Therefore it is important to coordinate the timing of alveolar bone grafting of the cleft defect with orthodontic tooth movement. Figure illustrates radiographs of different clefts and root alignment without bone grafting and orthodontic treatment. Emergence of the permanent canine is often at risk in children with alveolar clefting because of its mesial inclination. The canine crown is usually oriented mesially when the tooth begins its eruptive path i. Therefore before orthodontic alignment of the canine is initiated, it is important to plan and perform the bone grafting of the alveolar defect to ensure proper tooth eruption.
Figure A series of radiographs from children with cleft lip and palate showing the vulnerability of teeth in their formation and eruption. The shape of the cleft influences the orientation of the teeth. Eruption and enamel integrity are often compromised. Bone grafting can facilitate the eruption of teeth adjacent to a cleft. Restoration by recontouring the tooth with dental composites can camouflage the tooth defects.
A, Radiograph showing orientation of teeth to conform to the shape of the cleft. Such an orientation can divert the eruption path of the tooth in any of the three dimensions. Also note the defective enamel on the mesial surface of the lateral incisor adjacent to the cleft arrow. It is also noteworthy that the lateral incisor is in the maxillary segment and not in the premaxillary segment. B, Radiograph showing a bilateral cleft of the dental alveolus and palate.
Normal alignment of teeth would not be possible in this case without a bone graft. Attempts to align the teeth would result in the roots positioned into the cleft.
C, Radiograph showing a bilateral cleft of the dental alveolus and palate. Lateral incisor teeth are missing and enamel is distorted. D, Radiograph from a child with a unilateral cleft of the lip, dental alveolus, and palate. The erupti on path of the maxillary canine is medial to its normal course. Defective enamel hypoplasia and opacities is common in the teeth adjacent to the cleft site.
Enamel defects occur in persons with untreated clefts of the lip and alveolus but increase in frequency following surgical intervention. Because there is a higher occurrence of caries in teeth with enamel defects, the issue of prevention is of great importance in cleft children. There are many lessons to be learned from nature's variability of expression. Some of these lessons help.
For example, the formation of lateral incisors on either side of the cleft supports the migratory idea for tooth-forming cells. Other lessons sharpen the dentist's observations such as the higher frequency of anomalies in the maxillary lateral incisor area. Although the time for cleft occurrence is in the first few weeks of life, its impact on the subsequent stages of facial and dental development continues for the life of the individual. The child with a cleft often faces considerable social challenges and deserves the most empathetic care from the dentist.
Figure A sample of malformations resulting from failure of embryologic components to fuse or to form. A, Infant with midline cleft. The cleft is at the site of the midline groove. Midline clefts are less common than clefts from failed fusion of the maxillary and median nasal process. Midline clefts are commonly associated with neurologic deficits as was the case with this infant.
B, Child with a bilateral horizontal facial cleft. The cleft is along the line of expected fusion between the first branchial mandibular arch and the maxilla. C, Child with agenesis of the premaxilla. D, Child with unilateral cleft of the lip, palate, and lip pits. The presence of lip pits increases the chance of clefting in offspring. In all the cases discussed, the clinician can learn much from these children and adults who happen to have a variation from the average physical presentation.
Mishima K et al: Three-dimensional comparison between the palatal forms in complete unilateral cleft lip and palate with and without Hotz plate from cheiloplasty to palatoplasty, Cleft Palate Craniofac J 33 4 , Mortier PB et al: Evaluation of the results of cleft lip and palate surgical treatment: preliminary report, Cleft Palate Craniofac J 34 3 : , Enamark H et al: Lip and nose morphology in patients with unilateral cleft lip and palate from four Scandinavian centres, Scand j Plast Reconstr Hand Surg 27 1 : , Mazaheri M et al: Evaluation of maxillary dental arch form in unilateral clefts of lip, alveolus, and palate from one month to four years, Cleft Palate Craniofac J 30 1 , Tsai T -Z et al: Distribution patterns of primary and permanent dentition in children with unilateral complete cleft lip and palate, Cleft Palate Craniofac 2 , Neville BW et al: Abnormalities of the teeth.
Pope AW: Points of risk and opportunity for parents of children with craniofacial conditions, Cleft Palate Craniofac J 36 1 , These are general guidelines and do not include the extremes of variation, which may occur in postnatal growth. Growth Study Types Growth studies are of three basic types: cross-sectional, longitudinal, and mixed longitudinal. Health professionals need to compare the rate or velocity of growth of a patient with standards for velocity at the patient's age. Standards for velocity can only be derived from a longitudinal study.
