Prenatal and post natal

growth of mandible
DR.Pranali Agawane
First year MDS
Dept of orthodontics and dentofacial orthopaedics
Contents
• Introduction
• Anatomy
• Phylogenetic histrory of mandible
• Prenatal growth of mandible
• Post natal growth of mandible
• Structural signs of growth rotation
• Age changes in mandible
• Unloaded nerve concept
• Growth timing
• Archial growth concept
• G axis growth factor of mandible
• Anomalies of mandible
Introduction

• Develops from the 1st pharyngeal arch known as the Mandibular arch
• Largest and the strongest bone of the face.
• Serves for the reception of the lower teeth.
• Horseshoe-shaped body, and two perpendicular portions, the rami
which projects upwards from the posterior ends of the body and
provide attachment to muscles.
Muscle attachments.
Inner surface of left half of mandible
Phylogenetic history of mandible and TMJ
• In reptiles mandible consists of a number of bones united at sutures
only uppermost bone, dentary, carries the ankylosed teeth
• Mandibular articulation formed by a separate bone of mandible –
articulare and separate bone of the cranium – Quadratum
• During period of transition dentary attains larger proportions.
• Other mandibular bones diminish in size or disappear. Only dentary
forms the mammalian mandible
• Other bony components lost or changed to ossicles of ear
Articulare – malleus
Quadratum - Incus
 Reptile Mammal
• Mandible – number of bones Teeth with PDL
united by sutures

• Dentary – carries ankylosed TMJ

teeth

Condylar process
• Articulare – Quadratum joint
MANDIBLE
DENTARY
Prenatal growth of
mandible
Mandible
• derived from the 1st arch.
• arises as bilateral processes that grow ventromedially and fuse in the
midline.
• At about 5th week IUL,
bilateral rod like cartilaginous condensations develop from the site of
future ear to the midline
• At 36-38 days of IUL,
Mesenchymal condensations develop lateral to Meckel’s cartilage.
at 6th week of IUL,
ossification starts from the same
location near the future mental foramen.
• As the ossification proceeds medially towards the midline, Meckel's
cartilage largely disappears and what is left of it becomes the ear
ossicles —malleus and incus,
spine of sphenoid,
anterior ligament of malleus
sphenomandibular ligament
genial tubercle of the symphyseal region
• At 10th week of IUL (fetal period),
- Condylar cartilaginous condensation appears as cone shaped
projection
-The cartilage cells of the condylar process differentiate and increase in
number, thus increasing the size of the condyle.
-Cartilage undergoes both interstitial and appositional growth.
• at 14th week of IUL
-Most of the cartilaginous substance is replaced with bone by about the
midfetal period.
-The presence of cartilage in the superior end may be responsible for
the growth of mandible in the postnatal life.
Ossification
• Second bone (next to clavicle) to ossify in body
• Greater part ossifies intramembranously
• Each part of mandible ossifies from only one centre
• This centre appears at about 6th week of i.u life
in the mesenchymal sheath of meckels cartilage near the future
mental foramen.
INTRAMEMBRANEOUS • ENDOCHONDRAL

