The document discusses the growth and development of the maxilla from prenatal development through postnatal changes. It covers key topics like the theories of growth, growth spurts, and the development of structures like the palate. Prenatally, the maxilla develops from the first pharyngeal arch and forms through intramembranous ossification. The maxilla and premaxilla have distinct centers of ossification that spread during development.

1. GROWTH AND
DEVELOPMENT OF
MAXILLA
D R . K H U S H B O O M I S H R A J H A
1 S T Y E A R P G
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2. INTRODUCTION
DEFINITIONS
IMPORTANCE OF GROWTH
OSTEOGENESIS
THEORIES OF GROWTH
GROWTH SPURTS
CONTENTS
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3. SCAMMONS CURVE
GROWTH FIELD, SITES AND CENTRES
PRENATAL DEVELOPMENT OF MAXILLA
PRENATAL DEVELOPMENT OF PALATE
GROWTH OF SOFT TISSUES
POST NATAL DEVELOPMENT OF MAXILLA
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4. AGE CHANGES RELATED TO MAXILLA
DEVELOPMENTAL ANOMALIES
CONCLUSION
REFERENCES
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5. INTRODUCTION
 It is essential to study the growth and development of maxilla to
diagnose and the prosthetic management of the developmental
anomalies of maxilla successfully.
 Present knowledge of normal maxillary structure and growth is the
result of many diverse studies representing a variety of biologic
areas and methods, including comparative anatomy and
paleontology, anthropology and anthropometry, embryology, vital
staining, cephalometrics and experimental biology.
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6. • Stewart – It may be defined as a developmental increase in mass.
In other words it is a process that leads to an increase in the physical size of
cells, tissues, organs or organisms as a whole.
• Proffit – an increase in size or number.
• Pinkham – an increase, expansion or extension of a given
tissue.
GROWTH
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7. • Moyers – all the naturally occurring unidirectional changes in the life of an
individual from its existence as a single cell to its elaboration as a
multifunctional unit terminating in death.
• Todd – development means progress towards maturity.
• Proffit – development is in complexity.
DEVELOPMENT
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8. • Indicator of general health.
• Identify unusual growth patterns at an early stage.
• Etiology and development of malocclusion.
• Identify abnormal occlusion – early stage.
• Poorly timed extractions – malocclusion.
• Growth - effects stability of occlusion.
• Use of growth spurts.
Importance of Growth
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9. • Age-related changes of jaws and soft tissue profile are important both for
prosthodontist and general dentists.
• Mouth profile is the area which is manipulated during dental treatment. These
changes should be planned in accordance with other components of facial
profile to achieve ultimate aim of structural balance, functional efficacy, and
esthetic harmony.
• In Class I and Class II groups, there is a significant correlation between skeletal
VD and maxillo-mandibular growth.
• In the Class III group, there is a strong correlation of dental VD increase and
mandibular forward growth
Importance of Growth-PROSTHODONTISTS
OVERVIEW
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10. • The process of bone formation is known as osteogenesis
• Bone formation occurs by
1. Endochondral - As in chondrocranium
2. Intramembranous - As in desmocranium.
OSTEOGENESIS
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11. ENDOCHONDRAL BONE FORMATION
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12. 27/11/18 12

13. 27/11/18 13

14. INTRAMEMBRANOUS BONE FORMATION
• Osteoblasts differentiate directly from mesenchyme and begin secreting osteoid.
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15. 27/11/18 15

