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DEND 182

Facial Growth and Development

Final Exam Answers 1998

Department of Orthodontics,

Case Western Reserve University.

Directions: Use the following menu to skip to the desired answers of

the final exam or use it to view the questions only.

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1. An impacted or unerupted maxillary canine may be located most

accurately by means of

A. periapical and lateral jaw roentgenograms.

B. periapical and occlusal roentgenograms.

C. lateral jaw roentgenogram alone.

D. cephalogram.

2. The mandible usually stops remodeling at

A. 8 years of age.

B. 12 years of age.
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C. 18 years of age.

D. None of the above.

3. At birth the greatest dimension of the face is

A. depth.

B. width.

C. height.

D. All dimensions are equal.

4. Deposition of dye in animal bone growth studies is known as

A. anthropologic determination.

B. vital staining.

C. sutural deposition.

D. embryologic injection.

E. surface dying.

5. After a tooth has been moved from one position to another, the resulting

bone is

A. sclerotic bone.

B. cortical bone.

C. transitional bone.

D. compact bone.

6. The most stable point in a growing skull from a cephalometric standpoint is

A. sella turcica, the center of the pituitary fossa in the cranial

base.

B. nasion, the junction of the nasal and frontal bones.


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C. pogonion, the most anterior point on the bony chin.

D. the upper central incisor.

7. A good method for determining the location of growth sites in the growing

monkey skull would be

A. by injecting alizarin red dye and sacrificing the animal later.

B. through the use of oriented head x-rays.

C. by using anthropometric instruments.

8. The human face is displaced

A. downward and forward.

B. forward.

C. downward.

D. upward.

9. The dependence of tooth development and tooth eruption upon growth of

bone and bones is

A. negligible.

B. considerable.

C. unrelated.

10. In the study of occlusion it is necessary to study the growth and

development of the child, recognizing age, physical stature, familial

background and any abnormalities evidenced by clinical examination and

roentgenographic interpretation. Occlusion therefore is considered

A. static.

B. dynamic and functional.

C. mechanical and functional.


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D. a definite fixed position of teeth in each arch.

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11. At birth, which of the following structures is farthest from the size it will

eventually be in adulthood?

A. Cranium

B. Nasal capsule

C. Middle face

D. Mandible

12. Additional space for the eruption of succeeding maxillary molars is made

by

a. continuous expansion of the dental arch.

b. downward and forward displacement of the maxillary complex.

c. interstitial bone growth.

d. appositional growth at the maxillary tuberosity.

e. increase in palatal vault height.

A. (a) and (c)

B. (a) and (d)

C. (b) and (d)

D. (b) and (e)

E. (c) and (e)
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13. Growth sites can best be determined in the laboratory animal by means

of

A. vital staining.

B. intra-oral radiographs.

C. cephalometric radiography.

D. comparing dry skeletal material.

14. Patients who have ectodermal dysplasia have had prostheses

constructed during active growth to replace missing teeth. It has been

observed that the dentures

A. restricted lateral bone growth.

B. restricted jaw development.

C. did not restrict growth.

D. were not tolerated due to diminished salivary flow.

15. Cartilage can grow by which of the following methods?

A. Interstitial growth only

B. Appositional growth only

C. Both appositional and interstitial growth

D. Degenerative changes into bony structures

16. How does growth of the cranial base generally relate in time to growth ofthe jaws?

A. Precedes

B. Follows

C. Accompanies

D. Initially follows then accompanies


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17. In a patient with anodontia, which of the following would be true of

dental prosthetic treatment between the ages of 6 and 17 years?

A. Several dentures will be needed because growth in the inter-canine

region will cause the denture to become ill-fitting.

B. Several dentures will be needed because growth in the

retromolar areas and palatal vault will cause the denture to

become ill-fitting.

C. Since, in the absence of teeth, there will be no growth of alveolar bone,

the denture base will fit for 10 years or more.

D. Since the denture will restrict normal growth of the jaws, the dentures

will probably need to be remade every year to permit growth.