• Body of mandible except • Symphysis of mandible

anterior part • Ramus above mandibular
• Ramus of mandible till foramen
mandibular foramen • Coronoid process
• Condylar process
• The left and right sides of mandible are separate at birth.
• The ramus of mandible is relatively short and low.
• The coronoid and condylar process of the fetal mandible are at the
level of the occlusal plane.
• Coronoid process is bigger than the condylar process.
• height is gained by alveolar and ramal growth.
• The mandibular canal is low in position.
• The buds of deciduous teeth are contained in the mandibular corpus.
Post natal growth of
mandible.
• 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.
• Mandible is formed of numerous micro skeletal units,
- alveolar,
- condylar,
- coronoid,
-ramus,
- symphysis etc
• Mandible is the best example to explain expanding V principle.
• Every part of the bone undergoes remodeling following the expanding
V principle,
-apposition on the inner aspect of V
-resorption on the outer aspect
Condyle
• Superior and posterior
growth of condyle presses
causes an anterior thrust to displace
the lower jaw forward.
•Superior surface of condyle is depository.
Only the cap of condyle undergoes
endochondral ossification,
• the rest of the condyle and the neck of
condyle grows by intramembranous
ossification (cortical remodeling).
•The condyle grows like an expanding V.
Resorption -The neck of condyle on the
buccal and lingual surfaces
Deposition - on the condylar head
• According to Petrovic, the secondary cartilage(eg condyle) is more
open to external forces.
• It can be manipulated by external environmental influences.
• The cells of zone of growth in secondary cartilage, thus, are exposed
to the environment and are moldable to external influences.
• This is used to advantage in functional treatment
Ramus
• This concept was proposed by Hunter.
• resorption
at the anterior border of ramus
• Deposition
at the posterior border
• ramus is shifted to a more
posterior location and
corpus lengthened.
Ramal remodelling: Hunterian concept
• Mandible undergoes
a rotational pattern of growth.
• uprighting,
• there is selective deposition/resorption pattern
in the posterior and anterior borders
• ramus appears to have rotated slightly to change the angulation
though it is in the same position.
• There is not only change in angulation of ramus but there is also an
increase in vertical height of ramus.

Ramus: uprighting and direction of rotation

Mental foramen
• With the remodeling of ramus posteriorly, the
mandibular foramen maintains its position.
• Deposition –anterior rim
• Resorption – posterior rim
• it also shifts posteriorly
Mental foramen implications
• Administration of local anesthetic to mental nerve : at right angles to
body in infants & children; obliquely from behind in adults
• Location of mental foramen also alters its vertical relationship within
body of mandible from infancy to old age
• Dentulous, midway between upper & lower borders
• Edentulous, appears near upper margin of thinned mandible
Coronoid process
• resorption - the buccal surface of the coronoid process.
• Deposition -on the medial side of coronoid process
• It causes (v principle), the coronoid process is to grow in length, with
increase in thickness, an increase in height.
Ramus to corpus remodelling
conversion:
It is not a straight line backward growth
process as viewed in 2 D plane.
Antigonial notch
• A single field of surface resorption is
present on the inferior edge of the
mandible at the ramus-corpus junction.
• This forms the antegonial notch
by remodeling from the ramus just
behind it as the ramus relocates
posteriorly.
Ramus to middle cranial fossa relationship

• Horizontal enlargement of the middle cranial fossa and

brain growth advance the nasomaxillary complex by
forward displacement.

• The horizontal span of the pharynx correspondingly

increases.

• The ramus must necessarily increase to an

equivalent extent.
Corpus (body of mandible)
• depository -the outer surface
• resorptive - the inferior aspect
of the medial surface
• viewing the medial surface of the ramus,
it is seen that the remodeling is in the form of 'L',
•the depository area,
extending from the superior half of
medial surface of corpus to the
anterior half of medial surface of the
ramus (below coronoid).
•The resorptive area
follows depository area, from inferior
half of medial surface of corpus to
posterior half of medial surface of
ramus (below the condyle)
•Increase in height of alveolar
bone accompanies eruption of teeth
Symphysis
•The remodeling pattern tries to accentuate the
prominence of the chin.