16. Theories
of Growth
Sichers
sutural
hypothesis
Cartilaginous
theory
Moss theory
Van
limborghs
theory
Enlows
expanding
principle
THEORIES OF GROWTH
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17. GENETIC CONTROL THEORY
• Given by Davidson and Britten
• Genotype supplies all the information required for phenotype expression.
• Does not address the question of local and general factors modifying gene
expression.
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18. VAN LIMBORG THEORY
• Epigenetic factors are those which are determined genetically, and are effective
outside the cells and tissues in which they are produced
• These occur only indirectly, due to reactions of the structures which they influence
• Van Limborg- they can have an effect on the adjacent structures such as local
epigenetic factors (eg: embryonic induction influences brain,eyes,inner ear) or are
produced at distance and exert a general epigenetic influence (eg: Sex and growth
harmones)
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19. SICHER’S SUTURAL DOMINANCE THEORY
• Sicher in 1941
• He believed that craniofacial growth occurs at sutures.
• Paired parallel sutures which attach the facial bones to the cranial base and
skull push the nasomaxillary complex forwards to compare with mandibular
growth.
• Acknowledges the genetic influence on growth at the sutures.
• Transplantation of sutures to another site showed that there was no innate
growth potential.
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20. DRAWBACKS OF SUTURAL THEORY
• Number of points were raised
Suture transplanted another location Tissue doesn’t continue to grow
Lack of innate growth potential of
sutures
Growth in untreated cleft palate Even in absence of suture
microcephaly hydrocephaly
?????
Doubts about intrinsic genetic
stimulus of sutures
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21. CARTILAGE DIRECTED GROWTH THEORY
• James Scott- 1953, 1954, 1967
• Cartilage has intrinsic growth potential.
• Role of Periosteum and sutures are only secondary.
• All cartilages through out the skull are primary centres of growth.
• Growth of the maxilla is attributed to the growth of the Nasal septal cartilage.
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22. POINTS FAVOURING THIS THEORY:
In many bones Cartilage growth occurs
While bone merely
replaces that
Epiphyseal plate
transplanted to other
location
Continue to grow in
new location
Indicates innate
growth potential of
cartilage
Nasal septum
Innate growth
potential
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23. FUNCTIONAL MATRIX CONCEPT
By Moss
He introduced the
doctrine of
functional matrix
complimentary to
original concept of
functional cranial
component by Van
der Klaaus.
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24. Functional matrix theory
FUNCTION
FORM
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25. SERVOSYSTEM THEORY AND CYBERNETICS
• Craniofacial growth is a multifaceted process where the connections and
interrelationships are complex with interactions and feedbacks.
• The Servo system theory uses the Cybernetic language of information and
communication as a tool to explain the influence of various factors - extrinsic
and intrinsic on Craniofacial growth
• . “Cybernetics” derived from a greek word meaning ‘steersman’ by
Dr.Rosenbleuth and Norbert Weiner and others in 1947.
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26. SERVOSYSTEM THEORY AND CYBERNETICS
CYBERNATICS:
• A Cybernetically organized system operates through signals transmitting
information.
• Signals can be physical, chemical or electromagnetic in nature and of low
energy
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27. INPUT(STIMULUS)
ORTHOPAEDIC AND
FUNCTIONAL APPLIANCES
BLACK BOX
• GENETICALLY DETERMINED
AND CYBERNATICALLY
ORGANISED GROWTH
• MAXILLA LENGTHENING
AND WIDENING
• MANDIBLE WIDENING
• TEETH MOVEMENT
OUTPUT
CORRECTION OF
MALOOCLUSION AND
INTERMAXILLARY
RELATION
CYBERNATIC ORGANISATION OF
CRANIOFACIAL GROWTH
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28. GROWTH SPURTS
GROWTH DOES NOT
TAKE PLACE UNIFORMLY
AT ALL TIMES
Certain periods when
sudden acceleration of
growth occurs.
Growth
spurts?????
Physiological alteration
in hormonal secretion
GROWTH SPURTS
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29. TIMING OF GROWTH SPURTS
TIMINGS OF GROWTH SPURTS
JUST BEFORE BIRTH ONE YEAR AFTER BIRTH
MIXED DENTITION GROWTH SPURT BOYS: 8-11 YEARS GIRLS: 7-9
YEARS
PRE PUBERTAL GROWTH SPURT BOYS: 14-16 YEARS GIRLS: 11-13
YEAR
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30. SCAMMONS CURVE
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Richard E.
Scarnmon
S shaped curve

