1. Craniofacial Growth and Development Flashcards
Craniofacial growth and development
- Not merely an “____” process
- Takes place in ____ amounts and in varying directions
- Involves a ____ process within each bone• Synchondrosis - the growth of cartilage
○ It matures and closes at different ____ times
○ Closing at 7-8 - coincides with ____ developmental
§ SE
enlargement
unequal
remodeling
developmental
Synchondroses of Cranial Base:
Inter-sphenoid Synchondrosis: Closure at birth ____
Spheno-ethmoidal Synchondrosis: Closure at ____
Spheno-occipital Synchondrosis: Closure at ____
birth
7-8
15-20 yr
Synchondrosis of Cranial Base
-endochondral growth
____ > endochondral ossification
proliferating chondrocytes
Craniofacial Sutures - Intramembranous growth
• Undifferentiated \_\_\_\_ stem cells • New bone formed on both sides of \_\_\_\_ • Intramembranous growth • Major sites of bone expansion during \_\_\_\_ craniofacial growth
mesenchymal
suture
postnatal
Sutures
• The sutures in the maxilla: ○ \_\_\_\_ suture § Can see from the palatal side ○ \_\_\_\_ suture ○ \_\_\_\_ suture ○ \_\_\_\_ suture ○ \_\_\_\_ suture ○ Suture between the vomer and maxilla: \_\_\_\_ suture
intermaxillary nasomaxillary lacrimomaxillary frontal-maxillary zygomaticomaxillary vomer-maxillary
Sutural growth
• Osteoblasts are on both sides of the surface of the \_\_\_\_
bone
Bone surface remodeling
- intramembranous growth
• Mesenchymal cells in the fibrous connective tissue membrane (____) - intramembranous growth• Intramembranous includes the ____ growth and remodeling
○ For the ____
periosteum
sutural
maxilla
Condylar Growth - Endochondral Growth
* For the mandible, the condyle is the only place that has \_\_\_\_ growth because there is cartilage * For the rest of the mandible, the growth is not from the cartilage, but from bone remodeling > \_\_\_\_ growth * The condyle is \_\_\_\_ on the surface, then proliferating and mature \_\_\_\_
endochondral
intramembranous
fibrocartilage
cartilage
Mandibular Body Growth
- Intramembranous Growth
• Enlargement occurs from resorption from side of \_\_\_\_, and growth is on the \_\_\_\_ surface ○ Only condyle is endochondral growth
ramus
posterior
Craniofacial Growth - Sagittal consideration
- normal facial growth
- maxillary and mandibular ____• Maxilla goes down and forward, mandible goes down and forward
○ Red is older; black is younger
- maxillary and mandibular ____• Maxilla goes down and forward, mandible goes down and forward
downward and forward
Facial Growth
- sagittal consideration (forward rotation)• Used implants in the maxilla and mandible to see what kind of growth is occurring
○ Use it to see direction and amount of growth
• The boys are three years apart
• Maxilla and mandible grows ____; but the posterior part goes down more-so than the anterior part > ____ [???] Rotation
○ Makes the mandibular plane angle ____
• Superimpose the implants in the maxilla > the nasal surface has resorption, and the molar erupts as well as the incisor
• Superimpose the implants in the mandible > molars erupt and they mineralize, as well as the incisor; mandibular plane changes; the condyle also grows
downward and forward
forward
decrease
Facial Growth
- Sagittal consideration (backward rotation)
* Certain patients have different growth patterns: the mandible grows downward but NOT \_\_\_\_; the maxilla has normal growth however * A - maxilla; B - mandible * This kind of growth is not \_\_\_\_
forward
favorable
Facial Growth - sagittal consideration (class III)
* Schedule III - the mandible protrudes \_\_\_\_ * The mandible grows forward much more than the \_\_\_\_
outwards
maxilla
Facial growth
- sagittal consideration
* The growth of mandible vs. maxilla is \_\_\_\_ * The face of a growing child is always \_\_\_\_
different
changing
Facial growth
- sagittal consideration
- Longitudinal growth age ____
- The growth patterns of Class I and Class II are similar. Most children show mandibular ____ rotation.
- SNA and SNB increase from age ____.
- ____ grows more forward than A point. Thus, ANB ____ from age 9 to 18.• The face of a child from 9-18 becomes more straight on the profile because the ____ grows more anteriorly than the maxilla
9 to 18 forward 9 to 18 b point decreases mandible
Facial growth
- vertical consideration
[???]
notes here?
Facial growth
- vertical consideration
If vertical sutural growth and vertical alveolar growth is ____ than vertical condylar growth, mandible would rotate ____ (bite-opening).
If vertical sutural growth and vertical alveolar growth is ____ than vertical condylar growth, mandible would rotate ____ (bite-closing).
