skeletal growth prediction and Age estimation

Proffit W Fields H Sarver DContemporary Orthodontics 4 ed 2007 Elsevier

Skeletal Growth predictionamp

Age Estimation

Contents Introduction Gnomic growth and logarithmic spiral Arcial growth Rickettrsquos cepahlometric prediction Prediction of mandibular growth rotations

Mathematical model for prediction of craniofacial growth

VTOTooth mineralizationSkeletal maturity indicator

Introduction

It is not possible to predict how a patient is going to respond to a particular treatment

Variability is expected

Patientrsquos growth pattern

Variability

Effect of treatment on growth

In the absence of growth treatment responses are reasonably predictable

GROWTH IS NOThelliphellip

The goal of growth prediction is to reduce the clinicianrsquos ignorance of the futurehellip

What are we interested in predicting in the craniofacial complex

1 Future size of a part -The prediction of future size is primarily a problem of predicting future increments which are to be added to a size that is already known

Eg prediction of length of the mandible

2 Relationship of parts ndash The most important prediction for the

clinician is the future relationship of parts that is the future facial pattern

3 Timing of growth events ndash Because growth does not proceed evenly certain facial dimensions demonstrate marked change in their velocity curves These spurts make predictions much more difficult

If one were to predict a ldquospurtrdquo we might want to predict the a) time of onset b) duration of increased rate of growth c) rate of growth during the spurt

4 Vectors of growth- Most predictive method presume a continuation of the pattern first seenThe presumption is made that the vectors of the growth present at the time of prediction will remain

However this is not truehellipMandible which grow vertically for a

period of time can start to grow horizontally

Can such changes in growth direction be predicted

5 Velocity of growth- It would be of use to know the future expected rate of growth especially during pubescent spurt

6Effect of orthodontic therapy on any of the above predicted parameters

What effect therapy is having on the predicted and actual growth of one specific face

How well can we predict these parameters

Future Size Complex craniofacial growth Any simple series of size prediction is not

clinically useful

Relationship of parts Harvold Johnston Ballach ndash predicted maxillo mandibular relationshipNone were accuratehellip

Timing and growth events Hunter amp Miller reported the shape of the face as

roughly related to the timing of the pubuscent spurt

Frisancho- predict the individual spurt in stature from noting the time of calcification of the sesamoid bone

Vectors of growthThere is no means of anticipating change in the

direction of growthPredicting vector is not same as predicting

changes in the vectorhellip

VelocityNot much attention is given to this

The effect of orthodontic therapy on growth

Rickettsrsquo method- sets the prediction and then works to make them come true

Gnomic growth and logrithmic spiral

What is gnomic growth The process where upon the addition to a body

leaves the resultant body similar to the original is called gnomic growth

DrsquoArcy Thompson classified the sea shells in accordance to their pattern of enlargement and developed an equation

The Nautilus offers 2 fundamental characterstics-1 The shell grows in size but does not change its

shape new growth

2 Its gnomic growth can be described by a particular kind of curve- the logarithmic or equiangular spiral

The spiral is characterized by the movement of a point away from the pole along the radius vector with a velocity increasing as its distance from the pole

Logarithmic growth of human mandible

There are several functional conditions which are not violated during orofacial growth- one of these is neural innervations which must never be subjected to external loading

Craniometric studies were performed on American Indian skull they are representative of mandible with fetal deciduous mixed and adult dentition

Small lead shots were fixed to foramen ovale Mandibular foramenamp foramen mental

Lateral x-rays effectively outlined the pathway of the Inf Alveolar nerve

All the 3 neural foramina at all ages fit precisely upon a single mathematically defined logarithmic spiral

Another longitudinal and cross sectional clinical growth data showed that these foramina moved along the same logarithmic spiral in geometric fashion with the gradient of motion directly increasing with the distance of the foramina from the cranial base ie mental foramen moves most and the foramen ovale least

In the fetal period the 3 foramina are relatively near the origin of the spiral and at the same time they are placed nearer to each other than at later stage This produces a flatter curvatre hence gonial angle is relatively flat

With growth due to increase in distance ramus becomes straight relative to corpus and gonial angle acute

During all stages of development the corpus stays in essentially a horizontal position At the same time the mandible curves down the logarithmic spiral course of the inferior alveolar nerve

Arcial growth Ricketts in 1972 developed a method to

determine the arc of growth of the mandible PRINCIPLE A normal human mandible grows by superior

anterior apposition at the ramus on a curve or arc which is a segment formed from a circle The radius of this circle is determined by using the distance from mental protrubence (Pm) to a point at the forking of the stress lines at the terminus of the oblique ridge on the medial side of the ramus( point Eva)

