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INDIAN DENTAL ACADEMY
Leader in continuing dental education
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GROWTH AND
DEVELOPMENT
OF
CRANIOFACIAL
STRUCTURE
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INTRODUCTION

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Every pedodontist should keep in mind that
the patient on whom he works are in the state
of growth and development , which is a
dynamic and continuously changing process.
He almost never find a static picture in
pediatric patient. So a thorough understanding
of complex craniofacial growth is of great
importance for pedodontist Understanding of
developing craniofacial skeleton represents,
sum of growth of its separate parts in which
growth is highly differentiated and occurs in
different rates ,dimension and time.So keeping
all these in mind we start with seminar topic



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

Growth and development
can be seen in three aspects

a)
b)
c)

change in dimension
change in proportion
maturation
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DEFINATION OF GROWTH
 STEWERT(1982)

: growth is increase in
mass physical size of cell ,tissues ,
organ ,or organisms as a whole

PROFIT (1986): growth refers to
increase in size or number
MOYERS (1988) : growth is normal
change in the amount of living substance
PINKHAM(1994) :growth is increase
expansion or extension of any given
tissue
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DEFINATION OF
DEVELOPMENT
 TODD(1931)

:development is increase in

complexity
 LOWREY(1951) :development indicates
increase in skill and complexity of
function
 MOYER(1988) :development is the
unidirectional change in the life of an
individual from its existence as a single
cell to terminating in depth .
 PINKHAM(1994) :development addreses
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the progressive evolution of a tissue
 DIFFERENTIATION

:The change from a
generalized cell to one that is more specialized .it
is change in quality and kind .

As we see that many of times
growth and development are used synonymously,
but they are not. In simple words,
 * Growth is increase in size or number of
things .It is numerical .can be easily measured
with a specified scale. Ex. Height , weight of
persons.
 *development is increase in skill and
complexity of fuction.
 But, practically growth and development are
inseparable entities and are simultaneous on
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THEORIES

OF GROWTH

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GENETIC GROWTH
(Brodie)
It

says, growth is cantrolled by
genetic influence in all aspect. But it
cannot be accepted in all cases. As it
has been shown that the external
factor have significant modifying
effect on growth


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SUTURAL THEORY
(sicher)
 It

says that the proliferation of sutural
mesanchyme causes apposition of bone . It is
seen in membranous bone.
 Limitation :- lack of growth of suture if it is
transplanted .
 gowth occurs in cleft lip and cleft palate
pts.even if suture not present
 Suture also respond to external influence

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CARTILAGENOUS THEORY
(James Scott) :
 It

says that cartilage acts as primary
growth center and has a innate growth
potential
 Ex ;
condylar cartilage for mandible

Nasal cartilage for maxilla
(nasomaxillary complex)
 If it is transplanted it grows
independently
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FUNCTIONAL MATRIX THEORY
(Melvin Moss –1968)
It says that body has two element

a) skeletal element
b) functional matrix
 functional matrix comprised of
 1)periosteal camponent
 2)capsural camponent
 (neuro cranial),(orofacial)
 functional matrix has primary control on
growth of skeletal unit and bone respond in
passive manner

but it can not explain all aspects of
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growth

MULTY FACTORIAL THEORY

(Van Limborgh)
It says bone growth is controlled by

a) intrinsic genetic factor
 b) local epigenetic factor (nerves, brain )
– C)general epigenetic factor (harmones,
secondary messengers )
– d) local environmental factor (habit,
muscular force )
– e) general environmental factor ( oxygen,
nitrogen)

It is most satisfactory theory that explains
all aspect

It says growth is polygenic and
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multifactoral

NEUROTROPISM
(recent theory )
 It

includes epithelial , visceral , muscular
component for these component nerve
impulses which are transmitted has
growth potential for bone .It also has
indirect effect by influencing soft tissue
growth

but by experiments it has proved that
neurotropism has negligible effec
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PETROVICS HYPOTHESIS
It says that the interaction of serves
of casual changes and feedback
mechanism which determines
craniofacial growth
 ie brain---- cranium.


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THEORIES

RELATED TO
CRANIOFACIAL
GROWTH


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ENLOWS EXPANDING “V”
PRINCPLE


It says that most of craniofacial bones
especially intramembranous have v
shape eg:maxilla , mandible , palate
,nasal etc.

And

growth movement occurs
towards wide end of V deposition of
bone is seen in inner side and
resorption is seen in outer surface.
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ENLOWS COUNTERPART
PRINCIPLE


It explains that, growth of one bone has
influence on its adjuvant bone which is
called counter part, and this controls the
growth and proportional relationship
with its counterpart.

 E.g.:




nasomaxillary complex—cranialfossa
Maxilla ----------mandible
Tuberosity areas of upper/lower jaw
Pharyngeal space -------- middle
cranial fossa
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FACTORS AFFECTING
PHYSICAL GROWTH
Heredity
 Nutrition
 Illness
 Race
 Socioeconomic states
 Family size
 Psychogenic disturbance
 Exercise
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 Pharmacological

characteristic properties
of growth


concept of normality

growth states are always
accessed in normality value ie. in range
but can not be explained as ideal with a
definite value

Normality differs from age to age


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

Different growth :

Different organs grow at
different rate , different amount, and
different time .

It can be best explained by
SCAMMONS GROWTH CURVE


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

CEPHALOCUADAL GRADIENT
OF GROWTH

Axis of growth increases
extending from head to feet
 ie. 3 months intra uterine life head size--50%, birth head size---30%, adult head
size---12% of whole body




 Cranial

growth 70% completed at birth
to 1st year
 limbs 3month IUL-1% by birth-50% of
body
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GROWTH SPURTS

In spite growth is continuous process
there occurs a period when a sudden
acceleration of growth occurs called
growth spurts .

It is due to physiological alteration in
hormonal secretion
 They differ in boys and girls
This period is good for functional and orthodont
appliance use
Surgical correction involving jaws should
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carried out after cessation of growth spurts .



