Growth Modification Treatment Copyright by Orthodontic Department, UDM

1. Growth Modification treatment
Dr.Hla Hla Yee

2. Growth Modification treatmentGrowth Modification treatment
- Orthodontic treatment in growing child include
supervision, guidance and correction of the
growing and mature dentofacial structure
(growth modification treatment) through the
stimulation and redirection of the functional
forces within the craniofacial complex.

3. Goal of growth modificationGoal of growth modification
- always is to maximize the skeletal
changes and minimize the dental changes
produced by treatment.

4. The timing of the growth modificationThe timing of the growth modification
- GM must be done before the adolescent growth spurt- GM must be done before the adolescent growth spurt
end. In theory, it could be done at any point up to thatend. In theory, it could be done at any point up to that
time.time.
- Very early treatment, relapse occurs because if- Very early treatment, relapse occurs because if
continued growth in the original disproportionate pattern.continued growth in the original disproportionate pattern.
If children are treated very early, they usually needIf children are treated very early, they usually need
further treatment during the mixed dentition and again infurther treatment during the mixed dentition and again in
the early permanent dentition to maintain the correction.the early permanent dentition to maintain the correction.

5. Delaying treatment that long has two potentialDelaying treatment that long has two potential
problems:problems:
(1) by the time the canines , premolars and second(1) by the time the canines , premolars and second
molar erupt there may not be enough growthmolar erupt there may not be enough growth
remaining for effective modification especially inremaining for effective modification especially in
girls andgirls and
(2) the child would be denied the psychosocial and(2) the child would be denied the psychosocial and
functional benefits of treatment during anfunctional benefits of treatment during an
important period of the development.important period of the development.

6. Principles in growth modificationPrinciples in growth modification
- Orthodontic force applied to the teeth has the- Orthodontic force applied to the teeth has the
potential to radiate outward and affect distantpotential to radiate outward and affect distant
skeletal locations .skeletal locations .
- Orthodontic tooth movement can correct dental- Orthodontic tooth movement can correct dental
malocclusions, if the distant effects could changemalocclusions, if the distant effects could change
the pattern of jaw growth ; there also would be thethe pattern of jaw growth ; there also would be the
possibility of correcting skeletal malocclusionspossibility of correcting skeletal malocclusions..

7. - GM , through either a functional appliance or- GM , through either a functional appliance or
extraoral force , is aimed at the maxillary suturesextraoral force , is aimed at the maxillary sutures
and / or the mandibular condyles.and / or the mandibular condyles.
- Usually this is accomplished by applying forces- Usually this is accomplished by applying forces
directly to the teeth , and secondarily and indirectlydirectly to the teeth , and secondarily and indirectly
to the skeletal structures , instead of applyingto the skeletal structures , instead of applying
directdirect
pressure to the bones.pressure to the bones.

8. -Tooth movement, in addition to any changes inTooth movement, in addition to any changes in
skeletal relationships , is inevitable.skeletal relationships , is inevitable.
-It is possible now to apply force directly against the-It is possible now to apply force directly against the
bone by using natural implants (ankylosed teeth) thatbone by using natural implants (ankylosed teeth) that
can be removed later or temporary osseointegratedcan be removed later or temporary osseointegrated
implants.implants.
Therefore the dental changes that accompany growthTherefore the dental changes that accompany growth
modification often (but not always ) are undesirable.modification often (but not always ) are undesirable.
- Excessive tooth- Excessive tooth movementmovement, whether it results from a, whether it results from a
weakness in the treatment plan, poor biomechanicalweakness in the treatment plan, poor biomechanical
control, or poor compliance, can cause growthcontrol, or poor compliance, can cause growth
modification to be incomplete and unsuccessful.modification to be incomplete and unsuccessful.

9. -The maxilla grows by apposition of new bone at its posterior &The maxilla grows by apposition of new bone at its posterior &
superior sutures, in response to being pushed forward by thesuperior sutures, in response to being pushed forward by the
lengthening cranial base and pulled downward and forwardlengthening cranial base and pulled downward and forward
by the growth of the adjusted soft tissues.by the growth of the adjusted soft tissues.
-Tension at the sutures as the maxilla is displaced from its-Tension at the sutures as the maxilla is displaced from its
supporting structures appears to be the stimulus for newsupporting structures appears to be the stimulus for new
bone formation.bone formation.

10. -The mandible is pulled downward and forward by theThe mandible is pulled downward and forward by the
soft tissues in which it is embedded.soft tissues in which it is embedded.
- In response , the condylar process grows upward and- In response , the condylar process grows upward and
backward to maintain the temporomandibularbackward to maintain the temporomandibular
articulation.articulation.

12. • Successful GM must consider and account for treatmentSuccessful GM must consider and account for treatment
effects on the dentition, as well as the skeletal structures.effects on the dentition, as well as the skeletal structures.

14. Functional appliance
Frankel (FR III)

15. Face mask

16. -- Pressure resisting the downward & forwardPressure resisting the downward & forward
movement of either jaw growth, while addingmovement of either jaw growth, while adding
to the forces that pull them downward &to the forces that pull them downward &
forward should increase their growth.forward should increase their growth.
FR II Chin cup

17. Functional appliance
Monobloc

18. Twin Block Removable functional ApplianceTwin Block Removable functional Appliance

19. Herbst fixed type functional ApplianceHerbst fixed type functional Appliance

21. Objective of growth modificationObjective of growth modification
-- Is to correct the jaw discrepancy, not move teethIs to correct the jaw discrepancy, not move teeth
to camouflage it.to camouflage it.
- To minimize danger to the teeth, full time- To minimize danger to the teeth, full time
application of heavy force to the maxilla is unwise.application of heavy force to the maxilla is unwise.
-If part time application of heavy force produced-If part time application of heavy force produced
relatively more skeletal than dental effects.relatively more skeletal than dental effects.

22. - In growing children, growth hormone is releasedIn growing children, growth hormone is released
primarily during the evening and night ( between 8 pmprimarily during the evening and night ( between 8 pm
and midnight or 1 am ) , so addition of new bone atand midnight or 1 am ) , so addition of new bone at
the epiphyseal plates of the long bones occurs mostlythe epiphyseal plates of the long bones occurs mostly
perhaps entirely at night.perhaps entirely at night.
- Growth hormones release begins is the early evening- Growth hormones release begins is the early evening
and night ( between 8 pm and midnight or 1 am ) ,and night ( between 8 pm and midnight or 1 am ) ,
however so it probably is important to stress that ahowever so it probably is important to stress that a
patient should begin wearing headgear (or apatient should begin wearing headgear (or a
functional appliance) immediately after dinner ratherfunctional appliance) immediately after dinner rather
than waiting until bedtime.than waiting until bedtime.

23. Indication for Growth modificationIndication for Growth modification
(1) Skeletal pattern II(1) Skeletal pattern II
(2) Skeletal pattern III(2) Skeletal pattern III
(3) Skeletal deepbite(3) Skeletal deepbite
(4) Skeletal openbite(4) Skeletal openbite
(5) Skeletal crossbite(5) Skeletal crossbite