
• Family size
• Birth order
• Secular trends
• Climatic and seasonal effects
• Exercise
• Physiological disturbance

27. DIFFERENTIAL GROWTH
•Scammons growth curve
•Cephalo-caudal gradient

28. SCAMMONS GROWTH CURVE

29. SCAMMON’S CURVE OF GROWTH
• The body tissues can be broadly classified into four types.
• lymphoid tissue
• neural tissue
• general tissue
• genital tissue.

30. • Each of these tissues grows at different times and rate .
• Lymphoid tissue proliferates rapidly in late childhood and
reaches almost 200% of adult size.
• This is an adaptation to protect children from infection, as
they are more prone to them.
• By about 18 years of age, lymphoid tissue undergoes
involution to reach adult size

31. • Neural tissue grows very rapidly and almost reaches adult size
by 6-7 years of age.
• Very little growth of neural tissue occurs after 6-7 years. This
facilitates intake of further knowledge.
• General tissue or visceral tissue consists of the muscles, bones
and other organs. These tissues exhibit an “S” shaped curve
with rapid growth upto 2-3 years of age followed by a slow
phase of growth between 3- 10years.

32. • After the tenth year, a rapid phase of growth occurs
terminating by the 18-20th year
• Genital tissue consists of the reproductive organs. They show
negligible growth until puberty. However, they grow rapidly at
puberty reaching adult size after which growth ceases

33. CEPHALO- CAUDAL GARDIENT

34. CEPHALOCAUDAL GRADIENT OF
GROWTH
• Cephalocaudal gradient of growth simply means that there is
an axis of increased growth extending from head towards the
feet.
• a)The head takes up about 50% of the total body length
around the third month of intra uterine life.
• At the time of birth, the trunk and the limbs have grown more
than the head, thereby reducing the head to about 30% of
body length.

35. • The overall pattern of growth continues with a progressive
reduction in the relative size of the head to about 12% in the
adult.
• 3rd month of IU Birth Adult Head 50% 39% 12% Limbs
(Lower) rudimentary 30% 50%
• b) The lower limbs are rudimentary around the 2nd month of
intrauterine life. They later grow and represent almost 50% of
the body length at adulthood.

36. • c)There is increased gradient of growth evidence even within
the head and face .
• At birth, cranium is proportionally larger than face , Post
natally the face grows more than cranium.
• Mandible shows more growth than maxilla post natally

37. GROWTH SPURT
•Sudden increase in growth is termed growth
spurt
Timing of growth spurt
•just before birth
•1year after birth
•Mixed dentition growth spurt
•Pre-pubertal growth spurt

38. BABY GROWTH SPURT
• Common- about 10 days, between three and six weeks, and several times afterward,
often around three months, six months and nine months.
• babies can measurably gain weight and length in just 24 hours
• sprout as much as nine millimetres in length in just one day.
• In the day or so before a big growth spurt, some babies sleep more than usual.
• prefer food to snoozing during a spurt
• Becomes cranky
(Michelle Lampl, Emory University Atlanta.)

39. GROWTH SPURTS
• The rate of growth is more rapid at the beginning of cellular
differentiation, increases until birth and decrease there after.
This uneven activity is responsible for the interpretation of
growth as appearing in “spurts”.
• Believed to be due to physiological changes in hormonal
secretion

40. Name of growth spurt Girls Boys
• Infantile/childhood growth spurt 3 yrs
• Juvenile/mixed dentition growth Spurt 6-7yrs 7-9yrs
• Pre Pubertal/adolescent growth spurt 11-12yrs 14-15yrs
(Woodside (1968)Torrento)

41. • 1. Prenatal -- Just before birth.
• 2. Postnatal One year after birth.
• Mixed dentition growth spurt
Females : 7- 9 years.
Males : 8-11 years.
• Pre Pubertal growth spurt
Females: 11-13 years.
Males: 14-16 years
Modified by Bjork (1975)

42. Timing of Puberty
• Velocity curves for growth at adolescence shows difference
timing between boys and girls.
• Pubertal growth spurt occurs on an average nearly 2 years
earlier in girls than boys.
• Sex hormones are produced in adrenals by 6 years-
‘adrenarche’.
• More prominent in girls due to greater adrenal component

43. ADOLESCENT GROWTH SPURT
1. Begins distally with enlargement of Hand and Feet,
followed by the Arms & Legs and finally by the Trunk and
Chest.
2. Larynx, pharynx and lungs—Voice
3. Androgens- a) Sebaceous glands- Acne,
b) Optic globe-myopia
c) dental- jaw growth, loss of deciduous teeth
eruption of permanent cuspids, premolars, and finally molars

44. • Adolescence Growth - Period extends for 2.5 to 3 years; to
cross Sexual Maturity stages 2-5.
• Height gain is 27-29cm in boys & 24-26cm in girls; (1 cm
height will need 4500 Kcal)
• Weight gain in both 25-30 kg.

