GROWTH AND
DEVELOPMENT
OF MAXILLA AND
THE MAXILLARY
SINUS.
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INDIAN DENTAL ACADEMY
Leader in continuing dental education
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•INTRODUCTION
•DEFINITIONS
•FACTORS AFFECTING GROWTH
•GROWTH:CONCEPTS,METHODS OF GATHERING
DATA AND STUDYING GROWTH
•BONE ...
DEFINITIONS OF GROWTH

• J.S.Huxely: The self multiplication of living
substance.
• Krogman:Increase in size, change in pr...
DEFINITIONS OF
DEVELOPEMENT
• Todd:Development is progress towards maturity.
• Moyers: Development refers to all the natur...
FACTORS AFFECTING
PHYSICAL GROWTH
•
•
•
•
•
•
•
•
•
•
•

Heredity
Nutrition
Illness
Race
Race
Socioeconomic factors
Family...
SOME CONCEPTS OF
GROWTH
• Pattern
• Scammon’s Growth Curve

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SCAMMON’S GROWTH
CURVE

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METHODS OF GATHERING
GROWTH DATA
• Longitudinal studies
• Cross sectional studies
• Semi longitudinal studies
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TYPES OF GROWTH DATA
• Opinion
• Observations
• Ratings and rankings

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METHODS OF STUDYING
GROWTH
• Measurement approaches
• Craniometry
• Anthropometry
• Cephalometric radiology

• Experimenta...
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BONE DEVELOPMENT AND
GROWTH

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THEORIES OF GROWTH AND
DEVELOPMENT
•
•
•
•
•
•
•

Genetic theory
Sutural theory
Cartilagenous theory
Functional matrix the...
PRENATAL DEVELOPMENT
OF THE MAXILLA
The prenatal life may be divided into three periods :
The period of the ovum [fertili...
THE PERIOD OF THE EMBRYO:
This period is charecterised by the following events:
Formation of the three germ layers
Forma...
FORMATION OF THE THREE GERM LAYERS
The blastocyst [day 5 ] has cells arranged in two layers :
1.The outer cell mass which...
IMPLANTATION TAKES
PLACE AT THE END OF 1ST
WEEK

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--At the 8th day of development the trophoblast has differenti
ated into two layers:
Inner layer: Cytotrophoblast
Outer la...
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--A small cavity is formed within the epiblast . This is
called the AMNIOTIC CAVITY
--Around the 13th day of development t...
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During the 3rd week there is appearance of the “primitive
streak” with the “ primitive node”
In the region of the node a...
Notochord forms the midline axis which serves as the basis
for axial skeleton . It extends from the prochordal plate in
th...
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ECTODERM

MESODERM

ENDODERM

Central Nervous System

Myotome {muscle}

Epithelial lining for GIT,
Respiratory tract and
B...
THE NEURAL CREST CELLS
They give rise to
1. Sensory ganglia
2. Schawnn cells
3. Pigment cells
4. Odontoblasts
5. Meninges
...
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When the embryo is 41/2 weeks old five mesenchymal
swellings can be recognized:
The Mandibular Swellings [ 1st Pharyngeal...
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The mesenchyme of the maxillary process subsequently
gives rise to the following:
Premaxilla
Maxilla
Zygomatic bone
Te...
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BRANCHIAL AND
PHARYNGEAL ANOMOLIES
CONGENITAL AURICULAR SINUS AND CYSTS:
They are found in a triangular area of skin anter...
FORMATION OF THE
PHARYNGEAL ARCHES
The most typical feature in the development of the head and
neck is formed by the BRAN...
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When the embryo is 4 ½ weeks old, five
mesenchymal swellings can be seen:
Two Mandibular Swellings [1st Pharyngeal Arch ...
BRANCHIAL FISTULA:
It is a communication between the intratonsillar cleft and
the side of the neck- persistence of the 2nd...
TREACHER COLLINS SYNDROME:
Malar hypoplasia
Antimongoloid palpebral fissures
Defects of lower eyelids
Deformed externa...
DI GEORGE SYNDROME:
Hypoparathyroidism
Increased susceptibility to infections
Fish mouth deformity
Low set notched ear...
CONTROL PROCESSES AND
FACTORS IN FACIAL GROWTH
VAN LIMBORGH’S CLASSIFICATION
Intrinsic genetic factors:Inherent in skelet...
E P IG E N E T IC F A C T O R S
LO CAL
G e n e t i c c o n t r o l o ri g i n a t i n g
f r o m a d j a ce n t st r u ct u...
E N V IR O N M E N T A L F A C T O R S

