Pre Natal and Post Natal / Orthodontic Courses by Indian Dental Academy

Pre natal and post natal
growth and development

of nasomaxillary complex

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com

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 floor and
lateral wall of nasal cavity and part of
nasal bridge.
4. Greater part of floor of each
orbit.
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
Palatine process[maxilla]
Maxillary sinus
Frontal process
Maxillary process [palatine]
Alveolar process
ANATOMY MEDIAL VIEW
Horizontal plate of palatine
Nasal notch
Zygomatic process
ANS
Alveolar process
ANATOMY-LATERAL VIEW
Frontal process
Pre natal growth and
development
Pre-natal growth
At fourth week of of IUL-
1.migration of neural crest cells
2.formation of brachial arches

STOMODEUM
FRONTONASAL
MAXILLARY MAXILLARY
MANDIBULAR
MANDIBULAR
Medial nasal
process
Lateral nasal process
Maxillary process
Mandibular process
Maxillary and Mandibular processes-
{ first brachial arch}
Frontonasal processes- { downward
proliferation of mesenchyme of developing brain}
Medial nasal Lateral nasal
Mesenchyme of first arch
maxilla
palatine
mandible
zygomatic
Part of temporal
AT SEVENTH WEEK IUL-
1.Formation of upper lip
2.Intramembranous Bone
ossification Takes Place
3.Formation of Nasal Septum
4.Nasolacrimal Duct
5.Formation of Primary Palate
AT SEVENTH WEEK IUL
Primary ossification center -for each
maxilla at termination of infraorbital
nerve above canine tooth dental lamina.

Secondary center
zygomatic
orbitonasal
intermaxillary
nasopalatine
AT EIGHT WEEK IUL
Intramembranous ossification centers
appear for;
-Nasal and lacrimal bones.
-Medial pterygoid plate of sphenoid.
-Vomer.
-Zygomatic bone
Anteroposterior maxillo- mandibular
relationship approaches that of newborn
infant

Maxilla increases in height
BY TWELFTH WEEK
FRIEBAND-{the growth of palate in
human fetus}

1
st
trimester-narrow
2
st
trimester-moderate width
3
st
trimester- wide
Breadth>length
Height changes less dramatic

Pre-natal Growth and
development of palate
Formation of primary and secondary
palate

Elevation of palatal shelves

Fusion of palatal shelves
Early palate formation
28
th
day of IUL
-disintegration of buccopharangeal
membrane
-stomadeal chamber

Horizontal extensions
Oral cavity
Nasal cavity
2 palatal
shelves
Single primary palate
Structure of palate

PALATOGENESIS
Secondary palate
Primary palate
5
TH
week IUL 12
TH
week IUL
6
9
CRI TI CAL PERI OD
Primary palate
Frontonasal
process
Medial nasal
mesenchyme
W
e
g
d
e

Wedge shaped mass
between internal
surface of maxillary
prominence
Primary palate
Pre-maxilla
Primary
palate
Primary palate
Secondary palate
2 horizontal mesenchymal projections
Maxillary prominence
Lateral palatine process
Fuse-
With each other
Primary palate
Nasal septum
Secondary palate
Secondary palate
PALATAL SHELVES
At 6 weeks
1. Tongue {undifferentiated tissue}
pushes dorsally
2. palatal shelves become vertical
3. Elevation occurs from vertical to
horizontal position
Elevation of palate
Nasal
septum
Palatal
shelves
tongue
Histological section
At 8 weeks

Muscular
movement
Pressure
differences
Biomechanical
transformation
Intrinsic
shelf force
Differential
mitotic growth
Withdrawal of
embryos face
Fusion of palatal shelves
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
Fusion of palate
Incisive foramen
Mid palatine
raphe
Formation of palate[summary]
Primordium
of
Formed
by
Derived
from
Primary
palate
Secondary
palate
Pre
maxilla
Hard and
soft
palate
Median
palatine
process
Lateral
palatine
process
Frontonasal
process
Maxillary
process
Musculature of palate
Tensor veli palatini 40 days 1
st
arch
Palatopharangeous 45 days
Levator veli palatini 8
th
week 2
nd
arch
Palatoglossus 9
th
week
Uvular muscle 11
th
week 2
nd
arch
Growth in dimensions