Landmarks Xi point- The deepest point on the subcoronoid is selected as R1 R2 is selected directly opposite to it on post border of

ramus R3 is selected at the depth of the sigmoid notch R4 is directly on the lower border of ramus The centroid of the rectangle formed is called Xi point

Supra pogonion- It is a point located at the superior aspect of symphysis

It is labelled Pm This is substantiated as a reference point because- 1 It is the site of a reversal line (Enlow) 2 Stable unchanging bone in this area of bone (Bjork)

Point Dc ndash It is a point at the bisection of condyle neck

Point Eva- it is a biologic point as it is located over the point of forking of the stress line in the ramus

Ramus reference point (RR) is the point halfway between Xi point and R3 on the anterior border of ramus

Construction of growth arc

1 Point RR and R3 are connected

Mid point of RR and R3 is pt Eva

2 Take pt Eva ndashPm as radius- circle is drawn

1 taking eva as a centre 2 taking Pm as a centre3 The point of intersection is

TR (True radius) taking this as a centre an arc is drawn

4 Where this arc crosses sigmoid notch is called Murray point

Steps in growth prediction Step 1 amount of growth on arc- 25mm From pt Mu the mandible is grown out on the arc at

the sigmoid notch about 25mm cutoff for males=19yrs females= 145yrs

Step 2 Coronoid ndash upwards ampoutwards ndash 08mm yr Condyle - upward amp backward - 02 mm yr

Step 3 - Drift of gonial angle Females- no addition Males - 02 mm yr

Step 4 complete forcasting of the mandibular form

Connections from coronoid process ndashRR ndash 04mmyr

determine space available for 3rd molar

By constructing the growth arc growing the mandible on the arc extending and drifting the angular process this forecasting technique is tested

Drawbacks of arcial growth prediction

1 It relies heavily on the operators skill in tracing the cephalogram

2 Mitchell amp Jordan (1975) concluded Ricketts uses chronological age rather than the skeletal age If the patient is in a growth spurt or lag phase it will alter the result

3 The growth increments constants are for a fixed population

Ricketts cephalometric or short term prediction

The changes in the face during treatment were

thought to be influenced by a phenomenon within TMJ complex

1 The changes in the angle of cranial base to a more acute or obtuse relationship

2 Forward or backward movement of the condyle that influenced the chin behavior

Procedure for growth estimation Class II Div 1 case was selected to demonstrate

the procedure For growth estimation work the cranial plane

basion-nasion (Ba-Na) plane is employed It can be studied in following steps STEP 1 1 Projection of probable changes in the basi

cranium It includes Points N S amp Ba a) Sella ndash starting point Average expectancy for increase along SN

pubertal spurt ndash 1mm yr Mixed dentition ndash 05 ndash 07 mm yr

b) Expected changes between sella amp Basion change in length is 34th of S-N

c) Establish Expected Ba-N Connect the new S amp N amp Ba ndashformation of new

basicranium

STEP 2 Predeterming the behaviour of condyle Condyle position remained same in 60 of cases Downward amp forward movement of Ar amp Ba ndashsimilar after the age of 6 Superimposing Ba- N and registering Ba will reveal the future

condylar position

STEP 3 Ptm is outlined-evaluation of maxillary growth coronoid pr Superimposing of SN and registering at S shows Downward dropping of this fissure Tip of the coronoid process is located 3mm forward to ptm

at both start and completion of Treatment

STEP 4 Construction of condylar axis From the centre of condyle to antegonial angle

STEP 5 Contemplation of growth of condyle Estimated on the condyle axis During Rx 2mm of growth yr upto 9yrs During puberty = 3 or 4 mm yr may be expected The assessment of condylar growth permits the construction of the

post Border gonial angle sigmoid notchamp ant Border of ramus

STEP 6 assessment of remaining mandible Rotation of mandibular plane untill the change agrees with the

estimate of change for that case Forward direction of condyle ndash lower mandibular plane angle Backward condylar growth - higher mandible plane angle

STEP 7 Lengthening of body of mandible It is slightly greater than S-N plane 15 mm yr Changes in the symphysis are plotted

STEP 8 Facial plane and Y axis is constructed Superimposition on the BA-N plane will indicate the direction of

growth of mandible

Position of Maxilla Step1 Increase in face height( vertical changes) Facial plane is superimposed amp registered on N 40 above ANS 60 of TFH increase is due to the denture area ie below