• Cranial base is stable > the maxilla grows downward due to sutural growth, and then the mandible has condylar growth; the \_\_\_\_ erupt ○ This is vertical growth! • The amount of downward maxillary growth and eruption, compared with the mandibular condylar growth ○ Condylar growth is slightly more than the sutural downward growth and eruption > makes the mandible forward rotation; makes the posterior part of the face grow downward more than the anterior part ○ If there is not a lot of condylar growth, but more maxillary growth > the bite will open ○ ??? rotation
greater backward smaller forward molars
Facial growth
- vertical consideration
• The molar erupts a lot, the maxilla comes down a lot, there's not a lot condylar growth > mandible grows downward and backward > \_\_\_\_ rotation • Only sagittal and vertical growth is being discussed right now ○ Sagittal > max and man grow down and forward § Small % don't follow the pattern > go downward and backward ○ Vertical § Most children, condylar growth vertically is more than maxillary translation downward > forward rotation § Too much \_\_\_\_ eruption, and little condylar growth > the bite begins to \_\_\_\_ (downward and backward)
backward
molar
open
Facial growth
- vertical consideration
• Longitudinal growth age 9-18 • The growth patterns of Class I and Class II from age 9 to 18 are similar. • The Mandibular Plane Angle \_\_\_\_ from age 9 to 18. • The PFH:AFH ratio \_\_\_\_ from age 9 to 18.
• Normally, the mandibular plane would become flatter; if the angle becomes smaller, then you have \_\_\_\_ rotation which is unfavorable • A point > maxilla > the most \_\_\_\_ point is located here (the most forward point); the B point is the same concept, just in the mandible • ANB line has a small angle ○ Mandible grows more with growth > the angle should become \_\_\_\_ ○ Schedule III, ANB angle would be \_\_\_\_ because the mandible so far outward ○ If the mandible is \_\_\_\_ (schedule II) the ANB angle would be larger
decreases increases backward concave smaller negative short
Facial Growth
- transverse consideration
• Sagittal > face becomes \_\_\_\_ • [???] • Transverse growth ○ The maxilla grows \_\_\_\_, and the surface begins to remodel
straighter
downward
Maxillary Transverse Growth
• Transverse growth of maxilla is mainly through the \_\_\_\_, and will separate the two parts • Periosteum > \_\_\_\_ remodeling; there's also bone apposition • Age 4/5 to 18/20 > place two implants where the balls are, and watch the increase between the implants > sutural growth; and then beyond that it's bone remodeling • In the posterior, \_\_\_\_ growth occurs more than it does anteriorly • From growth the molars grow forward • Maxillary transverse growth is mainly \_\_\_\_ (more than 70%) • From any age to 18 ○ From 10/11 to 18 § Between implants in posterior: sutural growth is \_\_\_\_mm, but the molar width is only \_\_\_\_ (sutural growth vs intramolar growth is not the same)
suture
intramembranous
sutural
sutural
3
1.8mm
Facial growth
- transverse consideration
Jugale (J): at the jugal process, the intersection of the outline of the ____ and the zygomatic buttress.
Antegonion (Ag): at the ____
• Determine transverse growth through 3D imaging > \_\_\_\_ ○ Before that, used 2D imaging to determine the transverse growth
tuberosity of the maxilla
antegonial notch
CBCT
Facial growth
- transverse consideration
• Maxillary transverse growth after \_\_\_\_ is complete
14-15
Facial growth
- transverse consideration (maxilla)
• \_\_\_\_ y/o on females, transverse growth on the maxilla is complete; the \_\_\_\_ is still growing ○ It's a little bit later for \_\_\_\_
14-15
mandible
males
Facial growth (transverse) - arch width (moyers)
* At 12 > the first molar growth to 18 only changes \_\_\_\_mm * The changes are all minimal among the teeth
1
Facial growth (transverse) - maxillary arch • Upper intermolar margin change is only \_\_\_\_mm
2.6
Buccolingual inclination of posterior teeth - curve of wilson
• Curve of spee is on \_\_\_\_; curve of wilson is on the \_\_\_\_ • Upper molars long axis tend to incline \_\_\_\_; while the lower teeth incline \_\_\_\_ ○ This changes with \_\_\_\_
sagittal
transverse
buccally
lingually
Buccolingual Inclination of Posterior Teeth - Curve of Wilson
Resistance in loading:
Teeth aligned parallel to direction of ____ for optimum resistance to masticatory forces.
Masticatory function:
Allows food to be tossed directly onto ____.
internal pterygoid muscle
occlusal table
Buccolingual Inclination of Posterior Teeth - Curve of Wilson
A small ____ between the buccal segments allows for proper occlusal function.
An accentuated curve of Wilson results in ____ interferences, especially in the ____ area.
curve of Wilson
balancing
second molar
Normal Buccolingual Inclination of Untreated Adults
- Maxilla, slight ____ tipping
- Mandible, slight ____ tipping
buccal
lingual
Normal Buccolingual Inclination of Untreated Posterior Teeth
• The inclination of the \_\_\_\_ is greater than it is for the upper; these change with \_\_\_\_
lower teeth
growth
ABO - Buccolingual Inclination of Maxillary Posterior Teeth
• TL > upper second molar is inclined \_\_\_\_
too much
Buccolingual Inclination Changes of Molars With Growth
• With growth, the \_\_\_\_ also changes
curve of Wilson
Diagnosis of Transverse Problems
- There should be proper transverse ____ width, transverse dental width.
