POSTNATAL GROWTH AND By

DEVELOPMENT SUSANTH V SURESH

CONTENTS
• INTRODUCTION
• TERMINOLOGIES
• FACTORS INFLUENCING GROWTH
• RUDIMENTS OF BONE GROWTH
• GROWTH PATTERN VARIABILITY AND TIMING
• GROWTH SPURTS,GROWTH TRENDS,GROWTH
RHYTHM,GROWTH PATTERN
CONTENTS
• SITES AND TYPES OF GROWTH IN THE CRANIOFACIAL
COMPLEX
CRANIUM
BASE OF CRANIUM
MAXILLA
MANDIBLE
FACIAL SOFT TISSUE
CONTENTS

• MILESTONES OF GROWTH AND DEVELOPMENT

• NEONATAL REFLEXES
• GROWTH PREDICTION
• POST ADOLESCENT GROWTH AND DEVELOPMENT
• GROWTH ASSESSMENT PARAMETERS
• CRANIOFACIAL ANOMALIES
• CONCLUSION
• REFERENCE
INTRODUCTION

• Human growth encompasses physical, mental,

psychologic, social and moral development

• Human physical growth involves various sequence of

event that converts one cell into vastly complex
mature individual
• Humans are neotenous or long growing ,spending
nearly 30% of their entire life span growing

• This long period of time provides a large impact of

environmental influences on the growing biologic
system
IMPORTANCE OF GROWTH
1. To understand the etiology & development of
malocclusion
2. To assess the health & nutrition of children
3. To compare the growth of an individual with other
children.
4. To identify any abnormal occlusal development
5. Orthodontic treatment can make use of growth
spurt
6. Surgery is undertaken when growth is completed.
DEFINITIONS AND TERMINOLOGIES

Growth:
an increase in size or number (Proffit 1986)

The normal changes in the amount of living

substance(Moyer 1988)

Signifies an increase, expansion or extension of

any given tissue(Pinkham 1994)
The self multiplication of living substance(J.S HUXLEY)

Increase in size, change in proportion and progressive

complexity (KROGMAN)

An increase in size (TODD)

Entire series of sequential anatomic and physiological

changes taking place from the beginning of prenatal life to
senility (MEREDITH)
Developmental increase in mass. It is a process that
leads to an increase in the physical size of cells, tissues,
organ or organisms as a whole (STEWART, 1982)

Growth is an increase in the size of a living being or any

of its part , occurring in the process of development
(STEDMAN, 1990)
Development:
An increase in complexity (Todd 1931)

Naturally occurring unidirectional changes in the

life of an individual from its existence as a single
cell to its elaboration as a multifunctional unit
terminating in death (Moyer 1988)

Progressive evolution of a tissue (Pinkham 1994)

Development embraces other aspects of
differentiation of form, but principally involves
changes of function, including those largely shaped
by interaction with the structural, emotional or
social environment(VAUGHAM,1987)

The act or process of natural progression from a

previous, lower or embryonic stage to a later ,more
complex or adult stage (STEDMAN,1990)

Development is used to indicate an increase in the

skill and complexity of functions(LOWREY,1951)
CORRELATION BETWEEN GROWTH AND
DEVELOPMENT
• Growth is basically anatomic phenomenon
and quantitative in nature.
• Development is basically physiologic
phenomenon and qualitative in nature
Growth site:
a location at which growth occurs
eg: maxilla, sphenoid bone and occipital bone

Growth center:
a location at which independent ( genetically controlled) growth
occurs.
eg: primary cartilage in nasal septum, spheno-occipital
synchondroses

All centers of growth are growth sites, but all growth sites are not
growth centers.
Primary cartilage:
cartilage that forms during embryogenesis & early
fetal development
eg: spheno-occipital synchondrosis

Secondary cartilage:
cartilage that is not present during embryogenesis.
eg: mandibular condylar cartilage
FACTORS INFLUENCING GROWTH AND MATURATION