LO CAL

GENERAL

N o n g e n e t ic in flu e n c e e v o k e d b y s t im u li
o r...
THE CONTROL PROCESSES
THE GENETIC BLUE PRINT:
Genes have a fundamental and perhaps an overriding
influence in establishing...
WOLFF’S LAW: The architecture of bone is such that it can
best resist the forces that are brought to bear upon it with the...
CONTROL MESSENGERS:
Growth control is essentially a localised developmental
process working with local function as it resp...
POSTNATAL GROWTH AND
DEVELOPMENT OF
MAXILLA
The growth of maxilla depends on influence of several
functional matrices that...
The NASAL UNIT depends on the SEPTAL CARTILAGE
for its growth.
The TEETH provide the functional matrix for the
ALVEOLAR UN...
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THE 3 PRINCIPLE REGIONS OF
FACIAL AND NEUROCRANIAL
DEVELOPMENT
THE BRAIN AND THE BASICRANIUM:
The above said determines th...
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of the composite growth of many hard and soft tissues
along its pathway from nares to glottis.
These parts are again depen...
A CORNERSTONE OF
GROWTH PROCESS
Remodelling
Displacement
REMODELLING:
Refers to a process where bone deposition and reso...
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Sequentially relocate each of the component regions of
the whole bone to allow for overall enlargement.
Shape the bone t...
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DISPLACEMENT : THE GREAT
CONTROVERSY

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PRIMARY DISPLACEMENT:
Movement of a bone because of its own growth .
SECONDARY DISPLACEMENT:
Movement of a bone passively ...
THE MAXILLARY TUBEROSITY AND ARCH
LENGETHINING:
The horizontal lengethening of maxilla is produced by
remodelling at the ...
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THE GROWTH AND DEVELOPMENT OF THE
NASOMAXILLARY COMPLEX
The maxillary tuberosity and arch lengethening
The lacrimal sutu...
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THE LACRIMAL SUTURE A KEY GROWTH MEDIATOR
The lacrimal bone is a diminutive flake of a bony island
which is surrounded by...
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THE VERTICAL DRIFT OF TEETH: AN IMPORTANT
CLINICAL CONSIDERATION
The term vertical drift denotes the displacement of the
...
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 The breadth of the nasal bridge in the region just below
the frontonasal sutures does not markedly increase from
childho...
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PALATAL REMODELING
Even though the labial side of the whole anterior part of
the maxillary arch is resorptive, the arch n...
New bone added at the following sutures
-Frontomaxillary
-Zygotemporal
-Zygosphenoidal
-Zygomaxillary
-Ethmomaxillary
-Et...
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THE CHEEK BONE AND ZYGOMATIC ARCH
 The posterior side of malar protuberance within the
temporal fossae is deposited in wh...
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ORBITAL GROWTH
 The remodeling changes in orbit are complex as it
comprises of a number of bones including
1. Maxilla
2. ...
SEX DIFFERENCES
 The females have
1. More upright and bulbous forehead
2. Lesser eyebrow ridges
3. Small and less protrus...
DEVELOPMENT OF PALATE
 The palate is formed from three components
a) The two palatal process
b) The primitive palate form...
-

The sudden increase in tissue turgor

-

Intrinsic shelf force

-

Muscular movements

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ANAMOLIES OF PALATAL DEVELOPMENT
Epstein’s pearls and Bohn’s nodules
The entrapment of epithelial rests or pearls in the
l...
III. Torus palatinus:
IV. Oblique facial cleft
Failure of maxillary swelling to merge with its
corresponding lateral nasal...
CLASSIFICATION OF CLEFT LIP AND PALATE
Davis and Ritchi (1922) and Veau (1931) have given the
following classification
Cla...
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INCIDENCE
Cleft lip : 1:1000 Births, More in males
Cleft palate : 1:2500 Births, More in females
PROSTHODONTIC TREATMENT
I...
PHARYNGE
AL ARCH

NERVE

MUSCLES

SKELETON

Mandibular

V-Mandibular div.

Muscles of mastication, Ant.
Belly of Digastric...
ENDODERMAL POUCH

DERIVATIVES

I

Tubo tympanic recess-Auditory
tube,middle ear cavity,tympanic
antrum.

II

Tonsil.

