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

Pre natal and post natal
growth a...
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...
ANATOMY OF MAXILLA.
 PARTS

OF MAXILLA.

– 1. BODY –LARGE AND PYRAMIDAL IN
SHAPE.
– 2. FOUR PROCESSES.
FRONTAL
ZYGOMATIC
...
ANATOMY – MEDIAL VIEW

Frontal process

Maxillary sinus

Maxillary process [palatine]

Horizontal plate of palatine
Palati...
ANATOMY-LATERAL VIEW

Frontal process

Nasal notch
Zygomatic process
ANS
Alveolar process

www.indiandentalacademy.com
Pre natal growth and
development

www.indiandentalacademy.com
Pre-natal growth
 At

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

...
Medial nasal
process

Lateral nasal process
Maxillary process
Mandibular process

www.indiandentalacademy.com
Maxillary and Mandibular processes{ first brachial arch}
 Frontonasal processes- { downward


proliferation of mesenchym...
 AT

SEVENTH WEEK IUL1.Formation of upper lip
2.Intramembranous Bone
ossification Takes Place
3.Formation of Nasal Septum...
AT SEVENTH WEEK IUL
 Primary

ossification center -for each
maxilla at termination of infraorbital
nerve above canine too...
AT EIGHT WEEK IUL
 Intramembranous

ossification centers

appear for;
-Nasal and lacrimal bones.
-Medial pterygoid plate ...
BY TWELFTH WEEK
 Anteroposterior

maxillo- mandibular
relationship approaches that of
newborn infant

 Maxilla

increase...
 FRIEBAND-{the

growth of palate in

human fetus}
 1st

trimester-narrow
 2st trimester-moderate width
 3st trimester-...
Pre-natal Growth and
development of palate
 Formation

of primary and secondary

palate
 Elevation
 Fusion

of palatal ...
Early palate formation
 28th

day of IUL
 -disintegration of buccopharangeal
membrane
Oral cavity
 -stomadeal chamber
N...
 Structure

of palate

Primary palate



5 TH week IUL

Secondary palate

PALATOGENESIS

6

9

www.indiandentalacademy.c...
Primary palate
Frontonasal
process

Medial nasal

mesenchyme

Pre-maxilla

Wedge shaped mass
between internal
W
Primary pa...
Primary palate
Primary
palate

www.indiandentalacademy.com
Secondary palate
Maxillary prominence
2 horizontal mesenchymal projections

Lateral palatine process
With each other
Prima...
Secondary palate

PALATAL SHELVES
www.indiandentalacademy.com
Elevation of palatal shelves
At 6 weeks
1. Tongue {undifferentiated tissue}
pushes dorsally
2. palatal shelves become vert...
Elevation of palate
Histological section

Nasal
septum
Palatal
shelves

tongue

www.indiandentalacademy.com
 At

8 weeks

Muscular
movement

Pressure
differences

Biomechanical
transformation

Elevation of palatal shelves

Intrin...
Fusion of palatal shelves

www.indiandentalacademy.com
Fusion of the palatal
shelves
In the closest union there is still some
separate existence of component parts ;
in the most...
Fusion of palate
Incisive foramen

Mid palatine
raphe
www.indiandentalacademy.com
Formation of palate[summary]
Primordium Formed
of
by
Median
palatine
process

Primary
palate

Pre
maxilla

Secondary
palat...
Musculature of palate
 Tensor

veli palatini 40 days 1 st arch
 Palatopharangeous 45 days
 Levator veli palatini 8th we...
Growth in dimensions
height
width
length
 Length
 Width

Arched palate

- 7-8 weeks IUL
- 4th month onwards
www.indiande...
Growth in dimensions
 Pre

natal life
length > width

 At

birth
length =

width

 Post

natal life
width > length

www...
 Growth

at mid palatal suture ceases at
1-2 years

 Apposition

inferior surface
alveolar process
 Resorption –superio...
V principle of Bang and Enlow
Remodeling of palate



