Prenatal And

Postnatal Growth Of
Maxilla And
Mandible
BY:
Winnie Sharma
MDS 1st Year
 CONTENTS
• INTRODUCTION
• PRENATAL GROWTH OF MANDIBLE
• POSTNATAL GROWTH OF MANDIBLE
• PRENATAL GROWTH OF MAXILLA
• POSTNATAL GROWTH OF MAXILLA
• REFERENCES
 INTRODUCTION
• The maxilla and mandible develops from the
tissues of the first branchial arch.

Mandible = Mandibular Process

Maxilla = Maxillary Process
MAXILLA

• By the end of 3rd week, maxilla

MANDIBLE
and mandible starts to develop
PRENATAL GROWTH OF MANDIBLE

• Occurs by:
Intramembranous Ossification
Endochondral Ossification
 MECKEL’s CARTILAGE
• PRIMARY CARTILAGE

• from 1st branchial arch around 41st-45th day of

intrauterine life.

• Extends from cartilaginous otic capsule to

midline/symphysis
• GUIDING GROWTH OF MANDIBLE
• Close relationship to developing mandible but
makes no contribution to it.

• Major portion disappears without

contribution, remaining part develops into:
1. Mental Ossicles
2. Incus & Malleus
3. Spine of sphenoid
4. Anterior ligament of malleus
5. Spheno-mandibular ligament
• 1st structure to develop - mandibular division
of Trigeminal Nerve.
• 6th week IU , two primary ossification center
(one on each side) develop lateral to meckel’s
cartilage -> bifurcation of inferior alveolar
nerve.
 Primary ossification center
• Condensation of mesenchyme occurs lateral
to Meckel’s cartilage in the 6th week
gestation.
• This condensation begins at the angle formed
by division of the IAN into incisive and mental
branches.
• Intra-membranous ossification begins in this
condensation during the 7th week.
• Ossification begins in the membrane covering the
outer surface of Meckel’s cartilage.

• From this center, bone formation spreads rapidly,

anteriorly to the midline, posteriorly to the point of
division of the mandibular nerve into lingual nerve 
Formation of Mandibular Canal
• Ossification grows medially beneath the incisive
nerve, then spreads beneath this nerve and
Meckel’s cartilage.
• Incisive nerve is contained within this trough or
groove of bone formed by lateral and medial
plates which are united below the nerve.
• This trough comes in close contact with a similar
trough from the opposite side.
• The two fuse shortly after birth.
• Trough converted into canal when bone forms over
the nerve.
• Spread of ossification in the
backward direction produces
at first a trough- like
gutter of bone in which lies the
inferior alveolar nerve up to the
level of the future lingula.
• Later this gutter is converted to
bone.
Development of Body OF Mandible

• Above bony canal, medial and lateral alveolar plates

develop.
• Odontogenic epithelium forming the tooth germs lies
superiorly.
• Medial and lateral plates develop around these germs
and they come to lie in a secondary trough.
• Trough is partitioned by developing individual tooth
germs.
• Alveolar plates completely enclose the tooth germs.
 Development Of Ramus Of Mandible

• Ossification spreads posteriorly into

mesenchyme of the 1st arch.
• Spreads away from Meckel’s cartilage and this
point of turning away is the future lingula.
• By 10th week, primitive mandible is formed
almost entirely by membranous ossification.
FROM THIS POINT

Below And Around Inferior Alveolar Nerve & Its

Incisive Branch

Upward Trough Develops

Developing Tooth Buds

Dorsally & Ventrally Body & Ramus

• Ossification stops at the site : Lingula
• By 10th week mandible forms entirely by
intramembranous ossification
 SECONDARY GROWTH CARTILAGES

• Further growth of mandible is influenced by

endochondral bone formation by secondary
cartilages :
1. Condylar cartilage
2. Coronoid cartilage
3. Symphyseal cartilage
 Condylar cartilage

 5th week of IUL – mesenchymal condensation seen

above the ventral surface of mandible(developing)