Timings of growth spurts

 A)just

before birth
 B)one year after birth
 C) mixed dentition
 growth spurts ….girl—7-9yrs

boys- 8-11yrs
 c) pre pubertal
– growth spurt ……girls ----11-13 yrs

boys -----14-16yrs
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METHODS OF STUDING
GROWTH
 a)measurement

approach
 bimanual test height and weight
 b) experiment al approach :
vital staining- alzirine blue

alzirine red

lead acetate

Rdioisotopes-------- te 33 ,ca*45 ,
k*32 injected in bone
 c)Implants
 d)radiographs
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Mechanism of bone
development




1)endochondral bone
2)intramemebranes

 endochondral

bone this type of bone is
proceded by formation of cartilaginous
model
 intramembranes bone – bone is directly
laiddown in fibrous membrane
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prenatal growth
{day1 to 266 day}
It

is divided into 3 periods

1)

period of ovum (ferti. to 14th day)
2)period of embryo (14th day to 56th
day)
3)period

of fetous(56th day to birth)
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 period

of ovum(fertilization to 14th day)

 In

this period oocyte get fertilized with
spermatozoa to form zygote which is a diploid
cell. After this process cell division starts within
24 to36 hours. Cleavage continues to form ,
2,4,8,cells. In 8th cell stage process of compaction
occurs to get 1st embryo shape. 16th cell stage
called morual . Next stage called blastula which is
150 cells stage. It is of 1.5mm in length and 3 to 5
days old it has inner cell mass which forms fetus
& outer cell mass which forms yolk sack. On 5th
day blastocyte starts penetrating endometrium &
at 14th day it get implanted it self into uterine wall.

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or embryoblast

utenne epithelium

Uterine stroma

~,~~",".

Trophoblast cells

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Timeo!
DNA
duplicatiof

Endometrium (progestational stage)

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., ,.< ---I. ,I
Period of embryo
th

(14 day to 56th day)

 It

is the period where major development of
organ specifically craniofacial structure occur.
on 17th day process of gastrulation occurs to
form different germ layers. Ectoderm above
notochord thickens to form neural plate which
forms nervous system . On 21st day embryo is of
3mm now primordial of brain eye are seen in
prosenceophalon. On 3rd day otic &optic
plocodes are seen. In the same period most
inferior part of prosencephalon starts growing to
from front nasal process which overhangs
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future oral cavity which is wide & shallow.
P
rimitive pit and
neurenteric canal

Amnion
Wallo!
yolk sac

Cloacal plate
(membrane)

A

Not ochordal plat e

c

E
ndoderm

Int raembry onic mes oderm

Ex t raembry onic
mes oderm

E

Notochord
- ,u :1 I "e+r ~ t;n a for ,

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I ~.

,f/,'~
M.
W,'.
:~:i:
:> "-'.~
,

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on 3-4week oral groove starts deepening.
Same time bud for max and man process
show their presence lat to oral groove.
Deepened oral cavity is now called
stomodium and is separated by hind gut
with a membranes formed by endoderm
and ectoderm called buccopharyngeal
membranes . on 4th week the embryo is
5mm . Now frontal elevation shows some
ectodermal proliferation which form future
nasal placode and olfactory epithelium
optic placodes which are formed are
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placed very widely apart
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Otic placode

Lens
placode

Limb
ridge

B

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28 days
 Front

nasal process show more growth
mesially than laterally which forms medial
nasal process. As medial nasal process
grows faster, in future it unites with
maxillary process to form part of upper lip
specifically along line of philtrum . lateral
nasal process mainly contribute formation
of columella .on 5th week caudal to
frontonasal and maxillary process brachial
arches show their development they are
totally six with 5th one turning to be
rudimentary. 2nd brachial arch develop faster
than other and covers other brachial arches
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;
Pharyngeal pouch
Endoderma! epithelium

Nerve

1 st pharyngeal
arch

Cartilage

cleft

Ectodermal
epithelium.

2nd arch with ner ve,

artery, and
c<1rtllage

Mesenchymal tissue in
4th arch

A

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Auditory tube

Primitive
tympanic
cavity

Ventral side of
phary nx

External
auditory
meatus

- Foramen cecum
f

,
f


I
f
!
I
f

Palatine tonsil

,
I

,
'¥

Superior parathy roid gland
(f rom 4th pouch)

Thy roid gland
Inf erior parathy roid gland
(f rom 3rd pouch)

Ultimobranchial body

Foregut
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 same

time between and around primordial
of brian and eye Mesenchymal
condensation appears which gives a shape
of skull. Mesenchyma of brachial arch also
appears by 5th week. 1st brachial grows faster
to become distant .In 6th week mandibular
arch show accentuated growth to divide in
maxillary and mandibular process both
process grows medially . medial nasal
process from above also grows downwards
and towards midline as a result by the 7th
week fusion between maxillary and
frontonasal process occurs and this time
embryo is 14.5mm in length
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 Now

eye starts migrating towards midline
Mesenchymal of cranial and brachial arch
differentiates into cartilage (CHONDRIFICATION)



cartilage in the base of skull thins to join
with nasal and optic capsules. same time centers
for endochondral ossification appears in the
cartilage of base of skull, also Mesenchymal
condensation in intramembranous bone is seen.
At 8th week nasal septum further narrows to
become a prominent structure ,also external ear
starts its development. nasal pit breaks down to
form nostrils. Demarcation seen between lateral
nasal and maxillary to form nasolacrimal groove
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 primary

palat starts its development at 8 th
week .so till this time their occurs a direct
communication between oral and nasal
cavity . lidless eyes increase their
movement towards midline .both lateral
halves of mandibular process fuse by 8 th
week. at this time embryo is 18mm in
length .
 Rough head and face shape is almost
completed by 8th week . By end of 8th week
embryo increases in length almost by 4
times to that of 7th week
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














main structures formed in the embryonic period are
neural plate -2
buccopharyngeal membrane -2
mandibular arch –3
hypoglossal muscle—5
median and lateral nasal process-5
lens of eye-5, retina—5
external carotid artery-6
middle ear-6
larynx -6
maxillary process -6
external ear -7
nasal septum-8
palatal shelves-8 www.indiandentalacademy.com
*IN WEEKS OF IUL
FETAL PERIOD
(56days--9 months )
Eye

lid formation occurs .eyes get
close . nostrils are formed.
This period shows accelerated rate
of craniofacial growth resulting in an
increase size and proportion In 8th to
12 weeks fetus increases in length by
22—60mm .
mandible increases in size and
anteroposterior relationship of both
jaws develop as it is seen at birth
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