III
...
TIMING OF PRIMARY CLEFT LIP AND PALATE PROCEDURES.
{After Delaire}

CLEFT LIP ALONE

UNILATERAL
↓
One operation at 5-6 mon...
CLEFT LIP AND PALATE
UNILATERAL

↓
Two operations
↓
Cleft lip + soft palate – 5-6 months
↓
Hard palate + gum pad +/- lip r...
Thank you
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Growth of maxilla & sinus /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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  • Bone is formed by two
  • FIG 2.10 PG 31 LANGMANS
  • Fig 3.3 langmans
  • Fig 3.6 pg 44 langmans
  • Fig.4.1,4.2,4.5,langmans pg 48-51
  • Fig 16.3,16.4, langmans
  • Fig 16.6a,16.4,16.6,16.7,langman
  • Fig 16.6a,16.6,16.4,16.7 langmans
  • Growth of maxilla & sinus /certified fixed orthodontic courses by Indian dental academy

    1. 1. GROWTH AND DEVELOPMENT OF MAXILLA AND THE MAXILLARY SINUS. www.indiandentalacademy.com
    2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    3. 3. •INTRODUCTION •DEFINITIONS •FACTORS AFFECTING GROWTH •GROWTH:CONCEPTS,METHODS OF GATHERING DATA AND STUDYING GROWTH •BONE DEVELOPMENT AND GROWTH •THEORIES OF GROWTH •PRENATAL GROWTH AND DEVELOPMENT OF MAXILLA •POST NATAL GROWTH AND DEVELOPMENT OF MAXILLA •DEVELOPMENT OF THE PALATE www.indiandentalacademy.com
    4. 4. DEFINITIONS OF GROWTH • J.S.Huxely: The self multiplication of living substance. • Krogman:Increase in size, change in proportion and progressive complexity. • Todd:An increase in size. • Meridith:Entire series of sequential anatomic and phisiologic changes taking place from beginning of prenatal life to senility. • Moyers:Quantitative aspect of biologic development per unit time. • Moss: Change in any morphological parameter which is measurable. www.indiandentalacademy.com
    5. 5. DEFINITIONS OF DEVELOPEMENT • Todd:Development is progress towards maturity. • Moyers: Development refers to all the naturally occuring unidirectional changes in the life of an individual from its existence as a single cell to its elobaration as a multifunctional unit terminating in death. Thus it encompasses the normal sequential events between fertilization and death. www.indiandentalacademy.com
    6. 6. FACTORS AFFECTING PHYSICAL GROWTH • • • • • • • • • • • Heredity Nutrition Illness Race Race Socioeconomic factors Family size and birth order Secular trends Climatic and seasonal effects Psychological disturbances www.indiandentalacademy.com Exercise
    7. 7. SOME CONCEPTS OF GROWTH • Pattern • Scammon’s Growth Curve www.indiandentalacademy.com
    8. 8. www.indiandentalacademy.com
    9. 9. SCAMMON’S GROWTH CURVE www.indiandentalacademy.com
    10. 10. METHODS OF GATHERING GROWTH DATA • Longitudinal studies • Cross sectional studies • Semi longitudinal studies www.indiandentalacademy.com
    11. 11. TYPES OF GROWTH DATA • Opinion • Observations • Ratings and rankings www.indiandentalacademy.com
    12. 12. METHODS OF STUDYING GROWTH • Measurement approaches • Craniometry • Anthropometry • Cephalometric radiology • Experimental approaches  Vital staining  Radioisotopes  Implants  Radiographic techniques  Natural markers  Comparative anatomy www.indiandentalacademy.com
    13. 13. www.indiandentalacademy.com
    14. 14. www.indiandentalacademy.com
    15. 15. www.indiandentalacademy.com
    16. 16. BONE DEVELOPMENT AND GROWTH www.indiandentalacademy.com
    17. 17. THEORIES OF GROWTH AND DEVELOPMENT • • • • • • • Genetic theory Sutural theory Cartilagenous theory Functional matrix theory Van Limborgh’s theory Enlow’s expanding “V” principle Enlow’s Counterpart principle www.indiandentalacademy.com
    18. 18. PRENATAL DEVELOPMENT OF THE MAXILLA The prenatal life may be divided into three periods : The period of the ovum [fertilization to the end of fourteenth day] The period of the embryo [14th to 56th day ] The period of the foetus [56th to Birth ] THE PERIOD OF OVUM: This period consists primarily of cleavage of the ovum and attachment to the uterine wall . At the end of this period the ovum is only 1.5 mm in length and cephalad differention has not yet begun. www.indiandentalacademy.com
    19. 19. THE PERIOD OF THE EMBRYO: This period is charecterised by the following events: Formation of the three germ layers Formation of the pharyngeal arches Differentiation of the mesenchyme to signal beginning of endochondral and intramembranous bone formation www.indiandentalacademy.com
