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147 Cards in this Set

  • Front
  • Back
sheldons classification

relative predominance of soft roundness

digestive viscera are massive

derived from endodermal embryonic layer
relative predominance of muscle,bone, and connective tissue

physique is heavy,hard, and rectangular

skin is thick

derived from mesoderm embryonic layer
relative predominance of linearity(narrow and elongated form) and fragile

greatest sensory exposure

largest brain and central nervous system

derived from ectodermal embryonic layer
When are facial disharmonies and malocculusions most likely to occur?
when there is a mixture of somatotypic features
at what age is somatype determined?
at age 20-25 y/o and remains constant
How is somatotypes ranked?
on a scale from 1 to 7 for each component
2 head forms
long and narrow

facial type:
-mandible retrusion
wide and short head

face type:
-prominent lower jaw
-large facial angle small Y axis
T/F growth disposition is same for all health individuals
What is the difference between males and females and puberty time?
boys and girls reach pubertal growth spurt at different times

boys are two years behind girls
what is overall potential for growth primarly determined by?
intrinsic factors
what is individual maximum potential for growth effected by/
do all body parts grow at the same time?
no different body parts increase in size at different times and at different rates
types of bone growth and morphogenesis
cortical drift
differential growth
area relocation
tranlatory growth
expanding V principle
when is growth of neural tissue nearly complete?
by age 6-7
describe growth pattern of general body tissue like muscle, bone, and viscera
S shaped curve w/ difinite slowing of rate of growht during childhood and an acceleration at puberty
Describe growth curve of lymphoid tissue
lymph tissue proliferates excessively in late childhood and then undergoes involution (decreases) at the same time that genital tissues are accelerating rapidly
growth pattern of genital tissue
increase in puberty
5 theories of facial growth
1.functional matrix
2.hunter-enlow growth equiv.
3.scotts cartilaginous theory
4.sichers sutural dom. theory
5.expanding V principle
Weinmann-Sicher Theory of of facial growth
believed that sutural expansion was responsible for the downward and forward translation of the mandible
JH Scott and the cartilage theory of facial growth
proposed that cartilage can be considered to be a growth center

bc nasal cartilage, if transplanted, can continue to grow but condylar cartilage does not grow outside of its orginal location
Melvin moss and the the functionial matrix theory of facial growth
said that neither cartilage now condylar cartilage are determinants of facial growth

growth of the craniofacial complex is in response to the soft tissues aroung them
eg:brain, muscles of mastication,and sinuses

-mastoid air cell infection
How does melvin moss functional matrix work?
periosteal matrices act upon skeletal units in a direct fashion

by deposition and resorption causes changes in shape and size

capsular matrices act upon functional cranial components as a whole in a secondary and indirect manner. by altering the volume of the capsules this causes passive translation
hunter enlow growth equivalent theory
mandible,middle face, and cranial base are directly contiguous w/each other

growth events that occur in one affect the other two

growth occurs at sutures, periosteal and endosteal surfaces, and synchrondroses
who believes that growth is a combination of complex remodeling and translation?
hunter enlow
to hunter enlow what equivalents does the face consist of?
horizontal and vertical equivalents
what are the horizontal growth equivalents in the hunter enlow growth equivalent theory
anterior cranial base
body of mandible
how does mandible growth?
expanding V princple
male and female comparisons of mandibular growth during adulthood
in men, the mandible appears to move downward and forward

in women, the mandible appears to moved downward and backward
indicators of physical maturity
secondary sex characteristics

dental age

chronilogical age

skeletal age

hand wrist
what growth curve does facial skeletal growth follow?
follows a growth curve similar to that of the general skeleton

undergoes a puberal spurt
What does orthodontic treatment depend on?
developmental timing

amount of growth remaining
what should ortho tx take advantage of?
pattern of facial growth

puberal growth period
what is an unreliable guide of sexual maturation/
chrono age
secondary sex characteristics in boys
facial and axillary hair

larynx enlarges and voice low

growth of penis near complete
secondary sex characteristics of girls
breast buds appear at age 10

menarche usually occurs after the peak growth spurt around age 12.5 y/o
what does absence of sesamoid bone mean?
sesamoid bone is an ossification center

absence of sesamoid bone means pt is prepuberty

prescence of sesamoid bone means that pt is in pubertal spurt or passed puberty
what to look at in hand wrist xray to determine if pt is passed puberty
absence of precence of ossification centers
-sesamoid bone
-epiphyseal plate closure
what if epiphyseal plate is closed?
growth is complete
summary of facial change from yound child to old
goes from a concave to convex nasal dorsum, downward rotation of lobule, and shortening of upper lip
endochondral vs intramembranous growth
endochondral is when bone replaces cartilage

intramembranous is not associated w/cartilage. forms most of bones in skull
what type of growth does mandible undergo?
intramembranous growth