Development of tongue

 Appears

in embryo at 4th week of IUL . in the
form of two lateral swellings and one median
swelling that is tubercular impar .all are from 1 st
pharyngeal arch
 Another median swelling copula (hypobranchial
eminance) from 2,3 and 4th arch .posterior part
of 4th arch gives rise to epiglottis
 Two lateral swellings grows medially and
anteriorly and overgrows on TI . both half
meet each other to form anterior two third of
tongue
 Muscles of tongue develop from occipital
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myotomes
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 Thyroid

gland :


 Thyroid

appears as epithelial
proliferation of in the floor of tongue
between TI and HE
 Then it descends in front of pharyngeal
gut and forms bilobed diverticulum's
which forms two lobes



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GROWTH OF CRANIAL BASE
 As

we have seen that by 4th to 8th week of IUL
evidence of cranial base formation is seen .the
Mesenchymal form is derived from primitive
streak of neural crest and occipital
schlerotomes.
 condensed mesanchyma forms capsule around
brain called ectomenix basal portion of this
capsule gives rise future cranial base. The
process by which ectomeningeal capsule get
convert into cartilage is called chondrification .
 it mainly occurs in 4 regions

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Para chordal—around cranial end of
notochord
 Hypophyseal—it occurs in 4 centers

post sphenoid—body of
sphenoid

pre sphenoid –body of sphenoid

mesethmoid---plate of ethmoid


cristagalli


 Nasal-nostril
 Otic-mastoid

orbito sphenoid---lesser wing
ali sphenoid – greater wing
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OCCIPITAL BONE
It ossifies both endochondrally and
intramembranously. It has 2 intra membranous
centers and 5 endochondral centers
•
supra nuchal sq. part – one pair ---8th
week
•
infra nuchal sq.part --1 pair -------10th
week
•
basilar part –single median center -11thweek
•
foramen magnum occipital condyle ---1
pair –12th week


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






TEMPORAL BONE
It has 11 centers of ossification
Sq, part –1 center (IM)—8TH week
Tympanic ring 4 centers (IM)------12th
week
Petrous temporal bone ---4 centers
(EC)-----5th month
Styloid 2 centers (EC) 5th month



 ETHMOID




BONE

Its an endochondral bone with 3 centers
Median floor of anterior cranial
fossa –1 centers
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Nasal capsule 2 lateral centers
 SPHENOID

BONE

It has 15 centers of ossification

Lesser wing –2 orbito sphenoidal cartilage

Greater wing ,lateral pterygoid plate2(IM)1alisphenoid

Median pterygoid plate -2 secondary
cartilage of hamular process

Anterior part of body of sphenoid- 5 (EC)

Posterior part body of sphenoid - 4 (EC)

Cranial base chndrocraniam is relatively
stable during growth compared to cranial vault
and face so cranial base is taken as bases
against which cranial vault and facial skeleton
can be compared in cephalometric studies


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 FLEXURE

OF CRANIAL BASE

In early fetal period cranial base becomes flexed
in the region between pituitary fossa and
sphenooccipital junction this is accompanied by
developing brain stem so that spinal chord and
foramen magnum directed downwards from their
initial position of backwards this adaptation only
seen in human beings

It increases neurocranial capacity
 It facilitates predominant downward growth of
face
 At 10th week of intrauterine life flexure angle is 65
degrees with then flattens. anterior and posterior
part of cranial base grows at different rates that is
between 10th to 40th week anterior cranial base
increase in width bywww.indiandentalacademy.com
7 times but posterior increase
by 5 times
 Development

of palate
 Main part of palate arise from maxillary
process & small premaxilla is formed by
deeper part of medial nasal process.
initially medial nasal process gives rise to
small triangular projection which forms
futer premaxilla .then from maxillary
process lateral segments arise which are
placed vertically. In this period mandible
is small & already formed tongue is
pushed upwards in nasal cavity so
lateral segments of maxillary process
grow vertically .
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 Nasal

septum from above starts growing
downwards & backwards by 7th week of IUL .
Mandible shows accelerated growth so tongue
falls back & transformation of position of
palatal selves occurs from vertical to horizontal
this transformation takes place within hrs .
 Both palatal selves properly approximate by 8
½ to form hard palate & posterior part use to
form sot palate entire palate does not close at
once . initial contact occurs in central region of
secondary palate posteriorly to pre maxilla
from this point closure occurs both anteriorly
&posteriorly also from above end of nasal
septum fuses with palate .
 Palatal ossification (IM) 1 center 8th week
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 mid palatal suter ossifies at 12 to 14 years
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development

o maxillary sinus

 It

is formed around at 3rd month of IUL
It develops by expansion of nasal mucous
membrane into maxillary bone
 It enlarges later by internal resorption of
wall of maxilla

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meckels

cartilage

it derived from first brachial arch on 41st to 45th
day of IUL .extends from cartilaginous otic
capsule to sysmphysis .it acts as template and
guide for growth of mandible . a major portion
of this disappears and remaining part develops
in to

mental ossicle

incus, malleus

spine of sphenoid

ant. Ligament of malleus

sphenomandibular ligament
 1st structure that develops in promordia of man.
Is mandibular www.indiandentalacademy.com
division of 5th nerve this is
followed by osteogenesis (neurotropic theory )

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 on

6th week of IUL single ossification
center for each man. Arise in the region
of bifurcation of inferior alveolar nerve
in to mental and incisive. ossifying
membrane is located lateral to meckels
cartilage .IM ossification spreads
dorsally and ventrally to form body and
ramus of man. Ossification continues till
region of future linguala. meckels
cartilage continues into middle ear and
develops in to auditory ossicle that is
malleus and incus and SML
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 Endochondral

bone formation in man.

