GROWTH AND DEVELOPMENT

OF MANDIBLE

DR. KIRAN KUMAR K.S.

CONTENTS
 DEFINITIONS
 PRENATAL GROWTH
 POSTNATAL GROWTH
 FACTORS AFFECTING GROWTH
 AGE CHANGES IN MANDIBLE
 ANOMOLIES IN DEVELOPMENT
MANDIBLE
 REFERENCES
What is Growth?
 Growth refers to increase in size- Todd
 Growth usually refers to an increase in size
and number – Proffit
 Self multiplication of living substance –
J.S. Huxley
 Entire series of sequential anatomic and
physiologic changes taking place from the
beginning of prenatal life to senility -
Meridith
What is Development?
 It is the progress towards maturity –
Todd
 Development refers to all the naturally
occurring unidirectional changes in the life
of an individual from its existence as a
single cell to its elaboration as a
multifunctional unit terminating in death -
Moyers
•PRENATAL

•POSTNATAL
Prenatal Growth
 It’s the most dynamic phase and is divided
as

•Preimplantation period
•Embryonic period
•Fetal period
Formation of the Pharyngeal Arches

 The mesoderm of the lateral plate of

the ventral foregut becomes
segmented to form a series of five
distinct bilateral mesenchymal
swelling called as the Pharyngeal
Arches.
4th week
4 week embryo
Contents of each arch

 Skeletal element
 Striated muscle
 Nerve
 Artery
Internal view of pharyngeal floor and cut arches
Mandibular Arch

 Meckel’s cartilage
 Musculature
 Mandibular nerve
 Artery- maxillary and external carotid
Meckel’s cartilage

 41th- 45th day of I.U.L

 Provides a template
 Extends from Otic capsule –Midline
or Symphysis
 Ossification of Meckel’s
cartilage
 Mandibular division of trigrminal
nerve

Neurotrophic
factor

Osteogenesis
Ossification of Meckel’s cartilage
 In 6th week IU
Ossification of Meckel’s cartilage

Trough
Troughfor
fordev.
dev.teeth
teeth

1°centre
1°centreofofossification
ossification

below around
Infr
Infralv.
alv.Nerve
Nerve&&
Incisive
Incisivebranch
branch
Ossification of Meckel’s cartilage
 Ossification spreads dorsally and
ventrally
•Body
•Ramus

 Ossification stops at the site that

will become mandibular lingula
Fate of Meckel’s cartilage
 Meckel’s cartilage lacks enzyme phosphatase
 It disappears by 24th week of conception
 A small part transforms into sphenomandibular and
anterior malleolor ligaments
 Ventral end forms accessory endochondral ossicles
 Meckel’s cartilage dorsal to mental foramen gets
resorbed on the lateral surface.
 Immediately lateral to resorbing
cartilage,intramembranus bony trabeculae are
being formed.
Fate of Meckel’s cartilage

Woven
Wovenbone
bone
55ththmonth
month

Lamellar
Lamellarbone
bone++haversian
haversiansystem
system
 Fate of Meckel’s cartilage
Condylar cartilage
Coronoid cartilage

10th & 14th week

Sec. accessory
cartilage

Angular cartilage

Mental ossicle
 Secondary cartilage of coronoid process

 Develop within temporalis muscle

 Incorporated into intramembranus bone

of ramus
 Disappear before birth
 Secondary cartilage at Mental region
 1 or 2 small cartilage ossify mental
ossicles(7th month) in fibrous tissue of
symphysis
 It gets incorporated into intramembranous
bone

symphysis
menti

1st postnatal year

syndesmosis synostosis
Condylar cartilage
 Serves as a growth site

 Brings changes in the mandibular position

and form

 Growth increases during puberty

 Peak 12 – 14 years
 Ceases by 20 years
Types Of Ossification
 Mandible is the first bone to be
ossified (6th week)
 There are two types of ossification :

 INTRAMEMBRANOUS

 ENDOCHONDRAL
Intramembranous bone formation
Mesenchyme Collagen fibre

Osteoblast

Osteoid matrix

Osteoblasts
Calcium salts

Bone lamella
Intramembranous bone
formation
Intramembranous bone
formation
Endochondral bone formation

