The contributions of craniofacial growth to clinical orthodontics

Abstract

Balanced facial form and functions are derived from a harmonious integration of the various components of the craniofacial complex. These components grow and develop throughout life in a sequential, predictable, and orderly fashion, albeit with a wide range of variation in the amount and timing of growth. The knowledge of growth-related changes is essential in planning orthodontic treatment. It is important to understand and anticipate the amount and relative rate of growth in different parts of the face, especially during childhood and adolescence. The orthodontist needs to assess the developmental status of the individual and estimate the remaining growth to plan treatment. Incremental growth curves made on linear measurements from longitudinal cephalometric radiographs have demonstrated that all facial dimensions have varying relative rates of growth and show small prepubertal and postpubertal growth spurts. 1 The pubertal spurt in facial dimensions was found to coincide with the spurt in skeletal growth, as reflected by body height, lasting 3 to 4 years. It is apparently of shorter duration and occurs earlier in females than in males. To determine the time of the peak growth period in facial dimensions for an individual, several maturity indicators have been tested. The closest relationship was found with skeletal maturation, which can be readily assessed from hand and wrist radiographs. In many cases orthodontic treatment should commence before the onset or early during the pubertal spurt in order to take advantage of the accelerated growth period. Individual variability in amount and rate of growth is fairly large, related mainly to heredity (familial potential), gender, and ethnic background. In addition, growth is a life-long process. The face of an adult male continues to become progressively more orthognathic. 2 The nose grows downward and forward, while the commissure of the lips moves down with lengthening