Length - 7-8 weeks IUL
Width - 4
th
month onwards

height
width
length
Arched palate
Growth in dimensions
Pre natal life
length > width

At birth
length = width

Post natal life
width > length
Growth at mid palatal suture ceases at
1-2 years

Apposition
inferior surface
alveolar process
Resorption superior{nasal} surface
V principle of Bang and Enlow
Entire v shaped
structure moves
in a direction
towards the wide
end of the v
Remodeling of palate
Factors affecting growth of
palate
elevation of head and lower jaw
Oxygen and nutritional deficiency
Excess endocrine substances
Drugs
Irradiation
vascularity

teratogens
Elevation of head and lower jaw
ANOMALIES OF PALATE
Epithelial pearls

ANOMALIES OF PALATE
Torus palatinus
ANOMALIES OF THE PALATE
High arched palate
MARFANS
SYNDROME
CROUZON
SYNDROME
CLEIDOCRANIAL
DYSOSTOSIS
ANOMALIES OF PALATE
Cleft palate
Failure of fusion of the lateral palatine
process with each other or with the
median palatine process
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]
Genesis of cleft palate
Failure to fuse after contact as
epithelium does not break down

Rupture after fusion

defective merging
Types of cleft palate
Bifid uvula
Unilateral
cleft palate
Bilateral
cleft palate
Bilateral
cleft palate
Bifid uvula
Unilateral cleft palate
Etiology of cleft palate
Infectious
agents
irradiation
drugs
Nutritional
deficiency
Excess
hormones
Smoking
and
alcohol
Clinical features of cleft palate
Feeding problems particularly in infants
in whom suckling process demands
intact palate

Nasal regurgitation/nasal twang in voice

Collapsed arch

Difficulty in speech and swallowing

Post natal growth of
maxilla
Post natal growth of maxilla
Surface remodeling

displacement

CRANIAL BASE MAXILLA

apposition
resorption
MOSS
TRANSPOSI TI ON
TRANSLATI ON
SUTURES
Surface apposition
Sutural growth
nasal septum growth
Spheno occipital synchondrosis

In contrast to cranial base maxilla is
dominated by intra membranous
ossification
Surface apposition
Sutural growth
Spheno occipital synchondroses

Growth in height vertical

Growth in width transverse

Growth in length A - P
HEIGHT
DEPOSITION ON
THE ORAL SIDE

RESORPTION ON
THE NASAL SIDE
ENLOW AND BANG V
PRI NCI PLE
Sagittal view
Coronal view
HEI GHT - V PRINCIPLE
HEIGHT
APPOSITION IN THE
ALVEOLAR
PROCESS
ERUPTION OF
TEETH

Primary displacement
HEIGHT
PRIMARY DISPLACEMENT

SUTURAL THEORY

CARTILAGENOUS THEORY

FUNCTIONAL MATRIX HYPOTHESIS
SUTURAL THEORY
SUTURES HAVE
INNATE
GROWTH
POTENTIAL

OBLIQUE
NATURE

SLIDING EFFECT

SI CHER
CARTI LAGENOUS THEORY
NASAL SEPTUM INNATE GROWTH
POTENTIAL

THRUST EFFECT
SEPTOPREMAXILLARY LIGAMENT

MORE ROLE IN A-P THAN VERTICAL

SURGICAL REMOVAL OF NASAL
SEPTUM
SCOTT
Removal of nasal septum mid face
deficiency
FUNCTI ONAL MATRI X
HYPOTHESI S

