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ABPD 2021 > Growth and Development > Flashcards

Growth and Development Flashcards

1
Q

Period of the Ovum

A

0-10/14 days
Fertilization to implantation
Cell division (proliferation)

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2
Q

Period of the Embryo

A

Week 2-8
Remainder of first trimester
Cell differentiation

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3
Q

Period of the Fetus

A

Weeks 8-40
2nd and 3rd trimester
Maturation of organ systems

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4
Q

Overall structure components of a branchial arch

A

Cartilage
Nerve
Blood vessels
Surrounded by mesenchyme

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5
Q

Merging of the two medial nasal processes gives rise to what structures?

A 
Tip of nose
Columella
Philtrum
Primary palate
Maxillary incisor teeth
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6
Q

Merging of the maxillary process + medial nasal process gives rise to what?

A

Lateral aspect of upper lip
Cheek
Rest of maxillary teeth and secondary palate

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7
Q

Merging of the maxillary process + lateral nasal process gives rise to what?

A

Nasolacrimal duct

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8
Q

Overview of palate formation

A

Initially palatal shelves grow vertically on either side of developing tongue
Palatal shelf elevation occurs rapidly bringing the shelves into proximity
Fusion of shelves to each other and nasal septum follows

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9
Q

Definition of growth

A

Increase in size or number

Anatomical phenomenon

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10
Q

Definition of behavior

A

Increasing degree of organization, complexity and specialization
Physiological and behavioral phenomena

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11
Q

Hypertrophy

A

More cell size

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12
Q

Hyperplasia

A

More cell number

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13
Q

Interstitial vs appositional growth

A

Interstitial: occurs throughout the tissue; soft tissues and cartilage
Appositional: occurs on surface of tissue only; hard tissues

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14
Q

Intramembranous vs Endochondral growth

A

Intramembranous: secretion of bone matrix directly with connective tissues; radiating mesenchyme

Endochondral: cartilaginous precursor, replacement of cartilage with centers of ossification

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15
Q

Fetal skull growth

A

By week 8 in utero, cartilage of chondrocranium has begun to develop
By week 12, midline cartilage has begun to ossify and bones of the cranial vault, maxilla and mandible have begun to form

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16
Q

Mandible growth

A

Formed by both intramembranous and endochondral ossification

At 7 weeks, intramembranous ossification of the body of the mandible has begun lateral to Meckel’s cartilage

Condylar cartilage arises independently as a secondary cartilage, initially separated from the body of the mandible, but fuses in fetal life (endochondral)

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17
Q

Cephalocaudal gradient of growth

A

Growth is prioritized towards the skull, then proceeds towards caudal (tail) area

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18
Q

Scammon’s Growth Curve

A

Growth of different tissues (lymphoid, neural, general, genital)

Lymphoid: rapid acceleration and highest peak at age 10 then decreases
Neural: slow rise and plateaus around age 5 with everything done by 10
General: steady consistent rise
Genital: slow flat rise until about 12, which then has rapid rise

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19
Q

Definition of remodeling

A

Balance of apposition and resorption

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20
Q

Definition of relocation/drift

A

Movement of a component part of bone in response to remodeling

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21
Q

Definition of displacement/translation

A

Movement of a whole bone in response to remodeling

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22
Q

Cranial Vault Growth

A

Intramembranous ossification
Flat bones of skull
Fontanelles eventually beome sutures

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23
Q

Cranial Base Growth

A

Endochondral ossification
Frontal bone, sphenoid bone, temporal bone, occipital bone
After ossification takes place, synchondroses are leftover

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24
Q

Growth of maxilla

A

Maxilla forms through intramembranous ossification

Apposition of bone in the suture (superior and posterior) leads to displacement of the maxilla down and forward

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25
Q

Growth of mandible

A

Mixed endochondral and intramembranous ossification
Main sites of remodeling are resorption at anterior surface of ramus, apposition at posterior of ramus
Overall effect is down and forward translation/displacement

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26
Q

Primary Germ Layers

A

Ectoderm: epidermis, oral mucosa, enamel
Mesoderm: skeletal muscle
Endoderm: lining of gut
Neural crest: connective tissue cartilage, bone, dentin, cementum, pulp, PDL

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27
Q

Where germ layers do the structures of teeth come from?

A

Enamel comes from ectoderm

The rest comes from neural crest

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28
Q

When do primary tooth buds appear in utero?