GENETIC FACTORS
• The basic control of growth, both in magnitude
and timing, is located in the genes
• The actual outcome of growth depends on the
interaction between the genetic potential and
environmental influences.
• The marked advancement of girls over boys in the
rate of maturation is attributed to the delaying
action of the Y chromosome in males thus making
possible greater overall growth
Neural Control

• It is thought that a growth center exists in

the region of the hypothalamus
• During the first 2years of postnatal growth,
the neural control system has got the child
on its predetermined genetic curve.
• At birth, body size is limited to accommodate
the birth process.
• After birth, those children destined to
become large experience a burst of growth
activity,which levels off during the first 2
years.
Neural Control

• There is also evidence that the peripheral

nervous system plays a part in growth
control
• It is suggested that peripheral nerve fibers
exert a nutritive or trophic effect on the
structures they innervate.
Hormonal Control

• Probably all of the endocrine glands

influence growth.
• Growth hormone maintains the normal rate
of protein synthesis and appears to inhibit
the synthesis of fat and the oxidation of
carbohydrate.
• it has great effect on bone growth and,
consequently,height growth.
Hormonal Control

• Pituitary and thyroid hormones play little direct

role in growth during the adolescent spurt. The
changes seen at adolescence are caused by the
secretion of androgens and gonadal hormones.
• The timing sequence of maturation is
undoubtedly under hormonal control.
• Bone and dental growth from birth to the
adolescent spurt are under thyroid control.
Nutrition

• Sufficient intake of nutritious food is essential for

normal growth.
• Growth of teeth takes precedence over bone
growth, and bones grow better than soft tissues
such as muscle and fat.
• In starvation, protein in the body is not
accumulated but becomes consumed so that the
cell mass of the body is reduced.
• Fat is consumed and depleted.
• Extracellular body fluid is increased. Loss of weight
is thereby masked by famine edema.
Nutrition

• Nine amino acids are essential for growth.

• Absence of any one results in disordered
growth.
• Calcium, phosphorus, magnesium,
manganese, and fluorides are essential for
proper bone and tooth growth.
• Vitamins are also essential for normal
growth.
Secular Trend

• There is considerable evidence that children today are

growing faster than they grew in the past
• Although children are growing at a faster rate,they are
also stopping growth sooner.
• Early in the 20th century men reached their final
height at 25 years of age. Now final height is reached
at about 20 years of age.
• Secular change has been more marked in children
than in total adult height.
• There is progressive advancement in the timing of
menarche.
Season and Circadian Rhythm

• Growth in height is faster in the spring than

in the autumn and weight viceversa
• Growth in height and eruption of teeth is
greater at night than in the daytime.
• The reason for these differences is probably
related to fluctuations in hormone release.
Disease

• After an illness, a catch up growth period

usually brings the child back to the
predetermined growth curve.
• Females compensate better than males,
following illness. Diseases that slow growth
probably have the effect of reducing growth
hormone production as a result of increased
production of cortisone during the disease
Cultural Factors

• Cultural factors have various effects on growth.

• For example, a secular trend increase in height
occurred in Japan between males born in 1900
and those born near the middle of the 20th
century.
• However, males of Japanese heritage born near
the middle of the century in the United States
grew taller on average than both groups born in
Japan because of different cultural influences.
RUDIMENTS OF BONE GROWTH

Osteogenesis
• Bone forms in two basic modes named after
the site of ap­pearance: cartilage or
membranous connective tissue
1. Intramembranous ossification
2. Endochondral ossification
Intramembranous bone formation
Intramembranous bone formation

bone laid down directly in a fibrous membrane

the undifferentiated mesenchymal cells of the
membranous connective tissue change to
osteoblasts and elaborate osteoid matrix.
 The matrix or inter­cellular substance becomes
calcified, and bone results.
Intramembranous bone growth occurs in areas of
tension.
eg: vault of the skull , mandible , clavicle
Endochondral Bone Formation
Endochondral Bone Formation

bone formation is preceded by the formation of

a cartilaginous model that closely resembles the
bone to be formed
Endochondral bone is not formed directly from
cartilage; it invades cartilage and replaces it.
It involves bone in special regions where high
levels of compression occur like with movable
joints and some parts of basicranium
ENDOCHONRAL OSSIFICATION
GROWTH PATTERN VARIABILITY
AND TIMING
PATTERN