31. •
Maxilla- neural
growth
Mandible- somatic
growth
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32. TERMINOLOGY RELATED TO GROWTH
: The outside & inside surfaces of a bone are blanketed by
a
mosaic-like, pattern of soft tissues, cartilage or osteogenic membrane called as
Growth Fields.
: proposed by BAUME
• Growth sites are growth fields that have a significance in the growth of a
particular bone.
• Eg. Mandibular condyle in the mandible, Maxillary tuberosity in the maxilla.
Growth
Sites
Growth
Fields
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33. • Growth centres are special growth sites which control the overall grow
of the bone, eg: epiphyseal plates of the long bone.
• These are supposed to have an intrinsic growth potential.
Growth
centres:
Koski explained the
difference between
growth centre and
site
GROWTH
CENTRE
INTRINSIC
GENETIC
POTENTIAL FOR
GROWTH
3 FACTORS
-Intrinsic
genetic
potential
-mass increase
-epiphyseal
GROWTH
SITE
GROW BECAUSE OF
ENVIRONMENTAL
FACTORS
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34. MAXILLAE
• The face has 22 bones in an adult
• MAXILLAE are a pair of pneumatic bones and join together to form the upper
jaw
• They house the largest sinus in the body- the maxillary sinus
• Each maxilla assists in forming the boundaries of three cavities:
 the roof of the mouth
 the floor and lateral wall of the nasal antrum
 the wall of the orbit
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35. FOUR PROCESSES
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36. PRENATAL DEVELOPMENT OF MAXILLA
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37. • The prenatal life may arbitrarily divided into 3 periods:
Fertilization to 2
weeks
2 weeks to 8th
weeks
8th weeks to 9th
month
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38. Period of the ovum: This period extends for a period of approximately two
weeks from the time of fertilization. During this period the cleavage of the
ovum and the attachment of the ovum to the intra-uterine wall occurs.
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39. Period of the embryo: This period extends from the fourteenth day to the
fifty sixth day of intra-uterine life. During this period the major part of the
development of the facial & the cranial region occurs.
Period of the fetus: This phase extends between the fifty sixth day of intra-
uterine life till birth.
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40. PRENATAL EMBRYOLOGY OF MAXILLA
• 4TH WEEK OF INTRAUTERINE
• Maxilla is formed from 1st pharyngeal arch.
• A prominent bulge appears on the ventral aspect of the embryo corresponding
to the developing brain. Below the bulge a shallow depression which
corresponds to the primitive mouth appears called “ STOMODEUM”.
• Lying lateral to the stomodeum divided in 2 processes. –
Dorsal process – Maxillary process.
Ventral process – Mandibular process.
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41. DEVELOPMENT OF MAXILLA
MAXILLA PROPER PREMAXILLA
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42. 1.MAXILLA PROPER
Develops in mesenchyme of the maxillary process of mandibular arch.
Intramembranous ossification
One center of ossification
– lies above the part of dental lamina from which develop the enamel organ of
canine
- Lateral to and slightly below the infra orbital nerve where it gives off its anterior
superior dental branch.
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43. • Ossification spreads as follow
 Backward: Below the orbit toward the developing zygomatic bone.
 Forward: Toward the future incisor region
 Upward: To form the frontal process of the maxilla.
Downward: To form the outer alveolar plate for the maxillary tooth germs
Toward the midline: Ossification spreads with the development of the palatal
process in the substance of the united palatal folds to form the hard palate.
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44. 2. PREMAXILLA
Two centers of ossification for the premaxilla:
• A) The palatoficial center: From this center bone formation spreads:
 Above the teeth germ of the incisors.
 Then downward behind them.
 To form the inner wall of their alveoli & palatal part of the premaxilla.
B) The prevomerine center: It begins at about 8-9 iuw along the outer alveolar
wall. It is situated beneath the anterior part of the vomer bone and it forms
that part of the bone lies mesial to the nasal paraseptal cartilage
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45. • By around the 4th week of intra-uterine life, five branchial arches form in the region of
the future head & neck.
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46. PHARYNGEAL ARCH
Pharyngeal Arches There are
six pharyngeal arches –
however, the 5th regresses
soon after forming.
Each arch is innervated by
an arch-associated cranial
nerve, and has a muscular
component, a skeletal and
cartilaginous supporting
element and vascular
component.
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47. 27/11/18 47