A

6 weeks

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29
Q

Tooth buds

A

Primary incisor, canine, molar buds each have successional lamina for permanent successors
Permanent molar buds develop from the dental lamina that extends distally from primary second molar

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30
Q

Stages of tooth development - how it looks

A 
Bud
Cap
Bell
Dentinogenesis
Amelogenesis
Crown formation
Root formation
Eruption
Root completion
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31
Q

Stages of tooth development - what activities happen

A 
Initiation
Proliferation
Histodifferentiation
Morphodifferentiation
Apposition
Calcification 
Eruption
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32
Q

Cap Stage

A

Enamel organ forms from ectoderm, surrounded by condensation of ectomesenchyme

Ectomesenchyme forms the dental sac and papilla

Dental sac will become PDL and cementum

Dental papilla will become dentin and pulp

Enamel organ differentiates into 4 layers (OEE, IEE, stellate reticulum and stratum intermedium)
-IEE becomes ameloblasts

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33
Q

Bell Stage

A

Histodifferentiation of cells of tooth germ into inner ane outer epithelium and dental papilla
Morphodifferentiation of tooth germ that takes on morphology of tooth
Apposition of tissue matrix

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34
Q

Formation of enamel and dentin (histodifferentiation and apposition)

A

Odontoblasts are signaled by preameloblasts to make predentin - beginning the first dentin at the DEJ
Preameloblasts differentiate into mature ameloblasts after dentin is formed

Enamel and dentin matrices are deposited simultaneously from incisal portion to CEJ

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35
Q

Root formation

A

Begins toward end of crown formation and does not complete until 2-3 years after eruption
OEE and IEE form Hertwig’s Epithelial Root Sheath - guides the shape and number of roots
Breakup of HRS allows cells of dental sac to contact root dentin and differentiate into cementoblasts

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36
Q

Eruption

A

Root development correlates with eruption

PDL completes as tooth erupts

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37
Q

Three phases of eruption

A

Pre-eruptive: root formation begins and tooth is moving toward surface
Eruptive (prefunctional): development of tooth root through gingival emergence
-most roots 1/2-2/3 developed upon gingival emergence
Eruptive (functional): from gingival emergence to point where tooth meets antagonist

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38
Q

Eruption of primary incisors

A

6-12 months

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39
Q

Eruption of primary first molars

A

12-16 months

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40
Q

Eruption of primary canines

A

18-20 months

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41
Q

Eruption of primary 2nd molars

A

16-30 months

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42
Q

General features of primary dentition

A 
Developmental spacing 
Baume Type I: spacing
Baume Type II: no spacing 
Dental arches are ovoid shaped 
Deep bite initially that changes to edge to edge 
Flat curve of Spee
Flush terminal plane in most
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43
Q

Primate space

A

Distal to maxillary lateral

Distal to mandibular canine

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44
Q

First inter-transitional period

A

Period between completion of primary dentition and emergence of first permanent tooth

Early mesial shift

Deepening of bite due to attrition

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45
Q

Early mesial shift

A

Closing of interdental space between primary molars prior to eruption of first permanent molars

Affects mandibular primate space

Occurs around 4 years

Converts flush terminal plane to mesial step

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46
Q

First Transitional Period

A

6-8 years
Replacement of incisors and eruption of permanent molars

Incisor liability
Shark teeth

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47
Q

Incisor liability

A

Permanent incisors are larger than primary incisors
7.6mm in maxilla, 6mm in mandible
Interdental spacing helps compensate

Labial eruption path of permanent incisors leads to increased proclination of permanent incisors (increases arch perimeter)

Canines move distally to increase intercanine width

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48
Q

Second Inter-Transitional Period

A

8-10 years
Ugly duckling stage
From complete eruption of permanent incisors to beginning of replacement of primary canines ad molars

Spacing in maxilla, excess overjet, loss of primate space in maxilla

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49
Q

Second Transitional Phase

A

10-12 years
Replacement of primary molars and canines

Leeway space
Late mesial shift
Closure of maxillary diastema

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50
Q

Leeway space

A

Difference in MD dimension between primary canine and molars and permanent canine and premolars

Maxillary 2.2mm (Bishara), 1.8mm (Nance)
Mandibular 4.8mm (Bishara), 3.4mm (Nance)

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51
Q

Late mesial shift

A

Mesial movement of first permanent molars after exfoliation of primary molars
Arch length decreases 2-3mm

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52
Q

Permanent dentition stage

A

12 years to adult

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53
Q

Which dimension is last to complete growth? (vertical, transverse, anterior/posterior)

A

Vertical

Transverse dimension is completed before permanent dentition stage
AP dimension finishes before vertical

54
Q

Does dental age generally correlate with developmental age?

