Concepts of growth and Development

Dr Syed Sheeraz Hussain

BDS,DCPS,MCPS, FCPS (Orthodontics)
 Growth
 An increase in size(hypertrophy) or number(hyperplasia).
 A change in proportion
 Growth is largely an anatomic phenomenon.
 Growth
 The dramatic increase in size that characterizes the living
embryo is a consequence of
 (1) hyperplasia
 (2) hypertrophy
 (3) the increased amount of noncellular material (accretion)

 Hyperplasia tends to predominate in the early embryo

whereas hypertrophy largely prevails later.
 Growth
 Thymus Growth?
 Aging?
Growth: pattern, variability, and timing
 Pattern is the proportional relationship over time.
 Pattern

Ex. Ballons round and long

Pattern
 Scammon's curves
 Another aspect of the normal growth pattern is that not
all the tissue systems of the body grow at the same rate.
Cephalocaudal growth of head and face
 When the skull of a newborn infant is compared proportionally
with that of an adult, it is easy to see that the infant has a
relatively much larger cranium and a much smaller face.
 Predictability, Patterns repeat
 The proportional relationships within a pattern can be
specified mathematically, and the only difference between
a growth pattern and a geometric one is the addition of a
time dimension.
 Variability
 Everyone is not alike.
 Rather than categorizing
people as normal or
abnormal, it is more useful
to think in terms of
deviations from the usual
pattern and to express
variability quantitatively.
 Ex standard growth chart.
(relate between normal
and abnormal)
Variability
 Growth chart uses
 First, the location of an
individual relative to the
group.
 A general guideline is that a
child who falls beyond the range
of 97% of the population should
receive special study before
being accepted as just an
extreme of the normal
population.
 Second: over time followup to
evaluate whether there is an
unexpected change in growth
pattern.
 Timing
Variability in growth arises in
several ways:

From normal variation,

From influences outside the

normal experience (e.g., serious
illness).

From timing effects.

Because of time and variability,

chronologic age often is not a
good indicator of the individual's
growth status.

Growth velocity curves for early, average, and

late maturing girls. It is interesting to note that the earlier the
adolescent growth spurt occurs, the more intense it appears to be.
Obviously, at age 11 or 12, an early maturing girl would be considerably
larger than one who matured late. In each case, the onset
of menstruation (menarche) (M1, M2, and M3) came after the
peak of growth velocity.
 Reducing timing variability
 Reduced by using developmental age
rather than chronologic age.
 Ex. if data for gain in height for girls are
replotted, using menarche as a reference
time point , it is apparent that girls who
mature early, average, or late really
follow a very similar growth pattern.
 This graph substitutes stage of sexual
development for chronologic time, to
produce a biologic time scale, and
shows that the pattern is expressed at
different times chronologically but not at
different times physiologically.
 Variations in growth and development because of timing are
particularly evident in human adolescence.
 Some children grow rapidly and mature early, completing
their growth quickly and thereby appearing on the high side
of developmental charts until their growth ceases and their
contemporaries begin to catch up.
 Others grow and develop slowly, and so appear to be behind
even though, given time, they will catch up with and even
surpass children who once were larger. All children undergo a
spurt of growth at adolescence, which can be seen more
clearly by plotting change in height or weight , but the
growth spurt occurs at different times in different individuals.
 Development
 Occasionally, however, the increase will be in neither size
nor number, but in complexity. More often, the term
development will be used to refer to an increase in
complexity.
 Whereas development is physiologic and behavioral
phenomenon.
 Maturation
 Maturation is a counterpart of growth. Maturation
indicates not only the attainment of adult size and
proportions but also the attainment of the full adult
constituents of tissues (eg, mineralization) as well as the
complete capability of each organ to perform its destined
functions. When the age of occurrence of maturational
events is indicated (onset of ossification centers, fusion of
sutures, eruption of teeth, etc.),
 Maturation
 Although most growth normally ceases at the end of
adolescence, coinciding with the eruption of the third
molar teeth (hence the popular connotation of “wisdom”
teeth), the facial bones, unlike the long bones, retain the
potential for further appositional growth in adult life. Such
postadolescent growth may occur as a result of
hypersecretion of somatotrophic hormone from a pituitary
gland tumor, as in acromegaly, which is characterized by
enlargement of the bones of the face, hands, and feet.
Methods for studying physical growth
 Methods for studying physical growth
Sarnat in 1986
Two basic approaches to


