INTRODUCTION

• The word "mandible" derives from the Latin

word mandibula, which means "jawbone”.
• The mandible is the largest, strongest and
lowest bone in the human face.
• The mandible sits beneath the maxilla. It is
the only movable bone of the skull
(discounting the ossicles of the middle ear).
• Mandible is unpaired, U shaped long bone of the
body.
• Mandibular movements are attributed to the
complex and innovative type of joint by which it
attaches itself to cranial base.
• The joint is bilaterally present between condylar
process of mandible and glenoid fossa of
cranium. This joint is described as: Ginglymo –
Biarthroidal Joint.
• Mandible has an important anatomic and
functional role to play, and a thorough
understanding of its growth and development,
and the effect that treatment can have on its
development and function is of crucial
importance to the clinician.
 ANATOMY
• It consists of a horse shoe shaped, convex forward,
horizontal portion, the body
• Two perpendicular portions, the rami, which unite with
the ends of the body posteriorly nearly at right angles.
• Two processes-
• The coronoid process is a thin, triangular eminence,
which is flattened from side to side and varies in shape
and size.
• The condyloid process is thicker than the coronoid, and
consists of two portions: the head of condyle, and the
constricted portion which supports it, the neck.
• The mandibular notch, separating the two processes, is
a deep semilunar depression and is crossed by the
masseteric vessels and nerve.
 SURFACES
• External (Convex in outline)
Presents the following:
1. Symphysis menti
2. Mental Protuberance
3. Mental foramen
4. External oblique line
5. Incisive fossa
• Internal (Concave in outline)

1. Mylohyoid line/ridge
2. Submandibular fossa
3. Sub-lingual fossa
4. Genial tubercles.
 BORDERS
• UPPER BORDER (ALVEOLAR PART)
Sockets for lodging the roots of teeth.

• LOWER BORDER(BASE OF MANDIBLE)

Thick rounded become continuous with the
lower border of ramus behind 3rd molar.
Near midline the base shows an oval
depression called the diagastric fossa
 RAMUS
• Flat, quadrilateral part projecting
upwards from the posterior end of
the body on each side.
• SURFACE: Lateral, Medial.
• BORDER: Upper, Lower
Anterior, Posterior.
• PROCESS: Coronoid, Condyloid.
 SURFACE
• Lateral surface: Flat

• Medial surface: Mandibular foramen

Lingula
Mylohyoid groove
 BORDER
• Upper border of ramus is thin and is curved
downwards forming a mandibular notch.

• Lower border is backward continuation of the

base of the mandible.Posteriorly ,it ends by
becoming continuous with the posterior
border at the angle of the mandible.

• The anterior border is thin,while the posterior

border is thick.
 PROCESS
• Coronoid process: Flat and triangular
with the apex pointing upwards while
the base is fused to the upper and
anterior border of ramus.
• Condyloid process: Projects upwards
from the upper and posterior part of
ramus.
-Head of mandible
-Neck of mandible
 MUSCLE ATTACHMENT
Muscle attached on the external aspect of
mandible as follows:
1. Masseter is inserted into the lateral
surface of ramus and at the angle.
2. The buccinator arises from the outer
surface of the body just below the
molar teeth.
3. The depressor labii inferioris arises
from the anterior part of the oblique
line.
4. The depressor anguli oris arises from
the oblique line behind and below the
origin of the depressor labii inferioris.
5. The mentalis arises from the incisive
fossa.
6. Some fibers of the platysma are
inserted into the lower border of the
body
• Muscle attached on the interrnal aspect of
mandible as follows:
1. The temporalis is inserted into the medial
surface of the coronoid process including its
apex, and its anterior and posterior borders.
The insertion extends downwards along the
anterior border of the ramus.
2. The lateral petrygoid inserts into the fovea
on the anterior aspect of the neck.
3. The medial pterygoid is inserted into the
medial surface of the angle and the
adjoining part of the ramus.
4. The anterior belly of the digastric
arises from the digastric fossa.
5. The Genioglossus takes origin from
the upper genial tubercles.
6. The Mylohyoid arises from the
Mylohyoid line.
7. Some fibers of the superior
constrictor of the pharynx take
origin from the posterior end of the
Mylohyoid line.
Mandible play an important role in vital
functions:
1. Aesthetics
2. Speech
3. Respiration (Maintain airway)
4. Mastication
5. Deglutition
6. Facial expression
PRE NATAL GROWTH OF MANDIBLE
• The mandible develops bilaterally within the
mandibular processes of the first branchial
arch, where it is preceded by Meckel's
cartilage.
• On around 22nd day of gestation, first
branchial arch appears.
 1ST BRANCHIAL ARCH
• Precursor of both the jaws:
Maxilla + Mandible

• Initially gives rise to a large mandibular

prominence.

