Development Mandible Anisha

CRANIOFACIAL DEVELOPMENT OF
MANDIBLE
AND ITS APPLIED ASPECTS
Dr. Anisha Singh

1st Year PGT,
Department of Preventive
and Pediatric Dentistry
TABLE OF CONTENTS
3.Theories of Growth
1.Introduction 2.Pre Natal Growth and and Development
Development Related to Mandible
5.Age Changes
4.Post Natal Growth
and Development 6.Developmental Anomalies
7.Conclusion
INTRODUCTION
0 4.
MANDIBLE
● Greek word ‘mandere’-to masticate/chew

● Latin word ‘mandibula’-lower jaw
● Mandible – Largest and Strongest bone of the face
● Only movable bone of the face
● Derived from the First Branchial Arch
● Start developing at about 4 th week Intra Uterine Life
● Major part of the viscerocranium,
● is the second skeletal element to ossify,
the clavicle being the first.
PRENATAL
GROWTH & DEVELOPMENT
0 6.
P R E N ATA L G R O W T H A N D D E V E L O P E M E N T
Mandibular development involves cells that, originate from the neural crest
and populating the First Pharyngeal Arch (Also called the Mandibular arch)
The cartilaginous component is called Meckel’s cartilage that forms in the mid-
embryonic stage (32days Intra uterine life)
Signals from ectoderm,paraxial mesoderm, Meckel’s

and pharyngeal pouch endoderm
Neural cartilage
crest
cells
Osteoblats
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical publishing housing- USA shelton,
connecticut;2010. p. 121--186
7
S E T T I N G U P T H E S TA G E …
The first structure to develop in the region of

the lower jaw is the Mandibular
Division Of The Trigeminal Nerve.
Induces osteogenesis by production of

neurotrophic factors
Prior presence of neurovascular bundle ensures

the formation of mandibular foramen and canal
and mental foramen
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical publishing housing- USA shelton, connecticut;2010.
p. 121--186
0 8.
36-38 days of Intra Uterine Life
• The mandibular ectomesenchyme

Ectomesenchymal must interact with the epithelium of
condensation the mandibular arch before primary
ossification can occur
Resulting
INTRAMEMBRANOUS
BONE lies lateral to
Meckel’s cartilage of the
1st (mandibular)
pharyngeal arch
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical publishing housing- USA
shelton, connecticut;2010. p. 121--186
9.
6 week Intra Uterine Life
th
• Meckel’s cartilage extends as a solid

cartilagenous rod surrounded by
fibrocellular capsule.
• meets its fellow of the opposite side

ventrally
• It diverges dorsally to end in tympanic

cavity of each middle ear (derived from 1st
Pharyngeal pouch)
1 0.
6th week Intra Uterine Life Ossifying membrane is lateral to
Meckel’s cartilage and its accompanying
A single ossification center for each half of the neurovascular bundle.
mandible arises in the region of the bifurcation of
the inferior alveolar nerve and artery into mental
and incisive branches. From the primary centre below and around the
IAN and incisive branchOssification spreads
upwards to form a trough for developing teeth
Spread of the intramembranous

ossification dorsally and ventrally forms
the Body and Ramus of the mandible
Meckel’s cartilage becomes

surrounded and invaded by bone
1 1.
FROM
Backward to a point
Spreads anteriorly to the CENTER OF OSSIFICATION
where mandibular N.
midline divides into lingual and
inferior alveolar
branches.
✘ This trough of bone comes into close approximation
✘ Ossification stops dorsally at the
with a similar trough formed on the opposing side and
site that will become the
these two remain separate until they unite shortly after
Mandibular Lingula.
birth.
✘ The trough soon forms a canal as bone forms over the

nerve.
By 6th Week I.U 1 2.
• The trunk of the M.N  medial to and

above the dorsal end of the cartilage
• At the junction of its dorsal and middle

one-thirds  lingual nerve leaves the
main trunk and passes to the medial
side of the cartilage
• The remaining nerve fiber bundle

• continues forward toward the midline
along the superolateral aspect of the
cartilage.
• At junction of the middle and ventral

one-thirds  the inferior alveolar nerve
divides into: the mental nerve and the
incisive nerve
1 5.
Initial
InitialWoven Bone
Woven Bone Lamellar Bone
Lamellar Bone
By 5th month Intra uterine life:

Haversian systems already present
This remodeling occurs earlier than it occurs in other bones,

Thought to be a response to early intense sucking and swallowing,
which stress the mandible
1 6.
SECONDARY CARTILAGE
 Appears between the 10th and 14th weeks post conception.
Derivatives of secondary cartilage
Part Of
Mental
Head Of Coronoid
Protruberance
Condyle Process
Dixon AD, Hoyte DAN, Ronning O. Fundamentals of craniofacial growth. London, England: Routledge; 2017
1 7.
SECONDARY CARTILAGE
Beresford, 1981 Because its morphogenesis occurs late in prenatal development,The MCC has been
designated as a secondary cartilage
Low,1910 They are independent of the primary cartilaginous skeleton, to which Meckel's cartilage
belongs
Mizoguchi, Nakamura, Takahashi, They differ from primary cartilages most clearly in its superficial layers, comprising a
Kagayama, & Mitani, 1990 perichondrium in which the cells that are relatively undifferentiated(prechondroblastic)
secrete a matrix rich in type I collagen rather than the type II collagen matrix secreted by
chondrocytes
Trevisan and Scapino, Secondary cartilages increase in size by the proliferation and transformation of the
1976 prechondroblast cells.
This type of cartilage has large, haphazardly arranged chondrocytes, sparse intercellular
matrix compared to hyaline cartilage
Lydiatt & Davis, 1985) It is these undifferentiated cells of the prechondroblastic zone of the perichondrium, not the
chondrocytes in deeper layers, that proliferate and mature to effect growth at the MCC.
Unlike the proliferative chondrocytes of primary cartilaginous joints, the prechondrocytes
in the condylar cartilage exhibit a dual potential, forming either cartilage or bone,
depending on the mechanical forces impinging on the tissue
1 8.
FORMATION OF THE CONDYLE
• Mesenchymal condensation –
5th week ventral part of mandible
• Cone shaped cartilage at Ramal

10 week th
region
• First evidence endochondral

14 week th
bone formation Condylar cartilage Important
center of growth for the ramus and
• Migrate inferiorly and fuses with body of madible
4 month
th
mandibular ramus
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2nd edition. Peoples’s medical publishing
housing- USA shelton, connecticut;2010. p. 121--186
1 9.
FORMATION OF CORONOID PROCESS
By 10-14 week of IUL – Appearance of

Secondary accessory cartilage within
temporalis muscle – Coronoid Process
Grow as a response to temporalis

muscle
Becomes incorporated into expanding

ramus and Disappear before birth
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical publishing housing- USA shelton, connecticut;2010. p.
121--186
2 0.
FORMATION OF MENTAL PROTRUBERANCE
• Ossification starts - 7th month pc

