Paper - Normal facial growth in children (1937)
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Young M. Normal facial growth in children. (1937) J Anat. 71: 458-470. PMID 17104658
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Normal Facial Growth in Children
By Matthew Young
Institute of Anatomy, University College, London
For some time past the writer has been working in collaboration with some dental surgeons on facial growth in children with the object of trying to shed some light on the genesis of abnormal formation of the jaws. Associated with faulty closing of the dental arches and improper placing of the teeth, this condition is commonly met in dental practice. The deformities which occur are of various kinds, but it is clear that most of them begin very early in life and possibly even before birth. For the identification and precise diagnosis of the various types of abnormality in their. early stages accurate facial measurements are of great value, but it is obviously a necessary preliminary to the interpretation of these that exact information should be available as to the direction and rate of normal growth of the jaws and the normal correlation between different measurements in children of the same social class. Such data should not-only provide a sound basis for the diagnosis of abnormal conditions but might reasonably be expected to show in what respects and to what extent these abnormal conditions differ from the normal at different stages of growth.
The normal growth of the jaws from infancy to adult life was first investigated by Tomes (1891, 1892), and knowledge of the subject has more recently been advanced by the experimental work of Brash (1924) and by the measurements of Franke (1921), Lewis & Lehman (1929), Hellman (1988), Goldstein & Stanton (1986), Wingate Todd (1936), Holly Broadbent (1981) and others. Information on the subject, however, still remains inadequate.
Under the auspices of the Dental Committee of the Medical Research Council arrangements were made for the collection of a large series of facial measurements by Miss K. C. Smyth in normal children attending London County Council schools. The main part of the enquiry related to the age period 8-14 years, and for this about 1200 children, in whom the two dental arches exhibited what is regarded as morphologically normal occlusion, were selected for measurement. Only about 8 per cent of those whose mouths were examined were considered to show this relationship ideally. A restriction of this nature seemed to be essential if reliable standards of the normal were to be obtained. In these 1200 children the sexes were about equally represented, and the age distribution was so arranged that approximately 50 children of each sex belonged to each six-monthly age group from 8 to 14 years.
It was felt, however, that the investigation on normal growth would be yery incomplete without any records of children under 8 years of age. As a Normal Facial Growth in Children step towards repairing this defect, facilities were later obtained for taking the same series of measurements in a group of about 100 children ranging in age from 2 to 5 years who were in attendance at a Welfare Clinic. The children were about equally distributed over the 3 years, and the numbers of each sex at each age were approximately equal. In selecting the children at these ages as suitable for measurement less emphasis was laid on the presence of normal occlusion than in the older group.
The characters measured were twenty in number and may be classified
for convenience into five groups as follows:
(1) Antero-posterior measurements of face: Transmeatal axis to nasion wee . Transmeatal axis to upper incisor gum-margin Transmeatal axis to upper incisor incisal margin Transmeatal axis to lower incisor gum-margin... Transmeatal axis to mental point (2) Vertical measurements of face and jaws: Nasion to subnasal point ... eee Nasion to upper incisor incisal margin ... Nasion to submental point . Nasion to occlusal surface of upper first molars (tips of medio-lingual cusps) .. eee see Lower incisors (incisal margin of {1 fi) to submental point Lower molars (occlusal surface of |6 (6) to lower border of the mandible ... Height of palate . eee (3) Transverse measurements of the face: Maximum bizygomatic breadth of face .. Maximum bigonial breadth of face (4) Length of the dental arches: Length of upper dental arch from behind first permanent molars or second deciduous molars Length of lower dental arch from behind first permanent molars or second deciduous molars (5) Breadth of the dental arches: Maximum external breadth of upper dental arch at first deciduous molar or first premolar ... wee Maximum external breadth of upper dental arch at first permanent molar . vee vee see Maximum external breadth of lower dental arch at first deciduous molar or first premolar ... . Maximum external breadth of lower dental arch at first permanent molar
(TA to N) (TA to UIGM) (TA to UIIM) (TA to LIGM) (TA to MP)
(N to SNP) (N to UIIM) (N to SMP)
(N to 6|6)
(LI to SMP)
(LM to LBM) (Pal. Ht.)