• Mandibular prominence gives rise to a small

maxillary prominence which extends
cranioventrally which forms maxilla.
 COMPONENTS OF 1ST ARCH
• . Cartilage : MECKEL’S CARTILAGE
• Arises 41st – 45th Day I.U.
• It provides a template for subsequent
development of the mandible but most of the
cartilage substance disappears in formed
mandible.
 IMPORTANCE OF MECKLE’S CARTILAGE
• Meckel's cartilage takes no direct part in the
formation of the corpus of the mandible, but acts as
a support not only for the mandibular nerve but for
the membrane bone which will develop later.
• Proximally, Meckel’s cartilage articulates with the
cartilaginous cranial base in the petrous region of
the temporal bone, where it gives rise to the malleus
and incus bones of the inner ear.
• Meckel’s cartilage completely disappears by
approximately 24 weeks of gestation, remaining in
remnant form as the dense sphenomandibular
ligament and giving rise to the malleus and incus.
 MUSCULAR COMPONENT
• Muscles of Mastication.
• Mylohyoid Muscle.
• Ant. Belly of Digastric.
• Tensor Tympani.
• Tensor Veli Palatini Muscle.
• ARTERIAL COMPONENT
Part of Maxillary and External Carotid Artery.

• NERVE COMPONENT
Mandibular division of Trigeminal Nerve.
• The mandibular arch forms the lateral wall of the
primitive oral cavity.

• It gives off the bud from its dorsal end & is called
as the maxillary process.

• It grows ventromedially, cranial to the main part

of the arch, which is now called the mandibular
process.
• The mandibular processes of two sides grow
towards each other and fuse in the midline.
• They now form the lower margin of the
stomatodeum i.e. the lower lip & the lower jaw.
• The lower part of the face is supported by
Meckel's cartilage, which is solid hyaline
cartilagenous rod surrounded by a fibrocellular
capsule.
• This bar extends from near the midline of the
mandibular arch posteriorly into the otic
capsule (developing ear region), where the two
posterior elements later become the malleus
and incus.

• The mandibular branch of the trigeminal nerve

has a close relationship to the Meckel’s
cartilage, beginning two thirds of the way
along the length of the cartilage
• At this point, the mandibular nerve
divides into lingual & inferior alveolar
branches which run along the medial &
lateral aspect of the cartilage,
respectively.

• Anteriorly, the inferior alveolar nerve

divides into incisive & mental branches.
 OSSIFICATION
• By 6 weeks gestation, a condensation of
mesenchyme occurs in the angle formed by
the division of the inferior alveolar nerve and
its incisor and mental branches.
• At 7 weeks, a centre of ossification appears in
the perichondral membrane lateral to the
bifurcation of the incisive and mental nerves.
• From the centre of ossification, the bone
formation rapidly spreads anteriorly to the
midline & posteriorly towards the point where
the mandibular nerve divides into lingual &
inferior alveolar branches
Scheme of centre of ossification of mandible
lateral to Meckel’s cartilage at bifurcation of Inferior alveolar
nerve
• The intramembraneous ossificaton stops
dorsally at the site which will later become the
mandibular lingula.
• Anteriorly, the first branchial arch core of
Meckel’s cartilage meets that of the opposite .

• Posteriorly, the Meckel’s cartilage diverges to

end in the tympanic cavity of middle ear & is
surrounded by the forming petrous portion of
the temporal bone.
• The dorsal end of the Meckel’s cartilage
ossifies to form two auditory ossicles i.e.
malleus & incus.
 FATE OF MECKEL’S CARTILAGE
• The major portion of Meckel’s cartilage
disappears,leaving the mylohyoid groove of the
mandible in which it lay.

• The fibrous sheath surrounding the cartilage

remains as the sphenomandibular and the
sphenomalleolar ligaments.