A

No

Variation in timing of eruption

55
Q

Skeletal age

A

More highly correlated with menarche than height, weight or growth velocity

56
Q

Skeletal age staging methods

A

Carpal Index (Hand-Wrist Image) - seeing if epiphyses have ossified

Cervical vertebrae maturation stages - 5 stages of vertebra morphology

57
Q

Prepubertal growth peak

A

Age 6-7

58
Q

Pubertal growth peak

A
  1. 5 females

14. 5 males

59
Q

AP Dimension Changes

A

Decreases in maxilla when first molar erupts, then increases with incisors, and decreases once premolars erupt

Decreases in mandible when first molar erupts, stays stable, then decreases

60
Q

When is arch length the greatest in the mandible?

A

Early mixed dentition, before early mesial shift

61
Q

What does distal step primary molar relationship usually go to in permanent molars?

A

Class II

Can go to flush

62
Q

What does flush terminal plane go to in permanent molar relationship?

A 
56% class I
44% class II
63
Q

What does mesial step go to in permanent molars?

A 
68% class I
13% class II
19% class III
64
Q

Overall population permanent molar relationships

A 
61% class I
34% class II
4% class III
65
Q

Transverse dimension changes

A

As incisors erupt, increase in dimension and levels off with canine eruption
Intercanine width increase is not as great in the mandible as the maxilla

66
Q

When is intercanine width complete?

A

Mandible: 9-10 years (early for girls than boys)

Maxilla: 12 years (girls), 18 years (boys)

67
Q

Angle Classification

A

Class I: MB cusp of upper 1t molar occludes in buccal groove of lower 1st molar

Class II: lower molar distally positioned

Class III: lower molar mesially positioned

68
Q

Overjet

A

Normal = 2-3mm

Measured from labial surface of lower incisor to incisal tip upper incisors

Division 1: flared incisors
Division 2: retroclined incisors

69
Q

Components of AP direction

A

Angle molar class
Overjet
Incisor Angulation
AP incisor position

70
Q

Components of Vertical Dimension

A

Overbite
Incisor display
Curve of Spee
Occlusal Cant

71
Q

Overbite

A

Normal is 1-2mm or 20-30%

72
Q

Components of Transverse Dimension

A 
Midlines
Posterior crossbites
Arch width
Arch symmetry
Curve of Wilson
73
Q

Prediction of Alignment

A 
Crowding and arch length deficiency
Missing teeth
Supernumerary teeth
Impacted, transposed, ankylosed teeth
Diastema
74
Q

Bolton Analysis

A

Tooth size discrepancy
Ideal sizes of maxillary and mandibular teeth ratio
Only done in permanent dentition (not mixed)

75
Q

Mixed dentition analysis

A

Compares space available as measured in permanent dentition to space required as measured in erupted permanent incisors or unerupted permanent canines and premolars

76
Q

Direct measurement of mixed dentition analysis

A

Measure unerupted teeth on radiographs
Account for magnification errors
Compare space required with space available

77
Q

Tanaka and Johnston

A

Mandibular incisors must be erupted
Predicts unerupted permanent canines and premolars

1/2 the MD width of four lower incisors + 10.5mm = estimated width of mandibular canine and premolars of one quadrant

1/2 the MD width of four lower incisors + 11.0mm = estimated width of maxillary canine and premolars in one quadrant

78
Q

Moyers analysis

A

Uses prediction values for unerupted canine and premolars for one quadrant based on width of mandibular incisors

Most commonly used

79
Q

Tooth Size Discrepancy

A

5% of population have some degree of tooth size discrepancy

Most common teeth are upper lateral incisors and 2nd premolars

80
Q

Purpose of cephalometric analysis

A

Compare patient to normal reference group

Diagnose skeletal discrepancy

81
Q

Steiner analysis

A

First modern cephalometric analysis

Displayed measurements in a way that emphasized not just individual measurements but patterns

Offered specific guides for use of cephs

Most widely used analysis today

82
Q

SNA

A

Sella Turcica - Nasion - A point

Normal is 82 degrees

Relates cranial base to maxilla

Greater = prognathic maxilla
Lesser = retrognathic maxilla
83
Q

SNB

A

Sella Turcica - Nasion - B point

Normal is 80 degrees

Relates cranial base to mandible

Greater = prognathic mandible
Lesser = retrognathic mandible
84
Q

ANB

A

A point - Nasion - B point

Normal is 2 degrees

Relates maxilla to mandible

Greater = class II skeletal
Lower = class III skeletal

Does not specify which jaw is at fault

85
Q

Relationship of upper incisor to NA line

A

Normal is 4mm and 22 degrees

Greater = proclined and protrusive 
Lesser = retroclined and reclusive
86
Q

Relationship of lower incisor to NB line

A

Normal is 4mm and 25 degrees

87
Q

Interincisal angle

A

Normal is 131 degrees

Smaller = acute angle, proclined

Doesn’t tell which incisor is at fault

88
Q

Mandibular plane to Sella-Nasion plane

A

GoGn - SN angle

Normal is 32 degrees

Greater = steep mandibular plane angle (dolichofacial)
Lower = shallow mandibular plane angle (brachyfacial)
89
Q

