The Growth and Development

of the Mandible



1/23/2013
Dr. Akshi Gvalani
P.G. Dept Of Prosthodontics
Terna Dental College,Nerul,Navi Mumbai

The Growth and Development of the Mandible

2

CONTENTS
Definition of growth and development
Mechanism of formation of bone
Mechanism of growth of bone and factors affecting it
Theories of growth
Prenatal growth
Postnatal growth
Anomalies of growth
Age changes
Applied aspect
References

Growth
1. Growth refers to increase in size - Todd
2. Growth usually refers to an increase in size and number Proffit
3. Self multiplication of living substance - J.S.Huxley.
4. Change in any morphological parameter which is measurable Moyers

Development
1. Development is a progress towards maturity Todd
2. Development connotes a maturational process involving progressive differentiation at the cellular
and tissue levels Enlow
3. Development refers to all naturally occurring progressive, unidirectional, sequential changes in the
life of an individual from its existence as a single cell to its elaboration as a multifunctional unit
terminating in death Moyers

The Growth and Development of the Mandible

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MECHANISM OF GROWTH
MORPHOGENESIS A biologic process having an underlying control at the cellular and tissue levels
DIFFERENTIATION It is a change from generalized cells or tissues to a more specialized kinds during
development
MECHANISM OF BONE FORMATION
ENDOCHONDRAL



INTRAMEMBRANOUS

Matrix calcifies
Cartilage cells hypertrophy
Becomes cartilage
Original mesenchymal tissue
Matrix calcifies
Osteoid matrix formation
Osteoblasts
Original mesenchymal tissue
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The mandible is the second bone in the body to ossify
1. Intramembranous ossification
Whole body of mandible except the anterior part
Ramus of mandible as far as mandibular foramen
2. Endochondral ossification
Anterior portion of the mandible (symphysis)
Part of ramus above the mandibular foramen
Coronoid process
Condylar process
Mechanism of bone growth
Displacement
1. Primary
2. Secondary

Cortical drift

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Theories of growth

The Growth and Development of the Mandible

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Enlows v principle
The growth and enlargement of bones occur towards wide end of v due to differential deposition and
resorption
Enlows counterpart principle
Growth of any facial or cranial part relates specifically to other structural and geometric counterparts
The Growth and Development of the Mandible

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FACTORS AFFECTING GROWTH
1. Genetic
2. Hormonal imbalance
3. Nutrition
4. Systemic illness or chronic illness
5. Systemic illness in mother
6. Drugs
Local factors
1. Vascular abnormality
2. Lymphatic disturbance
3. Neurologic disease
4. Local infection
5. Ear infection or mastoiditis
6. Ankylosis
7. Trauma or fracture
8. Birth injury
9. Habits

The Growth and Development of the Mandible

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PRENATAL GROWTH
The first arch gives rise to Dorsal and Ventral portion.
o Dorsal portion Maxillary process
o Ventral portion Meckels cartilage or Mandibular process

A single ossification centre for each half of the mandible arises in the 6
th
week IU., in the region
of the bifurcation of the Inferior Alveolar Nerve and artery into Mental and Incisive branches











Development of a slender cartilage rod in the second month serves as a precursor for
mandibular mesenchyme .

The Growth and Development of the Mandible

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Secondary accesory cartilages appear in the 10
th
to 14
th
week in the coronoid condylar and
mental protruberance region
Fate of meckels cartilage
Appears 41
st
to 45
th
day of IUL
Disappears 24
th
week of IUL
Malleus
Incus
Sphenomandibular ligament
Anterior malleolar ligament
Spine of sphenoid


POSTNATAL DEVELOPMENT
The shape and size of the diminutive fetal mandible undergo considerable change during growth and
development
1. Ramus low and wide
2. Coronoid process large and protrudes above condyle
3. Body open shell with buds
4. Mandibular canal lies low
The initial separation of left and right halves disappears when the sydesmosis is converted into
synostosis between 4
th
to 12
th
month after birth.

The Growth and Development of the Mandible

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Although the mandible appears in the adult as a single bone, it is developmentally and functionally
divisible into several skeletal subunits.

Each of these skeletal subunits is influenced in its growth pattern by a functional matrix that acts upon
the bone :-
The teeth act as a functional matrix for the ALVEOLAR UNIT.
The action of the temporalis muscle influences the CORONOID PROCESS.
The masseter and medial pterygoid muscle acts upon the ANGLE and RAMUS of the mandible.
The lateral pterygoid has some influence on the CONDYLAR PROCESS.
The main sites of postnatal mandibular growth are:-
The condylar cartilages
The posterior borders of the rami
The alveolar ridges
The condylar cartilage of mandible serves dual roles of :-
An Articular Cartilage in TMJ
A Growth Cartilage
The GROWTH CARTILAGE may act as a Functional Matrix to stretch the periosteum inducing the
lengthened periosteum to form intramembranous bone beneath it.
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The formation of bone within the condylar heads causes the mandibular rami to grow UPWARDS and
BACKWARDS displacing the entire mandible in an opposite DOWNWARD and FORWARD direction.
Bone Resorption subjacent to the condylar head accounts for the narrowed condylar neck.