It reflects proportionality usually of complex set of

proportions rather than just a single proportional
relationship
 PROPORTIONALITY : Can be defined as a set of constraints
operating to preserve the integration of parts under
varying conditions or through time - Moyers
An important aspect of pattern is its predictability
A change in growth pattern would indicate some alteration
in the expected changes in body proportions.
DIFFERENTIAL GROWTH

Not all tissue systems of the body grow at the same

rate. Different tissues and different organs grow at
different rates. This process is called differential growth.
Eg :Muscular & skeletal – grow faster than brain and
CNS as reflected in the relative decrease of head size

 Scammon’s curve of growth

 Cephalo-caudal gradient of growth
 SCAMMON’S CURVE OF GROWTH

 Richard Scammon
reduced the growth
curves of the tissues of
the body to four basic
curves :→
A. Lymphoid
B. Neural
C. General
D. Genital
A. LYMPHOID CURVE-
Includes the thymus,
pharyngeal and tonsillar
adenoids, lymph nodes and
intestinal lymphatic masses.
Proliferates rapidly in late
childhood and reaches 200% of
adult size.
By about 18 years of age it
undergoes involution to reach
adult size
B. Neural curve –
Includes the brain, spinal cord,
optic apparatus, and body parts
of the skull, upper face and
vertebral column.
Grows very rapidly to almost
reach adult size by 6-7 years of
age.
Very little growth after 6-7
years.
C. General curve-
Includes the external dimensions of
the body, respiratory and digestive
organs, kidney, aorta, and pulmonary
trunks, spleen, musculature, and
skeleton and blood volume.
Exhibit an S-shaped curve.
Rapid growth up to 2-3 years of age
Slow phase of growth between 3-10
years
Rapid phase of growth- 10th year to
D. Genital Curve-
Includes the primary sex
apparatus and all secondary
sex traits.
Curve has small upturn in the
first year of life and then is
quiescent until after ten year
of age, at which time growth
of these tissues increases
during the time of puberty.
CEPHALOCAUDAL GROWTH GRADIENT

• It simply means there is an axis on increased growth

extending from head towards the feet.
• A comparision of body proportion of pre natal and
post natal growth reveals that postnatal growth of
regions of body that are away from hypophysis is
more.
• Represents the changes in over all body proportions
during normal growth and development
CEPHALOCAUDAL GROWTH GRADIENT

At about the 3rd month of

IU life the head takes up
almost 50% of the TBL
At the time of birth the
head proportion is
decreased to 30% of TBL
In adulthood it further
decreases to 12% of TBL
At birth the legs represent about 1/3rd of the total body length,
while in the adult they represent about half.

Even within the head and face, the cephalocaudal growth gradient
strongly affects proportions and leads to changes in proportion.

Infant has a relatively much larger cranium and a much smaller

face.

The mandible being farther away from the brain, tends to grow
more and later than the maxilla, which is closer.
VARIABILITY

• Obviously everyone is not alike in the way that

they grow as in everything else
• 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
• If the percentile position of an individual relative
to his or her peer group changes markedly the
clinician should suspect some growth
abnormality and should investigate further
 TIMING
• Variation in timing arises because the same event
happens for different individuals at different times or the
biologic clocks of individuals are set differently
• Variation in growth and development because of timing
are particularly evident in human adolescence
TIMING

Growth effects because of timing variation

can be seen clearly in girls in whom the
onset of manifestation gives an excellent
indicator of arrival of sexual maturity
Timing variability can be reduced by using
developmental rather than chronologic age
as an expression of an individuals growth
GROWTH SPURTS

Acceleration in the incremental changes in body

parts occurs at certain ages. These periods of
accelerated growth are called growth spurts.

