Orthodontics

Orthodontics
Growth and development

 Growth: increase in size or number (anatomic)
 Development: increase in complexity or specialization (physiological or behavioral)
o Pattern, timing and differentiation
 Growing pattern
o Cephalocaudal growth gradient
 Body parts closer to cranium grow faster earlier –> max grow faster
 Body parts further from the cranium grow more later
o Scammon’s growth curves
o Human growth curves
 Distance curve: tracks actual height each year
 Velocity curve: tracks change in height
o Boy and girl growth curves
 Average peak growth for girls: 12 yo
 For boys: 14 yo
 Growing timing
o Chronologic age
o Dental age
o Skeletal age
o Biology age: marker of maturation (best)
 How does growth happen

o Site: location at which growth is occurring
o Center: site of growth that has the ability to control its own growth
 Endochondral vs intramembranous
o Endochondral: within cartilage
 Growth form inside, increase in length
 Under more direct genetic control
 Zone of resting cartilage  zone of proliferating cartilage  zone of
hypertrophic cartilage  zone of calcified cartilage  zone of ossification
o Intramembranous: within memebrane
 Growth from the outside
 Increase in diameter
 Influenced more by environmental forces
 Growth theories
o Harry Sicher: suture
o James Scott: cartilage
o Melvin Moss: functional matrix theory
 Craniofacial growth
o Cranial vault: frontanelle, intramembranous ossification at suture and internal
surfaces
o Cranial base: ethmoid, sphenoid, and occipital
 Synchondroses
 Endochondral ossification
 Intersphenoid inactive by age 3
 Spheno-ethmoid inactive by age 7
 Spheno-occipital inactive later
o Maxilla
 Intramembranous ossification
 Growth + remodeling
 Resorption anterior maxilla
 Apposition palate, alveolar ridges, tuberosity
 Grow downward and forward
o Mandible (embryonic)
 Intramembranous ossification: embrypnic corpus + remodel of mand
 Resorption anterior ramus
 Apposition posterior ramus, chin, coronoid, alveolar ridges
 Endochondral ossification to create condylar cartilage  proliferates and
produces bone
 Fuse together at 4 months in utero
 Grow downward and forward translation away from the cranial base
 Growth rotation
 Condylar growth = molar eruption
 Condylar > molar  deep bite
 Condylar < molar  open bite, long face
 Planes of growth
o Transverse: 10-12, width
o Anteroposterior/sagittal: 14-16, length
o Vertical: 18-20+. Height
Craniofacial abnormalities
 Types of birth defects

o Syndrome= pattern of anomalies that occur together in a predictable fashion
due to a single etiology
o Sequence= group of related anomalies that generally stem from a single major
anomaly that alters the development of surrounding structures
 Different syndromes
o Neural crest
 Fetal alcohol syndrome
 Caused by exposure to high levels of ethanol during early
development
 Teratogen= any agent that interferes with early development
 CNS problems
 Mid face deficiency
 Cleft lip
 Treacher Collins syndrome (mandibulofacial dysostosis)
 Genetic mutation that affects development of facial bones and
tissues
 Underdeveloped mandible
 Downslanted palpebral fissures
 Cleft palate (35&)
 Microtia= small ear
 Hemifacial microsomia
 Loss of neural crest cells during migration
 Ear and mandibular ramus are deficient on affected side
o Trisomy 21/Down syndrome
 Nondisjunction that leads to an extra chromosome 21
 Midface deficiency
 Upslanted palpebral fissures
 No increased caries risk
 Increased periodontal disease risk
o Lack of fusion
 Cleft lip: 4 to 6 weeks in utero – MNP & MP anteriorly
 Cleft palate: 6 to 8 weeks in utero – MNP & MP posteriorly
 Tend to be Class III with deficient maxilla
o Pierre robin sequence

 Micrognathia= small mandible
 Glossoptosis= backward displacement of tongue
 Cleft palate
 Breathing and feeding difficulties
o Final differentiation of tissue
 Crouzon syndrome
 Craniosynostosis= early closure of skull sutures
 Brachycephalic= short skull
 Midface deficiency
 Frontal bossing= prominent forehead
 Hypertelorism= widely separated eyes
 Proptosis= bulging eyes
 Class III relationship
 Apert syndrome (acrocephalosyndactyly)
 Craniosynostosis
o Similar features to Crouzon
o Acrocephalic= tall skull
o Byzantine arch= narrow palate with high vault
 Syndactyly= fusion of fingers and toes
 Hurler and Hunter syndrome (mucopolysaccharidosis)
 Build up of glycosaminoglycans (GAG) due to an enzyme
deficiency
Development of occlusion
 Gum pad stage
 Primary dentition stage
 Mixed dentition stage
 Permanent dentition stage
Diagnosis and treatment

Biology of tooth movement
Mechanical principles of tooth movement
Orthodontic wire and brackets
Early treatment
Comprehensive treatment and appliances
Retention
Orthognathic surgery and complications

Orthodontics

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Orthodontics

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Orthodontics

Growth and development

 How does growth happen

 Types of birth defects

o Pierre robin sequence

Diagnosis and treatment

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