Seen in3 areas
 condylar process
 mental region
 coronoid process
 condylar process; at 5th week of IUL
mesanchymal condensation seen above
ventral part of man. By 10th week it
develops into cone shaped cartilage. by
14th week it starts ossifying. it then
migrates inferiorly and fuse with man.
Ramus by4th months . by 6-7 th month
of IUL much of cartilage ossifies except
upper end which ossifies at adult hood
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

mental region

 on

either of symphysis 2 small cartilage
appears in 7th month of IUL .it then
incorporates into body . symphysis
ossifies after 1yr after birth

coronoid


process

it is formed by secondary cartilage.
appears at 10-14th week of IUL. it grows
as response to temporalis muscle. it then
join with ramus

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TMJ


In IUL it develops in three phases

Blastamic stage (7—8th week) corresponds with
organization of condyle ,articular disc and
capsule
 Cavitations stage (9—11th week) initial
formation of inferior joint cavity
 Maturation stage (from 12thweek)
 At birth articular disc is flat but it then
transforms into S shape
 Articular disc at birth is 1.5mm thick. it then
thins down and replaced by endochondral
ossification
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 It grows in post . sup. Lat. Direction

POST

NATAL DEVELOPMENT
AND GROWTH



Maxilla and mandible are attached to
cranial base by means of sutures and TMJ
respectively. so any growth change in CB
affect growth of jaw

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

cranial base

 CB

grows post natally by complex interaction between
 1)
cortical drift and remodeling
 2)
elongation at synchondrosis
 3)
sutural growth

cortical drift and remodeling ; remodeling is
apposition or resorption of bone which bring about
change in size shape and relationship of bone

cranial base is divided into many components by
bony elevations called ridges .These ridges show bony
deposition and other part show resorption by this
process CB develops
 in the area where blood vessels and nerves pass CB
,show cortical drift ie by bone deposiotion and
resorption and maintain constant position
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

elongation of synchondrosis



cartilage at various junction of bone
called SY

they act as important growth sites as
they are primary cartilages

main synchondrosis are

sphenooccipital

sphenoethmoid

intra sphenoid

intra occipital


www.indiandentalacademy.com
 spheno

occipital SY ; it is active up to age
12—15years .these segments fuse in
midline by 20yrs . it shows pressure
adapted bone growth. direction of bone
growth at SY is upwards so it carries ant.
Part of cranium bodily forwards closure
of this SY occurs at 13-15yrs
 spheno ethmoid : it ossifies at 5-25yrs
 intra sphenoid : it ossifies at birth
 intra occipital:ossifies at 3–5yrs


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sutural


growth : --

growth seen sutures are

spheno frontal
 fronto temporal
 sphenoethmoid
 frontoethmoid
 frntozygomatic
 main timing of CB growth
 by birth 55%-60%
 4—7yrs 94%
 8—1yrs 98%
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
• post natal growth of
maxilla
– nasomaxillary complex grows by

displacement
 growth at suture
 surface remodeling
 displacement: as before discussed maxilla
attached attached CB by sutures so as CB
grows secondary displacement is seen in NMC
in downwards and forwards direction . it
mainly seen at 6—12yrs age. growth at
tuberosity seen in postrior direction to shift
maxilla in forwards direction


www.indiandentalacademy.com
growth

at suture

 main

sutures at which growth seen are
 frontonasal
 frontomaxillary
 zygomaticotemporal
 zygomaticomaxillary
 pterygopalatine
 these sutures are obliquely placed and by
this maxilla grows in forwards and
downwards direction . soft tissues carry
maxilla also in same direction
www.indiandentalacademy.com
 surface

remodeling ;

the remodeling changes seen in NMC.
 resorption occurs on lat. Surface of orbital region so
that eye moves laterally .on medial rim deposition seen
 floor of orbit due to remodeling grows in sup .lat. and
ant. Direction
 bone deposition occurs on posterior margin of maxillary
tuberosity which causes lengthening of dental arch and
enlargement of antero posterior dimension of entire
maxilla
 bone resorption seen on lateral wall of nose to increase
size of nasal cavity
 bone resorption seen in floor of nasal cavity and
deposition in palatal side so net downward shift occurs
leading to increase in maxillary height


www.indiandentalacademy.com
 zygomatic

bone moves in posterior
direction by resorption on anterior
surface and deposition on posterior
surface
 face enlarges in width by formation of
lateral surface of zygomatic arch and
resorption on medial surface
 anterior nasal spine increase in
prominence by deposition
 tooth eruption ,increase maxillary
height by alveolar bone deposition
 entire wall of sinus except mesial wall
undergoes resorption by which maxillary
sinus increase in size
www.indiandentalacademy.com
post.

Natal growth of man.

 Of

facial bone man. Has largest amount
of growth post natally
 Ramus : it moves posteriorly by bone
remodeling
 Resorption occurs in anterior part and
deposition occurs in posterior region so it
results in post . drift
 Body of man.: its growth depends on
remodeling growth of ramus so former
ramus converts into posterior body
www.indiandentalacademy.com
 Angle
 On

of mandible

lingual side of angle resorption takes place on
posteroinferior aspect and deposition occurs in
anterosuperior aspect on buccal side exactly opposite
process occurs this results in flaring of angle of
mandible as age advances
 Lingual tuberosity : it is vary similar to maxillary
tuberosity grows posteriorly and lingually
 Alveolar bone grows as tooth erupts in oral cavity
 Chin in infancy is under developed due to position of
head and precordial bulge its growth mainly influenced
by sexual and specific genetic factor
 Males have prominent chin
 In childhood mental protuberance forms and ossifies its
prominence is accelerated by bone resorption that
www.indiandentalacademy.com
occurs in alveolar region which creates concavity
 Condyle : it is main growth site its growth has 2 schools

of thought
 Earlier it was believed that growth occurs at surface of
condyle by bone deposition so condyle grows towards
CB condyle pushes against CB .so entire man. Is
displaced forwards and downwards
 Now it is believed that growth of soft tissue that is
muscle and CT carry man. forwards away from CB
( carry away phenomenon) and bone grows secondarily
to maintain contact with CB . condylar growth which
peak at 12—14yrs and stops at 20yrs
 Coronoid process : it follows enlows V principle ,
deposition occurs on lingual surface and with it vertical
dimension also increase so it gets a characteristic twist
that is sup. Post. Med.
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
THANK YOU

www.indiandentalacademy.com

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Growth and development /certified fixed orthodontic courses by Indian dental academy