The physiological alteration in hormonal

secretion is believed to be the cause for such
accentuated growth.
GROWTH SPURTS

• Normal spurts are

• Infantile spurt – at 3 years age
• Juvenile spurt – 7-8 years (females); 8-
10 years (males)
• Pubertal spurt – 10-11 years(females);
13-15 years (males)
 GROWTH SPURTS
Sudden increase in growth at certain
periods(Bjork)
a) Just before birth
b) 1 year after birth
c) Mixed dentition growth spurt
Boys : 8-11 years
Girls : 7-9 years
d) Pre pubertal growth spurt
Boys : 14-16 years
Girls : 11-13 years
• Timing of Puberty:

• The adolescent growth spurt occurs on the

average nearly 2 years earlier in girls than in
boys.
• This has an important impact on the timing of
orthodontic treatment, which must be done
earlier in girls than in boys to take advantage of
the adolescent growth spurt.
CLINICAL SIGNIFICANCE OF GROWTH SPURTS

Differentiate Normal or abnormal growth

Pubertal growth spurt offers best time in terms of
predictability,treatment direction and time
Treatment of skeletal discrepancies is more
advantageous if carried out in mixed dentition
period
Orthognathic surgeries should be carried out when
growth ceases
 RHYTHM OF GROWTH

• Human growth is not a steady and uniform process and

there seems to be a rhythm during the growth process.
This rhythm is most clearly seen in stature or body
weight.

• 1st wave– birth to 5th or 6th year in both sexes

• 2nd wave– adolescence (14-16 years in girls and 14 to 18

years in boys)

• 3rd wave– 18-20 years in girls , upto 25 years in boys.

Growth trends and clinical applications

By overlapping consequent cephalograms,Tweed

discerned a pattern of growth and termed it as Growth
trends
A.N.B. angle:

• This angle is formed by intersection of line

joining nasion to point A and nasion to
point B.
• Denotes the relative position of the maxilla
and mandible to each other
• Mean value is 2 degree
• Increase in this angle is indicative of a class
II skeletal tendency
• Less than normal or negative angle is
suggestive of a skeletal class III relationship
CLASSIFICATION OF FACIAL
GROWTH TRENDS:

FACIAL GROWTH TRENDS

Type A Type B Type C

25% 15% 60%
 Type A: 25%

• Maxilla and mandible grow

together
• So ANB angle remains
unchanged(<4.50)

No treatment is
indicated untill
the full eruption
of all 4 cuspid
teeth following
the serial
extraction
SUBDIVISION OF TYPE A

• Treatment-
CLASS with
restrict the growth ANB angle >
of maxilla allowing 4.5
mandible to catch
Place the patient
up under KLOEHN
completed in CERVICAL GEAR to
restrain the
15-21 months maxilary growth.
• Prognosis is
good,but some As the maxillary
denture moves
times requires posteriorly, point B
extraction moves forward
 Type B: 15%

• Growth of maxilla
exceeding that of
mandible
• ANB: 6-12 degree
• Treatment: cervical head
gear
36-42
months
• Prognosis is poor as trend
indicates that point B will
not catchup with point A
Type B subdivision:

ANB is large and continues to grow

indicating unfavorable growth trend.
Type C: 60%

•Maxilla and mandible growing forward and

downward, mandible growing more rapidly
than the maxilla

•ANB angle seems to be decreasing

•Favorable growth trend and treatment is not

indicated until the eruption of canines

•Treatment : 10-15months

•Retention- cuspid-cuspid lingual

bar for mandible
-labial bar for maxilla

•Prognosis- excellent
Type C subdivision:

• The mandible is found to be growing more forward

as compared with maxilla
• Mandibular incisors touch the lingual surface of
maxillary incisors
• Prognosis is good and mandiblar incisors need to
be retained from one cuspid to another
GROWTH & DEVELOPMENT OF AN
INDIVIDUAL

Post-natal
Pre-natal

BASE OF
CRANIUM MAXILLA MANDIBLE
CRANIUM
 POST NATAL GROWTH

What is post natal growth?

