GROWTH HORMONE DEFICIENCY AND CRANIOFACIAL DEVELOPMENT: IMPLICATIONS FOR ORTHODONTIC TREATMENT TIMING - A NARRATIVE REVIEW

Background: Growth hormone deficiency (GHD) is the most common pituitary hormone deficiency in children and a principal cause of short stature. Because it manifests during the period of active craniofacial growth, it is directly relevant to orthodontic and dentofacial orthopedic decision-making. 
Objective: This narrative review synthesises evidence published between 2016 and 2026 on craniofacial and dental characteristics in children with GHD and evaluates the effect of recombinant human growth hormone (rhGH) replacement on craniofacial morphology and its implications for the timing of orthodontic intervention. 
Methods: Secondary data were obtained from PubMed, Scopus, ScienceDirect, and Google Scholar using Boolean combinations of terms relating to GHD, GH therapy, craniofacial and mandibular growth, skeletal maturation, dental development, malocclusion, and orthodontic timing. English-language articles published from 2016 to 2026 were considered. 
Results and Discussion: GH acts principally through IGF-1 on the mandibular condylar secondary cartilage, producing effects that are dimension-specific: sagittal and vertical mandibular deficiency, with transverse and arch-length involvement of the maxilla. GHD is associated with reduced cranial base length, a shortened and retropositioned mandible, reduced ramus height, and altered facial height proportions, with Angle Class II malocclusion reported in up to 31% of patients in a systematic review covering 465 children with GHD. Dental maturation and eruption are delayed, and bone age lags further still. rhGH partially but incompletely normalises this phenotype, the mandible responding preferentially in the sagittal and vertical planes while dental maturation and transverse dimensions lag behind.
Conclusion: Chronological and dental age are unreliable timing criteria in GHD. Orthodontic and dentofacial orthopedic treatment in this population should instead be timed according to individualised skeletal-maturation assessment, coordinated with the child's ongoing endocrine treatment.