Original Article

Maxillary growth and maturation during infancy and early childhood

Utumporn Laowansiria; Rolf G. Behrentsb; Eustaquio Araujoc; Donald R. Oliverd;
Peter H. Buschange

ABSTRACT
Objective: To describe maxillary growth and maturation during infancy and early childhood.
Materials and Methods: Serial cephalograms (N 5 210) of 30 subjects (15 females and 15 males)
from the Bolton-Brush Growth Study were analyzed. Each subject had a series of six consecutive
cephalograms taken between birth and 5 years of age, as well as one adult cephalogram. Twelve
maxillary measurements (eight linear and four angular) and seven landmarks were used to characterize
maxillary growth. Maturation of the linear measures was described as a percentage of adult status.
Results: Maxillary and anterior cranial base size increased in both sexes between 0.4 and 5 years
of age. The linear anteroposterior (AP) measures (S-SE, SE-N, ANS-PNS) increased almost as
much as the vertical measures (S-PNS, SE-PNS, N-A, N-ANS) over the first 5 years. After 5 years
of age there was significantly more vertical than AP growth. The size and shape changes that
occurred were greatest between 0.4 and 1 years; yearly velocities decelerated regularly thereafter.
Overall linear growth changes that occurred between 0.5 and 5 years of age (a span of 4.5 years)
were generally greater than the changes in maxillary growth that occurred between 5 and 16 years
(a span of 11 years). The linear measures showed a gradient of maturation, with the AP measures
being more mature than the vertical measures. Male maxillae were less mature than female
maxillae at every age.
Conclusions: The maxilla undergoes its greatest postnatal growth change during infancy and
early childhood, when relative AP growth and maturation are emphasized. (Angle Orthod.
2013;83:563–571.)
KEY WORDS: Maxilla; Infancy; Maturation; Growth; Cephalometrics

INTRODUCTION deceleration of growth in recumbent length during the

first 3 years.2 Based on the close associations between
Postnatal somatic growth is fastest and most intense
somatic and craniofacial growth and development,3–5
during the first 5 years. Greater rates of somatic
greater rates of craniofacial growth might also be
growth occur during infancy than at any other time
expected during the first few postnatal years. Although
postnatally.1 US children, for example, show marked
limited, there is evidence of marked craniofacial growth
a
Resident, Department of Orthodontics, Saint Louis Univer- during infancy and early childhood. The greatest
sity, St Louis, Mo. amount of postnatal growth in facial depth occurs
b
Professor and Chairman, Department of Orthodontics, Saint
between 3 and 6 years of age.6,7 Farkas et al.8 showed
Louis University, St Louis, Mo.
c
Professor, Department of Orthodontics, Saint Louis Univer- that the greatest yearly growth increments in male
sity, St Louis, Mo. head height and length occurred between 1 and
d
Associate Clinical Professor, Department of Orthodontics, 3 years of age. Based on large samples, Ohtsuki et
Saint Louis University, St Louis, Mo. al.9 reported greater cranial base growth during the first
e
Professor and Director of Orthodontic Research, Department
of Orthodontics, Baylor College of Dentistry, Texas A&M Health 5 years than during the remaining postnatal years, with
Science Center, Dallas, Texas. the greatest anterior and posterior growth changes
Corresponding author: Dr Peter H. Buschang, Professor and occurring during the first 2–3 postnatal years.
Director of Orthodontic Research, Department of Orthodontics, Understanding relative craniofacial growth is impor-
Baylor College of Dentistry, 3302 Gaston Ave, Dallas, TX 75246
(e-mail: [email protected]) tant because it provides an indirect measure of a
structure’s response potential. Relative growth pro-
Accepted: October 2012. Submitted: July 2012.
Published Online: November 13, 2012
vides an indication of a structure’s growth response to
G 2013 by The EH Angle Education and Research Foundation, growth hormone supplementation10 and alterations in
Inc. masticatory function.11 Relative growth also makes it