 (i) Direct measurements and (ii) Indirect
studying physical growth  measurements.
 Measuring living  Direct measurements:
 • Anthropometry
animals  • Vital staining
 i. Madder feeding
 Experiments in which  ii. Alizarin red S injection
 Histological methods
growth is manipulated in  • Histochemical methods
some way  • Implants.
 Indirect measurements:
 • Impressions and casts
 • Photographs
 • Radioautographs
 • Radiographs
 • Serial Cephalometric Radiography and
Implantation
 • Other considerations.
Indirect methods
 Advantages
 • This method eliminates serious deficiencies of anthropologic
techniques.
 • It permits a dynamic study of the growing child, i.e. increase in size and
change in proportion of the same growing bone or group of bones forming
a bone complex (as in the middle third of the face and the neurocranium).
 • It reveals rate, amount and relative direction of bone growth.
 Disadvantages
 • In this technique three-dimensional information is being interpreted as a
two-dimensional process.
 • In addition (Moyers and Bookstein 1979), the conventional
cephalometric fails to capture the curving of form and its changes and
thus misrepresent growth.
 • Radiation exposure.
 Measurement Approaches(In ortho)
 Craniometry
 Anthropometry
 Cephalometric radiology
 Three dimensional imaging
Craniofacial Growth Study: Broadbent Study
Superimposition of Lateral Cephalogram to
Study Craniofacial Growth
 Experimental Approaches
 Vital staining
 Radioactively labeled metabolite. Gamma-emitting
isotope 99m tc
 Bone morphogenetic proteins
 Implant radiography
Experimental Approaches

implant radiography Alizarin red

ASSESSMENT OF AGE
ASSESSMENT OF AGE
 Krogman Classification of Developmental age
 5 types

1. Chronological age
2. Biological age which consists of morphologic age
,skeletal age , dental age and circumpubertal age
3. Behavioral age
4. Mental age
5. Self-concept age.
Chronological Age Biological Age
 it is a poor indicator of  Somatotypic Age
developmental status.  Ectomorph,
 Mesomorph, and
 Endomorph.
 Height and Weight Age
Dental Age Sexual and Facial Age
 Dental age does not correlate well
with the developmental age.
 The dental age method involves
the recognition of clinically
present teeth with eruption charts.
 The major limitation
 Variation in the timing of eruption,
 The influence of local and
environmental factors, and
 The fact that several or no teeth may
erupt during the same time interval.
SKELETAL AGE ASSESSMENT
 Hand wrist  Ceph(frontal sinus and
cvm) OPG(canine nad 3rd
molar)
CVM Stages Hassel and Farman (1995)
 Initiation: Inferior borders
of the second, third and
fourth cervical vertebrae
are flat at this stage.
 The third vertebra is
wedge shaped and the
superior vertebral borders
are tapered from posterior
to anterior.
 100% Growth.
Acceleration
 Concavities on the inferior
borders of second and
third vertebrae begin to
develop.
 Inferior borders of the
fourth vertebrae remain
flat. Vertebral bodies of
third and fourth vertebrae
are nearly rectangular in
shape.
 65 to 85% growth remains.
Transition:
 Distinct concavities are
shown on the inferior
borders of second and third
vertebrae.
 A concavity begins to
develop on the inferior
border of fourth vertebra.
Vertebral bodies of third
and fourth are rectangular
in shape.
 25 to 65% growth remains.
(maximally use)
Deceleration:
 Distinct concavities can be
observed on the inferior
borders of second, third
and fourth cervical
vertebrae.
 Vertebral bodies of third
and fourth begin to be
more square in shape.
 10 to 25% growth
remains.
Maturation:
 Marked concavities are
observed on the inferior
border of second, third and
fourth cervical vertebrae.
 Vertebral bodies of third
and fourth are almost
square in shape.
 5 to 10 % growth
remains.
Completion:
 Deep concavities are
observed on the second,
third, and fourth cervical
vertebrae.
 Vertebral bodies are
greater vertically than
horizontally.
 Pubertal growth has been
completed.
CVM
Modified Stages of Cervical Vertebral
Maturation (2005)
Mandibular Canine Calcification as an
Indicator of Skeletal Maturation
 Canine stage F indicates the initiation of puberty.
 The timing of stage G coincides with the capping of the third, middle and
the fifth proximal phalanges and the presence of the adductor sesamoid
 The intermediate stage between stages F and G should be used to identify
the early stages of the pubertal growth spurt.
Development of Mandibular Third Molar as an
Indicator of Skeletal Maturation
Frontal Sinus as Skeletal Maturity Indicator
SKELETAL GROWTH
Possibilities for growth @ cellular level
 Hypertrophy--prominent feature
 Hyperplasia--special circumstances
 Cells to secrete extracellular material--important in the
growth of the skeletal system. Accertion
 Growth of Soft tissues
 Interstitial growth
 Hyperplasia
 Hypertrophy
 Secretion of extracellular material
 All soft tissues & uncalcified cartilage
 Hard tissue growth
 Direct or surface apposition of bone
 Hyperplasia
 Hypertrophy
 Secretion of extracellular material
Endochondral Intramembranous (cranial vault and
both jaws)
 The maxilla forms initially from a center of mesenchymal
condensation in the maxillary process. This area is located
on the lateral surface of the nasal capsule, the most
anterior part of the chondrocranium, but although the
growth cartilage contributes to lengthening of the head
and anterior displacement of the maxilla, it does not
contribute directly to formation of the maxillary bone. An
accessory cartilage, the zygomatic or malar cartilage,
which forms in the developing malar process, disappears
and is totally replaced by bone well before birth, unlike
the mandibular condylar cartilage, which persists.
 The overall growth of bones, resulting in their
recognizable expansion, is a function of two phenomena:
remodeling and transposition. Remodeling is a
combination of accretional growth and resorption of bone
and is a response, at least in part, to periosteal functional
matrices.
SITES AND TYPES OF GROWTH IN THE
CRANIOFACIAL COMPLEX
 GROWTH FIELDS
 The outside and inside surfaces of the bone are blanketed by soft tissues,
cartilage or osteogenic membranes. With in this, blanket areas known as
growth fields which are spread all along the bone in a mosaic pattern, are
responsible for producing an alteration in the growing bone.
 GROWTH SITES
 Growth sites are growth fields that have special significance in the growth
of a particular bone, e.g. epiphyseal plates of long bones. These are
supposed to have an intrinsic growth potential.
 REMODELING
 It is differential growth activity involving deposition and resorption on the
inner and outer surfaces of the bone, e.g , ramus moves posteriorly by a
combination of resorption and deposition.
  