(Bizyg. B) (Bigon. B)
(LUA)
(LLA)
(Batdld on 4|4) (B at 6/6) (B at djd or 4]4) (B at 6/6) 460 Matthew Young
Details of the characters and the abbreviations or symbols by which they are occasionally represented when referred to in the text or tables are given in the foregoing list. Some of the more important are shown diagrammatically in Fig. 1. .
edcba|abcde 654821 | 123456
edeba|abcde “ 654821 [128456 surgeons to represent the deciduous and permanent teeth.
are conventions often used by dental
|
Pees S
SaaS ESE He (ss
‘ ' ' ( t
ry . beg = iy Ys . Sez Vy QHN \ 3s “ . Zz ~ mae -_=> I ' ~-227 ' ' t 2277 my “+ ty ¢ ‘wer t ' ' a, 1 =
n ' ° 1 s \ a ' ' Lo-4
Fig. 1. Showing the more important measurements of the face in the antero-posterior and vertical directions.
The antero-posterior measurements were all taken from the transmeatal axis to various points on the mid-line of the face by a prosopometer devised by Sir Norman Bennett. The depth of the palate and the length of the dental arch were measured by a special instrument designed for the purpose by Mr Campion. For all the other measurements specially designed callipers and specially adapted terminals were used. ,
The ideal method for carrying out such an investigation would be to have standardized radiographs of the profile and face views of large numbers of the same children taken over several consecutive years, but the adoption of such a procedure was quite impracticable at the time the investigation was begun.
A brief account of the main results of the study of facial growth in the normal children might be of interest. For this purpose it has been deemed sufficient to tabulate the average values for the different characters at the ages 2, 4, 8, 10 and 12 years and to indicate the progress of growth for each 2-yearly period as the percentage increase on the dimension at the earliest age shown, namely 2. The results for the antero-posterior measurements of the face are given for boys and girls separately in Table I.
Table I. Antero-posterior measurements of the face (facial depth)
TA toN TA to UIGM TA to UIIM TA to LIGM TA to MP AN Yo ~ VO A ‘NV OF * Y % + % + % + % + % + from from from from from Age Means age2 Means age2 Means age2 Means age2 Means age 2 (mm.) (mm.) (mm.) (mm.) (mm.) Boys 2-3 78-5 _ 75-0 —_— 76-1 _ 73-0 _ 82-2 _ (15)* (15) (14) (14) (14) 45 81-6 4 79-2 6 80-4 6 78-7 8 88-9 8 (18) (18) (18) (18) (18) 8-9 86-2 10 85-6 14 87-1 15 85-8 18 97-6 19 (75) (75) (75) (75) (75). 10-11 89-0 13 88-7 18 90-9 19 89-4 23 101-9 24 (58) (58) (58) (58) (58) 12-13 90-7 16 91-3 22 93-0 22 91-5 25 105-0 28 (60) (60) (60) (60) (60) Girls 2-3 ° «77-0 _— 75:8 — 76-5 _— 74:6 — 84-4 _ (16) (16) (16) (16) (16) 45 79-7 4 78-9 4 80-0 5 79-1 6 90-2 7 (13) (13) (13) (13) (13) 8-9 84-9 10 84-1 1l 85-7 12 84-5 13 96-3 14 (80) (80) (80) (80) (80) 10-11 86-5 12 86-3 14 884 8 16 86-9 16 99-6 18 (72) (72) (72) (72) (72) 12-13 89-0 16 89-4 18 91-4 19 89-7 20 103-5 23 (66) (66) (66) (66) (66)
The figures in brackets in all tables are the numbers of observations at each age. Here is shown in both sexes the regular increase in the dimension transmeatal axis to nasion (TA to N) from 2 up to 12 years of age when the increment is 16 per cent. As might be expected, the proportionate rate of increase in the character transmeatal axis to upper incisor gum-margin (TA to UIGM) and transmeatal axis to upper incisor incisal margin (TA to UIIM) is very similar, it is also regular and rather greater than in TA to N, the increment in the 10 years interval being 22 per cent. The antero-posterior measurements in relation to the lower jaw, transmeatal axis to lower incisor gum-margin (TA to LIGM) and transmeatal axis to mental point (TA to MP) show in the boys much the same proportionate increase up to 10 years, but at 12 years there is a suggestion that the measurement including the mental eminence may have gained slightly on that to the lower gum-margin. In both these characters the proportionate increase is rather greater than in the radial measurements that include the maxilla. In the girls the increases shown in the measurements to the upper jaw and the lower jaw appear to be less regular and less in degree than in the boys.