Resorption -the area of anterior surface of alveolus above

the chin
deposition - The lingual periosteum of the symphysis
Lingual tuberosity
•If viewed from the occlusal aspect, lingual
tuberosity appears to be in line with the dental
arch whereas ramus is slightly away along the
arms of the expanding V.
•Deposits on the tuberosity will cause a definitive
posterior growth of the posteriorly facing
tuberosity
•The region below lingual tuberosity is resorptive.
Structural signs of growth rotation of
mandible -Bjork
• Seven structural signs seen on lateral head films for the identification
1 Inclination of condylar head
2 Curvature of mandibular canal
3 shape of lower border of the mandible
4 inclination of symphysis
5 internicisal angle
6 interpremolar or intermolar angle
7 anterior lower face height
AGE CHANGES IN MANDIBLE
Age changes in
mandible
At birth
•Two halves of mandible are united
by fibrous symphysis menti.
•Alveolar process not yet formed.
•Ramus is quite short.
•Minimum condylar development.
•Coronoid process projects above
condyle.
In infancy and
children
•Two halves of mandible ossifies by ossification of
symphyseal cartilage
•Body elongates to accommodate erupting first
molar.
•Development of chin and alveolar process occurs
.
•Mental foramen opens below the sockets of the
two deciduous molars near the lower border
•Mandibular canal runs near lower border angle is
obtuse
•The coronoid process is large and projects
upward above the level of condyle
In adults
•Mental foramen :opens midway upper
and lower border .
•The mandibular canal runs parallel with
mylohyoid line .
• The angle reduces to about 110 or 120
degrees because the ramus becomes
almost verticle .
 Unloaded nerve concept
• The skeletal units and growth fields fulfill the
demand of protection of mandibular nerve by
formation of bone around .
• The most constant part of mandible is arc from
foramen ovale to mandibular foramen and mental
foramen .
• The basal tubular portion of mandible serves as a
protection for the mandibular canal and follows
logarithmic spiral in its downward and forward
movement
Growth timimg
Growth of width of mandible is completed first, then growth in length and finally
growth in height
 Width of mandible
• 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
Length of mandible
• Growth in length continues through puberty
• Girls—14-15 years
• boys---18-19 years
Height of mandible
• Ramus height increases correlate well with corpus length & overall
mandibular length
• On an average, ramus height increases 1-2 mm / yr.
• Alveolar process height increases highly correlate with eruption
Archial growth concept of mandible

Principle
“A normal mandible grows by superior-anterior ( vertical )
apposition at the ramus on a curve or arch which is a segment formed
from a circle ”.
-Ricketts 1972
Xi point – centroid of the
ramus of mandible

Pm point – protuberance
menti

Dc point – point of bisection

of the condyle
neck as high as
possible
After superimposing on Dc-Xi-Pm axis , it was found that mandible on an
average bend one-half degree per year .
 A
C
B

Curve A – passes through Dc, Xi and Pm did not produce enough bending , so
that in prediction of growth of mandible over a span of time, the
resulting mandible would be too obtuse.
Curve B – passes from the tip of coronoid process , Pm point and the anterior
border of the ramus at its deepest curve.
Curve C – represents the best possible curve for the growth of mandible.
• According to Ricketts , the archial movement of the mandible pushes the
symphysis or the chin under the denture as the teeth erupts upwards and
forwards. That’s how, chin button develops despite minimum apposition in
this area.
 G axis growth vector of mandible
• A study was undertaken to establish an improved
descriptive growth axis for the mandible, herein
defined as the G-Axis.
• The length of this axis is determined by Sella (S)
superiorly and G-point inferiorly.
Anamolies of mandible
1.Macrognathia
2. micrognathia
3. Agnathia
4. Robin sequence
5.Hemifacial microsomia or Goldenhar’s syndrome
6. Mandibular cleft
Macrognathia :
• Abnormally large jaw
• Associated with certain condition
eg pituitary gigantism
pagets disease
acromegaly
Micrognathia :
• Small jaw,either maxilla or mandible may be affected
• True micrognathia –congenital
• Acquired micrognathia – postnatal origin
 Agnathia

Hypoplasia or absence of
mandible
4 Robin sequence
• Previously known as Pierrie Robin syndrome
• Consist of 3 essential components
1.micrognathia or retrognathia
2.Cleft plate
3.Glossoptosis
5.Hemifacial microsomia or Goldenhar’s
syndrome
• Due to early loss of neural crest cells.
• Neural crest cells with the longest
migration path, those taking a
circuitous route to lateral and lower
areas of face are most affected.
6 mandibular cleft

Failure of mesodermal penetration

and merging of mandibular process
References

• Contemporary orthodontics 4th edition- William R Proffit

• Textbook of Craniofacial growth- Sridhar Premkumar
• Essentials of facial growth by Enlow
• Archial growth of mandible by Ricketts in 1972
• Association between structural sign of mandible and skeletal
morphology – Angle Orthodontist 2005
• B D Chaurasia’s -human anatomy -4th edition
THANK YOU