GROWTH FIELDS
 The outside and inside
surfaces of the bone are
blanketed by soft tissues,
cartilage or osteogenic
membranes. With in this,
blanket areas known as
growth fields which are
spread all along the bone
in a mosaic pattern, are
responsible for producing
an alteration in the
growing bone
GROWTH SITES
 Growth sites are growth fields that have special
significance in the growth of a particular bone, e.g.
epiphyseal plates of long bones. These are supposed to
have an intrinsic growth potential.
Bone Relocation & Remodeling
 REMODELING
 It is differential growth
activity involving
deposition and resorption
on the inner and outer
surfaces of the bone, e.g ,
ramus moves posteriorly
by a combination of
resorption and deposition.
Bone Relocation & Remodeling
 The process of relocation, as
indicated in underlies most of the
remodeling changes that take
place during bone growth. In the
mandible, for example, portions
of the condyle become converted
by remodeling into the neck. In
these superimposed growth
stages, sections of A and B show
the local changes in size and
shape that occur as the bone
enlarges. Remodeling is a process
of reshaping and resizing as a
consequence of progressive,
continuous relocation
GROWTH MOVEMENTS
 Growth movements are primarily of two types:
 Cortical drift
 Cortical drift is a type of growth movement occurring towards the
depository surface by a combination of resorption and deposition on
the opposing surfaces simultaneously.
 Displacement
 Displacement is the movement of the whole bone as a unit. Two
types are seen.
 Primary displacement: Displacement of bone in conjuction with
its own growth. It produces space within which the bones continue
to grow.
 Secondary displacement: Displacement of bone as a result of
growth and enlargement of adjacent bone.
Cortical drift
 Cortical drift is a type of
growth movement
occurring towards the
depository surface by a
combination of resorption
and deposition on the
opposing surfaces
simultaneously.
Displacement
 Displacement is the
movement of the whole
bone as a unit. Two types
are seen.
Primary displacement
 Displacement of bone in
conjunction with its own
growth. It produces space
within which the bones
continue to grow.
Secondary displacement
 Displacement of bone as a
result of growth and
enlargement of adjacent
bone.
V principle
 For bones that have a "V" shape (or
funnel shape), bone deposition
occurs on the inner side of the V,
resorption takes place on the
outside surface. The direction of
movement is toward the wide end
of the V.
Surface Principle
 Bone sides that face the
direction of growth are
subject to deposition and
oppose are subject to
resorption.
THEORIES OF GROWTH CONTROL
 The Genetic "Theory"
 The Genetic "Theory"
 The genetic theory simply said that “genes determine all”.
Although called a theory it was more assumed than
proven.
 After the general assumptions were found to be flawed,
some said "perhaps this part is genetically controlled
while that is not," or "this part, is more controlled by
heredity than that." Such statements showed uneasiness
with the all-embracing aspects of the' 'theory. "
Sicher's Hypothesis (Sutural Dominance)
 Sicher deduced from the many studies using vital dyes
that the sutures were causing most of the growth; in fact,
he said "the primary event in sutural growth is the
proliferation of the connective tissue between the two
bones. If the sutural connective tissue proliferates it
creates the space for appositional growth at the borders of
the two bones."
 Replacement of the proliferating connective tissue was
necessary for functional maintenance of the bones.
Sicher's Hypothesis (Sutural Dominance)
 He felt that the connective tissue in sutures of both the
nasomaxillary complex and vault produced forces which
separated the bones, just as the synchondroses expanded the
cranial base and the epiphyseal plate’s lengthened long bones.
 Sicher viewed the cartilage of the mandible somewhat
differently, stating that it grew both interstitially, as epiphyseal
plates, and appositionally, as bone grows under periosteum.