  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 4. Every pedodontist should keep in mind that the patient on whom he works are in the state of growth and development , which is a dynamic and continuously changing process. He almost never find a static picture in pediatric patient. So a thorough understanding of complex craniofacial growth is of great importance for pedodontist Understanding of developing craniofacial skeleton represents, sum of growth of its separate parts in which growth is highly differentiated and occurs in different rates ,dimension and time.So keeping all these in mind we start with seminar topic  www.indiandentalacademy.com
  • 5.  Growth and development can be seen in three aspects a) b) c) change in dimension change in proportion maturation www.indiandentalacademy.com
  • 6. DEFINATION OF GROWTH  STEWERT(1982) : growth is increase in mass physical size of cell ,tissues , organ ,or organisms as a whole PROFIT (1986): growth refers to increase in size or number MOYERS (1988) : growth is normal change in the amount of living substance PINKHAM(1994) :growth is increase expansion or extension of any given tissue www.indiandentalacademy.com
  • 7. DEFINATION OF DEVELOPMENT  TODD(1931) :development is increase in complexity  LOWREY(1951) :development indicates increase in skill and complexity of function  MOYER(1988) :development is the unidirectional change in the life of an individual from its existence as a single cell to terminating in depth .  PINKHAM(1994) :development addreses www.indiandentalacademy.com the progressive evolution of a tissue
  • 8.  DIFFERENTIATION :The change from a generalized cell to one that is more specialized .it is change in quality and kind .  As we see that many of times growth and development are used synonymously, but they are not. In simple words,  * Growth is increase in size or number of things .It is numerical .can be easily measured with a specified scale. Ex. Height , weight of persons.  *development is increase in skill and complexity of fuction.  But, practically growth and development are inseparable entities and are simultaneous on www.indiandentalacademy.com
  • 10. GENETIC GROWTH (Brodie) It says, growth is cantrolled by genetic influence in all aspect. But it cannot be accepted in all cases. As it has been shown that the external factor have significant modifying effect on growth  www.indiandentalacademy.com
  • 11. SUTURAL THEORY (sicher)  It says that the proliferation of sutural mesanchyme causes apposition of bone . It is seen in membranous bone.  Limitation :- lack of growth of suture if it is transplanted .  gowth occurs in cleft lip and cleft palate pts.even if suture not present  Suture also respond to external influence  www.indiandentalacademy.com
  • 12. CARTILAGENOUS THEORY (James Scott) :  It says that cartilage acts as primary growth center and has a innate growth potential  Ex ; condylar cartilage for mandible  Nasal cartilage for maxilla (nasomaxillary complex)  If it is transplanted it grows independently www.indiandentalacademy.com
  • 13. FUNCTIONAL MATRIX THEORY (Melvin Moss –1968) It says that body has two element  a) skeletal element b) functional matrix  functional matrix comprised of  1)periosteal camponent  2)capsural camponent  (neuro cranial),(orofacial)  functional matrix has primary control on growth of skeletal unit and bone respond in passive manner  but it can not explain all aspects of www.indiandentalacademy.com growth 
  • 14. MULTY FACTORIAL THEORY (Van Limborgh) It says bone growth is controlled by  a) intrinsic genetic factor  b) local epigenetic factor (nerves, brain ) – C)general epigenetic factor (harmones, secondary messengers ) – d) local environmental factor (habit, muscular force ) – e) general environmental factor ( oxygen, nitrogen)  It is most satisfactory theory that explains all aspect  It says growth is polygenic and www.indiandentalacademy.com multifactoral 
  • 15. NEUROTROPISM (recent theory )  It includes epithelial , visceral , muscular component for these component nerve impulses which are transmitted has growth potential for bone .It also has indirect effect by influencing soft tissue growth  but by experiments it has proved that neurotropism has negligible effec www.indiandentalacademy.com
  • 16. PETROVICS HYPOTHESIS It says that the interaction of serves of casual changes and feedback mechanism which determines craniofacial growth  ie brain---- cranium.  www.indiandentalacademy.com
  • 18. ENLOWS EXPANDING “V” PRINCPLE  It says that most of craniofacial bones especially intramembranous have v shape eg:maxilla , mandible , palate ,nasal etc. And growth movement occurs towards wide end of V deposition of bone is seen in inner side and resorption is seen in outer surface. www.indiandentalacademy.com
  • 19. ENLOWS COUNTERPART PRINCIPLE  It explains that, growth of one bone has influence on its adjuvant bone which is called counter part, and this controls the growth and proportional relationship with its counterpart.  E.g.:   nasomaxillary complex—cranialfossa Maxilla ----------mandible Tuberosity areas of upper/lower jaw Pharyngeal space -------- middle cranial fossa www.indiandentalacademy.com
  • 20. FACTORS AFFECTING PHYSICAL GROWTH Heredity  Nutrition  Illness  Race  Socioeconomic states  Family size  Psychogenic disturbance  Exercise www.indiandentalacademy.com  Pharmacological 
  • 21. characteristic properties of growth  concept of normality growth states are always accessed in normality value ie. in range but can not be explained as ideal with a definite value  Normality differs from age to age  www.indiandentalacademy.com
  • 22.  Different growth : Different organs grow at different rate , different amount, and different time .  It can be best explained by SCAMMONS GROWTH CURVE  www.indiandentalacademy.com
  • 23.  CEPHALOCUADAL GRADIENT OF GROWTH Axis of growth increases extending from head to feet  ie. 3 months intra uterine life head size--50%, birth head size---30%, adult head size---12% of whole body    Cranial growth 70% completed at birth to 1st year  limbs 3month IUL-1% by birth-50% of body www.indiandentalacademy.com
  • 24. GROWTH SPURTS In spite growth is continuous process there occurs a period when a sudden acceleration of growth occurs called growth spurts .  It is due to physiological alteration in hormonal secretion  They differ in boys and girls This period is good for functional and orthodont appliance use Surgical correction involving jaws should www.indiandentalacademy.com carried out after cessation of growth spurts . 