DOI: 10.2319/071312-580.1 563 Angle Orthodontist, Vol 83, No 4, 2013

564 LAOWANSIRI, BEHRENTS, ARAUJO, OLIVER, BUSCHANG

possible to directly compare structures, regardless of Cephalometric Analysis

absolute size differences. Buschang et al.12 reported a
In total, 210 cephalograms were hand traced,
growth maturity gradient between 4 and 16 years, with
scanned, and digitized by the primary author using
the maxilla being more mature than the mandible but
Dolphin 3D Imaging 10.5 Premium Software (Dolphin
less mature than the cranial base or vault. Farkas et
Imaging, Chatsworth, Calif). The cephalograms were
al.8 showed that, by 1 year of age, head circumference
taken at the minimum midsagittal plane to film
(87.5%) and length (87.1%) were relatively more
distance, producing average magnifications ranging
mature than other components of the craniofacial
from 7.4% to 8.4%.1 Differences due to magnification
complex, approaching adult size by 5 years of age. Liu
were not corrected in the present study.
et al.13 found that corpus length was consistently the
Seven landmarks were identified on the anterior
most mature measure, followed by overall length, then
cranial base and maxilla of each subject (Figure 1)
ramus height during the first 5 postnatal years. The
using operational definitions (Table 1). Eight linear
relative growth of the maxilla during the first 5 years of
measurements were calculated to represent maxillary
life has not been well studied.
and cranial base growth, including presphenoid seg-
Longitudinal studies of maxillary growth are limited,
ment length (S-SE), fronto-ethmoid segment length
especially during infancy and early childhood. Maxillary
(SE-N), posterior heights of the maxilla (SE-PNS and S-
growth is important due to the substantial vertical
PNS), anterior heights of the maxilla (N-A and N-ANS),
dentoalveolar changes that occur14 and the potential
dentoalveolar height (ANS-Pr), and palatal plane length
role of the midface in coordinating the occlusal and
(ANS-PNS). Maxillary maturity during the first 5
mandibular relationship.15 Broadbent et al.16 reported
postnatal years was calculated based on the percent-
that maxillary size (eg, N-ANS, S-N, ANS-PNS)
age of each linear measure’s adult size. Four angular
increased during the first 5 years. While SNA
measurements were calculated to describe the degree
decreased overall between 1 and 5 years, it did not
of maxillary prognathism (SNA), the direction of
change from 2 to 3 years, and it increased slightly from
4 to 5 years. A comprehensive longitudinal evaluation maxillary growth (N-S-A), the inclination of the palatal
of maxillary growth and maturation has not previously plane (SN/ANS-PNS, PPA), and the posterior position
been undertaken. The amount of maxillary growth that of palatal plane relative to cranial base (N-S-PNS).
occurs and the sites where it is the most active during Reliability was enhanced by having each of the tracings
the various stages of early development remain largely checked for accuracy by one of the co-investigators.
unknown.
The purpose of the present study was to describe Statistics
the early postnatal growth and maturation of the Descriptive and inferential statistics were calculated
maxilla. To evaluate sources of variation explaining using SPSS version 18.0 (SPSS Inc., Chicago, Ill).
differences in maxillary growth, the effects of sex and Skewness and kurtosis statistics showed that the
class of occlusion were secondarily evaluated. variables were normally distributed. Annual growth
velocities were calculated by dividing the differences
MATERIALS AND METHODS between measurements by the corresponding age
Serial lateral cephalometric records of 30 normal, differences. Analyses of variance were used to
untreated, healthy Whites were drawn from the Bolton- simultaneously evaluate sex and class effects, as well
Brush Growth Study.1 The sample included 15 males as their interactions. The relative maturity of each of
and 15 females, with equal numbers of Angle Class I the measures was calculated as the percentage of
or Class II division 1, as categorized by the Bolton adult size.
study. Subjects with poor-quality cephalograms were
excluded. RESULTS
The subjects were chosen based on having good-
Absolute Maxillary Growth Changes
quality, serial lateral cephalograms taken some time
during the first year of life (0.4 6 0.1 years), at Repeated measures analyses of variance showed a
approximately 1 year of age, and every year thereafter statistically significant (P , .05) class difference for
until approximately 5 years of age. Each subject also only one variable (N-S-PNS at 16 years), making it
had to have an adult cephalogram taken at the possible to combine the Class I and Class II subjects.
minimum ages of 15 and 17 years for females and There were, however, a number of statistically
males, respectively. The adult female and male significant sex differences for ANS-PNS, N-A, and
cephalograms were taken at 15.3 6 0.60 and 17.2 6 SE-N as well as for measures describing growth
0.75 years of age, respectively. changes, including the variables SE-N and N-ANS.