45. BRAIN GROWTH IN ADOLESCENCE
1. Early Childhood- Maximum Brain grows as “Frontal
circuits”- related to organization and planning.
2. Adolescence- Brain grows in the rear of the brain- linked
more to language learning and spatial understanding. Thus
brain development continues.
3. Myelination of the prefrontal cortex continues in
adolescence

46. SEXUAL DIMORPHISM –
1. Shoulder growth in boys and hip growth in girls.
2. They start puberty with similar fat and lean body mass
content . Girls finally have 27% fat and boys 18%, from 16%
. In boys, gain in lean body mass is twice than the girls. But
girls reduce LBM from 80% to 74%.These changes are due
to sex hormones
3. Maintenance cost of lean body mass needs more energy
.Thus boys have increased deposition of protein and
minerals e.g. Fe/Ca/Zn. Sports- need oxygen & nutrition.

47. SEXUAL DIMORPHISM IN FAT
DISTRIBUTION
0
2
4
6
8
10
12
14
16
18
0 5 10 15 20
Age (Years)
SFT(mm)
Boys
Girls
Subscapular
Triceps
Subscapular
Triceps

48. PUBERTY -GIRLS
1. First sign of ovarian estradiol secretion is breast
development “Thelarche”. (Breast budding)- GROWTH IN
HEIGHT.
2. Estradiol is a good stimulator of “GH” it doubles the growth
velocity “PEAK HEIGHT VELOCITY’(9-10 cm / yr).
3. Change in body shape
4. Growth under arm hair followed by secretion
5. Menarche follows PHV by 14-18 months.
6. Adult size breast

49. • The growth in the post menarche period is limited as girls can
gain 5-6 cm in linear growth, only.
• Thus the maximum gain in height is pre-menarche

50. PUBERTY- BOYS
1. Adrenarche is the ONSET & CONTINUITY of male
PUBERTY
2. Testosterone/dihydrotestosterone are needed in
large concentration to initiate “GH” via the
androgen receptors. (Thus later than girls by 1-2
yr).
3. Initiation testicular volume more than 4 ml;
maximum growth “PHV” (10-11 cm /year)
attained at Testicular volume 10-12 ml.
4. Testosterone –Deepens the voice and increases
body muscle mass (lean body mass).

51. • Growth effects because of timing variation can be seen
particularly clearly in girls, in whom the onset of menstruation,
often referred to as menarche, gives an excellent indicator of
the arrival of sexual maturity.
• Sexual maturation is accompanied by a spurt in growth.
• When the growth velocity curves for early (M1), average (M2),
and late(M3) maturing girls are compared, the marked
differences in size between these girls during growth are
apparent

52. • At age 11, the early(M1)maturing girl is already past the peak
of her adolescent growth spurt, whereas the late-maturing girl
(M3) has not even begun to grow rapidly. This sort of timing
variation, which occurs in many ways other than that shown
here, can be an important contributor to variability

53. • The timing of puberty makes an important difference in
ultimate body size, in a way that may seem paradoxical at first,
the earlier the onset of puberty, the smaller the adult size, and
vice versa.
• Growth in height depends on endochondral bone growth at
the epiphyseal plates of the long bones, and the impact of the
sex hormones on endochondral bonegrowth is twofold

54. • First, the sex hormones stimulate the cartilage to grow faster,
and this produces the adolescent growth spurt.
• But the sex hormones also cause an increase in the rate of
skeletal maturation, which for the long Bones is the rate at
which cartilage is transformed into bone.
• The acceleration in maturation is even greater than the
acceleration in growth.Thus during the rapid growth at
adolescence, the cartilage is used up faster than it is replaced.