  • 25.  Timings of growth spurts  A)just before birth  B)one year after birth  C) mixed dentition  growth spurts ….girl—7-9yrs  boys- 8-11yrs  c) pre pubertal – growth spurt ……girls ----11-13 yrs  boys -----14-16yrs www.indiandentalacademy.com
  • 26. METHODS OF STUDING GROWTH  a)measurement approach  bimanual test height and weight  b) experiment al approach : vital staining- alzirine blue  alzirine red  lead acetate  Rdioisotopes-------- te 33 ,ca*45 , k*32 injected in bone  c)Implants  d)radiographs www.indiandentalacademy.com
  • 27. Mechanism of bone development   1)endochondral bone 2)intramemebranes  endochondral bone this type of bone is proceded by formation of cartilaginous model  intramembranes bone – bone is directly laiddown in fibrous membrane www.indiandentalacademy.com
  • 28. prenatal growth {day1 to 266 day} It is divided into 3 periods 1) period of ovum (ferti. to 14th day) 2)period of embryo (14th day to 56th day) 3)period of fetous(56th day to birth) www.indiandentalacademy.com
  • 29.  period of ovum(fertilization to 14th day)  In this period oocyte get fertilized with spermatozoa to form zygote which is a diploid cell. After this process cell division starts within 24 to36 hours. Cleavage continues to form , 2,4,8,cells. In 8th cell stage process of compaction occurs to get 1st embryo shape. 16th cell stage called morual . Next stage called blastula which is 150 cells stage. It is of 1.5mm in length and 3 to 5 days old it has inner cell mass which forms fetus & outer cell mass which forms yolk sack. On 5th day blastocyte starts penetrating endometrium & at 14th day it get implanted it self into uterine wall. www.indiandentalacademy.com
  • 32. or embryoblast utenne epithelium Uterine stroma ~,~~",". Trophoblast cells www.indiandentalacademy.com
  • 34. Period of embryo th (14 day to 56th day)  It is the period where major development of organ specifically craniofacial structure occur. on 17th day process of gastrulation occurs to form different germ layers. Ectoderm above notochord thickens to form neural plate which forms nervous system . On 21st day embryo is of 3mm now primordial of brain eye are seen in prosenceophalon. On 3rd day otic &optic plocodes are seen. In the same period most inferior part of prosencephalon starts growing to from front nasal process which overhangs www.indiandentalacademy.com future oral cavity which is wide & shallow.
  • 35. P rimitive pit and neurenteric canal Amnion Wallo! yolk sac Cloacal plate (membrane) A Not ochordal plat e c E ndoderm Int raembry onic mes oderm Ex t raembry onic mes oderm E Notochord - ,u :1 I "e+r ~ t;n a for , www.indiandentalacademy.com
  • 37. on 3-4week oral groove starts deepening. Same time bud for max and man process show their presence lat to oral groove. Deepened oral cavity is now called stomodium and is separated by hind gut with a membranes formed by endoderm and ectoderm called buccopharyngeal membranes . on 4th week the embryo is 5mm . Now frontal elevation shows some ectodermal proliferation which form future nasal placode and olfactory epithelium optic placodes which are formed are www.indiandentalacademy.com placed very widely apart
  • 40.  Front nasal process show more growth mesially than laterally which forms medial nasal process. As medial nasal process grows faster, in future it unites with maxillary process to form part of upper lip specifically along line of philtrum . lateral nasal process mainly contribute formation of columella .on 5th week caudal to frontonasal and maxillary process brachial arches show their development they are totally six with 5th one turning to be rudimentary. 2nd brachial arch develop faster than other and covers other brachial arches www.indiandentalacademy.com
  • 42. ; Pharyngeal pouch Endoderma! epithelium Nerve 1 st pharyngeal arch Cartilage cleft Ectodermal epithelium. 2nd arch with ner ve, artery, and c<1rtllage Mesenchymal tissue in 4th arch A www.indiandentalacademy.com
  • 43. Auditory tube Primitive tympanic cavity Ventral side of phary nx External auditory meatus - Foramen cecum f , f I f ! I f Palatine tonsil , I , '¥ Superior parathy roid gland (f rom 4th pouch) Thy roid gland Inf erior parathy roid gland (f rom 3rd pouch) Ultimobranchial body Foregut www.indiandentalacademy.com
  • 46.  same time between and around primordial of brian and eye Mesenchymal condensation appears which gives a shape of skull. Mesenchyma of brachial arch also appears by 5th week. 1st brachial grows faster to become distant .In 6th week mandibular arch show accentuated growth to divide in maxillary and mandibular process both process grows medially . medial nasal process from above also grows downwards and towards midline as a result by the 7th week fusion between maxillary and frontonasal process occurs and this time embryo is 14.5mm in length www.indiandentalacademy.com
  • 50.  Now eye starts migrating towards midline Mesenchymal of cranial and brachial arch differentiates into cartilage (CHONDRIFICATION)  cartilage in the base of skull thins to join with nasal and optic capsules. same time centers for endochondral ossification appears in the cartilage of base of skull, also Mesenchymal condensation in intramembranous bone is seen. At 8th week nasal septum further narrows to become a prominent structure ,also external ear starts its development. nasal pit breaks down to form nostrils. Demarcation seen between lateral nasal and maxillary to form nasolacrimal groove www.indiandentalacademy.com
  • 53.  primary palat starts its development at 8 th week .so till this time their occurs a direct communication between oral and nasal cavity . lidless eyes increase their movement towards midline .both lateral halves of mandibular process fuse by 8 th week. at this time embryo is 18mm in length .  Rough head and face shape is almost completed by 8th week . By end of 8th week embryo increases in length almost by 4 times to that of 7th week www.indiandentalacademy.com
  • 55.               main structures formed in the embryonic period are neural plate -2 buccopharyngeal membrane -2 mandibular arch –3 hypoglossal muscle—5 median and lateral nasal process-5 lens of eye-5, retina—5 external carotid artery-6 middle ear-6 larynx -6 maxillary process -6 external ear -7 nasal septum-8 palatal shelves-8 www.indiandentalacademy.com *IN WEEKS OF IUL
  • 56. FETAL PERIOD (56days--9 months ) Eye lid formation occurs .eyes get close . nostrils are formed. This period shows accelerated rate of craniofacial growth resulting in an increase size and proportion In 8th to 12 weeks fetus increases in length by 22—60mm . mandible increases in size and anteroposterior relationship of both jaws develop as it is seen at birth www.indiandentalacademy.com