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EARLY MAXILLARY GROWTH AND MATURATION 565

Figure 1. Cephalogram and cephalometric tracing along with the seven landmarks digitized.

Maxillary size increased in both sexes between 0.4 Yearly growth velocities of the linear measurements
and 5 years of age. The linear AP measures (S-SE, decelerated over the first 5 postnatal years (Figure 2;
SE-N, ANS-PNS) increased almost as much as the Table 3). They were greatest during the first year and
vertical measures (S-PNS, SE-PNS, N-A, N-ANS) decreased progressively through the fifth year. During
over the first 5 postnatal years (Table 2). The the first year, several of the linear velocities decreased
sphenoidal portion of the anterior cranial base (S-SE) by more than 2 mm per year. S-SE showed the lowest
and anterior dentoalveolar height (ANS-Pr) showed rates of growth after the first year.
the smallest growth changes, while N-A showed the The angular measurements also showed the great-
greatest. Males were generally larger than females, est rates of change during the first year (Figure 3). The
with the differences often attaining statistical signifi- N-S-PNS angle increased 8u–10u during the first year,
cance. With the exception of S-PNS and SE-PNS, the 3u during the third year, and less than 1u during the fifth
linear measurements grew faster in males than year. Similarly, the palatal plane angle decreased
females. The SNA and PPA angles decreased over 3u–4u during the first year, approximately 2u during the
time in both sexes. The N-S-A and N-S-PNS angles third year, and increased slightly during the fifth year.
increased over time. The N-S-A angle showed progressively less change

Table 1. Cephalometric Landmarks Along with Their Abbreviations and Definitions

Landmark Abbreviation Definitions
Sella S Sella turcica, the center of the pituitary fossa of the sphenoid bone
Nasion N Junction of the frontonasal suture at the most posterior point on the curve at the bridge of the nose
Ethmoid registration point SE Intersection of the sphenoidal plane with the averaged greater sphenoidal wings (the
uppermost point of the sphenoethmoidal suture; greater wing of the sphenoid crosses
the cribiform plate or planum sphenoidale)
Posterior nasal spine PNS The most posterior point found at the tip of the posterior spine of the palatine bone on the
posterior part of the hard palate
Anterior nasal spine ANS The tip of the median, sharp bony process of the maxilla at the lower margin of the
anterior nasal opening
A A The deepest midline point on the curve of the maxilla between the anterior nasal spine
and prosthion (relative to ANS-PNS plane)
Prosthion Pr The most anterior, inferior point of the maxillary bone if no tooth has erupted, or its labial
contact with the maxillary central incisors