• Ventrally to mental foramen
- Accessory endochondral ossicles formed
 mental ossicle  incorporated into chin region
when the symphysis menti is converted from a syndesmosis
into a synostosis during the
1st postnatal year.
121--186
2 1.
DEVELOPMENT OF TMJ
The primitive joint within meckel’s cartilage (before the malleus and incus form)
functions briefly as a jaw joint. Mouth opening movements having started at 8
weeks post conception, well before the development of TMJ. When the TMJ forms at
10 weeks, both the incudomalleal and definitive jaw joint move in synchrony, for
about 8 weeks in fetal life.
71/2 weeksFirst sign of Articular Disc
8th week Lateral pterygoid muscle develops medial to the

future condylar area and initiates movement of the Meckel’s
cartilage by its contraction, functioning through the primary
meckelian joint
2 2.
10th - 12th week  Accessory condylar cartilage develops as the 1st
blastema growing toward the developing temporal blastema
10th week  2 clefts develop in the interposed vascular fibrous

connective tissues Joint cavities
develop.
 Inferior compartment forms first separating the
future disk from the developing condyle
11th weekJoint capsule composed of fibrous tissue forms

lateral ligament
111/2 weeks  Upper compartment starts to appear
2 3.
Cavitation occurs by degradation rather than by enzymatic liquefaction or
cell death.
Synovial membrane invasion may be necessary for cavitation.
Synovial-fluid production by this method lubricates movement in the joint .
Muscle movement is requisite to joint cavitation
The connective tissues separating the initially discrete small spaces have to
be ruptured for the spaces to coalesce into functional cavity.
POSTNATAL GROWTH AND DEVELOPMENT
THEORIES OF MANDIBULAR
GROWTH
2 5.
BONE REMODELING THEORY
• Proposed by Brash, 1930

• This theory concluded that bone grows only by interstitial
growth
• Bone grows by apposition
• Growth of jaws takes place by deposition of bone at the
posterior surfaces of the maxilla and mandible.
• This is described as “Hunterian growth”.
• Craniofacial skeletal growth takes place by bone
remodeling- selective deposition and resorption of bone at
its surfaces
Enlow DH. Essentials of facial growth. WB Saunders; 1996.
2 6.
GENETIC THEORY
• Proposed by ALLAN G BRODIE, 1941
• All growth is compelled by genetic influence i.e: genetic

encoding of mandible determines its growth.
• Role of genetics in growth is fundamental and has overriding

influence in establishing the basic facial pattern.
• The genes are - SoX9,CTGF (Connective Tissue Growth

Factor)FGF, Lim, Prx1, Prx2
2 7.
CARTILAGINOUS THEORY
• Proposed by James H Scott , 1950.

• According to Scott - Mandible  diaphysis of long bone
• Bent into horse shoe shape with epiphysis removed
• Cartilage constitute half of epiphyseal plate
• Mandible  Grow upward and backward direction

2 8.
FUNCTIONAL MATRIX THEORY
• Largest amount of growth and variability in morphology - Post Natally

• Mandible is divisible into several skeletal subunit.
Alveolar unit • Teeth act as functional matrix
Coronoid • Action of temporalis muscle

process
Angle and ramus • Masseter and medial

of mandible pterygoid
Condylar • Lateral pterygoid

process
121--186
29
According to Moss ,three important phenomenon occur during 2 9.

mandibular growth
Constancy of the relative position of Absolute migration of the dentition Change in the direction of
the mental foramen in the through the alveolar mental foramen in direction of
mandibular corpuse position bonemigration of dentition mental foramen
 If horizontal body is divided into This migration is most pronounced  When a pin is placed with
premental & postmental segments & during the eruption of permanent protruding head pointing
these segments when measured at dentition. towards the rapidly growing end
different ages  length of segments :
remain relatively proportional through  It shows that in newborn the
out the life. pin points forward while its
 Proves that increase in corpus length direction is upward at 6years &
cannot be due to condylar growth as relatively backward in adults.
this would increase the relative size of
the postmental segment.
3 0.
UNLOADED NERVE CONCEPT
• Basal tubular portion serves as a protection for the

mandibular canal & it follows a logarithmic spiral in its
downward & forward movement from beneath the
cranium
• Most constant part of mandible - the arc from foramen
ovale to the mandibular foramen and mental foramen.
The central core is straight at

first. Later it follows the
Enlow DH. Essentials of facial growth. WB Saunders; 1996. logarithmic curve
3 1.
ENLOW’S ‘V’ PRINCIPLE
• Most of the facial bones have a ‘V’ shaped

configuration.
• Bone deposition - in the inner side of ‘V’
resorption - in the outer surface.
• Due to this the bone moves in the direction
towards the wide end of ‘V’.
• Simultaneously deposition takes place at the
ends of the two arms of the ‘V’ resulting in its
widening.

3 2.
ENLOW’S COUNTERPART PRINCIPLE
Any given facial or cranial part relates specifically to other structural &
geometric counterpart in the face & cranium
PART COUNTERPART
Nasomaxillary Complex Anterior Cranial Fossa
Pharyngeal Space Middle Cranial Fossa

Breadth Of Ramus Poster Cranial Fossa
Maxillary Arch Mandibular Arch

3 3.
34.
SERVO SYSTEM THEORY
Proposed by Alexandre Petrovic (1977)
Anterior growth of the midface (A) Results in a

slight occlusal deviation between the maxillary
and mandibular dentitions (B) Perception of this
occlusal deviation by proprioceptors (C) Triggers
the protruder muscles of the mandible to become
more active tonically (D) In order to reposition the
mandible anteriorly.
The muscle activity and the protrusion in the
presence of
appropriate hormonal factors (E) Stimulate growth
at the
mandibular condyle (F). (Source: After David Carlson.
Evidences
Semin against the Theory:
Orthod
Goret-Nicaise, Awn (1983), found that the resection
2005;11:172-83) of the lateral pterygoid muscle fails to diminish
condylar growth
 Das, Myer and Sicher (1980) found that the occlusion remained unaffected in condylectomy studies.
POSTNATAL GROWTH OF MANDIBLE
3 6.
AT BIRTH – THE NEONATAL MANDIBLE
The ascending ramus  is low and wide
The coronoid process  relatively large and

projects well above the condyle
The body  an open shell containing the buds

and partial crowns of the deciduous teeth
Mandibular canal  runs low in the body.
3 7.
BY 1ST YEAR AFTER BIRTH
✘The initial separation of the right and left bodies of the

mandible at the midline symphysis menti is gradually
eliminated when ossification converts the syndesmosis
into a synostosis, uniting the two halves.
Although the mandible appears as a single bone in the

adult, it is developmentally and functionally divisible into
✘ several skeletal subunits Schema of “skeletal units” of the mandible
The Basal Bone Of The Body forms one unit, to

which are
attached the Alveolar, Coronoid, Angular, And
Condylar
Processes And The Chin.
3 8.
RAMUS
Ramus moves posteriorly by remodelling

Bone deposition – posterior side
Bone resorption – anterior side
Drift of the Ramus – Posterior Direction
Hunterian concept Remodeling

associated with
ramal uprighting
Basic Hunterian pattern of growth

3 9.
The remodeling of ramus occurs in an arcial pattern

After up righting – undergoes rotational
pattern of growth , by selective
deposition/resorption.
Anterior ramal border

