Pre natal and post natal /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Pre natal and post natal
growth and development
of nasomaxillary complex

Growth and development of
Nasomaxillary complex
 Anatomy
 Pre

natal growth
 Post natal growth
 Clinical implications


ANATOMY OF MAXILLA
 Two

maxillae articulate to form
–
1. Whole upper jaw.
–
2. Roof of oral cavity.
–
3. Greater part of floor and
lateral wall of nasal cavity and part of
nasal bridge.
– 4. Greater part of floor of each
orbit.

ANATOMY OF MAXILLA.
 PARTS

OF MAXILLA.

– 1. BODY –LARGE AND PYRAMIDAL IN
SHAPE.
– 2. FOUR PROCESSES.
FRONTAL
ZYGOMATIC
ALVEOLAR
PALATINE
MAXILLA HOUSES THE LARGEST SINUS OF THE
FACE THE MAXILLARY SINUS

ANATOMY – MEDIAL VIEW

Frontal process

Maxillary sinus

Maxillary process [palatine]

Horizontal plate of palatine
Palatine process[maxilla]
Alveolar process

ANATOMY-LATERAL VIEW

Frontal process

Nasal notch
Zygomatic process
ANS
Alveolar process


Pre natal growth and
development


Pre-natal growth
 At

fourth week of of IUL1.migration of neural crest cells
2.formation of brachial arches
FRONTONASAL

MAXILLARY

MAXILLARY

STOMODEUM

MANDIBULAR


MANDIBULAR

Medial nasal
process

Lateral nasal process
Maxillary process
Mandibular process


Maxillary and Mandibular processes{ first brachial arch}
 Frontonasal processes- { downward


proliferation of mesenchyme of developing brain}
Medial nasal

Lateral nasal

maxilla

mandible
Mesenchyme of first arch
zygomatic

palatine
Part of temporal


 AT

SEVENTH WEEK IUL1.Formation of upper lip
2.Intramembranous Bone
ossification Takes Place
3.Formation of Nasal Septum
4.Nasolacrimal Duct
5.Formation of Primary Palate


AT SEVENTH WEEK IUL
 Primary

ossification center -for each
maxilla at termination of infraorbital
nerve above canine tooth dental lamina.

 Secondary

center

intermaxillary

zygomatic
orbitonasal
nasopalatine


AT EIGHT WEEK IUL
 Intramembranous

ossification centers

appear for;
-Nasal and lacrimal bones.
-Medial pterygoid plate of sphenoid.
-Vomer.
-Zygomatic bone


BY TWELFTH WEEK
 Anteroposterior

maxillo- mandibular
relationship approaches that of
newborn infant

 Maxilla

increases in height


 FRIEBAND-{the

growth of palate in

human fetus}
 1st

trimester-narrow
 2st trimester-moderate width
 3st trimester- wide
 Breadth>length
 Height changes less dramatic


Pre-natal Growth and
development of palate
 Formation

of primary and secondary

palate
 Elevation
 Fusion

of palatal shelves

of palatal shelves

Early palate formation
 28th

day of IUL
 -disintegration of buccopharangeal
membrane
Oral cavity
 -stomadeal chamber
Nasal cavity

 Horizontal

extensions
Single primary palate

2 palatal
shelves

 Structure

of palate

Primary palate



5 TH week IUL

Secondary palate

PALATOGENESIS

6

9

CRITICAL PERIOD

12 TH week IUL

Primary palate
Frontonasal
process

Medial nasal

mesenchyme

Pre-maxilla

Wedge shaped mass
between internal
W
Primary palate
surface of maxillary
e
www.indiandentalacademy.com prominence
g
d

Primary palate
Primary
palate


Secondary palate
Maxillary prominence
2 horizontal mesenchymal projections

Lateral palatine process
With each other
Primary palate

Fuse-

Nasal septum
Secondary palate


Secondary palate

PALATAL SHELVES

Elevation of palatal shelves
At 6 weeks
1. Tongue {undifferentiated tissue}
pushes dorsally
2. palatal shelves become vertical
3. Elevation occurs from vertical to
horizontal position



Elevation of palate
Histological section

Nasal
septum
Palatal
shelves

tongue


 At

8 weeks

Muscular
movement

Pressure
differences

Biomechanical
transformation

Elevation of palatal shelves

Intrinsic
shelf force

Differential
mitotic growth


Withdrawal of
embryo’s face

Fusion of palatal shelves


Fusion of the palatal
shelves
In the closest union there is still some
separate existence of component parts ;
in the most complete separation there is
some reminiscence of union
Samuel Butler


Fusion of palate
Incisive foramen

Mid palatine
raphe

Formation of palate[summary]
Primordium Formed
of
by
Median
palatine
process

Primary
palate

Pre
maxilla

Secondary
palate

Hard and Lateral
soft
palatine
palate
process

Derived
from
Frontonasal
process

Maxillary
process

Musculature of palate
 Tensor

veli palatini 40 days 1 st arch
 Palatopharangeous 45 days
 Levator veli palatini 8th week 2nd arch
 Palatoglossus
9th week
 Uvular muscle
11th week 2nd arch


