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

www.indiandentalacademy.com
Growth & Development of
Nasomaxillary Complex
Stress trajectories of force
Maxillary rotations
Clinical Implications of G ...
Stress Trajectories of Force
“Function can influence the overall pattern and
relationship of the structures”.
Effect of fu...
Stress Trajectories of Force
In 1867 an anatomist named Meyer with the
help of the mathematician Culmann
propounded Trajec...
Stress Trajectories of Force

A change in the intensity and direction of
these forces would produce a change in the
intern...
Stress Trajectories of Force

Benninghoff made an exhaustive study of
the architecture of the cranial &facial
skeleton and...
3 main vertical pillars of stress trajectories
can be seen in the nasomaxillary region.
a.Canine pillar
b. Zygomatic pilla...
Maxillary rotations
Implant studies of jaw rotations were
mainly carried out by Bjork & Skeiller in
1960’s
Tantalum metall...
Maxillary rotations
 Lateral

implants:4yrs of age
-inserted laterally in the zygomatic
process of the maxilla.
 Anterio...
Lateral View

www.indiandentalacademy.com
MAXILLARY ROTATIONS
1. Transverse Plane
2. Vertical Plane

www.indiandentalacademy.com
Maxillary rotations
Transverse mutual rotation of the two
maxilla:-

www.indiandentalacademy.com
Maxillary rotations
Increase in width of the midpalatal suture is
not same between anterior and posterior
regions.As a res...
VERTICAL ROTATION

www.indiandentalacademy.com
Maxillary rotations
Vertical rotation of the maxillary
complex:-.
-Downward and forward displacement of
maxilla during gro...
www.indiandentalacademy.com
“Interaction between Jaw growth & Tooth
eruption.”
Translocation
True Eruption

www.indiandentalacademy.com
Clinical Implications of Maxillary
Growth.
Cessation of growth of maxilla is in the
following order:-Transverse direction
...
Transverse Growth of Maxilla
Growth in width is the first one to drop to
the adult levels [by onset of puberty].
Deficienc...
Crossbites
Skeletal

Dental

www.indiandentalacademy.com
.

RAPID MAXILLARY EXPANSION
Circummaxillary sutures.
1. Nasomaxillary Suture
2. Frontomaxillary Suture
3. Zygomaticomaxil...
Structure of the suture at different ages:

Infancy
Juvenile

Adulthood

www.indiandentalacademy.com
Activation of RME.
Upto 15yrs of age 1800 (2 turns daily)
15-20yrs. of age 1800 (4 turns daily)
Over 20yrs. 900 (2 turns d...
How much to Expand?
Palatal cusps of upper maxillary teeth
should occlude with the lingual inclines of
the buccal cusps of...
Effects of RME:-Midpalatal suture opens anteroinferiorly.
-Midline diastema.
-Buccal flaring of posteriors.

www.indianden...
Frontal View

www.indiandentalacademy.com
Ideal patients for RME treatment.
 Full

cusp cross bite with a skeletal
component

 Some

degree of dental as well as s...
Adverse effects of RME:Nasal hump & paranasal swelling.
Pain.
Buccal tipping of posteriors.
Root resorption.

www.indiande...
www.indiandentalacademy.com
Rapid maxillary expansion Vs slow expansion

www.indiandentalacademy.com
Dental cross bites are corrected by
-Quad helix
-W arch
-Arch wire

www.indiandentalacademy.com
Anteroposterior growth of maxilla.
Maxillary excess:-For restriction of
maxillary growth in growing individuals
appliances...
www.indiandentalacademy.com
Types of Head Gears:Cervical head gear:
used in patients with horizontal growth
pattern with reduced lower facial height.
...
Types of head gear’s
Occipital pull Head gear:Used in long face patients
with high mandibular
plane angle.

www.indiandent...
Functional Appliances
They are of two types:-Removable
-Fixed Appliances.

www.indiandentalacademy.com
Removable Appliances:

Bionator

Activator

www.indiandentalacademy.com

Twin Block
Fixed Appliances:-

Herbst Appliance

Jasper Jumper
www.indiandentalacademy.com
Dental camouflage can be done for mild to
moderate skeletal problems.
For adult patients where growth is no longer
present...
Maxillary Deficiency:-Growth
modulation in sagittal plane can be
done by
1.face mask
2.reverse functional appliances.