55. • Toward the end of adolescence, the last of the cartilage is
transformed into bone, and the epiphyseal plates close. At
this point growth potential is lost and growth stops

56. • Early cessation of growth after early sexual maturation is
particularly prominent in girls. It is responsible for much of
the difference in adult size between men and women.
• Girls mature earlier on the average, and finish their growth
much sooner.
• Boys are not bigger than girls until they grow for a longer
time at adolescence.

57. • The difference arises because there is slow but steady growth
before the growth spurt, and so when the growth spurt
occurs, for those who mature late, it takes off from a higher
plateau.
• The epiphyseal plates close more slowly in males than in
females, and therefore the cutoff in growth that accompanies
the attainment of sexual maturity is also more complete in
girls

58. • Growth of the jaws usually correlates with the physiologic
events of puberty in about the same way as growth in height.
• There is an adolescent growth spurt in the length of the
mandible, though not nearly as dramatic a spurt as that in
body height, growth occurs through increase in growth at the
sutures of the maxilla.
• The cephalocaudal gradient of growth, which is part of the
normal pattern, is dramatically evident at puberty

59. • More growth occurs in the lower extremity than in the upper
• within the face, more growth takes place in the lower jaw than
in the upper..
• The maturing face becomes less convex as the mandible and
chin become more prominent as a result of the differential jaw
growth

60. • Growth in width is completed first
• then growth in length,
• finally growth in height.
• Growth in width of both jaws, including the width of the
dental arches, tends to be completed before adolescent
growth spurt.
• Growth in width at the palatal suture occurs during the first 5
years of age, mostly at the intermaxillary and interpalatine
suture.
• Intercanine width more likely to decrease than increase after
age 12

61. • Cranium Maxilla Mandible
• 1 to 5 years 85% 45% 40%
• 5 to 10 years 11% 20% 25%
• 10 to 20 years 4% 35% 35%
• Percentage of craniofacial growth completed at different
stages
( grabber )

62. • Mandibular length changes
• Growth of the mandible continues at
a relatively steady rate before puberty. On the average, ramus
height increases 1 to 2 mm per year and body length
increases 2 to 3 mm per year

63. • Growth in length and height of both jaws continues through
the period of puberty.
• In girls, the maxilla grows slowly downward and forward to
age 14 to 15 on the average (more accurately, by 2 to 3 years
after first menstruation), then tends to grow slightly more
almost straight forward .
• In both sexes, growth in vertical height of the face continues
longer than growth in length, with the late vertical growth
primarily in the mandible

64. • growth modifications must begin in girls during mixed
dentition period, due to the adolescent growth spurt often
preceds the final transition of dentition, so by the time
second premolars and molars erupt growth get completed.
• In slow maturing boys on the other hand the dentition can
be relatively complete while a considerable amount of
physical growth remains
(profit)

65. Biological Maturity Indicators Morphologic Age:
( based on height.)
• A child’s height can be compared with those of his same age
group and other age groups to determine where he stands in
relation to others.
• Height, or morphologic age, is useful as a maturity indicator
from late infancy to early adulthood.
• Everyone is not alike in the way that they grow. It can be
difficult, but is important to decide whether the individual is
merely an extreme of the normal variation or falls outside the
normal range

66. • This is determined, using growth charts for the particular
population standards.
• Growth charts can be used to plot an individuals growth. These
charts provide information regarding the position of the
individual with relation to the group, and it can also be used to
follow a child overtime to evaluate whether there is an
unexpected change in growth pattern

67. • INTERPRETATION
• Plotted above the 90% shows child was larger than 90% of
the population.
• Plotted below the 10% line shows child was smaller than
0f the population.
• An individual who stood exactly at the midpoint of the
normal distribution would fall along the 50% line of the

68. Chronological age
• The most obvious and easily determined developmental age
parameter.
• Simply calculated from the child date of birth to till
examination of the patient date.
• Because of the wide variation among individuals in the
of the pubertal growth spurt, chronologic age cannot be
in the evaluation of growth potential
(Fiani,1998).

69. Dental Age:
• Dental age is determined from three characteristics;
• The first is which teeth have erupted.
• The second and third, are the amount of resorption of the
roots of primary teeth and the amount of development of
permanent teeth.