  • 57.  Development of tongue  Appears in embryo at 4th week of IUL . in the form of two lateral swellings and one median swelling that is tubercular impar .all are from 1 st pharyngeal arch  Another median swelling copula (hypobranchial eminance) from 2,3 and 4th arch .posterior part of 4th arch gives rise to epiglottis  Two lateral swellings grows medially and anteriorly and overgrows on TI . both half meet each other to form anterior two third of tongue  Muscles of tongue develop from occipital www.indiandentalacademy.com myotomes
  • 60.  Thyroid gland :   Thyroid appears as epithelial proliferation of in the floor of tongue between TI and HE  Then it descends in front of pharyngeal gut and forms bilobed diverticulum's which forms two lobes   www.indiandentalacademy.com
  • 61. GROWTH OF CRANIAL BASE  As we have seen that by 4th to 8th week of IUL evidence of cranial base formation is seen .the Mesenchymal form is derived from primitive streak of neural crest and occipital schlerotomes.  condensed mesanchyma forms capsule around brain called ectomenix basal portion of this capsule gives rise future cranial base. The process by which ectomeningeal capsule get convert into cartilage is called chondrification .  it mainly occurs in 4 regions www.indiandentalacademy.com
  • 62. Para chordal—around cranial end of notochord  Hypophyseal—it occurs in 4 centers  post sphenoid—body of sphenoid  pre sphenoid –body of sphenoid  mesethmoid---plate of ethmoid  cristagalli    Nasal-nostril  Otic-mastoid orbito sphenoid---lesser wing ali sphenoid – greater wing www.indiandentalacademy.com
  • 63. OCCIPITAL BONE It ossifies both endochondrally and intramembranously. It has 2 intra membranous centers and 5 endochondral centers • supra nuchal sq. part – one pair ---8th week • infra nuchal sq.part --1 pair -------10th week • basilar part –single median center -11thweek • foramen magnum occipital condyle ---1 pair –12th week  www.indiandentalacademy.com
  • 64.       TEMPORAL BONE It has 11 centers of ossification Sq, part –1 center (IM)—8TH week Tympanic ring 4 centers (IM)------12th week Petrous temporal bone ---4 centers (EC)-----5th month Styloid 2 centers (EC) 5th month   ETHMOID    BONE Its an endochondral bone with 3 centers Median floor of anterior cranial fossa –1 centers www.indiandentalacademy.com Nasal capsule 2 lateral centers
  • 65.  SPHENOID BONE It has 15 centers of ossification  Lesser wing –2 orbito sphenoidal cartilage  Greater wing ,lateral pterygoid plate2(IM)1alisphenoid  Median pterygoid plate -2 secondary cartilage of hamular process  Anterior part of body of sphenoid- 5 (EC)  Posterior part body of sphenoid - 4 (EC)  Cranial base chndrocraniam is relatively stable during growth compared to cranial vault and face so cranial base is taken as bases against which cranial vault and facial skeleton can be compared in cephalometric studies  www.indiandentalacademy.com
  • 66.  FLEXURE OF CRANIAL BASE  In early fetal period cranial base becomes flexed in the region between pituitary fossa and sphenooccipital junction this is accompanied by developing brain stem so that spinal chord and foramen magnum directed downwards from their initial position of backwards this adaptation only seen in human beings  It increases neurocranial capacity  It facilitates predominant downward growth of face  At 10th week of intrauterine life flexure angle is 65 degrees with then flattens. anterior and posterior part of cranial base grows at different rates that is between 10th to 40th week anterior cranial base increase in width bywww.indiandentalacademy.com 7 times but posterior increase by 5 times
  • 67.  Development of palate  Main part of palate arise from maxillary process & small premaxilla is formed by deeper part of medial nasal process. initially medial nasal process gives rise to small triangular projection which forms futer premaxilla .then from maxillary process lateral segments arise which are placed vertically. In this period mandible is small & already formed tongue is pushed upwards in nasal cavity so lateral segments of maxillary process grow vertically . www.indiandentalacademy.com
  • 68.  Nasal septum from above starts growing downwards & backwards by 7th week of IUL . Mandible shows accelerated growth so tongue falls back & transformation of position of palatal selves occurs from vertical to horizontal this transformation takes place within hrs .  Both palatal selves properly approximate by 8 ½ to form hard palate & posterior part use to form sot palate entire palate does not close at once . initial contact occurs in central region of secondary palate posteriorly to pre maxilla from this point closure occurs both anteriorly &posteriorly also from above end of nasal septum fuses with palate .  Palatal ossification (IM) 1 center 8th week www.indiandentalacademy.com  mid palatal suter ossifies at 12 to 14 years
  • 73. development o maxillary sinus  It is formed around at 3rd month of IUL It develops by expansion of nasal mucous membrane into maxillary bone  It enlarges later by internal resorption of wall of maxilla www.indiandentalacademy.com
  • 74. meckels cartilage it derived from first brachial arch on 41st to 45th day of IUL .extends from cartilaginous otic capsule to sysmphysis .it acts as template and guide for growth of mandible . a major portion of this disappears and remaining part develops in to  mental ossicle  incus, malleus  spine of sphenoid  ant. Ligament of malleus  sphenomandibular ligament  1st structure that develops in promordia of man. Is mandibular www.indiandentalacademy.com division of 5th nerve this is followed by osteogenesis (neurotropic theory ) 
  • 77.  on 6th week of IUL single ossification center for each man. Arise in the region of bifurcation of inferior alveolar nerve in to mental and incisive. ossifying membrane is located lateral to meckels cartilage .IM ossification spreads dorsally and ventrally to form body and ramus of man. Ossification continues till region of future linguala. meckels cartilage continues into middle ear and develops in to auditory ossicle that is malleus and incus and SML www.indiandentalacademy.com
  • 78.  Endochondral bone formation in man. Seen in3 areas  condylar process  mental region  coronoid process  condylar process; at 5th week of IUL mesanchymal condensation seen above ventral part of man. By 10th week it develops into cone shaped cartilage. by 14th week it starts ossifying. it then migrates inferiorly and fuse with man. Ramus by4th months . by 6-7 th month of IUL much of cartilage ossifies except upper end which ossifies at adult hood www.indiandentalacademy.com