man has 2 halves and makes one bone by the second year of life
translatroy growth
put growth in one area and it is being manifested in another area

growth of sphenoid area/ cranium is going to affect the bone structure of the face
first body part to reach max growth
1st tissue to reach maturity
neural tissue by age 6
what in oral cavity follow neural growth curve?
the toneue bc happens same time thyroid drops
what growth curve does maxilla/face follow?
general body growth curve
problem w/weinman sicher theory of facial growth
sutures allow movement but do not push the bones apart
last suture to close in craniofacial area
midpalatal suture
growth center
where growth occurs indirectly to whats going on in environment

ex: transplant tissue anywhere and it still grows
growth site
like sutures. some growth occurs in this area but they are not responsible for growth
describe mandibular growth
imposition of mental and posterior ramus

condyles go up and the posterior ramus is impositional and the anterior ramus is resorbtive

expanding V-growth on mandible occurs posteriorly and mental grows down and forward
how does shape and angle of mandible tell you how pt will grow?
L shape and flat pt is horizontal grower

C shape w/deep notch pt is vertical grower
what is shape of manibular condyle determined by?
condyle is vertical when pt is young as you age the shape changes and it is determined by alveolar process
as pt gets older, why does ANB change?
SNA stays the same but SNB gets large bc the chin comes forward so ANB decreases
what reaches max growth first, max or man?
when do girls have growth spurt of maxilla?
2 years before first period
can you predict growth by chrono age?
no need to take ht/wt
site of growth in long bones
epiphyseal plate
endochondral vs intramembranous ossification
endochondral bones form from cartilage matrix

intramembranous osteoblasts arise from undifferentiated cells and make their ouwn ostoid matrix
growth remodeling
progressive adjustment that functions to maintain the shape and proportions of the bone throughout its growth period
cortical drift
concurrent resorption and deposition of bone on opposite sides of cortical bone is the endostial or peristial direction so that the bone appears to drift in one direction
differential growth
certain parts of bone and certain areas of body grow faster than others
area relocation
the new bone is added to a surface of the existing old bone is shifted to a new position. this is a result of remodeling and differential growth during bone growth
translatory growth
appearance of growth/displacement in one area do to actual growth in another area
identify the growth theory which considers bones as the single driving force behind craniofacial dev
sicher and sutural dominence concept states that the CT produces actural force which is the driving force behind craniofacial growth. The primary event in sutrual growth is the proliferation of CT between the two bones
t/f there is a big corrleation between height age and skeltal age
major center of growth in mandiblee
what is primary stimulus for growth of mandible?
functional matrix stimulus
CVMS I(cervical vertebrate maturation)
lower borders of all three vertibrate (C2,3,4) are f;at w/possible exception of concavity at lower border of C2. the bodies of both C3 and C4 are trapezoid in shape. the peak in mandibular growth will occur not earlier that one year after this stage
Concavities at tlower bodrder of Both C2 and C3 are present. The bodies of C3 and C4 may be either trapezoid or rectangular. the peak in mandibular growth will occur wi one year after this stage
concavities at lower borders of C2,3,4 are not present. the bodies of C3 and C4 are rectangular. the peak in mandibular growth has occured wi one or two years before this stage
concavites at lower borders of C2,3,4 are still present. at least one of bodies of C3 or C4 is square. peak in man growth has occured not later that one year before this stage
Concavities at lower borders of C2,3,4 are still evident. at least on of bodies of C3 or C4 is rectangular or square. the peak in man gorwth hs occured not later that two years before this stage
order of maturity(direction)
an increase in anatomic size
3 parameters of growth
magnitude of growth
linear dimension overall
direction of growth
vector of size increase in 3D system
Velocity of growth
amt of change per unit time
2 manners in which size in growth can be documented
1.cumulative or distance curve: when growth is measured periodically and measurements are plotted as percentages of total growth

2.incremental or velocity growth curve: plots growth increments as a function of time
what does growth imply?
most remarkable growth stage
describe growth stages
remarkable in prenatal growth

plateu during childhood

increase in adolescence
what is overall potential for growth determined by?
primarily by intrinic and genetic factors
what is the extent to which an individual attains his/her potential for growth determined by?
what does growth of primary cartilage and functioning spaces have a direct influence on?
craniofacial pattern of change
where is primary cartilage found? describe growth
primary cartilage is in head and face and is identical to growth plates of long bones
what dictates craniofacial growth?
primary cartilage
what 3 things faciliate pattern growth of the head and face?
1.mandibular condylar cartilage

