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ITS DEVELOPMENT
INTRODUCTION
DEVELOPMENT OF MAXILLA
FEATURES OF MAXILLA
ARTICULATION OF MAXILLA
AGE CHANGES
PERIODONTAL CONSIDERATIONS
CONCLUSION
INTRODUCTION
Maxilla is the 2nd largest bone of
the face.
.
2 fossae, the infratemporal &
pterygopalatine.
The palate ossifies from a single centre derived from the maxilla.
The most posterior part of the palate does not ossify & forms the soft
palate.
Point at which the 2nd & 3rd branchial arches merge marked by the foramen
caecum just behind the sulcus terminalis, which marks a boundary between
root of the tongue and its active portion
Mucosal sac or covering of the body of the tongue originates from 1st lateral
lingual swelling of the mandibular arch.
By 14 weeks the taste buds can be observed in the fungiform papillae, & they
appear in circumvallate papillae at about 12 weeks
DEVELOPMENT OF
MAXILLARY SINUS:
Growth at Sutures
Surface Remodeling
Displacement
Growth of the cranial base
passive /secondary displacement
of nasomaxillary complex in
downward & forward direction.
The fronto-maxillary
suture
The zygomatico-temporal
suture
The zygomatico-maxillary
sututre
The pterygo-palatine
suture
Surface Remodeling :
Massive surface remodeling by
bone deposition & resorption
increase in size; change in shape
of bone; & change in functional
relationship.
Resorption occurs on lateral
surface of the orbital rim
lateral movement of the eyeball,
to compensate for this
resorption there is bone
deposition on the external
surface of the lateral rim.
Bone deposition occurs along
the posterior margin of the
maxillary tuberosity,
lengthening of dental arch &
enlargement of antero-posterior
dimension of entire maxillary
body & helps to accommodate
developing molars.
Zygomatic Process
Frontal Process
Alveolar Process
Palatine Process
PALATINE PROCESS
The Maxillary Sinus or Antrum of Highmore
(sinus maxillaris)
Immunological barrier
Medially : 5 bones
1) Ethmoid
2) Inferior nasal concha
3) Vomer
4) Palatine
5) Opposite maxilla
Laterally : 1 bone
1) Zygomatic bone
Age Changes
At birth :
Transverse and anteroposterior diameters >vertical diameter;
Frontal process is well marked
Body consists of a little more than the alveolar process;
The tooth sockets close to floor of orbit
Maxillary sinus is a mere furrow on the lateral wall of the nose.
In Adults:
Vertical diameter is greatest due to developed alveolar process
increase in the size of the sinus.
In Old
Infantile condition
Its height is reduced as a result of absorption of the alveolar process.
Nerve supply
Arterial supply
Muscle attachment
LYMPHATICS
PERIODONTAL CONSIDERATIONS
Severe bone loss in this region could result in the base of the periodontal
pocket approximating both zygomaticoalveolar ridge of the zygomatic process
of the maxilla and the attachment of the buccinator muscle. Each could
complicate any surgical attempt to deepen the vestibule or increase the zone of
attached gingiva.
Attachment of buccinator muscle may also limit the apical extent to which
one could establish the mucogingival junction and an adequate width of
attached gingiva.
Transverse growth:
The width of ant. portion of the arch is completed prior to the adolescent growth spurt,
but for post. portion, the width increase is closely tied to the increasing jaw length.
The width in the ant. portion ses mainly by growth at the midpalatal suture ,a growth
is 3x larger in 1st molar area than in front.
The intercanine distance will change only little after the age of 10 (0.9 mm)
Thus if a central incisor was replaced with an implant shortly after eruption, diastema
could develop between the implant and the adjacent natural central incisor ,resulting in
subsequent shifting of the midline to the implant side.
In most post. area changes can occur until complete tooth eruption.
The midpalatal suture usually closes after puberty around the age of 15 .
Sagital growth:
Maxilla ses in length due to both sutural growth & bone apposition at
maxillary tuberosity.
The ant. part of max. is rather stable.
When max. is displaced & during growth ,up to 25% of
displacement is lost via resorption at anterior site, latter could result in an
implant gradually losing labial bone.
Teeth have a spontaneous mesial drift. The lat. segment moves on average 5 m
mesially but max. incisors move only 2.5 mm buccally ,causing net loss in
space ,lead to crowding.
Implant does not take part in spontaneous tooth migration. Thus an implant in
lat. region could stop the mesial drift resulting in asymmetric arch.
Vertical growth:
Occurs via displacement and drift.
An implant inserted in ant. part at age of 7 will 9 years later be located 10 mm
more apically than the neighbouring teeth.
Misch bone density classification
Bone density Description Tactile analog Typical anatomical
location
D2 Porous cortical and coarse White pine or spruce wood Anterior mandible, posterior
trabecular mandible, Anterior maxilla
D3 Porous cortical and fine Balsa wood Anterior & posterior maxilla
trabecular
Osseous coagulum:
Sources were:
Exostoses
Edentulous ridges
Bone distal to terminal tooth
Lingual surface of maxilla at least 5 mm from the roots.
Cancellous bone marrow transplants obtained from:
Maxillary tuberosity
Edentulous areas
Healing sockets
upward: Superiorly at a 45
degree angle to occlusal plane
Inward: Medially toward
midline at 45 degree to occlusal
plane.
Backward : Posteriorly at 45
degree angle to long axis of 2nd molar
in one movement.
Alternative: Supraperiosteal injections: requires multiple needle
penetrations , provides shorter duration of anesthesia.
When combined with anterior superior alveolar block entire maxillary
arch on one side can be anesthetized (except palatal tissues).
Prevention: the risk of hematoma can be minimized by using a short
25 or 27 gauge needle, aspirating in two planes multiple times before
and during the slow deposition of anestheic.
If anesthesia of posterior palate is needed, greater palatine block should
be provided in addition to psa block.
Middle superior alveolar nerve :
(MSA)
Nerve branches off the main nerve
trunk(V2) within the infraorbital canal to
form a part of superior dental plexus,
composed of posterior, middle, and
anterior superior alveolar nerve.
Nerve block: