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aim of the paper
to dispel the
controversies around
this fundamental
concept
deals with basic
etiology of mandibular
growth rotation, effect
of various pathologies
and orthodontic
treatment
glimpse of mandibular
growth prediction and
its clinical utilization
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review of literature
concept introduced by Lande (1952)
Bjork (1955)
Odegard (1970)
Bjork and Skieller (1972)- dentoalveolar
adaptation
Lavergne and Gasson (1977)- positional
rotation, morphogenetic rotation
Bjork and Skieller (1983)- total rotation,
matrix rotation, intramatrix rotation
Dibbets (1985)- counter balancing
rotation for intramatrix rotation
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basic terminologies
rotation- angular
movement of one
rigid body relative to
another


angular change
single body change
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terminologies
true rotation (angle
between AA)

apparent rotation
(angle between BB)

angular remodeling of
the mandibular border
(angle between BB
when AA are
overlapped)

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condition Bjork Solow &
Houston
Proffit
rotation of mandibular core
relative to cranial base
total
rotation
true
rotation
internal
rotation
rotation of mandibular
plane relative to cranial
bases
matrix
rotation

apparent
rotation
total
rotation
rotation of the mandibular
plane relative to core of
mandible
intra-
matrix
rotation
angular
remodel-
ing
external
rotation
relation of terminologies
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condition Bjork Shudy Solow &
Houston
anterior growth
greater than
posterior
forward
rotation
-ve
clockwise
rotation
backward
rotation
+ve
posterior growth
greater than
anterior
backward
rotation
+ve

counter
clockwise
rotation
forward
rotation
-ve

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example
from 4 years to
adulthood -15
0
is
internal rotation
out of which 25% is
matrix rotation (A) and
75% intramatrix
rotation (B)
11-12
0
external rotation
so only (3-4
0
) total
rotation or decrease in
mandibular plane angle
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etiology
Differential growth
in anterior and
posterior facial
height
posterior facial
height- sum of the
vertical component
of the descent of
the middle cranial
fossa and growth
of the mandibular
condyle
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cont
anterior facial height-
primary determinant is
upper cervical
vertebral growth, this
acts through
differential growth in
the muscles and fascia
that are attached to
the mandible and pass
to the cranium above
and to the hyoid bone
and shoulder girdle
below

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normally occurring mandibular
growth rotation
forward internal rotation of mandible is
greater than the maxilla because vertical
condylar growth exceeds growth at the
maxillary sutures
so mandibular incisors become more
upright, mandibular molar moves mesially
more compared to maxillary
thus mandibular arch length decrease is
more and so mandibular anterior crowding

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natures compensation
dentoalveolar
compensation



periosteal
remodeling by
medial pterigoid
and masseter

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Pathologies affecting rotation
digit sucking or
extrusion of molars
open bite
fibrous ankylosis or
juvenile rheumatoid
arthritis of TMJ
factors affecting the
adequacy of the
nasal airway
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Prediction of mandibular growth
rotation Riketts (up to 1978)
facial axis open 1
0
-/5
mm of convexity
reduction, /3 mm
molar correction, /4
mm overbite
correction
facial axis opens 1-
1
1
/
2
0
- cross bite
correction
condyle will move 1
mm/year along DC-Xi
Pm will move 2
mm/year along Xi-Pm
fixed values are added
so less accurate

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prediction of mandibular growth
rotation
Bjork and Skieller (1984)
44 morphological variants
20 variants prognostication lies between
23%-60%
stepwise regression leads to 4 variants
with 86% prognostication
but any variant significance alone is not
more than 60%
only applicable for extreme cases is
disadvantage
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four variants
inter-molar angle
(a)
shape of the lower
border of the
mandible (b)
inclination of the
mandibular
symphysis (c)
inclination of
mandible (d)
(a) (b)
(c)
(d)
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prediction of mandibular
growth rotation by Todd Aki
and Ram S. Nanda (1994)
symphysis
ratio=height/width
large anterior facial
height is produced when
large symphysis ratio,
receding chin and high
mandibular plane angle
small symphysis ratio
will produce large chin,
low mandibular plane,
lower facial height
men posses stronger
relation with symphysis
morphology than women
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prediction of mandibular growth
rotation by Chvatal, Behrents, Ceen
& Buschang (2005)

longitudinal cephalograms provides
information on growth pattern, maturation
status, growth velocity, growth potential

construction of multilevel model
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Contd
horizontal movement of
mandible dose not have
adolescence growth
spurt, vertical growth
follows sigmoid growth
pattern leads to greater
decrease in MPA in
childhood & slight
increase of Me-0 during
adolescence
Me-Y is good predictors
of all
multilevel prediction
shown to be valid for
independent variables
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clinical consideration
clockwise rotation induced by orthodontic
treatment, particularly associated with the
use of class II elastics, anchorage bends
and anterior bite plates are often transient.


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contd
treatment induced increase in anterior face height
exceeds that which would normally have occurred
with growth, there will often be a gradual
anticlockwise rotation associated with intrusion of
teeth under the occlusal forces

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contd
clockwise
mandibular
rotation associated
with obstruction
leads to changes in
head posture to
maintain airway,
auto correction is
always expected
after removal of
cause
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contd
anticlockwise
mandibular rotation
associated with
reduction in anterior
face height and
deepening of overbite
is not a growth
rotation- it may follow
a treatment which has
raised the occlusal
plane unduly or it may
be a consequence of
loss of posterior teeth
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effect of class II orthodontic
treatment with fixed appliance
on mandibular rotation
more vertical growth direction of treated
cases as compared to untreated cases
greater occlusal movement of mandibular
molars
no great change in mandibular rotation
due to treatment
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class II case treated with
functional appliance
posterior and
upward growth
direction of condyle
with clockwise
growth rotation of
mandible can
improve the
sagittal
discrepancy
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treatment of class III patient
with chin cup
the principle effect of
chin cup appliance is
downward and
backward rotation of
mandible (clockwise)
so symmetric low
mandibular plane
angle patient with
short normal anterior
facial height are
preferred
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conclusion
mandibular growth rotation plays important
role in orthodontic treatment planning
so mandibular growth prediction becomes
equally important
currently available data based prediction
models are fair
but future efforts are needed to establish
mandibular growth prediction

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