GROWTH AND DEVELOPMENT OF MAXILA 16.pptx

GROWTH AND DEVELOPMENT OF MAXILA

1. Growth & D evelopment of M axilla M. Naveen Kumar I MDS Department of Prosthodontics 1

2. CONTENTS Introduction Definitions of growth and development Prenatal development of maxilla Post natal development of maxilla Age changes in maxilla Developmental anomalies Prosthodontic considerations Conclusion References 2

3. Introduction 3

4. GROWTH AND DEVELOPMENT “Growth usually refers to an increase in size and number” - PROFFIT “ Change in any morphological parameter which is measurable” - MOYERS “ Self multiplication of living substance” -J.S.HUXLEY “ Development refers to all naturally occurring progressive, unidirectional, sequential changes in the life of an individual from its existence as a single cell to its elaboration as a multifunctional unit terminating in death” - MOYERS . 4

5. Development of Maxilla Pre-natal period a dynamic phase in the development of a human being. Post-natal period involves complex interaction of different growth processes. 5

6. Pre-natal development of Maxilla 6

7. 4 th week By the end of 4 th week Pharyngeal arches 7

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9. Maxillary & Mandibular process fuse to form cheek 9

10. Development of Palate 10

11. Post-natal Development of Maxilla Displacement Growth at sutures Surface remodeling 11

12. Primary Displacement Secondary Displacement Primary Displacement is seen in a forward direction. Occurs by growth of the maxillary tuberosity in a posterior direction. This results in the whole maxilla being carried anteriorly. The bone get displaced as a result of growth and enlargement of adjacent bone The naso-maxillary complex is simply moved anteriorly as the middle cranial fossa grows in that direction . 12

13. GROWTH AT SUTURES As the growth of surrounding soft tissues occur Maxilla is carried downwards and forwards Opening up of spaces at sutural attachments New bone is formed on either side of sutures Results in overall increase in size of bones on either side 13

14. Surface remodeling Remodeling occurs by bone deposition & resorption to bring about: a) Increase in size b) Change in shape c) Change in functional relationship 14

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16. Growth of the PALATE exhibits V pattern of growth. As the maxilla descends, transversely, additive growth on the free ends increases the distance between them. The buccal segments move outward and downward, as the maxilla itself is moving downward and forward, following the principle of expanding . Enlows expanding V principle 16

17. AGE CHANGES OF MAXILLA IN CHILDREN : Transverse & A-P diameter > vertical diameter Tooth Sockets close to orbit Maxillary sinus is mere furrow on lateral wall of nose. IN ADULTS : Increase in vertical diameter due to development of the alveolar process and increase in size of the sinus . IN OLD AGE : Bone reverts to the infantile condition. It height is a result of resorption of the alveolar process. 17

18. DEVELOPMENTAL ANAMOLIES WITH PROSTHODONTIC CONSIDERATIONS 18

19. AGNATHIA MICROGNATHIA MACROGNATHIA FACIAL HEMIHYPERTROPHY CLEFT LIP CLEFT PALATE 19

20. AGNATHIA Absence of jaw. The incidence is estimated to be 1 in 70,000 infants (Schiffer et al. 2002). Autosomal recessive mode of inheritance. Mainly seen in mandible. Rarely seen in maxilla. In maxilla, absence of one maxillary process or premaxilla is seen. 20

21. MICROGNATHIA Retracted middle face due to deficiency of middle face or premaxillary area. Middle third of face appears retracted. 21

22. Syndromes associated with micrognathia Potter’s syndrome Rubinstien taybi syndrome Pierre robin syndrome 22

23. Cohen syndrome Treachercollin’s syndrome Fetal alcohol syndrome 23

24. MACROGNATHIA Abnormally large jaws. An increase in size of both jaws is frequently proportional to generalized increase in size of the entire skeleton. e.g. in pituitary gigantism. I t may be associated with certain other conditions, such as: 1. Paget's disease of bone, 2. Leontiasis ossea, 24

25. FACIAL HEMIHYPERTROPHY Also called hyperplasia. Hemi hyperplasia is a rare developmental anomaly characterized by asymmetric overgrowth of one or more body parts. It represents a hyperplasia of the tissues rather than a hypertrophy. It can be an isolated finding, or associated with a variety of malformation syndromes like Beckwith-Wiedemann syndrome Neurofibromatosis Proteus syndrome McCune-Albright syndrome Epidermal nevus syndrome 25

26. CLEFT LIP AND PALATE Veau’s classification 26 TYPE I:- Cleft of the soft palate only. TYPE II :- Cleft of the hard and soft palate to the incisive foramen. TYPE III:-Complete unilateral cleft of the soft and hard palate, and the lip and alveolar ridge on one side. TYPE IV:-Complete bilateral cleft of the soft and hard palate ,and the lip and alveolar ridge on both sides.