48. • The mesoderm covering the developing forebrain proliferates & forms a
downward projection that overlaps the upper part of stomodeum
• This downward projection is called “FRONTO-NASAL PROCESS”.
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49. • The stomodeum is thus overlapped superiorly by the frontonasal process.
• The mandibular arches of both the sides form the lateral walls of the
stomodeum.
• The mandibular arch gives off a bud from its dorsal end called the
“MAXILLARY PROCESS”.
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50. • The maxillary process grows ventromedio-cranial to the main part of the
mandibular arch which is now called the “MANDIBULAR PROCESS”.
• Thus, at this stage the primitive mouth or stomodeum is overlapped from
above by the frontal process, below by the mandibular process & on either
side by the maxillary process.
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51. • The ectoderm overlying the frontonasal process shows bilateral localized
thickenings above the stomodeum.
• These are called the “NASAL PLACODES”.
• These placodes soon sink and form the nasal pits.
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52. • The two mandibular processes grow medially & fuse to form the lower lip &
lower jaw.
• As the maxillary processes become narrow so that the two nasal pits come
closer. The line of fusion of the maxillary process & the medial nasal process
corresponds to the naso-lacrimal duct.
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53. PRENATAL DEVELOPMENT OF PALATE
• The palate anatomically separates the nasal cavity from the oral cavity and
structurally has a bony (hard) anterior component and a muscular (soft)
posterior component ending with the uvula.
• In palate formation there are two main and separate times and events of
development, during embryonic (primary palate) and an early fetal (secondary
palate).
• development begins during week 5, but fusion of its component parts is not
complete until week 12.
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54. 27/11/18 54
Week 5
Week 6

55. 27/11/18 55
Week 6.5
Week 7

56. 27/11/18 56
Week 8
Week 8

57. Primary palate
maxillary
components of the
first pharyngeal
arch (lateral)
frontonasal
prominence
(midline)
Secondary
palate
anterior hard palate
- ossified
posterior soft
palate - muscular
27/11/18 57

58. • week 9 - secondary palate shelves fuse, separating oral and nasal cavities.
– They project obliquely downward on each side of the tongue, but as the
jaw develops, the tongue moves down and the lateral palatine processes
grow toward each other and fuse
– Fusion begins anteriorly in week 9 and is completed posteriorly by week
LATERAL PALATINE
PROCESSES FUSES
Secondary
Palate
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59. TO SUMMARIZE…
MAXILLARY
PROMINENCE
fuse
6th week lateral
palatine process
2 horizontal
mesenchymal
projections
With each other-
12th week
Primary palate
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60. ELEVATION OF PALATAL SHELVES
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61. THEORIES OF PALATAL SHELF ELEVATION
EXTRINSIC
FORCES
DESCEN
T OF
TONGUE
Myoneural
activity
within
tongue
Mouth
opening
reflexes
SHELVES
PUSHED
UP BY
TONGUE
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62. INTRINSIC
FORCES
HYDRATION OF INTERCELLULAR SUBSTANCES
DIFFERENTIAL GROWTH ON ONE SIDE OF
PALATAL SHELF
SEROTONIN RELEASE FROM NEURAL TISSUE
CHANGING AMOUNT OF GAGS
27/11/18 62