Step 2 Horizontal position of maxilla It is postulated from the tendency of S-Na to remain

constant to Ba-N Pt A is dropped parallel with line NA Great amt of bodily retraction- Pt A will be moved back

as much as 3-5 degree

3 future facial convexity is determined by predicted behavior of Pt A

4 Descent of the palate is forecastPost nasal spine drops parallel to ptm

Soft tissue behavior Nose ndash superimposing of the palatal bone and registering

on ANS 2mm of growth of nose Profile outlined is then constructed to the area below nose

Upper Lip- severely protruding cases- 2-4 mm increase in thickness

Moderate protrusion 1-2mm increase in thickness

Lower lip- bisecting the overbiteamp overjet change and drawing sup portion of the lower lip at this level

This constitutes the complete procedure for estimating the changes that can be expected in any given case prior to treatment

Prediction of mandible growth Rotations

Bjork 1969 gave 3 methods to predict growth1Longitudnal ndash following the course of development

in annual x ndashray pattern of growth is not constant2Metric- prediction of the facial development on the

basis of facial morphology from a single x ray film

3Structural- based on the information concerning the remodelling process of the mandible during growth gained from implant studies

Principle- to recognize specific structural feature that develop as a result of remodelling in a paricular type of mandibular rotation A prediction of the subsequent course is then made on assumption that the trend will continue

Mandible may be regarded as an unconstrained bone

The site of the center of rotation may be located at Anterior ends Posterior ends Between the ends Thus center may not necessarily lie at TMJ

Forward rotation may occur in 3 ways- Type I Forward rotation centre in TMJ It gives rise to deep bite resulting in under development of anterior

face height Cause may be occlusal imbalance powerful muscular pressure

TYPE 2 Rotation centre at the incisal edges Marked Development of Post Facial height + normal

increase in Ant Facial height The post part of mandible rotates away from maxilla

Increase in post facial height lowering of middle cranial fossa increase height of ramus

Vertical direction of condylar growth Mandilble is lowered more than it is carried forward Muscle and ligamnetous attachment lowering takes place as a forward rotation in relation to

maxilla

Type 3 centre at pre molar In case of large maxillary overjet the center of rotation is displaced

backward in the archto the level of premolars AFH ndash under developed PFH - increases Dental arches are pressed into each other and basal deep bite

develops In Type II amp III the mandibular symphysis swings forward to a

marked degree and the chin becomes prominent

BACKWARD ROTATION OF THE MANDIBLE 2 types

TYPE 1 centre of rotation in TMJ

Backward rotation of the mandible about a center in the joints also occurs in connection with growth of the cranial base

In the case of flattening of the cranial base the middle cranial fossae are raised in relation to the anterior one

and then the mandible is also raised

There may be other causes also such as an incomplete development in height of the middle cranial fossae

This underdevelopment of the posterior face height leads to a backward rotation of the mandible with overdevelopment of the anterior face height and possibly open-bite as a consequence The mandible is in principle normal

TYPE 2 Centre at distal occluding molars

This occurs in connection with growth in the sagittal direction at the mandibular condyles

As the mandible grows in the direction of its length it is carried forward more than it is lowered in the face and because of its attachment to muscles and ligaments it is rotated backward

The symphysis is swung backward and the chin is drawn back below the face The soft tissues of the chin may not follow this movement and a characteristic double chin can form Basal open-bite may develop Difficulty in closing the lips without tension Lower incisors functionally related to the upper incisors become retroclined in the mandible and the alveolar prognathism is reduced

BJORK amp RUNE found a contrast between the positioning of mandible in a longitudnal series when superimposed on the cranial base and positioning contours resulting from superimposition on metallic implants They divided rotations into 3 components

1 Matrix Rotation2 Intramatrix rotation3 Total rotation

Matrix Rotation centre in the condyleRotation of bone with its matrix or periosteal

capsule in its articulation with surrounding bone

INTRAMATRIX ROTATION centre in corpus Rotation of the mineralized corpus inside the matrix periosteum Periosteal cellular activity rotation of the bony corpus Surface of bone are remodeled in compensatory fashion Matrix retains its stable inclination

TOTAL ROTATION Combination of the 2 types It is rotation of the mandibular corpus measured as a

change in the inclination of an implant line in the mandibular corpus relative to anterior cranial base

The position of center of rotation of total rotation is dependent on the other 2 centers of rotation

Structural method of growth prediction

STRUCTURAL SIGNS OF GROWTH ROTATION 7 structural signs of extreme growth rotation The greater in number that are present the more reliable the

prediction 1) INCLINATION OF CONDYLE HEAD Forward or backward inclination of the condylar head May not be easy to identify on the cephalograms