Inferior- Resorption
Superior- Deposition
Posterior ramal border

Inferior- Resorption
Superior- Deposition
4 0.
CORONOID PROCESS
• Follows Enlow’s V principle

• Medial surface  Deposition (increase in length and thickness)
• Buccal surface  Resorption
Due to backward growth  the area that was occupied once by
ramus and coronoid process, comes to be occupied by the lingual
tuberosity  increase in both length and width of mandible.
121--186
4 1.
CONDYLE
• Growth increases at puberty reaching a peak – 12½ -14 years

& Ceases – 20 years
• The condyle grows like an expanding V  deposition
on the inner aspect of V and resorption on the outer
surface .
• Inferiorly facing end of buccal surface  Depository
• superiorly facing end of lingual surfaces  Depository
• The region that was once condyle is gradually
remodeled to a neck  condyle relocates to a more
posterior and superior position.
121--186
4 2.
CONDYLAR CARTILAGE
• The condylar cartilage of the mandible uniquely serves as both

1. An articular cartilage in the temporomandibular joint,
2. A growth cartilage analogous to the epiphysial plate in a long bone,
• The growth cartilage  act as a “functional matrix”  stretch the periosteum

 lengthening periosteum to form intramembranous bone beneath it 
causes the mandibular rami to grow upward and backward  displacing
the entire mandible in an opposite downward and forward direction.
• Bone resorption subjacent to the condylar head accounts for the

narrowed condylar neck.
121--186
4 3.
SIGMOID NOTCH
• Bone deposition - post. Border of Coronoid

• Bone resorption - Ant. Surface of Condylar neck.
• Periosteal bone deposition - Lingual surface
Periosteal bone resorption - Buccal surface of
Sigmoid notch.
• Because of this remodeling, anterior region of
condylar neck shifts in lingual direction.
MANDIBULAR FORAMEN
• With the remodeling of ramus posteriorly,

The mandibular foramen maintains its
position.
Anterior rim- deposition

Posterior rim- resorption
• It also shifts posteriorly and is always

centered in the medial surface of the
ramus
4 5.
ANGLE OF MANDIBLE
LINGUAL BUCCAL
SIDE SIDE
Resorption –Posterior Inferior Aspect Resorption – Antero Superior Part

Deposition – Antero Superior Aspect Deposition – Postero Inferior Part
Flaring of angle of mandible

as age advance
4 6.
BODY OF MANDIBLE
• Lateral surface  Depository

• Medial Surface  Superior Aspect  Deposition
 Inferior Aspect  Resorption
• Body of mandible lengthens A-P

• Resorption in anterior border of ramus – accommodate
erupting permanent molar
4 7.
MENTAL FORAMEN
Child Adult
LaCroix  It is claimed that the periosteum of growing

bone is under tension & that the tensile force at a given
point is proportional to growth rates of the two ends of the
bone.
121--186
4 8.
• e - midway between the upper and lower borders of the

mandible.
• E - lacking an alveolar ridge - near the upper margin of the
thinned mandible
4 9.
LINGUAL TUBEROSITY
• Junction of corpus and ramus at the medial aspect.

• Equivalent to maxillary tuberosity.
• Posteriorly facing surface - Deposition of bone.
• Protrudes  lingual direction
• Prominence – resorption in lateral and below to it.
• Resorption – produced depression – lingual fossa.
5 0.
ALVEOLAR PROCESS
• Protective trough to the tooth buds

• Adds height and thickness of body
• A ledge extends lingually to ramus – accommodate 3rd
molar
5 1.
CHIN
• Formed in part of mental ossicle from

accessory cartilage
• Infancy – poorly developed
• Adulthood – significantly developed
Labial Cortex - Periosteal Resorption
Endosteal Deposition
Lingual Cortex - Periosteal Deposition
Endosteal Resorption
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2nd edition. Peoples’s medical
publishing housing- USA shelton, connecticut;2010. p. 121--186
5 2.
DEVELOPMENT OF TMJ
•Newborn: TMJ comparatively is a lax structure

stability solely dependent on the capsule surrounding the joint
it is more mobile than at any time later
By 1st year  Condyle : ↓ vascularity, entire growth

cartilage layer becomes significantly thinner.
This continues upto the 3rd year.
By 2 ½ years  the articular eminence increase from 2 –
4mm  due to resorption of the bone in
the roof of the mandibular fossa and
deposition at the anterior and posterior part
formation of ‘S’ shape curve.
At 7 years  articular tubercle begin to become prominent;
its development accelerates until the 12th years of age.
5 3.
2nd and 3rd decade:

 Characterized by progressive slowing of growth process.
 By 13-15 years decreased thickness of cartilage layer.
 Presence of proliferative layer atleast till age of 18 years.
 cortical bone cap coalescing with subchondral trabecular bone
by 10-12 years of age. This increases in thickness upto 3rd
decade of life.
 Bone cap is completed by 20 years of age although cartilage
and sparse cartilage cells remain.
4th decade
 Cartilage completely replaced by the bone
 Articular tissue  Relatively unchanged may undergo
changes depending on biomechanical loading.
5 4.
By 5th decade  mandibular fossa becomes more deep and articular

eminence becomes more prominent.
• In older adult temporal fossa: less pronounced chondroid layer.
• Articular eminence : is made of chondroid bone
• As age progresses further there is flattening of the articular

fossa and decrease in prominence of the articular eminence.
THANK YOU
57
CRANIOFACIAL DEVELOPMENT OF
MANDIBLE
AND ITS APPLIED ASPECTS PART-2
Dr. Anisha Singh

1st Year PGT,
Department of Preventive
and Pediatric Dentistry
58
Why to study Growth and Development ?
Understanding The Age Changes Of Various Anatomical Landmarks

Growth Modification
Understanding Developmental Anomalies
AGE CHANGES OF MANDIBLE
6 0.
ALVEOLAR RIDGE
Alveolar ridge height increases in presence of development of teeth

Lower ridge height  less retentive dentures, difficulty in placing implants
Shallow vestibule in infants  Deeper vestibule in adults  Shallow vestibule in old age
Only present as a open shell Alveolar and subdental region of body Gets resorbed
are equal
6 1.
MENTAL FORAMEN
 The direction of exit of Mental Nerve Clinical implications –

• Administration of local anesthetic to the mental
 perpendicular in children
nerve
 oblique in adults • Adults- the needle – Obliquely from behind to
achieve entry.
 Also the position determines the depth of penetration of needle
• Infants- needle - at Right Angle to the body of the
mandible to enter the mental foramen
Near lower border Midway between upper and lower Near the upper boarder
border
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical publishing
6 2.
RAMUS
 Obliquely placed ramus  promotes rapid A-P lengthening of mandible
 Gradual uprighting happens  mandible grows downwards and forward
 Thickness is proportional to  Posterior cranial fossa & parapharyngeal air space
Oblique in direction Vertical in direction Oblique in direction
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical publishing
6 3.
ANGLE REGION
 Gonial region is wider & antegonial notch is shallow  in infants

