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An understanding of the growth and development of the temporomandibular joint (TMJ) is necessary for successful treatment of TMJ ankylosis. The concept of a growth center in the condyle is probably misleading; instead, the soft tissues of the orofacial region seem to provide the primary growth forces. As a result of this concept, methods of treatment should be reexamined.
In a longitudinal study consisting of three single examinations dental findings of 89 individuals (40 boys and 49 girls) were recorded. The aim of the study was to check up the process of dental growth and development of 7.6- to 8.6-year-old children. Age- and sex-specific differences could be established in the three occlusal dimensions by means of clinical findings and 3-d-analysis of the plaster casts. The rate of DMF teeth was remarkably low in girls and boys; the presence of malocclusions was surprisingly high.
In this study the effect of the growth and development on soft tissue profile of preadolescent subjects with normal occlusion, skeletal class 1 and mesiodivergent structure was investigated. 10 girls, the mean skeletal age being 9.28 +/- 1.58 years and 10 boys, the mean skeletal age being 9.88 +/- 1.80 years were selected. Two standardized lateral cephalometric roentgenographs were taken from all subjects at one year interval. The angular and linear measurements were performed on tracing films. The mean values of these measurements were calculated and statistically evaluated. According to statistical evaluation, the growth and development of the lips and soft tissue chin in both girls and boys were normal and they were in harmony with each other. However in girls the increase of lower lip thickness and in boys the changes of hard and soft tissue pogonion positions were found to be statistically insignificant. In girls, the correlations between the upper lip position and maxillary growth.
The human face is a sensory complex with the task of transmitting to the central nervous system most of the information and signals from the surroundings. This perceptive centripetal activity is linked with continual centrifugal transmissions to the surroundings of a relational type. The cerebral extremity of a human being is ethological in essence. The human cephalic phenotype is, during the whole of its development, a succession of responses of the genome to the stresses of the environment: it is an open system. The phylogenesis of the cerebral cognitive organs and the phylogenesis of the skeleton which protects them are linked. The growth of the membranous cephalic skeleton is under the control of these cognitive organs. Practical applications are deduced from this in connection with the pre-operative functional test for prognathisms.
Cephalometric radiographic assessment of facial growth was carried out in 35 10-year-old boys with complete unilateral cleft lip and palate, operated upon in childhood with the technique of primary periosteoplasty. They were compared with two matched series of boys with clefts; one group was treated with primary osteoplasty and the second with the technique of surgical repair without a bone graft or periosteal flap. Comparison of the three surgical techniques disclosed that subsequent jaw development was most advantageous after primary periosteoplasty and least satisfactory after bone grafting. Facial changes after periosteoplasty consisted of a milder retrusion of the upper jaw, a maintenance of the overjet, and a more satisfactory prominence of the upper lip. Analysis also revealed that orthodontic treatment appeared to play a major part in improving the facial configuration.
This paper presents light-microscopical details of the late development of skeletal tissues at the joint between upper pharyngeal jaws (UPJs) and neurocranial base (parasphenoid and basioccipital bones) in the acellular-boned teleost Astatotilapia elegans. On each of the supporting elements, a bone tissue (AB) is deposited that is anomalous because of its retention of cells within the matrix. Later, this layer is gradually replaced by the anomalous large-celled chondroid kind of bone (CB). Both AB and CB probably grow by apposition from the overlying fibrous layer. Osteoblastlike cells secrete osteoid, which soon calcifies and traps the cells. As in young cellular membrane bone, cells in the AB have a wide, elongate shape and lie amidst sparse, calcified, bonelike matrix but lack a canalicular system. Later generations of enclosed cells have a more vesicular shape, with at least some cells remaining alive in the calcified matrix. Appositional growth of the chondroid bone at its articular side is matched from a certain stage onward by erosion at its basal side. On the upper pharyngeal jaws this resorption is clearly related to the development of new teeth. Although in older stages and adults the chondroid tissue resembles a secondary cartilage, the term chondroid bone (CB) was preferred because of (1) the continuing formation by osteoblastlike cells; (2) the staining affinities of its matrix with that of bone; and (3) its formation both on cartilage bone (the infrapharyngobranchials III-IV and basioccipital bone) and on membrane bone (the parasphenoid bone).
