PREPARED BY: ANJUCHANDRAN FINAL YEAR PART1

INTRODUCTION

Mandible is the largest of the facial bones and is the only movable bone in the craniofacial region

It undergoes the largest amount of growth postnatally and also exhibits the largest variability in morphology

Mandible consists of the following microskeletal units

Body Ramus Condyle

Coronoid

process Angular process Lingual tuberosity Alveolar process Chin

GROWTH OF MANDIBLE
PRENATAL GOWTH

POSTNATAL GROWTH

PRENATAL GROWTH
1st structure to develop in the primordium of lower jaw :Mandibular division of trigeminal nerve.

Prior presence of nerve induce osteogenesis by production of neurotrophic factors

 The

ossification of an osteogenic membrane formed at around 36-38 days of IU life. single ossification centre for each half of mandible arises in the 6th week of IU life. acceleration of growth b/w 8th &12th week of foetal life. resulting intramembraneous bone lies lateral to Meckels Cartilage of 1st arch.

Marked

The

 Growth

continues around the meckels cartilage until its posterior aspect is covered by bone.

Ossification

stops at this point which later becomes mandibular lingula.

Mandible at week of IU life

th 36

POSTNATAL GROWTH

Completes by 20 yrs of age.

3 PERIODS OF GROWTH;
Infancy[1st year of life] Childhood[1-13 yrs] Adolescence[13-20yrs]

#Postnatal growth results in the metamorphosis of the rudimentary structure seen at birth to the full-fledged and multifunctional adult form #At birth, mandible is composed of two small U shaped bars, separated by a thin line of fibrocartilage and connective tissue at the midline of symphysis,rami are quite short,condylar development is minimal and there is practically no articular eminence

Pattern of growth
SCAMMONS
200%

GROWTH CURVE
Lymphoid

Neural

100%
Maxillary Mandibular General Genital

Birth

10 Years

20 Years

Cephalo caudal gradient of growth

Axis

of increased growth from head towards mandible.

Explains

maxilla.

why mandible grows more than

Concept of mandibular growth

1st

concept- cranium reference point & chin moves downwards & forwards. staining experiments-posterior ramus ,cornoid & condyle as growth sites. concept- mandible is translated downward n forward&in response to this it grows upward & backward to maintain contact with skull

Vital

Correct

How postnatal growth occurs?

1.
2.

Explained by; Theories of growth Growth rotations

Genetic theory
Intrinsic

genetic stimulus in bone cause mandibular growth. of jaw shape from parents. JAW the prognathic mandible of german royal family

Inheritance

HAPSBURG

Cartilagenous theory
By

SICHER & WIENMANN mandible as diaphysis of long

Visualize

bone bent into horse shoe shape with epiphysis removed with condyles representing epiphseal plates.

Condylar cartilage as Growth Centre.

 Transplantation

condyles dosent have innate growth potential.

Thus

experiments proved

condylar growth is regional adaptive growth.

Hence

centre.

CONDYLE as growth site not

FUNCTIONAL MATRIX THEORY

Niether

bone nor cartilage as growth determinents. grows in response to functional needs & is mediated by soft tissue surrounding. growth at condyles and appositional at other surfaces is in response to growth of adjacent muscles & expansion of orofacial capsule causing mandible to translate in space.

Mandible

Endochondral

E XPANDINGV PRINCIPLE

RAMUS
It

moves more posteriorly by combination of deposition and resorption: resorption at anterior border deposition at posterior border

On growing the two rami also diverges outward from below to above thus increasing the superior inter-ramus distance;creating a V SHAPE. Hence mandibular growth can also be explained with ENLOWS EXPANDING V PRINCIPLE.

EXPANDING V

CORPUS / BODY OF THE MANDIBLE

Body

lengthens by conversion of the former ramal bone into its posterior part
at the posterior surface of lingual tuberosity and contiguous lingual side of the ramus also account for a small increase in the length of the body

Deposition

 Deposition

occurs also at the outer surface of the body and also around the mandibular canal

THE CORONOID PROCESS

Growth

at coronoid is best explained using the expanding V principle Condyle has a propeller - like twist ,o its lingual side faces 3 general directions all at once : posteriorly , superiorly and medially at lingual surface results in a superior growth movement because the surface faces superiorly. Deposition also carries the base of coronoid and anterior part

Deposition

 Since

the lingual surface also faces posteriorly, deposition t this surface brings about a posteriorly directed growth movement
side has a resorptive surface an faces away from the medial , superior and posterior directions of growth notch grows superiorly by deposition on the lingual side and resorption from the buccal side

Buccal

Sigmoid

ANGLE OF THE MANDIBLE

Lingual

side : deposition - anterosuperior resorption - posteroinferior

Buccal

side : deposition - posteroinferior resorption - anterosuperior

As

a result , angle flares out as age advances

LINGUAL TUBEROSITY

A major growth site of mandible

Deposition at the posterior facing surface with a resultant posterior growth movement .This also helps in lengthening of the body

 It

grows more prominent by deposition at the medial surface prominence is accentuated by a large resorptive field just below it resorptive field produces a depression called lingual fossa

The

The

THE ALVEOLAR PROCESS

Alveolar

process develops in response to the presence of tooth buds As teeth erupt , the process grows in height by deposition at the margins

It

grows in an upward and outward direction to accommodate the larger permanent teeth

THE CHIN
Chin

is a specific human characteristic and is the most recent phylogenic acquisition by sexual and specific genetic

Influenced

factors

Is

more prominent in males

Mental

protuberance forms by bony deposition during childhood The prominence

GROWTH ROTATIONS
Two types of growth rotations: Internal rotation External rotation Internal rotation: rotation taking place at the core of It is of two types:

Matrix rotation : rotation of the core around the condyle. It accounts for 25% of total internal rotation

 External

rotation : It is the rotation brought about by surface changes and alterations in the rate of tooth eruption External rotation is opposite to internal rotation and tends to mask it.

 Internal

rotation tends to decrease the mandibular plane angle i.e. , up anteriorly and down posteriorly and is given a negative sign Total intern0al rotation will be between 0 -10 to -15 External rotation is designated by a positive sign Total external rotation will be between +10 to + 12 Net rotation : -2 to -4
0 0
0

CLINICAL RELEVANCE
ACROMEGALY

CHINCAP

ANCHORAGE

DISTRACTION OSTEOGENESIS

CONCLUSION
A knowledge of the normal growth pattern helps in identifying normal variations in growth , any variation from norm and also in growth prediction .It also helps in the planning and evaluation of orthodontic treatment

REFERENCES
1.

2.
3. 4.

5.

Orthodontics Principles and Practice Graber TM contemporary orthodontics Proffit essentials of facial growth Enlow & Hans Orthodontics The Art and Science Bhalajhi Textbook of orthodontics Gurukeerat Singh