Milo Hellman

An introduction to growth of the human face from infancy to adulthood

Abstract The points to be made in this introductory report are: 1. 1. That in the study of growth of the face, the meaning of increases in dimensions must be clearly understood. 2. 2. That increase of the dimension of one part may mean decrease in substance (nasal aperture), and decrease in dimension of another part may mean addition of substance (relative decrease in upper and lower face height as compared with total face height—made up by development of dentition). 3. 3. That the human face, as it is represented by this group, grows by increase in size in three planes: vertical, transverse, and anteroposterior. 4. 4. That the dimensions are measurable by some sort of a measuring rod., while growth of the dimensions is measured by anatomic manifestations. 5. 5. That the dimension of the human face, as represented by the group studied, is greatest in width, less in height and least in depth. 6. 6. That the greatest dimension increases least and the smallest most. 7. 7. That with increase in size of the human face there is a change in proportion of the dimensions studied. 8. 8. That the dimensions of the same plane, at different levels, grow at different rates. 9. 9. That, as the face grows longer, it increases vertically more in the back than in the front; transversely and anteroposteriorly more below than above. 10. 10. That some of these changes are more emphasized in the male than in the female. 11. 11. That the face of the female is relatively longer and that of the male is relatively broader and deeper. That the female jaw bones and dental arches are relatively more prognathous than those of the male. 12. 12. That when the face increases its dimensions in height and depth, there is simultaneous but alternate acceleration and retardation of growth in the two planes, at the different levels of the same plane and in different sections of the same dimension. 13. 13. That the growth stages of the face are seriated in this paper not primarily according to chronologic age, but according to the sequence of eruption and shedding of deciduous teeth and appearance of permanent teeth. 14. 14. That the greater bulk of the observations were made on the same growing individuals over periods of from two to seven years. It is planned on a subsequent occasion to report the progress of growth changes in individuals.

Some facial features and their orthodontic implication

Abstract In a brief summary of the essential points aimed at, it may be stated: 1. 1. That according to prevailing notions among orthodontists a face is normal when its dentition is in normal occlusion and, conversely, a face is abnormal when its dentition is in malocclusion. The inference is that orthodontic treatment changes the abnormal face to the normal as the dentition is restored to normal occlusion from malocclusion. 2. 2. That what is meant by a normal face is usually just taken for granted because it was at no time clearly defined. 3. 3. That a systematic metrical study of facial features of sixty-two young adult white males with full complements of teeth in normal occlusion reveals the fact that their faces are extremely variable. 4. 4. That in order to understand the nature of facial variation, it is essential to have a standard measure to determine what is normal and what is not normal. 5. 5. That by the use of the standard described, it is found that the dimensions of the facial features studied in the group with normal occlusion are not all normal. The proportion of those features which are normal to those which are not normal is on the whole approximately 2:1. In faces with dentitions in Class II Division 1 and Class III, it is extremely variable, ranging from 4:1 to 1:2. 6. 6. That dimensions of facial features which are not normal are found to be of two sorts. One comprises those dimensions which are larger and the other those which are smaller than normal. 7. 7. That in some facial features, the number of anormal dimensions which are larger is equal to those which are smaller than normal; that is, they are symmetrically divided. 8. 8. That equally or symmetrically divided dimensions have little significance beyond the fact that they are larger or smaller than the normal and that they are as likely to be the one as the other. 9. 9. That when unequally or asymmetrically divided, the dimensions of those features which are not normal indicate certain trends; that is, they are more often either larger or smaller than the normal. 10. 10. That asymmetrical division is to be noted both in dimensions of faces with dentitions in normal occlusion and in faces with dentitions in Class II Division 1 and Class III malocclusion. 11. 11. That in faces with dentitions in normal occlusion, the asymmetries are very slight while in those with malocclusion they are very marked. 12. 12. That as the asymmetries become more unbalanced, they clearly indicate (a) the differences between the same features in faces with dentition in normal occlusion and malocclusion and (b) the differences between features of faces with dentitions in Class II Division 1 and Class III malocclusion. It is thus clear that the use of the described “standard” provides a measure which greatly reduces the confusing intricacies of facial variation and simplifies the practical problem of appraising faces for orthodontic needs.

