Maxilla

Good morn
PRESENTED BY
DR DIVYA JAIN
1ST YEAR POSTGRADUATE

CONTENT
Introduction
Definitions
Growth And Development
Prenatal And Post Natal Growth
 Anatomy Of Maxilla
Age Changes
Clinical And Prosthodontic Consideration
Conclusion

INTRODUCTION
• It is essential to study the growth and development of maxilla and
maxillary sinus to diagnose and prosthetic management of the
developmental anomalies of maxilla and maxillary sinus successfully.
• Since dentists are involved in the treatment of not just the dentition but
also the entire dentofacial complex, a through understanding of not only
the pattern of normal growth but also of the mechanisms that underlie it
is very essential.

DEFINITION
“Growth refers to increase in size” - Todd.
“Growth usually refers to an increase in size and number” – Proffit.
“Change in any morphological parameter which is measurable”- Moss
 “Self multiplication of living substance”-
J.S.Huxley.

Development is a progress towards maturity” – Todd
“Development refers to all naturally occurring progressive,
unidirectional, sequential changes in the life of an individual from it’s
existence as a single cell to it’s elaboration as a multifunctional unit
terminating in death” – Moyers

GROWTH AND DEVELOPMENT
To determine the growth deviation of particular individual, we study
normal health variations.
In order to make accurate description of growth observations,
corresponding precise information about the normal state must be
available.

Changes in the pattern of growth that occur over a period of time
within representative samples of population are valuable indicators of
changes in general health and nutritional status of the populations.
It would not be possible to design and conduct investigation
regarding control mechanism of growth, if no precise data were
available describing the resultant somatic effect.

Will be considered in 2 periods:
1. Prenatal period (intra uterine).
a. Pre embryonic (0-14 days).
b. Embryonic (14-55 days).
c. Foetal (56-270 days).
2. Post natal period (extra uterine).
Prenatal And Post Natal Growth

Pre Embryonic Period
Zygote Morula Blastula
Male gamete
Female gamete

Formation Of Germ Layers
• Bilaminar germ disc
Trilaminar germ disc

Derivatives of the Germ layers
ECTODERM ENDODERM
Central, nervous system
Peripheral nervous system
Skin, hair, nails
Enamel of teeth
Embryonic Phase
MESODERM
Muscle tissue
Cartilage and bone
subcutaneous tissue
All supporting
tissues
Vascular system
Epithelial lining of G.I.T
respiratory tract, urinary bladder
Dental pulp
Langman’s medical embryology – T.W. Sadler, 5th Edition

Pharyngeal
arch
Nerve Muscles Skeleton
Mandibular
arch
Trigeminal
N.
MASTICATION,
Mylohyoid,
Ant. Belly of
digastric,
Tensor tympani &
Tensor palatine
Premaxilla,
MAXILLA,
Zygoma,
Temporal bone
part,
MECKEL’scartila
ge,
MANDIBLE,
malleus,
sphenomandibul
ar lig., ant.lig.of
malleus
Derivatives of first pharyngeal arch

Prenatal Growth Of Maxilla
Maxilla is formed from 1st pharyngeal arch.
1st pharyngeal arch lying lateral to the stomadeum divided in 2 processes.
Dorsal process – Maxillary process.
Ventral process – Mandibular process.
Maxillary process, extending forward beneath the region of the eye and
subsequently gives rise to the:
Premaxilla
Maxilla
Zygomatic bone and part of the temporal bone.
Synopsis of orthodontics;2nd ed; Dr.M.S.Rani

Dev. Of the maxilla starts around the 4 week
 Maxillary prominence
 Mandibular prominence
 Olfactory placodes
 Lat. Nasal prominence
 Med. Nasal prominence
 Frontonasal prominence
 Stomodeum

Development Of Palate
The palate is formed from two separate embryonic structures: the
primary palate and the secondary palate.
The formation begins in fifth week of prenatal development, within
the embryonic period.
The palate is then completed during the twelfth week, within the fetal
period.