Entire ‘v’ shaped
structure moves
in a direction
towards the wide
e...
Factors affecting growth of
palate
 elevation

of head and lower jaw
 Oxygen and nutritional deficiency
 Excess endocri...
Elevation of head and lower jaw

www.indiandentalacademy.com
ANOMALIES OF PALATE
 Epithelial

pearls

www.indiandentalacademy.com
ANOMALIES OF PALATE
 Torus

palatinus

www.indiandentalacademy.com
ANOMALIES OF THE PALATE

High arched palate

MARFANS
SYNDROME

CROUZON
SYNDROME

CLEIDOCRANIAL
DYSOSTOSIS

www.indiandenta...
ANOMALIES OF PALATE
 Cleft

palate

Failure of fusion of the lateral palatine
process with each other or with the
median ...
Genesis of cleft palate
 Delay

in shelf elevation
 Disturbance in mechanism of shelf
elevation
 Failure of shelves to ...
Genesis of cleft palate
 Failure

to fuse after contact as
epithelium does not break down

 Rupture


after fusion

def...
Types of cleft palate

Bifid uvula

Unilateral
cleft palate
www.indiandentalacademy.com

Bilateral
cleft palate
Unilateral cleft palate

Bilateral
cleft palate

Bifid uvula
www.indiandentalacademy.com
Infectious
agents

irradiation

drugs

Etiology of cleft palate

Nutritional
deficiency

Excess
hormones
www.indiandentala...
Clinical features of cleft palate
 Feeding

problems particularly in infants
in whom suckling process demands
intact pala...
Post natal growth of
maxilla

www.indiandentalacademy.com
Post natal growth of maxilla
 Surface

remodeling

MOSS

TRANSPOSITION
resorption

apposition

 displacement

TRANSLATIO...
Post natal growth of maxilla
 Surface

apposition
 Sutural growth
 nasal septum growth
 Spheno occipital synchondrosis...
Surface apposition

www.indiandentalacademy.com
Sutural growth

www.indiandentalacademy.com
Spheno occipital synchondroses

www.indiandentalacademy.com
Post natal growth of maxilla
 Growth

in height

vertical

 Growth

in width

transverse

 Growth

in length

A -P

www...
HEIGHT
ENLOW AND BANG ‘V’
PRINCIPLE


DEPOSITION ON
THE ORAL SIDE



RESORPTION ON
THE NASAL SIDE

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HEIGHT -

‘V’ PRINCIPLE

Coronal view

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Sagittal view
HEIGHT

APPOSITION IN THE
ALVEOLAR
PROCESS
ERUPTION OF
TEETH
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HEIGHT
Primary displacement

www.indiandentalacademy.com
PRIMARY DISPLACEMENT
 SUTURAL

THEORY

 CARTILAGENOUS
 FUNCTIONAL

THEORY

MATRIX HYPOTHESIS

www.indiandentalacademy.c...
SUTURAL THEORY
SICHER


SUTURES HAVE
INNATE
GROWTH
POTENTIAL



OBLIQUE
NATURE



SLIDING EFFECT

www.indiandentalacade...
CARTILAGENOUS THEORY
SCOTT


NASAL SEPTUM –INNATE GROWTH
POTENTIAL



THRUST EFFECT–
SEPTOPREMAXILLARY LIGAMENT



MORE...
Removal of nasal septum –mid face
deficiency

www.indiandentalacademy.com
FUNCTIONAL MATRIX
HYPOTHESIS
MOSS
SKELETAL UNITS

FUNCTIONAL MATRIX




BASAL BODY

INFRAORBITAL
NERVE



ORBITAL UNIT
...
FUNCTIONAL MATRIX
HYPOTHESIS


HEIGHT

REMODELING
CHANGES IN
THE ORBIT

ENLARGING
ORO
FACIAL
CAPSULE

www.indiandentalaca...
WIDTH
 Finished
 WIDTH

earlier in postnatal life
GROWTH IN MID
PALATINE SUTURE
REMODELING IN THE
LATERAL SURFACE OF
ALV...
LENGTH
 Begins

rapidly in the 2 nd year of life

Maxillary
tuberosity

Palato -

primary secondary

maxillary
www.indian...
QUANTITATION OF MAXILLARY
REMODELING
Sheldon Baumrind,Edward Korn
AJO JAN 1987


Uniform displacement of all 3 pts in ver...
Maxillary tuberosity
 Established

by the posterior boundary
of anterior cranial fossa
 Helps in posterior and horizonta...
Key ridge
Reversal occurs at
the key ridge
Posterior - apposition
Anterior - resorption

www.indiandentalacademy.com
Maxillary sinus
 PRE

NATAL
 lateral evagination of mucous
membrane in middle meatus –3rd month
IUL
 AT BIRTH
 2mm
-lo...
Maxillary sinus
AGE

CHANGES

Expands - 2mm
vertically
3mm A-P - every
year
> in size resorption in walls +
alveolus
www....
Maxillary sinus
POST NATAL
 All internal
surfaces
resorption
[expect medial]