www...
Face mask Therapy
Delaire Facemask

www.indiandentalacademy.com
Face mask Therapy
Petit Face mask

www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Reverse Functional appliances:
Twin Block
Functional Regulator

www.indiandentalacademy.com
Vertical growth of maxilla
Vertical excess of maxilla can be controlled
by inhibiting the descent of maxilla and
eruption ...
Frequent respiratory
infection

Nasal Septal
deviation

Swollen Nasal
Mucosa
Enlarged
adenoids

Contracted
Maxillary arch
...
Hierarchy of effectiveness in long-face class II
treatment
HP headgear to functional appliance
ht Bite blocks on functiona...
-Highpull headgear to a maxillary splint

www.indiandentalacademy.com
Highpull headgear to a functional appliance.

www.indiandentalacademy.com
Functional appliance with increased
height of the bite blocks

www.indiandentalacademy.com
Bibliography:Contemporary orthodontics
-William Proffit
Orthodontic principles &practice
-T.M.Graber
Essentials of facial ...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Trajectories and rotations /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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Trajectories and rotations /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Growth & Development of Nasomaxillary Complex Stress trajectories of force Maxillary rotations Clinical Implications of G & D of Nasomaxillary Complex www.indiandentalacademy.com
  3. 3. Stress Trajectories of Force “Function can influence the overall pattern and relationship of the structures”. Effect of function on bone was first noted in femur . www.indiandentalacademy.com
  4. 4. Stress Trajectories of Force In 1867 an anatomist named Meyer with the help of the mathematician Culmann propounded Trajectorial theory of Bone formation. Julius Wolff –1870 “Trabecular alignment in the bone was primarily due to functional forces”. ROUX-Law of transformation of bone. www.indiandentalacademy.com
  5. 5. Stress Trajectories of Force A change in the intensity and direction of these forces would produce a change in the internal architecture and external form of the bone. Change in the functional forces produce measurable changes in bony architecture. www.indiandentalacademy.com
  6. 6. Stress Trajectories of Force Benninghoff made an exhaustive study of the architecture of the cranial &facial skeleton and so called “Stress Trajectories” or “Lines of force” evolved. www.indiandentalacademy.com
  7. 7. 3 main vertical pillars of stress trajectories can be seen in the nasomaxillary region. a.Canine pillar b. Zygomatic pillar. c.Pterygoid pillar www.indiandentalacademy.com
  8. 8. Maxillary rotations Implant studies of jaw rotations were mainly carried out by Bjork & Skeiller in 1960’s Tantalum metallic pins were used Rotations are classified into Internal Rotation External Rotation www.indiandentalacademy.com
  9. 9. Maxillary rotations  Lateral implants:4yrs of age -inserted laterally in the zygomatic process of the maxilla.  Anterior implants:10-11yrs of age -inserted below the anterior nasal spine. www.indiandentalacademy.com
  10. 10. Lateral View www.indiandentalacademy.com
  11. 11. MAXILLARY ROTATIONS 1. Transverse Plane 2. Vertical Plane www.indiandentalacademy.com
  12. 12. Maxillary rotations Transverse mutual rotation of the two maxilla:- www.indiandentalacademy.com
  13. 13. Maxillary rotations Increase in width of the midpalatal suture is not same between anterior and posterior regions.As a result the two maxillae rotate in relation to each other in transverse plane. www.indiandentalacademy.com
  14. 14. VERTICAL ROTATION www.indiandentalacademy.com
  15. 15. Maxillary rotations Vertical rotation of the maxillary complex:-. -Downward and forward displacement of maxilla during growth are associated with vertical rotation Bjork & Skeiller. www.indiandentalacademy.com
  16. 16. www.indiandentalacademy.com
  17. 17. “Interaction between Jaw growth & Tooth eruption.” Translocation True Eruption www.indiandentalacademy.com
  18. 18. Clinical Implications of Maxillary Growth. Cessation of growth of maxilla is in the following order:-Transverse direction -Anteroposterior plane -Vertical direction. www.indiandentalacademy.com
  19. 19. Transverse Growth of Maxilla Growth in width is the first one to drop to the adult levels [by onset of puberty]. Deficiency in the transverse growth of maxilla causes decrease in the width of palate leading to crossbite. www.indiandentalacademy.com