• A portion of Meckel’s cartilage contribute to

spine of sphenoid.
• The spread of membrane bone encloses the
mental nerve in a groove and forms a plate
extending laterally to the inferior alveolar
nerve.
• From below the groove containing the nerve,
bone formation extends beneath the incisive
nerve and upwards between the incisive nerve
and Meckel's cartilage.
• The groove containing the mental nerve
becomes the mental foramen by the extension
of bone over the nerve. With the formation of
bone over the incisive nerve, the incisive canal
is formed.
 DEVELOPMENT OF CONDYLE
• By approximately 10 ‐12 weeks gestation,
secondary cartilages appear. These are the
symphysial, angular, coronoid and condylar
cartilages.
• The symphysial and coronoid cartilages
disappear before birth.
• The most important cartilage in relation to the
development and growth of the mandible is
the condylar cartilage.
• Secondary cartilage has the characteristics
of both intramembranous bone and certain
histologic and functional features of hyaline
growth cartilage.
• Secondary cartilage is formed in areas of
high stresses and strains within
intramembranous bones, as well as in areas
of rapid development and growth of bone.
• The angular and the coronoid processes of
the mandible also may exhibit the presence
of secondary cartilage because these are
sites of very rapid bone growth associated
with the function of the muscles of
mastication.
• During the 10th week, a spherical codensation of
mesenchyme develops dorsally in future ramal
region, act as primordium of the future condyle.
• Cartilage cells differentiate from its centre, and
interstitial and appositional growth, the cartilage
head increases in size.
• The condylar cartilage attains its fullest form at
about 12 weeks of intrauterine life and the
condylar process appears as a separate carrot‐shaped
blastema of cartilage extending from the ramus
proximal to the mandibular foramen and extending
up to articulate with the squamous (membranous)
portion of the developing temporal bone.
• The articulation between the condylar cartilage
and the squamous portion of the temporal bone
becomes apparent as the temporomandibular
joint (TMJ) by about 12 weeks gestation.
• The condyle grows rapidly at its distal end both
appositionally and interstitially.
• By 14 weeks endochondral ossification is taking
place and the bone thus formed is
indistinguishable from the membrane bone of
the mandibular corpus.
• The condylar cartilage is converted quickly to bone
by endochondral ossification, so that at 20 weeks
only a thin layer of cartilage remains in the condylar
head.
• This remnant of cartilage persists until the end of
the second decade of life, providing a mechanism for
growth of the mandible, in the same way as the
epiphyseal cartilage does in the limbs.(Nanci 2003)
• Histologic analysis of the human TMJ has
demonstrated progressive changes in the thickness
of cartilage and as such the growth activity of the
condyle cartilage throughout development.
• These changes appear to be coordinated with
functional changes associated with occlusal
development.
• The condylar head is separated from the
temporal bone by a thin disk of connective
tissue which appears as a result of two clefts in
the fibrous tissue that form the upper and
lower compartment of the joint cavity.

• Gradually, this collagenous disk thickens as

does the bone forming the joint cavity until the
complete joint is developed.
• The condylar cartilage of
the mandible serves the
uniquely dual roles of an
articular cartilage in the
TMJ, characterised by a
fibrocartilage surface layer
and as a growth cartilage
analogous to the
epiphyseal plate in a long
bone, characterised by a
deeper hypertrophying
cartilage layer.
 DEVELOPMENT OF MENTAL REGION

• A small part of the ventral end of Meckel’s

cartilage forms accessory endochondral
ossicles that are incorporated into the chin
region of the mandible.
• These ossicles become incorporated into the
intramembranous bone when symphysis
ossifies completely during first year of post
natal life and latter serves as a growth site.
 DEVELOPMENT OF THE
CORONOID PROCESS
• The coronoid cartilage appears at about 4 months
of development, located at the anterior border and
top of the coronoid process.
• This secondary cartilage of coronoid process is
thought to grow as a response to the developing
temporalis muscle.
• This cartilage becomes incorporated into the
expanding intramembranous bone of the ramus .
 DEVELOPMENT OF RAMUS
• The ramus of the mandible develops by a
rapid spread of ossification backwards into the
mesenchyme of the first branchial arch
diverging away from Meckel’s cartilage.
• This point of divergence is marked by the
mandibular foramen.
 DEVELOPMENT OF BODY
• As the spread of the new bone occurs
anteriorly along the lateral aspect of the
Meckel’s cartilage ,a trough is formed that
consist of lateral & medial plates that unite
beneath the incisive nerve.