    20. 20. FORMATION OF THE THREE GERM LAYERS The blastocyst [day 5 ] has cells arranged in two layers : 1.The outer cell mass which will form the trophoblast 2.The inner cell mass which will give rise to the embryo proper “embryoblast” www.indiandentalacademy.com
    21. 21. IMPLANTATION TAKES PLACE AT THE END OF 1ST WEEK www.indiandentalacademy.com
    22. 22. --At the 8th day of development the trophoblast has differenti ated into two layers: Inner layer: Cytotrophoblast Outer layer:Syncytiotrophoblast The cells of embryoblast also differentiate into two layers: ---A layer of small cuboidal cells : hypoblast ---A layer of high columnar cells : epiblast The hypoblast and the epiblast together constitute the bilaminar germ disc www.indiandentalacademy.com
    23. 23. www.indiandentalacademy.com
    24. 24. --A small cavity is formed within the epiblast . This is called the AMNIOTIC CAVITY --Around the 13th day of development the following structures are seen: Secondary yolk sac Extraembryonic coelom [ Chorionic cavity ] Connecting stalk [ Future embryonic stalk ] Prochordal plate [ Where the epiblast cells are firmly attached to the hypoblast cells ……The future Buccopharyngeal membrane ] www.indiandentalacademy.com
    25. 25. www.indiandentalacademy.com
    26. 26. During the 3rd week there is appearance of the “primitive streak” with the “ primitive node” In the region of the node and the streak, the epiblast cells invaginate a new cell layer between the hypoblast [ now called the ENDODERM ] and the epiblast [now called the ECTODERM] This third layer is called the MESODERM  The process of mesoderm formation is called the GASTRULATION These cells form a tube like process called the NOTOCHORDAL PROCESS which gets filled in by cells to form the NOTOCHORD www.indiandentalacademy.com
    27. 27. Notochord forms the midline axis which serves as the basis for axial skeleton . It extends from the prochordal plate in the cephalic region to the cloacal membrane in the region caudal to the primitive streak . www.indiandentalacademy.com
    28. 28. www.indiandentalacademy.com
    29. 29. www.indiandentalacademy.com
    30. 30. ECTODERM MESODERM ENDODERM Central Nervous System Myotome {muscle} Epithelial lining for GIT, Respiratory tract and Bladder. Peripheral Nervous System Sclerotome {Cartilage and Bone} Parenchyma of tonsil, thyroid,parathyroid,thymus ,liver and pancreas. Sensory Epithelium of the Ear, Nose and Eye Dermatome {Subcutaneous tissue of skin} Epithelial lining of tympanic cavity and Eustachian tube Skin, Hair, Nails Vascular System Pituitary, Mammary and Sweat Glands Uro-genital System {excluding the bladder} Enamel of the Tooth Spleen and Supra Renal glands www.indiandentalacademy.com
    31. 31. THE NEURAL CREST CELLS They give rise to 1. Sensory ganglia 2. Schawnn cells 3. Pigment cells 4. Odontoblasts 5. Meninges 6. Cartilage cells of branchial arches They have a possible important function in the formation of face www.indiandentalacademy.com
    32. 32. www.indiandentalacademy.com
    33. 33. www.indiandentalacademy.com
    34. 34. When the embryo is 41/2 weeks old five mesenchymal swellings can be recognized: The Mandibular Swellings [ 1st Pharyngeal Arch ] The Maxillary Swellings [ Dorsal portion of 1st Arch] The Frontal Prominence Each Pharyngeal Arch is thus characterized by its own : Muscular Component Cranial Nerve Component Arterial component www.indiandentalacademy.com
    35. 35. www.indiandentalacademy.com
    36. 36. The mesenchyme of the maxillary process subsequently gives rise to the following: Premaxilla Maxilla Zygomatic bone Temporal bone in part All these bones undergo intramembranous ossification. www.indiandentalacademy.com
    37. 37. www.indiandentalacademy.com
    38. 38. www.indiandentalacademy.com
    39. 39. BRANCHIAL AND PHARYNGEAL ANOMOLIES CONGENITAL AURICULAR SINUS AND CYSTS: They are found in a triangular area of skin anterior to ear. They are remnants of the 1st branchial groove. BRANCHIAL SINUSES: Open on the side of the neck and result from the failure of the 2nd branchial groove to close. The blind pit or sinus that remains opens along the anterior border of the sternocleidomastoid. www.indiandentalacademy.com