Cross-Sectional Studies in cross-sectional studies a large number of individuals of different ages are examined on one occasion to develop information on growth attained at a particular age.
The method has the advantage of accumulating much information about growth at many ages in a short period of time. The majority of information about growth has been obtained using cross-sectional methods. Cross-sectional studies provide the best data for establishing national standards for growth and for comparing growth in different populations. A random or representative sample of boys and girls at each age is needed for construction of national standards.
The number of children measured at each age should be proportional to the rate of growth. In the first year, samples should be taken at three intervals, the second year at two intervals, and during adolescence at two intervals each year. Although a mean rate of growth for a population can be estimated from cross-sectional data, nothing. Longitudinal Studies Longitudinal studies involve the examination of a group of children repeatedly over a long period during active growth.
This method produces the most valuable data for the study of growth rates and the variability of individual growth. However, the drawbacks of this kind of study include small sample size, difficulties in keeping subjects in the study, and long-term data collection.
Analysis of the data must follow the period of data collection. Mixed Longitudinal Studies Mixed longitudinal studies are a combination of the cross-sectional and longitudinal types. Subjects at different age levels are seen longitudinally for shorter periods e. In a 6-year span, growth can be studied between birth and 6 years for one group, between 5 and 11 years for another group, between 10 and 16 years for another group, and between 15 and 21 years in another group so that growth from birth to 21 years can be studied in 6 years.
Figure Height curves for distance, A , and velocity, B , and weight curves for distance, C , and velocity, D , for English boys and girls. Graphic Interpretation of Growth Data Growth data are presented in a graphic format, which reveals the substance of growth study findings in an easily grasped illustration. The two basic curves of growth are as follows: 1. The distance curve, or cumulative curve, indicates the distance a child has traversed along the growth path Figure , A and C.
The velocity curve or incremental curve indicates the rate of growth of a child over a period see Figure , B and D. Data are derived from longitudinal studies. Assessment of Normal Growth Knowledge of normal human growth is essential to the recognition of abnormal or pathologic growth. Clinicians need norms or standards for height, weight,.
Growth studies of a representative sample of a population provide the data from which standards are developed. For example, the growth of North American white people should be assessed by standards derived from a representative sample from this population. Normal height growth is commonly and arbitrarily referred to as the measurements that fall one standard deviation around the mean Figure Patients who fall outside the normal range are unusual, but not necessarily abnormal.
Standard deviations usefully describe data that fall into a normal distribution such as height and age at menarche. Data for body weight and skinfold thickness do not fall into a normal distributions Those.
Normal distribution curve divided into percentiles and standard deviations. Clinically normal measurements are arbitrarily defined as those falling in the interval between one standard deviation above and below the mean Height and weight data are usually represented in charts based on percentiles. The normal range of one standard deviation about the mean for a normal distribution falls between the 16th and 84th percentiles see Figure Variation in Systemic Growth Richard Scammon6,7 reduced the growth curves of the tissues of the body to four basic curves.
For each year, each curve has a certain percentage of its adult value. He proposed four curves from top to bottom : lymphoid, neural, general, and genital Figure The lymphoid curve includes the thymus, pharyngeal and tonsillar adenoids, lymph nodes, and intestinal lymphatic masses. The neural curve includes the brain, spinal cord, optic apparatus, and related bony parts of the skull, upper face, and vertebral column. The curve rises strongly during childhood.
Growth in size is accompanied by growth in internal structure, enabling the 8-year-old child to function mentally at nearly the same level as an adult. Figure Scammon's basic growth curves. Redrawn from Scammon RE: The measurement of the body in childhood. Figure Growth curves for height of boys and girls.
The general curve includes external dimensions of the body, respiratory and digestive organs, kidneys, aorta and pulmonary trunks, spleen, musculature, skeleton, and blood volume. This curve rises steadily from birth to 5 years of age and then reaches a plateau from 5 to 10 years, followed by another upsweep during adolescence and finally a slowdown in adulthood. The genital curve includes the primary sex apparatus and all secondary sex traits. The curve has a small upturn in the first year of life and then is quiescent until after 10 years of age, at which time growth of these tissues increases during the time of puberty.