Rapid continues
downward growth
close pro...
Zygomatic region
Posterior relocation
anterior

posterior

Increase in height
frontozygomatic

Inferior
border

Lateral gr...
Nasal airway
Lining surface of
bony wall and floor

Downward relocation
of palate

resorptive

Lateral and anterior
expans...
Nasal airway
Ethmoidal
conchae
lateral + inferior
deposition
medial + superior
resorption


Inter nasal
septum
Lengthens
...
Clinical Implications
and Summary

www.indiandentalacademy.com
Pre natal growth
Formation of
germ layers

Migration
and
proliferation
of cell
population

Day 17

Fetal alcohol
syndrome
...
Pre natal growth
Primary palate
formation

28-38
days

Cleft lip /cleft palate
other facial clefts
Cleft palate/synostosis...
Post natal growth

www.indiandentalacademy.com
Post natal growth
AT BIRTH
Hard palate : length = width
maxillary sinus : not visible
radiographically
1 – 2 years
Extensi...
Post natal growth
THE MIXED DENTITION
YEARS

www.indiandentalacademy.com
Post natal growth
THE MIXED DENTITION YEARS
Growth in width of the
dental arch anterior to the
first molar
Inter canine wi...
Post natal growth
THE MIXED DENTITION YEARS


THE DEPOSITORY GROWTH POTENTIAL OF
TUBEROSITY ALLOWS FOR ARCH
EXPANSION BY ...
Post Natal Growth
THE EARLY PERMANENT
DENTITION YEARS
•Growth modification still possible in
boys
•RME can still be tried ...
Age changes
 All

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

Tooth loss

...
References
 Contemporary

orthodontics- PROFFIT
 Principles and practice of orthodontics –
GRABER
 Essentials of facial...
References
 quantitation

