Bone Growth

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Armil O. Purificacion

Bone Resorption
Osteoclasts resorb bone How? 1. Anchor themselves to surface of bone 2. Create a sealed zone and within zone create acidic environment which dissolve mineral content from bone 3. Enzymes are released from osteoclasts which remove collagenous bone matrix

Bone Formation
-osteoblasts refill cavities created by osteoclasts osteoblasts move into the resorption space and produce and deposit organic matrix called osteoid -osteoid made mostly of collagen, build a scaffold which minerals (calcium and phosphate) crystalize

Bone Formationn
-Some active osteoblast get trapped in the matrix they secrete and become osteocytes -other osteocytes will undergo apoptosis or revert back to lining cells which cover surface of bone

Bone formation by osteoblast Bone modeling

Bone formation by osteoblast occur without prior bone resorption by osteoclast - Increase in bone mass - Important for maintaining bone strength - Optimizing growing structure - After age 30, most people experience gradual loss of bone mass due to relative decrease of osteoblast compared with osteoclast

Bone formation by osteoblast Bone modeling

- Glucocorticoids (steroid hormone) can promote osteoclast activity and reduce bone formation - When bone experiences reduce load, resorption and remodeling increase to eliminate underloaded bone - important to stay active and be active to reduce risk factors and for healthy bones

Growth Development of the Maxilla

Development of the Maxilla

Forms within maxillary prominences extending ventrally from dorsal aspect Ossification of maxilla begins slightly later than in mandible

Development of the Maxilla

Primary ossification center appears for each maxilla in 7th week Secondary centers are at: Zygomatic Nasopalatine Orbitonasal

Development of the Palate

Palatogenesis begins towards end of 5th week Completed by 12th week Palate develops from 2 primordia* Primary Palate Secondary Palate

Primordia An organ at its earliest stage of development

 Primary Plate Finishes at 5th week Develops from deep part of intermaxillary segment of maxilla Internal merging of medial nasal prominences Represents only small part of adult hard palate Secondary Plate Primordium of hard/solft palate posterior to incisive forament Begins to develop in 6th week, from shelf like structure called Lateral Palatine Process

 The processes fuse in midline w/ Nasal Septum and posterior part of Primary Plate Palate begins anteriorly during 9th week and completed posteriorly by 12th week Posterior part of palatal process remains unossified

Post Natal Growth of Maxilla

Growth movements
1. Drift: movement of bone surface cauesd by deposition and resorption towards depository surface. AKA Transformation 2. Displacement: growth of bone as whole unit, so that bone is taken away from its articulation w/ other bones. AKA Translation 1. Primary/Active Displacement: movementn due to growth of bone itself 2. Secondary Displacement: movement of one bone due to growth of other bones.

 Maxillae articulates w/ surrounding bone with help of sutures: 1. Zygomaticomaxillary 2. Frontomaxillary 3. Pterygopalatine 4. Zygomaticotemporal Growth at these paired parallel sutures will move maxilla Downward and Forward

Translation
Process by which specific local areas come to occupy new positions as entire bone enlarges Active: growth at tuberosity of maxilla pushes maxilla forward

Passive: when maxilla grows downward and forward by spheno-occipital synchondrosis When maxillary bone is translated in space by growth of corresponding capsular matricdes Capsules (3): Orbital, nasal and oral capsule

Remodeling
Simultaneous resorption and deposition moves surfaces of maxilla while maintaining integrity and shape of bone

Maxillary Growth
Matures first in Width Depth Length

Maxillary Width
Nasal Cavity Faces anterior, lateral and superior direction Growth proceeds in same direction Surface removal: periostium lining inner aspect of nasal cavity Deposition: enndosteal surface, allows expansion of cavity Orbital Part of Maxilla Orbital floor faces laterally, anteriorly and superiorly Growth proceeds in same direction by deposition and resorption on lateral surface of orbital rim

Anteroposterior/Depth
Zygomatic Bone Moves: posteriorly and laterally Deposition in posterior and lateral surface Resporption in medial surface In anteroposterior direction: appositional growth I posterior tuberosity area, for space for permanent teeth Zygomatic bone moves in posterior direction to keep its relation w/ maxilla, via resorption in anterior surface and deposition I posterior surface

Maxillary Height
Maxillary bones increase I height by apposition along alveolar processes Increase is seen as long as teeth erupt Resorption along nasal floor Deposition along palatal roof

Growth of the Mandible

 Mandible is the only movable bone of all bones in face Horeshoe shaped w/ the followings parts 1. Body of mandible 2. Ramus 3. Codnylar process Condylar Process 4. Coronoid Process 5. Alveolar Process