His ideas came to be called the "sutural dominance
theory," but it would seem he held sutures, cartilage, and
periosteum all responsible for facial growth and assumed all
were under tight intrinsic genetic control.
 Scott's Hypothesis (Nasal Septum)
 Scott held that they continued to dominate facial growth
postnatally. He specifically emphasized how the cartilage of the
nasal septum during its growth paced the growth of the maxilla.
 Sutural growth, Scott felt, came in response to the growth of other
structures including cartilaginous elements, brain, the eyes, and
so forth.
 Latham elaborated on Scott's ideas about the nasal septum and
maxillary growth, emphasizing the role of the septo-premaxillary
ligament beginning in the later part of the fetal period.
 He felt the maxillary sutures began as sliding joints adapting to
initiating growth forces elsewhere, but later manifest increasing
osteogenesis, contributing to the main displacing force at the free
surfaces. Thus, he combines ideas of Scott, Sicher, and Moss.
 Moss' Hypothesis (Functional Matrix)
 Moss feels that bone and cartilage lack growth
determination and grow in response to intrinsic growth of
associated tissues, noting that the genetic coding for
craniofacial skeletal growth is outside the bony skeleton.
He terms the associated tissues "functional matrices.”
 Each component of a functional matrix performs a
necessary service-such as respiration, mastication, speech-
while the skeletal tissues support and protect the
associated functional matrices.
Moss' Hypothesis (Functional Matrix)
 Moss divides the skull into a series of discrete functional components each
comprised of a functional matrix and an associated skeletal unit, (designating
functional matrices as either periosteal or capsular. A periosteal functional
matrix affects deposition and resorption of adjacent bony tissue; therefore,
the matrix controls remodeling and the size and shape of a bone (e. g., the
interaction between the temporal muscle and the coronoid process of the
mandible).
 Moss identifies two large, enveloping capsular matrices: the cerebral and
the facial
 Each contain specific tissues and structures and spaces, spaces which must
remain open to fulfill their functions. As each capsular matrix and its
associated elements expand, all of the bones, endochondral and
intramembranous, grow to maintain the physiologic spaces.
 Thus, Moss argues, the skeletal tissues grow only in response to soft-tissue
growth. The effect is a passive translation of skeletal components in space.
Petrovic's Hypothesis (Servosystem)
 Using the language of cybernetics, Petrovic reasoned that it is the
interaction of a series of causal change and feedback mechanisms
which determines the growth of the various craniofacial regions.
 According to this servosystem theory of facial growth, control of
primary cartilages takes a cybernetic form of a "command" whereas, in
contrast, control of secondary cartilage (e.g., the mandibular condyle) is
comprised not only of a direct effect of cell multiplication but also of
indirect effects.
 In his experiments Petrovic detected no genetically predetermined final
length for the mandible rather; the direction and magnitude of condylar
growth variation are perceived as quantitative responses to the
lengthening of the maxilla.
 Petrovic's provocative ideas are specially useful in understanding the
role of functional appliances in mandibular growth.
 Van Limborgh theory
 Recent hypothesis assumes that postnatal facial skeletal
development is controlled by a multifactorial system
which is influenced by genetic, intrinsic and local factors
(Van Limborgh 1970, Petrovic, 1970).
 FACTORS AFFECTING PHYSICAL
GROWTH
 The development of the dentofacial complex is dependent on
the following three elements:
 Genetic :
 Inherited genotype, like heredity
 Operation of genetic mechanisms, like race.
 Environmental factor:
 Nutrition and biochemical interactions
 Physical phenomena like temperature, pressure, hydration etc
 Functional forces:
 Extrinsic and intrinsic forces of muscle actions, like exercises
 Space occupying organs and cavities
 Growth expansion
Regional Growth
 To understand growth in any area of the body, it is
necessary to understand:
 (1) The sites or location of growth,
 (2) The type of growth occurring at that location, and
 (3) The determinant or controlling factors in that growth
Cranial Vault
 Flat bones
 Intramembranous bone formation, without cartilaginous
precursors.
 Periosteal growth
 Remodeling and growth occur
 -at the periosteum- -the cranial sutures,
 -& periosteal activity also changes both the inner and outer surfaces of these
plate-like bones.
 Simultaneous Bone removal & deposition result in
changes in contour.
 Func. of sutures:
 unite bone, absorb forces, act as joint , growth sites
 Fontanelles
 At birth, the flat bones of the skull are rather widely separated by
relatively loose connective tissues. These open spaces, the fontanelles,
allow a considerable amount of deformation of the skull at birth. This is
important in allowing the relatively large head to pass through the birth
canal. After birth they closes.
 Fontanelles
 Anterior : lozonges shaped @ saggital and coronal surturs closes @ age 1 yrs.
 Posterior : triangular , @ saggital and Parieto occipital sutures closes@ 2
months.
 Posteriolateral: rectangular ,@ paritomastoid, parioto occipital, and
occipitomastoid,chages @ 1 yrs.
 Anteriolateral: @ coronal & sphenoparietal suture.
 Closes 3-6 month
 The cranial base
 Cranial base are formed by endochondral ossification.
 *Midline structures. More lat surface remodeling become
more important.
 Synchondroses
 Synchondroses remain between the centers of ossification.
 spheno-occipital synchondrosis, (12-15yrs)
 intersphenoid synchondrosis, ( fuse @ birth)
 spheno-ethmoidal synchondrosis, ( fuse @ birth)
Cranial base flexure