 Gonial region shrinks & antegonial notch is deep  in adults
 Antegonial notch is flattened  in old age
Obtuse (near 180) Right angle (near 90) Obtuse (near 140)
6 4.
CORONOID & CONDYLAR PROCESS
Coronoid process is larger Condylar process is above the Condylar process is above the level
and is above the level of level of coronoid process of coronoid process
condylar process But is bent backwards
6 5.
MANDIBULAR CANAL
Lies a little above the Runs nearly parallel to the Runs closer to the upper
mylohyoid line mylohyoid line alveolar ridge
Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical
6 6.
ANATOMICAL
AT BIRTH ADULT OLD AGE
LANDMARK
Alveolar Ridge Only present as a open shell Alveolar and subdental region Gets resorbed
of body are equal
Mental Foramen Near lower border Midway between upper and Near the upper boarder
lower border
Ramus Oblique in direction Vertical in direction Oblique in direction
Angle Obtuse (near 180) Right angle (near 90o) Obtuse (near 140o)
Coronoid & Coronoid process is larger and Condylar process is above the Condylar process is above
Condylar Process is above the level of condylar level of coronoid process the level of coronoid
process process
But is bent backwards
Mandibular canal Lies a little above the Runs nearly parallel to the Runs closer to the upper
mylohyoid line mylohyoid line alveolar ridge
Symphysis Menti Present, the bone remains in Represented by a faint ridge Not recognizable or absent
two halves united together by only in the upper part
fibrous tissue
GROWTH MODIFICATION OF MANDIBLE
6 9.
 Growth modification is meant to take the advantage of the body's

natural growth to guide the unfavourable position of lower jaw to a
more favorable normal position.
 Growth modification is most effective, while the jaw is still developing,
which is around the time of puberty, before growth is complete
The timing of growth spurts
1. Just before birth. 4. Prepubertal growth

2. One year after birth spurts:
3. Mixed dentition growth spurts: Boys =14 - 16 years
Boys = 8 – 11 years Girls = 11 -13 years
Girls =7- 9 years
Profitt WR: Contemporary Orthodontics, St Louis, CV Mosby,1986

7 0.
Growing
Patient
Skeletal
class II
Mandibular Mandibular
deficiency deficient and
maxillary excess
Myofunctional Headgear and

therapy myofunctional
appliance
7 1.
Growing
Patient
Skeletal
class III
Mandibular Mandibular excess

Excess and maxillary
deficiency
Chin cup Facemask and chin cup /

myofunctional appliance
7 2.
MYOFUNCTIONAL THERAPY
Activator
Function Regulator
FR1 - Class I & II div I Malocclusion

FR1a – Class I malocclusion– mild to moderate crowding, class I deep
bite
FR1b – Class II,div I – Overjet not exceed 5mm
FR1c – Class II, div II – more than 7mm
FR2- Class I & II Div 1and 2
FR3- Class III
FR4- Open bite & Bi-maxillary protrusion
FR5- Used along with headgear in long faced patients
high mandibular plane angle

7 4.
FACE MASK
• Used in case of prognathic mandible and retrusive maxilla
Delaire type Tubinger type Petit type

7 5.
CHIN CUP
Restrict the forward and downward growth of mandible

7 6.
MILWAUKEE BRACE
• Used for the correction of scoliosis

• Exerts tremendous force on the
mandible leading to retardation of
Mandibular growth

04.
DEVELOPMENTAL
DEVELOPMENTAL DISTURBANCES
OF MANDIBLE
DISTURBANCES
OF MANDIBLE
ACHONDROPLASIA
• FGFR3 mutation- change in mandibular

shape, size and position
• Primary cause of dwarfism
• Most common form of chondrodysplasia
• Mid face hypoplasia
• Cartilages are severely disturbed
• Affects both endochondral and
membranous ossification
• Limited joint movements
• Rhizomelic
Baujat G., Legeai-Mallet L., Finidori G., Cormier-Daire V., Le Merrer M. (2008) Achondroplasia. Best Pract. Res. Clin. Rheumatol, 22, 3–18.
7 9.
AGNATHIA
Characterized by hypoplasia or absence of mandible.
Partial absence of mandible more common > absence of

Entire mandible
Agnathia-Otocephaly complex- agnathia + malformed ears
• AETIOLOGY Failure of migration of neural crest

mesenchyme into maxillary prominence ,
atrophy in the development of the mandibular
prominences at 4th – 5th week post conception
• PROGNOSIS: Poor and it is considered to be lethal.
Treatment-Mandibular reconstruction
Shafer, hine, levy. Shafers’s textbook of oral pathology. 7th edition. Elsevier; 2012. p. 3-80.
8 0.
MICROGNATHIA
Means small jaw, Retrusion of jaw can also

produce an image of micrognathia
Syndromes including
• Pierre robin syndrome
• Cat-cry (cri du chat) syndromes,
• Treacher collins syndrome
• Progeria
• Patau syndrome
• Nagar syndrome
Neville, Damm, Alen, Bouquot. Oral and maxillofacial pathology. 3rd edition. Elsevier; 2009. p. 1-53.
8 1.
MACROGNATHIA
• Refers to the condition of abnormally Large Jaws .

• Aetiology – unknown, follows hereditary patterns.
• Diseases associated with  Paget’s Disease of bone
 Acromegaly
 Leontiasis ossea
• Treatment – Surgical correction – ostectomy or
resection portion of a mandible
8 3.
CONGENITAL HEMIFACIAL HYPERTROPHY
• Represents hyperplasia rather than hypertrophy.

• Female: Male = 2:1,often affecting on right side.
• Asymmetry starts at birth  Enlargement is more
accentuated at the age of 6years and continues till the overall
growth ceases.
• Enlargement of the mandible and teeth on the affected side.
• The bone is wider and thicker.
• Premature shedding of the deciduous teeth.
• The roots of the teeth are sometimes proportionately
enlarged but may be short
• Permanent teeth on the affected side is often enlarged, most
frequently involving cuspid, premolars, and first molar
• Permanent teeth on affected side develops more rapidly and
erupt before there counterpart on the uninvolved side.
TREATMENT:
No specific treatment, other than cosmetic Surgery Surgery is done after the cessation of growth
Neville, Damm, Alen, Bouquot. Oral and maxillofacial pathology. 3 rd edition. Elsevier; 2009. p. 1-53
8 4.
HEMIFACIAL MICROSOMIA (Goldenhar’s syndrome)
• Rare congenital defect - incomplete development of the ear, nose, soft

palate, lip, and mandible.
• ETIOLOGY - Anomalous development of the 1st and 2nd branchial arch
Treatment: Orthodontic and prosthetic treatment
8 5.
MEDIAN MANDIBULAR CYST
✘ It is an extremely rare and controversial lesion.

