With more adults seeking orthodontic treatments, the Bolton-Brush Growth Studies Center at the Case Western Reserve University School of Dental Medicine—one of the world’s longest running projects on normal human growth—will begin to focus on establishing standards for what is considered normal adult development.
Taking the center into its future endeavors will be Dr. Mark Hans, chair of dental school’s orthodontics department. He has assumed leadership responsibilities from Dr. B. Holly Broadbent, Jr., who became director emeritus after working on the project since 1969.
According to Hans, the next step for the center, which has tracked human development for the past 70 years, is to use new and available technology to develop three-dimensional computerized craniofacial models. The center, located in the orthodontic department, is well positioned to produce these kinds of images with its state-of-the-art computed tomography (CT) cone beam scanner. The new model will be based on a composite of data collected from patients coming to the dental school for treatment and imaged using the cone beam scanner.
The center has enlisted engineer, Krishna Subramanyan, who earned his Ph.D. in from the Case School of Engineering, to design the program to establish the standards for what is normal at the age of 30, 40, 50, 60 and the following decades of life. They also plan to revise the childhood standards for male and female children from 3 to 18 years old with the new technology. Also developing standards for normal craniofacial development of African-Americans and other ethnic groups will be part of the center’s new direction.
According to Hans, while orthodontists still treat patients that need anatomical corrections such as cleft palates, many more patients seek quality of life changes through cosmetic enhancements to balance the face.
“The idea of aesthetic surgery is to balance the face,” said Hans.
He also noted that someone in their 40s may not want that balance derived from a standard model for an 18 year old but a procedure to eliminate or reduce wrinkles and still allow animation in their facial features.
“As society become healthier, it is the quality of life that starts to become more important for individual seeking orthodontic care,” said Hans.
One of the major contributions to human growth that the Bolton-Brush Growth Studies Center has given science is that the human face changes and continues to grow throughout life.
With his retirement, Dr. Broadbent has left a legacy of information about those changes through the vast archives of cephalometric (measurements of the head) readings of the Bolton-Brush participants who were followed from their toddler years—and who are now in their 80s and 90s.
The younger Broadbent became the center’s director when his father, Dr. B. Holly Broadbent, Sr. stepped down for health reasons after 45 years of overseeing the growth project, which included the research for the development of the “The Bolton Standard” for what is normal bone growth and structure. These standards were detailed measurements on paper.
Information and voluminous records gathered have provided important insights and research data about head development that has aided orthodontists and maxillofacial surgeons in correcting skeletal problems in facial formation, according to Broadbent, who is on the Case dental school faculty.
The Bolton-Brush study includes 250,000 x-rays, 22,000 physical examinations, 90,000 mental and psychological tests on some 4,000 children from Cleveland between the late 1926 through 1959.
The investigation into development combined two longitudinal studies—the Brush Inquiry, that explored the physical and mental health progress of the children, and the Bolton Study that focused on the normal development of the cranial-facial skeleton and dentition (teeth). The studies began at the then Western Reserve University School of Medicine (now Case Western Reserve University) during the 1920s and moved to the Case School of Dental Medicine in the 1970s.
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