Dolichocephalic Brachycephalic
 Brain is narrow & long  Brain is wide and rounded
 Cranial flexure is open  Cranial fleaxure is more
 Nasomaxillary complex is upright
forward and lowered  Naso maxillary process is
 Mn rotate downward and posteriorly placed
lowered  Mn rotate upward nad
 Class II profile forward
 Class I or III
 Nasomaxillary complex
 Develops postnatally by intramembranous ossification.
 growth occurs in two ways:
 (1) by apposition of bone at the sutures
 (2) by surface remodeling.
 Other areas
 NASAL SEPTUM
 ALVELAR PROCESS
 Nasomaxillary complex
 As growth of surrounding
soft tissues translates the
maxilla downward and
forward, opening up space
at its superior and
posterior sutural
attachments, new bone is
added on both sides of the
sutures.
 Nasomaxillary complex
 As the maxilla is carried
downward and forward, its
anterior surface tends to
resorb. Resorption
surfaces are shown here in
pink. Only a small area
around the anterior nasal
spine is an exception.

The overall growth changes are the result of both a downward and forward translation
of the maxilla and a simultaneous surface remodeling.
 Nasomaxillary complex
 It is not necessarily true
that remodeling changes
oppose the direction of
translation. Depending on
the specific location,
translation and remodeling
may either additive or
subtractive,
 Ex. on the roof of the
mouth.
Nasomaxillary complex
Adolescence Nasomaxillary
growth
Adolescence Nasomaxillary growth
 Growth of the nasomaxillary area is The cranial base lengthens and
produced by two basic mechanisms: the anterior lobes of the brain grow in size.
(1) Passive displacement, created by
growth in the cranial base that pushes
the maxilla forward, and
(2) Active growth of the maxillary
structures and nose
Adolescence Nasomaxillary growth
 As the maxilla is translated downward
and forward, bone is added at the
sutures and in the tuberosity area
posteriorly, but at the same time,
surface remodeling removes bone
from the anterior surfaces (except for a
small area at the anterior nasal spine).
For this reason, the amount of forward
movement of anterior surfaces is less
than the amount of displacement. In
the roof of the mouth, however,
surface remodeling adds bone, while
bone is resorbed from the floor of the
nose. The total downward movement
of the palatal vault, therefore, is
greater than the amount of
displacement.
Mandible Growth
 Mandible
 Intramembranous
 Endochondral ;
 Condylar process, cronoid,
symphesis

