FACIAL

DEVELOPMENT AND
TOOTH ERUPTION
An implant study at the age of puberty
A. Björk and V. Skieller
MATERIAL

■ The method by which the metallic implants are

inserted in the jawbone to serve as fixed reference
points on the films.
■ 21 subjects were chosen: 9 girls and 12 boys.
■ The metallic implants were inserted in both jaws,
except in Cases 1 and 9, which were inserted in
the mandible only
MATERIAL

■ The analysis was confined to the lateral view.

■ In order to obtain uniformity with regard to
physical maturity, the study was limited to a
period of 6 years around puberty.
METHOD

■ The facial photographs show the first and last

stages and were taken with the head in natural
balance with the eyes directed straight forward.
■ The cephalometric growth tracings show all three
stages.
 METHOD

■ The position of point articulare at the three

stages of growth of the mandible was marked
with a cross.
■ These points were used in calculating the
direction of condylar growth which was
marked on the top of the condylar head with
an arrow.
METHOD

■ This illustrates details in the

growth of the maxilla and the
paths of eruption of the
maxillary teeth, with
orientation in relation to an
implant line
 METHOD
■ This shows the development of the
face, with orientation in relation to the
Sella-Nasion line and a perpendicular
drawn through the sella point.
■ The position of the articulare point
reflects the downward and backward
displacement of the condyles in
relation to the anterior cranial base
during growth.
 METHOD
■ Method for determining the direction
growth at the mandibular condyles
with orientation with respect to the
implants from to four different
reference lines
– Ramus Line
– Mandibular Line
– Lower Occlusal Line
– Sella-Nasion Line
METHOD
■ Method for determining the
direction of the lowering of the
maxilla with orientation with
respect to the nasion-sella line
■ Method for determining the
change in sagittal jaw relation
where the line IP was drawn
through the most anterior implant
in the two jaws.
METHOD

■ Growth changes in thirty-two variables were

determined, twenty-eight of them were angles and
four linear distances.
■ The variables represented the following:
– No. 1: change in the direction of condylar
growth between the first and last observation
periods.
METHOD
– No. 2 to 5: direction of condylar growth from the
first to the last stages in relation to four reference
lines at the first stage.
– No. 6: direction of the lowering of the maxilla at
its posterior border.
– Nos. 7 to 29: growth changes for other angles,
from Stages A to C
– No. 29 to 31: changes in occlusion
– No. 32: the intensity of the condylar growth.
FINDINGS
■ A general feature of the facial development was a
more or less marked forward rotation of the face,
including the two jaws, but greater for the mandible. 
■ There was a strong association between the facial
rotation and the condylar growth. 
FINDINGS

■ At the lower border of the mandible about one half of

the rotation was masked by remodeling in the area. 
■ At the posterior border of the ramus about four fifths
of the mandibular rotation was masked by
remodeling. 
FINDINGS: ROTATION OF THE FACE

■ Cases 2 and 4 showed a backward rotation while for

the other 19 subjects the rotation of the mandible was
forward in direction
■ In forward rotation, there is a marked apposition
below the symphysis and the anterior part of the
lower mandibular border leading to an increase in
convexity in this area while resorption below the
angle of the mandible leads to flattening.
FINDINGS: ROTATION OF THE FACE

■ In Cases 2 and 4, with a backward rotation of the

mandible, there is a remodeling in the opposite
direction, characterized by only slight apposition
below the symphysis and the anterior part of the
lower border of the mandible. This area is
therefore flattened or almost straight.
FINDINGS: ROTATION OF THE FACE

■ For the maxilla, a forward rotation was present in

eighteen of the cases.
■ From the tracings, it is seen that this remodeling
was dependent on the condylar growth direction
and also on the degree of appositional growth
behind the region of the angle.
FINDINGS: ROTATION OF THE FACE
■ development in height was associated with the
condylar growth direction.
■ The general growth pattern of maxilla shows that the
entire increase in length takes place posteriorly, with
little if any remodeling on the anterior surface. Apart
from the sutural growth, the development in height
takes place by appositional growth of the alveolar
process in combination with a resorptive lowering of
the nasal floor.
FINDINGS: ROTATION OF THE FACE

■ varied according to the direction and magnitude of the

rotation of the maxilla. The remodeling was greatest
anteriorly or posteriorly according to whether the
rotation was forward or backward, and of
compensatory nature.
FINDINGS: CONDULAR GROWTH

■ the intensity of the condylar growth was strongly

correlated with the rotation of the mandible and also
significantly with the rotation of the maxilla.
FINDINGS: TOOTH ERUPTION & GROWTH OF
FACE
■ the center for forward rotation of mandible was
located in the anterior part of the dental arch is evident
from the fact that the angle between the lower implant
line and the lower occlusal line was opened backward,
thus indicating that the eruption of the molars was
greater than that of the incisors
FINDINGS

■ The rotation of the maxilla was likewise masked by

remodeling of the nasal floor, which remained almost
unchanged in inclination. 
■ While the rotation of the mandible during growth can
be judged clinically from internal structures, there is
no similar orientation method for the maxilla
FINDINGS

■ the path and the degree of eruption of the upper teeth

therefore cannot be analyzed without the use of
implants.
FINDINGS

■ The rotation of the face necessitates compensatory

adaptation of the paths of eruption of the teeth. When
there is full compensatory occlusal development, the
lower incisors retain their inclination in the face
practically undisturbed, irrespective of the rotation of
the jaw, because of a forward tipping on the jaw
base. 
FINDINGS

■ The posterior teeth in the lower jaw are involved in

this compensatory occlusal development and are
likewise tipped forward. 
■ The lower dental arch then shifts forward on the jaw
base without undergoing any appreciable change in
shape. 
FINDINGS

■ The intermolar inclination remains comparatively

constant as the lateral teeth in both jaws follow the
rotation of the face. 
■ What clinically has been regarded as an eruption of
the upper molars appeared to be a combination of
active eruption of the teeth in the jawbone and bodily
rotation of the maxilla
CONCLUSIONS

■ A general conclusion that may be drawn from the

results is that malocclusions are to a greater extent
due to incomplete compensatory guidance of
eruption than to dysplastic deformation of the dental
arches. 
CONCLUSIONS

■ Prophylactic and interceptive measures should therefore

be focused on the factors potentially responsible for
impairing the compensatory mechanism. 
■ In the planning of orthodontic treatment the therapy
should be designed to take into account the action of
such forces on the development of the occlusion.
CONCLUSIONS

■ As orthodontic treatment should be planned in

accordance with the individual pattern of facial
growth, it is essential to increase our knowledge in
this field. It is likewise of importance to time the
treatment according to the rate of maturation.