Growth in Height When a chart showing height for age is constructed from data taken from a large number of children, a wide spread of measurements is seen for each age. The curve shown is a distance curve. Curves of males and females differ and are used separately in clinical applications. A child who falls beyond the average measurements for his or her age is not necessarily abnormal.
Parental heights are important factors in determining the potential for height growth because. When the distance curves of boys and girls are compared, the girls' curve crosses the boys' curve at about 10 years of age, the beginning of the pubertal growth spurt, which occurs earlier in girls. From 10 to 13 years of age the girls are, on average, taller than the boys. At age 14 the boys overtake the girls in height see Figure , A. This is known as the adolescent spurt, the prepubertal acceleration, or the circumpubertal acceleration.
The earlier onset of the spurt in females is illustrated in Figure , B. During the spurt boys grow about 8 inches in height, whereas girls grow about 6 inches. In girls, menarche always follows the peak velocity of the adolescent spurt in height. One reason the females are shorter on average than males is that they grow for a shorter period of time than males during postnatal growth.
When longitudinal measurements taken from several children are combined on the same velocity graph and averaged, the adolescent spurt is smoothed out and less dramatic. This happens because the spurt occurs at different ages in the children. When the peak velocity for each child is superimposed on the peak velocities of other children, the spectacular nature of the spurt and the variability in spurt onset, magnitude, duration, and cessation can be usefully described.
Although growth in height stops at about 18 years in females and 20 years in males, there is evidence that height may slightly increase up to 30 years of age because of growth of the vertebral column. Loss of height begins at middle age and is caused by degeneration of intervertebral disks and to thinning of joint cartilages in the lower limbs. On the basis of longitudinal data, it is possible to obtain a reasonably accurate prediction of adult height.
Figure Growth curves for weight of boys and girls. From age 3 years to the adolescent spurt, the predictions are most reliable. In comparison to height, there is much more variation in weight measurements Figure However, with weight, every tissue in the body is involved. The distance curves for height and weight illustrate this difference see Figures and Weight at birth is more variable than length.
At birth, full-term females are on the average about 5 oz lighter than full-term males. Small mothers have small babies. Later children in a family are usually heavier than the first born.
Weight gain is rapid during the first 2 years of postnatal growth. This is followed by a. At ages 11 to 13 years of age, girls are, on average, heavier than boys. Following their adolescent spurt, boys become heavier see Figure , C. The average age for the adolescent weight spurt in girls is 12 years and in boys is 14 years. The spurt is of less magnitude in girls compared with boys see Figure , D. The adolescent first becomes taller and then begins to fill out in weight.
Similarly, body weight does not reach its adult value until after adult height has been attained. I ndices of Maturity Several methods are used to assess the level of maturity attained by a child during postnatal growth. The dental age maturity indicator based on tooth crown and root calcification has an advantage over the maturity indicator based on eruption age because it is useful throughout the development of the teeth, not just during the narrow period covered by eruption.
Body Build and Proportions A continual change in body proportions is seen during postnatal growth. Figure shows some of the major changes that include shrinking proportions for the head and increasing proportions for the lower limbs.
These changes in proportions are related to the varying rates and duration of growth of the component parts of the body. The center of gravity is higher in children than in adults, which makes children top heavy. At all ages the head is in advance of the trunk and the trunk is in advance of the limbs regarding maturity. The more peripheral parts of the limbs are in advance of the more.
Figure Developmental stages of permanent teeth. There is a transient stage during adolescence when the hands and feet are large and ungainly relative to the rest of the body. The foot stops growing early, before most other parts of the skeleton. In the later stages of adolescence, laterality overtakes linearity in growth. In adolescence, male shoulders grow more than the pelvis, and the reverse occurs in females.
Deposition of fat in the female body produces considerable alterations in body shape. In general, male and female differences are exaggerated in adolescence. Systolic pressure is about 80 mm Hg at age 5 and rises to the adult value of mm Hg.
Girls show a pubertal spurt in systolic blood pressure, which occurs earlier than the corresponding spurt in the male. Heat production decreases during postnatal growth, with females experiencing a greater decrease in heat production than males. Differences are seen between the sexes in the increase in muscle strength during adolescence. Sexual Development Body Composition In a breakdown that may be overly simple, it is possible to say that there are five major structural components of the human body: 1 skin and superficial fat, 2 viscera, heart included, 3 the central and peripheral nervous system, 4 muscle, and 5 bone.