Table II. Vertical measurements of the face and jaws NtoSNP NtoUIIM NtoSMP Nto6|6orejle Pal. Ht. LItoSMP LMtoLBM % + % + % + % + % + % + % + Means from Means from Means from Means from Means from Means from Means from Age (mm.) age2 (mm.) age2 (mm.) age2 (mm.) age 2 (mm.) age2 (mm.) age 2 (mm.) age 2
Boys . 23 339 — 529 — 831 — 564 — 136 — 294 — 221 — (17) (17) (14) (15) (10) (17) (16) 45 37-0 9 586 11 89-6 8 61:2 9-154 13. 32-1 9 278 Ii (18) (18) (18) (18) (18) (18) (18) 89 414 22 656 24 984 18 684 21 159 17 358 22 295 18 (92) (92) (92) (92) (92) (91) (91) 10-11 42°99 27 680 29 1015 22 705 25 175 29 37:00 26 30-7 22 (86) (86) (86) (86) (86) (84) (84) 12-13 444 31 69:9 32 1032 24 728 29 184 35 388 32 33-1 32 (99) (99) (99) (99) (99) (99) (99) Girls 23 318 — 510 — 793 — 538 — 131 — 290 — 23 — (17) (17) (17) (14) (13) (17) (17) 45 355 12 563 10 87-1 10 585 9 1445 211 3211 7 27-4 8 (13) (13) (13) (13) (12) (13) (13) 8-9 40:7 28 638 25 961 21 670 25 154 18 349 20 28-7 13 (88) (88) (88) (88) (87) (88) (88) 10-11 42-1 32 656 29 983 24 682 27 163 24 35:9 24 302 19 (97) (97) (97) (97) (97) (99) (97) 12-13 43:2 36 67-4 32 1018 28 706 31 181 38 374 29 32:3 28 (102) (102) (102) (102) (102) (102) (102)
In Table II are shown the average values of the vertical measurements of the face and jaws and the percentage increments from 2 to 12 years.
The percentage increments:in the height of the upper face, nasion to upper incisor incisal margin (N to UIIM), at the different stages from 2 to 12 years coincide in boys and girls; at age 12 the increase is 82 per cent over the mean value at age 2. In both boys and girls the proportionate increase in total face height (N to SMP) seems to be rather less than that in the upper face height.
Both the characters, lower incisors to submental point (LI to SMP) and lower molars to lower border of the mandible (LM to LBM) at age 12 show an increase of 32 per cent over these characters at age 2. In the girls the rate of progress of growth in these characters appears to be rather slower.
The palatal height at age 12 shows an increase of 35 per cent in boys and 388 per cent in girls over the corresponding mean values at age 2. The percentage increases from 8 to 12 years are 16 and 18 respectively.
Although the measurements of the characters nasion to upper permanent first molars or deciduous second molars (N to 6|6 or ele), palatal height and LM to LBM are not taken from exactly the same points in the children at ages 2 and 4 as in children at the later ages and of course use deciduous instead of permanent teeth, the percentage increases in these have still been tabulated. They are to be regarded as approximations only, showing the general trend of growth.