Primary Palate Formation
The primary palate is derived from the intermaxillary segment during
the fifth week.
Intermaxillary segment and with different components

Secondary Palate Formation
•The secondary palate is derived from the
two shelf like outgrowths from the
maxillary swellings called palatine
shelves.
•The palatine shelves ascend to attain a
horizontal position above the tongue and
fuse forming secondary palate.

i. Posterior two- thirds of the hard palate
ii. Soft palate and uvula.
iii. Incisive foramen may be considered the midline landmark between
the primary and secondary palate.
iv. Median palatine raphe
 The secondary palate will give rise to

COMPLETION OF PALATE
Fusion of primary palate with the secondary palate during twelfth
week of prenatal development
The oral cavity thus becomes separated from the nasal cavity.

SOFT PALATE
• Ossification does not occur in the most posterior part of the palate, giving
rise to the region of the soft palate.
• Myogenic mesenchymal tissue of first, second and fourth branchial
arches migrate into the region supplying musculature of the soft palate
and fauces.

Fetal Period
• Fetal period: The beginning from 8th week until term.
• Identified by the 1st appearance of ossification centres and earliest
movement by foetus.
• There is little new tissue differentiation or organogenesis but there
is rapid growth and expansion of the basic structures already
developed.

Postnatal Period
• The growth of maxilla depends on influence of several functional
matrices that act upon different areas of the bone thus allowing its
subdivision into skeletal units:

Nasomaxillary Complex
• Maxillary tuberosity and arch lengthening.
• Lacrimal suture - A key growth mediator.
• Maxillary tuberosity and the key ridge.
• Vertical drift of teeth.
• Nasal airway.
• Palatal remodelling.
• Downward maxillary development.
• Cheek bone and zygomatic arch.
• Orbital growth.

Maxillary tuberosity and arch lengthening.
The essentials of facial growth – Enlow and Hans, 1st Edition.

Lacrimal suture - A key growth mediator.

Vertical drift of teeth.

Nasal airway.

Palatal remodelling.

Downward maxillary development.

Cheek bone and zygomatic arch.

Orbital growth.

• The overall growth changes are the
result of downward and forward
translation of the maxilla and
simultaneous surface remodelling.
• Maxilla is like the platform on
wheels being rolled forward while at
the same time, its surface,
represented by the wall in the
cartoon, is being reduced on its
anterior surface and built up
posteriorly, moving in space
opposite to the direction of overall
growth.
REMODELLING
TRANSLATION
Contemporary Orthodontics – William R. Proffit

-Maxilla, is second largest of facial bones.
It is a paired bone enters into formation of the
face
nose
mouth
orbit
Part of the infratemporal
Part of pterygopalatine fossa

• Ossification is from three centres.
One for maxilla proper –above the canine fossa during 6th week
of intrauterine life.
Two for premaxilla-
1.above the incisive fossa during 7th week of intrauterine life.
2.ventral margin of nasal septum during 10th week of intrauterine
life.

Structure Of Maxilla
• BODY
• 4 PROCESSES
ZYGOMATIC
FRONTAL
ALVEOLAR
PALATINE

It is roughly pyramidal and
encloses maxillary sinus.
The base of the pyramid is
formed by the nasal
surface and the apex is
directed towards the
zygomatic process

It has 4 surfaces:
• Anterior/facial surface :
• Posterior/infra temporal:
• Superior/orbital surface :
• Medial/nasal surface :
It encloses a large cavity:THE MAXILLARY SINUS
SURFACE

Posterior (Infratemporal Surface)
Maxillary
tuberosityOpenings for alveolar
canals(posterior
superior alveolar n &v)
Maxillary tuberosity
articulating with palatine
bone
Groove for
maxillary
nerve(greater
palatine)

Infra orbital groove
Infraorbital canal
canalis sinosus
Infraorbital foramen
Infraorbital nerves and vessels
Anterior superior alveolar nerves and vessels
Superior(Orbital Surface……)

Frontal Process
•It projects postero-superiorly between the nasal and lacrimal bones.
•The frontal process apically joins with the nasal notch of frontal bone
at fronto -maxillary suture.
•Anterior border articulates with lateral border of nasal bone and the
posterior with lacrimal bone.

Zygomatic Process
It is a pyramidal projection where anterior, infra temporal and orbital
surfaces converge.
• It articulates with the maxillary process of zygomatic bone.