  • 79.  mental region  on either of symphysis 2 small cartilage appears in 7th month of IUL .it then incorporates into body . symphysis ossifies after 1yr after birth coronoid  process it is formed by secondary cartilage. appears at 10-14th week of IUL. it grows as response to temporalis muscle. it then join with ramus www.indiandentalacademy.com
  • 80. TMJ  In IUL it develops in three phases Blastamic stage (7—8th week) corresponds with organization of condyle ,articular disc and capsule  Cavitations stage (9—11th week) initial formation of inferior joint cavity  Maturation stage (from 12thweek)  At birth articular disc is flat but it then transforms into S shape  Articular disc at birth is 1.5mm thick. it then thins down and replaced by endochondral ossification www.indiandentalacademy.com  It grows in post . sup. Lat. Direction 
  • 81. POST NATAL DEVELOPMENT AND GROWTH  Maxilla and mandible are attached to cranial base by means of sutures and TMJ respectively. so any growth change in CB affect growth of jaw www.indiandentalacademy.com
  • 82.  cranial base  CB grows post natally by complex interaction between  1) cortical drift and remodeling  2) elongation at synchondrosis  3) sutural growth  cortical drift and remodeling ; remodeling is apposition or resorption of bone which bring about change in size shape and relationship of bone  cranial base is divided into many components by bony elevations called ridges .These ridges show bony deposition and other part show resorption by this process CB develops  in the area where blood vessels and nerves pass CB ,show cortical drift ie by bone deposiotion and resorption and maintain constant position www.indiandentalacademy.com
  • 83.  elongation of synchondrosis  cartilage at various junction of bone called SY  they act as important growth sites as they are primary cartilages  main synchondrosis are  sphenooccipital  sphenoethmoid  intra sphenoid  intra occipital  www.indiandentalacademy.com
  • 84.  spheno occipital SY ; it is active up to age 12—15years .these segments fuse in midline by 20yrs . it shows pressure adapted bone growth. direction of bone growth at SY is upwards so it carries ant. Part of cranium bodily forwards closure of this SY occurs at 13-15yrs  spheno ethmoid : it ossifies at 5-25yrs  intra sphenoid : it ossifies at birth  intra occipital:ossifies at 3–5yrs  www.indiandentalacademy.com
  • 85. sutural  growth : -- growth seen sutures are spheno frontal  fronto temporal  sphenoethmoid  frontoethmoid  frntozygomatic  main timing of CB growth  by birth 55%-60%  4—7yrs 94%  8—1yrs 98% www.indiandentalacademy.com 
  • 86. • post natal growth of maxilla – nasomaxillary complex grows by displacement  growth at suture  surface remodeling  displacement: as before discussed maxilla attached attached CB by sutures so as CB grows secondary displacement is seen in NMC in downwards and forwards direction . it mainly seen at 6—12yrs age. growth at tuberosity seen in postrior direction to shift maxilla in forwards direction  www.indiandentalacademy.com
  • 87. growth at suture  main sutures at which growth seen are  frontonasal  frontomaxillary  zygomaticotemporal  zygomaticomaxillary  pterygopalatine  these sutures are obliquely placed and by this maxilla grows in forwards and downwards direction . soft tissues carry maxilla also in same direction www.indiandentalacademy.com
  • 88.  surface remodeling ; the remodeling changes seen in NMC.  resorption occurs on lat. Surface of orbital region so that eye moves laterally .on medial rim deposition seen  floor of orbit due to remodeling grows in sup .lat. and ant. Direction  bone deposition occurs on posterior margin of maxillary tuberosity which causes lengthening of dental arch and enlargement of antero posterior dimension of entire maxilla  bone resorption seen on lateral wall of nose to increase size of nasal cavity  bone resorption seen in floor of nasal cavity and deposition in palatal side so net downward shift occurs leading to increase in maxillary height  www.indiandentalacademy.com
  • 89.  zygomatic bone moves in posterior direction by resorption on anterior surface and deposition on posterior surface  face enlarges in width by formation of lateral surface of zygomatic arch and resorption on medial surface  anterior nasal spine increase in prominence by deposition  tooth eruption ,increase maxillary height by alveolar bone deposition  entire wall of sinus except mesial wall undergoes resorption by which maxillary sinus increase in size www.indiandentalacademy.com
  • 90. post. Natal growth of man.  Of facial bone man. Has largest amount of growth post natally  Ramus : it moves posteriorly by bone remodeling  Resorption occurs in anterior part and deposition occurs in posterior region so it results in post . drift  Body of man.: its growth depends on remodeling growth of ramus so former ramus converts into posterior body www.indiandentalacademy.com
  • 91.  Angle  On of mandible lingual side of angle resorption takes place on posteroinferior aspect and deposition occurs in anterosuperior aspect on buccal side exactly opposite process occurs this results in flaring of angle of mandible as age advances  Lingual tuberosity : it is vary similar to maxillary tuberosity grows posteriorly and lingually  Alveolar bone grows as tooth erupts in oral cavity  Chin in infancy is under developed due to position of head and precordial bulge its growth mainly influenced by sexual and specific genetic factor  Males have prominent chin  In childhood mental protuberance forms and ossifies its prominence is accelerated by bone resorption that www.indiandentalacademy.com occurs in alveolar region which creates concavity
  • 92.  Condyle : it is main growth site its growth has 2 schools of thought  Earlier it was believed that growth occurs at surface of condyle by bone deposition so condyle grows towards CB condyle pushes against CB .so entire man. Is displaced forwards and downwards  Now it is believed that growth of soft tissue that is muscle and CT carry man. forwards away from CB ( carry away phenomenon) and bone grows secondarily to maintain contact with CB . condylar growth which peak at 12—14yrs and stops at 20yrs  Coronoid process : it follows enlows V principle , deposition occurs on lingual surface and with it vertical dimension also increase so it gets a characteristic twist that is sup. Post. Med. www.indiandentalacademy.com