Late Stages of Development

Late Stages of Development
Adolescence: The Early Permanent Dentition Years

- Adolescence -> sexual maturity is attained – growth spurt, fertility attained, maturation of the sex organs and
the accompanying surge in secretion of sex hormones
- Exchange from the mixed to the permanent dentition, an acceleration in the overall rate of facial growth and
differential growth of the jaws
Initiation of Adolescence
- Puberty begins -> pulsatile release of gonadotropin-
releasing hormone (GnRH) from neurosecretory cells
in hypothalamus -> increase significantly and
stimulates pituitary gland to produce variety of
hormones -> activate release of both estrogens and
androgens from adrenal gland and ovaries or testes
- Controlled by trans-synaptic activity of neurons in the
arcuate nucleus
- Pituitary portal system -> substances secreted by the
nerve cells pass into capillaries in this vascular region
and are carried the short distance to the pituitary by
blood flow
- Pituitary gonadotropins – stimulate endocrine cells
in both the adrenal glands and the developing sex organs to
produce sex hormones
- Female -> pituitary gonadotropins stimulate secretion of
estrogen by the ovaries, later progesterone by the same organ;
male sex hormones are produced in the adrenal cortex,
stimulated by still another pituitary hormone
- Released into the bloodstream in quantities sufficient to cause
development of secondary sexual characteristics and
accelerated growth of the genitalia
- Neural growth unaffected by the events of adolescence – it is
complete by age of 6
- Feedback of levels of circulating sex hormones affects amount
GnRH -> amount of gonadotropins that are released -> control
of this endocrine system is managed from the hypothalamic
level
- Three stage amplifier -> GnRH –> 100-1000 times more of
pituitary gonadotropin -> 1000 times more of produced sex
hormones
Timing of Puberty
- Puberty and growth spurt occur 2 years earlier in girls than in boys
- Adolescence in girls can be divided into 3 stages -> I – breast buds
and early stages of pubic hair; the peak velocity for physical
growth occurs 1 year after the initiation of stage I, coincides with stage II of development of sexual
characteristics – noticeable breast development; stage III – 1-1,5 year after stage II and is marked by
menstruation (menarche) – growth spurt is complete -> broadening of hips with more adult fat distribution and
development of the breasts is complete
- Puberty in boys 5 years, in girls 3,5 years
- Boys -> I stage – fat spurt, weight gaining, scrotum begins to increase in size; stage II (1 year after) the spurt
height is beginning, pubic hair begin to appear, and begins the growth of penis; stage III (8-12months later)
peak velocity in gain in height, axillary hair appear, and facial hair on upper lip only; stage IV (15-24 months
later) difficult to pinpoint, facial hair on the chin and upper lip, adult distribution and color of pubic and axillary
hair, further increase in muscular strength
- The earlier the onset of puberty, the smaller the adult size and vice versa
- Sex hormones stimulate the cartilage to grow faster -> major factor in adolescent growth spurt
- Sex hormones cause increase in the rate of skeletal maturation, which for the long bones is the rate at which
cartilage is transformed into bone -> during rapid growth at adolescence, the cartilage is used up faster than it
is replaced
- The epiphyseal plates close more slowly in males than in females, cutoff in growth that accompanies the
attainment of sexual maturity is also more complete in girls
- Growth tends to be faster in spring and summer than in fall and winter, city children tend to mature faster than
rural ones
- Maturing face become less convex as the mandible and chin become more prominent as a result of the
differential jaw growth
Growth Patterns in the Dentofacial Complex
Dimensional Changes
GROWTH OF THE NASOMAXILLARY COMPLEX
- Two basic mechanisms – passive displacement, created by growth of the cranial base that pushes the maxilla
forward and active growth of the maxillary structures and nose
- Surface modeling must be taken into account when active growth of the maxilla is considered
- Nose grows more rapidly than the rest of the face, particularly during adolescent growth spurt – increase in
size of the cartilaginous nasal septum
MANDIBULAR GROWTH
- Accentuation of the prominence of the chin – combination of forward translation of the chin as a part of the
overall growth pattern of the mandible and resorption above the chin that alters the bony contours
TIMING OF GROWTH IN WIDTH, LENGTH AND HEIGHT
- Growth in width is completed first, then in length and finally growth in height
- Growth in width of both jaws, including width of dental arches tends to be completed before the adolescent
growth spurt – intercanine width is more likely to decrease than increase after age 12
- Growth in length and height of both jaws continues through period of puberty. In girls maxilla grows slowly
downward and forward to age 14-15 then tends to grow slightly more almost straight forward
Rotation of Jaws During Growth