27. KERNAHAN’S STRIPPED “Y” CLASSIFICATION: 27 Each block represents a specific area of oral cavity Block 1 and 4 – Lip Block 2 and 5 – Alveolus Block 3 and 6 – Hard palate anterior to incisive foramen Block 7 and 8 – Hard palate posterior to incisive foramen Block 9 – Soft palate

28. DENTAL FEATURES Congenitally missing teeth (most commonly the upper laterals) Presence of natal or neonatal teeth Presence of supernumerary teeth Ectopically erupting teeth Anomalies of tooth morphology Enamel hypoplasia 28

29. Microdontia Fused teeth Aberrations in crown shape Macrodontia Mobile and early shedding of teeth due to poor periodontal support Posterior and anterior cross bite Protruding premaxilla Deep bite Spacing\crowding 29

30. Multidisciplinary cleft palate team 30

31. 31 Cleft Lip and Palate Treatment Protocol

32. PROSTHODONTIC CONSIDERATIONS 32

33. Micrognathia It is difficult to take the impression, so they need Sectioned trays Flexible tray techniques Flexible plastic trays Reinforced flexible impression trays in order to improve esthetics we should give the prosthesis with increased size of teeth Kumar KA, Bhat V, Nair KC, Suresh R. Preliminary impression techniques for microstomia patients. J Indian Prosthodont Soc 2016;16:229-33 33

34. 34 Pierre robin syndrome  pre- epiglottic baton plate 

35. While recording the impression extension of the tray is required Macrognathia 35 In pagets disease : ( i ) Supporting area such as maxillary tuberosities may have continuous enlargement so adjusting dentures frequently may be necessary (ii)Oral implants are contraindicated in the affected regions

36. 36 Management of cleft lip & palate

37. PRE SURGICAL NASOALVEOLAR MOULDING Avhad R, Sar R, Tembhurne J. Presurgical management of unilateral cleft lip and palate in a neonate: a clinical report. J Prosthet Dent. 2014 Sep;112(3):676-9. doi : 10.1016/j.prosdent.2013.12.012. Epub 2014 Mar 24. PMID: 24674805. 37 Described by grayson BENEFITS: Reduction of alveolar cleft Symmetric nasal cartilages Nonsurgical lenthening of columella Less surgical Procedures Eliminates the need of bone grafts

38. Premaxilla Positioning Appliance : In case of complete bilateral cleft lip , premaxilla and prolabium are protrusive and rotated upward making surgical repair difficult because clefts may be wide and there would be excessive tension along suture lines of the surgically corrected lip. Premaxilla positioning appliance is a nonsurgical technique that retracts and rotates the malposed segment to a more favorable position for lip repair. 38

39. Palatal lift Prosthesis: Valopharyngeal incompetance occurs when the surgically corrected soft palate is of adequate length but of inadequate mobility to elevate to achieve valopharyngeal closure. This prosthesis extends posteriorly to engage softpalate and physically elevate and extend it to the proper position to achieve the closure. 39

40. Speech aid Prosthesis Prosthetic Speech Appliances for Patients with Cleft Palate Mohammed Mazaheri 40 This improves the speech and can also improve swallowing because it eliminates nasal regurgitation.

41. Expansion Appliance The type of appliance to be placed will be determined by the configuration of the cleft. Generally, if any degree of collapse is manifested, an expansion appliance is placed. If the collapse appears to be primarily in the anterior region a fan type of split acrylic appliance is used. If it appears that the arch is collapsed throughout its length, a straight jackscrew appliance is used 41

42. Holding Appliance If the cleft configuration is wide or if the segments appear in an ideal relationship, a holding appliance is used. Primary purpose of the appliance prior to lip closure is not to proliferate tissue or initiate growth but to guide the maxillary segments into proper spatial position with each other and with the mandibular arch. After the maxillary appliance has the segments in good alignment, the plastic surgeon restores lip continuity 42

43. Palatal obturator : A palatal obturator covers the opening and contributes to normal speech production. It eliminates hypernasality and assists speech therapy. Palatopharyngeal obturator : Velopharyngeal insufficiency occurs when cleft palate is unrepaired or when a surgically treated soft palate is too short to make contact with pharyngeal wall during function. Excessive nasal airflow and inadequate oral pressure for normal speech and there might be nasal regurgitation during feeding 43