Growth in dimensions
height
width
length
 Length
 Width

Arched palate

- 7-8 weeks IUL
- 4th month onwards

Growth in dimensions
 Pre

natal life
length > width

 At

birth
length =

width

 Post

natal life
width > length


 Growth

at mid palatal suture ceases at
1-2 years

 Apposition

inferior surface
alveolar process
 Resorption –superior{nasal} surface


V principle of Bang and Enlow
Remodeling of palate



Entire ‘v’ shaped
structure moves
in a direction
towards the wide
end of the ‘v’


Factors affecting growth of
palate
 elevation

of head and lower jaw
 Oxygen and nutritional deficiency
 Excess endocrine substances
 Drugs
teratogens
 Irradiation
 vascularity

Elevation of head and lower jaw


ANOMALIES OF PALATE
 Epithelial

pearls


ANOMALIES OF PALATE
 Torus

palatinus


ANOMALIES OF THE PALATE

High arched palate

MARFANS
SYNDROME

CROUZON
SYNDROME

CLEIDOCRANIAL
DYSOSTOSIS


ANOMALIES OF PALATE
 Cleft

palate

Failure of fusion of the lateral palatine
process with each other or with the
median palatine process

Genesis of cleft palate
 Delay

in shelf elevation
 Disturbance in mechanism of shelf
elevation
 Failure of shelves to contact due to lack
of growth
 Failure to displace the tongue during
closure [Pierre Robin syndrome]


Genesis of cleft palate
 Failure

to fuse after contact as
epithelium does not break down

 Rupture


after fusion

defective merging


Types of cleft palate

Bifid uvula

Unilateral
cleft palate

Bilateral
cleft palate

Unilateral cleft palate

Bilateral
cleft palate

Bifid uvula

Infectious
agents

irradiation

drugs

Etiology of cleft palate

Nutritional
deficiency

Excess
hormones

Smoking
and
alcohol

Clinical features of cleft palate
 Feeding

problems particularly in infants
in whom suckling process demands
intact palate

 Nasal

regurgitation/nasal twang in voice

 Collapsed
 Difficulty

arch

in speech and swallowing

Post natal growth of
maxilla


Post natal growth of maxilla
 Surface

remodeling

MOSS

TRANSPOSITION
resorption

apposition

 displacement

TRANSLATION

SUTURES


CRANIAL BASE


MAXILLA

 Surface

apposition
 Sutural growth
 nasal septum growth
 Spheno occipital synchondrosis
 In

contrast to cranial base maxilla is
dominated by intra membranous
ossification

Surface apposition


Sutural growth


Spheno occipital synchondroses


 Growth

in height

vertical

 Growth

in width

transverse

 Growth

in length

A -P


HEIGHT
ENLOW AND BANG ‘V’
PRINCIPLE


DEPOSITION ON
THE ORAL SIDE



RESORPTION ON
THE NASAL SIDE


HEIGHT -

‘V’ PRINCIPLE

Coronal view


Sagittal view

HEIGHT

APPOSITION IN THE
ALVEOLAR
PROCESS
ERUPTION OF
TEETH

HEIGHT
Primary displacement


PRIMARY DISPLACEMENT
 SUTURAL

THEORY

 CARTILAGENOUS
 FUNCTIONAL

THEORY

MATRIX HYPOTHESIS


SUTURAL THEORY
SICHER


SUTURES HAVE
INNATE
GROWTH
POTENTIAL



OBLIQUE
NATURE



SLIDING EFFECT


CARTILAGENOUS THEORY
SCOTT


NASAL SEPTUM –INNATE GROWTH
POTENTIAL



THRUST EFFECT–
SEPTOPREMAXILLARY LIGAMENT



MORE ROLE IN A-P THAN VERTICAL



SURGICAL REMOVAL OF NASAL
SEPTUM

Removal of nasal septum –mid face
deficiency


FUNCTIONAL MATRIX
HYPOTHESIS
MOSS
SKELETAL UNITS

FUNCTIONAL MATRIX




BASAL BODY

INFRAORBITAL
NERVE



ORBITAL UNIT

EYEBALL



NASAL UNIT

SEPTAL CARTILAGE



ALVEOLAR UNIT
TEETH

FUNCTIONAL MATRIX
HYPOTHESIS


HEIGHT

REMODELING
CHANGES IN
THE ORBIT

ENLARGING
ORO
FACIAL
CAPSULE


WIDTH
 Finished
 WIDTH

earlier in postnatal life
GROWTH IN MID
PALATINE SUTURE
REMODELING IN THE
LATERAL SURFACE OF
ALVEOLAR PROCESS

Mutual transverse rotations of
maxillary halves give palate ‘u’ shape

LENGTH
 Begins

rapidly in the 2 nd year of life

Maxillary
tuberosity

Palato -

primary secondary

maxillary
www.indiandentalacademy.comdisplacement
suture

QUANTITATION OF MAXILLARY
REMODELING
Sheldon Baumrind,Edward Korn
AJO JAN 1987


Uniform displacement of all 3 pts in vertical
direction [downward displacement –0.3mm/year]