• Postnatal growth begins at birth and terminate when
adult maturity is attained or growth ceases
• Post natal growth is the first 20 years of growth after
birth.
How does it defer from prenatal growth?
• Prenatal growth is characterized by a rapid increase in
cell numbers and fast growth rates
• Postnatal growth is characterized by declining growth
rates and increasing maturation of tissues.
 SITES AND TYPES OF GROWTH IN THE CRANIOFACIAL COMPLEX

• 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.
For the following discussion of sites and types of
growth, it is convenient to divide the craniofacial
complex into four areas that grow rather differently:
(1) the cranial vault, the bones that cover the upper and
outer surface of the brain;
(2) the cranial base, the bony floor under the brain, which
also is the dividing line between the cranium and the face;
(3) the nasomaxillary complex, made up of the nose,
maxilla, and associated small bones
(4) the mandible.
• The skull can be divided
into two parts
1.Neurocranium
• forms a protective case
around the brain
2.Viscerocranium
• which forms facial
skeleton
 CRANIAL VAULT
• The primary function of bony
cranial vault is protection of the
brain.
• Vault growth is paced by growth
of brain itself
• The cranial vault is made up of a
number of flat bones that are
formed directly by
intramembranous bone
formation, without cartilaginous
precursors
 Cranial vault

At birth, the flat bones of the skull are widely

separated by connective tissues. These open spaces,
the fontanelles, allow a considerable amount of
deformation of the skull at birth.
 Cranial vault
After birth, apposition of bone eliminates these open
spaces fairly quickly, but the bones remain separated
by a thin, periosteum-lined suture.

• Apposition of new bone at these sutures is the major

mechanism for growth of the cranial vault.
Cranial vault

• There is also remodeling of the inner and outer

surfaces, the bone is removed from the inner surface
of the cranial vault, while at the same time, new
bone is formed on the exterior surface

• Since brain growth is largely completed in early

childhood cranial vault is one of the first regions of
craniofacial skeleton to achieve full size ,though vault
sutures are patent for sometime after growth is
mostly over
CRANIAL BASE

• Bones of cranial base are

formed initially in cartilage
and are later transformed
by endochondral
ossification to bone
• Growth process occuring
at cranial base,maxilla and
mandible are related to
each other at various
sutures and TMJ
• Cranial base grow postnatally by complex
interaction between following growth
process
1. Extensive cortical drift and remodelling
2. Elongation at synchondroses
3. Sutural growth
1) CORTICAL DRIFT AND BONE REMODELLING

1. Resorption on the anterior

wall of middle cranial fossa
2. Deposition on the orbital
face of sphenoid
3. Anterior displacement of
anterior cranial fossa
4. Elevation of petrous
temporal bone
5. Lowering of the foramen
magnum
6. Perimeter of foramen
enlarges
2)Elongation at synchondroses

• Elongation of cranial base is provided by growth

at synchondroses and direct cortical growth
• As the anterior fossae and cranial floor elongate
the underlying space occupied by nasomaxillary
complex,pharynx and ramus increases
correspondingly
• Cranial floor displays less compensatory growth
relative to the viscerocranium than is seen in
other craniofacial structures
2)Elongation at synchondroses
• The cranial base grows primarily by cartilage growth in
the sphenoethmoidal, intersphenoidal,spheno-occipital
and intraoccipital synchondroses,mostly following the
neural growth curve
• Activity at the intersphenoidal synchondrosis disappears
at birth.
• The intraoccipital synchondrosis closes in the 3rd to 5th
years of life.
• The sphenooccipital synchondrosis is a major
contributor as the ossification here extends till the 20th
year of life.
3) SUTURAL GROWTH
TIMING OF CRANIAL BASE