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566 LAOWANSIRI, BEHRENTS, ARAUJO, OLIVER, BUSCHANG

Table 2. Maxillary Size (mm) and Shape (u) During Infancy and Early Childhooda
Age, y
0.4 1 2 3 4 5
Variables Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD D0.4–5 y
Female
S-SE 20.0 2.1 22.7 4.6 22.7 2.4 23.0 2.0 23.5 2.3 23.6 1.9 3.7
SE-N 30.0 2.3 32.2 5.9 35.9 3.0 37.0 2.7 35.2 9.4 38.8 2.4 8.5
ANS-PNS 31.6 2.6 35.8 3.0 39.9 2.1 40.6 2.7 42.7 2.0 44.6 2.7 12.9
S-PNS 28.1 3.8 31.7 3.9 34.2 3.9 37.0 2.5 38.4 2.4 39.4 3.7 12.0
SE-PNS 23.7 4.1 28.6 4.8 31.4 5.1 34.4 3.7 36.2 3.7 36.9 4.9 14.4
N-A 32.0 2.7 35.8 3.2 40.9 2.4 43.2 3.8 44.8 3.8 47.1 3.1 15.1
N-ANS 29.2 2.6 31.5 3.0 36.2 2.3 37.7 2.6 39.3 2.9 41.3 2.6 12.2
ANS-Pr 12.1 2.2 13.3 1.9 15.6 2.5 16.5 2.1 17.3 2.5 17.6 2.5 5.3
SNA 82.0 4.9 82.9 4.0 81.0 4.4 80.8 3.8 81.4 3.7 81.6 3.0 16.7
N-S-A 34.8 2.2 35.2 2.9 37.7 2.5 38.7 3.4 39.3 3.1 39.9 2.4 5.1
PPA (SN/ANS-PNS) 13.4 4.1 9.0 6.2 9.1 5.6 6.4 3.5 5.9 3.3 6.4 4.5 20.5
N-S-PNS 51.1 6.4 55.1 7.1 60.8 6.0 63.7 5.3 65.7 4.6 66.9 4.5 27.9
Male
S-SE 19.7 2.3 22.2 2.2 23.1 2.8 23.9 2.1 24.1 2.0 24.5 1.8 4.9
SE-N 30.9 2.5 34.6 2.4 36.9 1.7 38.1 1.5 39.6 1.7 40.4 2.1 9.6
ANS-PNS 32.6 3.6 37.5 3.9 40.5 3.6 42.4 2.8 44.5 2.6 46.1 2.7 13.6
S-PNS 29.1 2.4 33.1 3.2 35.4 4.2 38.2 3.2 39.2 2.7 39.8 3.7 10.7
SE-PNS 25.0 4.9 28.8 4.0 31.9 3.6 35.3 3.1 37.3 3.1 37.9 4.5 12.7
N-A 33.6 2.3 39.6 3.1 43.4 2.6 46.1 2.8 48.4 3.3 49.9 3.6 16.5
N-ANS 30.1 1.8 34.8 2.7 37.0 2.3 39.2 2.9 41.7 2.6 43.2 3.0 13.2
ANS-Pr 11.8 2.3 13.8 2.2 15.0 2.2 16.8 1.9 17.2 1.8 18.0 2.2 6.3
SNA 82.0 4.2 80.5 3.5 79.8 3.6 80.1 3.4 78.9 3.0 79.8 3.2 15.0
N-S-A 35.9 2.4 37.6 1.8 39.1 2.1 39.9 2.2 41.0 2.6 41.1 2.5 5.1
PPA (SN/ANS-PNS) 13.2 6.4 10.3 4.7 8.4 5.1 6.6 4.0 6.8 2.9 7.7 4.5 22.2
N-S-PNS 52.6 10.1 58.7 7.8 61.4 6.2 64.5 5.4 67.6 4.3 67.8 5.0 25.3
a
SD indicates standard deviation. See Table 1 for variable definitions.

over time. The S-N-A showed small, inconsistent (Table 4). The angular changes were also generally
changes during the first 5 years. greater during the first 4.5 years than the subsequent
The overall linear growth changes that occurred 11 years. The PPA, which underwent substantial
between 0.4 and 5 years of age (span of 4.5 years) changes initially, showed only minor changes after
were generally greater than the changes in maxillary 5 years of age. Before 5 years of age, N-S-PNS
growth that occurred between 5 and 16 years (a span increased approximately three times as much, and
of 11 years). The linear growth changes from 6 to N-S-A increased approximately twice as much, as they
16 years were greater in males than females, but did after 5 years of age. The S-N-A angle decreased
only the SE-N difference was statistically significant during the first 5 years and increased slightly thereafter.

Figure 2A. Yearly velocities of linear maxillary measurements Figure 2B. Yearly velocities of linear maxillary measurements
of females. of males.

