Growth Prediction
Growth Prediction
Growth Prediction
KISHAN ANTALA
GUIDED BY: DR.HINA DESAI
Introduction
Need of growth prediction
Methods of prediction of craniofacial growth
HAND WRIST RADIOGRAPHS AND SKELETAL MATURITY
A Cervical vertebrae maturation indicators
Huterian concept
Gnomic growth and logrithmic spiral
Arcial growth
Mesh analysis
Johnston’s forecast grid
Todd’s methods
VTO( Visualized Treatment Objective)
Ricketts VTO
Holdaway VTO
clinical implication
conclusion
Variety is the spice of life. Every child extensively
differs in the rate,amount and direction of growth and
in the expression of the extent of his malocclusion.
Growth pridiction help in predicting to certain extent
the response to treatment and the growth changes.
Growth assessment procedures indicate the growth
status of the patient at a perticular time and provide an
assessment of the percentage of growth left.
As proffit says , growth prediction can never be
accurate especially when the child is growing .
- Sridhar premkumar, craniofacial growth-194
Growth prediction can be difined as the forecast of
growth related changes with the objactive of prediction
the direction and amount of the growth of the maxilla
and perticularly the mandible as well as the timeing of
the adolescent growth period.
Being able to predict growth well help craniofacial
biologist in two principal way.
20
Phulari,pag no-210
Stage 5: This stage heralded the peak of the pubertal
growth spurt, capping of the diaphysis by the
epiphysis was seen in; a) Middle phalanx of the third
finger b) Proximal phalanx of the thumb, c) Radius
(males 14.0y, females 11.0y).
Phulari,pag no-210 21
Stage 7: Union of epiphysis and diaphysis of the
proximal phalanx of the third finger.
(males 15.9 y, females 13.3 y).
26
Graber,pag no- 480
3. Transition :
•Distinct notch are shown on the
inferior borders of second and
third vertebrae.
• c4 still flat.
• Vertebral bodies of third and
fourth are still retains trapezoidal
in shape while others are more
rectangular horizontal shape.
•At this stage maximum
craniofacial growth velocity is
anticipated .
27
•Graber,pag no- 480
4. Deceleration stage:
•Distinct notches can be observed on
the inferior borders of second, third
and fourth cervical vertebrae.
• Vertebral bodies of third and fourth
begin to be more recangular
horizontal in shape.
• continued craniofacial growth can be
anticipated but lesser rate than is
seen in CS-3.
28
5. Maturation stage:
• notches are observed on the
inferior borders of second, third and
fourth cervical vertebrae.
• Vertebral bodies of third and fourth
are almost square in shape.
•In this stage most craniofacial
growth has been achived.
29
•Graber,pag no- 481
6. Completion:
• notching are observed on the
second, third and fourth cervical
vertebrae.
• Vertebral bodies are greater
rectangular vertical in shape.
• Pubertal growth has been
completed.
30
John huter hypothesized a liner model for mandibular
growth where there is resorption in the anterior border of
ramus and deposition in the posterior border, thus
lengthening the mandible. The hunterian concept of
mandibular growth was held as a dictum till bjork proved
that mandible and maxilla underwent rotational growth in
his implant studies.
Moss ML salentijin, herbert p. the logarithmic properties of active and passive mandibular growth.AJO
1974;66:645-64, - S premkumar , craniofacial growth-197
Lateral x-rays effectively outlined the pathway of the Inf.
Alveolar nerve.
All the 3 neural foramina at all ages fit precisely upon a
single mathematically defined, logarithmic spiral.
41
S premkumar , craniofacial growth-199
Dc R3
R1
R2
Xi
R4
42
Pm
By studying the mandibular growth on these axis
it was found that the bending of the mandible
occurred in an orderly fashion, with greater the
magnitude of growth, greater was the bending.
Now the next task was to make an arc to predict
this growth.
Point Pm, Xi, Dc were used to depict the
mandibular core, and the prediction of the
mandibular size and shape at five years interval
was done.
43
S premkumar , craniofacial growth-199
The current arcial prediction of Ricketts was reached in
three steps
1. An arc was made passing through these three points. But
it was found that the increase in size could be produced
but not increase in curvature. The Pm point was taken as
constant.
2. A second arc was made using the tip of the coronoid
process, anterior border of the ramus at the deepest point
(R1) and Pm. Using this it was found that the mandible
would bend too much.
44
S premkumar , craniofacial growth-199
3. So it was thought that the actual arc must lie in
between these two.
So a point in between Xi and R1 was selected.
An arc was made with a radius from this point to Pm.
R3 Mu
EVA
RR
TR
Xi
Pm
49
Having become satisfied with this arc as a tool for
prediction the next problem lay in the amount of
growth to forecast on the arc.
From point Mu the mandible is grown out on the arc
at the sigmoid notch about 2.5mm/yr.
The coronoid and condylar process grow upward and
outward.
51
In the series of the steps in forecasting of the
mandible growth. Art work for normal contours is
employed as connections are made from the
coronoid process to point RR on the coronoid crest.
The oblique ridge shows apposition of about
0.4mm/year.
The change in position of each landmark at a perticular
age period(8-16yrs)is calculated as a percentage shift.
There is usually an incrise in overall size of patients
face;every landmarks undergoes growth/ change by a
certain extent with large inter-individual difference but
the facial type remains constant through 8 to 16 years.
Retrognathic mandible have posterior distoration of
rectangles; while high mandibular angles will have
downward displacement of the mash.
S premkumar , craniofacial growth-202
Developed by L.E. Johnston in 1975
Based on the addition of mean increments of growth by
direct superimposition on a printed grid
Johnston designed sex specific templates by utilizing the
numerical standards obtained from the publications of Riolo et
al who used the cephalograms from university of Michigan.
Johnston’s template uses normative standard rather than idiel
standards which can be difficult for comparison while using for
children with altered growth .
LE johnston.A simplified approch to pridiction; ajo 1975;253-57, S premkumar , craniofacial growth-202
The land marks used are :
S–N plane as a
reference plane
Point A
Point B
Point M
Posterior Nasal Spine
Tip of nose
Holdaway RA. A soft tissue cephalometric analysis and its u e in orthodontic treatment planning. Am
J Orthod 1983;84:1-28
Holdaway RA. A soft tissue cephalometric analysis and its u e in orthodontic treatment planning. Am
J Orthod 1984; - S premkumar , craniofacial growth-206
Step II (Fig. 2)
First, superimpose on the SN line and move the tracing to show
expected growth (0.66 to 0.75 mm per year unless a pubertal
growth spurt is expected from wrist plate studies). Second, copy
the outline of sella. Third, either copy or change the facial axis
(Ricketts' foramen rotundum to gnathion) as you expect it to
behave according to the facial type of the patient and the
treatment mechanics that you customarily use in such cases.
(The facial axis line is usually opened about 1°, but it may even
be closed if one is confident that mandibular growth of the
forward rotational type will occur during treatment.)
Because of the uncertainties involved in
predicting growth ,orthodontic treatment
becomes a game of strategy against nature.
However The Goal of growth prediction is to
reduce the clinicians ignorance of the future.
The best can be done ,is to base the
treatment planning in the existing facial pattern
allowing for average growth changes for the group
to which patient belongs. With the knowledge
and better understanding of growth prediction,
we can be skilled and better equipped to
intervene during growth process.