Klepáček

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Morphology of the
orofacial system
St. Apollonia
Ivo Klepáček
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OROFACIAL SYSTEM
is mutually cooperating biological
multifunctional system; its parts support
and save each other
Teeth and muscles related
to mandible, extrinsic and
intrinsic tongue muscles
Muscles
Fast healing
of the
infectious
wounds
Teeth
CNS
fonation
speech
gnawing
digestion
Periodontium, joints,
ligaments, nuchal muscles
Joints
Jaws
Periodontium (parodontium)
Important
from the
aesthetic
point of
view
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rovina okluze
occlusal plane
protetická rovina Camper plane
x
vodorovná rovina
horizontal plane
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Enamel
Dentine
Pulp
Periodontium and cement
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Projection of the root canaliculi to the crown pulp cavity
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Tooth
axis
angle
sign
Rooth sign
Curve
sign
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Signs of determination
deciduous
Number
Position
Size
Colour
Form of the
crown (roots)
Pulp cavity
Med 1968
permanent
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FDI
Fedérale
Dentaire
Internationale
ADA
American Dental
Association
Adolph Zsigmondy
(1816 - 1880), Hungarian
dentist
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Bolk L: Das Gewicht der
Zähne. Anat Anz 1925; 59:572-574.
Multitubercular dimeric theory:
Appearance of ´para teeth´ means
separation of tooth primordia from
original multitubercular primordium ??
Lodewijk 'Louis' Bolk (1866 – 1930) Dutch anatomist
(fetalization theory (neoteny))
Fully matured organism exhibits juvenile signs
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TEETH
DENTES
tooth
dens lat.
odoús (ὀδoύς),
odóntos (ὀδόντος) gr.
(incisor, canine, premolar,
molar
(Y5 “dryopithec“ formula )
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M1
Gingival border of occlusal plane
Prominentia (swallen tubercle surface)
determines direction of tubercle gliding during mastication
Sklovinná lišta spojuje hroty hrbolků a valy
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Detail of the enamel
crown
neck
Detail of the damaged enamel
Tooth – SCAN
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Central contacts = responsible for
buccolingual and mesiodistal stability of
lower masticatory plane
Tripodization:
contacts on triangular-like swellings near
the foveolae
Bipodization: contacts on margines of neigbouring teeth
fossa–tubercle;
tubercle–fossa
(tooth – tooth)
fossa–tubercle;
tubercle–marginal
tooth line
(one tooth-two teeth)
Upper
jaw
Ideal situation:
between molars – 9; between premolars 4, between canines
and incisors 2
Lower
jaw
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Dental
arches
Jaw
forms
Closed eclipse
(elipsoid form)
Conics
Opened eclipse
(parabolic form)
Schuenke a kol. 2006
Berkovitz a kol. 2002
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Edward
Hartley
Angle
Normoocclusio I. class
(1855 – 1930)
american dentist
and orthodontist
„father of
modern
orthodontia“
Usual occlusal relation between antagonistic teeth
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Varieties
and
anomalies
• Mesiodens
• Paramolar
• Tuberculum Carabelli
• Divergency or
convergency of roots
• root fusion
• tooth in the tooth
(dens in dente)
• hyperplasia of the
roots
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Varieties
of the
tooth
positions
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Shark palate
Rugae ???
? Folds or ´dental
arches´ ?
..That is a question…
Human palate
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First jaws
Second jaws
Similar demands result in formation of the similar
structures (even from the developmentally different
primordia)
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rovina okluze
occlusal plane
protetická rovina Camper plane
x
vodorovná rovina
horizontal plane
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Position of the M3 right
lower (I. Developmental
stage –
see left tab.)
After Komínek and Rozkovcova
(Rozkovcová E., Marková M., Láník, J, Zvárová J.: Development of third molar
in Czech population. Prague Med Report 2005, 106: 367-398.)
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Mesenchym of
neural crest
Interaction
Epithelium
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Eruption
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Bite enhancement
and formation of the
relations between dental
arches during eruption
The distance between opposite alveolar margines is increased
I.
II.
^
Bite
enhancement
year
year
Bite
enhancement
year
Ash, M. M. and Stanley J. Nelson, S. J.: Dental
Anatomy, Physiology, and Occlusion. 8th edition. 2003
III.
Bite
enhancement
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Formation of the
dental arch and
upper jaw
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multifACTORIAL
ANTICONVULSIVA
(phenobarbital, diphenylhydantoin)
Cytostatic drugs
Imunosupresiva,
Tet racyklin,
radiation
Diabetes
Hypoglykemia
Epilepsia
Stres
corticoids
! Prevency: to cure clefts to second
month of pregnancy !
Early put diagnosis – after third
pregnancy period; to discuss how to
interrupt pregnancy
Clefts
Nen fusion of the face processes
Congenital and teratogenic influences
(criticalperiod and time of influence)
Three critical periods:
25.- 35. day isolated cleft lip
37.- 53. day isololated cleft
palate through damage of
palatal shelves
53.-57. day isololated cleft
palate because of decreased
growth of mandible
20 perc ent – hereditary
10 per cent – outer influence (mother, x-ray)
70 per cent - unknown
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Clefts
Non fusion of face processes;
congenital or teratogenic
influences
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Location of the cleft lines
after Tessier
Location of the cleft lines
after van der Meulen
Tessier P, "Anatomical Classification of Facial,
Cranio-Facial and Latero-Facial Clefts", Journal
of Maxillofacial Surgery 1976
Van der Meulen, JCH et al (1989). "Facial
Clefts". World J. Surg. 13 (4): 373–383.
