Dr.

Munizeh Khan
S.R Orthodontics
Cranial vault

Cranial base

Nasomaxillary complex

Mandible

a) Function:
Protection of the brain

b) Growth:
1) Mechanisms & sites:
O Sutures
O Surface remodeling
2) Timing:
O Paced by brain growth
a) Functions:
Protection & support of brain and spinal cord
Articulation of skull with vertebrae, mandible & maxilla

b) Growth:
1) Mechanisms & Sites:
Sutural growth
Elongation at synchondroses
Extensive cortical drift & remodeling (ectocranial)

Combination provides:
Differential growth between calvaria & cranial base
Expansion of endocranial fossae
Maintenance of passages and housing for vessels and
nerves (foramina)

Clinical Significance:
Spheno-occipital complex anterior displacement of
midface
Fwd displacement of mandible ramus growth

O Timing:
Paced with brain growth

Synchondroses:
Intra-sphenoidal = after birth
Intra-occipital = 3-5 yrs
Spheno-ethmoidal = 6-7years
Spheno-occipital = 13 years

a) Functions:
O Mastication, Respiration
O Encloses the eyes

b) Growth:
1) Sites:
O Sutures
O Nasal septum
O Alveolar process
O Periosteal & endosteal surfaces

2) Mechanisms:
O Passive Displacement
Growth of cranial base
Important up to age 7yrs
1/3
rd
of total maxillary forward movement

O Active Growth
Sutural growth
Cortical drift
Surface remodeling
O Anterior surface resorptive
O Posterior surface depository

O Direction: downward and forward


3) Amounts & Directions:
Maxillary Height:
Sutural growth towards frontal & zygomatic bones
Appositional growth in the alveolar process (40%)
Orbits
Hard palate
Maxillary Length:
Apposition on maxillary tuberosity
Anterior region is resorptive
Posterior region is depository

Maxillary Width:
Midpalatal suture
Vertical growth of alveolar process (divergence)

E Timing:
Alveolar process eruption of teeth
Roughly coincident with general body growth
Coincides with CVM 2-3 stages

E Compensatory Mechanisms:
alveolar process
a) Functions:
E Mastication, airway, speech & facial expression

E Type of growth:
E Slender, U-shaped bone
E Bentlong bone:
endochondral = ends

intramembranous = in between



b) Mechanisms & Sites:
1) Condylar cartilage:

CONTROVERSY: Growth site or center??
O Secondary cartilage
O Grows in face of pressure
O Experiments:
No condyle but normal function
Transplanted alone = no growth
Transplanted with functional forces = growth



THUS:
O Condyle is dependant on articular function
O Articular function is dependant on how mandible grows
O Mandibular growth is dependant on factors outside the
mandible, i.e. Maxillary growth, soft tissue matrix
O CONDYLE:
O Important growth SITE
O Aids in translation of mandible (AP growth)
O Highly responsive to functional forces
Reacts faster to lower threshold forces
Displacement
1st!!!!
Adaptive
2nd!!!!
Primary Displacement of
Mandible
2) Ramus:
Undergoes cortical drift posteriorly and laterally
Backward transposition of ramus
Helps in elongation of mandibular body
Vertical lengthening of ramus as mandible is
displaced

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Posterior Relocation of Ramus
As a result of cortical drift
3) Corpus:
Moves in conjunction/in response to maxilla
Displaced downward and forward

Areas of Muscle attachments:
O Encourage cortical drift and local remodeling
O Coronoid process & gonial angle
O Areas with deficient/abnormal muscle function
under-developed
4) Alveolar Process:
O Formation controlled by dental eruption
O Serve as important buffer zones
O Help to maintain occlusal relationships during
differential midface & mandibular growth
c) Amounts & Directions:
O Height:
Ramus growth
Alveolar process
Dental eruption
Anterior mandibular height

O Width:
Symphyseal cartilage plays no major role
V-principle of growth
Length increase + natural divergence of mandible
Length:
Over-all length (Co-Go)
Corpus length (Pog-Go)
Correlated with increase in height
Spurt occurs in conjunction with spurt in stature
O Sequence in which growth is completed in both jaws:

O Width
Mostly over before puberty

Length
Continues through puberty

O Height
Continues post-puberty
Hemifacial Microsomia

Appreciated after implant studies

Rotation types:
O Internal rotation
O External rotation

Overall change:
orientation of jaw
Palatal plane
Mandibular plane
O Confusing!!

O Simplified by Proffit
Proffit : simplified terminology

Internal rotation:
Rotation of mandibular core relative to cranial base

External rotation:
Rotation of mandibular plane relative to core of mandible

Total rotation:
Rotation of mandibular plane relative to cranial base
Equals internal rotation external rotation
O Internal rotation:
Rotation of mandibular core relative to cranial base
Has 2 components:
Matrix rotation= around the condyle
Intra-matrix rotation = centered within mandibular body



Matrix rotation
Intra-matrix rotation
E External rotation:
Rotation of mandibular plane relative to core of mandible
Surface changes:
E Posterior part of lower border of Md: resorption
E Anterior part: unchanged or slight apposition
* Anterior rotation: * Posterior rotation:
Forward, counter-clockwise Backward, clockwise
Negative sign (-) Positive sign (+)

O Internal rotation = -15
o
25% from matrix rotation, 75% from intra-matrix rotation

O External rotation = + 11 to 12
o

O Total rotation= Internal External
= -15 (+ 11/12)
= -3
o
or 4
o

Therefore:

15 degrees : forward rotation
11 to 12 degrees: backward rotation
Net result: 3 to 4 degrees forward rotation
O Maxillary core less defined

O Internal rotation:
No matrix rotation (no condyle)
Intra-matrix rotation present

O External rotation:
Resorption on nasal floor, deposition on palatal side

O Total rotation:
Equal and opposite internal and external rotations
= zero degree change in jaw orientation

O Variation in face types:

Normal angle High angle Low angle
(long face) (short face)
O After summer break = conclude growth
section

O Test on growth (September 2010)
O Moyers
O Proffit
O Any other text you may like to add
Enjoy your summer vacations!


Stay safe and see you soon inshAllah!