Development of cranial vault & base /certified fixed orthodontic courses by Indian dental academy

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Development of cranial vault & base /certified fixed orthodontic courses by Indian dental academy

  1. 1. GROW TH AND DEVELOPMENT OF CRANIAL VAULT www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. In the closest of union there is still some separate existence of component parts; in the most complete separation there is still a reminiscence of union. The notebook of Samuel Butler www.indiandentalacademy.com
  4. 4. SKULL At Birth- 45 bony elements  In Adult- 22 bones Face- 14 bones Cranium- 8 bones  www.indiandentalacademy.com
  5. 5. Four regions of the Craniofacial complex:o The Cranial Vault o The Cranial Base o The Naso-maxillary complex o The Mandible www.indiandentalacademy.com
  6. 6. Further – Pre - natal and Post - natal growth Attention to:i. Site and location of growth ii. Type of growth occurring. iii. Determinant or controlling factors. www.indiandentalacademy.com
  7. 7. ANATOMY  Norma Verticalis – Above  Norma Basalis – Below  Norma Lateralis – Side  Norma Occipitalis – Back  Norma Frontalis - Front www.indiandentalacademy.com
  8. 8. anatomy  Span –  Superciliary ridges & glabella of frontal bone upto & including Squamous occipital bone. Also includes part of Squamous temporal bone laterally. www.indiandentalacademy.com
  9. 9. anatomy When viewed from above:a. Ellipsoidal (roughly) b. Bones –  Frontal  Parietal  Occipital  Temporal  Greater wing of sphenoid www.indiandentalacademy.com
  10. 10. anatomy c. Sutures  Frontal (metopic)  Coronal  Sagittal  Lambdoid  Parietal with Sphenoid  Parietal with Temporal  Bregma  Lambda www.indiandentalacademy.com
  11. 11. scalp www.indiandentalacademy.com
  12. 12. Pre-Natal Growth Mesenchyme first arranged as capsular membrane Endomeninx – Neural crest origin Ectomeninx – Neural crest and paraxial mesoderm. www.indiandentalacademy.com
  13. 13. Pre-Natal Growth Ectomeninx Duramater Superficial membrane Vault www.indiandentalacademy.com Base
  14. 14. Pre-Natal Growth Endomeninx Piamater www.indiandentalacademy.com Arachanoid
  15. 15. Pre-Natal Growth  Close relation between ectomeninx and endomeninx except in areas of venous sinuses.  Dura mater- Fiber bundles- Falx cerebri, Falx cerebelli and Tentorium cerebelli- closely related &strongly attached to the sutural system- later develops in the vault .  Shape of brain www.indiandentalacademy.com
  16. 16. Pre-Natal Growth Site site of future bones Ossification Intra membranous Controlling factor Brain growth www.indiandentalacademy.com
  17. 17. Pre-Natal Growth Mesoderm – Frontal, Parietal, sphenoid, petrous temporal & occipital. Neural crest – Lacrimal, nasal, squamous temporal, zygomatic, maxilla & mandible www.indiandentalacademy.com
  18. 18. Pre-Natal Growth  Frontal Bone  Primary centre ------ Superciliary arch(8th wk)  Secondary centers ------ zygomatic process, (fusion 6-7 mts) nasal spine, trochlear fossae At birth- Metopic suture, fusion 2-7yrs www.indiandentalacademy.com
  19. 19. Pre-Natal Growth  Parietal bone   Occipital bone (Squamous part)   Region of Parietal eminence 8th wk, fuse by 4th month. Just above superior nuchal line Temporal bone (Squamous part)  Root of zygoma www.indiandentalacademy.com
  20. 20. Pre-Natal Growth  Tympanic ring of temporal bone  4 centers in lateral wall of tympanum appear in the 3rd month of i.u birth, fuse at birth.  Formation of Sutural/ wormian bones  Unusual centers of ossification www.indiandentalacademy.com
  21. 21. Pre-Natal Growth  Osification centers appear around 8th week IU.  Fontanelles  Close at various times- 2 months to 2 years www.indiandentalacademy.com