Studies on the etiology of Angle's Class II malocclusal manifestations

Summary In summing up what has been brought forth in this contribution, the following points will become manifestly evident: (1) That irregularity of the teeth or of any other organ is a biologic phenomenon and may occur in all living things. (2) That malocclusions due to irregularities of the teeth, like the disturbed functions due to irregularities of other parts of animals and plants, are biologic phenomena. (3) That attempts at classifying the irregularities and malocclusion of the teeth have been made as early as 1803. (4) That these attempts terminated in the simple classification worked out by Angle which is accepted throughout the world. (5) That the basis of Angles classification does not prove satisfactory with respect to the divisions of Class II manifestations. (6) That in skulls presenting Class II, division 1, the mandible is found to present a more acute angle than those belonging to skulls with normal occlusion. The body of the mandible therefore assumes a more posterior position in relation to the maxilla than in the normal skulls. The teeth of the mandible are therefore in distal occlusion. (7) That in skulls presenting Class II, division 2, manifestations, there appears a reversal of this condition, i.e., the maxillary alveolar process appears to have drifted anteriorly; the teeth therein contained are consequently in mesial relation to those of the mandible. (8) That various factors of malocclusion accepted by the modern orthodontist date back many centuries. Most of them have come down to us by tradition, and accepted on no other grounds but by the recommendations of some authority. (9) That when put to test not one of the recommended factors is found to bear any definite relationship to a particular form of malocclusion. (10) That the only factor found in close and positive relation to Class II, division 1, is the habit of sucking. (11) That malocclusion is essentially an expression of some discrepancy in growth. (12) That growth, though occurring as a constant manifestation from the fertilization of the egg to the adult size of the individual, is modified by retardations and accelerations. (13) That accelerations and retardations when influenced by pathologic conditions result in deformities. (14) That the development of the jaws and teeth are similarly subject to these retardations and accelerations. (15) That 80 per cent of the individuals examined were bottle-fed. (16) That the bottle-fed individuals present a higher incidence of diseases due to the artificial nature of the food. (17) That of the individuals examined with reference to diseases 97 per cent had malocclusion of the teeth. (18) That there is no correlation found between disease processes and any definite form of occlusion. (19) That accelerations and retardation in growth influenced by pathologic conditions may explain the modified mandible in Class II, division 1, and the overdeveloped lateral portion of the upper alveolar arch and the concomitant underdeveloped premaxillary bone in Class II, division 2.. It may, therefore, be safely concluded, (1) That mouth-breathing is not specially concerned in the production of Class II any more than it has influence to produce Class I. (2) That the sucking habit has a positive though not exclusive relationship to Class II, division 1. (3) That artificial feeding stands in direct relation to a higher susceptibility to pathologic conditions. (4) That pathologic conditions have an exaggerating or activating influence upon retardation and acceleration in association with growth. (5) And that retardations and accelerations associated with growth, influence the formation and completion of the masticatory apparatus as they do everything else that depends upon growth and development for its perfection. And, therefore, they also have an influence in the retarded development and diminutive size of the mandible with distal occlusion in Class II, division 1, and the forward drifting of the maxillary lateral halves with mesial occlusion of the maxillary teeth in Class II, division 2.

Diagnosis in orthodontic practice

Abstract To sum up, the following points may be reiterated: 1. 1. That the general concept of diagnosis is much divided and lacks a uniform understanding, a sound basis, and a proper approach to the solution of the problem of malocclusion. 2. 2. That a systematic classification of malocclusion, as proposed by Angle, offers a reliable starting point for planning and carrying out orthodontic treatment. 3. 3. That the use of the face in the diagnosis of malocclusion rests on obscure assumptions and leads to erroneous conclusions. 4. 4. That evidence derived from scientific research in malocclusion supports the view that to understand the problem of diagnosis more thoroughly, it is of importance to have a better knowledge of development. 5. 5. That development, as it is concerned with orthodontic patients, is chiefly confined to the differentiation of the dentition, to the growth of the face, and to the form of occlusion. 6. 6. That to understand the course of events in growth and differentiation, a standard for measuring them both is of importance. 7. 7. That the normal standard used to appraise the face clearly points out the vagaries of both growth and differentiation. 8. 8. That by the use of this standard, it is shown that differentiation in dentition alternates with growth in face. 9. 9. That comparable differences in relationship between facial features and dental occlusion are relative. 10. 10. That occlusal contact relationship in Class II, Division 1 malocclusion is absolute. 11. 11. That the growth changes of the faces with dentitions in Class II, Division 1 simulate those with dentitions in normal occlusion. 12. 12. That the status of the face having Class II, Division 1 can be appraised satisfactorily by proper method, technique, and skill. 13. 13. That facial appraisal to be of significance must be repeated periodically for a considerable length of time. 14. 14. That appraising the faces of orthodontic patients does not imply the diagnosis of malocclusion of the dentition. On the contrary, a typical form of malocclusion is a valid symptom for a reliable diagnosis of the face. 15. 15. That measurements of dimensions and a standard for evaluating them furnish a means of pointing out, not only the status of the face, but also the pattern of its growth potentialities. 16. 16. That knowing and showing in advance of orthodontic treatment what the pattern of development is and what the subsequent effect is likely to be is a duty to ourselves and an obligation to the patient.

Notes on the Type of Hesperopithecus Harold Cookii Osborn

CONTENTS I. Analysis of characters of the type......................................... 9 II. Remarks on figs. 1-4.................................................... 10 III. Remarks on the comparative measurements and indices of Hesperopithecus. 12 IV. Radiographic examination of typespecimen..18 Remarks (M. H.) ........................................................ 19 V. Geological occurrence of the Hesperopithecus tooth.......................... 20 VI. Conclusions............................................................ 22