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EARLY MAXILLARY GROWTH AND MATURATION 567

Table 3. Year Growth Velocities of the Linear (mm/y) and Angular (u/y) Measures During Infancy and Early Childhooda
Age, y
0.4–1 1–2 2–3 3–4 4–5
Variables Mean SD Mean SD Mean SD Mean SD Mean SD
Female
Linear
S-SE 4.7 6.9 0.7 2.3 0.3 0.8 0.5 0.9 0.1 1.1
SE-N 3.0 9.4 3.7 3.8 1.1 1.0 0.7 0.9 3.6 9.5
ANS-PNS 6.5 5.2 4.1 3.3 0.7 2.1 2.1 2.4 1.9 1.6
S-PNS 6.3 7.7 2.5 2.5 2.8 3.8 1.4 2.6 1.0 2.1
SE-PNS 9.3 7.2 2.8 3.5 2.9 4.5 1.9 3.4 0.7 3.0
N-A 7.0 5.9 5.1 2.8 2.3 2.7 1.6 2.7 2.3 2.5
N-ANS 4.6 5.3 4.7* 2.5 1.5 1.4 1.7 1.3 2.0 1.5
ANS-Pr 2.2 3.6 2.2 2.3 1.0 2.1 0.7 2.5 0.3 2.9
Angular
SNA 0.6 7.5 22.0 3.9 20.1 1.7 0.6 2.1 0.2 2.7
N-S-A 1.6 5.4 2.5 3.0 1.0 2.3 0.6 1.8 0.6 1.6
PPA (SN/ANS-PNS) 27.5 12.8 0.1 4.5 22.7 6.1 20.6 4.1 0.6 3.1
N-S-PNS 8.5 13.9 5.7 5.4 2.9 5.5 2.1 4.3 1.2 2.9
Male
Linear
S-SE 4.2 4.3 1.1 1.8 0.7 1.9 0.2 0.8 0.4 0.8
SE-N 6.3 6.5 2.3 1.7 1.1 1.6 1.6 1.0 0.8 1.2
ANS-PNS 8.2 7.7 3.1 3.5 1.9 2.3 2.1 3.0 1.6 1.7
S-PNS 6.6 5.4 2.3 3.5 2.8 2.9 1.0 1.9 0.6 2.9
SE-PNS 6.4 8.8 2.9 4.9 3.4 4.0 2.0 1.6 0.6 3.2
N-A 9.9 5.2 3.8 2.7 2.7 2.8 2.3 2.7 1.5 2.3
N-ANS 7.8 4.2 2.3* 1.7 2.2 2.4 2.5 1.8 1.5 2.1
ANS-Pr 3.3 4.2 1.3 2.3 1.8 1.9 0.4 1.8 0.8 1.9
Angular
SNA 22.4 5.5 20.8 1.5 0.3 2.3 21.2 2.7 0.8 1.8
N-S-A 2.7 3.7 1.4 2.1 0.9 2.3 1.0 1.9 0.1 1.7
PPA (SN/ANS-PNS) 24.9 12.8 21.7 7.3 21.8 5.3 0.2 2.9 0.9 4.0
N-S-PNS 10.2 16.6 2.4 7.2 3.0 5.4 3.2 4.0 0.2 3.8
a
SD indicates standard deviation. See Table 1 for variable definitions.
* Indicates statistical significance.

Relative Maxillary Maturity less mature at 5 years. S-SE was the most mature
measure, having attained 77.9% (females) and 73.1%
The maturity of the linear measures at 0.4 years
(males) of its adult size at 0.4 years of age. SE-PNS
ranged between 49% and 78% for females and
was the least mature measure at 0.4 years of age for
between 50% and 73% for males (Table 5). The
both sexes, having attained 49.2% and 49.9% of its
maxilla of males was 1%–10.4% less mature than
adult size in females and males, respectively (Figure 4).
the maxilla of females at 0.4 years and 0.1%–9.7%

Figure 3A. Yearly velocities of angular maxillary measurements Figure 3B. Yearly velocities of angular maxillary measurements
of females. of males.