63. SOFT PALATE
• The soft palate mechanism of closure has not yet been determined, with
several existing theories.
• A recent study of embryos from the late embryonic-early fetal period (54 to 74
days post-conception) has identified the timing of soft palate closure.
• 57 days - Late embryonic, epithelial seam present throughout the soft palate
• 64 days - Early fetal epithelium only persists in the most posterior regions of
the soft palate
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64. • Growth of soft tissues occurs by a combination of hyperplasia and hypertrophy
that is nothing but interstitial growth
• Sonic hedgehog gene play a key role in mediating growth and pattering of
early face.
Growth of soft tissues
MSX GENE
MSX 1
EXPRESSED IN
BASAL BONE
NOT IN
ALVEOLAR
BONE
MSX-2
STRONGLY
EXPRESSED IN
ALVEOLAR
PROCESS
27/11/18 64

65. POST NATAL GROWTH OF MAXILLA
27/11/18 65

66. • Since, the maxillary complex is attached to the cranial base, there is a strong
influence of the latter on the former.
• Although there is no sharp line of demarcation between the cranium &
maxillary growth gradients, yet the position of the maxilla is dependent upon
the growth at spheno-occipital synchondroses.
• Postnatal growth of maxilla is a multifactorial process
• According to Moss-
Post natal growth of maxilla
Transposition
Translation
27/11/18 66

67. Growth of naso-
maxillary complex
Displacement Growth at suture Surface remodeling
Post natal growth of maxilla
27/11/18 67

68. PRIMARY DISPLACEMENT
 This is a primary type of displacement as the
bone is displaced by its own .
PRIMARY DISPLACEMENT
27/11/18 68

69. • A passive or secondary displacement of the nasomaxillary complex occurs in a
downward and forward direction as the cranial base grows.
• The nasomaxillary complex is simply moved anteriorly as the middle cranial
fossa grows in that direction.
SECONDARY DISPLACEMENT
27/11/18 69

70. GROWTH AT SUTURES
The maxilla is connected to the cranium
and cranial base by a number sutures
which include-
27/11/18 70

71. • In addition to the growth occurring at the sutures massive remodeling by bone
deposition and resorption occurs to bring about
SURFACE REMODELLING
Increase in
size
Change in
functional
relationship
Change in shape of
bone
27/11/18 71

72. BONE REMODELLING CHANGES SEEN IN THE NASO
MAXILLARY COMPLEX
The floor of the orbit faces superiorly, laterally and anteriorly .
ORBIT
Lateral-bone
resorption
Medial-bone
deposition
27/11/18 72

73. Bone deposition occurs along the posterior
margin of the maxillary tuberosity causing
lengthening of the dental arch and
enlargement of the A-P dimension of the entire
maxillary body. This helps in accommodating
the erupting molar.
Maxillary Tuberosity
posterior surface-
bone deposition
27/11/18 73

74. • Bone resorption occurs on the lateral wall of the nose leading to an increase in
size of the nasal cavity. Bone resorption is seen on the floor of the nasal cavity.
To compensate this, there is bone deposition on the palatal side. Thus a net
downward shift occurs leading to increase in maxillary height.
Growth of palate exhibiting V
pattern of growth
27/11/18 74

75. • The face enlarges in width by bone formation on the lateral surface of the zygomatic
arch and resorption on its medial surface.
zygomatic bone moves in a
posterior direction.
Anterior-resorption
Posterior-deposition
27/11/18 75

76. • As the teeth starts erupting, bone deposition occurs at the alveolar margins
which increases the maxillary height and the depth of the palate.
• The entire wall of the sinus except the mesial wall undergoes resorption,
resulting in increase in size of the maxillary antrum.
27/11/18 76

77. AGE CHANGES RELATED TO MAXILLA
• At birth
Transverse and anteroposterior diameters>vertical
diameter
Frontal process is well marked
Body of bone-little more than alveolar process
Tooth socket-close to floor of orbit
Maxillary sinus presents the appearance of a furrow on
lateral wall of nose
27/11/18 77