2.craniofacial sutures

3.appositional-resoptive bone change
what part of face matures first?
anterior face
2 ways to examine craniofacial pattern
1.chair side
ideal frontal facial pattern of 7 year old
right/left halves are symmetrical

glabella to subnasale=subnasale to menton

subnasale to lower border of upper lip represents 1/3 distance from subnasale to menton

upper central incisor edge is 2 mm inferior to lower border of upper lip
ideal facial profile pattern for 7 y/o
chin 5 mm behind FHP

most anterior aspect of lower lip on FHP

most anterior aspect of upper lip 5 mm ahead of FHP

nasolabial angle of 10 degree

no more than 2 mm lip seperation when relaxed
goal of treating facial imbalance in kids
establish architectural balance and facial pattern
what animal has nonpathological cleft?

therefore we study them
5 prominence which jaw develops from
frontal/nasal (1)
nasal (2)
mandibular (2)
formation of premaxilla
by day 28, nasal placodes form from thickening of surface ectoderm from frontonasal prominence. neural crest cells around the placodes give rise to medial and lateral nasal prominences. plaodes invaginate forming nasal pits. the medial nasal prominences migrate and merge to form premaxilla

it is not the premaxilla untill both sides Fuse together
what does medial nasal prominence give rist to?
bridge of nose
alveolar process w/incisors
how do palatal shelfs fuse?
palatal shelves elevate, roll over tongue, and come together

there is medial edge epithelium on the 2 shelves. when the shelves come together they form a midline epithelial seam (MES) the MES under goes epithelia mesenchymal transformation.
what happens if when the Midline epithelial seam (MES) is made it does NOT undergo Epithelial mesenchymal transformation (EMT)?
a cleft will form bc the 2 sides will not come togehher bc the epithelium breaks down
what is on anterior and posterior end of MES?
Epithelial Triangles

premaxilla is above the upper epithelial triangle of the MES
what is the cause of clefts?

in which direction does palate close?
from anterior to posterior
problems that arise w/ cleft palate pts
missing teeth (esp lat incisors)

supernumerary teeth (esp max lat incisors)

when should a bone graft be done on a cleft pt?
during transition of dentition

before bone graft expand the palate to open the cleft
what class is most cleft pts?
usually class III bc there is a lip/face defiency
Classification of Cleft lips class I
unilateral notching of vermillion not extending into the lip
Classification of cleft lip CLASS II
unilateral extending into lip but excluding the nasal floor
Classification of cleft lip class III
extends into nasal floor
Classification of cleft lip class IV
Classification of Cleft palate Class I
soft palate only
Classificaiton of Cleft palate Class II
soft as well as hard but not including alveolar process
Classification of cleft palate class III
extends into the alveolar process
what is the similiarty between Class I-III of cleft palate classification?
they are all unilateral
Classification of cleft palate class IV
why does cleft pt get crossbite?
bc there is a collapse of the posterior segment
2 types of bone
difference in tx of skeletal crossbite and dental crossbite
skeltal crossbite Tx is bone expansion

dental crossbite Tx is tooth removal
woven bone
not fully mineralized

no organization

it is isotropic
2 examples of lamellar bone
it is isotropic

pagets disease
woven bone that it somewhere it should not be
what type of bone is anisotropic
woven bone
3 types of bone cells
basic metabolic unit of bone
what is bone remodelling dependent on?
what age group has more flat cells and osteocytes in their bone?
how much higher is trabecular remodeling than cortical?
5-10 x higher
what does cortical remodeling depend on?
haversian and volkmanns' canals
when does activation of bone (conversion from quiescence to active bone surface) occur?
every 10 sec. in adults and sites may be active for as long as 8 mos
osteoclast resorbtion rate
20-40 micrmeter/day but resorbs a v.large area
function of haversian canals in compact bone
The Haversian canals surround bloods vessels and nerve cells throughout the bone and communicate with osteocytes
volkmanns canals
run perpendicular to haversian canals in compact bone and connect them together
type of bone that is v. vascularized
cortical bone
describe relationship between osteoblasts and osteoclasts
osteoclasts have a Rank steriod receptor and the osteoblasts has a Rank-L protein ligand. the osteoclasts Rank rec. binds to osteoblasts Rank L causing activation of the osteoclasts
people w/ osteoporosis take OPG (Osteoprotegerin) . what is its purpose?
OPG are receptors that bind to the RankL on the osteoblasts to that the Rank of the osteoclasts cannot bind. therefore, osteoclasts do not get activated
2 types of bone formation

condylar growth type
long bones of limb growth type
epiphyseal growth
how does cartilage grow?
most common CF anomaly
cleft lip and palate
what % of cases does cleft lip and palate together account for?
what % of cases does isolated cleft lip and isolated cleft plate occur?
25% each
severe problems associated w/cleft pts
natal teeth (max centrals)

absenst teeth (lat incisors)

supernumerary teeth (lat)

ectopic primary lat incisor and canines located palatally to cleft

tooth anomalies(enamel hypoplasia,weird crown shape, etc)

teeth adjacent to cleft, no alveolar bone so lost

no alvolar bone to external forces from muscles cause crossbite in posterior
facial profile of cleft pt

class III