- Roots should be in ____ bone with proper buccolingual inclination
- There should be no dental ____.
skeletal
basal
crossbite
Scammon’s Curve of Growth
• At age 10, the ____ is more advanced in its growth (more mature)
• Growth spurt - ____ is usually two years ahead
maxilla
girls
Timing of Growth Modification
- before growth spurt
[???]
LOOK ME UP!
Handwrist film
• To evaluate growth, you take ____ photos (because some have different schedules)
• Width of ____, capping, ossification and fusion > used to evaluate the schedule age > like to see if the patient has ____ and helps you treat the patient more effectively
handwrist
epiphyses
growth potential
Cervical Vertibra Maturation (CVM)
- C 2, C3, C4
- Shape (trapezoid, square, rectangle)
- Presence of notch on lower border‣ What is the difference between CS3 and CS4?
• ____ has notches on all there but CS3 only has notches
on ____
CS4
C2
C3
Facial growth modification - sagittal (skeletal class II)
• Skeletal Class II
- Usually ANB > ____ with significant ____.
- Treatment should be started before ____ to improve skeletal relationship, girls usually 2 years earlier than boys.
- Skeletal effects using ____ or functional appliances generally are positively impacted.• Skeletal class II > patient has a small ____; on the profile the mandible is behind vs a patient with a strong mandible and you see a concavity
• For a patient with a small mandible > inhibit ____growth so the mandible grows naturally - class II molar relationship:
overjet - ____, overbit - ____
• Headgear is ____
• Mandibular growth is forward, and the maxillary growth is not forward > evening out their bite
4 overjet growth spurt headpiece mandible maxillary
12mm
1mm
orthopedic
Facial growth modification - sagittal (skeletal class III)
Class III Malocclusion
- The anterior crossbite should be treated as ____ as possible due to its adverse effects on the facial growth and development. It can be treated as early as ____ years old in the ____ dentition.
- For a true skeletal Class III, treatment with orthopedic appliance can be started in the early ____ dentition.
- Example of a crossbite
- Would like to move the ____ forward
- ____
early 5-6 primary mixed maxilla anterior crossbite
Vertical Consideration on Facial Growth
- Maxillary downward growth
- Maxillary dentoalveolar
growth - Mandibular dentoalveolar
growth - Condylar growth• Control the ____ eruption to help the vertical consideration > will help the mandible have ____ rotation
molar
forward
Facial Growth Modification
- vertical
Class II High Angle: \_\_\_\_ High pull head gear \_\_\_\_ Molar intrusion
Class II Low Angle:
• ____
• Anterior bite plate
vertical chin cup
posterior bite plate
cervical head gear
Facial growth modification
- vertical (skeletal open bite)
- Often displays a ____ mandibular plane angle, longer lower facial height, and super-eruption of the ____ teeth with increased dentoalveolar height.
- A dental open bite is typically related to ____ or digit sucking habits. The skeletal open bite demonstrates more ____ and incisor eruption than a dental open bite.
- Should be treated early to be successful (phase I- age ____ years).
- Could involve using a bonded ____ with a high pull head gear to reduce vertical ____ growth and encourage forward rotation of the mandible.
high maxillary thumb molar 7-9 RPE maxillary
Facial Growth Modification
- vertical (skeletal deep bite)
- ____
- Cervical pull head gear
- ____
- Orthognathic surgery
anterior bite plate
conventional orthodontics
Facial Growth Modification
- vertical
• This patient had a biteplate on the molar area for a few years > resulted in an \_\_\_\_
open bite
Facial growth modification
- vertical
• Encourage the growth of the \_\_\_\_
molars
Facial growth modification
- vertical
• Give the patient a \_\_\_\_ > takes the patient about 4 months
bite plate
Facial growth modification
- vertical (skeletal open bite)
• Open bite > vertical problem > control the \_\_\_\_ eruption
molar
Facial growth modification
- transverse (RPE)
• Narrow maxilla > \_\_\_\_ problem
transverse
Mid-palatal suture
• At a young age, the sutures are like a straight line but then
they become more ____
• We already know that suture growth accounts for major
growth of the ____
• So we like to open the suture when patients are ____
interdigitated
maxilla
young
Facial Growth Modification
- transverse (RPE)
* \_\_\_\_ * Maxilla is \_\_\_\_ > crossbite * Orthopedic > using an \_\_\_\_ > try to open the suture * When you expand maxilla > open the \_\_\_\_
crossbite
narrow
expander
nasal cavity
Transverse effects of RPE on maxilla
* The maxillary bone widens and so does the nasal cavity; not as much as you expand the \_\_\_\_ > the lower part you expand more, the upper you expand less * Use \_\_\_\_ to see if you open the suture
molars
CBCT