✘ Located along the midline of the mandible.
✘ Developed Due To Entrapment Of Epithelium during fusion of two
halves of the mandible. Partially understood
✘ Controversy  Mandible develops as single bilobed proliferation of
mesenchyme with a central isthmus in midline. So as the mandible
develops, the isthmus disappears without any room for epithelial
entrapment !!
✘ Asymptomatic (diagnosed during routine radiographic examination).
Produce expansion of the involved cortical bone and associated teeth.
✘ It is unilocular,well circumscribed radiolucency may be seen in midline.
TREATMENT :  Surgical Enucleation.
8 6.
STAFNE BONE CYST
✘ This condition represents a focal concavity of the cortical bone on

the lingual surface the mandible.
✘ Ectopically placed minor salivary gland in mandible Atrophy Empty cavity 
Pseudo cyst (not lined by epithelium)
✘ Asymptomatic radiolucency below the mandibular canal between
the molar teeth and angle of the Mand.
✘ Anterior lingual salivary defects associated with the Sublingual S.G
 Here the lingual surface the mandible showing an anterior
cortical defect caused by sublingual gland can be appreciated.
✘ CT image showing well defined concavity in lingual surface.
TREATMENT  No treatment required > if the lesion is static.

Surgery > if there is increase in size.
PROGNOSIS: Good.
8 7.
TORUS MANDIBULARIS
✘ Develops along the lingual aspect of the mandible, just above

the mylohyoid line in the region of premolars.
✘ Etiology: Genetic or Environmental.
✘ Bilateral involvement occurs in more than 90% of cases.
✘ May be single/multiple nodules.
✘ Asymptomatic unless the overlying mucosa is ulcerated due
to secondary trauma.
✘ Radiograph shows the radiopacity that is superimposed over
the roots of the mandibular teeth.
TREATMENT  Surgical removal is required to accommodate

complete/partial dentures.
 May recur in presence of teeth.
8 8.
PARAMEDIAN LIP PITS
• Rare congenital invaginations of the lower lip

• Arise from persistent lateral sulci on the
embryonic mandibular arch
• Bilateral
• Symmetric fistulas – on each side
TREATMENT - Excision
B rauen RO. General aspects of the bilateral cleft lip repair. In: Grabb WC, Rosenstein SW, Bzoch KR. Cleft lip and palate, 1st ed. Boston: Little/Brown;1971 P. 278 9.
8 9.
MANDIBULAR CLEFTS
✘ Extremely rare condition.

1819, the first case was reported by Couronne. So far fewer than 80 cases
✘
have been described in the world literature so far.
✘ Result from lack of development of the midline of 1st branchial arch
TREATMENT Surgical Reconstruction
9 0.
MANDIBULOFACIAL DYSOSTOSIS
• Hypoplasia of mandible + macrostomia + high arched

palate+ bird or fish like face + antimongoloid slant +
coloboma of lower eye lids
Treatment :
• Severe cases - facial reconstruction
• Combined orthodontic therapy + orthognathic surgery.
9 2.
CORONOID HYPERPLASIA
Rare developmental anomaly resulting in limited mandibular movements.

Male: female = 5:1 , Often seen in puberty
TYPES
UNILATERAL BILATERAL
Enlarged Coronoid process Mandibular restrictions may

impinging on the posterior surface of progressively worsen over several
the zygoma restricting the mandibular years during childhood and reach
movements maximum severity in late teens.
 Mandible deviates to the affected side
No pain /associated abnormality in
occlusion.
TREATMENT : Coronoidectomy / Coronoidotomy  intraoral approach.

Post-operative physiotherapy  re-establishing normal function.
9 3.
CONDYLAR HYPERPLASIA
✘ Enlargement of the mandible

✘ Etiology :unknown
Some possible etiological factors  Local circulatory disturbance
 Endocrine disturbance.
 Trauma.
✘ Discovered in adolescence/young adults.
✘ Facial asymmetry , prognathism , open bite, cross bite.
✘ Radiographically there is irregular enlargement of the Condylar head.
✘ Some cases may demonstrate hyperplasia of the entire ramus.
TREATMENT  Unilateral condylectomy.

Unilateral/bilateral mandibular osteotomies.
Patient with compensatory maxillary growth > maxillary
osteotomy.
Frequent orthodontic therapy
9 5.
BIFID CONDYLE
✘ Rare developmental anomaly characterized by double-headed

mandibular condyle.
✘ Some may have medial and lateral heads divided by
anteroposterior grooves.
✘ Some may have anterior and posterior heads.
✘ Etiology : Anteroposterior bifid condyletraumatic origin.
✘ Mediolateral traumatic, teratogenic, abnormal muscle
attachments, persistence of fibrous septum in fibrous cartilage
✘ Discovered in routine radiographs. Shows bilobed appearance
of the Condylar head.
✘ Asymptomatic
✘ Some may have “pop” or “click” of the TMJ during mouth
opening.
TREATMENT  Asymptomatic  no treatment required.

Temporomandibular therapy may be required.
9 6.
TMJ ANKYLOSIS
Clinical Features UNILATERAL BILATERAL

UNILATERAL BILATERAL
• Facial asymmetry • Bird-face
• Microgenia
• Convex facial profile
• Short posterior
• Retrognathic mandible
facial height
• Minimal condylar •Obtuse cervico-mental
movements on angle
palpation •Marked decreased
lower face height
Ankylosed mass can be – Fibrous
Fibro-osseous
osseous
9 7.
TMJ ANKYLOSIS
CAUSE
TRAUMA INFECTION INFLAMATION SURGICAL
• Condylar fracture •Otitis media • Rheumatoid arthritis • Post-op
• Heamarthrosis •Suppurative arthritis • Ankylosing complication of TMJ/
• Obstetric trauma •Parotitis spondylitis orthognathic surgery
•mastoiditis • Still’s disease •Forceps delivey
• Psoriatic arthritis
TREATMENT – Surgical Rehabilitation
CONCLUSION
All the events taking place during development of mandible play an important role in
determining the final structure of mandible, any deviation of which can give rise to various
abnormalities in the oro facial region.
 A thorough knowledge is required by a Pedodontist to:
 Understand the aetiology behind such anomaly, and intervene them at the earliest.
 Gain idea about growth vectors, which enables to modify them to get a favourable
outcome
 Evaluate the age changes of various skeletal landmark
REFERNCES
● Dixon AD, Hoyte DAN, Ronning O. Fundamentals of craniofacial growth. London, England: Routledge; 2017
● Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd edition.
Peoples’s medical publishing housing- USA shelton, connecticut;2010. p. 121--186
● Enlow DH. Essentials of facial growth. WB Saunders; 1996.
● Agarwal V, Tandon R, Singh K, Chandra P, Agarwal S. Growth prediction methods: A review. IP Ind J of Ortho and
Dentofa Res 2021;7(2):106–13.
● Neville, Damm, Alen, Bouquot. Oral and maxillofacial pathology. 3 rd edition. Elsevier; 2009. p. 1-53
● Shafer, hine, levy. Shafers’s textbook of oral pathology. 7 th edition. Elsevier; 2012. p. 3-80.
THANK YOU
1st structure to develop – mandibular
nerve
Mesenchymal condensation forming 1st

branchial arch
Neurotrophic growth factors – produce by

nerve – induce osteogenesis
Single ossification – each half of mandible

– bifurcation of inferior alveolar nerve
01
THEORIES OF GROWTH
105
THEORIES OF GROWTH:
● Bone Remodelling Theory – Brash, 1930
● Genetic Theory – Brodie, 1941.
● Sutural Dominance Theory – Sicher, 1955.
● Scott’s Cartilaginous Theory – Scott, 1953.
● Functional Matrix Concept – Moss, 1962.
● Van Limborg’s Concept – Von Limborg, 1970.
● Cybernetics - Petrovic, Stutzman, 1977.
• Proposed by BRASH, 1930
• Principle : bone growth mainly attributed to apposition at surfaces.
• Eg: Growth of jaws
• All craniofacial skeletal growth occurs exclusively by the bone remodelling + bone grows only by interstitial growth.
• Drawback – failure to explain the role of sutures, cranial bone synchondroses and mandibular cartilage.
107
01 BONE REMODELLING THEORY
• Proposed by BRASH, 1930

• Principle : bone growth mainly attributed to apposition at
surfaces.
• Eg: growth of jaws
• All craniofacial skeletal growth occurs exclusively by the bone
remodelling + bone grows only by interstitial growth.
DRAWBACK – failure to explain the role of sutures, cranial bone

synchondroses and mandibular cartilage.
108
109
02 GENETIC THEORY:
• ALLAN G BRODIE, 1941.