Horizontal direction posterior displacement of all
3 pts [however the displacement of PNS was
greater than ANS and pt A ]



THE INCREASE IN LENGTH IS PRIMARILY
BECAUSE OF GROWTH IN POSTERIOR BORDER

Maxillary tuberosity
 Established

by the posterior boundary
of anterior cranial fossa
 Helps in posterior and horizontal
lengthening of arch

Anterior displacement
= posterior lengthening

Key ridge
Reversal occurs at
the key ridge
Posterior - apposition
Anterior - resorption


Maxillary sinus
 PRE

NATAL
 lateral evagination of mucous
membrane in middle meatus –3rd month
IUL
 AT BIRTH
 2mm
-long, 1mm in width + height
 PNEUMATISATION
PRIMARY

SECONDARY


Maxillary sinus
AGE

CHANGES

Expands - 2mm
vertically
3mm A-P - every
year
> in size resorption in walls +
alveolus

Maxillary sinus
POST NATAL
 All internal
surfaces
resorption
[expect medial]


Rapid continues
downward growth
close proximity to
buccal maxillary
teeth



Zygomatic region
Posterior relocation
anterior

posterior

Increase in height
frontozygomatic

Inferior
border

Lateral growth

Zygomaticotemporal [anterior]

displacement

Frontozygomatic [inferior]


Nasal airway
Lining surface of
bony wall and floor

Downward relocation
of palate

resorptive

Lateral and anterior
expansion


Nasal airway
Ethmoidal
conchae
lateral + inferior
deposition
medial + superior
resorption


Inter nasal
septum
Lengthens
vertically at
sutural
junctions www.indiandentalacademy.com


Clinical Implications
and Summary


Pre natal growth
Formation of
germ layers

Migration
and
proliferation
of cell
population

Day 17

Fetal alcohol
syndrome
[mid face
deficiency]

Day 19-28


Treacher Collin
syndrome

Pre natal growth
Primary palate
formation

28-38
days

Cleft lip /cleft palate
other facial clefts
Cleft palate/synostosis

Secondary
palate
formation

42-55
days

CROUZON syndrome
Epithelial pearls
Torus palatinus
high arched palate


Post natal growth


Post natal growth
AT BIRTH
Hard palate : length = width
maxillary sinus : not visible
radiographically
1 – 2 years
Extensive remodeling
descent of
palate /enlargement of nasal cavity
Mid palatine suture growth

ceases


No synostosis

Post natal growth
THE MIXED DENTITION
YEARS


Post natal growth
THE MIXED DENTITION YEARS
Growth in width of the
dental arch anterior to the
first molar
Inter canine width
completed

Ceases by 5-6 yrs

12 yrs - females
18 yrs - males

mid palatine suture
RME BEST DONE
starts closing at 9- 10
BETWEEN 9-14 yrs
years

Post natal growth
THE MIXED DENTITION YEARS


THE DEPOSITORY GROWTH POTENTIAL OF
TUBEROSITY ALLOWS FOR ARCH
EXPANSION BY MOVING THE TEETH
POSTERIORLY INTO THE AREA OF BONE
DEPOSITION




EXTENSIVE SCOPE FOR GROWTH
MODIFICATION BEFORE ADOLESCENT
GROWTH SPURT

Post Natal Growth
THE EARLY PERMANENT
DENTITION YEARS
•Growth modification still possible in
boys
•RME can still be tried till 12 -15 yrs
•>15 years

complete closure[synostosis]

Orthognatic surgery


Age changes
 All

para nasal sinuses increase in size
 Vertical height decreases
Alveolar process
resorbed

Tooth loss

 Vertical

changes > AP > width
 Soft tissue changes > skeletal
 Nose growth continues till 25 years
 Inclination of palatal plane
increases[post downwards]

References
 Contemporary

orthodontics- PROFFIT
 Principles and practice of orthodontics –
GRABER
 Essentials of facial growth- ENLOW
 Craniofacial embryology- SPERBER
 The developing human-KEITH MOORE
 oral histology and embryologyTENCATE
 Handbook of orthodontics-MOYERS

References
 quantitation

of maxillary remodeling-S
BAUMRIND ,E KORN –AJO JAN 97
 Dentistry for child and adolescent-MAC
DONALD
 Clinical pedodontics-FINN
 Color atlas of Embryology
MOORE,PERSUAD
 Clinical oral pathology-NEWILLE
,WHITE
 Diseases of oral mucosaBORK,HOEDE

Thank you
For more details please visit


Pre natal and post natal /certified fixed orthodontic courses by Indian dental academy

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (8)

Andere mochten auch

Andere mochten auch (18)

Ähnlich wie Pre natal and post natal /certified fixed orthodontic courses by Indian dental academy

Ähnlich wie Pre natal and post natal /certified fixed orthodontic courses by Indian dental academy (20)

Mehr von Indian dental academy

Mehr von Indian dental academy (20)

Pre natal and post natal /certified fixed orthodontic courses by Indian dental academy