    40. 40. FORMATION OF THE PHARYNGEAL ARCHES The most typical feature in the development of the head and neck is formed by the BRANCHIAL or the PHARYNGEAL ARCHES They appear in the 4th and 5th week of development and contribute greately to the characteristic appearance of the embryo. With this a number of outpocketings the PHARYNGEAL POUCHES appear along the lateral walls of the pharyngeal gut-the most cranial part of the foregut. At the end of 4th week the centre of the face is formed STOMODEUM ,surrounded by the first pair of pharyngeal www.indiandentalacademy.com arches .
    41. 41. www.indiandentalacademy.com
    42. 42. When the embryo is 4 ½ weeks old, five mesenchymal swellings can be seen: Two Mandibular Swellings [1st Pharyngeal Arch ] Two Maxillary Swellings[Dorsal Portion of the 1st Arch] The Frontal Prominence www.indiandentalacademy.com
    43. 43. BRANCHIAL FISTULA: It is a communication between the intratonsillar cleft and the side of the neck- persistence of the 2nd branchial groove and the 2nd pharyngeal pouch. BRANCHIAL CYST: Remnants of part of cervical sinus and/or the 2nd branchial groove may persist and form this cyst …..it is located along the anterior border of the sternocleidomastoid. FIRST ARCH SYNDROME: Due to insufficient migration of the neural crest cells into the 1st arch. Some of the more common are: www.indiandentalacademy.com
    44. 44. TREACHER COLLINS SYNDROME: Malar hypoplasia Antimongoloid palpebral fissures Defects of lower eyelids Deformed external ears Abnormalities of middle and internal ears PIEERE ROBIN SYNDROME: Hypoplasia of mandible Cleft palate Defects of the eye and the ear www.indiandentalacademy.com
    45. 45. DI GEORGE SYNDROME: Hypoparathyroidism Increased susceptibility to infections Fish mouth deformity Low set notched ears Thyroid hypoplasia Cardiac abnormalities www.indiandentalacademy.com
    46. 46. CONTROL PROCESSES AND FACTORS IN FACIAL GROWTH VAN LIMBORGH’S CLASSIFICATION Intrinsic genetic factors:Inherent in skeletal tissues themselves.They exert influence inside the cell to which they are inherent. Local Epigenetic factors:Epigenesis includes the sum total of all biochemical and biophysical events produced by the functioning of the cells and organs ……Petrovic General Epigenetic factors Local environmental factors www.indiandentalacademy.com General environmental factors
    47. 47. E P IG E N E T IC F A C T O R S LO CAL G e n e t i c c o n t r o l o ri g i n a t i n g f r o m a d j a ce n t st r u ct u re a n d p ro vi d e l o c a l a ct i o n s E xa m p l e : E m b ryo n i c i n d u ct i o n i n f l u e n ce s s k. g ro w t h B ra i n , e ye GENERAL G e n e t i c co n t r o l o ri g i n a t i n g f r o m d i s t a n t st r u ct u re a n d p ro vi d e g e n e ra l a ct i o n s E xa m p l e : H o rm o n e s www.indiandentalacademy.com
    48. 48. E N V IR O N M E N T A L F A C T O R S LO CAL GENERAL N o n g e n e t ic in flu e n c e e v o k e d b y s t im u li o r ig in a t in g fr o m e x t e r n a l e n v ir o n m e n t E x a m p le : h a b it s , fo r c e s o f m u s c . c o n t r a c t io n T h e s e a r e G e n e r a l n o n g e n e t ic in flu e n c e s E x a m p le : N u t r it io n , fo o d , o x y g e n . www.indiandentalacademy.com
    49. 49. THE CONTROL PROCESSES THE GENETIC BLUE PRINT: Genes have a fundamental and perhaps an overriding influence in establishing basic facial pattern but they are NOT exclusive determinants of all growth parameters. BIOCHEMICAL FORCES: The play of physical forces acting on a bone to regulate its development, morphologic configuration, histological structure and physical properties. www.indiandentalacademy.com
    50. 50. WOLFF’S LAW: The architecture of bone is such that it can best resist the forces that are brought to bear upon it with the use of as little tissue as possible. It has a flaw in that the law doesn’t distinguish between physical forces acting on a bone and forces acting on the osteogenic connective tissue that actually produce any remodelling of the bone. SUTURES,CONDYLES AND SYNCHONDROSES: Growth,form and dimensions of a bone are governed by intrinsic genetic programming residing within that bone’s own bone –producing cells of periosteum,sutures and bone related cartilages –provide inclusive growth regulation for each of the whole bones they serve. Modern research discounts such a concept . www.indiandentalacademy.com