Mn Remodeling
 Mandible
 Both endochondral and
periosteal activity are
important in growth of the
mandible.
 Mandible ramus remodeling
 As the mandible grows in
length, the ramus is
extensively remodeled, so
much so that bone at the
tip of the condylar process
at an early age can be
found at the anterior
surface of the ramus some
years later.
Mandible growth
Adolescence Mandibular growth
Adolescence Mandibular growth
 Growth of the mandible
continues at a relatively
steady rate before puberty.
 Average, ramus height
increases 1 to 2 mm /yr
 Body length increases 2 to
3 mm/yr.
 Chin growth
 One feature of mandibular growth is an accentuation of
the prominence of the chin.
 Small amounts of bone are added,
 Resorption b/w chin and alveolar process.
 The increase in chin prominence with maturity results from a
combination of forward translation of the chin as a part of the
overall growth pattern of the mandible and resorption above the
chin that alters the bony contours.
Timing of Growth in Width, Length, and
Height.-------------------------------------- Width
 Growth in width-length,-height.
 Growth in width of both jaws, completed before the
adolescent growth spurt.
 Intercanine width is more likely to decrease than increase
after age 12.7
 Length
 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
 Height
 Height of the face continues longer than growth in length,
with the late vertical growth primarily in the mandible.
Increases in facial height and concomitant eruption of
teeth continue throughout life, but decline to the adult
level.
Facial Growth in Adults
Facial Growth in Adults
 Facial growth had continued during adult life.
 3D increase in all of the facial dimensions.
 Vertical changes >anteroposterior changes.
 Width changes were least evident.
 An apparent deceleration of growth in females in the late
teens was followed by a resumption of growth during the
twenties.
 The data also revealed that rotation of both jaws continued
into adult life, in concert with the vertical changes and
eruption of teeth.
 Facial Growth in Adults
Male growth changes age 37 to age 77 (red).
Growth changes in a woman age 34 and 83. Note that both
Note that both the maxilla and mandible grew forward, jaws grew forward and somewhat downward, and that the
and the nose grew considerably. nasal structures enlarged.
Facial Growth in Adults
 A, Mean dimensional changes in
the mandible for males in adult
life. It is apparent that the
pattern of juvenile and
adolescent growth continues at a
slower but ultimately significant
rate.

 B, The mean positional changes

in the maxilla during adult life,
for both sexes combined. Note
that the maxilla moves forward
and slightly downward,
continuing the previous pattern
of growth.
Mandibular Rotations
 Mandibular rotation
 Growth rotations are reflections of differential growth in
the anterior and posterior face height. \Bjork (1955, 1969)
has shown with implant studies.
 Mandible has rotational element i.e,
 forwards or
 backwards.
 Exsisting stable anatomical structures are:
 I.D. canal.
 Inner cortex or mandibular symphysis.
 Unerupted tooth germs of lower third molars
Mandibular rotation
 The core. (the core of the
mandible rotates up forward down
posterior.)
 Functional processes.
 Components of Mandibular rotation
 True mandibular rotation (Core/total rotation) ---------
rotation, relative to the cranial base, of the mandibular
body when registered on stable structures / implants.
 Apparent mandibular rotation (matrix rotation) ----------
angular change in the orientation of the mandibular
(plane) line, relative to the cranial base. The effect of
angular remodeling on the true mandibular rotation.
 Angular remodeling (intramatrix rotation)
-------------------- angular change in the mandibular line
when the mandible is registered on stable structures/
implants(Core).
 Mandibular rotation
 Backward rotations
 Type I: point of rotation about the condyle, resulting in an
increased anterior face height.
 Type II: point of rotation around the most distal occluding
molar.
20% are backward rotations and may show
generalized features of increased anterior face height,
long face, class II skeletal relationship, reduced
overbite.
 