Alveolar Process
Thick, arched, wide behind and
socketed for tooth roots
- Eights sockets on either side
Canine: deepest
Molars: widest and subdivided into three by septa
Incisors and Second premolar: single socket
first premolar: sometimes double
- Maxillary torus may be occasionally present

PALATINE PROCESS
Greater palatine foramen
(greater palatine nerves and vessels)
Intermaxillary suture
Incisive foramen
(terminal parts of nasopalatine
nerves and
Greater palatine vessels)
Posterior nasal spine
Alveolar process
Palatomaxillary suture
Palatine torus seen sometimes

Maxillary Sinus
• Pyramidal
• ROOF: floor of the orbit transvered by
the infraorbital canal.
• FLOOR: by the alveolar process of
maxilla. Lies about half inch below the
level of the floor of the nose.
•APEX : Directed laterally towards
zygomatic bone.
•MEDIAL WALL OR BASE : Partly by
the lateral wall of the nose and by palatal
process of maxilla.

• Sinus opens in to middle meatus of nose usually by two openings.
• In the lower part of the haitus semilunaris the second opening at posterior
end of haitus.

Anteroposteriorly Superioinferiorly Mediolaterally
Perinatal period 7-16mm 2-13mm 1-7mm
1 year 15mm 6mm 5.5mm
15 years 31.5mm 19mm 19.5mm
Adult 34mm 33mm 23mm
Size of maxillary sinus

Articulations Of Maxilla
1. Frontal
2. Lacrimal
3. Nasal
4. Ethmoid
5. Opposite Maxilla
6. Inferior Nasal Choncha
7. Palatine
8. Vomer
9. Zygomatic
superiorly
medially
laterally

B. NERVES AND VESSELS:
- Infraorbital nerve and vessels
- Anterior superior alveolar nerve and vessels- canalis sinosus
- Groove for maxillary nerve- maxillary tuberosity
- Nasopalatine nerve- incisive canal
- Greater palatine artery- incisive canal
- Greater palatine nerve and vessels
- Posterior superior alveolar nerve and vessels alveolar canals
58

Age Related Changes In Maxilla
At Birth:
• Transverse and anteroposterior diameters are each more than
vertical diameter.
• Frontal process is well marked .
• The tooth socket reaches the floor of the orbit.
• Maxillary sinus is more furrow on the lateral wall of the nose.

In Adults:-
• Vertical diameter is greatest due to development of the alveolar process
and increase in size of the sinuses.
In Old Age:-
• Height of the bone is reduced .
• Resorption of the alveolar process or ridges takes place in a characteristic
fashion .
• In addition to this, there is either lingual or vestibular resorption ,the
alveolar ridges frequently do not develop cortical bone and present sharp
and cancellous bony ridges immediately below the alveolar mucosa.

• The maxillary tooth are inclined labially and following their loss the
labial plate of the bone resorbs more than the lingual plate.
• It results in smaller alveolar arch and an overall decrease in necessary
support area.
• Vertically the posterior segment tends to shrink more than the anterior
segment.

CLINICALAND PROSTHODONTIC
CONSIDERATION

Developmental Anomalies Of Maxilla
Epstein’s pearls and Bohn’s
nodules
(Neville BW, Damm DO, White OK:Color atlas of clinical oral pathology. ed 2,Philadelphia,
1999,Williams& Wilkins.)
Franschetti (Mandibulo
facial dystosis)
(treacher collins)

Torus palatinus.
Oblique facial cleft

Down syndrome
(Trisomy 21)
Cleft lip and palate
Colour Altas Of Oral Disease In Children And Adolescent:Crispia S And Richard W

Cleidocranial dysplasia
Pierre robin syndrome (bird
faces)
Colour Altas Of Oral Disease In Children And Adolescent:Crispia S And Richard W

Apert syndrome
Crouzon’s / craniofacial
dysplasias

Achondroplasia
Paget’s disease/ ostetis
deformans

Maxillary Anatomic Landmark And Denture Showing
Corresponding Landmark
 Prosthodontic Treatment For Edentulous
Patients;13th Ed ;Zarb And Bolender

ARAMANY CLASSIFICATION SYSTEM FOR MAXILLECTOMY
DEFECTS.
J Prosthet Dent. 1978; 40: 554-557).