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568 LAOWANSIRI, BEHRENTS, ARAUJO, OLIVER, BUSCHANG

Table 4. Comparison of Linear and Angular Measurements Between T1–T6 and T6–T7a
Females Males
Prob Prob
0.4–5 y 1–5 y 5–16 y
Differences 0.4–5 y 1–5 y 5–16 y Differences
DT1–T6 vs D0.4–5 y vs
Variables Mean Change/y SD Mean Mean Change/y SD DT6–T7 Mean Change/y SD Mean Mean Change/y SD D5–16 y
Linear
S-SE 3.7 0.8 2.2 0.9 2.0 0.2 0.9 0.016 4.9 1.1 2.1 2.2 2.4 0.2 1.3 0.002
SE-N 8.5 1.9 1.8 6.7 6.5 0.6 1.9 0.010 9.6 2.1 3.7 5.8 8.5 0.8 1.9 0.273
ANS-PNS 12.9 2.8 4.2 8.9 6.8 0.6 3.1 ,.001 13.6 3.0 4.2 8.6 9.1 0.8 3.5 0.012
S-PNS 12.0 2.6 3.3 7.8 10.4 0.9 3.9 0.090 10.7 2.3 3.6 6.7 11.2 1.0 4.3 0.829
SE-PNS 14.4 3.1 3.9 8.3 11.1 1.0 4.5 0.011 12.7 2.8 5.0 9.1 12.9 1.2 3.9 0.994
N-A 15.1 3.3 2.9 11.3 11.7 1.1 3.2 0.032 16.5 3.6 2.5 10.4 13.4 1.2 4.3 0.029
N-ANS 12.2 2.7 2.7 9.8 12.1 1.1 3.1 0.915 13.2 2.9 2.4 8.4 12.7 1.2 2.6 0.404
ANS-Pr 5.3 1.2 3.4 4.2 20.9 20.1 3.4 0.002 6.3 1.4 3.4 4.2 0.8 0.1 3.5 0.002
Angular
N-S-PNS 16.7 3.6 7.1 21.3 4.2 0.4 4.1 ,.001 15.0 3.3 9.3 20.7 5.8 0.5 4.6 0.004
N-S-A 5.1 1.1 2.0 4.6 3.1 0.3 2.1 0.032 5.1 1.1 2.0 3.5 2.7 0.2 3.0 0.022
SNA 20.5 20.1 3.8 22.6 0.6 0.1 1.9 0.423 22.2 20.5 3.7 22.6 0.2 0.0 2.9 0.036
PPA (SN/
ANS-
PNS) 27.9 21.7 4.6 11.8 0.7 0.1 6.8 ,.001 25.3 21.2 6.2 9.1 20.8 20.1 3.8 0.021
a
SD indicated standard deviation; bold indicated statistically significant (p,.05) differences. See Table 1 for variable definitions.

The other measures graded more or less regularly DISCUSSION

between these two. With the exception of ANS-Pr, Growth rates were greatest during the first year and
the vertical measures were consistently less mature then decelerated over the next four years. Rapid
than the AP measures, regardless of sex. This deceleration of growth during the early years has been
graded pattern was maintained until 2 years of age previously described for general somatic growth. For
in females and 3 years of age in males, at which point example, rates of growth in recumbent length for
ANS-Pr became and remained the most mature males decrease from approximately 25 cm/y during the
measure. first year to 0 cm/y during the third year.2 The greatest