  22. 22. Fontanelles www.indiandentalacademy.com
  23. 23. Pre-Natal Growth -Control of Morphogenesis 3 questions posed by Van Limborgh: Relationship between skull and primordia of other organs?  Co-ordination of endochondral and intramembranous ossification?  Co-ordination of growth of skull and other organs? www.indiandentalacademy.com
  24. 24. Pre-Natal Growth -Control  Intrinsic genetic factors  Epigenetic factors  Environmental factors www.indiandentalacademy.com
  25. 25. Intrinsic Genetic control Local epigenetic factors Cranial Cranial differentiation differentiation General epigenetic factors Local Environmental factors General Environmental factors www.indiandentalacademy.com
  26. 26. Pre-Natal Growth -Control Shift of belief:Genetic influence Epigenetics Examples- Primordia of eye. - Brain. www.indiandentalacademy.com
  27. 27. Intrinsic Genetic control Local epigenetic factors Cranial Cranial differentiation differentiation General epigenetic factors Local Environmental factors General Environmental factors www.indiandentalacademy.com
  28. 28. Post-Natal Growth Related to Growth of the Brain  Maximum growth upto the 5th year of life – (91% as shown by Davenport)  www.indiandentalacademy.com
  29. 29. Post-Natal Growth Various Theories of Growth, and how they relate to the cranial vault. Sicher’s Sutural dominance theory Scott’s Cartilaginous theory Moss’ FMH www.indiandentalacademy.com
  30. 30. Sicher’s Theory Intrinsic Genetic control Local epigenetic factors Desmocranial Desmocranial Growth Growth General epigenetic factors Local Environmental factors General Environmental factors www.indiandentalacademy.com
  31. 31. Post-Natal Growth  Scott’s theory Inherent growth controlling factors present in Cartilages & Periosteum.  Sutures respond secondarily www.indiandentalacademy.com
  32. 32. Post-Natal Growth Intrinsic Genetic control Chondrocranial Chondrocranial Growth Growth Local epigenetic factors General epigenetic factors Desmo- Sutures cranial Periosteal Growth growth Local Environmental factors General Environmental factors www.indiandentalacademy.com
  33. 33. Post-Natal Growth Moss’ FMH Intrinsic Genetic control Local epigenetic factors Desmocranial Desmocranial Growth Growth General epigenetic factors Local Environmental factors General Environmental factors www.indiandentalacademy.com
  34. 34. Post-Natal Growth Sicher – Intrinsic control Hydrocephalus, anencephaly, microcephaly   Scott – Cartilage not responsive to pressure or tension, but intra membranous bone is. www.indiandentalacademy.com
  35. 35. Post-Natal Growth www.indiandentalacademy.com
  36. 36. Post-Natal Growth  Synchondrosis Sutures Sarnat, Burdi, Baume, Petrovic etc. Also explains why growth of cranial base is less influenced by brain growth than growth of Cranial vault - Van Limborgh www.indiandentalacademy.com
  37. 37. Post-Natal Growth Moss’ explanation for brain growth controlling growth of the cranium… Hydrocephalus, synostosis www.indiandentalacademy.com
  38. 38. Post-Natal Growth V A U L T Brain B A S E www.indiandentalacademy.com
  39. 39. Post-Natal Growth Van Limborgh's Summarization:1. Intrinsic control of growth is exhibited at synchondroses 2. Intrinsic control of sutural growth is less 3. Synchondroses should be considered as Growth centre 4. Sutural growth controlled by both cartilaginous growth and growth of other structures. 5. Periosteal bone growth (vault) controlled epigenetically by adjacent structures 6. Growth of cranial vault also controlled by local environmental factors (muscle forces inclusive) www.indiandentalacademy.com