• This trough extends to the midline where it

comes in close approximation with similar
trough formed in adjoining mandibular
process.
• The trough is soon converted into a canal as
bone forms over the nerve, joining the lateral
& medial plates.
• The backward extension of ossification
proceeds in the condensed mesenchyme to the
point where the mandibular N divides into
inferior alveolar & lingual nerves. Here it
forms a gutter which later on converted into a
canal, containing the inferior alveolar nerve.
• From this bony canal, the medial & lateral
alveolar plates of the bone develop i.r.t. the
forming tooth germs that occupy the secondary
trough of bone which later on is partitioned &
occupy individual compartment & is finally
enclosed by the growth of the bone over the
tooth germ. In this way, the body of the
mandible is formed.
• Complete bony union to form a synostosis is
not complete until the end of the first year
after birth.
 DEVELOPMENT OF TMJ
• There is some evidence that malleus and incus
function to provide a movable joint until the
mandibular condyle develops in relation to
glenoid fossa of the temporal bone.
• From 8th to 18th week, this joint may function
in jaw movement until an anterior shift in
temporomandibular articulation occurs.
• TMJ develops at around 10th week and takes
over by 19th week.
• The mandible, at birth is
small, with short ramus, large
gonial angle, and flat
mandibular fossa with no
articular eminence. The
condyles are at the level of
the occlusal plane.
POST NATAL DEVELOPMENT
•Postnatal growth lasts for about the first 20
years of life and is characterized by
declining growth rates and increasing
maturation of tissues.
•Both pre and post natally only a small % of
mandibular growth is endochondral; a far
greater portion is intramembranously
developed.
• In contrast to maxilla, both endochondral
and periosteal activities are important for the
growth and development of mandible.
 A thin line of fibrocartilage and
connective tissue exists at the midline of
the symphysis to separate the right and the
left mandibular bodies.
 This initial separation is gradually
eliminated between the 4th and 12th month
post natally when ossification converts the
syndesmosis into a synostosis uniting the
two halves.
• In the superimposed
mandibles several
contrasting relationships are
seen between the two
growth stages.
• The mandible has enlarged in
all dimensions. The
predominant course of
growth movement, however,
is posterior.
• The right and left condyles
have become only slightly
separated.
• The body has increased
proportionately in breadth.
• Both the body and the ramus
have become significantly
lengthened.
 FUNCTIONAL UNITS
• Mandible consists of
various subunits.These
subunits of mandible
are influenced in its
growth pattern by
functional matrix that
acts upon it .
• Functional units.(Graber et al. 2011)
• 1. The mandibular condyle is closely related to the articular
function of the TMJ and movements of the mandible. The condylar
cartilage also plays a significant role in mandibular growth.
• 2. The gonial region of the mandible, at the inferior aspect of the
ramus, is related to the function of the masseter and medial pterygoid
complex of muscles.
• 3. The coronoid process is primarily related to the temporalis
muscle. Variation in the growth and form of each of these regions is
due in large part to variation in the function of the muscles of
mastication.
• 4. The alveolar process of the mandible functions to provide
support for the dentition.
• 5. The body of the mandible, extending from the mandibular
foramen to the mental process, provides support and structural
connection between the various functional components of the
mandible.
• It appears as if mandibular growth is forward and
downwards, and as such one could suppose that the
mandible enlarges by growth at the anterior end.
• Studies by Brash and Brodie ( Brash 1924; Brodie
Adamson 1941, as cited in Enlow 1964), has
however shown that growth mainly happens in a
posterior direction, with forward and downwards
displacement.
• A. Growth of the mandible
as viewed from the
perspective of a stable cranial
base: the chin moves
downward and forward.
• B. Mandibular growth as
viewed from the perspective
of vital staining studies that
reveal minimal changes in
the body and chin. There is
growth and remodelling in
the ramus moving it
posteriorly.
• The correct concept is that
the mandible is translated
downward and forward and
grows upward and backward
in response to this
translation. (Profitt 2013)
• The main sites of postnatal mandibular growth
are at the condylar cartilages, the posterior borders
of the rami, and the alveolar ridges.
• These areas of bone deposition account
grossly for increases in the height, length and width
of the mandible
• During the first year of life appositional growth is
particularly active at the alveolar border, at the
distal and superior surfaces of ramus, at the
condyle, along the lower border of the mandible
and on its lateral surface
• Growth of the mandible was thought to occur
principally by growth at condyle. Superior and posterior
growth of condyle presses against the glenoid fossa/
cranial base providing an anterior thrust to displace the
lower jaw forward.
• Moss considers that it is not the growth of condyle that
leads to anterior displacement, instead, the expansion
of orofacial capsule leads to passive displacement of
mandible with secondary adaptive growth in the
condyle. (Moss & Salentijn 1969)
• Although the main translatory growth is by addition at
the condyle and posterior border of the ramus, there
are numerous localized growth sites that grows and
remodels during the growth process of the mandible.
 DEVELOPMENT OF CONDYLE
• The condyle is a major site of growth involved in
the upward and backward elongation of the
ramus, in combination with coordinated growth
activity by the periosteum and endosteum in
cortical parts of the condyle, neck, and ramus.
• The Condylar growth centre is however, not the
primary centre for the growth of the entire
mandible and is not responsible for governing
overall mandibular growth.
• The condylar growth mechanism represents
direct linear growth in a field involving pressure,
and it is a composite of articular endochondral
(pressure adapted) growth and membranous
(cortical) growth.
• The endochondral and membranous growth are
mutually interdependent processes of
enlargement, and produces a movement of the
entire condyle that results in the elongation of
the ramus.
• As it grows, the deeper portion of the
proliferating cartilage becomes continuously
replaced by endochondral bone, thereby
producing medullary bone additions in the
condyle and its neck. This process is
continuous, and as the condyle moves by
growth, former levels of the condyle become
simultaneously converted into the elongating
neck.
• The outer cortical plate is produced by the
activity of the periosteum and endosteum
independent of the growth cartilage but in
conjunction with it.
•The neck is sequentially derived from
the head by remodelling, a marked
reduction in width takes place.
In sequence: Condylar head parts
incorporated into new upper Condylar
neck Upper parts of the neck undergo