  20. 20. Crossbites Skeletal Dental www.indiandentalacademy.com
  21. 21. . RAPID MAXILLARY EXPANSION Circummaxillary sutures. 1. Nasomaxillary Suture 2. Frontomaxillary Suture 3. Zygomaticomaxillary Suture 4. Lacrimomaxillary Suture 5. Ethmoidomaxillary Suture 6. Vomeromaxillary Suture www.indiandentalacademy.com
  22. 22. Structure of the suture at different ages: Infancy Juvenile Adulthood www.indiandentalacademy.com
  23. 23. Activation of RME. Upto 15yrs of age 1800 (2 turns daily) 15-20yrs. of age 1800 (4 turns daily) Over 20yrs. 900 (2 turns daily) www.indiandentalacademy.com
  24. 24. How much to Expand? Palatal cusps of upper maxillary teeth should occlude with the lingual inclines of the buccal cusps of the lower mandibular teeth. www.indiandentalacademy.com
  25. 25. Effects of RME:-Midpalatal suture opens anteroinferiorly. -Midline diastema. -Buccal flaring of posteriors. www.indiandentalacademy.com
  26. 26. Frontal View www.indiandentalacademy.com
  27. 27. Ideal patients for RME treatment.  Full cusp cross bite with a skeletal component  Some degree of dental as well as skeletal constriction initially  No pre-existing dental expansion. www.indiandentalacademy.com
  28. 28. Adverse effects of RME:Nasal hump & paranasal swelling. Pain. Buccal tipping of posteriors. Root resorption. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. Rapid maxillary expansion Vs slow expansion www.indiandentalacademy.com
  31. 31. Dental cross bites are corrected by -Quad helix -W arch -Arch wire www.indiandentalacademy.com
  32. 32. Anteroposterior growth of maxilla. Maxillary excess:-For restriction of maxillary growth in growing individuals appliances like 1.Headgear 2.Functional appliances www.indiandentalacademy.com
  33. 33. www.indiandentalacademy.com
  34. 34. Types of Head Gears:Cervical head gear: used in patients with horizontal growth pattern with reduced lower facial height. www.indiandentalacademy.com
  35. 35. Types of head gear’s Occipital pull Head gear:Used in long face patients with high mandibular plane angle. www.indiandentalacademy.com
  36. 36. Functional Appliances They are of two types:-Removable -Fixed Appliances. www.indiandentalacademy.com
  37. 37. Removable Appliances: Bionator Activator www.indiandentalacademy.com Twin Block
  38. 38. Fixed Appliances:- Herbst Appliance Jasper Jumper www.indiandentalacademy.com
  39. 39. Dental camouflage can be done for mild to moderate skeletal problems. For adult patients where growth is no longer present surgical correction should be done. www.indiandentalacademy.com
  40. 40. Maxillary Deficiency:-Growth modulation in sagittal plane can be done by 1.face mask 2.reverse functional appliances. www.indiandentalacademy.com
  41. 41. Face mask Therapy Delaire Facemask www.indiandentalacademy.com
  42. 42. Face mask Therapy Petit Face mask www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44. www.indiandentalacademy.com
  45. 45. Reverse Functional appliances: Twin Block Functional Regulator www.indiandentalacademy.com
  46. 46. Vertical growth of maxilla Vertical excess of maxilla can be controlled by inhibiting the descent of maxilla and eruption of posterior teeth. www.indiandentalacademy.com
  47. 47. Frequent respiratory infection Nasal Septal deviation Swollen Nasal Mucosa Enlarged adenoids Contracted Maxillary arch Reduced Nasal breathing Decrease in Nasal width Mouth breathing Lowered tongue position Extended head posture Lowered Mandibular www.indiandentalacademy.com Posture
  48. 48. Hierarchy of effectiveness in long-face class II treatment HP headgear to functional appliance ht Bite blocks on functional appliance High-pull headgear to maxillary splint High-pull headgear to molars. www.indiandentalacademy.com
  49. 49. -Highpull headgear to a maxillary splint www.indiandentalacademy.com
  50. 50. Highpull headgear to a functional appliance. www.indiandentalacademy.com
  51. 51. Functional appliance with increased height of the bite blocks www.indiandentalacademy.com
  52. 52. Bibliography:Contemporary orthodontics -William Proffit Orthodontic principles &practice -T.M.Graber Essentials of facial growth - Enlow Factors affecting the growth of mid face - James Mc Namara Rapid maxillary expansion - Donald J. Timms www.indiandentalacademy.com
  53. 53. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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