of maxillary remodeling-S
BAUMRIND ,E KORN –AJO JAN 97
 Dentistry for child and adolescent-MAC...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Pre natal and post natal /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,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com Pre natal and post natal growth and development of nasomaxillary complex www.indiandentalacademy.com
  2. 2. Growth and development of Nasomaxillary complex  Anatomy  Pre natal growth  Post natal growth  Clinical implications www.indiandentalacademy.com
  3. 3. 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. www.indiandentalacademy.com
  4. 4. 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 www.indiandentalacademy.com
  5. 5. ANATOMY – MEDIAL VIEW Frontal process Maxillary sinus Maxillary process [palatine] Horizontal plate of palatine Palatine process[maxilla] Alveolar process www.indiandentalacademy.com
  6. 6. ANATOMY-LATERAL VIEW Frontal process Nasal notch Zygomatic process ANS Alveolar process www.indiandentalacademy.com
  7. 7. Pre natal growth and development www.indiandentalacademy.com
  8. 8. Pre-natal growth  At fourth week of of IUL1.migration of neural crest cells 2.formation of brachial arches FRONTONASAL MAXILLARY MAXILLARY STOMODEUM MANDIBULAR www.indiandentalacademy.com MANDIBULAR
  9. 9. Medial nasal process Lateral nasal process Maxillary process Mandibular process www.indiandentalacademy.com
  10. 10. 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 www.indiandentalacademy.com
  11. 11.  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 www.indiandentalacademy.com
  12. 12. 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 www.indiandentalacademy.com
  13. 13. AT EIGHT WEEK IUL  Intramembranous ossification centers appear for; -Nasal and lacrimal bones. -Medial pterygoid plate of sphenoid. -Vomer. -Zygomatic bone www.indiandentalacademy.com
  14. 14. BY TWELFTH WEEK  Anteroposterior maxillo- mandibular relationship approaches that of newborn infant  Maxilla increases in height www.indiandentalacademy.com
  15. 15.  FRIEBAND-{the growth of palate in human fetus}  1st trimester-narrow  2st trimester-moderate width  3st trimester- wide  Breadth>length  Height changes less dramatic www.indiandentalacademy.com
  16. 16. Pre-natal Growth and development of palate  Formation of primary and secondary palate  Elevation  Fusion of palatal shelves of palatal shelves www.indiandentalacademy.com
  17. 17. Early palate formation  28th day of IUL  -disintegration of buccopharangeal membrane Oral cavity  -stomadeal chamber Nasal cavity  Horizontal extensions Single primary palate 2 palatal www.indiandentalacademy.com shelves
  18. 18.  Structure of palate Primary palate  5 TH week IUL Secondary palate PALATOGENESIS 6 9 www.indiandentalacademy.com CRITICAL PERIOD 12 TH week IUL
  19. 19. 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
  20. 20. Primary palate Primary palate www.indiandentalacademy.com
  21. 21. Secondary palate Maxillary prominence 2 horizontal mesenchymal projections Lateral palatine process With each other Primary palate Fuse- Nasal septum Secondary palate www.indiandentalacademy.com
  22. 22. Secondary palate PALATAL SHELVES www.indiandentalacademy.com
  23. 23. 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  www.indiandentalacademy.com
  24. 24. Elevation of palate Histological section Nasal septum Palatal shelves tongue www.indiandentalacademy.com
  25. 25.  At 8 weeks Muscular movement Pressure differences Biomechanical transformation Elevation of palatal shelves Intrinsic shelf force Differential mitotic growth www.indiandentalacademy.com Withdrawal of embryo’s face
  26. 26. Fusion of palatal shelves www.indiandentalacademy.com
  27. 27. 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 www.indiandentalacademy.com
  28. 28. Fusion of palate Incisive foramen Mid palatine raphe www.indiandentalacademy.com
  29. 29. Formation of palate[summary] Primordium Formed of by Median palatine process Primary palate Pre maxilla Secondary palate Hard and Lateral soft palatine palate process www.indiandentalacademy.com Derived from Frontonasal process Maxillary process
  30. 30. 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 www.indiandentalacademy.com
  31. 31. Growth in dimensions height width length  Length  Width Arched palate - 7-8 weeks IUL - 4th month onwards www.indiandentalacademy.com
  32. 32. Growth in dimensions  Pre natal life length > width  At birth length = width  Post natal life width > length www.indiandentalacademy.com
  33. 33.  Growth at mid palatal suture ceases at 1-2 years  Apposition inferior surface alveolar process  Resorption –superior{nasal} surface www.indiandentalacademy.com
  34. 34. V principle of Bang and Enlow Remodeling of palate  Entire ‘v’ shaped structure moves in a direction towards the wide end of the ‘v’ www.indiandentalacademy.com
  35. 35. Factors affecting growth of palate  elevation of head and lower jaw  Oxygen and nutritional deficiency  Excess endocrine substances  Drugs teratogens  Irradiation  vascularity www.indiandentalacademy.com
  36. 36. Elevation of head and lower jaw www.indiandentalacademy.com
  37. 37. ANOMALIES OF PALATE  Epithelial pearls www.indiandentalacademy.com
  38. 38. ANOMALIES OF PALATE  Torus palatinus www.indiandentalacademy.com
  39. 39. ANOMALIES OF THE PALATE High arched palate MARFANS SYNDROME CROUZON SYNDROME CLEIDOCRANIAL DYSOSTOSIS www.indiandentalacademy.com
  40. 40. ANOMALIES OF PALATE  Cleft palate Failure of fusion of the lateral palatine process with each other or with the median palatine process www.indiandentalacademy.com
  41. 41. 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] www.indiandentalacademy.com