78. In adult
The vertical diameter is the greatest due to
developed alveolar process.
Increase in the size of sinus
Maxillary sinus
 With increasing age
it expands
 Becomes more and
more pneumatized
down around
maxillary teeth
27/11/18 78

79. In old aged
Infantile condition
Its height is reduced as a result of absorption
of alveolar process.
27/11/18 79

80. PREMAXILLA
The anterior outline of the bony maxillary arch
in the infant has a vertically convex
topography. This is in contrast to the
characteristic concavity this region develops in
the adulthood.
The alveolar bone in this area of the adult face
is noticeably protrusive.
Anterior contour of premaxilla is flat in infants;
the differential remodeling process draws out
this contour
27/11/18 80

81. AGE-RELATED ARCH WIDTH CHANGES IN MAXILLA
• Bishara et al. found that for maxillary arch, intercanine width increases
between 3 and 13 years by 6 mm but decreases by 1.7 mm between 13 and
45 years.
• On the other hand, intermolar width increases by 2 mm between 3 and 5 years
and by 2.2 mm between 8 and 13 years but decreases by 1 mm by 45 years of
age.
27/11/18 81

82. DEVELOPMENTAL ANOMALIES
There are four clinically significant types of congenital anomaly
 Malformation :
A morphological defect of an organ, part of an organ, or larger region of the
body that results from an intrinsically abnormal developmental process.
 Disruption :
A morphological defect of an organ, part of an organ, or a larger region of the
body that results from the extrinsic breakdown of, or an interference with, an
originally normal developmental process
27/11/18 82

83.  Deformation :
An abnormal form, shape, or position of a part of the body that results from
mechanical forces
 Dysplasia :
An abnormal organization of cells into tissues and its morphological results.
27/11/18 83

84. • Cleft palate - A congenital fissure in the roof of the mouth, resulting from
incomplete fusion of the palate during embryonic development.
• Cleft lip - A congenital deformity characterized by a vertical cleft or pair of
clefts in the upper lip, with or without involvement of the palate.
CLEFT LIP AND PALATE
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85. 27/11/18 85
SUBMUCOUS CLEFTS

86. • Cleft lip is common among males while cleft palate is more common among
females.
Unilateral clefts - 80% of
the incidence
Bilateral clefts -
remaining 20%
27/11/18 86

87. ETIOLOGY AND RISK FACTORS
• Increased Parental Age
• Infections During Pregnancy
• Smoking During Pregnancy
• First Child with Cleft lip
• Drugs- Steroids, Phenytoin, Diazepam,
• Alcohol, Smoking
• Maternal Diabetes Mellitus
• Nutritional Deficiency- Folic Acid
• Associated Syndromes- Pierre Robin’s Syndrome, Stickler’s Syndrome,
Shprintzen’s Syndrome, Down’s Syndrome, Apert’s Syndrome
27/11/18 87

88. PROBLEMS ASSOCIATED WITH CLEFT LIP AND
PALATE
Microdontia
Fused teeth
Macrodontia
Mobile and early shedding of
teeth due to poor periodontal
support
Posterior and anterior cross bite
Protruding premaxilla
Deep bite
Spacing
Esthetic
Speech and
Hearing
Psychologic
27/11/18 88

89. RULE OF 10
• Primary repair: repaired at approximately 10 weeks
• Child weighs 10 pounds
• Haemoglobin 10 grams
• WBC more than 10,000
27/11/18 89

90. Aka craniofacial dysostosis
C/F:-
 Premature closure, especially of coronal suture, occasionally lambdoidal..
 Variable cranial form depending on order and rate of progression of suture
closure
 Optic nerve damage
CROUZON SYNDROME
27/11/18 90