Changes in the proportional amounts of these five components occur during postnatal growth Table At adolescence, a number of changes occur in the development of the primary and secondary sex apparatus. The earliest sign of male puberty is the growth of the testicles. In response to hormone production of the testes, the other parts of the sex apparatus begin their adolescent development.
In the females, growth of the ovaries precedes growth of the rest of the sex apparatus. Menarche occurs after the peak velocity in height growth. The potential for growth is genetic. The actual outcome of growth depends on the interaction between the genetic potential and environmental influences. Studies of twins have shown that body size, body shape, deposition of fat, and patterns of growth are all more under genetic control than under environmental control.
Heredity controls both the end result and rate of progress toward the end result. The handwrist, dental, sexual, and other biologic ages of identical twins are similar, whereas the maturity indicators for nonidentical twins may differ considerably. Genetic factors most likely play a leading role in male-female growth differences.
The marked advancement of girls over boys in the rate of maturation is attributed to the delaying action of the Y chromosome in males. By delaying growth, the Y chromosome allows males to grow over a longer period of time than females, therefore making possible greater overall growth.
Individuals with the chromosome pattern XXY Klinefelter's syndrome are long legged and have a growth pattern similar to males even with the presence of two X chromosomes. Individuals with Turner's syndrome, having only one X chromosome, develop with a female pattern of growth.
Physiologic Changes Many physiologic changes occur during postnatal growth, many of which show male-female differences. This agrees with the general biologic rule that the heart rate is inversely related to body size. Resting mouth temperature falls in females a degree or more from infancy to maturity, whereas in males the drop continues another half degree.
Some physiologic functions mature much earlier than others. The filtration rate of the glomeruli of the. Individuals with an XYY chromosome constitution are very tall 6 feet or more , which lends support to the hypothesis that the Y chromosome has a delaying effect on growth.
Neural Control It is thought that a growth center exists in the region of the hypothalamus, which keeps children on their genetically determined growth curves. Although the correlation between birth size and adult size is low, by the age of 2 the correlation becomes reasonably high. The interpretation of this fact is that during the first 2 years of postnatal growth, the neural control system has got the child on its predetermined genetic curve. At birth, body size is limited to accommodate the birth process.
After birth, those children destined to become large experience a burst of growth activity, which levels off during the first 2 years.
Not all children experience this burst of early growth, thus some mechanism is obviously operating to make these early changes. The hypothalamus is located above the pituitary gland, and it is thought that the hypothalamus sends messages to the pituitary gland through an elaborate feedback system. There is also evidence that the peripheral nervous system plays a part in growth control.
If a somatic muscle is denervated, it atrophies. It is suggested that peripheral nerve fibers exert a nutritive or trophic effect on the structures they innervate. Hormonal Control Probably all of the endocrine glands influence growth. The anterior lobe of the pituitary gland produces a protein called growth hormone, or somatotropin. This can be detected at the end of the second fetal month, soon after the pituitary has formed.
It is thought that the growth hormone, although not essential for fetal growth, is essential to growth from birth onward. Growth hormone maintains the normal rate of protein synthesis and appears to inhibit the synthesis of fat and the oxidation of carbohydrate. It is necessary for the proliferation of cartilage cells thus it has a great effect on bone growth and, consequently, height growth.
Its growth functions become ineffective when the epiphyses close, but it probably maintains its effects on protein synthesis throughout life. Production of growth hormone is thought to be controlled by the hypothalamus. An excess of growth hormone produces a pituitary giant, and a deficiency of the hormone produces a pituitary dwarf. Human growth hormone is used in the treatment of pituitary dwarfism.
A complicated interaction exists between growth hormone and insulin. Insulin is important in protein synthesis, and growth hormone is incapable of causing the formation of normal amounts of ribonucleic acid without the help of insulin. Other evidence suggests that, in diabetes, excess production of growth hormone may depress insulin production.
There may be an antagonism between the production of growth hormone and production of cortisone by the cortex of the suprarenal glands. Growth hormone is produced in a daily rhythmic secretion, the amount varying inversely with cortisone secretion. The peak of daily secretion of growth hormone is in the early stages of sleep.