  40. 40. Chondrocranial Chondrocranial Growth Growth Intrinsic Genetic control Local epigenetic factors General epigenetic factors Desmocranial Desmocranial Growth Growth Local Environmental factors General Environmental factors www.indiandentalacademy.com
  41. 41. Post-Natal Growth Growth of the cranial vault – direct influence of Neurocranial capsule www.indiandentalacademy.com
  42. 42. www.indiandentalacademy.com
  43. 43. New deposition on flat surfaces  Endosteal surfaces- resorptive  Increases overall thickness- expands medullary spaces.  www.indiandentalacademy.com
  44. 44. Post-Natal Growth Thickening not uniform:Inner table Brain Outer table mechanical influences and functional stresses Growth of the frontal sinus (Benninghoff) www.indiandentalacademy.com
  45. 45. Post-Natal Growth Arc of curvature of the whole bone decreases www.indiandentalacademy.com
  46. 46. Post-Natal Growth 90% of cranial vault growth complete by 5-6 yrs In accordance with -Scammon’s curve - Cephalocaudal Gradient. www.indiandentalacademy.com
  47. 47. Clinical Implications  Distortion of head during birth – Fontanelles www.indiandentalacademy.com
  48. 48. Clinical Implications  Synostosis syndromes  Courzon’s syndrome  Apert’s syndrome www.indiandentalacademy.com
  49. 49. Clinical Implications  Other conditions – Hydrocephalus, Anencephaly, Microcephaly www.indiandentalacademy.com
  50. 50. Clinical Implications  Various conditions – cretinism, progeria, trisomy 21, cleidocranial dysostosis,  Anterior fontanelles remain open  Bossing of forehead  Brachycephalic skull www.indiandentalacademy.com
  51. 51. Clinical Implications  Herniation of dura mater into the nose Dura remains in contact with the ectoderm in the region of the anterior neuropore. Ventral bending of the fronto-nasal process brings this junction close to the future nose. Nasal capsule forms around this, and the junction sinks forming the foramen caecum www.indiandentalacademy.com
  52. 52. Clinical Implications The dura then separates from the ectoderm, and foramen caecum closes. If this foramen fails to close, dura can herniate in to the nose. Also formation of dermoid cysts, sinus or encephalocele. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. Clinical Implications  Abnormal external forces applied to the cranial vault, as by headboards, by primitive tribes. www.indiandentalacademy.com
  55. 55. GROW TH AND DEVELOPMENT OF CRANIAL BASE Dr. Safeena www.indiandentalacademy.com
  56. 56. Cranial Base Reasonably stable reference structure in cephalometric analysis  Basis to compare and understand abnormal growth patterns  www.indiandentalacademy.com
  57. 57. Functions  Supports & protects the brain & spinal cord  Articulation of skull with vertebral column , mandible & maxilla  Buffer zone between the brain, face & pharyngeal region www.indiandentalacademy.com
  58. 58. ANATOMY  ANTERIOR CRANIAL FOSSA  MIDDLE CRANIAL FOSSA  POSTERIOR CRANIAL FOSSA www.indiandentalacademy.com
  59. 59. ANTERIOR CRANIAL FOSSA 1. 2. 3. Orbital part of frontal bone Cribriform plate of ethmoid Anterior part of the body of sphenoid & lesser wing www.indiandentalacademy.com
  60. 60. ANTERIOR CRANIAL FOSSA www.indiandentalacademy.com
  61. 61. CRIBRIFORM PLATE OF ETHMOID THE SPHENOID BONE  Anterior part of the upper surface of its body is termed the JUGUM SPHENOIDALE www.indiandentalacademy.com
  62. 62. ORBITAL PLATE OF FRONTAL BONE It separates the orbit and its contents from the inferior surface of the frontal lobe of the brain Its antero medial part split into 2 laminae FRONTAL SINUS www.indiandentalacademy.com
  63. 63. MIDDLE CRANIAL FOSSA It is deeper than the anterior fossa  It shaped like a butterfly. In front it is bounded by posterior borders of the lesser wing of sphenoid and the body of the sphenoid,  Behind by superior borders of the temporal bones & Dorsum sellae of sphenoid bone www.indiandentalacademy.com
