Basic Principles of Growth

Dr. Munizeh Khan S.R. Orthodontics K.C.D

Bone Formation
Embryogenesis of craniofacial skeletal tissue:
Chondrogenesis
Endochondral bone formation Intramembranous bone formation

Chondrogenesis
Formation of cartilage:
Chondroblasts produce intercellular matrix
Cells become encased in matrix and become

chondrocytes Chondrocytes enlarge, divide and produce matrix (interstitial growth) New chondrocytes differentiate from surface membrane (appositional growth) Matrix remains uncalcified

Endochondral Bone Formation

Cartilage is converted into bone: Begins 9th week IUL
Hypertrophy of chondrocytes
Cartilage matrix begins to calcify Invasion of blood vessels and CT cells Osteoblasts differentiate and lay down osteoid matrix Osteoid tissue calcifies Membrane covers the bone and is essential

Intramembranous Bone Formation

Bone formation from undifferentiated mesenchymal

tissue Process begins in 8th week IUL

Osteoblasts from ectomesenchyme produce osteoid

tissue Cells become encased in matrix and become osteocytes Blood vessels retained within spaces and develop haversian system Osteocytes lose capacity to produce osteoid Periosteum produces more osteoid tissue (appositional growth) Osteoid calcifies Essential membrane covers bone

Intramembranous Bone Formation

Blue arrow: surface layer of osetoblasts

Red arrow: bone marrow cells

Green arrow: osteocytes entrapped in bone

Bones formed by Endochondral Ossification

Mostly forms bones of the cranial base
Sphenoid bone Parts of occipital bone Ehtmoid bone Temporal bone Malleus, Incus, Stapes Hyoid bone

Clinical Significance: WHY is endochondral bone

formation so necessary at the cranial base?

Answer:
Cranial base is a region where PRESSURE forces

exist Cartilage is pressure tolerant Results in increase in cranial base length against existing pressure (synchondroses)

Bones formed by Intramembranous Ossification

Mostly forms bones of the calvaria and facial

regions
Frontal bone, Parietal bone, Parts of occipital bone

(interparietal) Parts of sphenoid (greater wing, pterygoid plates) Parts of temporal bone (squamous and tympanic) Maxilla, Zygoma, Lacrimal bone Nasal bone, Vomer Mandible
Occurs mostly where mild tension forces are

present

Bone formation
In the mature craniofacial skeleton, there are no qualitative differences between bone derived from endochondral or intramembranous mechanisms

Terminology related to Growth

Growth field

Growth site
Growth center Remodelling

Cortical drift
Displacement

Growth Field
Both inner and outer surfaces of bone are covered

by an irregular pattern of growth fields comprised of various soft-tissue osteogenic membranes or cartilages
The bones investing soft-tissue induces bone

growth, and may be in the form of:

Muscles Mucosa

Blood vessels
Nerves Connective tissue

Growth Field
Bone has depository + resorptive fields over its

surfaces (50-50) The varying activities and rates of growth of these fields are the basis for the differential growth processes that produce bones of irregular shapes The irregularity arises due to varied functions imposed on the bone by articulation of sutures, muscle attachments, insertions of teeth etc

Growth Site
Growth fields having special roles in the growth of

certain particular bones are called growth sites

These include:
Mandibular condyle Maxillary tuberosity Sutures Alveolar processes

Growth Center
Special growth sites that control the overall growth

of a particular bone are termed as growth centers The force or energy motivating growth of a bone
Examples:
Epiphyseal plates of long bones Synchondroses of the cranial base

Remodeling
The differential growth activity involving

simultaneous deposition and resorption on all the inner and outer surfaces of the bone
Facial bones do not get bigger as a balloon enlarges Growth activity requires bone shaping

Remodeling
This shape change is brought about by remodeling Remodeling:
Basic growth process
Provides regional changes in shape, dimensions and

proportions Produces regional adjustments that allow the bone to adapt to developing functions
Basically is a process of reshaping and resizing of

bone

Remodeling
Types:
Biochemical remodeling: continuous removal and

deposition of ions to maintain mineral homeostasis Growth remodeling: the constant replacement of bone during childhood Haversian remodeling: secondary process of cortical reconstruction as primary vascular bone is replaced Healing: the regeneration and reconstruction of bone following pathology or trauma

Growth Movements: 1. Cortical Drift

Movement of a bone as a result of remodeling

Growth by selective deposition and resorption

Growth movements of the enlarging portion of the

bone towards the depository surface

Remodeling (deposition + resorption) Depository surface = increase in size of bone =

enlarging portion Apparent growth towards that side as: deposition of bone on one side of cortical plate resorption of bone on other side

Cortical Drift

Inferior Relocation of Palate

- -

- - - - -

- - -

+ + + + + ++

+ +

Posterior Relocation of Ramus As a result of cortical drift

+ + + - - ++ + + + + + +

Growth Movements: 2. Displacement

Movement of the whole bone as a unit

As a bone is carried away from its articulation with other

bones, growth remodeling simultaneously maintains relationships of the bones to each other Types:
Primary: displacement associated with the bones own

enlargement, e.g. Mandibular growth

Secondary: movement of a bone related to enlargement of

other bones, e.g. Cranial base development resulting in secondary displacement of the maxilla

Displacement

Primary Displacement of Mandible

Adaptive 2nd!!!!

Displacement 1st!!!!

Secondary Displacement of Maxilla

+ + + + + + + + + + + + + + + + ++ + + ++

Combinations of Drift & Displacement

Questions?