 By middle of fetal life,

much of cartilage replaced
by bone, except its upper end
persists into adulthood acting
growth and articular cartilage.
 10th week – cone shaped cartilage
 14th week – ossification starts
 4 months – migrates inferior and fuses with
mandibular ramus

10th week
4th month
 Coronoid cartilage

 10th week of IUL – secondary accessory

cartilages appear in the region of coronoid
process ----grows as a response to developing
temporalis muscle
 Before birth – incorporated into the expanding
intra membranous bone of the ramus and
disappears
 Symphyseal cartilage
 7th month of IUL – 1 or 2 small cartilages
appear to ossify (on either side of symphysis)
to form variable number of mental ossicles in
the fibrous tissues of the symphysis
 During 1st year of post natal life - become
incorporated into the intra membranous bone
 POSTNATAL GROWTH OF MANDIBLE

• Largest amount of growth

• Exhibits the largest variability in morphology
• Body of mandible is one unit to which other
parts are attached
 RAMUS
• Moves progressively posterior by a
combination of deposition and resorption.

• Resorption = anterior part of ramus

• Deposition = posterior region

• Results in “DRIFT” of the

ramus in a posterior direction.
• Functions of remodeling of ramus :

1. To accommodate the increasing mass of

masticatory muscles inserted into it.
2. To accommodate the enlarged breadth of
the pharyngeal space.
3. To facilitate the lengthening of the
mandibular body, which in turn
accommodates the erupting molars.
 BODY OF MANDIBLE
• Resorption = anterior part of ramus
• Deposition = posterior region

• Displacement of ramus results

in the conversion of former ramus
bone into the posterior part of the
body of mandible.

• Body of mandible Lengthens.

• Space created by resorption of anterior border is used to accommodate

the erupting permanent molars.
 ANGLE OF MANDIBLE

LINGUAL ASPECT BUCCAL ASPECT

• Resorption = Posterio- • Resorption = Antero-

inferior aspect superior aspect
• Deposition = antero- • Deposition = Posterio-
superior aspect. superior part

Results on flaring of mandible as age advances.

 LINGUAL TUBEROSITY
• Forms a major site of growth for
the lower bony arch.
• Forms the boundary between the
ramus and the body.
• Moves posteriorly by
deposition on its posteriorly
facing structure.
• Protrudes noticeably in a lingual
direction and that it lies well
towards the midline of the ramus.
• Prominence of tuberosity = increased by the
presence of large resorption field just below
it.

• Resorption produces a sizeable depression,

the lingual fossa.
• Combination of
resorption + deposition
(fossa) (medial surface of
tuberosity)

Prominence of lingual tuberosity

 ALVEOLAR PROCESS

Presence of tooth buds

Teeth develops

Bone deposition at margins

Increase in height of bone

 CHIN

• Specific human characteristic

• Infancy- underdeveloped
• With advancing age- significant
• More prominent in males
 CONDYLAR PROCESS

• Important growth site

• Head of condyle = CONDYLAR CARTILAGE
ROLE OF CONDYLE
1. Growth occurs at surface of condylar
cartilage by bone deposition

Entire mandible gets

displaced FORWARDS &
DOWNWARDS
2. Growth of soft tissues including the muscles and
connective tissues carries the mandible forwards
away from the cranial base (carry away phenomenon)

• growth increases at
puberty (peak between
12-14 years)
• Growth ceases around
20 years
 CORONOID PROCESS

• Follows enlarging ‘V’ principle

• Deposition on lingual surface of the left and
right coronoid process
• Vertical dimensions also increases
• Deposition brings about a posterior growth
(occlusal aspect)
• “Propeller like twist”
 MAXILLA
• Develops from a center of ossification in the
mesenchyme of the maxillary process in the
angle between anterosuperior dental nerve and
inferior orbital nerve.

• No primary cartilage exists.