18. Most Class II malocclusions can be prevented by

A. maintaining the integrity of the primary dentition.

B. preventing deleterious habits (such as thumb sucking, lip biting, etc.).

C. breast feeding.

D. no known techniques.

E. (A), (B) and (C) above

19. The "V" principle of growth is illustrated by the

A. nasal septum.

B. mandibular condyle.

C. mandibular symphysis.

D. spheno-occipital synchondrosis.

20. The greatest period of cranial growth occurs between

A. birth and 5 years of age.

B. 6 and 8 years of age.

C. 10 and 12 years of age.


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D. 14 and 16 years of age.

Go to Questions: 1-10 | 11-20 | 21-30 | 31-40 | 41-50 | 51-60 | 61-70 | 71-80 | 81-90 |

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| 81-90 | 91-100 | 101-110 | 111-120 | 121-130 | 131-136

21. At birth, which of the following structures is nearest the size it will

eventually attain in adulthood?

A. Cranium

B. Mandible

C. Clavicle

D. Middle face

E. Nasal capsule

22. The downward and forward direction of facial growth results from

displacement of the maxilla in this direction along with:

A. upward and backward remodeling of the maxillary sutures.

B. vertical eruption and distal drift of the dentitions.

C. interstitial growth in the maxilla.D. epithelial induction at the growth centers.

23. A needle fragment embedded in the anterior border of the ramus of the

mandible of a 6-year old child would

A. soon become embedded more deeply as new bone covered it.

B. soon become free in the soft tissue as resorption uncovered it.


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C. remain on the surface as the ramus was translated.

D. stimulate formation of a bony protuberance at the site of the needle

fragment.

24. Arch length space for the eruption of permanent mandibular second and

third molars is created by

A. apposition of the alveolar process.

B. apposition at the anterior border of the ramus.

C. resorption at the anterior border of the ramus.

D. resorption at the posterior border of the ramus.

25. Cephalometric studies show that, on the average,

a. the mandible grows more slowly than the maxilla.

b. the maxilla, during growth, is translated in a downward and forward

direction.

c. cranial base growth determines mandibular growth.d. mandibular growth stops after maxillary growth.

A. (a) and (b)

B. (b) and (c)

C. (b) and (d)

D. (c) and (d)

26. What is the chief factor in the formation of the alveolar process?

A. Eruption of teeth

B. Normal process of growth

C. Lengthening of the condyle

D. Overall growth of the bodies of the maxilla and the mandible


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27. Which of the following methods is least accurate in determining the site

of new bone deposition in laboratory animals?

A. Implants

B. Radiographs

C. Alizarin stains

D. Tetracycline stains

E. Histochemical stains

28. After age 6, the greatest increase in size of the mandible occurs

A. at the symphysis.

B. between the canines.

C. along the lower border.

D. distal to the first molars.

29. The downward and forward direction of facial growth results from

A. upward and backward growth of the maxillary sutures and the

mandibular condyle.

B. vertical eruption and mesial drift of the dentitions.

C. interstitial growth in the maxilla and the mandible.

D. epithelial induction at the growth centers.

30. The condyle of the mandible grows by

A. membrane bone growth.

B. interstitial bone growth.

C. appositional bone growth.

D. proliferation of cartilage.

E. none of the above.

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| 81-90 | 91-100 | 101-110 | 111-120 | 121-130 | 131-136

31. The cranial vault increases rapidly in size the first few years postnatally

and completes approximately 90 per cent of its growth by 6 years of age.

This is typical of which of the following types of tissues?

A. Neural

B. Dental

C. Genital

D. Lymphoid

E. General (somatic)

32. At birth, which of the following structures is farthest from the size it will

eventually attain in adulthood

A. Mandible

B. Cranial vault

C. Cranial base

D. Middle face

E. Nasal capsule

33. Dental arch form is ultimately determined by

A. skeletal growth pattern.

B. classification of malocclusion.

C. facial type coupled with body type.

D. the functional relationship of posterior teeth.

E. interaction of environmental influences on the genetic pattern.
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34. Which of the following are sites of cartilaginous growth postnatally?