  64. 64. MIDDLE CRANIAL FOSSA www.indiandentalacademy.com
  65. 65. MIDDLE CRANIAL FOSSA Centrally   Optic Canal Hypophyseal Fossa Laterally      Superior Orbital Fissure Foramen Rotundum Foramen Ovale Foramen Spinosum Foramen Lacerum www.indiandentalacademy.com
  66. 66. POSTERIOR CRANIAL FOSSA Largest and deepest of the cranial fossa www.indiandentalacademy.com
  67. 67. POSTERIOR CRANIAL FOSSA www.indiandentalacademy.com
  68. 68. POSTERIOR CRANIAL FOSSA VARIOUS FORAMINA  FORAMEN MAGNUM  JUGULAR FORAMIN  INTERNAL ACOUSTIC MEATUS  FACIAL CANAL  HYPOGLOSSAL CANAL www.indiandentalacademy.com
  69. 69. PRENATAL GROWTH Cranial base develops by endochondral bone formation www.indiandentalacademy.com
  70. 70. PRENATAL GROWTH CHONDRIFICATION  Mesenchyme derived from paraxial mesoderm and neural crest .  Form ECTOMENINGEAL CAPSULE .  Earliest evidence of skull formation.  Mesenchyme starts converting into Cartilage Starting on day 40 i.u. Cartilage www.indiandentalacademy.com
  71. 71. PRENATAL DEVELOPEMENT CRANIUM NEUROCRANIUM VISCEROCRANIUM BASICRANIUM www.indiandentalacademy.com
  72. 72. PRENATAL DEVELOPEMENT At the cellular level    Hyperplasia Hypertrophy Accretion www.indiandentalacademy.com
  73. 73. PRENATAL DEVELOPEMENT CARTILAGES  PARACHORDAL CARTILAGE  HYPOPHYSEAL CARTILAGE  OTIC CAPSULE  NASAL CAPSULE www.indiandentalacademy.com
  74. 74. PRIMORDIAL CARTILAGES www.indiandentalacademy.com
  75. 75. PRENATAL GROWTH PARACHORDAL CARTILAGES Chondrification centers forming around the cranial end of the notocord Parachodal cartilages fuse with the sclerotomes arising from occipital somites surrounding the neural tube www.indiandentalacademy.com
  76. 76. PRENATAL GROWTH www.indiandentalacademy.com
  77. 77. PRENATAL GROWTH 2 Hypophyseal cartilages - Postsphenoid Sella turcica Body of the sphenoid (post. Part) www.indiandentalacademy.com
  78. 78. PRENATAL GROWTH 2 Presphenoid cartilage- Presphenoid bone Body of the sphenoid bone (ant. Part) www.indiandentalacademy.com
  79. 79. PRENATAL GROWTH Most anteriorly- presphenoid cartilages- Mesethmoid Ossifies into perpendicular plate of ethmoid Upper edge forms crista galli www.indiandentalacademy.com
  80. 80. PRENATAL GROWTH Orbito sphenoid - Lesser wing  Alisphenoid - Greater wing  www.indiandentalacademy.com
  81. 81. PRENATAL GROWTH OTIC CAPSULE Mastoid and petrous portions of the temporal bones Otic capsule does not chondrify. www.indiandentalacademy.com
  82. 82. PRENATAL GROWTH NASAL CAPSULE- 2nd month i.u Cartilages of nostrils and the nasal septal cartilage  Functional matrix- downward & forward growth  It helps in transferring compressive forces from incisor region to the sphenoid region www.indiandentalacademy.com
  83. 83. CHODROCRANIAL OSSIFICATION   110 ossification centers in embryonic human skull. Ossification starts in the 4 months UNOSSIFIED CHONDROCRANIAL REMNANTS –  Alae & septum of the nose,  Spheno-occpital & spheno-petrous junctions,  The apex of the petrous bone and  Between the separate parts of the occipital bone www.indiandentalacademy.com
  84. 84. CHODROCRANIAL OSSIFICATION www.indiandentalacademy.com
  85. 85. OSSIFICATION OCCIPITAL BONE - 7 centres  Supranuchal Squamous portion – 2 intramembranous centres ( 8 th week)  Infranuchal squamous – 2 endochondral centres (10 th week) (Kerckring centre) www.indiandentalacademy.com
  86. 86. OCCIPITAL BONE Basioccipital bone – 1 endochondral (11th week) Exoccipital bone – 2 endochondral centres (12 th week) www.indiandentalacademy.com