remodelling conversion into the new
lower parts The lower portions receive
direct remodelling changes into the
ramus proper.
• The condylar head is much
broader than the neck
beneath it.
• Reduction is brought
about by surface
resorption of bone on
periosteal side of the
cortical plate together
with continued, Endochondral bone formation at
(b) in medullary portion of
proportionate deposition condyle.The enclosing bony
of bone on the endosteal cortices (c) are produced by
surface. periosteal–endosteal osteogenic
activity.
• The growth and
remodelling processes in
the condylar neck follow
the V principle. New
bone is added to the
inner side of the V
‐shaped neck while bone
is removed from the
outer (periosteal) surface
at the same time.
• The endosteal manner of cortical growth
involves a process of cancellous compaction
which brings about a conversion of medullary
spongy bone into compact cortical bone.
• The inward drifting cortex continuously moves
into areas occupied by medullary cancellous
bone, and deposition of endosteal bone in the
irregular spaces reduces their lumen size to
that of ordinary vascular canals.
 CORONOID PROCESS
• The growth of the coronoid process follows the
enlarging ‘V’ principle.
• The two coronoid processes are positioned in such
a manner that they form vertically oriented V.
• The movement of this V in a direction toward its
wider end involves new bone deposition on the
inner side with bone removal from its outer
surface
The combination of lingual deposition and
buccal resorption using the V‐principle
produces:
1. Drift of the coronoid process in upward and
backward directions.
2. The apices of these processes move apart in
lateral directions as they grow in a superior
course.
3. A progressive relocation of the base of the
coronoid process, adjacent to its junction with
the ramus, successively higher as it follows the
upward moving apices.
Schematic showing the V‐principle of growth of the Coronoid
process. Note that the two coronoid processes become larger
and higher and that they grow farther apart at their apices (3)
by additions on the lingual surface ( 4') with contralateral
removal from the buccal side ( 4). Note also that this same
mechanism of lingual deposition brings their bases toward
each other (5).
 DEVELOPMENT OF RAMUS
• The ramus moves progressively
posterior by a combination of
deposition and resorption.
Resorption occurs on the anterior
part of the ramus while deposition
occurs on the posterior region.
This results in drift of ramus in
posterior and superior direction.
• The key role of ramus
is placing the corpus
and dental arch into
everchanging fit with
growing maxilla and
face has limitless
structural variations.
• This is by critical
remodelling and
adjustment in ramus
alignment, vertical
length and AP
breadth. Schematic showing deposition at
posterior margin of the ramus
 FUNCTION OF REMODELLING OF
RAMUS
1. To accommodate and provide an attachment
base for the increasing mass of masticatory
muscles.
2. To accomadate the enlarged breath of
pharyngeal space.
3. To accommodate the vertical lengthening of the
nasomaxillary part of the growing face.
4. To facilitate the lengthening of the corpus which
in turn accommodate the erupting molars.
 DEVELOPMENT OF BODY
• The body of the mandible is growing
continuously into areas previously occupied by
the posteriorly moving ramus.
• The posterior portion of the body becomes
consecutively converted from the former
ramus by direct structural remodelling due to
the V mechanism of growth.
• New bone deposits are
added onto the lingual
surface of the
V‐shaped, anterior
portion of the ramus
and posterior portion
of the body as they
both move posteriorly
toward the wide end
of the V.
• RAMUS AND CORPUS REMODELLING:-
• By the progressive addition of new periosteal
bone on the lingual surface, the anterior part
of the ramus grows and moves in a lingual
direction to accommodate alignment with the
growing body.
• The lingual addition of bone thus serves to
bring the basal part of the V toward the
midline. This provides successive relocation of
the ramus, during this conversion, into the
more lingual position of the elongating body
and dental arch.
• The broad resorptive zone that begins on the
lingual side of the neck just beneath the
condyle extends obliquely downward and
forward across the ramus and passes beneath
the lingual tuberosity.
• It then continues forward to about the level of
the canine or first premolar
• In the forward part of the mandibular arch lingually,
this resorptive zone narrows progressively until it
terminates.
• It provides:
• (I) proportionate cortical drift in a buccal direction
by the formation of endosteal bone.
• (II) it undercuts the diminishing ledge found in this
alveolar area.
• The result is a lateral movement of the lingual
cortex associated with the widening of the
mandibular arch and an elevation of its superior
portion as the entire arch becomes heightened.
• On the buccal side, the whole
mandibular arch is depository in
nature except, the mental
region.
• The entire basal portion of the
arch is also depository. This
enlarges the inferior border of
the mandible in a downward.
• In the posterior region of the
body, the periosteal surface of
the buccal cortex is primarily
depository. Its superior surface,
is resorptive in conjunction with
the remodelling conversion
from ramus to body.
 LINGUAL TUBEROSITY
• It is the direct anatomic equivalent of
maxillary tuberosity. The lingual tuberosity is a
major growth site for mandible.
• The lingual tuberosity protrudes noticeably in
lingual direction (i.e. medially)
• It is a boundary between two basic parts of
mandible i.e. is ramus and corpus (body) of
mandible.
• Prominence of tuberosity is increased by
presence of large resorptive field just
below it.This field produce a
depression,called lingual fossa.
• The lingual tuberosity grows posteriorly
by deposition on its posterior facing
surface.
• It remodels (relocates) in an almost
directly posterior direction with only a
relatively slight lateral shift.
• The posterior growth of the
tuberosity is accomplished by
continues new deposits of bone on its
posterior facing exposure.
• As this take place the part of ramus
just behind the tuberosity grows
medially thereby coming in line with
axis of arch and thereby lengthening
the corpus.
Schematic showing the complex remodelling patterns in the Body of the
Mandible. A "buccal drift" of the posterior mandibular body is seen in a,
b, and c as bone is added on the buccal side with corresponding
resorption and endosteal bone formation on the lingual side. An area of
periosteal bone deposition on the lingual surface has produced the
lingual tuberosity. In the area of the chin (e) the cortex on both sides
grows in a generally lingual direction with some periosteal deposits
being added at the apex of the chin itself.
 DEVELOPMENT OF MENTAL REGION
• The mental region of the young mandible
becomes progressively more prominent with
increasing age due to involvement of a differential
combination of surface resorption and deposition
in the different parts of the mandibular arch in the
region forward of the bicuspids.
• It is poorly developed in infants.

