Craniofacial Growth and Dental Maturation in Short Children Born Small for Gestational Age: Effect of Growth Hormone Treatment

Abstract

Short children born small for gestational age (SGA) may be candidates for treatment with growth hormone (GH). We examined craniofacial growth and dental maturation in a cohort of short SGA children. The general growth failure of these children is reflected to a differential extent within the craniofacial complex. As a group, these children have a small retrognathic face with a relatively increased lower anterior face height; in contrast to skeletal maturation, dental age is not delayed. GH treatment in short prepubertal SGA children leads to craniofacial catch-up growth, which is particularly pronounced in regions where interstitial cartilage is involved, the result being that the facial profile becomes less convex; dental maturation does not appear to be influenced by GH treatment. In conclusion, in short SGA children, GH treatment does not only result in an increase of body stature but also in a trend towards normalization of craniofacial growth and this without notable advancement of dental maturation.

Influence of growth hormone therapy on selected dental and skeletal system parameters

“…Kjellberg et al [2], observed in their own studies on a group of short stature boys, that dental age was delayed by about 1 year, which was also confirmed by other authors [3][4][5]. There is also the opinion in the study by Van Erum et al [27] that treatment with GH does not markedly affect the mean value of dental age. However, this theory has not been confirmed by other studies.…”

Craniofacial morphology in Turner syndrome patientstreated with growth hormone

“…According to the results from previous studies, early initiation of treatment is necessary in order to have significant effects on craniofacial development. 18,25,27 Since GH therapy effects are age dependent, it could have been beneficial if the subjects were divided into age groups. Still, the number of investigated TS patients in subgroups would not have been sufficient for adequate statistical analyses.…”

“…This finding can be explained by the results from clinical and experimental studies which found that GH has positive effects on enchondral ossification centers in the cranial base. 17,18,27 Additionally, the age of patients receiving GH has an impact on craniofacial growth, the effects being more pronounced in the younger patients. 18,27 The starting age of GH therapy, which was before the age of 7 in most of the patients in our study, contributed to normal cranial base development.…”

“…17,18,27 Additionally, the age of patients receiving GH has an impact on craniofacial growth, the effects being more pronounced in the younger patients. 18,27 The starting age of GH therapy, which was before the age of 7 in most of the patients in our study, contributed to normal cranial base development. Earlier studies of TS patients did not find significant differences when comparing annual changes of cranial base angle and lengths during GH therapy, 24,25 nevertheless growth rate and pattern were similar to healthy controls.…”

Recent Advances in the Genetics of Orthodontics

“…Disproportionate growth of the cranial base structures and jaws results in facial retrognathia, which entails a proportionately smaller posterior than anterior facial height in persons of short stature with GH deficiency (Kjelberg et al, 2000). GH therapy for children with short stature or Turner syndrome results in characteristic patterns of craniofacial growth (Van Erum et al, 1988;Simmons, 1999). Responses to systemic GH therapy are time-and site-dependent in the craniofacial region, and are associated with an increase in cartilage growth, particularly within the mandibular ramus (Van Erum et al, 1988;Simmons, 1999).…”