a. Spheno-occipital synchondrosis

b. Mandibular condyle

c. Frontomaxillary suture

d. Nasal septum

e. Alveolar process

A. (a) and (b) only

B. (a), (b) and (d)

C. (b), (c) and (e)

D. (c) and (e) onlyE. All of the above

35. Interstitial growth is observed at which of the following sites?

a. Spheno-occipital synchondrosis

b. Maxillary tuberosity

c. Mandibular condyled. Zygomaticomaxillary suture

e. Apex of an erupting premolar

A. (a) and (b)

B. (a) and (c)

C. (a) and (d)

D. (b) and (d)

E. (b) and (e)

36. Which of the following methods is least accurate in determining the site

of new bone deposition in laboratory animals?

A. Implants

B. Radiographs

C. Alizarin stains


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D. Tetracycline stains

E. Histochemical stains

37. There is more adolescent growth spurt of the maxilla than of the

mandible because lymphoid tissue in the nasopharynx decreases at

puberty.

A. Both statement and reason are correct and related.

B. Both statement and reason are correct but NOT related.

C. The statement is correct but the reason is NOT

D. The statement is NOT correct but the reason is an accuratestatement

E. NEITHER statement nor reason is correct.

38. In determining a patient's skeletal growth pattern, the most important

factor is

A. diet.B. habits.

C. heredity.

D. dental occlusion.

39. Bone tissue grows by

A. the "V" principle.B. interstitial growth.

C. osteoclastic activity.

D. proliferation of endodermal tissue.

E. differentiation of cartilaginous tissue.

40. What is the chief factor in the formation of the alveolar process?


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A. Eruption of teeth

B. Normal process of growth

C. Lengthening of the condyle

D. Overall growth of the bodies of the maxilla and the mandible

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41. The cranial vault increases rapidly in size the first few years postnatally

and completes approximately 90 per cent of its growth by 6 years of age.

This growth is typical of which of the following types of tissues?

A. NeuralB. Dental

C. Genital

D. Lymphoid

E. General (somatic)

42. Following the growth rate curve typical for lymphoid tissue, tonsillar and

adenoid tissue masses can be expected to show

A. continuous growth throughout life.

B. a rapid increase in size at the time of puberty.

C. a decrease in size beginning in the circumpubertal period.

D. a progressively decreasing rate of growth from birth to adulthood.

E. no significant increase in size between 4 and 10 years of age.

43. Cartilage differs from bone in that cartilage can increase in size by


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A. apposition

B. sutural expansion

C. interstitial growth

D. selective resorption

E. endosteal remodeling

44. What is the relationship between growth curves for lymphoid tissues

(tonsils, neck nodes, adenoids) and sexual characteristics?

A. Both curves slope upward in parallel form.

B. Lymph tissues grow more slowly than genital tissues.C. Lymph tissues stop growing when genital tissues begin growing.

D. Lymph tissues regress as genital tissues develop.

E. These curves are not related.

45. Cross-sectional growth studies sample

A. different individuals at the same age intervals.B. the same individuals, but different midsagittal sections.

C. different individuals and different sagittal sections.

D. the same individuals at different age intervals.

E. none of the above.

46. Surgery on the hard palate of a 3-year old cleft patient may inhibit

growth of the nasal septum, causing the facial profile to become

A. straight

B. elongated

C. shortened

D. more convex

E. more concave


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47. The formation of the philtrum of the upper lip occurs around 6-8 weeks

in utero by fusion of the median nasal processes

A. True

B. False

48. The masseter muscle develops embryologically from which brachial

(pharyngeal) arch

A. I-First

B. II-Second

C. III-Third

D. IV-Fourth

E. V-Fifth

49. Cartilage tissue is pressure tolerant and able to provide flexible support

because it is avascular and contains an intracellular matrix of

proteoglycans.

A. The first statement is True, the second statement is true and

they are related.

B. The first statement is True, the second statement is true and they are

NOT related.

C. The first statement is True, the second statement is False

D. The first statement is False, the second statement is true.

E. Both statements are false.

50. The periodontal ligament acts as a static supporting mechanism for the

teeth.