Growth Development of Mandible

- Prenatal Development - During 4th week: thickening develops in lateral and ventral aspect of carnialmost part of foregut called pharyngeal/buccal arches - Throughout intrauterine life left and right mandible are not fused at midline

Growth Develpmt of the Mandible

- Primary cartilage of 1st Pharyngeal arch is the Meckels cartilage, helps in formation of lower jaw

Meckels Cartilage
- Meckels cartilage appears at 6th week of IUL - Provides template for development of mandible

Growth Development of the Mandible

- Ossification starts at the division of mental and incisive branch of inferior alveolar nerve lateral to Meckels cartilage around 6th week IUL - Fate of Meckels Cartilage - Greater part of Meckels cartilage degenerate w/o contributing formation of mandible by 24th week

Development of the Mandible

5th week of IUL: mandibular process of both sides approach easchother and are fused Meckels cartilage extends from area of future ear to midline of fused mandibular processes 6th week: cartilaginous rods begin chondrifying (change into cartilage), rods support forming skeletal framework of mandible Part of mandible mesial to mental foramen: Endochondral ossification Lateral to foramen undergoes intramembranous ossification

Development of the Mandible

10th week: formation of condylar process begins 14th week: Ossification begins except region of tip of head of condyle superiorly. Maintained till teens for future growth Once condyle finished: TMJ jointt is shifted anteriorly 16th week: ossification of ramus 7th month of IUL: 1 or 2 cartilaginous fragments in region of mental foramen ossify and fuse w/ bone Failure of fusion of both mandibular process from both sides leads to Midline cleft

Postnatal Growth of Mandible

At Birth Ramus short horizontal & w/ obtuse gonial angle Angle of mandible obtuse around 140 degrees+ Condyles: low, at position of occlusal plane

Mandibular Growth in the 1st Year

Growth at symphyseal suture Lateral expansion of anterior region to accommodate erupting anterior teeth Suited for suckling activity since condyle and glenoid fossa is flat Helps in anteroposterior movement of mandible

Mandible in the Adult

Ramus: longer Gonial Angle: Less obtuse Bone is larger on the whole Condyle: is well-developed - Condylar growth rate increases at puberty - Peaks between 12 to 14yrs of age - Normally ceases about 20 years of age

V-Principle of Growth in Mandible

All these changes take place w/ the growth of the mandible in the form of an expanding V

Alveolar Process
- Alveolar growth occurs around tooth buds - As teeth develops & begins to erupt, alveolar process inncreases in size and height - Continnued growth of alveolar bone increases height of mandibular body - Alveolar process grows Upwards and outwards On expanding arch -Permits dental arch to Accommodate larger Permanennt teeth

Length of the Mandible

Anteroposterior growth: deposition at posterior surface of ramus Resorption of the leading edge anterior surface Helps lengthen mandible so anterior part of the ramus is occupied by posterior part of body in future and to accommodate the developing permanent molars

Length of the Mandible

As mandible grows posteriorly, its displaced anteriorly Articulation of the condyle to the glenoid fossa is constant, and change in length can only take place by anterior displacement

Width of the Mandible

Deposition, lateral surface of ramus Resorption, lingual surface below mylohyoid ridge Coronoid pprocess, undergoes apposition at medial surface, and resorption at lateral surface. This expands mandible like a V Condyle undergoes reduction on lateral aspect of neck, deposition corresponding to the V makes condyle longer at neck

Height of the Mandible

Alveolar process height corelate well w/ eruption of teeth Bone deposition taking place in lower border of mandible also contribute to increase in height of mandible

Thumb Sucking
Thumb Sucking: Placing the thumb into various depths into the mouth Commonly seen habits Observed in intrauterine life Sucking- 1st co-coordinated muscular activity in the infant

Thumb Sucking
Normal TS 1st & 2nd Year of Life DONT GENERATE ANY MAOCCLUSION Abnormal TS Can cause malocclusion

Thumb Sucking

Mouth Breathing

 Mouth breather usually has lips open most of the time Causes facial development narrow and long

 tongue usually presses forward between teeth which do not contact when swallowing Tongue action prevents arch development Narrow V-shaped upper arch w/ crowding is result

 Class II Division 1 w/ open bite is created by action of tongue

Class II: Distocclusion (retrognathism, overjet) In this situation, the upper molars are placed not in the mesiobuccal groove but anteriorly to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars. There are two subtypes:

Class II Division 1: The molar relationships are like that of Class II and the anterior teeth are protruded.

 Backward movemtn when swallowing compreses TMJ causing TMJ problems

References
Prep Manual for Undergraduates: orthodonticsc, Premkumar, Sridhar. 2008 Elsevier http://www.slideshare.net/dr_abi/growthdevelopment-of-maxilla-and-mandible http://orthocj.com/2009/06/a-camouflagetreatment-of-class-ii-division-malocclusion/