Occlusal plane to SN

A

Norm = 14 degrees

Greater = dolichofacial

90
Q

Management of Skeletal Problems

A

Skeletal solutions for skeletal problems

Dental solutions for skeletal problems = camoflauge

Growth modification and surgery

91
Q

Growth Centers and Growth Sites

A

Growth Center: area considered to be under genetic control that exhibit tissue-separating capabilities

Growth Site: area where active skeletal growth occurs in a secondary, compensatory manner

All growth centers are growth sites, but not all growth sites are growth centers

92
Q

Nasal Septum Theory (1950s)

A

Proposed by Scott

Cartilage is primary target of genetic activity

Cranial base, nasal septum, mandibular condyles drive growth (growth centers)

Pretty accurate, but difficultt o modify these growth centers

93
Q

Functional Matrix Hypothesis (1960s)

A

Proposed by Moss

Main idea = form follows function

Soft tissues are primary targets of genetic activity

Skeletal structures grow in response to their extrinsic environment (bone is growth site, soft tissue is growth center)

Functional cranial components - cranial bones respond to growth of brain

Not considered 100% accurate, but some elements are true as a lot of skeletal growth is driven by soft tissues

94
Q

Servosystem Theory (1970s)

A

Proposed by Petrovic

Nasal septum and cranial base are primary targets of genetic activity

Condylar growth is secondary

Midface growth is driven by sutures

Occlusal deviation leads to mandibular growth

Mandibular growth proprioception sends back information

95
Q

Modification of growth at anatomical sites

A

Periosteal tissues: difficult to modify
Sutures: susceptible to pressure and tension (easiest to modify)
Cartilage (difficult to modify)
Synchondroses: questionable susceptibility to pressure and tension

96
Q

Transverse growth modification of maxilla

A

Create tension at midpalatal suture

RPE: Hyrax (more force), Haas (acrylic; hygiene not good)
Quad helix: springs, less force
W arch: stronger than quad helix, but not as much as RPE
Schwartz: removable; takes longer

97
Q

AP growth modification of maxilla

A

Create tension at circum-maxillar sutures

Face mask (reverse pull headgear): used for early class III - tries to pull maxilla forward via fixed appliance in maxilla and pad on forehead and chin

98
Q

AP restriction modification of maxilla

A

Create pressure at circum-maxillary sutures

Parietal pull headgear (up and back): used for dolichofacial

Cervical pull headgear (down and back): used for brachyfacial

Occipital headgear: normocephalic

99
Q

AP growth modification of mandible

A

Modify function of mandible
Difficult to achieve much growth, produces teeth movements
Should be done right before puberty

100
Q

AP growth of mandible appliances

A

Bionator: removable appliance, makes it uncomfortable to bite unless mandible is forward

Twin block: removable appliance, inclined plane to force mandible forward

Herbst: fixed appliance, pin and tube apparatus pulls mandible forward (can be removable)

Mandibular Anterior Repositioning Appliance (MARA): one element on maxilla, one on mandible similar to Herbst

101
Q

AP growth restriction of mandible

A

Restrain growth in condylar cartilage at periosteum

Chin cup: not a ton of success, requires a lot of compliance

102
Q

Timing of growth modification

A

RPE and Facemasks should be done in childhood, before pre-pubertal minimum

Functional appliances are done at pubertal maximum (preteen)

103
Q

Management of over-retained teeth

A

Problems = gingival inflammation, deflected eruption

Solutions = self-exofliation if mobile, extraction if not

104
Q

Management of ectopic lateral incisors

A

Problems = premature loss of primary canine (indication for space analysis)

Solutions = lingual arch with or without spur to prevent midline shift and prevent lingual tipping

105
Q

Management of ectopic maxillary first molars

A

Problems = blockage of eruption

Solutions = active survillance or intervention

2/3 self-correct
Observe for 6 months, and if no change, intervention necessary

106
Q

Intervention for ectopic maxillary first molars

A

Halterman (fixed appliance)