44. Modeling plastic impression compound is warmed and placed on a tongue blade. An adhesive is placed on the modeling plastic impression compound completed impression with irreversible hydrocolloid Final Cast Completed Obturator A small hole is placed in the anterior border of the new obturator The first feeding of the infant Case of a Cleft Lip & Palate 44

45. ANDREW’S BRIDGE 45 A Fixed Removable Partial Dentures

46. 46 Case report 1 Extra oral view Intraoral view OPG Metal try- in Wax try-in Hajira N, Khandelwal P, Shashidhar HS, Sachdeva H, Khare S. Andrew’s Bridge: Achieving Esthetics with a Prosthetic Alternative—Managing Severe Anterior Ridge Defects in Operated Case of Cleft Lip and Palate. Int J Prosthodont Restor Dent 2016;6(4):93-97

47. Hajira N, Khandelwal P, Shashidhar HS, Sachdeva H, Khare S. Andrew’s Bridge: Achieving Esthetics with a Prosthetic Alternative—Managing Severe Anterior Ridge Defects in Operated Case of Cleft Lip and Palate. Int J Prosthodont Restor Dent 2016;6(4):93-97 47 Intraoral view after placement of Prosthesis

48. Prosthetic rehabilitation of maxillary dentoalveolar defects with fixed dental prostheses: Two clinical reports Ceyhun Canpolat , DDS,a Zeynep Özkurt-Kayahan , DDS,b and Ender Kazazoglu , DDSc Yeditepe University, Faculty of Dentistry, Istanbul, Turkey(j prosthet dent 2014) Zirconia core CASE REPORT: 2 48

49. CONCLUSION The human face is a fascinating study of physiology and psychology. The amount of information a human face can relay is unending. Humans are capable of making 10,000 unique facial expressions! While the face is complicated, it is also our most useful and most underestimated tool for communication. A prosthodontist engaged in treating patients with oral, facial, and speech deficits should be thoroughly familiar with the anatomic and physiologic deviations of the region involved and with the basic principles involved in prosthetic dentistry. 49

50. References Human Embryology - INDERBIR SINGH , G.P. PAL – 8 th edition. Simplified feeding appliance for an infant with cleft palate Shaila Masih , Reena Annie Chacko , Abi M Thomas, Namita Singh, Rodny Thomas, Deena Abraham A feeding appliance for a newborn baby with cleft lip and palate Abhay Agarwal ,  Vivek Rana , and  Shabina Shafi . Maxillofacial Prosthetics Multidisciplinary Practice. VAROUJAN A. CHALIAN JOE B. DRANE S.MILES STANDISH Avhad R, Sar R, Tembhurne J. Presurgical management of unilateral cleft lip and palate in a neonate: a clinical report. J Prosthet Dent. 2014 Sep;112(3):676-9. doi : 10.1016/j.prosdent.2013.12.012. Epub 2014 Mar 24. PMID: 24674805 Guiding Atypical Facial Growth Back to Normal Part 1: Understanding Facial Growth By Steve Galella , DDS, IBO; Daniel Chow, BDS, DDS, MAGD, FIAO, FIAOFE; Earl Jones, DDS,Donald Enlow , MS, PhD; Ari Masters, DDS AUTHOR (YEAR). Title of the publication. Publisher 50

51. Prosthetic rehabilitation of maxillary dentoalveolar defects with fixed dental prostheses: Two clinical reports Ceyhun Canpolat , DDS,a Zeynep Özkurt-Kayahan , DDS,b and Ender Kazazoglu , DDSc Yeditepe University, Faculty of Dentistry, Istanbul, Turkey. Prosthodontic management of a patient having maxillary defect: A case report Dr. Roma Goswami Clinical Dentistry , Mumbai • December 2013 Hajira N, Khandelwal P, Shashidhar HS, Sachdeva H, Khare S. Andrew’s Bridge: Achieving Esthetics with a Prosthetic Alternative—Managing Severe Anterior Ridge Defects in Operated Case of Cleft Lip and Palate. Int J Prosthodont Restor Dent 2016;6(4):93-97 Prosthetic Speech Appliances for Patients with Cleft Palate-Mohammed Mazaheri Treating Velopharyngeal Inadequacy Using an Interim Palatal Lift Prosthesis – A Case Report -Dr. Ashwin Kumar, Dr. K. Harshakumar , Dr. C. S. Ravichandran 51

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