 Mandibular rotation
 Forward rotations
 Type I: point of rotation about the condyle, resulting in deep
bite and reduced anterior face height.
 Type II: POR-incisal edge of the lower incisors, posterior face
height & normal anterior face height.
 Type III: POR-premolars, anterior face height becomes
underdevreloped and the posterior face height increases with a
basal deep bite. Shown in cases with large overjet/ reverse
overjets.
 80% are forward rotations and generalized features may show
increased overbite, lower incisor crowding with age and slow
space closure.
Mandibular rotation
 Mandibular rotation
 The core of the mandible rotates forward an
average of 15 degrees, the mandibular plane
angle, representing the orientation of the jaw to
an outside observer, decreases only 2 to 4
degrees on the average.
 The reason that the internal rotation is
compensated by external rotation.
 This means that the posterior part of the lower
border of the mandible must be an area of
resorption, while the anterior aspect of the
lower border is unchanged or undergoes slight
apposition. On the average, then, there is about
15 degrees of internal, forward rotation and 11
to 12 degrees of external, backward rotation
producing the 3 to 4 degree decrease in
mandibular plane angle observed in the
average individual during childhood and
adolescence.
 Rotation of maxilla
 A small amount of backward internal rotation of the
maxilla (i.e., down anteriorly). A small amount of
forward rotation is the more usual pattern, but
backward rotation occurs frequently.
MATURATIONAL AND AGING CHANGES
IN THE DENTAL APPARATUS
Space Relationships
Assessment of Skeletal and Other
Developmental Ages
SYNDROMES ASSOCIATED WITH
HEAD AND NECK
SYNDROME

 The word syndrome is derived from a Greek word and its literal
meaning is ‘concurrence of symptoms or run together’

 Syndrome is defined as “ A group of signs and symptoms that

occur together and characterize a particular abnormality or
condition”

 Examples include:
 TMJ syndrome
 RAS syndrome etc.
DISEASE
 It is defined literally as “deviation or interruption of normal structure or
function of an organ characterized by a specific set of signs and symptoms”

 Broadly defining disease is a morbid entity characterized by 2 of the

following criteria:
 1.Recognized etiologic agent (cause)
 2.Identifiable group of signs and symptoms
 3.Consistent anatomic alterations

 Examples are:
 Influenza
 Mumps
 Hepatitis etc
ASSOCIATION.

 It is defined as “A state in which two attributes occur together

either more or less often than expected by chance.”

 Examples are:
 Blood group O
 peptic ulcers.
DIFFERENCE BETWEEN SYNDROME
AND DISEASE
SYNDROME disease
1. In a syndrome usually the In a disease there is mostly
cause and the etiological factor a recognizable cause or
Is not known. etiological factor present.
2. In a syndrome the signs In a disease there is a
and symptoms are too specific set of signs and
variable. Symptoms.
3. In a syndrome consistent In a disease consistent
anatomical alterations are not anatomical alterations
seen. are seen.
4. In a syndrome the treatment is In a disease underlying cause
usually symptomatic because is treated.
cause is not known.
Down Syndrome
Down Syndrome
DiGeorge (VELOCARDIOFACIAL)syndrome
TREACHER-COLLINS SYNDROME
Robin
Crouzen
Apert Syndrome
THEORIES OF THE CRANIOFACIAL
GROWTH
Part 2
4 vicarage mews bradford bd24 lg
Thanku
 Various theories have been proposed to explain the exact
mechanism involved in the growth of bone. All theories
however, were based on three basic principles:
PRIMARY DETERMINANTS OF GROWTH?

They have innate growth potential.

Bones?

Cartilage?