  87. 87. OSSIFICATION TEMPORAL BONE - 21 centres Squamous portion-1 intramembranous centre (8 th week)- Zygomatic process  Tympanic ring – 4 intramembranous centres (3 th month)  Petrosal part – 14 endochondral centres (16th week)  Styloid process – 2 endochochondral centres(at birth) Start to fuse during 1st yr of life  www.indiandentalacademy.com
  88. 88. OSSIFICATION ETHMOID BONE – 3 centres  Perpendicular plate & crista galli – 1 endochodral centre  Lateral labrynths in the nasal cartilages- 2 endochondral centres www.indiandentalacademy.com
  89. 89. OSSIFICATION- SPHENOID BONE Intramembranous ossification centres  Medial pterygoid plates – 2  Lateral pterygoid plates -2 Endochondral ossification centres  Presphenoid – 3  Postsphenoid – 4  Orbitosphenoids - 2  Alisphenoids - 2  Pterygoid hamuli - 2 www.indiandentalacademy.com
  90. 90. OSSIFICATION VOMER Alae – 2 intramembranous centres Inferior nasal concha Lamina – 1 endochondral centre www.indiandentalacademy.com
  91. 91. OSSIFICATION BONE OCCIPITAL (2) SITE & NUMBER OF OSSIFICATION INTRAMEMBRANOUS ENDOCHONDRAL _ Supranuchal squamous (2) Infranuchal squamous Basilar (1) Exoccipital (2) TEMPORAL _ Squamous (1) Tympanic (4) Petrosal (14) Styloid (2) ETHMOID _ Lateral labrynths (2) Perpendicular plate; Crista (1) www.indiandentalacademy.com
  92. 92. OSSIFICATION BONE - SITE & NUMBER OF OSSIFICATION INTRAMEMBRANOUS ENDOCHONDRAL VOMER _ AlAE (2) SPHENOID _ Medial pterygoid Presphenoid (3) plates (2) Postsphenoid (4) Lateral pterygoid Orbitosphenoid (2) plates (2) Alisphenoids (2) Pterygoid hamulus (2 Sphenoidal conchae (2) INFERIOR NASAL CONCHA _ Lamina (1) www.indiandentalacademy.com
  93. 93. CRANIAL BASE ANGULATION Angle at the hypophyseal fossa where prechordal & chordal parts meet each other www.indiandentalacademy.com
  94. 94. CRANIAL BASE ANGULATION www.indiandentalacademy.com
  95. 95. PRE NATAL GROWTH Highly Uneven Anterior cranial base increases its length and width by 7 folds between the 10th and 40thweek of I.U life Posterior cranial base grows only 5 fold www.indiandentalacademy.com
  96. 96. POSTNATAL GROWTH EXPANTION of cranial base occurs by  Growth of the cartilage remnants of the chondrocranium- basicranial bones  Forces from growing brain www.indiandentalacademy.com
  97. 97. POSTNATAL GROWTH Cranial base acts as a template from which the face develops The endocranial surface of the basicranium is resorptive in most areas Remodeling is required to accommodate the massively enlarged human brain www.indiandentalacademy.com
  98. 98. POSTNATAL GROWTH FOSSA ENLARGEMENT www.indiandentalacademy.com
  99. 99. POSTNATAL GROWTH Endocranial compartments- separated by bony elevations • Middle & posterior fossae – petrous elevation • Olfactory fossae – crista galli • Right & left middle fossae – Sphenoidal elevation • Right & left anterior & posterior fossae – Longitudinal midline bony ridge www.indiandentalacademy.com
  100. 100. POSTNATAL GROWTH Fossa expands outward by resorption,  Partitions between them enlarge inward by deposition  www.indiandentalacademy.com
  101. 101. POSTNATAL GROWTH The mid ventral segments of cranial base grows more slowly to accommodate the medulla, pons, hypothalamus & optic chiasma Foramen Drift process Spinal Cord Defferential remodelling www.indiandentalacademy.com
  102. 102. POSTNATAL GROWTH SYNCHONDROSIS- SEEN IN MIDLINE PART OF BASICRANIUM www.indiandentalacademy.com
  103. 103. POSTNATAL GROWTH SYNCHONDROSIS A growth centre Bipolar direction of growth www.indiandentalacademy.com
  104. 104. POSTNATAL GROWTH SPHENO-OCCIPITAL SYNCHONDROSIS Major contributor in the postnatal growth Fuses at 12-13 years in girls and 14-15 years in boys and ossifies at 20 years of age Pressure adapted bone growth mechanism www.indiandentalacademy.com