• It develops almost as an important subunit of the

mandible that is influenced by sexual as well as
specific genetic factors.
 Common variations in
endosteal‐periosteal cortical patterns

Solid white lines indicate surfaces that grow by

additions of periosteal deposits.
Dotted lines represent surfaces that undergo
resorptive removal during growth and
remodelling
• The chin becomes significant at adolesence &
arises from development of the mental
protuberance & tubercles & lingual movement
of the labially inclined mandibular incisors.
• The protuberance is usually marked by
deposits of periosteal bone.
• These periosteal deposits encircle the base and
continue onto the lingual side where they
extend for the full height of the lingual cortex
in the genial region.
• The maturation of the chin in shape and size
proceeds slowly through the postnatal period
of facial growth.
• The forward shift of the growing mandibular body changes
the direction of the mental foramen during infancy and
childhood.
• The mental neurovascular bundle emanates from the mandible
at right angles or even a slight forward direction at birth.
• In adulthood the mental foramen (and its neurovascular
content) is characteristically directed backward.
• This change may be ascribed to forward growth in the body
of the mandible, while the neurovascular bundle ‘drags
along’.
• The combination of
continued periosteal
deposition around the
base and apex of the
chin, together with
periosteal resorption and
endosteal deposition
inthe alveolar region
above it, serves to
progressively enlarge the
whole
mentalprotuberance and
change its contour.
• Resorption of bone at the anterior alveolus thins
the bone on the surface of roots of lower anterior
teeth. Danger of exposure of root is avoided by
gradual uprighting of lower incisors that happen
with age.
• The cortical region at or just above the chin is the
only place on the entire surface of the mandible
that remains stable during postnatal growth. This
is the reason for it serving as a useful site for
superimposing successive radiographs.(Graber et
al. 2011)
 ALVEOLAR PROCESS
• The alveolar process is not present when teeth
are absent. It develops in response to the
presence of tooth buds as a protective trough,
& become superimposed on a ‘basal bone’ of
the mandibular body.

• Its formation is controlled by dental eruption

and it resorbs when teeth are exfoliated or
extracted.
• The alveolar process serve as important buffer
zones helping to maintain occlusal relationship
during differential mandible and midface
growth.