The postnatal development of the hard palate was studied by conventional histologic and microradiographic means on autopsy material from thirty-three boys and twenty-seven girls aged 0 to 18 years. The findings indicated thet growth in length of the hard palate until the age of 13 to 15 was due to growth in the transverse suture and to apposition on the posterior margin of the palate. After this age the sutural growth was found to cease, whereas the apposition seemed to continue for some years. During the postnatal development the morphology of the transverse suture changed. At birth the suture was broad and slightly sinuous; later it developed into a typical squamous suture, the palatine part covering the maxillary part. During puberty the course of the suture was again slightly sinuous. The importance of this change for the vertical growth of the hard palate was discusses. It was pointed out that the lowering of the anterior part of the palate. The transverse growth of the midpalatal suture continued up to tha age of 16 in girls and 18 in boys. On the basis of morphology, the development of the median suture could be divided into three stages. In the first stage the suture was short, broad, and Y shaped; in the second the course was more sinuous; and in the third interdigitation was so heavy that a separation of the two halves of the maxilla would not be possible without fracturing the interdigitated processes.
Taking the presence of an interplay between the vertical and sagittal components of craniofacial development into consideration, the beneficial therapeutic potential impacts of controlling vertical development on the correction of Class II discrepancies has been previously investigated. In the present study, a modified maxillary orthopaedic splint combined with an anterior high-pull headgear was used for early correction of the vertical and consequently sagittal dentoskeletal discrepancy as the initial stage of treatment. The aim was to evaluate its effects on the maxillary and mandibular dentoskeletal development, as well as rotational growth pattern. In order to compare with and distinguish from the uninterrupted growth changes, a control group was formed by matching each one of the control subjects to a subject in the treatment group according to certain criteria. The initial and second standardized lateral cephalograms of each subject was evaluated by means of an adopted and biologically more substantial cephalometric analysis. Evaluation of the changes induced by the splint in comparison with the uninterrupted growth changes revealed that the splint had both orthopaedic and orthodontic effects on the growth pattern of the dentoskeletal structures. There seemed to exist a relationship between the direction of total mandibular and maxillary rotations. In addition, it was believed that in order to cause a forward mandibular rotation, i.e. to change the rotational mandibular growth pattern from a backward into a forward direction, the posterior vertical maxillary development should be restrained, but anterior vertical maxillary development should be relatively more restrained or reversed and, thereby, the rotational growth pattern of the maxilla should be changed from a backward into a forward direction. Moreover, the bite block effect of the splint seemed to cause a favourable change in the condylar growth direction from a backward to an upward direction.
Case reports of five bilateral cleft lip and palate patients subjected to premaxillectomy at ages from 5 to 11 years are presented and the reasons for the procedure noted in each instance. Followed into adolescence, an abnormal peaked configuration of the maxillary arches termed "church steeple" defect developed in four of the five patients. Midfacial growth arrest with pseudoprognathism did not occur in any. Details of the surgical technique used are specified. Features of prosthetic and soft-tissue reconstruction are noted. The history and rationale of primary and secondary premaxillectomy are reviewed. Secondary excision of the premaxilla can be a valid treatment option in a few specifically selected cases.
Fifty five children with deciduous dentition and 36 adults were selected from 160 Class III patients, 40 children with normal occlusion used as cephalometric control group. T test was operated between the children with normal occlusion, Class III malocclusion with positive family background and with negative family background separately, and distinct analysis was carried out between the two Class III groups. Distribution of family background of skeletal Class III in children and in adults was chi 2 tested. Results show that craniofacial deformities of deciduous Class III malocclusion with positive family background are not more serious than those with negative one, and the rate of developing a skeletal class III malocclusion for patients with positive family background is not higher than those with negative one. It was implied that the value of family information collected by inquiring and cursorily examining the parents is limited for differential diagnosis between skeletal and functional class III malocclusion and it may mislead the prediction of treatment result in orthodontic clinic.
A favorite quote from John Fowles can be applied to the debate over the optimal recall intervals for children: "Total sight or all else is desolation." Piecemeal considerations such as the patient's caries prevalence or the rate of progression of a carious lesion, on their own, are insufficient to determine the optimal time for a recall examination. Only a regular, comprehensive examination permits the dentist to understand and apply the ecological model--how best to reduce the incidence of a oral disease and how best to care for or alleviate a disease process. This knowledge permits a practitioner to customize, to individualize his decisions with respect to frequency of examination, and when and where to apply preventive and/or treatment regimens. This applies to the management of dental caries, periodontal conditions, and growth and development problems of the dental/oral-facial complex. A practitioner can only manage the whole patient-as opposed to just the disease entity-by individualizing the frequency of recall examinations. Similarly, we can only implement optimal preventive measures-and ethically postpone invasive procedures-by individualizing recall examinations.
