GAP Australasian-Dentist-May June 2019

Category 52 AustrAlAsiAn Dentist t he transition from theory or fringe concept into mainstream reality is now virtually complete with regard to the understanding of and clinical intervention in to Human Facial Growth & Development. the following is the first in a series of articles on this topic by Dr. steve Galella, a clinician who has been at the vanguard of not just educating his fellow Doctors on the subject but designing and overseeing the manufacture of a range of specific corrective appliances. these growth guidance and habit changing devices are at the forefront of correcting facial growth anomalies and have become the go to option for his patients and indeed patients all over the world including Australia. Galella’s range of patented growth and corrective appliances are only available exclusively through nAOl Australia and it needs to be noted that any appliances from other sources claiming to be a Galella appliance are not. Many dental practitioners find the complexity of facial growth a bit overwhelming and thus merely observe and accept the clinical features of atypical growth in their patients. unfortunately, without an understanding of facial growth and development they will fail to comprehend the long-term consequences. such consequences include functional problems, tMD disorders, breathing problems, sleep apnea, and other health issues. With practical knowledge of the basics of facial growth, practitioners can adequately assess each patient to determine the cause of atypical facial growth and design treatment that will guide atypical growth back to normal. Facial growth and development is a strictly controlled biological process. normal growth involves ongoing bone remodeling and positional displacement of each bone in the craniofacial architecture. Atypical growth begins when this biological balance is disturbed. With the understanding of these processes, clinicians can adequately assess patients and determine the causes of these atypical facial growth patterns and design effective treatment plans. the blueprint for facial bone growth lies in the muscles, tongue, lips, cheeks, integument, mucosa, connective tissue, nerves, blood vessels, airway, pharynx, tonsils, adenoids, and other organ masses. it is best to examine the source of these controls to understand normal facial growth, then if normal facial growth goes awry, a practitioner can manipulate these controls to guide facial growth back to normal. the direct target for clinical intervention should be the control process regulating the biology of growth and development. the reader should understand that the following material has been simplified for clinical application. A reference of reading material for a comprehensive understanding can be found at the end of this paper. Bone remodeling and movement is the cornerstone of the facial growth process. Bone remodeling has several functions, which include: 1. Changing size and/or shape to accommodate the various functions required. 2. relocation of functional components to allow for overall enlargement, such as the mandible, nasomaxillary complex, teeth, etc. 3. Adaptation of the comprehensive facial skeleton in response to functional stress placed upon it. 4. Provide progressive “fitting” of each bone with the facial skeleton and the associated soft tissues. Most practitioners are familiar with the remodeling process as it relates to changes in size and shape of the face; however, it is critical to understand that facial bone remodeling requires without exception the simultaneous process of resorption and deposition of bone. An example of this principle is the ability of the ramus to upright during growth while at the same time enlarging the mandible. structural modifications craniofacial complex include adaptations of facial bones to maintain function because of intrinsic or extrinsic forces as described by Wolf’s law. these structural modifications also include aligning separate bones to “fit” one another to maintain continuity and integrity. Growth displacement (movement) of bone includes physical movement of a facial bone while it simultaneously remodels or changes its shape. it is imperative to understand that the expansive force of all the growing soft tissues that surround and attach to any facial bone (by anchoring fibres) regulates this physical movement of a facial bone. simply put, the surrounding soft tissue acts as the trigger or regulator which determines the direction and pattern of displacement (movement). (Figure 1). throughout growth movement, the remodeling process permits new bone deposition which in turn keeps each bone touching the contact surfaces of the surrounding bone. During facial bone growth, as displacement occurs, each bone is simultaneously remodeled causing each bone to lengthen primarily at the sites where the facial bone is displaced. Again, keep in mind that facial growth is a strictly controlled biological process which infers that local areas of hard and soft tissue work together to maintain the overall stability and function of the facial skeleton. Without this delicate balance and control, the facial skeleton would be quite asymmetrical and undoubtedly nonfunctional. u To read more on this subject and for links to references go to www.naolcourses.com source: adapted from: enlow DH,Hans MG. essentials of Facial Growth. Philadelphia, PA: WB saunders; 1996. Steve Galella Human Facial Growth & Development Part 1 By Dr Steve Galella Figure 1 lInICal