Soft Tissues?
 It is verified that that growth is strongly influenced by
genetic factors, but it also can be significantly affected by
environmental factors such as nutritional status, physical
activity, & health or illnesses.
 The major difference in these various theories, is the
location at which genetic control is expressed.
A. THE GENETIC THEORY
 It simply determines that the genes determine all. This
theory is more assumed than proven & hence is more of
just a hypothesis, with the general assumption found to be
flawed.
SICHER`S HYPOTHESIS (SUTURAL
DOMINANCE)
 Sicher deduced from various studies using vital dyes that
growth was mainly caused by sutures. He stated that:
“the primary event in sutural growth is the proliferation
of connective tissue between two bones.”
 Replacement of the proliferating connective tissue was necessary
for functional maintenace of the two bones. He felt that the
connective tissue in the suture of both, the nasomaxillary
complex & the cranial vault produced forces which separated the
bones, just as the synchondrosis expanded the cranial base, & the
epiphyseal plates lengthened the long bones.
 He however believed that the cartilage of the mandible grew
both interstitially (as epiphyseal plates) as well as appositionally(
as bone grows under the periosteum).
 Sicher thus believed that the facial growth was controlled by
sutures, cartilage & periosteum & all were under tight genetic
control. This theory thus came to be known as the Sutural
Dominance Theory
The hypothesis become discredited because:
 Translatory growth of bones continues normally either in
the absence of sutures.
 In untreated clefts of palate sutures are not present, yet
growth continues.
 Occurance of microcephaly & hydrocephaly raises doubt
about the intrinsic genetic stimulus of sutures in
determining growth.
SCOTT`S HYPOTHESIS (NASAL SEPTUM)
 He stated that the intrinsic growth controlling factors are
present in the cartilage & periosteum, with sutures being
only secondary & growth is thus dependant on extra-oral
influence.
 Scott based his theory noting the prenatal importance of
cartilaginous portion of the head, nasal capsule, mandible
& cranial base. He felt this development was under
intrinsic genetic control & that they continued to dominate
facial growth post-natally.
 He emphasized how cartilage of the nasal septum, during
its growth was in pace with growth of the maxilla. He
stated sutural growth came in reponse to growth of other
structures such as cartilagenous elements as well as soft
tissues such as brain, eyes, etc.
 Thus according to Scott`s theories, growth is in response
to synchondrosis proliferation & local environmental
factor.
 Thus the experimental evidences to support this theory
include:
 Atraumatic resection of nasal septum leads to significance
interference in growth of midface or maxilla.
 In cases of cleft palate where there are no sutures, growth
still takes place.
MOSS`S HYPOTHESIS( FUNCTIONAL
MATRIX THEORY)
 Supports Environmental influence.
 Facial response occur as a response to functional needs &
is mediated by the Soft tissue in which the jaws are
embedded
 EXAMPLES;
 Orbit grows due to eye growth.
 Maxillary sinus growth with oxygen demand.
 Cranium growth due to brain growth.
 Examples in Orthodontics:
 RPE, Functional Appliances, Tongue volume effect on
lower dental arch size.
VAN LIMBORGH THEORY

A multifactorial theory was put forward by Van Limborgh

in 1970.According to him, the previously proposed
theories were not satisfactory , but each contains elements
of significance that cannot be denied. He explained the
process of growth and development in a view that
combines all the existing theories. He supports the
functional matrix theory , acknowledges some aspects of
Sutural theory, and doesn’t rule out the genetic
involvement.
Van Limborgh suggested the following five factors that he
believed controls growth.
Intrinsic genetic factor: They are the genetic control of the
skeletal unit themselves.
Local epigenetic factor: Bone growth is determined by
genetic control originating from adjacent structures like
brain, eyes etc.
General epigenetic factor: They are genetic factors
determining growth from distant structures. Eg: Sex
hormones, growth hormones.
Local environmental factor: They are non genetic factors
from local external environment . Eg: habits, muscle force
General environmental factor: They are general non genetic
influences such as nutrition, oxygen etc.
 The views expressed by Van Limborgh can be summarized in the
following points:
 1.Chondrocranial growth is controlled mainly by intrinsic genetic factors.
 2.Desmocranial growth is controlled by epigenetic growth factors eg:
eye/brain)
 3.The cartilageneous part of the skull must be considered as the growth
centres.
 4.Sutural growth is controlled mainly by influences originating from the
skull cartilages and from other adjacent skull structures.
 5.Periosteal growth largely depends upon growth of the adjacent
structures.
 6.Sutural and periosteal growth are additionally governed by local non
genetic environmental influences.
THANK YOU!
BONE ARTICULATIONS
 Because the sites of junction between bones, known as articulations or
 joints, are important in relation to bone growth, it is useful to classify them
at
 this juncture. These sites can be classified as movable joints (diarthroses) or
 immovable joints (synarthroses). Diarthroses, per se, do not play a
significant role in bone growth except in
 the case of the temporomandibular joint: the articular cartilage of this joint,
 alone of all the articular cartilages, provides a growth potential for one of
the
 articulating bones, the mandible.
 Synarthroses, on the other hand, play a very significant part in the growth
 of the articulating bones. Types and examples of immovable joints are
shown
 in Fig. 6–2 and in the following table.