2) CURVATURE OF MANDIBULAR CANAL Vertical condylar growth ndash curvature of canal is more Sagittal condylar growth - straight mandibular canal

3) SHAPE OF THE LOWER BORDER OF MANDIBLE Vertical condylar growth ndash apposition below the symphysis and anterior part of mandible Sagittal growth ndash ant rounding absent thin cortical layer jaw angle is convex

4 INCLINATION OF SYMPHYSIS Vertical type ndash symphysis swings forward Sagittal type ndash swings backward with receding chin

5Position of the lower incisor seems to be functionally related to the upper incisors

Inter incisal angle undergoes a smaller change than the rotation of the jaws

6 INTERMOLAR amp PREMOLAR ANGLE Forward growth rotation - mandibular post More upright increase in inter molar premolar angle

Backward rotation - mandibular molar and premolars inclined forward

small inter molar premolar angle

7 LOWER ANT FACIAL HEIGHT Forward growth rotation- decrease in lower AFH Backward rotation - over development of AFH

Thus from structural method for prediction of rotation Brsquojork concluded

Forward inclination of condyle- ant rotation of the mandible

Backward inclination- post rotation of the mandible

Drawbacks

There is no absolute correlation between structural growth prediction and degree of growth rotation in cases showing average changes

The method should be primarily used to determine whether any typical signs of ant or post Growth rotations are present

C- AXIS

M point- by Nanda amp Meritt (AJO 1994)

It is a constructed point representing the center of the largest circle that is tangent to the superior anterior amp palatal surfaces of maxilla as seen in the sagital plane

C-Axis The line from the sella (S) to M- point is defined as C- axis

It permits the quantification of a complex maxillary growth process

Age group -74-1875yrs The regression formula is independent of gender

within the chronological age studied Upto age 14 both male and females show-

growth increment of 141mm amp131mmyr

The mean growth axis angle (C-axis- SN) Increased for both males and females Males = 398 Females = 225

Palatal plane to C-Axis

Palatal plane is geometrically related to C-axis Females= increases from 354 ndash 374 Males =increases from 393- 416 These changes tend to flatten the palatal plane

A single M point cannot by itself summarize the growth of dentomaxillary complex in sagital plane

However when associated with the palatal plane the downward amp forward migration is more accurately decsribed

Quantification of the displacement of the mandible

Y axis

What about remodeling of external symphyseal areahellip

G Axis

G ndashAxis A growth vector for mandible Stanley Braun et al Angle orthodontist Vol 74

No3 2004G point it is a point representing the centre of

largest circle that is tangent to the internal inf anterior and post surfaces of the mandibular symphyseal region as seen on lat cephalograms

G point it is a point representing the centre of largest circle that is tangent to the internal inf anterior and post surfaces of the mandibular symphyseal region as seen on lat cephalograms

Length of this axis is determined by Sella amp G- point Direction is determined by alpha angle -Mean growth axis vector angle Theta angle- Mandibular plane amp G-axis - Mean mandibular plane angle

Age group- 6- 1925yrs G-axis length Females ndash 16mmyr Males ndash 23mmyr

Mean Growth vector angle Females ndash decreases 002yr Males ndash increases 014yr

Mean mandibular plane angle Females ndashincreases by 04yr Males ndash increases by 03yr

Thus G-axis allow for the quantification of the complex mandibular growth process in cephalometric terms relative to various craniofacial structure in the sagittal plane

VTO It is completely practical as a treatment planning

procedure to approach the proposed orthodontic changes from a soft tissue analysis perspective

Possible soft tissue profile is established--- compute the tooth movements

It can be done manually or cephalometric tracings Tracing represents the expected growth or any growth

changes induced during treatment This is especially noticeable when growth over a period

of 5yrs or longer was forecast

Mathematical Model for prediction of craniofacial growth

Presented by James T Todd amp Leonard Mark

The model is derived from the basic assumptions about the long range effects of gravitational pressure on the remodelling of bone and expressed formally on a single geometric transformation

The validity of the model is examined empirically using data for 20 individuals from the Denver Child research Council longitudnal growth study

It is based on the following hypothesis- ldquoThe overall pattern of craniofacial growth

is primarily controlled by biomechanical influencesrdquo This is known as Wolf lsquos law

The wolf lawrsquos states- The bone elements place themselves in the direction of functional pressure and increase or decrease their mass to reflect the amount of functional pressure

Todd amp mark conclude that the mathematical transformation was shown to make reasonably accurate prediction over a span of 10-15 yrs