By the use of diagrammatic representations of the face an attempt has been made to illustrate for the sexes separately the progress of growth in the principal characters of these two groups, antero-posterior and vertical, in the period of life under review. In preparing these diagrams for boys and girls (Figs. 2 and 8) it has been assumed for convenience that the transmeatal axis remains constant in position and the chord TA to N constant in direction from age 2 to 12 which, it will be readily understood, is not necessarily true. In Fig. 4 is shown in diagrammatic form the average rate of growth of the face in the horizontal and vertical directions in boys with normal occlusion at a rather later age, namely from 9 to 15 years. The measurements providing the averages on which this figure is based were taken by Dr Sheldon Friel of Dublin at the Artane Industrial School by means of a prosopometer specially devised by himself. This instrument records on a chart the co-ordinates of any point of measurement in the mid-line of the face, for example the nasion, in relation to the transmeatal axis as zero and the horizontal plane passing through this axis and the lowest point of the lower border of the left orbit, i.e. the nearest approximation to the Frankfort horizontal plane that can be obtained in the living subject. The regularity of the increase and the similarity to that shown in the London children at the later ages are clearly indicated.
Fig. 2. Showing in diagrammatic form the average progress of facial growth in the anteroposterior and vertical directions and the change in position of the dental occlusal plane n normal boys at ages 2, 4, 8, 10 and 12 years from the L.C.C. schools.
Fig. 3. Showing in diagrammatic form the average progress of facial growth in the anteroposterior and vertical directions and the change in position of the dental occlusal plane in normal girls at ages 2, 4, 8, 10 and 12 years from the L.C.C. schools.
Fig. 4. Showing in diagrammatic form the average progress of facial growth in the anteroposterior and vertical directions in normal boys at ages 9, 11, 13 and 15 years from the Artane school in Dublin. Normal Facial Growth in Children 465
Reverting to the data for the London school children, in Table IIT is shown the progress of growth in the transverse measurements of the face near its upper and lower limits, the bizygomatic and bigonial breadths.
Table III. Transverse measurements of the face
Bizygomatic breadth Bigonial breadth Male Female Male Female Cc A ~ c A” ‘ c A” — Cc “~ ‘ % + % + % + % + from from from from Age Means age 2 Means age 2 Means age 2 Means age 2 (mm.) (mm.) (mm.) (mm.) 2-3 111-4 _— 109-1 _— 84:3 _— 84-2 _ (17) (17) (17) (17) 4-5 115-1 3 110-4 1 88-3 5 86-1 2 (18) (13) (18) (13) 8-9 120-0 8 117-7 8 96-2 14 = 94-0 12 (92) (88) (92) (88) 10-11 122-7 10 120-1 10 97-8 16 95-9 14 (86) (97) . (86) (97) 12-13 125-6 13 123-6 13 100-5 19 98-2 17 . (99) (102) (99) (102)
From 2 to 12 years the bizygomatic breadth increases by 18 per cent and the bigonial breadth from 17 to 19 per cent, so that the rate of growth is appreciably slower in the former. The increase in upper facial breadth is slower and of smaller degree than in both the antero-posterior and vertical measurements of the face.
The rate of increase in bigonial breadth though less than in the vertical measurements of the face does not differ greatly from that shown in the antero-posterior measurement transmeatal axis to upper incisor gum-margin (TA to UIGM). It may be mentioned here that there is definite evidence in the boys and some indication though it is less certain in the girls that the total length of the face, N to SMP, increases relatively to the breadth (bizygomatic) as age increases from 8 to 12 years. The facial index, 100 x N to SMP/Bizyg. B., increases in that age interval by two units from 82 to 84. There is no change, however, in the relative proportions of the component parts of the face in the vertical direction in the same period, the index of facial proportion, 100 x N to SNP/N to SMP, remaining at 42-2 in boys and 42-4 in girls.