A. True

B. False


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51. Seven year old Jack is in your office. He has severe crowding of the

upper incisors and the permanent lateral incisors contact the deciduous

first molars. You can safely tell the mom and dad:

A. That Jack will outgrow this problem.

B. That this problem is caused by large teeth and Jack will need crowns on

the teeth to decrease their size.

C. That Jack needs to have the deciduous first molars extracted to make

room for the permanent canines.

D. That Jack will probably need braces if he wants straight teeth.

52. A priority plan exists during prenatal growth and development of the

face and the body in general. Which of the following organ systems would

have the highest priority?

A. Masticatory System

B. Nervous System

C. Urinary SystemD. Respiratory System

E. Reproductive System

53. Which of the following is/are true?

1. Newly formed bone is radiolucent.

2. All types of bone are highly calcified.


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3. Bone is a dynamic tissue.

4. Cartilage is tension adapted.

5. The periodontal ligament is a dynamic structure.

A. 1,2,5

B. 1,3,4

C. 2,4,5

D. 1,3,5

E. 3,4,5

54. Osseointergrated titanium implants can undergo vertical drift andmovement in much the same way as natural teeth

A. True

B. False

55. Which of the following statements about bone growth is/are true?

1. Remodeling of bone occurs on both endosteal and periosteal surfaces.

2. Remodeling of bone stops around age 18.

3. Remodeling of bone results in the histologic structures called osteons.

4. Remodeling of bone only occurs in the face.

5. Deposition and resorption may not occur in equal amounts.

A. 1,3

B. 1,2,3

C. 1,3,5D. 3,4

E. 2,3


1. The matrix of ordinary cartilage is calcified.

2. Osteocytes have a limited lifespan.


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A. 1. is true

B. 2. is true

C. Both are true statements

D. Neither is a true statement.

57. Haversian systems is/are:

1. Characteristically found in the adult skeleton.

2. Formed by cutting and filling cones.

3. A structural unit of bone.

4. A structural unit of cartilage.5. A neuromuscularly induced response to mechanical force.

A. 1,2,3

B. 2,3,4

C. 2,3,5

D. 2,3 only

E. 1,3 only

58. Biochemical remodeling of bone refers to:

A. Rebuilding of macromolecules from micromolecules.

B. The exchange of minerals and other ions between the blood and

bone.

C. Chemical treatment of bone to induce resorption or deposition.

D. Decalcification of bone.

59. Which of the following statements correctly describe bone growth:

1. There is a general uniform deposition of new bone on all periosteal

surfaces.

2. There is a general uniform resorption of bone on all endosteal surfaces.

3. The endosteal surface may contribute significantly to new bone

formation.


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4. Interstitial growth of bone is necessary to change the morphology of the

fetal face to the adult face.

5. Displacement of bones is necessary to change the fetal face to the adult

face.

A. 1 and 2

B. 1, 2 and 3

C. 3, 4 and 5

D. 3 and 5

E. 1, 3 and 5

60. The maxilla grows upward and backward and is displaced downward and

forward. This statement means:

1. Adequate space for second and third molars can not be assessed at age

six.

2. Additional bone is usually not deposited on the anterior surface of the

premaxilla.

3. Nothing, the statement is not true.

4. Additional arch length (space for teeth) is likely to be gained anterior to

the cuspids.

A. 1 and 2

B. 2 and 3

C. 3 and 4

D. 1 and 4

E. 3

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1. Macrostomia (large mouth) results from a failure of fusion.

2. Bone can grow interstitially due to its calcified matrix.

3. At birth the premaxilla is fused to the maxilla.

4. At birth the right and left sides of the maxilla are not fused.

A. 1 and 2

B. 2 and 3

C. 3 and 4D. 1 and 4

E. 2 and 4

62. A dental implant placed in the area of the upper lateral incisor at age 7

will:

A. be displaced along with the maxilla during growth.

B. drift vertically with the alveolar process along with the natural teeth.C. be resorbed by the body as a foreign body.

D. eventually be replaced by new bone laid down by cutting and filling

cones.

63. The grand design of the human face is the result of two growth

processes which interact to produce the final result. What are they?