• All functions of growth and development GENES
• Pre-programmed
• Role of genetics in growth is fundamental and has overriding
influence in establishing the basic facial pattern.
• Gregor Mendel opened up the field of genetics , notably
regarding the mechanism of inheritance and transmission.
DRAWBACK – Failed to explain, how growth takes place , where it

takes place ,how genes are responsible .
110
03 SUTURAL DOMINANCE THEORY

• Proposed by Sicher and Weinmann, 1941.
• Sutures, cartilages and periosteum are all
responsible for facial growth .
The Theory : Essence of the theory:
Primary event in sutural According to Sicher , “the
growth is the proliferation of sutures are the primary
the connective tissue between determinants of craniofacial
the two bones. This creates the growth. The craniofacial
space for appositional bone skeleton enlarges due to the
growth between the borders of expansible forces exerted by
two bones. the sutures as they separate.”
Koski K. : Cranial Growth Centres: facts or fallicies? , AJO DO: Aug 1968, 566-583.
Examples :
1. Increase in the size of the cranial vault takes
place via primary growth of bone at sutures
which forces the bone of the vault away from
each other .
2. Growth of midface takes place via intrinsically
determined sutural expansion of the Schematic representation of the Sutural Theory
of craniofacial growth using the cranial vault as
circummaxillary a model. Increase in the size of the cranial vault
suture system , which forces the midface takes place via primary growth of bone at the
sutures, which forces the bones of the vault
downward away from each other.
and forward.
3. Mandibular growth takes place via intrinsically
determined growth
Koski of the
K. : Cranial cartilage
Growth of orthe
Centres: facts fallicies? , AJO DO: Aug 1968, 566-583.
mandibular condyle, which pushes the mandible

112
The first school of thought •The second school of

( Sicher and thought ( Pritchard, Scott and
Weinmann) considers sutures as Girgis , 1956) sees the suture as
a thre a five layer structure.
layered structure. •Each bone at the suture has
It is stated that the its own two layer periosteum on
connective tissue between the both sides and intervening fifth
two bones plays the same role layer between these periosteal
as the cartilage at the base of layers.
the skull or like the epiphysis of •This layer plays a role in
long bones. adjustment between the bones
There is spreading of suture during growth, while the active
due to proliferation of middle proliferating role is played by
EVIDENCES AGAINST SUTURAL THEORY
1. Trabecular pattern in the bones at the suture 5. Closure of suture appears to be extrinsically
change with age, indicating the changes in determined (Moss ML, 1954).
the direction of growth. It cannot be accepted
that sutures will have the necessary 6. Sutural growth can be halted by mechanical
information for altering growth . force like clips placed across the sutures
(LEITUNEN,1956).
2. Subcutaneous auto-transplantation of the
zygomaticomaxillary suture in the guinea pigs 7. The parallelism of the circum-maxillary suture
has not been found to grow . (Watanbabe M so as to effect a forward and downward growth
Laskin) of maxilla is only superficial .
3. Extripation of facial sutures has no 8. Presence of forces trigger bone resoption rather
appreciable effect on the dimensional growth than deposition.
of the skeleton. (Sarnat, 1963).
9. Growth can be seen in untreated cases of cleft
4. Shape of sutures have been found to depend palate patients even in absence of sutures.
on functional stimulus (Moss &
Salentejin ,1969).
114
CONCLUSION
• Present evidences indicate sutures as adaptive

growth sites.
• Sutural tissues have no tissue separating force and
they are not comparable to growth center.
• They can be considered as growth sites instead.
115
04 CARTILAGENOUS THEORY
• Proposed by James H Scott , 1950.
• Also known as nasal septum theory / cartilaginous theory/
nasocapsular theory .
Scott felt that cartilaginous Essence of the theory:
development was under tight Sutures are considered as
genetic control and continued merely passive , secondary and
to dominate in postnatal facial compensatory sites of bone
growth Scott concluded nasal formation and growth.
septum is mostly active &
vital for craniofacial growth
both prenatally and postnatally.
116
DISCUSSION:
● This theory is based on the fact that cartilage

is a pressure adapted tissue and expansion of
cartilage provides the force to displace maxilla
downward and forwards .
● According to Scott , bone separation must
precede the adaptive sutural bone growth.
● The bone separation occurs secondary to the
growth of organs like the brain, eyeballs etc.
117
Acc to Scott, there are two suture systems:

● Posterior suture system- lies behind the
maxilla and separates it from palatine ,lateral
mass of ethmoid ,lacrimal , zygomatic and
vomer bones .
● Anterior suture system separates premaxilla ,
nasal and vomer bone .
118
A – POSTERIOR SUTURE SYSTEM B – ANTERIOR

SUTURE SYSTEM
119
IN FAVOUR THE THEORY AGAINST THE THEORY
1. Extirpation of septal cartilage in growing 1. Moss and Bloonberg found only slight
rats resulted in deficient growth of the deformity after extription of septal
snout. cartilage .
2. Latham and Burstone concluded that nasal 2. Latham and Burstone reported a case
septum has a role in determining with missing nasal septum .The child
anteroposterior growth of upper face. had a normal resorption and deposition
3. Burston emphasized the importance of the of palate , height of upper face .
septal growth impulse to maxillary growth 3. Moss stated that malformations in
in cleft palate cases . Failure of under snout following excision of nasal
developed maxillary segment to unite with septum is due to trauma following
nasal septum in complete unilateral clefts surgery .
deprives it of growth impulse or energy .
The normal contralateral side in the other
CONCLUSION
hand ,attained normal growth . : It
is still accepted as a
reasonable explanation for craniofacial
growth .
120
FUNCTIONAL MATRIX HYPOTHESIS