BASAL BODY INFRAORBITAL
NERVE

ORBITAL UNIT EYEBALL

NASAL UNIT SEPTAL CARTILAGE

ALVEOLAR UNIT TEETH

MOSS
SKELETAL UNI TS FUNCTI ONAL MATRI X
FUNCTI ONAL MATRI X
HYPOTHESI S

HEIGHT

ENLARGI NG
ORO FACI AL
CAPSULE
REMODELI NG
CHANGES I N
THE ORBI T
WIDTH
Finished earlier in postnatal life

WIDTH
GROWTH I N MI D
PALATI NE SUTURE
REMODELI NG I N THE
LATERAL SURFACE OF
ALVEOLAR PROCESS
Mutual transverse rotations of
maxillary halves give palate u shape
LENGTH

Begins rapidly in the 2
nd
year of life

Maxillary
tuberosity
Palato -
maxillary
suture
primary secondary
displacement
QUANTITATION OF MAXILLARY
REMODELING
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

Sheldon Baumrind,Edward Korn
AJO JAN 1987
Maxillary tuberosity
Established by the posterior boundary
of anterior cranial fossa
Helps in posterior and horizontal
lengthening of arch

Anterior displacement
= posterior lengthening
Key ridge
Reversal occurs at
the key ridge
Posterior - apposition
Anterior - resorption
Maxillary sinus
PRE NATAL
lateral evagination of mucous
membrane in middle meatus 3
rd
month
IUL
AT BIRTH
2mm -long, 1mm in width + height
PNEUMATISATION
PRIMARY
SECONDARY
Maxillary sinus
AGE CHANGES
Expands - 2mm
vertically
3mm A-P - every
year
> in size -
resorption in walls +
alveolus
Maxillary sinus
POST NATAL
All internal
surfaces
resorption
[expect medial]

Rapid continues
downward growth
close proximity to
buccal maxillary
teeth

Zygomatic region
Posterior relocation
anterior posterior
Increase in height
frontozygomatic
Inferior
border
Lateral growth
displacement
Zygomaticotemporal [anterior]
Frontozygomatic [inferior]
Nasal airway

Lining surface of
bony wall and floor
resorptive
Downward relocation
of palate
Lateral and anterior
expansion
Nasal airway
Ethmoidal
conchae
lateral + inferior
deposition
medial + superior
resorption

Inter nasal
septum
Lengthens
vertically at
sutural
junctions
Clinical Implications
and Summary
Pre natal growth
Formation of
germ layers
Day 17
Fetal alcohol
syndrome
[mid face
deficiency]
Migration
and
proliferation
of cell
population
Day 19-28
Treacher Collin
syndrome
Pre natal growth
Primary palate
formation
28-38
days
Cleft lip /cleft palate
other facial clefts
Secondary
palate
formation
42-55
days
Cleft palate/synostosis
CROUZON syndrome
Epithelial pearls
Torus palatinus
high arched palate

Post natal growth
Post natal growth
AT BI RTH
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
No synostosis
Post natal growth
THE MIXED DENTITION
YEARS
Post natal growth
mid palatine suture
starts closing at 9- 10
years
RME BEST DONE
BETWEEN 9-14 yrs
THE MIXED DENTITION YEARS
Growth in width of the
dental arch anterior to the
first molar
Ceases by 5-6 yrs
Inter canine width
completed
12 yrs - females
18 yrs - males
Post natal growth
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
THE MIXED DENTITION YEARS
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
Age changes
All para nasal sinuses increase in size
Vertical height decreases

Vertical changes > AP > width
Soft tissue changes > skeletal
Nose growth continues till 25 years
Inclination of palatal plane
increases[post downwards]

Alveolar process
resorbed
Tooth loss
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 embryology-
TENCATE
Handbook of orthodontics-MOYERS
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 mucosa-
BORK,HOEDE


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Pre natal and post natal

growth and development

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