[Morphometric studies on the fetal development of the human mandible]

Mandibular canal changes assessed using three-dimensional imaging (CBCT)

INTRODUCTION

To identify changes in the adolescent mandibular canal (MC) using cone-beam computer tomography (CBCT) by locating three-dimensional (3D) anatomical landmarks in the mandible for later growth and treatment applications.

METHODS

Two CBCT images taken 1.5-2 years apart for 50 patients (ages 11-17) were landmarked using AVIZO^®. Six core landmarks were placed relative to the right and left MCs. Three-dimensional coordinates (x, y, z) were obtained. Average distances between paired landmarks were measured using a paired samples t-test. Mean distance differences <1.50mm were determined clinically insignificant and stable. To determine landmark position consistency, repeat CBCTs from 11 patients were landmarked three times one week apart. Coordinates were determined and intra-class correlation coefficient statistics (ICC), mean error difference and confidence intervals were measured.

RESULTS

X and y-coordinates had an internal consistency of 1.00. Z-coordinates had a consistency of 0.995 or higher. Measurement error was <1mm. The largest mean distance change was 2.25mm±3.06mm between the right mandibular foramen and the landmark directly on the right canal, closest to the mesial root of the first molar. The smallest mean distance change was <0.01mm±1.7mm between the right and left mental foramina. Additionally, the bilateral mandibular foramina, bilateral distal and mesial roots of the first molar, and bilateral regions on the MC inferior to both distal and mesial roots of the first molar were stable.

CONCLUSION

All landmarks were determined reliable. The region between the right and left mental foramina was found most stable for this time period in adolescents.

Cephalometric assessment of human fetal head specimens

BACKGROUND

Past investigations of prenatal craniofacial growth have largely relied on histological sections. Few studies have taken measurements on three-dimensional representations (3D reconstruction, 3D CT, postmortem) or varying depth levels (ultrasound), and we know of no craniofacial growth studies done on cleared-and-stained specimens of whole fetal heads.

MATERIALS AND METHODS

This study comprised 14 human fetal head specimens cleared and stained with alizarin red and alcian blue. They had been stored in glycerol and represented weeks 8-12 of gestation, with crown-rump lengths ranging from 23-145 mm. These specimens were cephalometrically analyzed in norma frontalis and norma lateralis, which notably included the opportunity for side-to-side comparison.

RESULTS

As the cranial membrane bones progressively approached each other, the orbits, maxilla, and mandible gradually grew wider. Likewise, the sagittal dimensions of the maxilla and mandible increased continuously and synchronically. We noted side-to-side differences ranging from 2-5 mm. Another notable finding concerned the inclination of the maxilla relative to the cranial base, which increased more on the right than on the left side.

CONCLUSION

This is the first investigation presenting side-to-side comparative measurements of human fetal head specimens. Such measurements are essential in the quest toward validating the findings of other imaging techniques such as CT or MRI and-most importantly-intrauterine sonography.

Fetal and infant growth patterns of the mandibular symphysis in modern humans and chimpanzees (Pan troglodytes)

Comparison of the early development of the mandibular symphysis between primates and modern humans is of particular interest in human palaeontology. Using geometric morphometric methods, we explored and compared the ontogenetic shape changes of 14 chimpanzee mandibles (Pan troglodytes) against 66 human CT-scanned mandibles over the age range from fetal life to the complete emergence of the deciduous dentition in a visualization incorporating the deciduous tooth arrangement. The results reveal that the symphysis is anteriorly inclined in the youngest chimpanzee fetuses but develops an increasingly vertical orientation up until birth. At the same time, the anterior teeth reorient before a vertical emergence, and a symphyseal tuber appears on the labial side. When the deciduous canine emerges, the symphysis inclines anteriorly again, exhibiting the adult characteristic slope. These two phases are characterized by a repositioning of the simian shelf. Unlike chimpanzees, the human symphysis remains vertical throughout fetal development. However, the combination of morphological changes observed in chimpanzee fetuses is similar to that of modern humans after birth, as the mental region projects forward. By elongating the alveolar process, the inclination of the chimpanzee symphysis could be a key event for emergence of the deciduous canine, as space is lacking at the alveolar ridge in a vertical symphysis once the deciduous incisors and molars have emerged. The repositioning of the simian shelf suggests that the suprahyoid muscles have a significant influence on the anterior growth of the symphysis. The anteroposterior positioning of the basal symphysis in both species may be related to hyoid bone position during ontogeny.