IMPLANT STUDIES OF JAW ROTATION
- Internal rotation – occurs in the core of each jaw but tends to be masked by surface changes which produce
external rotation
- Overall change in the orientation of each jaw results from combination – judged by palatal plane and
mandibular plane
- Core of mandible is the bone that surrounds the inferior

alveolar nerve, the rest of the mandible consists of its several
functional processes – alveolar, muscular, condylar. Core of
the mandible rotates during growth in a way that would tend
to decrease the mandibular plane angle (up anteriorly and
down posteriorly)
- Forward rotation and negative sign – more growth
posteriorly than anteriorly -> chin upward and forward
- Backward rotation and positive direction – lengthens
anterior dimensions more than posterior ones -> chin
downward and backward
- For most patients – the external rotation is opposite in
direction and equal in magnitude to the internal rotation so
that the two rotations cancel and net change in jaw
orientation is zero.
- Rotational patterns of growth are quite different for
individuals who have short-face or long-face types of
vertical facial development
- SHORT-FACE – short anterior lower face height, excessive forward rotation of the mandible
during growth; nearly horizontal palatal plane, low mandibular plane angle, large gonial
angle; deep bite malocclusion and crowded incisors usually accompany this type of
rotation
- LONG-FACE – excessive lower anterior face height, palatal plane rotates down
posteriorly, often creating negative rather than the normal positive inclination to the true
horizontal; mandible shows opposite, backward rotation with increase in the mandibular
plane angle. Lack of the normal forward internal rotation, or backward internal rotation.
Internal rotation is primarily centered at the condyle; anterior open bite malocclusion
and mandibular deficiency. Backward rotation also occurs in patients with abnormalities
or pathologic changes affecting TMJ – growth at the condyle is restricted
INTERACTION BETWEEN JAW ROTATION AND TOOTH ERUPTION
- Path of eruption of the maxillary teeth is downward and somewhat forward, movement
of the teeth relative to the cranial base could be produced by combination of translocation as tooth moved
along with the jaw in which it was embedded and true eruption movement of the tooth within its jaw
- Eruption path of mandibular teeth is upward and somewhat forward
- Relationship between jaw rotation and incisor position – vertical and anteroposterior position of the incisors
are affected in short-face and long-face individuals
- Short-face – excessive rotation, incisors tend to be carried into overlapping position even if they erupt very
little, this is why where is a strong tendency for deep bite malocclusion; rotation also progressively uprights the
incisors, displacing them lingually and causing tendency toward crowding.
- Long-face – anterior open bite will develop as anterior face height increases unless the incisors erupt for an
extreme distance – the rotation of the jaws also carried the incisors forward, creating dental protrusion
Maturational and Aging Changes

- Affect hard and soft tissues as slow growth continues in adult life
- Important aging effects on teeth, their supporting structures and dental occlusion itself
Facial Growth in Adults

- Facial growth continues during adult life; essentially increase in all facial dimensions, but both size and shape
of craniofacial complex altered
- Vertical changes are more prominent than anteroposterior changes; width were least evident
- Rotation of both jaws continued into adult life; not possible to precisely differentiate internal from external
rotation
- Males  net rotation in forward direction, slightly decreasing mandibular plane angle
- Females  tendency toward backward rotation with increase in mandibular plane angle
- Compensatory changes in the dentition so occlusal relationships were maintained
- Changes in facial soft tissue profile were greater than changes in facial skeleton  elongation of nose,
flattening of lips, augmentation of the soft tissue chin
Changes in Facial Soft Tissues

- Lips and other soft tissues of the face sag downward with aging  decrease in exposure of upper incisors and
increase of the lower at rest and on smile
- Lips also become progressively thinner, with less vermilion display
- Exposure of all upper incisors and small amount of gingiva on smile I both youthful appearing and esthetic ->
vertical relationship of the lip to the teeth will change after adolescence
Changes in Alignment and Occlusion

- Alveolar bone bends during heavy mastication, allowing teeth to move relative to one another – coarse diet 
occlusal wear reduce the height of the crowns but also the width of teeth was reduced as interproximal wear
occurred  some spacing may develop anteriorly
- Modern populations  strong tendency for crowding of mandibular incisors to develop in the late teens and
early 20s
a) lack of “normal attrition” in the modern diet – in primitive population large amounts of interproximal and
occlusal attrition occurred – theory of Begg does not find confirmation
b) pressure from third molars – late crowding develops at about time the third molars should erupt but also in
ppl who do not have them – so it is not explanation
c) late mandibular growth – cephalocaudal gradient; position of the dentition relative to the maxilla and
mandible is influenced by the pattern of growth of the jaws so if mandible grows forward relative to the
maxilla, mandibular incisor teeth tend to be displaced lingually
In patients with tight anterior occlusion before late mandibular growth:
1) mandible displaced distally, distortion of TMJ and displacement of articular disc
2) upper incisors flare forward
3) lower incisors become crowded
Aging Changes in Teeth and Supporting Structures

- Permanent tooth erupts – pulp chamber relatively large  additional dentin deposits on inside so pulp
chamber gradually becomes smaller with increasing age
- Apical movement of the gingival attachment resulting in vertical growth of the jaws; at the late teens the
gingival attachment is usually near cementoenamel junction  active eruption of teeth

Late Stages of Development

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Late Stages of Development

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Late Stages of Development

Adolescence: The Early Permanent Dentition Years

Growth Patterns in the Dentofacial Complex

TIMING OF GROWTH IN WIDTH, LENGTH AND HEIGHT

Rotation of Jaws During Growth

- Core of mandible is the bone that surrounds the inferior

INTERACTION BETWEEN JAW ROTATION AND TOOTH ERUPTION

Maturational and Aging Changes

Facial Growth in Adults

Changes in Facial Soft Tissues

Changes in Alignment and Occlusion

Aging Changes in Teeth and Supporting Structures

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