1. Remodeling

2. Displacement

3. Disarticulation

4. Occlusal equilibration

5. BPRD

A. 1 and 2

B. 2 and 3

C. 3 and 4


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D. 1 and 4

E. 2 and 4

64. Displacement and remodeling can occur in opposite directions.

A. True

B. False

65. While you are infiltrating the palatal root of the upper first molar in a six

year old you accidentally break off the tip of the needle and it imbeds in

the bone of the hard palate acting as a metallic implant. Ten years later

you would find this metal fragment:

A. In the floor of the nose

B. In the soft tissue of the roof of the mouth

C. In the small intestines

D. In the tonsillar pillars

66. The functional matrix theory holds that:

1. Soft tissue is primary.

2. Bone is responsive to soft tissue.

3. Respiration does not influence midfacial growth.

4. Deglutition (mandibular function) influences mandibular growth.

5. The condylar cartilage is the center for all facial growth.

A. 1,2,3

B. 1,2,4

C. 2,3,4

D. 3,4,5

E. All of the above.


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67. The skilled orthodontist is able to control facial growth to improve facial

appearance.

A. True

B. False

68. Which of the following are directions of growth for the dentist to consider

when evaluating a young patient?

1. Vertical

2. Horizontal

3. Transverse

A. 1,2

B. 1,3

C. 2,3

D. All of the above

E. None of the above

69. Facial growth is a dynamic process.

A. True

B. False

70.Rapid palatal expansion of the maxilla is a therapeutic procedure that

most closely mimics what biologic process?

A. Remodeling

B. Fusion

C. Merging

D. Displacement


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71. The maxilla grows by:

A. Downward and Forward Displacement.

B. Interstitial enlargement in the area of the tuberosity.

C. Upward and backward endochondral bone formation.

D. All of the above

E. Two of the above

72. Cortical drift occurs by a combination of periosteal deposition and

endosteal resorption because deposition and resorption always occur

together in equal and opposite amounts.

A. The first statement is true, the second statement is true and they are

related.

B. The first statement is true, the second statement is true and they are

NOT related.

C. The first statement is false, the second statement is true.

D. The first statement is true, the second statement is false. E. The first statement is false, the second statement is false.

73. A osseointegrated titanium dental implant will behave biologically most

similar to:

A. A deciduous tooth

B. A permanent tooth


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C. An ankylosed tooth

D. An impacted tooth

74. In children and teenagers, vertical growth of the maxilla during

orthodontic treatment

A. can contribute favorably to the correction of deep overbite.

B. does not usually occur.

C. does not contribute to treatment success.

D. is not a target for treatment intervention.

75. The "switch" that turns facial growth on and off is

A. located in the cerebellum.

B. located in the periosteum.

C. part of the genetic code.

D. an environmental signal.

E. not known at this time.

76. The sutural theory of facial growth holds that the cells lining the sutures

push the bones apart and create displacement of the bones. This theory

has been rejected by modern craniofacial biologists because:

A. Bones can not "push" on other bones.

B. The nasal septum theory replaced the sutural theory.

C. Sutures are important sites of adjustment.D. Sutures do not exist in the adult skull.

77. The mandibular condyle is an important control center for mandibular

growth because the condylar cartilage is capable of producing

endochondral bone throughout life.


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A. The first statement is true the second is false.

B. The first statement is false , the second statement is true.

C. Both statements are true and are related.

D. Both statements are true but are not related.


78. Areas of muscle attachment are under tension and therefore they are

always depository bony surfaces.

A. The first statement is true, the second false

B. The first statement is false, the second true

C. Both statements are true and relatedD. Both statements are true but not related


79. The temporomandibular joint contains which of the following histologic

structures:

A. fibrocartilageB. Meckel's cartilage

C. osteophytes

D. trophoblasts

E. none of the above

80. The temporomandibular joint is:

A. capable of controlling mandibular growth.

B. a hinge joint.

C. a ball and socket joint.

D. a ginglymoarthroidal joint.

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81. In the anatomically normal TMJ the superior joint compartment provides:

A. Rotational movement.

B. synovial fluid pressure.

C. Translational movement.

D. most TMJ pain.

82. The meniscus of the TMJ is:

A. important for normal function of the joint.

B. made up of growth cartilage.

C. often calcified in older patients.

D. not part of a normal TMJ.

83. The condyle of the mandible is part of the temporomandibular joint and

is capable of multidirectional adaptation and growth. This is important

function because:

A. occlusion of the teeth is complex and dynamic, thus requiring a

joint capable of continuous adjustment.

