Facial growth Flashcards
What is general growth defined as
An increase in size by natural development and is a consequence of cellular proliferation and differentiation
How do we measure general growth
Using the height distance curve
What does the height distance curve measure
Age against height
What organs/ body systems can we use to measure growth patterns
- Lymphoid
- Neural
- Somatic
- Genital
Out of the 4 main organs we use which shows general growth
Somatic
What does the maxillary growth pattern follow
The neural growth pattern
What does the mandibular growth pattern follow
The somatic growth pattern
How do clinicians assess general growth
- Growth charts (height and age)
2Median/ decile values for boys and girls
What do we assess general growth
If there is anything abnormal we can investigate early
Other than general growth what else do we assess
Rate of growth
How do we measure rate of growth
Height velocity curve
Age against change in height
What does a normal height velocity curve show
3 phases:
- Rapid growth at birth, progressively decelerates till age of 3
- Slow deceleration phase persisting until adolescent growth spurt
- Adolescent growth spurt followed by progressive deceleration until adulthood
When do girls usually have their growth spurt
10.5-12.5 years
When do boys usually have their growth spurt
12.5- 14.5 years
When do girls usually have their growth cessation
15-16 years
When do boys usually have their growth cessation
17-19 years
How can we predict future growth
- Sequential height measurements
2. Secondary sexual characteristics
Talk through the stages of adolescence in girls
- Early breast development
- Axillary (armpit) pubic hair development
- Onsent of menstruation
Talk through the stages of adolescence in boys
- Fat spurt
- Initial pubic hair development
- Armpit and upper lip facial hair development
- Chin facial hair development
What growth pattern does the maxilla follow
Neural
What growth pattern does the mandible follow
Somatic
How do bones of the face grow
- Relocation (growth remodelling)
2. Growth displacement
Name the 3 planes the facial Skelton is assessed in
- Antero- posterior
- Vertical
- Transverse
What is the antero-posterior plane
Plane running from the front to the back of the head
What is the vertical plane
The plane running from eh top of the head to the bottom of the head
What is the Transverse plane
The plane running from one side of the face to the other
Describe the growth of the maxilla in the antero posterior plane
- Partial displacement forwards with tiny in fill at sutures
- Partial periostea remodelling
- Tuberosities grow backwards lengthening the dental arch
Describe the growth of the maxilla in the vertical plane
- Increase in height of alveolar process
- Downwards drift of hard palate with remodelling
- Bony in fil at sutures
Describe the growth of the maxilla in the transverse plane
- 2 halves of the maxilla move apart
2. Neal cavity and air sinuses increase in size
Describe the growth of the mandible in the antero posterior plane
- Mandible displaces anteriorly with infiltration at the condyle
- The mandible remodels especially in the anterior region
- Chin becomes more prominent
- Normal increase in length is 2-3mm per year
When does mandible growth double
During pubertal growth spurt
Describe the growth of the mandible in the vertical plane
- Alveolar process becomes taller as teeth erupt
- Ramus becomes taller
- Growth infield at condylar cartilage causing lengthen
Describe the growth of the mandible in the transverse plane
- Remodelling with resorption on inner surface and deposition on outer surface
- Increase width especially posteriorly
How do we assess the anterior posterior skeletal pattern
In classes: I II III
When does anterior poster growth stop in boys
19 years
When does anterior poster growth stop in girls
16-17 years
Describe a class I AP skeletal pattern
If the mandible lines within 2-4mm of the maxilla
Describe a class II AP skeletal pattern
If the mandible is more than 4mm posterior to the maxilla
Describe a class III AP skeletal pattern
If the mandible is less than 2mm posterior to the maxilla
What might improve a class II profile
Mandibular growth during pubertal growth spurt (not in all cases)
At what age for boys do we use functional appliances to correct a class 2 profile
12.5-14.5 years
At what age for girls do we use functional appliances to correct a class 2 profile
10.5-12.5 years
What can happen during AP growth in a class III profile
Malocclusion can worsen
What are our treatment option to correct a class III occlusion
- Orthodontic camouflage
2. Surgical correction
When can we determine the severity of a Class III pattern
Wait until growth is complete
If we identify a class III skeletal pattern in a pre pubertal patient what can we do
Use interceptive orthodontics such as protraction face mask
When is a protraction face mask most successful
between 8-10 years
How do we assess vertical development
By using:
- FMPA
- Facial thirds
When does vertical growth stop in boys
20 years
When does facial growth stop in girls
17-18 Years
List some signs go an abnormal increased vertical development
- Increased FMPA
- Increased lower anterior facial height
- Reduced overbite/ anterior open bite
List some signs go an abnormal decreased vertical development
- Reduced FMPA
- Reduced lower anterior facial height
- Increased overbite
Describe the features of normal transverse plane
- No asymmetry extra orally
- Maxillary and mandibular centre lines coincident to each other and the mid facial plane
- No cross bites
When does transverse facial growth stop in boys
12 years
When does transverse facial growth stop in girls
12 years
What features do we look at when assessing fro abnormal transverse development
- Facial symmetry
- Unilateral or bilateral cross bite
- Centreline discrepancy
What causes a bilateral buccal cross bite
transverse discrepancy between maxilla and mandible
When should we treat bilateral buccal cross bite
In early permanent dentition before fusion of mid palatal suture
How can we manage bilateral buccal cross bites
- Removable appliance with a midline expansion
- Fixed appliances
- Rapid maxillary expander
When do we we a Rapid maxillary expander
After age of 16 when mid palatal suture has fused
In regards to dental growth what would we like to predict
- Future size of jaws
- Rate of growth and when it occurs
- Direction of growth
- Soft tissue growth
Gives some methods of assessment we use to predict dental growth
- Chronological age
- Growth chart
- Secondary sexual characteristics
- Radiographs