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Prenatal development of the human mandible. 3D reconstructions, morphometry and bone remodelling pattern, sizes 12-117 mm CRL.

Human embryos and fetuses ( n=25) ranging from 12 to 117 mm CRL (crown-rump-length) were serially sectioned and the mandibles were reconstructed in 3D. In addition, characteristic areas of apposition, resorption and resting zones were projected onto the surface of the mandibular reconstructions after histological evaluation of the remodeling processes. Furthermore, morphometric data were taken to describe growth processes in horizontal views. In this way the changing outlines as seen in 3D could be correlated with the remodeling patterns and with the changes in growth. In these stages the mandible showed a general appositional growth, but resorption areas were found at the posterior margins of the mental foramen and at the lateral and medial posterior bony planes at concave surfaces. The bulging of bone underneath and over Meckel's cartilage could be recognized as active appositional growth areas. Meckel's cartilage itself lay in a trough which could be characterized by less apposition and even resorption. Questions were raised in how much the gap between our present knowledge of genetic expression of signaling molecules and the precise morphologic description of the mandibles can be bridged.

Bone Remodeling↗

Overeruption without root exposure of third molars and periodontal health in the mandible.

Bone formation is seen around the third molar even when the tooth is exposed to the oral environment due to overeruption. To determine if overeruption of the third molar with or without root exposure is related to the status of the exposure of other teeth in the mandible, using orthopantomographs, 424 third molars were studied in 371 patients who were over 41 years of age. The rate of overeruption and root exposure in third molars was measured, and its relationship to the number of teeth lost and the rate of root exposure in other teeth in the mandible was analyzed. Tooth loss in the group of third molars with overeruption without root exposure was greater than in that without overeruption or root exposure in men, whereas the relationship was not seen in women. We found that root exposures of other teeth in the group of third molars with overeruption without root exposure were significantly smaller than in those with root exposure in both genders. Third molars with overeruption without root exposure, in which bone formation was easy to observe for radiographic diagnosis, were correlated with periodontal health in the mandible, suggesting a component of precision determination for predicting resistance to periodontitis.

Adult↗

[Effect of positioning errors on magnification factors in the mandible in digital panorama imaging].

Magnification factors (VF) in relation to various head positions were evaluated for a digital panoramic radiography machine (Orthophos DS, Sirona) by means of a dry skull phantom. Six metallic objects were attached to the facial layer of the mandible. A set of 170 digital radiographs (program 1) was produced, with defined positioning errors within the vertical and horizontal plane. Repeated digital measurements of the object images were performed by one reader, applying the mouse-driven measurement tool integrated in the proprietary software. In addition, the central layer of the radiographic device was experimentally determined and its location compared to that of the accurately positioned dry mandible. All objects were located on the outside of the central layer of minimum distortion and therefore placed towards the sensor. One- and two-way analysis of variance was applied for the statistical evaluation of the data, with VF as dependent variable and the positions as factors, respectively. Vertical inclinations of the skull affected horizontal VF only in the premolar region (p = 0.0069). However, when the skull was rotated within the horizontal plane, VF was significantly influenced in all anatomical regions of the mandible (p = 0.0001). This was particularly obvious in the premolar region, with a maximum variation of 10.3%. Fluctuations of VF were more pronounced in the premolar region than at the mandibular angle. We conclude from this study that, as expected, digital panoramic radiographs exhibit identical distortion effects as compared to conventional panoramic x-rays. Exact quantification of regional magnification requires (spherical) reference objects with known dimensions. Horizontal magnification is quite unreliable and far less reproducible than vertical magnification. Whenever several panoramic radiographs of one patient are to be compared quantitatively, accurate positioning of the patients' head is a necessary prerequisite.

Artifacts↗

Prenatal growth patterns of the human mandible and masseter muscle complex.