The effects of early transposition of the masticatory muscles on the craniofacial growth and development of infant primates are documented with the aid of serial cephalometry, EMG's, and dry-skull preparations. The bilateral posterior transposition of the insertion of the masseter and temporalis muscles was followed by a significant superior and anterior rotation of the midfacial growth pattern as well as by marked skeletal morphological changes. The study documents the ability to change skeletal craniofacial growth patterns by altering muscle attachments.
Cichlids have undergone extensive evolutionary modifications of their feeding apparatus, making them an ideal model to study the factors that underlie craniofacial diversity. Recent studies have provided critical insights into the molecular mechanisms that have contributed to the origin and maintenance of cichlid trophic diversity. We review this body of work, which shows that the cichlid jaw is regulated by a few genes of major additive effect, and is composed of modules that have evolved under strong divergent selection. Adaptive variation in cichlid jaw shape is evident early in development and is associated with allelic variation in and expression of bmp4. Modulating this growth factor in the experimentally tractable zebrafish model reproduces natural variation in cichlid jaw shape, supporting a role for bmp4 in craniofacial evolution. These data demonstrate the utility of the cichlid jaw as a model for studying the genetic and developmental basis of evolutionary changes in craniofacial morphology.
It has been established in primate studies that mouth-breathing can affect lower facial development. We submit that mouth-breathing has a similar effect on human development--specifically, that chronic mouth-breathing during growth contributes to long-face syndrome. When reconstructive surgery is contemplated for this deformity, we believe that the sequence of surgical steps is important and that particular attention should be given to enhancing nasal respiration. The possibility that mouth-breathing is a factor in relapse following mandibular surgery is discussed.
Hypohidrotic ectodermal dysplasia is a rare congenital disease that affects several ectodermal structures. The condition is usually transmitted as an x-linked recessive trait, in which gene is carried by the females and manifested in males. Manifestations of the disease differ in severity and involve teeth, skin, hair, nails and sweat and sebaceous gland. Ectodermal dysplasia is usually a difficult condition to manage. Prosthodontically, because of the typical oral deficiencies, and afflicted individuals are quite young to receive extensive prosthodontic treatment, which restores their appearance and helps them, for the development of positive self-image. This case report describes the management of upper jaw with over denture with copings on existing teeth i.e. two permanent peg shaped centrals as well as lateral incisors. However with adequate of retainer lower denture was provided with a new treatment modality.
By means of computer-X-ray cephalometric system to study the dento-maxillo-facial growth and development was performed in 65 patients of anterior deep bite with lingoversion of upper incisors. The patients were divided into two groups: (1) 35 cases aged 12-16 years and (2) 30 cases aged 17-26 years. The same number of the subjects with normal occlusion were used as control group. The findings were as follows: 1. Besides the dento-maxillo-facial growth and development was abnormal vertically, the posterior anterior discrepancy of the growth trend is also one of the main problems in this kind of malocclusion. 2. The growth of the alveolar bone was inhibited anteriorly by the upper incisors; 3. The deformed mandible has the growth trend to rotate forward and upward in Counterclock wise direction so that it is wise to treat of early.
The effects of the masticatory function on age changes of the temporomandibular joint were studied in 163 C3H/He strain male mice, separated into solid and liquid diet groups from 2 weeks of age. The sizes and shapes of the mandibular condyles and glenoid fossae of the two groups were compared up to 60 weeks. The sizes and shapes of the condyles in the solid diet group increased and developed with age, but there was almost no change after 3 weeks of age in the liquid diet group. The sizes and shapes of the fossae increased and developed with age until 20 weeks in both groups, and there was no differences between the two groups. The poor functional stimulus of mastication has distinct effects on the underdevelopment of the condyle. Since the effects on the fossae were less than those on the condyles, not only the amount of mandibular movement, but also its pattern may have affected the liquid diet group.
This is a longitudinal study of 12 patients with craniofacial synostosis syndromes (Crouzon's, Apert's, Pfeiffer's) who underwent Le Fort III advancement under the age of 7 years (average age 5.1 years, range 4.0 to 6.7 years). The average follow-up was 5.0 years and included clinical, dental, and cephalometric examinations according to a prescribed protocol. The study demonstrated that the procedure could be safely performed in the younger child with an acceptable level of morbidity. There was a remarkable degree of postoperative stability of the maxillary segment. However, although vertical (inferior) growth or movement of the midfacial segment was demonstrated, there was minimal, if any, anterior or horizontal growth. Any occlusal disharmony developing during the period of follow-up could be attributed to anticipated mandibular development and could be corrected by orthognathic surgery. The roles of surgical overcorrection and anterior-pull headgear therapy after release of intermaxillary fixation are also discussed. The Le Fort III osteotomy is justifiably indicated during early childhood for psychological and physiologic reasons.