Mesenchymal cells Hyaline cartilage

Alkaline
phosphatase

Primary areolae Calcified

Blood vessels
Secondary areolae osteoid Lamella of bone
Endochondral bone
formation
Endochondral bone
formation
ENDOCHONDRAL INTRAMEMBRANOUS

 Cartilage template is  Direct deposition of

replaced by osseous tissue in
endochondrial bone periosteal membrane

 Indirect bone growth  Direct bone growt

 Slow expansion  Rapid expansion

Parts Of Mandible Derived From

1. INTRAMEMBRANOUS OSSIFICATION
i. Whole body of mandible except the anterior part
ii. Ramus of mandible as far as mandibular foramen

2 . ENDOCHONDRAL OSSIFICATION
i. Anterior portion of the mandible (symphysis)
ii. Part of ramus above the mandibular foramen
iii. Coronoid process
iv. Condylar process
Neonatal mandible
 Ascending Ramus low and wide
 Large Coronoid process
 Body – open shell containing tooth
buds and partially formed deciduous
teeth
 Mandibular canal that runs low in
the body
Neonatal mandible
Differential growth
During
Duringfetal
fetallife
life
88weeks
weeks - - mandible
mandible>> maxilla
maxilla
11
11weeks
weeks - - mandible
mandible== maxilla
maxilla
13
13––20
20weeks
weeks maxilla
maxilla>>mandible
mandible

AtAtBirth
Birth
Mandible
Mandibletends
tendstotobe beretrognathic
retrognathic
Early
Earlypost
postnatal
natallife
life- -orthognathic
orthognathic
Post Natal Growth

 Mechanism of bone growth

 Theories of growth

 Anatomy
 Mechanisms Of Bone Growth
Growth Of The Mandible Primarily Involve

1. Bone remodeling
Process Of Bone Deposition And Resorption

2. Cortical drift
Combination of bone deposition and resorption resulting in
growth movement towards deposition surface

3. Displacement
Movement of whole bone as a unit

I) Primary displacement
II) Secondary displacement
Theories of growth
Theories of growth
 Other theories for growth
 ENLOW’S “V”
PRINCIPLE

 The growth and

enlargement of
bones occur towards
wide end of ‘V’ due
to differential
deposition and
resorption
 Enlow’s Counterpart
Principle

 ‘The growth of any given facial or cranial part

relates specifically to other structural and
geometric “counter” parts in the face and
cranium’.
 Eg. Maxillary arch is counter part of mandibular
arch.
Regional
Regionalpart counter
part counterpart
part

Balanced
Balancedgrowth
growth
Anatomy
Growth timings
 The overall growth of mandible takes
place at different stages.
 First there is increase in its
 Width

 Length

 Height
 Width
 Growth in width is completed before
adolescent growth spurt
 Intercanine width does increase after
12 years
 Both molar and bicondylar width shows
small increase until growth in length
ends
Growth in length
 Growth in length continues through
puberty

 Girls - 14-15 years

 Boys - 18-19 years
Growth in height
 CONTINUES IN BOTH THE SEXES FOR A
LONGER PERIOD

 GROWTH INCREASE OCCURS WITH

CONCOMITANT ERUPTION OF TEETH
AND CONTINUES TO INCREASE
THROUGH OUT LIFE AND DECREASES IN
ADULT LIFE
Main sites of post natal growth in the
Mandible
 Condylar cartilage

 Posterior border of the Rami

 Alveolar ridges
 Condylar cartilage
Site of growth for ramus and body of mandible
Dual function
articular
articular

growth
growth
Not a primary Centre of growth but rather site of growth
2°
2°ininevolution
evolution
2°
2°ininembryonic
embryonicorigin
origin
2°to
2°toadaptive
adaptivechanges
changes
 Is the Condylar cartilage the principle
force that produces the displacement of
the mandible ?