    51. 51. CONTROL MESSENGERS: Growth control is essentially a localised developmental process working with local function as it responds to multiple developmental interplay with other growing parts. FORCE/PRESSURE/TENSION BIOPHYSICAL REACTIONS-Bone deformation,compression of periodontal ligament,tissue injury PRODUCTION OF FIRST MESSENGERS Hormones[PTH],Prostaglandins,Neurotransmitters PRODUCTION OF 2nd MESSENGERS[Camp,Cgmp,Ca] www.indiandentalacademy.com INCREASE IN CELLS OF RESORPTION/DEPOSITION
    52. 52. POSTNATAL GROWTH AND DEVELOPMENT OF MAXILLA The growth of maxilla depends on influence of several functional matrices that act upon different areas of the bone thus allowing its subdivision into skeletal units: The BASAL BODY beneath the INFRAORBITAL NERVE, later surrounding it to form the infraorbital canal. The ORBITAL UNIT responds to the growth of the eyeball www.indiandentalacademy.com
    53. 53. The NASAL UNIT depends on the SEPTAL CARTILAGE for its growth. The TEETH provide the functional matrix for the ALVEOLAR UNIT The PNEUMATIC UNIT reflects maxillary sinus expansion,which is more a responder than a determiner of the skeletal unit. www.indiandentalacademy.com
    54. 54. www.indiandentalacademy.com
    55. 55. THE 3 PRINCIPLE REGIONS OF FACIAL AND NEUROCRANIAL DEVELOPMENT THE BRAIN AND THE BASICRANIUM: The above said determines the persons headform and type Ex:A long and narrow basicranium gives rise to dolicocephalic facial form while a brachycephalic facial form gives a wider facial configuration BASICRANIUM is the template that establishes the shape and perimeter of the facial growth field. THE AIRWAY: The configuration and www.indiandentalacademy.com airway are a product dimensions of the
    56. 56. www.indiandentalacademy.com
    57. 57. www.indiandentalacademy.com
    58. 58. of the composite growth of many hard and soft tissues along its pathway from nares to glottis. These parts are again dependent upon the airway for maintanance of their own functional and anatomic position. It functions as a key stone for the face. THE ORAL REGION: Compensatory adjustments by the remodelling process occur throughout growth and development in many ways. The oral region is one of the areas around which these changes take place. www.indiandentalacademy.com
    59. 59. A CORNERSTONE OF GROWTH PROCESS Remodelling Displacement REMODELLING: Refers to a process where bone deposition and resorption occur so as to bring about change in size , shape and relationship of the bone . FUNCTIONS OF REMODELLING: www.indiandentalacademy.com Progressively create the changing size of bone
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    61. 61. Sequentially relocate each of the component regions of the whole bone to allow for overall enlargement. Shape the bone to accommodate its various functions Provide fine tune fitting of all the separate bones to each other and to their contiguous soft tissues. DISPLACEMENT: It is the physical movement of the whole bone and occurs while the bone simultaneously remodels by resorption and deposition. Bone deposition doesn’t push the articular contact surface of another bone and provide growth….rather bone is carried by the expansive force of all growing soft tissues around it and attached to it by anchoring fibres. www.indiandentalacademy.com
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    63. 63. DISPLACEMENT : THE GREAT CONTROVERSY www.indiandentalacademy.com
    64. 64. PRIMARY DISPLACEMENT: Movement of a bone because of its own growth . SECONDARY DISPLACEMENT: Movement of a bone passively or secondary to growth of contiguous bone/s. DRIFT: The combination of bone deposition and resorption resulting in a growth movement towards the depositing surface is called drift. RELOCATION: The progressive sequential movement of component parts as a bone enlarges is relocation. www.indiandentalacademy.com
    65. 65. THE MAXILLARY TUBEROSITY AND ARCH LENGETHINING: The horizontal lengethening of maxilla is produced by remodelling at the maxillary tuberosity Back facing periosteum of tuberosity has continuous deposits of new bone as long as srowth in this part continues. The lateral surface is also depositiory …the arch widens. The endosteal side of the cortex is resorptive …the maxillary sinus expands as a result. The whole maxilla undergoes primary displacement in an anterior and inferior direction as it grows. www.indiandentalacademy.com