• The alveolar bone adds to the height ,thickness

of the body of the mandible & manifests as a
ledge extending lingually to the ramus to
accommodate the third molars.
 AGE CHANGES IN
MANDIBLE :
1)At Birth
• At birth, the mandible is in two
separate halves united in the
median plane by fibrous tissue -
symphysis menti.
• A trace of separation near the
alveolar margin may still be visible
at the beginning of the 2nd year.
• The body elongates more
especially behind the mental
foramen.
 2) 1st and 2nd year

• During the 1st and 2nd year,

as the prominence of chin
develops the mental foramen
alters in direction.

• Proliferation of condylar
cartilage leads to increase in
vertical height of ramus and
downward and forward
growth of mandible.

• Also the distance between the

condyle increases as the base
of skull widens.
• As the mandible increases in size bone is laid down
along the posterior borders of mandibular ramus and
the coronoid process and resorption of bone occurs
along their anterior borders.

• This remodelling goes on until the bone has reached

the adult size and it enables the alveolar part to
lengthen sufficiently to provide the necessary space
for the permanent molar teeth.
 3) Adults
• The angle of mandible
diminishes as the height of
ramus increases with age but
contour of the angle of
mandible remains unaltered.
4) Old age
• Bone is decreased in size as
the teeth are lost.
• Following the loss of teeth the
alveolar part is resorbed and
consequently the mandibular
canal and mental foramen are
close to the alveolar border.
• Angle is 140 degrees and neck of
mandible is bent backwards.

• The process of resorption affects chiefly

the thinner of the two alveolar walls .