91.  hemifacial microstomia
• craniofacial abnormalities involving the maxillary , temporal and zygomatic
bones which are small and flat
• Ear (anotia-no ear), eye(tumors and dermoid in eye balls)
• Asymmetry -65% cases
OCULOAURICULOVERTEBRAL SPECTRUM
27/11/18 91

92. • Agnathia is an extremely rare congenital defect characterized by absence of
the maxilla or mandible. More commonly only a portion of one jaw is missing.
AGNATHIA
27/11/18 92

93. Micrognathia : It likely means a
small jaw.
27/11/18 93

94. • Macrognathia : It refers to the condition of abnormally large jaws.
• It may be associated with Pagets disease, Acromegaly.
27/11/18 94

95. PROSTHODONTIC CONSIDERATIONS
RESIDUAL ALVEOLAR RIDGE : is the portion of alveolar ridge and its soft
tissue covering which remains following of or loss of teeth.
~GPT-8
27/11/18 95

96. PROSTHODONTIC CONSIDERATIONS
• During 1st year after extraction, the reduction of residual ridge height is about
2-3 mm for maxilla and 4-5 mm for mandible.
• After healing resorption continues but with decreased intensity,resulting in loss
of varying amount of jaw structure- dental cripple.
• Rate of reduction in maxilla annually is generally 4 times less than
(about 0.1-0.2 mm).
27/11/18 96

97. WHY RESORPTION LESSER IN MAXILLA??
• Cancellous bone is ideally designed to absorb and dissipate forces it is
subjected to.
• The maxillary residual ridge is often broader, flatter and more cancellous than
mandible.
• Trabecullae in maxilla are oriented parallel to the direction of compression
deformation, allowing for maximal resistance to deformation.
27/11/18 97

98. IN DRY SPECIMENS
• External cortical surface of maxilla and mandible are uniformly smooth &
crestal area of residual ridge shows porosities and imperfections.
• Bones with more severe RRR display gross porosities of medullary bone on the
crest of ridge.
27/11/18 98

99. DIRECTION OF BONE RESORPTION
27/11/18 99
Maxilla resorbs upward and inward to
become progressively smaller because of the
direction and inclination of the roots of the
teeth and the alveolar process.
The opposite is true of the mandible, which
inclines outward and becomes progressively
wider.
This progressive change of the edentulous
mandible and maxilla makes many
patients appear prognathic.

100. • RRR is centripetal in maxilla and centrifugal in mandible.
27/11/18 100

101. PATTERNS OF BONE RESORPTION
• In the Mandible, large proportions of bone loss occurs in the
labial side of anterior residual ridge,
equally on the buccal and lingual side in premolar region and
lingually in the posterior or molar region.
 In the Maxilla bone loss primarily occurs on the labial or buccal aspect.
27/11/18 101

102. CONCLUSION
• It is important for the clinician to know the normal and the abnormal ranges of growth
for proper diagnosis, treatment planning and selecting appropriate clinical procedures
• A knowledge of growth and development is the precious key to grasp and the form
and direction of anatomical structures. It is a vital key to the mastery of the aberrant as
well as the normal
27/11/18 102

103. REFERENCES
• Gurkeerat singh, textbook of orthodontics
• S.I Balaji, textbook of orthodontics
• Inderbir singh, textbook of human embryology
• Shobha tandon, textbook of Pedodontics
• Enlow DH, Bang S. Growth and remodelling of the human maxilla
• Human Embryology : Inderbir singh, 7th edition
• Oral Histology and Embryology
• Oral Histology : Richard tencate, 5th edition
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104. • Oral Pathology : Shafer, 3rd edition
• Prosthodontic Treatment For Edentulous Patients : Boucher’s 11th edition.
• Craniofacial Embryology : G.H. Sperber, 2nd edition
• Orthodontics : S.I. Bhalajhi
• Contemporary Orthodontics : Profitt, 2nd edition
• Facial Growth : Enlow, 3rd edition
• Handbook of Orthodontics : Moyers, 2nd edition
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