For many years considered primary growth

center

Condyle absent yet mandible positioned

normally

Considered secondary cartilage -no intrinsic

growth potential
 Condylar cartilage and functioning muscles
translate the mandible and in the absence
of one the other does best to compensate

 Integrity of periosteum is important

 When environment changes compensatory

contributions are enhanced
 Current Concept
 Condylar cartilage does have a measure of intrinsic
genetic programming
 But extra condylar factors are needed to sustain this
activity
Physiologic Intrinsic and extrinsic
inductors biomechanical forces
ENLOW :
Increase pressure – growth inhibition based mainly on animal
Decrease pressure – stimulates growth experiments
Age changes in mandible
Ramus
 Moves progressively
posterior by:-
 Deposition POSTERIOR PART

ANTERIOR PART
 Resorption
 Ramus

Superior part of ramus lingual-deposition

below sigmoid notch

Buccal-resorption

Lower part of ramus

below the Coronoid
process
Buccal-deposition

Lingual-resorption
Ramus
Coronoid process
 Deposition on lingual side

 Resorption on buccal surface

 Coronoid process

‘’V’ PRINCIPLE OF ENLOW

Lingual surface
 Body of mandible
 The increase in width of the mandible occurs primarily due
to resorption on the inside and deposition on the outside
 Increase in length occurs due to drift of the ramus
posteriorly
 Increase in height occurs due to eruption of the teeth
Body of mandible
 Ramus corpus junction

 Inferior Border of
junction - resorption

 Forms Antegonial notch

 Antegonial notch

Size depends upon ramus – corpus angle

Lingual Tuberosity
 Grows posterior
and medial by
deposition

 Resorptive field
below-
Lingual fossa
 Alveolar Process

 Adds to the height

and thickness of
the mandibular
body
 Teeth absent fails
to develop
 Teeth extracted
resorbs
Alveolar Process
 Maintain occlusal relationship during
differential mandibular & midfacial
growth– buffer zones

 Maintains vertical height

Alveolar Process
Lingual
Lingualmovement
movementofofanteriors
anteriors
Mental Protuberance

 Formed by mental ossicles from

accessory cartilage and ventral
end of Meckel’s cartilage

 Poorly developed in infants

Mental Protuberance
 Forms by osseous
deposition during
childhood

 Prominence is
accentuated by
bone resorption
above it
 Mental Protuberance

 Reversal between 2
growth fields

 Concave  convex

 Reversal line could

be High or low
Chin
 Protrusive chin is unique human trait

 More prominent in male

 Less prominent in female

 Symphysis Menti

 Limited growth till

fusion

 No widening after
fusion
Mental Foramen
Growth rotation
 The ramus
undergoes
remodeling rotation
this produces
displacement
rotation as a whole
Rotation is of two type
 Internal rotation Matrix

Intramatrix

 External rotation
Growth rotation
 The rotation is considered forward if
growth is more posteriorly than anteriorly.
 The rotation is considered backward if
growth is more anteriorly than posteriorly.

 Short face -forward growth

 Long face -backward growth

 Males-slight forward growth

 Females-slight backward growth
 Factors Affecting Growth
A) Systemic Factors
1. Genetic
2. Hormonal imbalance
3. Nutrition
4. Systemic illness or chronic illness
5. Localized alteration/ diseases of uterus
6. Systemic illness in mother
B) Local factors
1. Vascular abnormality

2. Lymphatic disturbance
3. Neurologic disease
4. Local infection
5. Ear infection or mastoiditis
6. Ankylosis
7. Trauma or fracture
8. Birth injury
Age changes in mandible
Radiographs of midsagital
section’s of mandible

Pre-extraction High well-rounded

Post-extraction
 Knife edge

Low well rounded

With out cortical layer
Low well rounded on crest
with cortical layer on crest
ANOMALIES OF MANDIBLE
 Syndromes associated with mandibular
abnormality

•Pierre-Robin’s syndrome
•Treacher-collins syndrome
Pierre-Robin’s syndrome
Treacher-collins syndrome
ANOMALIES OF MANDIBLE
 Congenital

•Agnathia
•Micrognathia
•Macrognathia
ANOMALIES OF MANDIBLE
 Developmental
•Torus Mandibularis
•Achondroplasia
•Stafne’s cyst
•Odontogenic cyst
Torus mandibularis
Stafne’s cyst
REFERENCES

 Oral histology, development, structure and

function – A.R. Ten Cate, 4th Edition
 The essentials of facial growth – Enlow and Hans,
1st Edition.
 Orthodontics principles and practice – Graber,
3rd edition
 Craniofacial Embryology- GH Sperber, 4th
edition
 Textbook of oral pathology– William Shafer, 5th
Edition
REFERENCES
 Orthodontics art and science-
Bhalajhi,3rd edition
 Human embryology- Inderbir singh,7th
edition
Thank you