Since experimental and clinical evidence supports some role of musculature in determining the form and size of facial bones during the active periods of growth after birth, this study addresses the same basic relationships between muscle and bone during the periods of active growth before birth. The relationship between the masseter muscle and the mandible, including its ramal and body components, was chosen as the model for study in nineteen human fetuses (ages 16 to 36 weeks). Cross-sectional cephalometric data indicated that, although increases in the size of the muscle and mandible were linearly related to increasing age, the ramal portion of the mandible was more closely related to changes in the masseter muscle than to changes in the mandibular body. Moreover, it appears that reorientation of the muscle anteriorly and downward precedes a similar reorientation of the ramus, with the combination of both fetal events leading to the typical relationships of the two structures expected after birth. Although this study does not get to cause-and-effect relationships, and although the fetal specimens cannot be monitored longitudinally over time, the parallelisms between our prenatal findings and those reported for postnatal periods certainly lend further support to the observation that many aspects of morphogenesis and growth are continual processes spanning the periods on either side of birth.

Body Height↗

Autorotation of the mandible: effect of surgical superior repositioning of the maxilla on mandibular resting posture.

Mandibular autorotation is a generally accepted cephalometric phenomenon that occurs when surgical superior repositioning of the maxilla is planned. This investigation was undertaken to determine whether autorotation of the mandible is a biologic phenomenon as well. Fifteen adults with vertical maxillary excess who underwent a mean surgical superior repositioning of 6.2 mm. were evaluated with cephalometric, kinesiometric, and electromyographic instrumentation immediately before and 3 months following surgery. Five persons selected at random from the original group (who also underwent a mean surgical superior repositioning of 6.2 mm.) were similarly evaluated 24 months following surgical intervention. The results of this study, which were analyzed by the Wilcoxon Matched-Pairs Signed-Rank test, revealed that a significant compensatory autorotation of the mandible occurred by the third month and was still constant 2 years later. We propose, on the basis of this preliminary evidence, that an "occlusal programming feedback mechanism" within the central nervous system mediated the compensatory autorotation of the mandible following surgical superior repositioning of the maxilla.

Adolescent↗

The effects of retinoic acid on the growth of mandible and long bone in fetal rats.

Timed-pregnant rats were injected with a total of 90 microgram of retinoic acid from day 13 until delivery. Other pregnant groups were given either a total of 390 microgram of retinol from day 5 or a total of 270 microgram of retinol from day 13 until delivery. Although the weight gains and food intake of the dams during gestation showed no difference between groups, the long bones were slightly heavier in pups born from retinoic acid-injected dams. Total collagen content in both mandibles and long bones did not show differences between retinoic acid- and retinol-injected groups, but collagen synthesis in both bones was greatly increased in the retinoic acid-injected groups. Calcium content of the mandible in the retinol-injected group from day 13 of gestation was increased, whereas 45Ca uptake of long bone of this group was increased. Retinoic acid, when injected in physiological doses during gestation, may have some effects on the organic phase of bone, long bones being slightly more sensitive to retinoic acid than the mandibles.

Animals↗

Initiation of secondary cartilage in the mandible of the Syrian hamster in the absence of muscle function.

The functioning lower jaw is a prerequisite of the ongoing secondary chondrogenesis in the mammalian mandibular condyle. Does the articular function also initiate secondary chondrogenesis in the mandible? The angular process of the fetal mammalian mandible possesses a large secondary cartilage without any apparent articular function. Past studies have shown that the anlage of the lower jaw of the mouse embryo grown in organ culture produces condylar and angular cartilages as in vivo. In order to clarify further the capacity of the mandibular anlage to initiate secondary chondrogenesis in a non-functional environment, mandibular arch explants taken from the prenatal hamster before any cartilage or bone formation was apparent were grown in organ culture. Both primary and secondary cartilage could be found in them within 9-10 days. The results thus indicate that initiation of the condylar and/or angular secondary cartilaginous development in the rodent mandible occurs in the absence of jaw-opening function, although the pertinent literature indicates that function maintains cartilaginous differentiation in the condyle.

Animals↗

Instruction by retinoic acid of incisor morphology in the mouse embryonic mandible.