• As alveolar ridge resorbs the mandible

widens.
 CLINICAL IMPORTANCE OF
MANDIBULAR GROWTH

• The mandible is the bone in the craniofacial

complex with the most post‐natal growth
potential. As such it would be of great value to
be able to manipulate its growth during
orthodontic treatment.
EFFECT OF REMOVABLE FUNCTIONAL
APPLIANCES
• Functional appliances are designed to alter the
position of the mandible, both sagittally and
vertically, to induce supplementary
lengthening of the mandible by stimulating
increased growth at the condylar cartilage
(Marsico et al. 2011)
• Marsico et al (Marsico et al. 2011) did a systematic
review of the available literature on the effect of
removable functional appliances. 4 articles, based on
data from 338 patients (168 treated vs 170 controls)
with Class II malocclusion in the mixed dentition, were
selected for the final analysis. The quality analysis of
these studies were at the medium‐high level.
• The results obtained from the analysis showed a
statistically significant difference of 1.79 mm annual
mandibular growth of the treatment groups compared
with the control groups.
• This meta‐analysis showed that the treatment resulted
in a change of skeletal pattern; however, these
effectively small increases of the mandibular length,
even if statistically significant, appear unlikely to be
very clinically significant.
• Koretsi et al (Koretsi et al. 2015) included seventeen
studies (1031 patients; mean age: 10.6 years), with most
of them originating from university clinics and
reporting short‐term effects.
• Their results were as follows:
1. Class II malocclusion of treated patients was
moderately improved.
2.Minimal reduction of SNA angle.
3. Minimal increase of SNB angle.
4.Upper central incisors were significantly retroclined.
5. Significant proclination of the lower incisors was
observed .
6.Influence of RFA treatment on the soft tissues was
evident, as indicatedby the significant changes of
especially the labiomental angle.
 EFFECT OF FIXED FUNCTIONAL
APPLIANCES
The findings of the studies for the correction of
Class II malocclusion due to mandibular
retrognathia by using Fixed Functional Appliances
were contradictory, where some authors found
favourable treatment outcomes based on
mandibular growth, attributed either as a
mandibular length augmentation or effective
condyle growth (e.g. Franchi et al), others dispute
the magnitude of these effects (e.g. Cozza).
Moreover, existing evidence indicates that the
dentoalveolar changes produced by functional
treatment outweigh the skeletal changes attained
(e.g. Cope).
• Zymperdikas (Zymperdikas et al. 2016) did a systematic review of the
literature available on the effect of Fixed Functional Appliances and
the following was found. Nine studies were included (244 patients;
mean age: 13.5 years and 174 untreated controls; mean age: 12.8
years) reporting on cephalometric effects directly after the removal of
FFAs.
• FFAs were found to induce a small reduction of SNA angle
• Small increase of SNB angle
• Moderate decrease of ANB angle
• Significant dentoalveolar and soft tissue changes.
• Significant retroclination of the upper incisors was observed
• Lower incisors were significantly proclined.
• A statistically significant decrease in the interincisal angle.
• The influence of FFAs on the soft tissues was significant , with the
labiomental angle providing the more evident change . Further, the
H‐angle was slightly decreased, while the N′SnPg′ angle was slightly
increased compared to untreated patients.
 EFFECT OF FIXED FUNCTIONAL APPLIANCES IN COMBINATION WITH
MULTI‐BRACKET APPLIANCE
• Ishaq et al (Ishaq et al. 2016) did a systematic review of
available literature of fixed functional appliances. They used
seven articles in the qualitative synthesis and 5 in the
meta‐analysis
• Their results could be summarised as follows:
• The positional changes (SNB angle) did not significantly differ.
• Regarding effective mandibular length, no difference between
the treated and control patients was observed in the pubertal and
post‐pubertal groups.
• Little impact on the vertical dimensions was observed.
• It may therefore be tentatively inferred that FFA can be used in
high‐angle cases without concerns relating to excessive increases
in the vertical dimension.
 EFFECTS OF CHIN‐CUP THERAPY
• A systematic review done by Liu (Liu et al. 2010), stated that no RCTs
were found for the outcomes of chin cup therapy. All studies used in this
review were cohort studies, with shortcomings such as no randomization,
no previous estimation of sample sizes, and no discussion on the
possibility of type II error occurring.
• Their findings were:
• SNB angle: All of the studies reported a significantly better result in the
chin cup group compared with the control group.
• ANB angle. Chin cup therapy significantly increased the ANB angle,
and there was an improvement of the maxillomandibular relationship.
• Gonial angle (Ar‐Go‐Me). Results showed that the gonial angle
increased.
• The studies included there was no significant change in these variables -
Mandibular length (Cd‐Gn), body length (Go‐Me), and ramus height
(Ar‐Go).
 DEVELOPMENTAL ALOMALIES
1. Macrognathia or
Acromegaly: due to
large jaw size producing
prognathism. Such
conditions may be due to
hormonal imbalances
like hyperpituitarism.
2. Micrognathia – Small
jaw size seen in number
of congenital disorders
like Pierre Robin
syndrome.
3. Agnathia: Case where
mandible may be grossly
deficient or absent due to
neural crest deficiency.
4.Treacher Collins Syndrome
• In this congenital syndrome both the maxilla and
mandible are underdeveloped as a result of
generalized lack of mesenchymal tissue. Recent
work suggest that the problem arises because of
excessive cell death in the trigeminal ganglion
which secondarily effects neural crest cells. Those
affected exhibit short curved mandible and lack of
middle ear development which results in loss of
hearing.
.
• A characteristic facial appearance
is:
• Down‐slanting palpebral
fissures;
• Zygomatic, supraorbital and
mandibular hypoplasia;
• Colobomas (areas of tissue
deficiency) of the lower eyelids;
• Severe malformation of the ears.
• Isolated cleft palate.
• Severely class II skeletal pattern
with increased vertical
proportions, due to mandibular
deficiency and posterior
mandibular growth rotation.
5. PIERRE ROBIN
SYNDROME:
This is a defect of the
branchial arch and is
characterized by a short
mandible, enlarged
tongue and possible
cleft palate
6. Hemifacial Microsomia: As the
name suggests it is primarily a
unilateral and always an
asymmetric problem. Typically
the external ear is deformed and
both the ramus of the mandible
and associated soft tissue are
deficient or missing.
7. Mandibular Cleft: Midline
defects also occur in mandible
although they are rare. They
result from a lack of development
of the midline of the first
branchial arch resulting in both
skeletal and soft tissue deficiency
at that site.
8. Deformities can also be seen in:
- Down’s syndrome (mandibular prognathism)
- Progeria – hypoplastic mandible
- Cat – cry syndrome
- Turners syndrome
 CONCLUSION
• All the events taking place during development of
mandible play an important role in determining
the final structure of mandible, any deviation of
which can give rise to various abnormalities in the
oro facial region.
• As far as orthodontist is concerned a thorough
knowledge of growth and development is
important for proper diagnosis and treatment in
any malocclusion concerning the mandible.
• Armed with this knowledge the clinician can
make informed decisions as to possible treatment
possibilities, be it orthodontic or surgical.
 REFERENCES
1. Craniofacial Development - Sperber
2. Graber's Textbook of Orthodontics: Basic
Principles and Practice, 6th edition.
3. Orthodontics , the art and science- S. I. Bhalaji
4. Oral and Maxillofacial pathology – Neville 13th
edition
5. Langman’s Medical Embryology 13th edition
6. BD Chaurasia's Human Anatomy Regional and
Applied Dissection and Clinical: Vol. 3: Head-
Neck Brain 8TH edition