B. many teeth are lost to decay, thus requiring a joint capable of

continuous adjustment.

C. occlusion is simple and static.

D. none of the above.

84. Adult facial growth
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A. follows the same pattern for males and females.

B. is more vertical in the male population.

C. is more horizontal in the female population.

D. none of the above.

85. Investigators studying the influence of genes on growth often examine

the _______ of the cell:

A. number of mitochondria

B. endoplasmic reticulum

C. messenger RNAD. chondroblastic potential

86. The Functional Matrix Hypothesis holds that:

A. The soft tissues of the brain expand thus pacing growth of the

flat bones of the skull.

B. The territorial matrix of the chondrocytes is responsible for the resiliencyof this tissue.

C. Cellular function is controlled by genes.

D. Hypothetically, function of the organism is not related to growth.

87. The glenoid fossa of the TMJ

1. is lined with hyaline/fibrocartilage.2. may undergo remodeling.

3. is located in the sphenoid bone.

4. indirectly affects the position of the chin.

5. becomes deeper with age.

A. 1,2,3,4

B. 1,2,4,5

C. 1,3,4,5


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D. 2,3,4,5

E. All of the above

88. Adult facial growth (change after age 25) could affect:

A. the dental occlusion

B. Eruption of third molars

C. single tooth dental implants

D. All of the above

E. Two of the above

89. As we grow older our faces look different this is commonly the result of

1. Remodeling of the bones of the face.

2. Changes in the soft tissue integument.

3. Displacement of the bones of the face.

4. TMJ dysfunction.

5. Interstitial growth of the bone.

A. 1,2

B. 1,2,3

C. 1,2,3,4

D. 1,2,4

E. 1,2,5

90. Branemark implants have been used to successfully rehabilitate

edentulous mouths. The fact that implants are not capable of drifting

within the alveolus has not affected the success rate, this is most likely

because:

A. Adult facial growth does not occur.

B. Displacement of bones does not occur.

C. The implants are used to support complete lower dentures.


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D. Dental drift does not occur in adults.

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91. Growth (remodeling and displacement) occurring in palatine bones

results in relative changes in the position of the maxillae. This is an

example of:

A. Secondary displacement.

B. Primary displacement.

C. Cortical drift.

D. The "V" principle of growth.

92. It is generally more physiologic to orthodontically move teeth into areas

of depository activity. Which of the following is/are physiologically sound

movements:

A. Distal or lingual movement of the lower incisors.

B. Labial or forward movement of the lower incisors.C. Labial or forward movement of the upper incisors.

93. The midface is suspended from:

A. The cranial base.

B. The mandible.

C. The cerebellum.


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D. The spinal cord.

E. none of the above

94. In general , midfacial growth __________ mandibular growth

A. is temporally not related to

B. follows

C. precedes

95. One of the basic principles of facial growth is:

A. The face grow proportional to the nose.

B. The brain is the pacemaker for facial development.

C. The face grows out from under the brain.

96. The relative position of the eyes within the face :

A. Is lower the older you are.

B. Is relatively the same at all ages.

C. Is higher the older you are.

97. Facial growth is a dynamic process

A. True

B. False

98. As a general principle, the glenoid fossa

A. Becomes deeper and more anatomically defined with increasing

age.

B. Is found in the parietal bone.


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C. Is an important growth site, but not a growth center.

D. Is a critical component of the endochondral bone formation mechanism.

99. Rotational movement in the healthy TMJ occurs:

A. In the superior joint space.

B. In the inferior joint space.

C. In outer space.

D. In cyberspace.

100.The condylar cartilage of the TMJ allows for physiologic adaptation of the

condylar head to changing stresses in the masticatory system. Which of

the following statements are true:

a must print ortho

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