Clinical application of Growth

1. 1 Clinical application of growth Clinical application of growth Prepared by: Prepared by: Dr. Mohammed Alruby Dr. Mohammed Alruby C Clinical linical application of growth application of growth Dr. Mohammed Alruby Dr. Mohammed Alruby

2. 2 1-Timing of growth spurts Time prenatal Postnatal a-infantile Female Immediately before birth 1 -3 years very active in 1st year and 1st few months – 25cm /year Male Immediately before birth 1 – 3 years very active in 1st year and 1st few months 25cm /year 8 -11 year 6cm /year 14 -16 year 8 -12cm /year b-mixed dentition c-pubertal spurt 7-9 year 6cm /year 11 – 13 year 8 -12 cm/ year Growth spurts: certain periods where sudden accelerate of growth occurs 2-Change in craniofacial by age Site Cranium Maxilla Mandible 1 -5 year 85% 45% 40% 5 –10 year 11% 20% 25% 10 – 20year 4% 35% 35% 3-Changes in dental arch Maxillary: Intercanine width will increase by 6mm from 3 – 13 year Inter-molar width will increase by 2mm from 3 – 5 year and 2mm from 10 -13 year Mandibular: Intercanine width will increase by 3 – 7mm from 3 – 13 year Intermolar width will increase by 1- 5mm from 3 – 5 years And: 1mm from 8 13 years = median diastema should not be closed before the cusp tip of canine passed beyond the apical 1/3 of lateral incisor 4-Maxillary 1st permanent molars width increase significantly more than lower arch due to: a-Lower erupted tipped in lingual direction b-Both lower 6 move mesially due to late mesial shift assuming diameter along convergent dental arch 5-Ugly duckling stage (Broadbent phenomenon): Upper right and left canine pass on the distolabial surface of U2 right and left which leading to fan shape of upper central incisors. a-Canine passing against their apices b-The width at the base of the nose has not yet attained its proper dimension 6-Incisor liability: (Warren Mayne) The difference in size between deciduous and permanent incisors Permanent incisors are large in size by 7mm in upper arch and 6mm in lower arch this difference called liability which is corrected by: a-Interdental spacing in deciduous teeth: 4mm in U, 3mm in L C Clinical linical application of growth application of growth Dr. Mohammed Alruby Dr. Mohammed Alruby

3. 3 b-More labial inclination in lower incisors: 2mm c-Primate space: mesial to U3 and distal to L3 d-Increase intercanine width: 3mm 7-Changes in arch length: Decreased by eruption of deciduous dentition---- then Increased by eruption of incisors permanent ------ then Decreased by molar eruption and mesial shift 8-Mandibular angle: Decreased by age: 170 degree at birth ------- to 124 degree in adult Due to forward movement of mandible and action of elevating muscles 9-Pre-dental stage: a-Retrognathic gum pad corrected with forward growth of mandible b-Anterior open bite: corrected by eruption of deciduous anterior teeth c-Simple hinge movement only corrected by eruption of incisors and molars d-Infantile swallowing: corrected at end of 1st year when children are fed solid food 10- In primary dentition stage: a-Anterior deep bite corrected by eruption of primary molars and attrition of anterior teeth b-Flush terminal plane: corrected to Class I molars by late mesial shift c-Anterior spacing: corrected by eruption of permanent teeth 11-In mixed dentition stage: a-Mid line diastema and ugly duckling stage: corrected by eruption of maxillary permanent canine b-Lingually erupted mandibular incisors: corrected by tongue pressure and spacing in primary dentition c-End to end molar relationship: corrected by late mesial shift (utilize lee way space) d-Anterior deep bite: corrected by eruption of posterior teeth 12-Early permanent dentition: Increased over jet and over bite decreased by eruption of all posterior teeth and downward, forward growth of mandible. 13-TMJ movements: -Simple hinge movement:----------- gum pads -Anterior posterior direction: -----with eruption of incisors -Lateral movement:--------------- with eruption of molars 14-Curve of spee: Ferdinand Graf Von spee -Primary curve of spee was flat -Increase depth of curve after eruption of 1st permanent molars -Increase another time after eruption of 2nd permanent molars -Stable depth throughout the adulthood C Clinical linical application of growth application of growth Dr. Mohammed Alruby Dr. Mohammed Alruby