REVISED CARDIOIDAL STRAIN

Rrsquo = R +bP

Gravity influences the biomechanics of growth which is exerted on every point with in the craniofacial complex and it also provides a counter force for the action of muscles

Heads are not perfectly spherical There are other sources of stress operating on

craniofacial complex besides the force gravity The orientation of the head with respect to the

gravity does not remain fixed

The predictions that were made were not accurate because of-

mechanical errorsOral habits Nevertheless they very closely predict

the actual outcome of growthhelliphellip

COMPUTERIZED GROWTH FORECASTING

Computerized growth predictionsCephalometric software (quickceph image

dentofacial planner) have replaced manual acetate tracings with computer generated tracings derived from digitized head film During the process of digitization the x-y coordinates of cephalometrics landmarks are recorded and stored in data set from which various cephalometric measurements are made

Growth and treatment response can be displayed and measured by longitudnal superimposition of serial datasets on stable cranial base or regional landmarks

Rickettrsquos technique- It is the most widely used and the first technique that is implemented in software

It assigns mean increments of growth to a series of landmarks along reference lines determined by the use of growth increments that are sensitive to the skeletal age

Computerized VTO- The manual method of prediction gives a

reasonable good graphic representation of growth changes to create a VTO

Computer offers the added advantage quicker access to information greater accuracy in producing the tracing useful in pt education Software used are Rocky Mountain Data

System Quickceph II

Mesh analysisCoenrad FA moorrees et al

The mesh diagram is composed of a grid of rectangular scaled on the ptrsquos upper facial height and depth

The face is inscribed in a coordinate system consisting of 24 rectangles

The length and height of mesh rectangle differs among individuals

The size increases from 8-16yrs Boys-45mm- ht Girls- 35mm-ht Length- 32mm in boys Length 24mm in girls Shape of mesh rectangle is determined by

shape of the core rectangle- represents the ratio between face depth and upper facial height

In the original proposal the grid was distorted to fit the proportionate location of ptrsquos cephalometric landmark as compared to the norm thereby graphically representing how the patient face deviated from the norm

Disadv- complex and laborious method

Modification ndash a norm is superimposed on the ptrsquos grid in order to reveal difference from a normalized mesh diagram

Advantages- graphically display ptrsquos deviationNormal mesh diag is readily understood by

patient

Computerized mesh analysis It is a quantitative assessment of the direction

and amount of deviation of each facial landmark of the patient

A modified 3 dimensional mesh analysis could then be used to compare patients values to reference soft tissue data collected on normal standard

Construction of the reference grid

Normal reference have been constructed on the basis of the data bank available at LAFAS Milan with the use of 3D facial morphometry which detects 3 dimensional coordinates

The digitized landmarks described the head the face the orbits the nose lipsampmouth Mean values were computed within genders

A standard lattice of equidistant horizontal verticalamp A-P line was constructed comprising 84 parallelopipeds (28 frontal 21 sagital 12 horizontal tracings)

Comparison of the patient to the norm

3 dimensional coordinates of the facial landmarks of each pt were obtained oriented on x-y-z axis amp a grid is constructed

Step 1 std normal reference is superimposed on the patients tracings

Size and shape difference is evaluated by calculation of new relevant displacement vector for each landmark

Conclusion Burstone has pointed out ldquo the knowledge

of prediction might best proceed by learning to predict untreated growing facesrdquo

The clinician must always wonder what effect his therapy is having on the patient and actual growth of one specific face

`Research work may develop mathematical

models devise predictive procedures and test them statistically but the practicing orthodontist treating one child at a time will prove the ultimate worth of any suggested methodhellip

THANK YOU

Skeletal Growth predictionamp Age Estimation

Contents

Introduction

What are we interested in predicting in the craniofacial comple

Arcial growth

Procedure for growth estimation

Position of Maxilla

C- AXIS

G Axis

Computerized growth forecasting

Mesh analysis

Computerized mesh analysis

Conclusion

Contents Introduction Gnomic growth and logarithmic spiral Arcial growth Rickettrsquos cepahlometric prediction Prediction of mandibular growth rotations

Introduction

Variability

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Introduction

Variability

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Introduction

Variability

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Variability

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

clinically useful

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

shape new growth

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

basicranium

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

condylar position

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

growth of mandible

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

maxilla

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Drawbacks

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

C- AXIS

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Y axis

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

G Axis

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Rrsquo = R +bP

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

System Quickceph II

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

patient

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

THANK YOU

Contents

Introduction

Arcial growth

Position of Maxilla

C- AXIS

G Axis

Mesh analysis

Conclusion

Health & Medicine

skeletal growth prediction and Age estimation