Oral Biology 5301 Bone growth and development Bone biology Educational objectives Exposure to basic concepts of bone biology Correlation of basic bone biology to clinical treatment Special considerations / implications of bone biology to dentistry

Clinical Correlates of Bone Growth and Development Facial skeletal development Maxillary development Mandibular development

Clinical Correlates of Bone Growth and Development Effect of congenital anomalies on facial growth and development Effect of surgical correction of congenital anomalies on facial growth and development Tooth development and retention influence on alveolar bone levels

Clincal Correlates of Bone Growth and Development Orthodontic tooth movement Bone healing following tooth extraction Bone response to alloplastic materials Bone healing in approximation of dental implants

Clinical Correlates of Bone Growth and Development Bone grafting to treat dentoalveolar defects Bone grafting to treat discontinuity defects Fracture healing

Cellular Growth Hypertrophy Hyperplasia Secretion of extracellular material Interstitial growth

Embryologic Type of Bone Endochondral Intramembranous

Functional Matrix Theory of Growth “Growth of the face occurs as a response to the functional need and is mediated by the soft tissue in which the bone is embedded” Soft tissues grow, bone and cartilage react

Growth Control Bone is the determinant of its own growth Cartilage is the determinant of bone growth Soft tissue matrix is the determinant of growth All are controlled genetically

Orthodontic Tooth Movement Bone apposition and resorption Effects on the pulp Effects on the PDL Effects on the tooth root

Effects of Periosteum Provision of undifferentiated mesechymal cells Envelope to limit/regulate bone apposition

Introduction 10 y.o. female 12/98 CC: Noticed swelling in face on left side for two weeks HPI: Facial swelling Left lower lip “tingles” No pain or change in bite

Examination Left lower facial swelling, without thrill/bruit Lower vestibular swelling, L>R No abnormal tooth mobility Teeth 19-28 vital with EPT CN II-XII grossly intact

Assessment Problem list: Diff. Dx: Multilocular radiolucent lesion Teeth vital without resorption, displacement, or mobility Apparent cortical expansion Diff. Dx: Central Giant Cell Lesion Ameloblastomic Fibroodontoma Ameloblastoma

Treatment Plan Impressions for splint fabrication Screening labs Ca, alk phos, PTH All WNL CT of mandible: Multilocular radiolucents, from infer border to encompass tooth roots superiorly Buccal and lingual cortices intact, although expansion present Incisional bx

Facial Growth and Development 15 year old man Congenital cleft lip and palate 29 surgeries to nose and lip Significant malocclusion Status post facial skeletal growth Masticatory insufficiency

Facial Growth and Development 4 year old boy with jaw immobility Mother concerned about failure to thrive and ability to receive dental care Anterior open bite Etiology unknown

Facial Growth and Development 7 year old boy Condylar neoplasm resected as infant (age 2) and recurrence treated age 4 Concerns about facial growth and development