Endogenous retinoids are present in the embryonic mouse mandible and reach a peak in concentration at the time of the formation of the dental lamina. All-trans retinoic acid is present in a 10-fold higher concentration in the future incisor region of the mouse embryonic mandible at day 11.5. It was found here that exogenous all-trans retinoic acid has pleiotropic effects on the pattern of odontogenesis when applied before the formation of the dental lamina. These effects include a change in the pattern of the dental lamina, supernumerary buds and incisors in the diastema region, and replacement of molars with incisors in the molar region. Thus retinoic acid appears to instruct incisor morphology in the mouse embryonic mandible.

Animals↗

Biologic laws governing functions of muscles that move the mandible. Part IV. Degree of jaw separation and potential for maximum jaw separation.

Accurate diagnosis and treatment of the gnathostomatic system require an understanding of both its biomechanics and its physiology. Clinically, the treatment consists of modifying the existing occlusal program to relieve stress from distressed tissues. The objective of treatment is to effect a neuromuscular release of the mandible. This may be accomplished by (1) equilibration of the natural occlusion, (2) orthodontics, (3) restorative procedures, or (4) surgery. Most frequently, however, the treatment entails some combination of these procedures. The criteria for success of treatment are not determined by the method or technique employed but by the neuromuscular response that the treatment produces. The purpose of this article is not to suggest which occlusal scheme produces the most favorable muscle response in the gnathostomatic tissues. Neither is an objective of this article to teach the mandible-manipulation techniques that are needed to identify occlusal irritants, perform occlusal equilibrations, or obtain accurate centric relation recores. The objective of this article is to emphasize that there are definite principles by which the muscles respond to occlusal contacts. Occlusal contacts can excite bruxism and the sequelae to bruxism. Knowledge of the laws which govern functions of the muscles that move the mandible enables the dentist to acquire the mandibular-manipulation skills that are necessary for the effective diagnosis and treatment of occlusal conditions.

Biology↗

Effect of a resilient layer in a removable partial denture base on stress distribution to the mandible.

The results of two-dimensional finite element analyses of a mandible indicate that a resilient layer within a denture base can act as an effective "shock absorber" and may slow down ridge resorption. Finite element models of similar types can easily be used to further investigate various applications of resilient layers. The magnitudes and distributions of stresses generated in the mandible by force application to two types of a distal extension denture base were determined and compared. The results were obtained by using the finite element method of stress analysis. In the first analysis, a conventional distal extension denture base resting on the mandible was simulated. In the second analysis, the same testing force was applied to a distal extension denture base with a resilient layer between the teeth and the basal seat. The results indicated that the stress distribution was more uniform during occlusal loading through a resilient layer. The vertical displacement of the alveolar ridge under the denture base with a resilient layer was far less than that of the conventional denture base.

Dental Stress Analysis↗

Augmentation rib grafting to the inferior border of the atrophic edentulous mandible: a 5-year experience.

Inferior border rib grafting appears to be a useful procedure in providing bony augmentation for severely atrophic edentulous mandibles. Major advantages to the prosthodontic patient are that (1) remodeling and changes in the denture-bearing surfaces are minimal following surgery, (2) the interocclusal space is unaltered, (3) in nonunion body fractures occurring in severely atrophic mandibles, the ribs applied to the inferior-buccal and inferior-lingual aspects of the mandible hold the fragments in a much more favorable position, thus preventing superior elevation of the posterior segment and inferior displacement of the anterior segment, and (4) resorption rates seem acceptable. The patient should be informed of possible consequences. As with all preprosthetic special procedures, a psychosocial analysis may also be indicated.

Alveolar Ridge Augmentation↗

Stress distribution around dental implants: influence of superstructure, length of implants, and height of mandible.

The stress distribution around dental implants was investigated by use of a two-dimensional model of the mandible with two implants. A vertical load of 100 N was imposed on abutments or the bar connection. The stress was calculated for a number of superstructures under different loading conditions with the help of the finite element method. The length of the implants and the height of the mandible were also varied. A model with solitary abutments showed a more uniform distribution of the stress when compared with a model with connected abutments. The largest compressive stress was also less in the model without the bar. Using shorter implants did not have a large influence on the stress around the implants. When the height of the mandible was reduced, a substantially larger stress was found in the bone around the implants because of a larger overall deformation of the lower jaw.