The anterior lobe of the pituitary gland also secretes thyrotrophic hormone, which affects growth by stimulating the thyroid gland to secrete. The hormones of the thyroid gland, thyroxine and triiodothyronine, both stimulate general metabolism and are important in growth of the bones, teeth, and brain. Iodine deficiency reduces the production of these hormones. Deficiency in childhood of the thyroid hormones produces a mentally retarded dwarf. Thyroid secretion decreases from birth to adolescence and then increases for the duration of the adolescent spurt.
It is agreed that the pituitary and thyroid hormones play little direct role in growth during the adolescent spurt. The changes seen at adolescence are caused by the secretion of androgens and gonadal hormones. Androgens are produced by the suprarenal cortex, which is controlled by the adrenocorticotrophic hormone ACTH produced by the pituitary gland. No change in the amount of the ACTH occurs during adolescence, thus it is thought that perhaps an inhibiting mechanism to androgen production is removed at adolescence to permit secretion of the androgens.
The androgens play a major role during adolescent growth in both sexes. The gonadotrophic hormone of the pituitary gland stimulates production of testosterone in males and estrogen and progesterone in females.
Testosterone and the adrenal androgens both stimulate growth of muscle, bone, blood red cells, and secondary sex characteristics in males. Ovarian secretions have less general affects on growth, and in females the androgen production from the adrenal gland is primarily responsible for growth at adolescence.
The ovarian secretions do control secondary sex changes, including alterations in body shape. The parathyroid secretions, parathormone and calcitonin, control the amount of calcium in the blood and its interchange with calcium in the bone. The two hormones are mutually antagonistic. They affect bone growth. The timing sequence of maturation is undoubtedly under hormonal control. Bone and dental growth from. At adolescence, bones fall under increasing influence of the gonadal hormones.
Nutrition Sufficient intake of nutritious food is essential for normal growth. Rats fed on a calorie-deficient diet, otherwise satisfactory, ceased to grow. When adequate calories are added to the diet, they begin to grow again. This kind of adjustment of the body to varying dietary sufficiency also occurs in humans. Undernutrition tends to accentuate the normal differential growth of the body tissues.
Growth of teeth takes precedence over bone growth, and bones grow better than soft tissues such as muscle and fat. Starvation alters the composition of the body. In starvation, protein in the body is not accumulated but becomes consumed so that the cell mass of the body is reduced. Fat is consumed and depleted. Extracellular body fluid is increased. Loss of weight is thereby masked by famine edema. A sufficient diet includes an adequate supply of protein.
Nine amino acids are essential for growth. Absence of any one results in disordered growth. Calcium, phosphorus, magnesium, manganese, and fluorides are essential for proper bone and tooth growth. Iron is needed for hemoglobin production.
Vitamins are also essential for normal growth. Vitamin A controls activities of both osteoblasts and osteoclasts. Defects in bone growth occur with vitamin A deficiency. Vitamin B2 has considerable influence on growth. Vitamin C is necessary for proper bone and connective tissue growth. Vitamin D is required for normal bone growth.
Oxygen is also a necessary component of normal growth. Children born with congenital cardiac defects may show stunting and retardation of growth, which is often reversed by surgical repair. Figure Growth curves for the mean height of North American white boys in and Secular Trend There is considerable evidence that children today are growing faster than they grew in the past.
Secular change in the height of North American boys between and is shown in Figure Boys at 15 years of age were 5 inches taller in than their counterparts in A similar trend has been seen in younger children. Between and the average height of American and West European children increased.
The trend is probably the result of both more food and better balanced diets. Other benefits such as decreased illness and improved health care have also contributed to secular trend. Although children are growing at a faster rate, they are also stopping growth sooner. The adolescent height spurt is earlier now, but not more accentuated today than in the past.
Early in the 20th century men reached their final height at 25 years of age. Now final height is reached at about 20 years of age. Secular change has been more marked in children than in total adult height.
Adults are getting larger but less dramatically than children. An interesting feature of the secular trend is the progressive advancement in the timing of menarche. This change may be related to better nutrition. Finally, there is evidence that the secular trend in height and weight has hit a plateau in the United States during the past 30 years. Season and Circadian Rhythm Growth in height is faster in the spring than in the autumn.