• Center of ossification is closely associated with

cartilage of nasal capsule.
• From this center, bone
formation spreads
posteriorly below the orbit
toward the developing
zygoma and anteriorly
toward the future incisor
region
• Ossification also spreads
superiorly to form the
frontal process.
• As a result of this pattern of bone deposition, a
bony trough forms for the Infraorbital nerve.

• From this trough a downward extension of bone

forms the lateral alveolar plate for the maxillary
tooth germs.

• Ossification also spreads into the palatine process

to form the hard palate.
• The medial alveolar plate
develops from the junction
of the palatal process and
the main body of the
forming maxilla.

• This plate, together with its

lateral counterpart, forms a
trough of bone around the
maxillary tooth germs,
which eventually become
enclosed in bony crypts.
• Secondary cartilage i.e. zygomatic,
or malar, cartilage appears in the
developing zygomatic process.

• The body of the maxilla is

relatively small because the
maxillary sinus has not developed.

• Forms 16th week as a shallow

groove on the nasal aspect of the
developing maxilla.

• At birth the sinus is still a

rudimentary structure about the
size of a small pea
POST NATAL GROWTH OF MAXILLA
Growth of naso-maxillary complex influenced by
following mechanism: -

a. Displacement
b. Growth at sutures
c. Surface remodelling
 DISPLACEMENT
Primary Displacement Secondary Displacement
 GROWTH AT SUTURES
• Frontomaxillary
• Frontonasal
• Zygomaticotemporal
• Zygomaticomaxillary
• Pterygopalatine sutures

Leads to downward and forward repositioning

of maxilla
• These sutures are all oblique and more or less
parallel to each other.
• Leads to opening up of space at the sutural
attachments.
• New bone is now formed on either side of the
suture.
• Overall size of the bones on either side increases.
• Hence, a tension related bone formation occurs at
the sutures.
 SURFACE REMODELLING
• In addition to the growth occurring at the
sutures , there is massive remodelling by bone
deposition and bone resorption occurs to
bring about :
* Increase in size
* Change in shape of bone
* Change in functional relationship
1. Bone deposition
occurs on the
posterior margin of
the maxillary
tuberosity. This
causes lengthening
of the dental arch.
2. Bone resorption occurs on
the lateral wall of the nose
leading to increase the size
of nasal cavity.

3. Bone resorption is seen in

the floor of the nasal
cavity and bone
deposition on the palatal
side results in increase the
maxillary height.
4. Bone formation occurs on
the lateral surface of the
zygomatic arch and resorption
at the medial surface results in
increase in width of face.

5. It will increase the height of

maxilla as teeth starts erupting
bone deposition occurs at the
alveolar margins and causes
increase in the depth of
palate.
• 6. Enlargement of maxillary sinus plays an
important role in the growth of the body of
the maxilla. It expands by bone resorption on
the sinus side and bone deposition on the
facial surface of the maxillary process.
 Molecular Genetics

• Interestingly, even though both mandibular

and maxillary primordia originate from similar
NCCs and possess similar molecular features,
they develop into very different structural
entities
• In the first branchial arch, a gradient of gene
expression involving the Dlx family of transcription
factors (intra-arch Dlx code) promotes coordinated
gene expression along the dorso-ventral axis that
regulates jaw patterning.

• Distinct sets of Dlx family members are important for

determining the identity of the mandible
(Dlx1/2/5/6) versus the maxilla (Dlx1/2).
 Dlx3/4
Hand1/2
Alx3/4
MANDIBLE Dlx5/6 Pitx1
Gbx2
Bmp7

Pou3f3
MAXILLA Dlx1/2 Foxl2
Irx5

Thus Dlx family members are critical for determining the

identity of the mandible versus the maxilla.
THANK YOU
 REFERENCES
• S.I. Bhalajhi - Orthodontics-the Art and
Science , 6th edition
• Graber - Orthodontics current principles and
techniques , 5th edition
• Antonio Nanci - Ten Cate’s Oral histology, 6th
edition
• GS Kumar – Orban’s Oral Histology and
Embryology, 13th edition