70. • At dental age 10, approximately one half of the roots of the
mandibular canine and mandibular first premolar have been
completed, nearly half the root of the upper first premolar is
complete, and there is significant root development of the
mandibular second premolar, maxillary canine, and maxillary
second premolar

71. Sexual Age:
• This is based on development of secondary sexual
both boys and girls.
• This type of indicator is useful only for assessment of
adolescent growth.

72. Adolescent Growth Stages versus Secondary
Sexual Characteristics
• Total Duration of Adolescent Growth : 3 ½ years period
• Stage 1 Beginning of adolescent Growth Appearance of breast
buds, initial pubic hair.
• Stage 2 (About 12 Months Later) Peak velocity physical growth
(in height) Noticeable breast development, axillary hair,
darker/more abundant pubic hair.
• Stage 3 (12-18 Months Later) Growth spurt ending Menses,
broadening of hips with adult fat distribution, breasts
completed.

73. BoysTotal Duration of Adolescent Growth :
• 5 years period
• Stage 1 Beginning of adolescent growth “Fat spurt” weight
gain.
• Stage 2 (About 12 Months Later) Height spurt begins
Redistribution/reduction in fat, pubic hair, growth of penis.
• Stage 3 (8-12 Months Later) Peak velocity in height Facial
hair appears on upper lip only, axillary hair, muscular growth
with harder/more angular body form.
• Stage 4 (15-24 Months Later) Growth spurt ending Facial
hair on chin and lip, color of pubic and axillary hair, adult
body form.

74. • Recent research has shown that sexual development really
begins much earlier than previously thought.
• Sexhormones produced by the adrenal glands first appear at
age 6 in both sexes, primarily in the form of a weak androgen
(dehydroepiandrosterone , [DHEA]).This activation of the
adrenal component of the system is referred to as adrenarche.

75. • DHEA reaches a critical level at about age 10 that correlates
with the initiation of sexual attraction.It is likely that a
juvenile acceleration in growth is related to the intensity of
adrenarche and not surprising that a juvenile acceleration is
more prominent in girls because of the greater adrenal
component of their early sexual development

76. • Skeletal age assesment Hand wrist radiographs
• The hand – wrist region is made up of numerous small
These bones show a predictable and scheduled pattern of
appearance, ossification and union from birth to
maturity.There by merely comparing a patient’s hand-wrist
radiograph with standard radiographs that represent
skeletal ages, we will be able to determine the skeletal
maturation status of that individual

77. • We all know end of long bones grow at their
end called epiphysis.
• The newly formed bone starts getting
mineralised at the metaphysis
• most matured bone seen at the diaphysis.
• The epiphysis initially forms a cartilage tissue
which later ossifies and fuses with the
metaphysis as it matures

78. CONCLUSION
• Pubertal increments offers best time for, determining the
predictability, growth direction, patient management and
total treatment time.
• Understanding the growth, predictability of future growth of
maxilla, mandible and alveolar process helps in diagnosing
and achieving excellent results of the malocclusion

79. • Functional jaw orthodontic therapy takes advantages of
redirection of remaining growth of craniofacial region.
• Functional appliances like Twin block, Bionator, Frankel
appliances are given for class II skeletal correction.
Effectiveness of these appliances to modify skeletal growth is
minimal after pubertal growth spurt

80. • Orthopaedic appliances like headgears are also advantageous
to correct maxillary prognathism during growing stage of the
patient.
• Maxillary horizontal growth is completed much earlier than
mandible and so the use of headgear to restrict or redirect its
growth should be started much before pubertal growth spurt
in mixed dentition period

81. • Maxillary expansion procedures in cases of jaw constriction
should be carried out during early mixed dentition.
• Growth in width of maxilla occurs by sutural growth in
interpalatine and intermaxillary sutures.
• Maximum growth occurs in first 5 years.The skeletal
expansion procedures should be carried out before the fusion
of palatal sutures, i.e. by 10 years

82. • Orthopaedic appliances like facemask and chin cup are used
for the treatment of skeletal class III malocclusions early
during the mixed dentition period.
• However, the continuing growth of mandible and its pubertal
growth spurt can lead to development of malocclusion after
early interventions

83. • Active growth cessation is prerequisite for Orthognathic
surgery particularly in cases with mandibular prognathism

84. REFERENCE
• AJO-DO 1982 Oct (299-309): Maturation indicators and the
pubertal growth spurt - Hägg and Taranger
• Text book of orthodontics kharbanda
• Textbook pediatric dentistry nikhil marwah