Brass wire

Ortho separator

Arkansas separator

107
Q

Management of ectopic maxillary canines

A

Problems = retention of primary canines, impaction

Solutions = extraction of primary canines, maxillary expansion

Often associated with small lateral incisors

If canine is behind midline of maxillary incisor (sector I or II), 91% self-correct
If past the midline of lateral, 64% self-correct (sector III)

108
Q

Management of ankylosed teeth

A

Problems = effect on eruption of permanent successor, mesial tipping of distal tooth, supraeruption of opposing tooth, vertical bone defect

Solutions = buildup with composite, anesthetize and subluxate

If no successor, treatment could be extract and allow mesial drift, or decoronation and maintenance of bone

109
Q

Factors associated with prolonged sucking habits

A

Older maternal age
Higher maternal education level
No older siblings

110
Q

How many children have oral habit in first year of life?

A

> 90%

111
Q

Outcomes of prolonged NNSH

A

Anterior open bite
Posterior crossbite
Excess overjet

112
Q

What type of NNSH is more common in posterior crossbite?

A

Pacifier habit

113
Q

What type of NNSH is more common for excess overjet?

A

Digit sucking

114
Q

Timing of intervention for NNSH

A

Intervene before eruptio nof permanent teeth (start 3-4 years)

115
Q

Options for intervention for NNSH

A 
Psychosocial health 
Counseling
Reminder therapy
Reward system
Adjunctive therapy (tongue crib, quad helix, etc.)
116
Q

Tongue thrust

A

Outcome: Anterior open bite
Treatment: tongue crib, myofunctional therapy

117
Q

Mouth breathing

A

Outcome: longer lower face, maxillary constriction, adenoid facies

Normal for 3-6 year olds to be lip incompetent

Treat with T&A if from airway obstruction

118
Q

Nail biting

A

Rare in children under 3
Suggested as manifestation of stress
Impact: no evidence of impact on occlusion, possible enamel fractures
No treatment recommended

119
Q

Bruxism

A

Impact: wear of primary canines and molars 9rare effect on pulp), muscle soreness, TMJ pain

Causes: stress, localized causes, medical causes

Treatment: equilibrium of occlusal interferences, rule out systemic problems, mouthguard, stainless steel crowns as needed, therapy

120
Q

Etiology of Premature Tooth Loss

A 
Caries
Trauma
Ectopic eruption
Congenital disorders
Arch length deficiencies resulting in resorption
121
Q

Early loss of primary incisors

A

Usually due to caries or trauma

Minimal loss of arch length
<2 years, possible space loss

Minimal impact on masticatory function

Possible impact on speech (lingual-dental sounds like s, z, th)

122
Q

Early loss of canines

A

Usually due to arch length deficiencies
No detectable relationship with posterior alignment
Accompanied by lateral shift of incisors and midline shift

123
Q

Early loss of primary first molars

A

Usually due to caries
Canine and incisor dislocation toward extraction site
Mesial movement of second molar

No statistically significant loss of arch width, length and perimeter in primary dentition
-less space loss after eruption of permanent molars

124
Q

Early loss of second primary molars

A

Usually due to caries, sometimes due to ectopic eruption of permanent first molar

Arch length reduction

125
Q

When does the greatest space loss occur after loss of tooth?

A

First 4-8 months after extraction

126
Q

Impact of early tooth loss on occlusion

A

Mandibular effects worse than maxillary

Second primary molar effects worse than first

Earlier tooth loss worse than later

Tooth loss in crowded arch worse than in spaced

127
Q

Summary of early tooth loss

A

Premature loss of primary teeth correlates with increasing likelihood of ortho treatment

Premature loss of primary incisors and canine does NOT affect posterior occlusion

Premature loss of primary canines MAY affect anterior alignment

Premature loss of primary molars MAY affect posterior occlusion

128
Q

Treatment options for crowding

A

Mild: 0-4mm; maintain space available
Moderate: 4-8mm; increase space available
Severe: >8mm; decrease space required

129
Q

Serial Extraction

A

Planned sequence of tooth removal to reduce crowding and irregularity during transition from the primary to permanent dentition

Extraction of primary canines, primary first molars, first premolars

Allows permanent teeth to erupt through keratinized tissue rather than displaced buccal or lingual

130
Q

Key concepts of space management

A

In mixed dentition, space available is measured the same way as in permanent dentition

In mixed dentition, space required must be estimated to predict the size of unerupted teeth

The serial extraction protocol is initiated in the mixed dentition

ABPD 2021 (14 decks)

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