[Genes, forces and forms: mechanical aspects of prenatal craniofacial development]

Current knowledge of molecular signaling during craniofacial development is advancing rapidly. We know that cells can respond to mechanical stimuli by biochemical signaling. Thus, the link between mechanical stimuli and gene expression has become a new and important area of the morphological sciences. This field of research seems to be a revival of the old approach of developmental mechanics, which goes back to the embryologists His [36], Carey [13, 14], and Blechschmidt [5]. These researchers argued that forces play a fundamental role in tissue differentiation and morphogenesis. They understood morphogenesis as a closed system with living cells as the active part and biological, chemical, and physical laws as the rules. This review reports on linking mechanical aspects of developmental biology with the contemporary knowledge of tissue differentiation. We focus on the formation of cartilage (in relation to pressure), bone (in relation to shearing forces), and muscles (in relation to dilation forces). The cascade of molecules may be triggered by forces, which arise during physical cell and tissue interaction. Detailed morphological knowledge is mandatory to elucidate the exact location and timing of the regions where forces are exerted. Because this finding also holds true for the exact timing and location of signals, more 3D images of the developmental processes are required. Further research is also required to create methods for measuring forces within a tissue. The molecules whose presence and indispensability we are investigating appear to be mediators rather than creators of form.

Genes, forces, and forms: mechanical aspects of prenatal craniofacial development

Current knowledge of molecular signaling during craniofacial development is advancing rapidly. We know that cells can respond to mechanical stimuli by biochemical signaling. Thus, the link between mechanical stimuli and gene expression has become a new and important area of the morphological sciences. This field of research seems to be a revival of the old approach of developmental mechanics, which goes back to the embryologists His (1874), Carey (1920), and Blechschmidt (1948). These researchers argued that forces play a fundamental role in tissue differentiation and morphogenesis. They understood morphogenesis as a closed system with living cells as the active part and biological, chemical, and physical laws as the rules. This review reports on linking mechanical aspects of developmental biology with the contemporary knowledge of tissue differentiation. We focus on the formation of cartilage (in relation to pressure), bone (in relation to shearing forces), and muscles (in relation to dilation forces). The cascade of molecules may be triggered by forces, which arise during physical cell and tissue interaction. Detailed morphological knowledge is mandatory to elucidate the exact location and timing of the regions where forces are exerted. Because this finding also holds true for the exact timing and location of signals, more 3D images of the developmental processes are required. Further research is also required to create methods for measuring forces within a tissue. The molecules whose presence and indispensability we are investigating appear to be mediators rather than creators of form.