Table 5. Maxillary Maturity, as a Percentage of Adult Size, During Infancy and Early Childhooda
Age, y
0.4 1 2 3 4 5
Variables Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD
Female
S-SE 77.9 8.5 85.9 8.8 88.8 5.2 89.9 3.7 91.8 4.3 92.4 3.3
SE-N 66.7 4.9 70.9 12.2 79.3 5.7 81.8 4.4 83.3 5.4 85.9 3.5
ANS-PNS 62.0 8.8 69.9 7.4 77.9 5.9 79.3 6.0 83.4 5.4 87.0 5.0
S-PNS 56.5 6.1 63.7 8.3 68.6 7.2 74.3 4.6 77.2 5.3 79.2 6.9
SE-PNS 49.2 8.9 59.8 10.5 65.5 9.8 71.6 5.5 75.6 6.8 77.0 9.4
N-A 54.3 3.8 61.2 6.6 69.7 4.4 73.6 6.6 76.3 6.4 80.2 4.4
N-ANS 54.5 5.6 59.0 5.8 67.8 3.3 70.7 4.8 73.8 4.6 77.5 4.7
ANS-Pr 74.9 18.0 81.7 17.0 94.8 17.2 101.1 17.5 105.1 17.1 107.9 22.0
Male
S-SE 73.1 8.8 82.2 6.6 86.0 7.8 88.8 4.7 89.8 5.5 91.2 4.5
SE-N 63.2 6.7 70.7 3.6 75.6 2.6 77.9 3.8 81.1 3.4 82.6 3.3
ANS-PNS 59.2 6.0 68.3 8.0 73.7 6.8 77.2 6.1 81.0 5.0 83.9 5.5
S-PNS 57.5 5.8 65.2 5.9 69.6 7.8 74.9 5.1 77.0 4.0 78.3 7.3
SE-PNS 49.9 10.4 57.2 6.5 62.9 6.5 69.5 3.3 73.5 3.8 74.7 7.1
N-A 53.3 3.8 62.6 3.7 68.6 5.0 72.9 4.5 76.6 5.8 78.9 5.8
N-ANS 54.2 3.6 62.5 3.0 66.3 3.1 70.3 3.8 74.7 3.5 77.4 3.8
ANS-Pr 64.5 16.3 75.3 15.4 81.8 14.7 91.5 15.5 93.6 15.5 98.2 18.3
a
SD indicates standard deviation. See Table 1 for variable definitions.

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EARLY MAXILLARY GROWTH AND MATURATION 569

Figure 4A. Percent adult status of females 0.4–5 years of age.

changes in cranial base growth also occur during the and decreased progressively thereafter. It appears that
first 5 postnatal years, especially during the first 2– the decelerating pattern of rapid growth observed
3 years.9 Liu et al.13 found that mandibular growth immediately after birth reflects a continuation of the
changes were also greatest during the first 6 months even more rapid growth that occurs prenatally.

Figure 4B. Percent adult status of males 0.4–5 years of age.