Bite Force↗

Autogenous cancellous-marrow bone grafts in irradiated dog mandibles.

A pilot study was conducted to investigate the osteogenic potential of autogenous cancellous-marrow grafts placed in irradiated tissue. Three dogs received 4,100 rads in ten treatments ooer 32 days. Postirradiation discontinuity mandibular defects were created. These defects were restored with cancellous-marrow autogenous bone supported in position by a titanium mesh basket. Bony union occurred in all the mandibles. The titanium mesh partially eroded through the oral mucosa in two animals. The quantity of new bone formed in the surgical defect varied. Two dogs had complete restoration of the resected mandible. Histologic observations were documented in both the graft area and the surgically uninvolved contralateral side of the mandible.

Animals↗

Indications for simultaneous mobilization of the maxilla and mandible for the correction of dentofacial deformities.

As improvements in diagnosis, treatment planning, and surgical techniques have evolved it has become increasingly more common to consider simultaneous mobilization of the maxilla and mandible in order to achieve optimal correction of selected dentofacial deformities. In the experiences of the authors, there are patients with specific deformities of the Class III, Class II, Class I, and asymmetry types who can benefit from simultaneous mobilization of both jaws. It is the purpose of this article, the first in a series of three, to detail those specific conditions which warrant consideration for simultaneous mobilization of the maxilla and mandible. In the second article the details of treatment planning for simultaneous mobilization of the maxilla and the mandible will be presented, and in the third article the results of treatment in 100 consecutive cases will be evaluated.

Cephalometry↗

Staple implant through bone graft at inferior border of mandible.

This article reports on a patient with an unusual history of ankylosis of the left mandible. The case demonstrates retarded growth on the side of the ankylosis as it occurred at an early age. A gap arthroplasty performed at the angle of the mandible, lower than usual, had produced an adequate result, and a bone graft augmentation genioplasty was performed in an attempt to improve the patient's appearance. Subsequently, a mandibular bone plate implant was successfully placed through the bone graft along the anterior inferior border of the mandible.

Alveolar Ridge Augmentation↗

Location of the mandibular canal within the atrophic mandible.

In 43 edentulous, lower jaw halves, sections were carried out in the area between the mental foramen and the third molar. The relative changes in the location and course of the mandibular canal which are caused by atrophy were analysed. For this purpose, the mandibles were classified according to so-called residual ridge orders which describe the different stages of alveolar ridge resorption. The following findings were obtained: The distance between the mandibular canal and the lingual and buccal external border does not change in any stage of the atrophic process, i.e. it remains conspicuously constant. However, the distance between the mandibular canal and the cranial and caudal borders of the body of the mandible partly changes to a statistically highly-significant extent, the distance between the canal and the atrophic alveolar ridge being affected more strongly than that between the canal and the base of the mandible. These changes were most clearly pronounced in the area of the first molar.

Aged↗

The role of autogenous primary rib grafts in treating fractures of the atrophic edentulous mandible.

Fractures of the atrophic edentulous mandible are relatively uncommon representing less than 1% of all facial bone fractures seen at The Queen Victoria Hospital, East Grinstead. Only 35 patients have been treated for fractures of the atrophic edentulous mandible at this unit from a total of over 4000 facial bone fractures seen here between 1975 and 1994. All traditional treatment modalities have been utilised with varying degrees of success. A technique is presented whereby all displaced fractures of the atrophic edentulous mandible with a measured bony vertical dimension of less than 10 mm at the fracture site are managed with primary autogenous rib grafting. This reduces the risk for formation of pseudarthrosis and facilitates subsequent prosthetic rehabilitation.

Aged↗

Primary malignant fibrous histiocytoma of the mandible: surgical approach and report of a case.

A case of histologically proven malignant fibrous histiocytoma (MFH) of the mandible is presented. This tumor rarely occurs as a primary neoplasm of the mandible. An intraoral block resection of the mandible, including adjacent clinically normal soft tissue was performed. To maintain the soft tissue bed and esthetics, and to preserve mandibular function, immediate reconstruction was carried out with methyl methacrylate, the anatomical configuration of which was derived from the resected specimen.

Female↗