Three-dimensional analysis of mandibular growth and tooth eruption

Normal and abnormal jaw growth and tooth eruption are topics of great importance for several dental and medical disciplines. Thus far, clinical studies on these topics have used two-dimensional (2D) radiographic techniques. The purpose of the present study was to analyse normal mandibular growth and tooth eruption in three dimensions based on computer tomography (CT) scans, extending the principles of mandibular growth analysis proposed by Björk in 1969 from two to three dimensions. As longitudinal CT data from normal children are not available (for ethical reasons), CT data from children with Apert syndrome were employed, because it has been shown that the mandible in Apert syndrome is unaffected by the malformation, and these children often have several craniofacial CT scans performed during childhood for planning of cranial and midface surgery and for follow-up after surgery. A total of 49 datasets from ten children with Apert syndrome were available for study. The number of datasets from each individual ranged from three to seven. The first CT scan in each of the ten series was carried out before 1 year of age, and the ages for the 49 scans ranged from 1 week to 14.5 years. The mandible and the teeth were segmented and iso-surfaces generated. Landmarks were placed on the surface of the mandible, along the mandibular canals, the inner contour of the cortical plate at the lower border of the symphysis menti, and on the teeth. Superimposition of the mandibles in the longitudinal series was performed using the symphysis menti and the mandibular canals as suggested by Björk. The study supported the findings of stability of the symphysis menti and the mandibular canals as seen in profile view previously reported by Björk & Skieller in 1983. However, the mandibular canals were, actually, relocated laterally during growth. Furthermore, the position of tooth buds remained relatively stable inside the jaw until root formation started. Eruption paths of canines and premolars were vertical, whereas molars erupted in a lingual direction. The 3D method would seem to offer new insight into jaw growth and tooth eruption, but further studies are needed.

Prenatal craniofacial morphogenesis: four-dimensional visualization of morphogenetic processes

OBJECTIVES

Basic research concerning craniofacial development presently runs along two pathways, namely the molecular and the morphometric. This gap needs to be bridged.

DESIGN

Using histological serial sections of human fetuses computer-aided three-dimensional reconstructions were made (Software Analysis, SIS) with special focus given to all anatomical structures of the orofacial region of the growing head.

RESULTS

All reconstructions can be viewed from any rotation and they are available for virtual dissection according to anatomical rules. As an example, the prenatal development of the human mandible with the formation of the mental foramen therein is described. Furthermore, the spatial arrangement of bone, cartilage and nerves is presented in three dimensions in different developmental stages. The interaction of tissues with possible morphogenetic interaction is discussed.

CONCLUSIONS

This work serves as a reference system for prenatal development in comparison with pathological development.

Prenatal development of the muscles in the floor of the mouth in human embryos and fetuses from 6.9 to 76 mm CRL

The development of the muscles in the floor of the mouth is described in 10 human embryos and fetuses ranging from 6.9 to 76 mm CRL by means of computer-aided graphical 3D-reconstructions. All primordia of the muscles in the floor of the mouth could be identified from the 15.6 mm CRL stage on. The proportions and insertion lines of the early muscles were found to be different from adult anatomy. Each muscle first inserted in the medial surface of Meckels cartilage, but during the developmental period between 19 and 68 mm CRL the insertion lines were gradually transposed to the bony ridges of the mandible which progrediently embraced Meckels cartilage. The fibers of the mylohyoid muscles left the anterior region near the symphysis mentalis free during all stages of this study. The digastric muscle revealed only one belly with a constriction of its continuous fibers where it passed the hyoid bone primordium. There was no attachment of digastric muscle fibers to the hyoid; only geniohyoid and mylohyoid fibers. Geniohyoid and genioglossus muscles basically correspond to their definite arrangement, but they underwent proportional changes. Individual specimens embodied irregularities such as accessory geniohyoid and hyoid portions and muscle fibers separate from the mylohyoide muscle.

4D-computerized visualisation of human craniofacial skeletal growth and of the development of the dentition

The understanding of growth and developmental changes can be improved when shapes and changes in size, proportion, and relationships are visualized in 3 dimensions and at different stages. This applies particularly to craniofacial skeletal growth and the development of the dentition. For that purpose 3D-data were collected from prenatal human heads ranging from 18 up to 275 mm CRL and from a collection of macerated fetal and postnatal skulls. Computer-aided graphical reconstructions were obtained from histological serial sections of embryonic and early fetal specimens. Proportional changes in the growing skull were recorded by means of radiological and cephalometric evaluation. In addition, computed tomography was applied to fetal and postnatal skulls. Furthermore, the prenatal and postnatal development of the dentition was digitized. To that end 3D-polygone sets of these data were read into a workstation computer and animated by means of the software Soft Image (Microsoft). This comprehensive 4D insight into growth facilitates the understanding and teaching of normal and abnormal development.