• Influenced by ideas of Van Der Klaaw ( 1946)
• Proposed by Melvin Moss in 1960 .
• Essence of the theory .
• Definition .
• Explanation .
• Functional cranial analysis of maxilla .
• Functional cranial analysis of mandible .
• Neurotrophism .
• Constriants of functional matrix hypothesis.
Moss primary role of functional matices – AMJO – DO
FUNCTIONAL MATRIX THEORY
● Influenced by ideas of Van Der Klaaw ( 1946)
● Proposed by Melvin Moss in 1960 .
● Moss stated that “the functional matrix is primary and the origin, development and maintanence of all the skeletal units is secondary,
compensatory and mechanically obligatory responses to changes in shape and special position of its related functional matrix.”
● ESSENCE OF THE THEORY:
● Functional matrix hypothesis maintains that apart from initiating

the process of development , hereditary and genes play no role
in growth of skeletal structures in general and craniofacial
skeleton in particular.
● The craniofacial skeleton develops initially and later grows in
direct response to the extrinsic epigenetic environment .
● FMH claims that epigenetic, non-skeletal factors or process are
the prior, proximate, extrinsic and primary cause of all adaptive,
122
DEFINITION
Functional matrix hypothesis claims that the

origin , growth and maintenance of all skeletal
tissues and organs are always secondary
compensatory and obligatory responses to
temporarily and operationally prior events or
processes that occur in specifically related
non skeletal tissues , organs or functioning
spaces .
123
EXPLANATION
● Head is a composite area of individual, an encapsulated area
within which specific functions like respiration , digestion,
olfaction ,vision, neural integration are performed .
● To perform each function certain hard & soft tissues are
involved .
● The totality of all the skeletal structures ,soft tissues &
functioning spaces necessary to carry out a specific function is
collectively called a functional cranial component .
124
EACH CRANIAL COMPONENT CONSISTS OF :

FUNCTIONAL SKELETAL UNIT NEUROTROPHISM
MATRIX
Refers to all soft tissues & • Microskeletal unit • Neuromuscular
spaces that perform a • Macroskeletal unit • Neuroepithelial
given function . • Neurovisceral
• Periosteal matrix
• Capsular marix
(Neurocranial capsule,
Orofacial capsule.)

125
FUNCTIONAL CRANIAL COMPONENT:
FUNCTIONAL MATRIX SKELETAL UNIT
PERIOSTEAL MICRO-
MATRIX SKELETON
CAPSULAR TRANSFORMATION MACRO-

MATRIX SKELETON
TRANSLATION
GROWTH
126
PERIOSTEAL MATRIX
 Corresponds to the immediate local environment. They are virtually self defining.
 Example : muscles, blood vessels ,nerves ,etc .
 All periosteal matrices act homogenously by means of osseous deposition & resorption.
 The periosteal matrices stimulation causes growth of the microskeletal units .
 They act to alter the size or shape or both of the bones.
 The growth process that occur due to periosteal marix stimulation are called transformation.

127
CAPSULAR MATRIX
Defined as the organs & spaces that occupy a border anatomical complex .
 Each capsule is an envelope which contains a series of functional cranial
components, skeletal units and their related functional matrices & is sandwiched
between two covering layers .
 Neurocranial capsule – consists of skin & duramater. The neurocranial matrix
volume consists of the brain, leptomeninges & CSF .
 Orofacial capsule – skin & mucosa form .The orofacial capsular matrix is
surrounded by orofacial capsule and exists as volume .
 The capsular matrix does not alter the size or shape of the skeletal units instead
they change their locations in space. This is called translation .

128
SKELETAL UNIT
. Refers to the bony stuctures that support the functional matrix
& these are necessary or permissive for that function.
They are
1. Microskeletal units – parts of the bone whose growth is
modulated by the periosteal matices.
2. Macroskeletal units – capsular matrix expansion causes the
macroskeletal unit to passively change the position .
 The overall skeletal growth is a combination of changes in

microskeletal & macroskeletal due to stimulation of periosteal &
capsular matrices.
 This total growth change is termed as transformation or
interosseous growth by Moss .

129
FUNCTIONAL CRANIAL ANALYSIS OF MANDIBLE
The mandibular matrix consists of

● All muscles with mandibular attachments
● Neurovascular triads (arteries,veins& nerves)
● Associated salivary glands
Teeth
●
● Fat, skin & connective tissues

● The tongue
● The oral & pharyngeal spaces
130
 Moss speaks of mandible as a group of microskeletal

units and a basal core part.
 Coronoid process is one microskeletal unit under the
influence of temporalis muscle
 Gonial angle is another microskeletal unit under the
influence of masseter & pterygoid muscles.
 Alveolar base is the microskeletal unit for teeth.
131
Basal tubular portion serves as a protection for

the mandibular canal & it follows a logarithimic
spiral in its downward & forward movement
beneath the cranium.
This is called as ‘ unloaded nerve concept’ .
The most constant portion of the mandible is
the arc from foramen ovale to mandibular
foramen & mental foramen .
132
MANDIBLE : CORE AND

MICOSKELETON
PROTECTED
NERVE
CONCEPT
133
According to Moss ,three important phenomenon occur

during mandibular growth
 Constancy of the relative position – If the horizontal body
is divided into premental & postmental segments & these
segments when measured at different ages, it was found
the length of segments remain relatively proportional
through out the life.
 It proves that increase in corpus length cant be due to
condylar growth as this would increase the relative size of
the postmental segment.
134
● Absolute migration of dentition – This movement is

different from mesial drift during first two decades.
● While the position of mental foramen remains constant ,
the relationship of mandibular dentition to it doesnt .
● This migration is most pronounced during the eruption of
permanent dentition .
● Change in direction of mental foramen – Mental foramen
is compared to nutrient foramen of long bones.
135
● When a pin is placed with protruding head pointing

towards the rapidly growing end :
● It shows that in newborn the pin points forward while its
direction is upward at 6years & relatively backward in
adults.
● The reason for this is given by LaCroix It is claimed
that the periosteum of growing bone is under tension &
that the tensile force at a given point is proportional to
growth rates of the two ends of the bone .
136
• When growth rates of one end predominates , the

periosteal tension in that direction will be greater.
• The effect of such unequal tension is seen as
slipping of periosteum & consequent migration of
the point of entry of the nutrient vessel.
• Along with the surface of apposition of new bone
which accompanies growth in width, causes the
foramen to face in the direction of most rapid
growth.
137
138
NEUROTROPHISM
● Behrent, Moss - 1976
● Defined as a non impulsive transmitive neurofunction
involving axoplasmic transport providing for the long
term interaction between neurons and innervated
tissue , which homeostatically regulate the
morphological, compositional and functional integrity
of those tissues .
● The nerve influences the gene expression & reflects
constant neurotropic regulation stemming from a higher
neural source .
139
1. Neuroepithelial trophism –Epithelial mitosis & synthesis

are neurotrophically controlled. The normal epithelial
growth is controlled by release of certain neurotrophic
substances by the nerve synapses. If this neurotrophic
process is lacking or is deficient, abnormal epithelial
growth , orofacial hypoplasia & malformation, etc. occur.
2. Neuro muscular trophism – Embryonic myogenesis is
independent of neural innervation & trophic control.
3. Neurovisceral trophism –The salivary glands , fat tissue &
other organs are trophically regulated ,at least in part.
140
Constraints of functional matrix hypothesis