The growth in length and breadth of the dental arches will now be considered. The mean values for length at the different ages are shown in Table IV. By length of the dental arch is meant the distance between the incisal margins of the upper central incisors and the mid-point of a straight line joining the distal surfaces of the upper first permanent molars when these are present, i.e. from 6 years onwards, or if not erupted the corresponding line in relation to the second deciduous molars. A close approximation to the measurement made in one way from that made in the other can be obtained by allowing for the average mesio-distal measurement of the first permanent molar tooth. In Table IV such an adjustment has been made. The length of the dental arch at age 8 and subsequent ages has been made comparable with that at the earlier ages by deducting 10-3 and 10-2 mm. respectively from the actual mean values for the upper and lower arches. The figures clearly show that after age 2 there is no increase in the length of that part of the alveolar arch originally occupied by the deciduous teeth.
Table IV. Length of the dental arches
Length of upper arch (LUA) Length of lower arch (LLA) Male Female Male Female A A ‘ To To . ‘ To ‘ To To ‘ ‘ To To Age eleor5|5 6|6 ele or 5|5 a efeor5[5 6/6 efeord5|[5 6/6 2-3 28-5 —_ 28-0 24-8 —_ 24-9 _ (12) (13) (14) (13) 4-5 28-6 _— 27-7 —_— 24-7 _— 24-2 (18) (13) (18) (13) 8-9 28-7* 39-0 28-1* 38-4 24-7F 34-9 24-1F 34-3 (56) (56) - (56) (56) 10-11 28-5* 38-8 28-6* 38-9 24-3f 34:5 23-7¢ 33-9 (47) (56) (47) (56) 12-13 28-5* 38-8 27-8* 38-1 e6t 32-8 22-0f 32-2 (12) (18) (12) (18)
Estimated by deducting 10-3 mm. from LUA to 6)6. { Estimated by deducting 10-2 mm. from LLA to 6]6.
The length of the upper arch actually remains unchanged from 2 to 12 years, while the length of the corresponding lower arch shows some tendency to shortening at age 12. These results amply confirm the observations of John Hunter (1771) and Bolk (1924).
The growth in breadth of the dental arches is shown in Table V. The terminal points of measurement are on the buccal aspects of the necks of the teeth, d|d, 4|4 and 6|6, in close relation to the alveolar margin, and thus should not differ greatly from the corresponding measurements in skulls.
The average values for the anterior breadth have been tabulated separately at ages 8-10 years for the respective groups of children with first deciduous molars, d|d, and first premolars, 4/4, present to show the influence if any of change of dentition. It will be seen that in the upper arch, the breadth at d|d changes little if at all from age 2 to 4 in either sex. From 4 to 8 there is an appreciable increase of about 3 mm., but from 8 to 10 there is no definite evidence of a further increase. In the children with 4|4 present, there is evidence of an average increase from 8 to 10 years of about 2 mm. in both sexes, but the averages at the earlier age are based on small numbers and may not be very reliable. There is, however, an average increase of exactly the same amount but clearly significant in the breadth at 6|6 in both boys and girls as age increases from 8 to 10 years. In both boys and girls at age 10 the anterior width of the arch when 4|4 is present is significantly greater than its width when d|d is present.
Table V. Breadth of the dental arches
Male . Female c A \ r A \ Male Female Age B at djd Bat4|4 Batdld B at 4|4 B at 6|6 B at 6|6 Upper 2-3 39-9 —_ 39-6 _— _— _— (17) (17) 4-5 40-6 _— 39-4 _ _ — (18) (13) : 8-9 43-4 44-0 42-0 42-6 55-5 53-6 (68) (4) (62) (11) (76) (80) 10-11 43-1 45-6 42-7 43-9 56-0 54-6 (22) (25) (20) (46) (56) (72) 12-13 _— 45-9 _— 44-5 57-4 55-5 (59) (64) (60) (66) Lower Age Batdjd Bat4i Batd[d Bat4a Bat 66 Bat 86 2-3 36-3 _ 35-5 _— —_— —_— (17) (17) , 4-5 36-4 — 35-0 — — — (16) (13) . 8-9 37-7 38-8 37-1 37-1 53-6 52-1 ° (64) (6) (67) (9) (76) (80) 10-11 37-7 40-0 36-8 38-7 53-8 52-7 (29) (21) (17) (47) (56) (72) 12-13 _ 40-3 _ 39-1 55-0 53-4 (58) (65) (60) (66)
The progress of growth in breadth of the dental arches in the lower jaw shows, as might be expected, a close correspondence with that in the upper.