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    67. 67. THE GROWTH AND DEVELOPMENT OF THE NASOMAXILLARY COMPLEX The maxillary tuberosity and arch lengethening The lacrimal suture-a key growth mediator. The maxillary tuberosity and the key ridge The vertical drift of teeth The nasal airway Palatal remodelling Downward maxillary displacement The cheekbone and the zygomatic arch Orbital growth www.indiandentalacademy.com
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    69. 69. THE LACRIMAL SUTURE A KEY GROWTH MEDIATOR The lacrimal bone is a diminutive flake of a bony island which is surrounded by sutural connective tissue. The sutural system of the lacrimal bone provides for the slippage of multiple bones along sutural interfaces with the pivotal lacrimal as they all enlarge differentially. The lacrimal sutures allow maxilla to slide downward along its orbital contacts which facilitates inferior displacement of the maxilla. THE MAXILLARY TUBEROSITY AND THE KEY RIDGE: Major change occurs in surface contour along the vertical crest below malar protruberance called the key ridge. A reversal occurs here where by external surface of maxillary arch anterior to it is resorptive. www.indiandentalacademy.com Similarly reversal is seen at Point A as well.
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    71. 71. THE VERTICAL DRIFT OF TEETH: AN IMPORTANT CLINICAL CONSIDERATION The term vertical drift denotes the displacement of the whole tooth along with its alveolar housing in an occlusal direction. As the jaws grow the dentition drifts both vertically and horizontally to keep phase in the respective anatomic positions. THE NASAL AIRWAY The lining surfaces of the bony walls and floor of the nasal chambers are resorptive accept for the nasal side of the olfactory fossae. This produces a lateral and anteiror expansion of the www.indiandentalacademy.com nasal chamber and a downward relocation of the palate.
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    73. 73.  The breadth of the nasal bridge in the region just below the frontonasal sutures does not markedly increase from childhood to adult hood. More inferiorly in the inter orbital area the medial wall of each orbit expands and balloons out considerably in a lateral direction. www.indiandentalacademy.com
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    75. 75. PALATAL REMODELING Even though the labial side of the whole anterior part of the maxillary arch is resorptive, the arch none the less increases in width and the palate becomes wider (the ‘V’ principle). DOWNWARD MAXILLARY DISPLACEMENT The primary displacement of the whole ethmomaxillary complex in a downward direction is accompanied by simultaneous remodeling in all areas. www.indiandentalacademy.com
    76. 76. New bone added at the following sutures -Frontomaxillary -Zygotemporal -Zygosphenoidal -Zygomaxillary -Ethmomaxillary -Ethmofrontal -Nasomaxillary -Nasofrontal -Frontolacrimal -Palatine -Vomerine www.indiandentalacademy.com
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    78. 78. THE CHEEK BONE AND ZYGOMATIC ARCH  The posterior side of malar protuberance within the temporal fossae is deposited in while the anterior surface is resorptive. Thus the cheek bone relocate posteriorly as it enlarges.  This results in a protrusive appearing nose and an anteroposteriorly much deeper face. www.indiandentalacademy.com
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    80. 80. ORBITAL GROWTH  The remodeling changes in orbit are complex as it comprises of a number of bones including 1. Maxilla 2. Ethmoid 3. Lacrymal 4. Frontal 5. Zygomatic 6. Greater and lesser wings of sphenoid  There is bone deposition along much of the walls of the orbit except the lateral wall which is resorptive.  The orbit also grows by ‘V’ principle, so that the cone shaped orbital cavity moves in a direction towards its wide opening.  In the child the floor of nasal and orbital cavities are at about the samewww.indiandentalacademy.com adult the nasal level. But in the