• By birth  55-60 % of adult size attained

• By 4-7 years  94% of adult size attained

• By 8-13 years  98% of adult size attained

 NASOMAXILLARY COMPLEX

Nasomaxillary complex provides

• a significant portion of the airway,
• contains the physiologically important
nasal mucosa with their glands and
temperature adjusting vascular
components,
• enclose the eyes
• and adds reasonance to the voice
• The maxilla develops postnatally entirely by
intramembranous ossification.
• Since there is no cartilage
replacement,growth occurs in two ways:
(1) by apposition of bone at the sutures that
connect the maxilla to the cranium and cranial
base, and
(2) by surface remodeling.
Postnatal development of nasomaxillary complex
is attained by growth observed at sutures,nasal
septum and alveolar process

The growth mechanism is produced by

Displacement
Growth at sutures
Surface remodelling
DISPLACEMENT

• Displacement is a movement away from a

postion or place
Primary displacement

It is when there is a

displacement of a bone in
conjuction with its own
growth
It is initiated by the sum
or expansive forces of soft
tissue
This occurs by growth of
maxillary tuberosity in a
posterior direction
resulting in whole maxilla
being carried
Secondary displacement

Movement of bone is not

directly related to its own
enlargement but by the
other bones and soft
tissue
This occurs when
Nasomaxillary complex
grows in downward and
forward direction as the
cranial base grows
 GROWTH AT SUTURES

The maxilla is connected to

the cranium and cranial
base by a number of
sutures
1. Frontonasal suture
2. Frontomaxillary suture
3. Zygomaticomaxillary
suture
4. Zygomatiocotemporal
suture
5. Pterygopalatine suture
These sutures are all oblique
and more or less parallel to
each other, which allows
downward and forward
repositioning of maxilla as
growth occurs at these
sutures

There is also some growth at

median palatine suture and
there is downward
SURFACE REMODELLING

• Massive remodelling by bone deposition and

resorption occurs to bring about
Increase in size
Increase in shape of bone
Change in functional relationship
GROWTH CHARACTERISTICS IN NASOMAXILLARY
COMPLEX
Resorption occurs on lateral surface and
deposition on the medial rim of orbit
Bone deposition occurs along the posterior
margin of maxillary tuberosity which helps in
accomodating erupting molars
Bone resorption occurs on the lateral wall of
nose leading o an increase in size of nasal cavity
Face enlarges in width by bone formation on the
lateral surface of the zygomatic arch and
resorption on its medial surface
 Zygomatic bone moves in posterior direction as
resorption occurrs on anterior surface and
deposition on posterior surface
The anterior nasal spine prominence increase
due to bone deposition and there is resorption
from periosteal surface of labial cortex
As teeth start erupting bone deposition
occurs at the alveolar margins,this increases
maxillary height and depth of palate
Entire wall of sinus except mesial wall
undergoes resorption
This results in increase in size of maxillary
antrum
Orbit
Most of lining roof & floor
-depository
Lateral wall  resorption
Medial wall  deposition

lateral movement of eyeball

Endocranial side  Resorptive

Orbital side Depository

Orbit is relocated anteriorly

Nasal cavity

Bone resorption on the Increase in size of the

lateral wall of the nose nasal cavity

Bone resorption on the Downward shift occurs

floor of the nasal cavity leading to maxillary
compensated by bone height
deposition on the
palatal side

Anterior nasal spine prominence increases due to bone

deposition
 Maxillary sinus
The entire wall of the sinus except the mesial wall
undergoes resorption

Increase in size of the maxillary antrum

SINUS

Postnatal Appearance of Sinus

OM Prakash Kharbanda. Orthodontics: Diagnosis and management of

Malocclusion and dentofacial deforminties
 Maxillary Tuberosity

Bone deposition along the posterior margin of maxillary

tuberosity

Lengthening of dental arch and antero-posterior

dimension of maxillary body

Accommodation of erupting molars

Anterior displacement= posterior lengthening

 Alveolar process
 Resorption from the
periosteal surface of the
labial cortex compensated
by bone deposition on the
endosteal surface of the
labial cortex and periosteal
surface of the lingual cortex
• As teeth erupt bone
deposition occurs at the
alveolar margins