There is thus clear evidence that the section of the dental arch occupied by the deciduous teeth and later by their successors becomes a wider arc, though there is no evidence that it increases in length.
The records of measurements of the many facial characters in the children with normal occlusion provided the means for determining the degree of association or relationship that obtained between each of the several pairs of characters, a knowledge of which might be expected to be of value in throwing light on the normal growth of the face including the jaws in childhood. Accordingly, a fairly long series of correlation coefficients between pairs of characters was calculated for each of the three groups: children from 2 to 5 years, boys from 8 to 14 years, and girls from 8 to 14 years. Subsequently, the partial correlation coefficients which show the intensity of the association that persists when the influence of increasing age is eliminated were computed. These coefficients are not tabulated. It would be impracticable to discuss them in detail here, but a brief reference may be made to some of the more important relationships shown. As might be expected, some of the coefficients are of quite a high order showing that the correlation that exists is of con468 Matthew Young
siderable intensity. Thus the coefficient between the characters nasion to upper incisor incisal margin (N to UIIM) and nasion to first permanent molars (N to 6|6) is approximately 0-8, and that between the characters or measure ments lower incisors to submental point (LI to SMP) and lower molars to lower border of the mandible (LM to LBM) about 0-7. The coefficients between these characters, the first two of which belong to the upper face and the last two to the lower face or mandible are definitely higher in all the groups of children than those found between the characters N to UIIM and LI to SMP and between N to 6|6 and LM to LBM, that is, vertical growth in the maxilla is less closely related to that in the mandible than is the corresponding growth in different axes of the maxilla or of the mandible.
The correlations between the various absolute measurements of the dental arches are also as might be expected of a relatively high magnitude. Thus the coefficient between the external widths of the dental arch at 66 (upper) and 6/6 (lower) is approximately 0-8 in both boys and girls, and that between the widths at 4|4 (upper) and 6|6 (upper) exceeds 0-7. The correlation between the lengths of the upper and lower dental arches (LUA and LLA) also exceeds 0-7.
Some of the other coefficients, though considerably smaller than those already referred to, nevertheless indicate very interesting relationships. Thus the height of the palate has a slight but significant positive association, represented by a coefficient of 0-3 in boys and 0-4 in girls, with the distance between the nasion and upper incisors (N to UIIM), in other words, the height of the upper face. The palatal height has also a very slight but significant association with the upper facial index (100 x N to UIIM/Bizyg. B.) in boys and girls at ages 8-14 years, though there appears to be no such association in children at ages 2-5 years. A relatively long face thus shows a very slight tendency to be accompanied by a relatively high palate. The height of the palate, on the other hand, shows no appreciable association with the width of the dental arch at 6|6 in boys, though there is a slight positive correlation between these characters in the girls. The width of the upper dental arch at 6|6 and also at 4|4 is quite definitely associated with the bizygomatic breadth,
the correlation coefficients being approximately 0-5 and 0-4 respectively, though such a relationship has been denied by other observers. It is doubtful, however, what proportion of the correlation coefficient observed may be held to express true or “‘organic” correlation.
In contrast with the relationship shown to exist between the absolute measurements, the coefficients between the breadth of the upper dental arch at 6|6 and the upper facial index (100xN to UIIM/Bizyg. B.) show quite definitely that there is no correlation between these facial characters in either boys or girls at ages 8-14 years. There is thus no apparent association between a relatively narrow face (as measured by height in relation to breadth) and a narrow dental arch, though there is, as has been mentioned, a very slight but apparently significant tendency for 4 relatively narrow face to be associated with a relatively high palate.