    81. 81. SEX DIFFERENCES  The females have 1. More upright and bulbous forehead 2. Lesser eyebrow ridges 3. Small and less protrusive nose 4. Lower nasal bridge 5. A more rounded nasal tip 6. Flatter face 7. Wider appearing face with more prominent appearing cheek bones. www.indiandentalacademy.com
    82. 82. DEVELOPMENT OF PALATE  The palate is formed from three components a) The two palatal process b) The primitive palate formed from frontonasal process. The definitive palate is found by the fusion of these three parts  The transition from vertical to horizontal position is completed within hours.  Some of the mechanisms are - Biochemical transformation in the physical consistency of the connective tissue matrix of the shelves. - Variation in vasculature and blood flow to this structures www.indiandentalacademy.com
    83. 83. - The sudden increase in tissue turgor - Intrinsic shelf force - Muscular movements www.indiandentalacademy.com
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    88. 88. ANAMOLIES OF PALATAL DEVELOPMENT Epstein’s pearls and Bohn’s nodules The entrapment of epithelial rests or pearls in the line of fusion of the palatal shelves may give rise to median palatal rests cysts. II. Dental lamina cysts Epithelial remnants of dental lamina that develop on the crest of alveolar ridge. www.indiandentalacademy.com
    89. 89. III. Torus palatinus: IV. Oblique facial cleft Failure of maxillary swelling to merge with its corresponding lateral nasal swelling results in this deformity. V. Cleft lip and Palate Successful fusion of the three embryonic components of the palate involves complicated synchronization of 1. Shelf movements with growth 2. Withdrawal of the tongue 3. Growth of the mandible and head www.indiandentalacademy.com
    90. 90. CLASSIFICATION OF CLEFT LIP AND PALATE Davis and Ritchi (1922) and Veau (1931) have given the following classification Class I – Cleft of soft palate only Class II – Cleft of hard and soft palate till the incisive foramen Class III – Complete unilateral cleft of the soft palate, hard palate, the alveolar ridge and the lip on one side. Class IV – Complete cleft of soft palate, hard palate, alveolar ridge and the lip on both sides. www.indiandentalacademy.com
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    92. 92. INCIDENCE Cleft lip : 1:1000 Births, More in males Cleft palate : 1:2500 Births, More in females PROSTHODONTIC TREATMENT If it is decided the surgery will be unsuccessful for the treatment of cleft soft palate then the first obturator is given at 2 years There are three types: 1. Fixed pharyngeal 2. Hinged pharyngeal 3. Meatal The cleft of hard palate can be so easily covered by www.indiandentalacademy.com means of a simple acrylic or metallic palate.
    93. 93. PHARYNGE AL ARCH NERVE MUSCLES SKELETON Mandibular V-Mandibular div. Muscles of mastication, Ant. Belly of Digastric,Tensor Palatini,Tensor Tympani. Incus,Malleus, Ant. Ligament of Malleus,Sphenomandibular ligament ,Portion of mandible. Hyoid VII-Facial Muscles of facial expression, Post. Belly of Digastric, Stylohyoid,Stapedius. Stapes,Styloid process,Stylohyoid Ligament, Smaller horn and Superior body of Hyoid. III IX-Glossopharyngeal Stylopharyngeus Greater horn, Lower part of Body of Hyoid. IV-VI Sup.Laryngeal, Rec.Laryngeal. Muscles of Pharynx, Soft Palate and Larynx. Laryngeal Cartilages. www.indiandentalacademy.com
    94. 94. ENDODERMAL POUCH DERIVATIVES I Tubo tympanic recess-Auditory tube,middle ear cavity,tympanic antrum. II Tonsil. III Inferior Parathyroids,Thymus. IV Sup.parathyroids. V Ultimo Branchial bodyParafollicular cells of thyroid. www.indiandentalacademy.com
    95. 95. TIMING OF PRIMARY CLEFT LIP AND PALATE PROCEDURES. {After Delaire} CLEFT LIP ALONE UNILATERAL ↓ One operation at 5-6 months. BILATERAL ↓ One operation at 5-6 months. CLEFT PALATE ALONE SOFT PALATE ALONE ↓ One operation at 5-6 months. SOFT + HARD PALATE ↓ Two operations ↓ Soft palate –6 months ↓ Hard palate- 12- 15 months www.indiandentalacademy.com
    96. 96. CLEFT LIP AND PALATE UNILATERAL ↓ Two operations ↓ Cleft lip + soft palate – 5-6 months ↓ Hard palate + gum pad +/- lip revision – 12-15 months BILATERAL ↓ Two operations ↓ Cleft lip + soft palate – 5-6months ↓ Hard palate + gum pad +/- lip revision – 12-15 months www.indiandentalacademy.com
    97. 97. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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