Nasal
dysplasia
Nasomaxillary
dysplasia
Internasal
dysplasia
Maxillary
dysplasia
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Development of the skull basis
Edwin Stephen Goodrich
1868-1946
Studies on the Structure &
Development of Vertebrates
The evolution of living organisms
Week 6
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Skull and branchial arches of shark
hyomandibulare
6
5
4
Vertebrae
occipitales
3
Capsula
optica
Capsula
otica
Capsula
ethmoidea
1
2
palatoquadratum
VI
V
IV
III
II
I
hyoideale
Arcus
branchiales
mandibula
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Neurocranium a splanchnocranium
(viscerocranium, facial skeleton)
Os frontale, parietale, occipitale, temporale,
sphenoidale, ethmoidale
zygomaticum (1), palatinum (1), maxilla, nasale,
lacrimale,vomer, concha nasalis inferior, mandibula
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desmocranium
chondrocranium
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Neurocranium a Viscerocranium
(splanchnocranium
)
Formation of splanchnocranium from branchial arches
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Holoprosencephalia
příklad: Cyclopia
Acrania
příklad: Anencephalia
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otocephalia, otoencephalia, agnathia
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The main events determining skull form
Brain growth; ossification of synchondrosis sphenooccipitalis; expanding of eye
bulb, muscle drawing; nasal septum growth; teeth eruption
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Mimic muscles around oral cavity are more
developed
Masticatory muscles are less developed
Mimic muscles around oral cavity are slowly
growing
Masticatory muscles are more developed
juvenilis
neonatus
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Change of the bone thicknesses
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External form changes
neonatus
1 year
27 years
juvenile
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Postnatal growth:
Face width
increases slowly
and fis finished
earlier; face length
increases more
and it is finished
later
After yera 40
resorption is more
significant than
apposition
The time of
mandibular growth
is the longest in
comparison to
other facial bones
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Maxillla –
growth
Periostal
apposition
Maxilla dextra
Mandibular
Growth
Periostal
apposition
Jaws
exhibit
physiologic
anterorotation
True rotation:
apparent
rotation +
angular
remodelling
Foramen mandibulae is
before year 15 under upper
margin of the alveolar
process; after yr 15 can be
seen above level crossing
the molar cusps
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Additions in
females
between year
9-18 are even
about one half
lesser than in
males
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see: www.lf1.cuni.cz
or: http://anat.lf1.cuni.cz/aindex.html
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sphenooccipitalis 17.year
Postnatal growth Synchondrosis
Synchondrosis sphenoethmoidalis after delivery
Dislocation
up and
ventrally
Intraoccipital synchondroses year 5
Sphenoid synchondroses delivery time
Fast to year 12.
Dislocation
ventrally
to year 7.
Dislocation
down and
ventrally
after Schumacher 1992, Enlow et al. 2009
Growth to width in the middle and
anterior skull fossa relates to
slight eyeball rotation medially
and ventrally
Slow to year 1518.
Expansion and growth in
synchondroses influence skull
basis form and final appearance
of the face
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Gender differences
between male and female
skulls
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Patrová deska
Palate plate
after Deffeze
1985
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Transmition
of the
masticatory
press on
skull
structures
Midface
buttresses
Three buttresses allow
face to absorb force
Nasomaxillary
(medial) buttress
Zymaticomaxillary
(lateral) buttress
Pyterigomaxillary
(posterior) buttress
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Horizontální
trajektorie
(pilíře)
lebky
Horizontal
trajectories
(butresses)
of the skull
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Traction and tension lines and
main fracture lines in skull basis
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Fractures after Le Fort (René Le
Fort 1902)
Broken lines :
• Medial wall of orbit
• Lateral wall of orbit; line
runs to sutura
frontozygomatica
• Processus pterygoideus
• Basal part of the nasal
septum
• arcus zygomaticus
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Fracture lines in
the mandible
Traction and tension
lines
Condyle
Upper
Lower neck
Retromolar
(angular)
Through
canine,
through
mental region
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rovina okluze
occlusal plane
protetická rovina Camper plane
x
vodorovná rovina
horizontal plane
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Sources
Berkowitz et al.: Oral Anatomy, Histology and Embryology. 3rd ed.. Mosby 2002
Woelfel, Scheid: Dental Anatomy, 6th ed. Williams & Wilkins, 2002
Feneis, Dauber: Pocket Atlas of Human Anatomy. Georg Thieme, 2007
Weber: Memorix Zahnmedizin. 2nd. ed., Georg Thieme Verlag 2003
Schuenke,Schulte,Schumacher: Head and Neuroanatomy. Thieme, 2006
Fehrenbach,Herring: Anatomy of the Head and Neck. 3rd ed., Saunders Elsevier, 2007
Snell: Clinical Anatomy for Medical Students. Williams and Wilkins, 2004
Moore, Agur: Essential Clinical Anatomy, Williams and Wilkins 2002
Lang: Clinical Anatomy of the Masticatory Apparatus and Peripharyngeal Spaces.
Stuttgart, Thieme, 1995
White, Pharoah: Oral Radiology: Principles and Interpretation 5th ed., Mosby, 2003
Bath-Balogh: Workbook for Illustrated Dental Embryology, Histology and Anatomy. 2nd
ed. 2005, Saunders
Whaites: Essentials of Dental Radiography and Radiology. 4th ed., 2006
Churchill Livingstone
Ivo Klepáček, J. Mazánek et al.: Klinická anatomie ve stomatologii. Grada 2002
Own archive
see: www.lf1.cuni.cz
or: http://anat.lf1.cuni.cz/aindex.html