The attachment of the lateral pterygoid muscle
In infants the condyles of mandible are inclined almost horizontally so that the condylar growth leads to
an increase in the length of the mandible, rather than increase in height.

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The mental neurovascular bundle emanates from the mandible at right angles or even a slightly forward
direction at birth.
In adulthood the mental foramen is directed backwards.
This change may be ascribed to forward growth in the body of the mandible, while the neurovascular
bundle drags along.

It may be contributed by the differential rates of bone and periosteal growth.
The ALVEOLAR PROCESS develops as a protective trough in response to the tooth buds and becomes
super imposed upon the basal bone of the mandibular body

The CHIN is very poorly developed in the infants
The chin becomes significant only at adolescence from development of the mental protuberance and
tubercles.
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The skeletal unit of the chin may be an expression of the functional forces exerted by the lateral
pterygoid muscles that, in pulling the mandible forward, indirectly stress the mental symphyseal region
by their concomitant inward pull.
ANOMALIES OF MANDIBULAR GROWTH
Downs syndrome
Treacher-collins syndrome
Pierre Robin syndrome
1. Congenital
i) Agnathia
ii) Micrognathia
iii) Macrognathia
iv) Facial hemihypertrophy
v) Facial hemiatropy
2. Developmental
I) Infantile cortical hyperostosis
ii) Torus mandibularis
iii) Stafnes cyst
iv) Odontogenic cyst
vi) Odontogenic tumour


The Growth and Development of the Mandible

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Downs syndrome

Midface hypoplasia
Most common
Maternal age >35 carries increased risk
1866, described by John Landon Down
Airway and hearing problems
Treacher-collins syndrome

Bilateral abnormalities of 1
st
and 2
nd
branchial arches
Hypoplasia of maxilla, zygoma, and mandible
Downward slanting eyes with colobomas of lower eyelid and absence of eyelashes
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Pierre Robin syndrome

Triad of palatal cleft, micrognathia, and glossoptosis

AGE CHANGES IN THE MANDIBLE

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RESIDUAL RIDGE RESORPTION

Rrr
A localized pathologic loss of bone that is not built back by simply removing the causative factor
Chronic Progressive Irreversible Cumulative

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Etiology
Anatomic quantity
quality
Metabolic local
systemic
Mechanical frequency
intensity
duration
direction
Consequences of RRR
Decreased sulcus width and depth
Decreased VDO
Exposure Of Mandibular Canal And Mental Foramen
In severe situations, the superior border of the mandibular canal was resorbed under progressive
residual ridge resorption.
A resorbed superior border of the canal was found more often in edentulous women than in men.
Asthma, thyroid disease, and thin cortex at the mandibular angle were significantly related to resorption
of the mandibular canal wall.
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Systemic factors, gender, asthma, and thyroid disease played important roles in resorption of the
mandibular canal wall of the edentulous elderly.

Grade 0: The crest of the residual ridge above both the mental foramen and the mandibular canal
(Fig. 1, a )
Grade I: The crest of the residual ridge above the mandibular canal and the mental foramen at the
top of the residual ridge with or without a partially resorbed border (Fig. 1, b )
Grade II: The superior border of the mandibular canal at the top of the residual ridge and the
mental foramen with or without a partially resorbed border (Fig. 1, c )
Grade III: The superior border of the mandibular canal partially resorbed and the borders of the
mental foramen totally resorbed (Fig. 1, d ).

Management of RRR
Increased denture bearing area
Decreased dental units
Decreased buccolingual width of artificial teeth
Anatomy of teeth
Increased interocclusal space
Increased tongue space


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REFERENCES
Essentials of complete denture prosthodontics Sheldon Winkler
Human embryology SD Gangane
B.D. Chaurasia Human osteology, 1
st
edition, 1984
Shafer W.G. Textbook of oral pathology, 4
th
edition, 1983
Pediatric dentistry Principles and practice Muthu, Muthu and Sivakumar
Contemporary orthodontics Proffit
Resorption of mandibular canal wall in the edentulous aged population The Journal of Prosthetic
dentistry vol 77 no 6;596-600 Qiufei Xie, DDS, MS, a Juhani Wolf, DDS, PhD, b Reijo Tilvis, MD, PhD, and
Anja Ainamo, DDS, PhD d
Craniofacial development Geoffrey Sperber
RRR a review ,Ajay Gupta et al ,Indian journal of dental sciences March 2010 vol 2 issue 2 pg 7
Some clinical factors related to rate of resorption of residual ridges Douglas Allen Atwood ,The jour nal
of prosthetic dentistry,may june 1962 ,vol 12 no 3 441-450.