  42. 42. Genesis of cleft palate  Failure to fuse after contact as epithelium does not break down  Rupture  after fusion defective merging www.indiandentalacademy.com
  43. 43. Types of cleft palate Bifid uvula Unilateral cleft palate www.indiandentalacademy.com Bilateral cleft palate
  44. 44. Unilateral cleft palate Bilateral cleft palate Bifid uvula www.indiandentalacademy.com
  45. 45. Infectious agents irradiation drugs Etiology of cleft palate Nutritional deficiency Excess hormones www.indiandentalacademy.com Smoking and alcohol
  46. 46. 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 www.indiandentalacademy.com
  47. 47. Post natal growth of maxilla www.indiandentalacademy.com
  48. 48. Post natal growth of maxilla  Surface remodeling MOSS TRANSPOSITION resorption apposition  displacement TRANSLATION SUTURES  CRANIAL BASE www.indiandentalacademy.com MAXILLA
  49. 49. Post natal growth of maxilla  Surface apposition  Sutural growth  nasal septum growth  Spheno occipital synchondrosis  In contrast to cranial base maxilla is dominated by intra membranous ossification www.indiandentalacademy.com
  50. 50. Surface apposition www.indiandentalacademy.com
  51. 51. Sutural growth www.indiandentalacademy.com
  52. 52. Spheno occipital synchondroses www.indiandentalacademy.com
  53. 53. Post natal growth of maxilla  Growth in height vertical  Growth in width transverse  Growth in length A -P www.indiandentalacademy.com
  54. 54. HEIGHT ENLOW AND BANG ‘V’ PRINCIPLE  DEPOSITION ON THE ORAL SIDE  RESORPTION ON THE NASAL SIDE www.indiandentalacademy.com
  55. 55. HEIGHT - ‘V’ PRINCIPLE Coronal view www.indiandentalacademy.com Sagittal view
  56. 56. HEIGHT APPOSITION IN THE ALVEOLAR PROCESS ERUPTION OF TEETH www.indiandentalacademy.com
  57. 57. HEIGHT Primary displacement www.indiandentalacademy.com
  58. 58. PRIMARY DISPLACEMENT  SUTURAL THEORY  CARTILAGENOUS  FUNCTIONAL THEORY MATRIX HYPOTHESIS www.indiandentalacademy.com
  59. 59. SUTURAL THEORY SICHER  SUTURES HAVE INNATE GROWTH POTENTIAL  OBLIQUE NATURE  SLIDING EFFECT www.indiandentalacademy.com
  60. 60. CARTILAGENOUS THEORY SCOTT  NASAL SEPTUM –INNATE GROWTH POTENTIAL  THRUST EFFECT– SEPTOPREMAXILLARY LIGAMENT  MORE ROLE IN A-P THAN VERTICAL  SURGICAL REMOVAL OF NASAL SEPTUM www.indiandentalacademy.com
  61. 61. Removal of nasal septum –mid face deficiency www.indiandentalacademy.com
  62. 62. FUNCTIONAL MATRIX HYPOTHESIS MOSS SKELETAL UNITS FUNCTIONAL MATRIX   BASAL BODY INFRAORBITAL NERVE  ORBITAL UNIT EYEBALL  NASAL UNIT SEPTAL CARTILAGE  ALVEOLAR UNIT TEETH www.indiandentalacademy.com
  63. 63. FUNCTIONAL MATRIX HYPOTHESIS  HEIGHT REMODELING CHANGES IN THE ORBIT ENLARGING ORO FACIAL CAPSULE www.indiandentalacademy.com
  64. 64. 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 www.indiandentalacademy.com
  65. 65. LENGTH  Begins rapidly in the 2 nd year of life Maxillary tuberosity Palato - primary secondary maxillary www.indiandentalacademy.comdisplacement suture
  66. 66. 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 www.indiandentalacademy.com
  67. 67. Maxillary tuberosity  Established by the posterior boundary of anterior cranial fossa  Helps in posterior and horizontal lengthening of arch Anterior displacement = posterior lengthening www.indiandentalacademy.com
  68. 68. Key ridge Reversal occurs at the key ridge Posterior - apposition Anterior - resorption www.indiandentalacademy.com
  69. 69. 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 www.indiandentalacademy.com
  70. 70. Maxillary sinus AGE CHANGES Expands - 2mm vertically 3mm A-P - every year > in size resorption in walls + alveolus www.indiandentalacademy.com
  71. 71. Maxillary sinus POST NATAL  All internal surfaces resorption [expect medial]  Rapid continues downward growth close proximity to buccal maxillary teeth  www.indiandentalacademy.com
  72. 72. Zygomatic region Posterior relocation anterior posterior Increase in height frontozygomatic Inferior border Lateral growth Zygomaticotemporal [anterior] displacement Frontozygomatic [inferior] www.indiandentalacademy.com
  73. 73. Nasal airway Lining surface of bony wall and floor Downward relocation of palate resorptive Lateral and anterior expansion www.indiandentalacademy.com
  74. 74. Nasal airway Ethmoidal conchae lateral + inferior deposition medial + superior resorption  Inter nasal septum Lengthens vertically at sutural junctions www.indiandentalacademy.com 
  75. 75. Clinical Implications and Summary www.indiandentalacademy.com
  76. 76. Pre natal growth Formation of germ layers Migration and proliferation of cell population Day 17 Fetal alcohol syndrome [mid face deficiency] Day 19-28 www.indiandentalacademy.com Treacher Collin syndrome
  77. 77. 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 www.indiandentalacademy.com
  78. 78. Post natal growth www.indiandentalacademy.com
  79. 79. 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 www.indiandentalacademy.com No synostosis
  80. 80. Post natal growth THE MIXED DENTITION YEARS www.indiandentalacademy.com
  81. 81. 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 www.indiandentalacademy.com
  82. 82. 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 www.indiandentalacademy.com
  83. 83. 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 www.indiandentalacademy.com
  84. 84. 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] www.indiandentalacademy.com
  85. 85. 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 www.indiandentalacademy.com
  86. 86. 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 www.indiandentalacademy.com
  87. 87. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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