  105. 105. POSTNATAL GROWTH  Sinus secondarily grows as the body of the sphenoid bone expands keeping constant junction with the moving naso-maxillary complex www.indiandentalacademy.com
  106. 106. POSTNATAL GROWTH Post border of N-Mcomplex coincides with boundary between ant and middle cranial fossa Secondary displacement effect (Anterior cranial floor , nasomaxillry complex & mandible) www.indiandentalacademy.com
  107. 107. POSTNATAL GROWTH  Frontal lobe growth completes by 5years.  Temporal lobes continue to enlarge for several more years and displaces the frontal lobe forward. www.indiandentalacademy.com
  108. 108. POSTNATAL GROWTH www.indiandentalacademy.com
  109. 109. CLINICAL IMPLICATIONS Configuration of neurocranium(& brain) determines a person’s head form type - DOLICOCEPHALIC - BRACHYCEPHALIC - MESOCEPHALIC www.indiandentalacademy.com
  110. 110. Cranial base growth for Dutch boys and girls –Monique Henneberke & Birte Prahl Andersen (AJO 1994) Hypothesis that there is no difference in the cranial base growth between children with or without ortho treatment- was tested  S-N 153(boys)and 167 (girls)  N-Ba and S-Ba 116 (boys) and 116 (girls), 7-14 yrs Mixed longitudinal study www.indiandentalacademy.com
  111. 111. RESULTS 1. The effect of orthodontic therapy on cranial base was not significant 2. The cranial base displayed sexual dimorphism in absolute size, timing and amount of growth. 3. Girls did not show growth spurts where as boys showed growth spurts for S-N and N-Ba. www.indiandentalacademy.com
  112. 112. CLINICAL IMPLICATIONS ACHONDROPLASIA Disturbance in endochondral bone formation Deficient growth at the synchondrosis Maxilla is not translated forward This results in abnormal depression of the bridge of the nose Relative midface deficiency www.indiandentalacademy.com
  113. 113. CLINICAL IMPLICATIONS www.indiandentalacademy.com
  114. 114. CLINICAL IMPLICATIONS  Premature ossification or synostosis of the suture between the presphaenoid and postsphenoid parts of the spheno-occipital suture - depressed nasal bridge and dished face www.indiandentalacademy.com
  115. 115. CLINICAL IMPLICATIONS  Anomalous development of the presphenoidal elements Excessive separation of orbits and abnormally broad nasal bridge. -HYPERTELORISM  ANENCEPHALY (Absence of calvaria ) Retain acute cranial base flexure www.indiandentalacademy.com
  116. 116. CLINICAL IMPLICATIONS  INADEQUATE GROWTH OF CHONDROCRANIUM Impacted eruption of third molars CLIEDOCRANIAL DISOSTOSIS Abnormalities of the skull, teeth, jaws and shoulder girdle  www.indiandentalacademy.com
  117. 117. Abnormalities Of Cleidocranial Disostosis – Kreiborg,bjork& Skeiller (AJOMay; 1981 ) KREIBORG,BJORK & SKIELLER conducted a qualitative screening for abnormal morphological traits in the cranial base. (8 males & 9 females) RESULTS    The anterior and posterior cranial base was shorter and the cranial angle smaller in the syndrome groups Patients shown small pituitary fossae and bulbous dorsum sellae The amount of bone resorption was lesser than normal. www.indiandentalacademy.com
  118. 118. I will praise thee: for I am fearfully and wonderfully made. Psalm CXXXIX 14 www.indiandentalacademy.com
  119. 119. REFERENCES 1. Craniofacial Embryology -G.H.SPERBER 2. Essencials Of Facial Growth -D.H.ENLOW 3. Contemporary orthodontics W.R.PROFFIT 4. Anatomy –Gray 5. Grants Atlas 6. Abnormalities Of Cleidocranial Disostosis – Kreiborg,bjork& Skeiller (Ajo May; 1981 ) 7. Cranial Base Growth For Dutch Boys & Girls – M.Herneberke,b.P. Andersen (Ajo November; 1994 ) www.indiandentalacademy.com
  120. 120. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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