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570 LAOWANSIRI, BEHRENTS, ARAUJO, OLIVER, BUSCHANG

The overall growth changes that occurred during the 9.7% less mature at 5 years. Buschang et al.,12 who
first 5 postnatal years were generally greater than the also quantified craniofacial relative maturity, found that
changes that occurred between 5 and 16 years. Broad- the maxilla of 4.5 years of males was 1%–2% less
bent et al.16 found that the growth of ANS-PNS from 1 to mature than the maxilla of females. Liu et al.13 reported
5 years was slightly less than the growth that occurred that male mandibles were 3.3%–3.9% less mature
between 5 and 16 years, as were the changes of N- than female mandibles at 0.4 years. The maturity
ANS. However, that study started at 1 year of age, while differences indicate that females have less growth
the present study started at 0.4 years, and the greatest potential than males for birth onwards.
growth changes occurred during the first year. Anterior dentoalveolar height (ANS-Pr) showed
The relationship of the anterior maxilla to the anterior greater increases in maturation than the other mea-
cranial base changed only slightly during infancy and sures during the first 3 years, closely approaching its
early childhood. SNA decreased 0.4u and 2.2u in adult size by 4–5 years. Buschang et al.12 showed that
females and males, respectively. While using a smaller anterior maxillary height had attained over 100% of
sample of subjects from the Bolton records, Broadbent adult size by 5.5 years of age, with size decreasing
et al.16 showed that SNA decreased 1.2u and 1.5u for rapidly thereafter, followed by size increases. Savara
females and males, respectively. Ohtsuki et al.18 and Singh21 and Singh and Savara22 reported the
reported greater decreases in the SNA angle between greatest increases in the growth of ANS-Pr during the
birth and 5 years of age. SNA decreases may first 5 years, followed by decreases between 6 and
represent a relative posterior repositioning of the 8 years due to loss of primary central incisors. This
maxilla associated with greater relative forward repo- indicates that appositional bone growth of the alveolar
sitioning of the anterior cranial base or with the process occurs rapidly during the first 2–3 years to
pronounced flexing of the cranial base the occurs accommodate both the deciduous and permanent teeth
during the first few postnatal years.9 This suggests that prior to the early mixed dentition phase of development.
N is moving forward relatively more than A.18 With the exception of ANS-Pr, which showed a
Unlike the anterior region, the posterior aspect of the different maturity pattern related to the developing
maxilla underwent substantial posterior repositioning dentition, the various measures showed a graded
relative to the cranial base between birth and 5 years pattern of maturation, with the vertical measures being
of age. The N-S-PNS angle increased 15u–16u, 5u–6u less mature than the AP measures. Buschang et al.12
of which occurred during the first year. Ohtsuki et al.18 were the first to report a maturity gradient for the entire
also reported a substantial increase of this angle craniofacial complex, showing that the vertical aspect
between birth and 5 years of age. In contrast, Brodie19 of the maxilla (N-ANS) was also less mature than the
reported that PNS advances slightly relative to the S-N AP (ANS-PNS) at 4.5 years of age, with percent
line (S was their stable references point) from birth to maturity coinciding with the values obtained in the
1 year of age, and then maintains a straight forward present study. It has also been shown that the AP
growth direction. As previously suggested, the N-S- dimensions of the mandible are more mature than its
PNS angle might be expected to increase with the vertical dimensions.12,13
relative posterior repositioning of the maxilla. While it remained relatively unchanged after 5 years
During the first 5 years of life, absolute AP maxillary of age, the palatal plane angle (PPA) decreased
growth was similar to vertical growth, while vertical substantially during the first 5 years. Although no
growth outpaced AP growth during later childhood and descriptive statistics were provided, Brodie’s19 illustra-
adolescence. Farkas et al.8 reported that the AP tion representing 21 white males also showed that the
growth of the head was significantly greater than PPA decreases during the first 5 years of life. The
vertical growth before 5 years, while vertical growth decreases could be explained by the growth of the orbit,
was greater after 5 years. This difference explains why which grows rapidly during the first few years along with
the AP maxillary measures are more mature than the the rest of the nervous system, and contributes greatly
vertical measures during infancy and early childhood.
to the vertical growth of the anterior part of the maxilla.
Similar patterns reported by Liu et al.13 found that the
The roof of the orbit, AP length of the orbital floor, orbital
mandibular corpus length (Go-Gn) was consistently
breadth, orbital height, and orbital volume grow most
more mature than ramus height (Co-Go) during the
rapidly during the first year of life.23
first 5 years. Fields20 also reported that the vertical
facial growth was the last dimension to be completed.
CONCLUSIONS
On average, late vertical growth increments are
greater in girls than in boys and occur in the maxilla. N Maxillary and anterior cranial base growth rates are
The maxilla of males was 1% to 10.4% less mature the greatest during the first year, and then deceler-
than the maxilla of females at 0.4 years, and 0.1% to ated over the next 4 years.

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EARLY MAXILLARY GROWTH AND MATURATION 571

N Overall growth changes during the first 5 postnatal 10. Singleton DA, Buschang PH, Behrents RG, Hinton RJ.
years are generally greater than the changes Craniofacial growth in growth hormone-deficient rats after
growth hormone supplementation. Am J Orthod Dentofacial
between 5 and 16 years. Orthop. 2006;130:69–82.
N The absolute growth of the AP measures is 11. Abed GS, Buschang PH, Taylor R, Hinton RJ. Maturational
comparable to the growth of the vertical measures, and functional related differences in rat craniofacial growth.
whereas vertical growth outpaces AP growth during Arch Oral Biol. 2007;52:1018–1025.
late childhood and adolescence. 12. Buschang PH, Baume RM, Nass GG. A craniofacial growth
maturity gradient for males and females between 4 and
N ANS-Pr is the most mature during the first 3 years, 16 years of age. Am J Phys Anthropol. 1983;61:373–381.
closely approaching its adult size by 4–5 years. 13. Liu YP, Behrents RG, Buschang PH. Mandibular growth,
N The maxilla of males is 1%–10.4% less mature than remodeling, and maturation during infancy and early
females at 0.4 years, and 0.1% to 9.7% less mature childhood. Angle Orthod. 2010;80:97–105.
at 5 years. 14. Weinmann J, Sicher H. Bone and Bones. St Louis, Mo: The
CV Mosby Co; 1947.
15. Petrovic AG, Stutzmann JJ, Oudet CL. Control processes in
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