• Increase in maxillary
height and depth of the
palate
 Zygomatic bone

Resorption on the anterior

surface and deposition Movement in the
on the posterior surface posterior
of the zygomatic bone direction

Bone deposition on the

lateral surface of the
zygomatic arch and Face enlarges in width
resorption on its
medial surface
 MANDIBLE
• Developmentally and functionally
the mandible is made of several
skeletal subunits

• Basal bone or body of mandible

forms one unit to which is attached
the alveolar process,the coronoid
process,condylar process, angular
process, ramus, lingual tuberosity
and chin
• The right and left halves of
mandible fuse by one year after
birth
• Both endochondral and
periosteal activity are
important in growth of
mandible
• Actual growth occurs at
mandibular condyle and
posterior surface of ramus
translating the mandible
downward and forward
GROWTH TIMING
• Growth of width of mandible is completed
first, then growth in length and finally growth
in height
WIDTH OF MANDIBLE
• Growth in width is completed before
adolescent growth spurt
• Intercanine width increase after 12 years
GROWTH IN LENGTH
• Growth in length continues through puberty
• Girls—14-15 years
• Boys---18-19 years
GROWTH IN HEIGHT
• Continues in both the sexes for longer period
• Growth increase occurs with eruption of teeth and
continues to increase through out life and decreases
in adult life
 Parts of mandible derived from
•INTRAMEMBRANOUS OSSIFICATION
i) Whole body of mandible except the anterior part
ii) Ramus of mandible as far as mandibular foramen
•ENDOCHONDRAL OSSIFICATION
i) Anterior portion of the mandible (symphysis)
Ii) Part of ramus above the mandibular foramen
iii) Coronoid process
iv) Condylar process
 RAMUS

Ramus moves
progressively posterorly
by a combination of
deposition and resorption
RAMUS

• Resorption  Anterior Part

• Deposition Posterior region

This results in drift of

ramus in posterior
direction and lengthening
of mandibular body
 RAMUS

Greater amount of
resorption inferiorly
than superiorly

Greater amounts
of bone additions Uprighting of Ramus
on the inferior
part
 ANGLE OF MANDIBLE
• LINGUALLY-Resorption
occurs on posterointerior
aspect of angle and
deposition occurs on
anterosuperior aspect
• BUCCALLY-Resorption occurs
on anterosuperior part and
deposition occurs on
posterosuperior aspect
• This results in flaring out of
angle of mandible as age
advances
 LINGUAL TUBEROSITY
• It moves posteriorly by
deposition on its posterior
facing surface
• The prominence of the
tuberosity is increased by
the presence of a large
resorption field just below
it
• Deposition on medial
surface of tuberosity itself
accentuates prominenceof
lingual tuberosity
ALVEOLAR PROCESS

• It develops in presence of
tooth buds
• As teeth erupts alveolar
process develops and
increases in height by bone
deposition at margins
• Alveolar bone adds to height
and thickness of body
ANTI- GONIAL NOTCH

Growth of the mandibular condyle

fails to lower mandible

Masseter and medial pterygoid

growth cause the bone in the
region of angle to grow downward

Produce Antegonial notching.