Prosthodontic Consideration
Zygomatico-Alveolar crest:
-The mucosal covering is very thin, mucosa not considered desirable for stress
bearing and sometimes should be relieved. If not, it results in poor retention of
the denture.
 Maxillary tuberosity:
- Provides resistance to horizontal movements. Posterior wall resists
movement in anterior direction.
- The denture base should cover the tuberosity and fill the hamular notch.
Mid palatine suture:
If prominent, becomes fulcrum point around which the denture rotates causing
discomfort and damage to soft tissues
72

 Palatal torus:
Hyperplastic growth of bone which needs to be relieved or removed surgically.
 Incisive foramen:
Nasopalatine nerve makes its exit to the palate. The foramen should be relieved in
the denture.
Cleft Palate:
Feeding plate and Obturator
Cleft lip :
Missing lateral incisors are replaced with RPD or FPD or Implants
Torus Palatinus: LARGE----Surgery
SMALL----Relief in denture
Soft Palate Cleft:
Artificial velum
Carcinoma Of Maxillary Sinus-
Maxillectomy-Obturator

Anatomical Consideration In
Implantology In Maxilla

Dental Impalnt Prosthetics-Carl E Misch;2nd Edition

J. Pharm. Sci. & Res. Vol. 8(6), 2016, 565-569

From Lekholm U, Zarb GA: Patient selection and preparation. In Brånemark P-I, Zarb GA, Albrektsson T, editors: Tissue
integrated prostheses: osseointegration in clinical dentistry, Chicago, 1985, Quintessence
Lekholm And Zarb -Bone Qualities For The
Anterior Region Of The Jaw

Subantral Classification
Dental Impalnt Posthetics-Carl E Misch;2nd edition

• The implant should be at least 1.5 mm away from the adjacent teeth
• The implant should be at least 3 mm away from an adjacent implant
• A wider diameter implant should be selected for molar teeth.
• Distance of implant from nasal floor is 5mm.
• Distance of implant from maxillary sinus is 2-3 mm.
• Success rate of mandible is more compare to maxilla as more bone
density and blood supply.

• After acquisition of data, an individual computer-based 3D model of the bony
defect is generated.
•These data are transferred into RE software to create the prosthesis using a
computer-aided design (CAD) model, which is directed into the RP machine for
the production of the physical model.
• The precise fit of the prosthesis is evaluated using the prosthesis and skull
models.
•The prosthesis is then directly used in investment casting such as “Quick
Cast”pattern to produce the titanium model.
•To improve the maxillofacial surgery outcome modern manufacturing methods
such as rapid prototyping (RP) technology and methods based on reverse
engineering (RE) and medical imaging data are applicable to the manufacture of
custom-made maxillary prostheses.

CONCLUSION
• In order to construct a prosthesis a dentist requires an
understanding of the foundation, it’s components, its
properties and qualities must be analysed to assure proper
support for the proposed prosthesis.

 Langman’s Medical Embryology – T.W. Sadler, 5th Edition.
 An Introduction To Human Embryology For Medical Students – Inderbir Singh, 5thedition.
 Craniofacial Embryology – G.H. Sperber, 4th Edition.
 Oral Anatomy,histology And Embryology ;3rd Ed; Berkovitz
 Colour Atlas Of Clinical Embryology – Keith L. Moore, T.V.N. Persaud, 2nd Edition.
 The Essentials Of Facial Growth – Enlow And Hans, 1st Edition.
 Contemporary Orthodontics – William R. Proffit.
 Handbook Of Orthodontics;4th Edn; Robert E.Moyers
 Orthodontics-the Art And Science ;3rd Edn; S I Balaji
 Prosthodontic Treatment For Edentulous Patients;13th Ed ;Zarb And Bolender
 Thieme Atlas Of Anatomy Head And Neuroanatomy; Michael Schuenke Erik Schulte Udo
Schumacher, Lawrence M. Ross Edward D. Lamperti Ethan Taub, Markus Voll Kariwesker 2010
 Colour Altas Of Oral Disease In Children And Adolescent:crispia S And Richard Welbury
 Dental Impalnt Posthetics-Carl E Misch;2nd edition

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