GROWTH AND DEVELOPMENT

Growth Rotation
Dr Syed Bazli Alwi B. Syed Bakhtiar

Introduction

Early cephalometric growth studies show that as the face

enlarges progressively, it grows downwards and
forwards.
The direction of growth is curved, giving a rotational
effect (Bjork,1983).

Introduction
Growth rotation on the maxilla:
- effects are small.
- almost completely masked by surface remodelling.
Growth rotation on the mandible:
- effects are significant.
- vertical dimension.
- determine the ratio of the posterior to anterior facial
heights.

Introduction
Factors affecting the growth of the posterior
facial height:
- direction of growth at the condyles.
- vertical growth at the spheno-occipital
synchondrosis.
- masticatory musculature at the ramus.

Introduction
Factors affecting the growth of the anterior facial
height:
- eruption of teeth.
- vertical growth of the soft tissues, suprahyoid
musculature and fasciae, spinal column.

Introduction
Forward growth rotations are more common than
backward growth rotations.
Average - mild forward rotation which produces a wellbalanced facial appearance.
Forward growth rotation, anterior vertical facial
proportions, overbite.
Treatment plan considerations eg. Class II malocclusion
will be helped by a forward growth rotation.

Growth Rotation
1. Total Rotation
The rotation of the
mandibular corpus in relation
to cranial base.

Growth Rotation
2. Matrix Rotation
Change in inclination of the tangential mandibular line
(ML) in relation to S-N line.

Growth Rotation
3. Intramatrix Rotation
Change in inclination of a reference line in the corpus
relative to the ML (difference between total and matrix
rotations).
Reflects bony remodelling on the lower border of the
mandible.

Centre of Rotation
Forward/Anterior/Anti-clockwise rotation:
Condylar head
Lower premolars
Lower incisal edges
Backward/Posterior/Clockwise rotation:
Condylar head
Distal occluding molars

Bjork, 1969

Centre of Rotation (Forward Rotation)

Type I
Growth rotation at a
centre located at the
condyle.
Resulting in
underdevelopment of
anterior facial height.

Centre of Rotation (Forward Rotation)

Type II
Growth rotation at a
centre located at the
incisal edges of the lower
anterior teeth.

Centre of Rotation (Forward Rotation)

Type III
Centre of rotation at the
premolar area.
Anterior facial height
becomes underdeveloped
when the posterior facial
height increases.

Centre of Rotation (Backward Rotation)

Type I
Lies in the condyles.
Increase in anterior facial
height.

Centre of Rotation (Backward Rotation)

Type II
Situated at the most distal occluding molars.

Consequences of Excessive Rotation

of Mandible
Short Facial Height:
Excessive forward rotation of mandible.
Reduced lower anterior facial height (LAFH), prominence
of chin point, deep overbite and incisors rotate toward
the palate.
Long Facial Height:
Excessive backward rotation of mandible.
Increased LAFH, reduced lip competence, reduced the
prominence of chin point, reduction of overbite/anterior
open bite (AOB).

Consequences of Excessive Rotation of

Mandible
Altered Chin Prominence:
Backward rotation tends to decrease the prominence of chin point
whereas forward rotation increases chin prominence.
Path of Incisors Eruption:
Backward rotation generates more anterior path of eruption whereas
forward rotation generates upright path, incisors crowding and
reduction of arch length.
Relapse in Orthodontic treatment:
Backward rotation of mandible results in downwards and backwards
rotation of the incisors with a consequent relapse of anterior open
bite and overjet correction. Forward rotation can result in relapse in
deep overbite correction.

References
1. Bjork, A. and Skieller, V. (1983). Normal and abnormal
growth of the mandible. A synthesis of longitudinal
cephalometric implant studies over a period of 25
years. European Jounal of Orthodontics, 5, 1-46.
2. Mitchell, L., Littlewood, S.J., Doubleday, B., and
Nelson-Moon, Z.L. (2007). An Introduction To
Orthodontics, 3rd edn, Oxford.

THANK YOU