There is evidence that growth in height and eruption of teeth is greater at night than in the daytime. The reason for these differences is probably related to fluctuations in hormone release. Cederquist R: General body growth and development. Scammon RE: The measurement of the body in childhood. Scammon RE: Developmental anatomy. Simmons K, Greulich WW: Menarcheal age and the height, weight, and skeletal age of girls age 7 to 17 years, J Pediatr , Roche AF: Predictions.
Bayley N: Growth curves of height and weight for boys and girls, scaled according to physical maturity, J Pediatr , Widdowson EM: Mental contentment and physical growth, Lancet 1 , Disease The effects of disease are similar to those of malnutrition.
Females compensate better than males, following illness. Diseases that slow growth probably have the effect of reducing growth hormone production as a result of increased production of cortisone during the disease. Cartilage cell growth is stopped temporarily and the result is seen on xrays as a line of arrested growth.
Similar lines can be found in the teeth. Cultural Factors Cultural factors have various effects on growth. For example, a secular trend increase in height occurred in Japan between males born in and those born near the middle of the 20th century. However, males of Japanese heritage born near the middle of the century in the United States grew taller on average than both groups born in Japan because of different cultural influences.
The most effective time for orthodontic treatment is during the period of postnatal growth, when alteration of the developing dentition and surrounding facial structures can be accomplished in conjunction with growth.
As stated, there are a number of functions carried out by the head. Some functions are more essential than others, but all require the development and maintenance of spaces. Neural growth and integration is a critical function, and space is required for the brain as well as the central and peripheral nervous system expansion. Respiration and deglutition are also essential to life and require development of nasal, pharyngeal, and oral spaces. Sight, olfaction, hearing, and speech are important craniofacial functions that also require development of functioning spaces.
A likely craniofacial growth scenario describing the direct influence of functioning space development on head and face pattern includes rapid size increase of the brain during prenatal and early postnatal life that thrusts the calvarial bony plates outward and the midface forward and downward.
Repositioning of the mandible and tongue takes place to ensure patency of the nasooropharyngeal spaces. The mandible is depressed and thrusts forward for these functions to be supported and maintained. Sarnat BG: Craniofacial change and non-change after experimental surgery in young and adult animals, Angle Orthod , Knott VB: Changes in cranial base measures of human males and females from age 6 years to early adulthood, Growth , Hight JR: The correlation of spheno-occipital synchondrosis fusion to hand-wrist maturation, Am J Orthod , Bjork A: Variations in the growth pattern of the human mandible: a longitudinal radiographic study by the implant method, J Dent Res , Bjork A: Sutural growth of the upper face studied by the implant method, Acta Odont Scand , Koski KL: Cranial growth centers: facts or fallacies?
Am J Orthod , In the latter case chondroblasts initially form cartilage, which, in turn, is calcified and invaded by osteogenic tissue to form bone. A comparison between bone and cartilage properties is presented in Table The first evidence that cartilage is converted into bone in the craniofacial skeleton occurs during the eighth prenatal week.
In the craniofacial skeleton, only the bones of the cranial base and portions of the calvarium are derived by way of endochondral bone formation. For the sake of comparing and contrasting endochondral bone formation with chondrogenesis and intramembranous bone formation, a five-step sequence is used.
As with craniofacial cartilage, intramembranous bone is derived from neural crest cells. The earliest evidence of intramembranous bone formation in the skull occurs in the mandible during the latter portion of the sixth prenatal week.
By the eighth week, centers of ossification appear in the calvarial and facial regions in areas where mild tension forces are present. By fol-. Changes in the Shape and Position of Bone Any change in bone morphology or spatial relationship can be accomplished by one of two processes: remodeling and translation. Although these changes may occur simultaneously in the same bone, they are not necessarily equal in amount or opposite in direction.
This results in differential changes and alterations in the size as well as the morphology shape of a given bone. Translation or Displacement As a result of bone remodeling and changes in its shape and size, the bone itself will change its position in space. This phenomenon is called primary translation Figure , A. Secondary translation, on the other hand, occurs when the growth of one bone results in a change in the spatial position of an adjacent bone see Figure , B.
For example, the. This intramembranous sutural growth system replaces the fontanels, which are present at birth. One of the last functions of the fontanels is to allow the cranium sufficient flexibility during parturition. Therefore it is reasonable to assume that the growth of the cranial vault follows the. Figure A, Changes occurring within bone "x" cause the bone to change its position in space. B, Changes occurring in bone "x" result in the translation or displacement of bone "y.
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