These results fn modern children are of special interest in view of Sir Arthur Keith’s conviction (1924) that in a considerable proportion of the modern population of Britain there is a tendency for the face to become higher and narrower, and that the tendency is directly related to narrowing and arching of the palate.
Other coefficients indicate that there is a slight tendency for a greater antero-posterior length to be associated with relative narrowness of the face.
The average values of the facial characters at the different ages, their variabilities and the intensity of their interrelationship with one another and with age, stature and body weight as indicated by the correlation coefficients provide the means of determining whether the measurement of a particular facial character in an individual child diverges to such a degree from the corresponding standard derived from the normal children that it should be regarded as probably abnormal in the sense that it is not of such a magnitude as would be likely to be found except very rarely in children of similar age or stature or with other facial characters of a given order.
The mean values and variabilities of the facial characters described at the several ages and the intensity of their interrelationships in this group of normal children supplemented by similar data for other characters in another normal series have been used as standards of comparison for the corresponding values in large series of children at corresponding ages showing the most common form of mal-occlusion of the teeth, namely inferior post-normal occlusion, and the results seem to shed some new light on the features that characterize this abnormality.
Summary
- The mode of growth of the face from 2 to 15 years follows a uniform pattern in normal children.
- The proportionate increase in facial growth antero-posteriorly, i.e. facial depth, is greater in the region of the lower jaw than in that of the upper.
- In both boys and girls the proportionate increase in total height of the face appears to be rather less than that in the upper facial height.
- The increase in upper facial breadth is less in degree than that shown in both facial depth and facial height.
- The ratio of facial height to facial breadth increases in both sexes with age.
- The portion of the dental arch occupied by the deciduous and later by the permanent teeth becomes part of a wider arc but does not increase in length.
- The vertical axes of growth in the upper face are more closely correlated with one another than with those of the lower face, i.e. the maxillary growth is to some extent independent of mandibular growth. 470 Matthew Young
- The face widens relatively more in its lower than in its upper region.
- A relatively long face shows a slight tendency to be accompanied by a relatively high palate.
- Though the absolute width of the upper dental arch is significantly correlated with the bizygomatic breadth, there appears to be no appreciable association between a relatively narrow face, as expressed by the facial index, and a narrow dental arch.
- A narrow face shows a tendency to be deep or long antero-posteriorly.
- The use of the average values at the several ages, the variabilities and the interrelationships of the facial characters brought under review in these and other series of normal children has added considerably to the knowledge of the features that characterize the common dental abnormality, post-normal occlusion.
References
Bou, L. (1924). Verh. Akad. Wet., Amst., Bd. xxvu, Nos. 3 and 4.
Brasu, J. C. (1924). Lectures published by the Dental Board of the United Kingdom.
BroaDsBent, B. Hotuy. (1931). ““A new X-ray technique and its application to orthodontia.” Angle Orthodontist, vol. 1, p. 45. /
Franke, G. (1921). Uber Wachstum und Verbildungen des Kiefers und der Nasenscheidewand. Leipzig.
Goxpstst, M. S. & Stanton, F. L. (1936). Int. J. Orthod. vol. xx, No. 6, p. 549.
Heiman, M. (1933). Int. J. Orthod. vol. x1x, p. 1116.
Hunter, J. (1771). The Natural History of the Human Teeth. 3rd edit. 1803.
Kerru, Stir A. (1924). Lecture published by Dental Board of the United Kingdom.
Lewis, 8. J. & Lenman, I. A. (1929). Dent. Cosmos, vol. Lxx1, p. 480.
Topp, T. WineaTe (1936). Int. J. Orthod. vol. xxt1, No. 4, p. 321.
Tomess, Cuaruss §. (1891). Trans. odont. Soc., Lond., vol. xxiv, p. 143.
—— (1892). Brit. J. dent. Sci. vol. xxxv, p. 433.
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