 CHIN

At birth chin is usually

underdeveloped
As age advances growth of
chin becomes significant and
is influenced by sexual and
specific genetic factors
Males have prominent chins
as compared to females.
CHIN

• Deposition on the
anterioinferior surface
• Resorption in
anteriosuperiorly
• Chin prominence is
accentuated by alveolar
bone resorption above
the chin
MENTAL PROTRUBENCE

• Formed by osseous deposition during

childhood
• prominence is accentuated by bone
resorption
SYMPHYSIS MENTI

• Show limited growth till fusion

• No widening after fusion
CORONOID PROCESS

It follows enlarging V principle

Depostion occurs on the lingual(medial) face
of left and right coronoid process
There is also associated increase in height of
coronoid process
From occlusal aspects deposition on the
lingual of coronoid process brings about a
posterior growth movement in V pattern
 Follows enlarging V
principle

Lingual side faces three general directions all at once:

posteriorly, superiorly, and medially
CONDYLE

It forms an important growth site

Head of condyle is covered by a thin layer of
cartilage called condylar cartilage
Condylar growth increases by puberty
reaches peak by 12-14yr
Growth ceases by 20 years
• It was earlier believed that growth occurs at the
surface of the condylar cartilage by means of
bone deposition and as the condyle pushes
against the cranial base the entire mandible gets
displaced forwards and downwards
• It is now believed that growth of soft tissues
including the muscles and connective tissues
carries the mandible forward away from the
cranial base
• Bone growth follows secondarily at condyle
AGE CHANGES IN MANDIBLE

In infants and children In Adults

1. The two halves of the 1. The mental foramen
mandible fuse during the opens midway
first year of life between the upper
2. At birth the mental and lower borders.
foramen opens below the 2. The mandibular canal
sockets for the deciduous runs parallel to the
molar teeth near the mylohyoid line.
lower border. The foramen
and canal gradually shifts
upwards.
In infants and children In Adults

3. The angle is obtuse 3.The angle reduces to about

around 140 degrees or 110-120 degrees because the
more ramus becomes almost
4. The coronoid process is vertical.
large and projects upwards
above the level of the
condyle.
 During fetal life
8 weeks - Mandible > Maxilla
11 weeks - Mandible = Maxilla
13 – 20 weeks -Maxilla > Mandible

At birth
Mandible tends to be Retrognathic
Early post natal life - Orthognathic
Neonatal mandible
• Ascending Ramus low and wide
• Large Coronoid process
• Body – open shell containing tooth buds and partially
formed deciduous teeth
• Mandibular canal that runs low in the body
 FACIAL SOFT TISSUES

• An important concept is that the growth of

the facial soft tissues does not perfectly
parallel the growth of the underlying hard
tissues
GROWTH OF LIPS

The lips trail behind the growth of the jaws prior

to adolescence,then undergo a growth spurt to
catch up
Lip separation at rest is maximal during
childhood and decreases during adolescence
So what look like too much of display of gingiva
prior to and in adolescence can look perfectly
normal in a young adults
Lip thickness reaches its maximum during
adolescence then decreases to that in their 20s
and 30s
GROWTH OF LIPS
GROWTH OF LIPS
 GROWTH OF NOSE

Growth of the nasal bone is

complete at about age 10.
Growth there after is only of
the nasal cartilage and soft
tissues,both of which
undergo a considerable
adolescent spurt.
 The result is that the nose
becomes much more
prominent at adolescence,
especially in boys
 GROWTH OF NOSE

Nose and chin become more

prominent with adolescent and
post-adolescent growth while the
lips do not, so the relative
prominence of the lips decreases.
 This can become an important
point in determining how much
lip support should be provided by
the teeth at the time orthodontic
treatment typically ends in late
adolescence.
REFERENCE

• Paediatric Dentistry Scientific Foundation & Clinical Practice-Ray

E Stewart
• Contemporary Orthodontics (4th edition)-William R Profitt
• Craniofacial Development –Geoffrey H Sperber
• Paediatric Dental Medicine-Donald J Forrester
• Handbook of Orthodontics(4th edition)-Robert E moyers
• Orthodontic Principles and practice(3rd edition)-T M Graber
• Textbook of Orthodontics(2nd edition)-Gurkeerat Singh
• Nelson Textbook of Paediatrics(19th edition)-Robert E Kleigman
• Textbook of Orthodontics-Samir E Bishara
Thank you…