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What maturational factors are pertinent relative to the timing  
                                 of facial surgery?


             The 'Maturational Patient Report' supplied by GrowthTek clearly
                assists and guides the clinician in formulating a well-timed treatment
                plan.  It is very important not to rely on chronologic age in 
                determining the best time to initiate facial surgery whether it be
                for the maxilla and/or the mandible.  

                Although the surgeon and orthodontist usually prefer to delay surgery
                until all facial growth is completed, an individualized maturational
                analysis often reveals a developmental pattern that allows for earlier
                intervention.  This often is desirable for psychological reasons.  For
                instance, advanced maturers tend to become 'burnt out' relative to 
                future amounts of incremental skeletal growth.  On the other hand, 
                delayed maturers tend to 'catch up' by continuing to grow incremental
                amounts over a longer period of time.  The uniqueness of the individual
                can be evaluated on this basis resulting in a more rational approach 
                to the timing of surgery.  GrowthTek provides this information.

                The following example is of an individual who demonstrates a skeletal
                disharmony associated with excessive vertical growth of the lower
                face, upper facial retrusion, lower facial protrusion, Class III molar
                relationship, anterior dental cross-bite relationship, concave facial
                profile, etc.


           Note: CentroGraphic Analysis (CGA) was utilized to evaluate the facial form
                        Fishman LS  Individualized evaluation of facial form  JODO 1997
                        (Subtelny, JD  Early Orthodontic Treatment, Chapter 13, 2000)

               The following chart illustrates nine different developmental scenarios 
                for the  male patient relative to maturational age.  The first three
                patients ( A,B,C ) all demonstrated on their pretreatment hand-wrist 
                x-rays the same maturational stage of SMI 6, a period of very high
                maxillary and mandibular growth velocity.  All three patients 
                demonstrated different maturational levels, Patient A being
                advanced, Patient B being average and Patient C being delayed.  The
                second series of three patients ( D,E,F) also demonstrated the same
                respective maturational levels, but demonstrated maturational stages
                of 10, a developmental period associated with deceleration of growth.
                The remaining three patients ( G,H,I ) also demonstrated the same
                respective maturational levels but demonstrated very late adolescent
                maturational stages of 10++.  The respective pretreatment chronologic
                ages and maxillary ( S-A ) and mandibular ( S-Gn ) measurements
                are notated. 

                'Patient Maturational Reports' were completed for all nine patients.
                Within each of the three subgroups of advanced, average and delayed
                maturers, 24 mo. estimations were made of expected maxillary and
                mandibular growth.  It becomes evident that a significant difference
                can exist between advanced, average and delayed maturers even if 
                they commonly share the same maturational stage prior to treatment.  
                It is not uncommon to demonstrate insignificant amounts of future 
                growth in an advanced maturer, often providing the basis for chrono-
                logically early surgical intervention.  The reverse of this can also
                be seen whereby surgical intervention needs to be delayed until a
                late chronologic age is achieved.  GrowthTek evaluates all of these
                maturational factors and provides the clinician with clear guidelines
                for diagnosis and treatment planning.

Note: Fishman, LS   Maturational patterns and prediction during adolescence.
                                                  Angle Orthod.  1987

                    Note: Please refer to the other questions in this 'Clinical Applications'
                             section of this web site for specific clinical information regarding
                             maturational timing of treatment.     Also refer to the 'Background
                             Information' section of this web site for additional information.

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