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

Introduction10 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:

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