1.Methodological - FMH used only macroscopic measurement by
using point mechanics and arbitrary reference frames like
cephalometric radiograph.
2. Hierarchial - it does not explain how the extrinsic, epigenetic

functional matrix stimuli are transduced into regulatory signals at
the cellular, multicellular or molecular levels
CONCLUSION:
Both genomic and epigenetic factors are necessary and
sufficient cause for control of morphogenesis .
141
FUNCTIONAL MATRIX THEORY REVISITED:

1) CONCEPT OF
MECHANOTRANSDUCTION:
● Mechano-transduction signifies cellular signal
transduction.
● It is the process by which the macromolecular
extrinsic stimuli are converted into cellular signals,
which can be internalized by a cell and processed so
that a suitable adaptive response can be generated.
142
MECHANORECEPTORS TRANSMIT
ALTERED EXTERNAL ENVIRONMENT VITAL CELLS PURTURBED EXTRACELLULAR STIMULUS TO
RECEPTOR CELLS
MECHANO-TRANSDUCTION:
INTRACELLULAR ACTIVATION TRANSFORMS STIMULUS INTO
INTERCELLULAR SIGNAL
143
OSSEOUS MECHANOTRANSDUCTION:
● Highly specialized, unique mechanism  bone cells
respond to external stimuli.
● Occurs in single bone cells, which are computational
elements that function as a connected cellular
network.
● Unique nature is higlighted by –
Unlike other mechanosensory cells, osteocytes are not
specialized for such stimuli.
144
These cells show aneural transmission of signals.

These show multiple adaptational responses to a single force.
Changes brought about by the stimuli is isolated to the very
osteocyte that received the signal.
* The osseous mechanotransduction translates the periosteal
functional stimulus into a skeletal unit cell signal by two
processes namely ionic and mechanical.
145
BONE AS AN OSSEOUS
CONNECTED CELLULAR NETWORK:
● The word ccn implies to a network that exists
between the adjacent cells of a tissue through
specialised structures in the cell membrane.
● Includes- gap junctions and tight junctions 
conduct stimuli rapidly across cells.
● Extensive ccn (Connexin 43) exist within bones-
main component – gap junctions – allows
passage of ionic currents of molecular signals.
146
THE FMH AND EPIGENETICS:

● This concept of moss aimed to find a middle path to solve the
controversy of genomic vs epigenetic control of biologic
processes.
● Epigenetics : Includes the sum of all biochemical, bioelectric and
biophysical parameters- instantaneously present inter, intra and
extracellularly – all of which are produced by the functioning of a
cell, tissue, organ and organism itself.
● It is postulated that these epigenetic factors act on the products of
the genome to regulate all developmental processes leading to
production, increase and maintanence of biological complexity
and provides feedback regulation of the genome itself
Moss ML. Functional Matrix hypothesis and epigenetics.

GraberTM, Physiologic principles of functional appliances , ST Loius, CV Mosby
147
● The FMH denies that the genome of skeletogenic cells

contain sufficient information to regulate the type, site, rate,
direction and duration of skeletal growth.
● In contrast, epigenetics veiws genome as providing a set of
formal prior intrinsic and necessary causal factors which
when combined with efficient proximate extrinsic factors
and epigenetic causal factors are sufficient to account for
the regulation of development.
148
VAN LIMBORG’S THEORY:

● VAN LIMBORG, 1970.
● Previous theories  incomplete, unacceptable significant
elements  van limborg’s multifactorial theory.
● 5 factors control growth :
- Intrinsic genetic factors
- Local epigenetic factors
- General epigenetic factors
- Local environmental factors.
- General environmental factors
149
Van Limborg summarize his theory:
⊷ Chondro-cranial growth is mainly controlled by intrinsic genetic factor.

⊷ Desmo –cranial growth controlled by intrinsic genetic factor
⊷ Cartilaginous part of skull is the growth center.
⊷ Sutural growth is controlled by influence from skull cartilage.
⊷ Periosteal growth depends upon growth of adjacent structures.
⊷ Sutures and periosteal growth is governed by non-genetic
environmental factors.
150
CYBERNETICS
● PETROVIC, 1977.
● Using the language of
cybernetics, Petrovic reasons
that it is the interaction of
series of casual changes of
feedback mechanisms which
determine the growth of
cranio-facial regions.
Demonstrate – Qualitative and quantitative

relationship between observed and experimental
findings.
Meckel's cartilage has a close spatial
relationship to the nerve fiber bundles of the
mandibular division of the trigeminal nerve
The trunk of the mandibular nerve lies

medial to and above the dorsal end of the
cartilage and comes into close relationship
with it at the junction of its dorsal and middle
one-thirds

Development Mandible Anisha

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Development Mandible Anisha

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CRANIOFACIAL DEVELOPMENT OF

Dr. Anisha Singh

● Greek word ‘mandere’-to masticate/chew

Signals from ectoderm,paraxial mesoderm, Meckel’s

The first structure to develop in the region of

Induces osteogenesis by production of

Prior presence of neurovascular bundle ensures

• The mandibular ectomesenchyme

• Meckel’s cartilage extends as a solid

• meets its fellow of the opposite side

• It diverges dorsally to end in tympanic

Spread of the intramembranous

Meckel’s cartilage becomes

✘ The trough soon forms a canal as bone forms over the

• The trunk of the M.N  medial to and

• At the junction of its dorsal and middle

• The remaining nerve fiber bundle

• At junction of the middle and ventral

By 5th month Intra uterine life:

This remodeling occurs earlier than it occurs in other bones,

 Appears between the 10th and 14th weeks post conception.

Derivatives of secondary cartilage

• Cone shaped cartilage at Ramal

• First evidence endochondral

By 10-14 week of IUL – Appearance of

Grow as a response to temporalis

Becomes incorporated into expanding

• Ossification starts - 7th month pc

71/2 weeksFirst sign of Articular Disc

8th week Lateral pterygoid muscle develops medial to the

10th week  2 clefts develop in the interposed vascular fibrous

11th weekJoint capsule composed of fibrous tissue forms

111/2 weeks  Upper compartment starts to appear

• Proposed by Brash, 1930

• Proposed by ALLAN G BRODIE, 1941

• All growth is compelled by genetic influence i.e: genetic

• Role of genetics in growth is fundamental and has overriding

• The genes are - SoX9,CTGF (Connective Tissue Growth

• Proposed by James H Scott , 1950.

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

• Largest amount of growth and variability in morphology - Post Natally

Alveolar unit • Teeth act as functional matrix

Coronoid • Action of temporalis muscle

Angle and ramus • Masseter and medial

Condylar • Lateral pterygoid

According to Moss ,three important phenomenon occur during 2 9.

• Basal tubular portion serves as a protection for the

The central core is straight at

• Most of the facial bones have a ‘V’ shaped

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

Pharyngeal Space Middle Cranial Fossa

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

Proposed by Alexandre Petrovic (1977)

Anterior growth of the midface (A) Results in a

The ascending ramus  is low and wide

The coronoid process  relatively large and

The body  an open shell containing the buds

Mandibular canal  runs low in the body.

✘The initial separation of the right and left bodies of the

Although the mandible appears as a single bone in the

The Basal Bone Of The Body forms one unit, to

Ramus moves posteriorly by remodelling

Drift of the Ramus – Posterior Direction

Hunterian concept Remodeling