GROWTH PREDICTION

Under the guidance of

Dr. Anil Chandna
Dr. Deepak Agarwal
Presented by
Dr. Preeti Bhattacharya
Dr. Surabhi Saxena JR1 Dr. Ankur Gupta
Department of Orthodontics Dr. Ravi Bhandari
Dr, Shivani Singh
 CONTENTS

•Introduction

•Methods of growth prediction

•Gnomonic growth

•Logarithmic spiral

•Archial growth of mandible

 INTRODUCTION

The large variability in the amount and direction of

facial growth in different subjects and the importance of
facial growth for the success of orthodontic treatment
has been generally recognized over the past decade. This
has led to a marked interest in methods for predicting
the amount and direction of facial growth in the
individual patient.
If an attempt is made to assess the growth trend at an
early stage, the information can be used in designing
the treatment or evaluating the problems that may
arise before growth is completed.
A growth analysis consists essentially of three qualities,
each of which is clinically significant
• An assessment of the development in shape of the face which
implies changes in the intermaxillary relationship

• An assessment of whether the intensity of the facial growth in

general is high or low

• An evaluation of the individual rate of maturation. This is

important in establishing whether puberty has been reached and
when the growth may be expected
Bjork in his studies on “prediction of mandibular growth
rotation” has distinguished three methods for predicting
growth:
 LONGITUDINAL METHOD

Applied by Tweed

Determine the pattern of growth

It consists of following the course of development in

annual x-ray cephalometric films.
Patient divided into three categories
• Type A
Growth of the middle and lower face proceeds in unison with
changes in vertical and horizontal dimension being
approximately equal
• Type B
Middle face grows downward and forward more rapidly than
the lower face, predominantly in a vertical direction
• Type C
Lower face develops at a faster rate than the middle face
 LIMITATIONS

• Can only be observed with population averages, not

useful in any one individual

• Accurate only when performed retrospectively but not

prospectively

• The pattern and rate of growth in one period is not

similar to that occuring in a subsequent period in any
given individual
 METRIC METHOD

It aims at a prediction of facial development on the basis of

the facial morphology, determined metrically from a single
x-ray film.

However, statistical studies of the possibility of predicting

the intensity or direction of subsequent development from
size or shape at childhood indicate that this is not feasible,
no matter which system of cephalometric analysis has been
used.
 STRUCTURAL METHOD
Developed by Bjork

Based on information concerning the remodeling processes

of the mandible during growth, gained from the implant
studies.

Principle- recognize specific structural features that

develop as a result of the remodeling in a particular type of
mandibular rotation.

A prediction of the subsequent course is then made on the

assumption that the trend will continue.
• Inclination of condyle
• Curvature of mandibular canal
• Inclination of symphysis
• Shape of lower border of mandible
• Interincisal angle
• Interpremolar or molar angles
• Anterior lower face height
 GNOMONIC GROWTH

Thompson analyzed the growth of sea shells.

•Here the sea shell chambered nautilus is studied

•This shell grows in size but does not change its shape

•Even though shell grows asymmetrically (adding new

mineral salts at one end) the original shape remains constant.

•Aristole qualified nautilus as one of those things that

suffered no alteration except change in magnitude when they
grow.
 That portion or increment
which when added achieves
such a growth, in Greek, is
called as “gnomon”, and the
process of growth
whereupon the addition of a
figure or body leaves the
resultant figure similar to the
original is called “gnomonic
growth”.
 LOGARITHMIC OR EQUIANGULAR SPIRAL

•Gnomonic growth can be explained by this curve called

“logarithmic spiral”.

•The spiral characterized by the movement of a point away

from the pole, along the radius vector with a velocity
increasing as its distance from the pole, such that, equal
angles of the spiral are formed by a straight line drawn out
from the pole.

•The spiral of the nautilus has been fitted with a precise

logarithmic formula-
θ = k log r Where θ = vectorial angle, r = radius, k
= constant.
With the help of this formula the spiral can be
generated at any time to reveal the final shape.

•Acc to Moss – orofacial capsular matrices ,

particularly the oronasopharyngeal functioning
spaces, manifest gnomonic growth.
•Ricketts suggested a number of gnomonic figures that
are correlated to the three branches of the trigeminal
nerve- opthalmic, maxillary and inferior alveolar.

•Moss and Salentijn , essentially in agreement with

ricketts , concluded that the orofacial capsule responsible
for the translative movement of the mandible creates a
gnomonic growth.
 ARCHIAL GROWTH OF THE
MANDIBLE
R.M. Ricketts devised a growth prediction method in which
he used longitudinal cephalometric records and computers
to determine the arc of growth of mandible.

Principle- “a normal human mandible grows by superior

anterior apposition at the ramus on a curve or arch which
is a segment formed from a circle.” The radius of the
circle is determined by using the distance from mental
protuberance to a point at the forking of the stress lines at
the terminus of the oblique ridge on the medial side of
the ramus.
The following points are marked on the mandible:
•R1 – Deepest point on the subcoronoid incisure.
•R2 – Pt selected opp. R1 on the posterior border of the
ramus
•R3 – Depth of the sigmoid notch
•R4 – Pt directly inferior on the lower border of the
mandible
•Xi – centroid of the ramus – crossing point of diagonals
drawn from the corners of the rectangle.
•A third point Dc represents the bisection of the condyle
neck as high as visible in the cephalometric film below the
fossa.
•Dc-Xi – condyle axis
•Xi-Pm – corpus axis
•In an average mandible using Xi and Pm as reference ,
the mandible was found to bend about one – half degree
each year.
•Next step- development of the arc that described this
bending.
•Three curves were drawn-
•Curve A- through Dc, Xi and Pm. Resulting mandible
was too obtuse
•Curve B-through tip of coronoid process, ant. border of
ramus at it’s deepest curve and Pm. Projected mandible
was bent excessively.
•Curve C- through point Eva ( point of confluence of
stress lines on the medial surface of mandible.) and Pm.
When a new point Tr is used as center of a circle whose
segment passes through Eva and Pm with radius as Eva-
Pm, the true arc for growth of the mandible is developed.
Annual increases of 2.5 mm were seen.
 IMPLICATIONS OF ARCHIAL
GROWTH :

•It appears that the symphysis rotates during growth from a

horizontal to a more vertical inclination and the downward
movement of the genial tubercle and the lingual plate
suggests the same. This explains the chin button
development. This phenomenon explains why the reversal
lines are seen in the area of pogonion and suprapogonion.

•It explains why the mandible plane changes extensively in

some individuals and not in others.
•It also shows why the ankylosed jaw shows disturbed
occlusal plane development.

•Early ankylosis of a lower molar tooth terminates with the

tooth located at the lower border of the mandible. The
mandible continues to grow and the tooth gets trapped
within the cortical bone, and border resorption point up to
it.
• It suggests why the mandibular anchorage is risky in
retrognathic cases, as less space is available for molar
eruption, due to more vertical eruption in such cases
than the prognathic ones.

• It explains why good dentures may become

progressively more crowded in long tapered faces and
sometimes even in normal faces.
DRAWBACKS OF ARCHIAL GROWTH
PREDICITON
•Relies heavily on the operators’ skill in tracing the
cephalogram. Minor errors could produce wrong prediction.

•Mitchell and Jordan concluded that Ricketts uses the

patient’s chronological age rather than the skeletal age, as
he requests for no hand wrist radiographs.
•As average growth increments are added to the age; if
the patient has completed growth or if he is in a
growth spurt or lag phase, it will alter the results.

•Derived from western population.

THANK YOU