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normal and abnormal facial growth Flashcards

1
Q

what does the facial growth of hard tissues involve?

A

bone

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2
Q

in what ways are facial bones laid down?

A

-endochondral ossification (bone laid within cartilage)
-intramembraneous ossification (bone laid within a membrane)

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3
Q

what can occur after bone is laid down?

A

bone remodelling- where bone is laid down and bone is resorbed to alter size and shape of individual bone

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4
Q

how do bones connect?

A

via sutures- peri-ossteous-fibrous joins (none movable)

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5
Q

what joint is the exception to a non-movable joints?

A

-TMJ

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6
Q

what bony structures of the face?

A

-calvarium (skull)
-cranial base
-naso-maxiallary complex
-mandible

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7
Q

what type of bone lay down occurs in the calvarium?

A

intramembraneous ossification

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8
Q

how many fontanelles are found in the calvarium and what are they for?

A

6- to allow compression of head during birth

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9
Q

where are fontanelles found?

A

where the sutures merge

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10
Q

when do fontanelles close?

A

-18 months

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11
Q

how do fontanelles close?

A

as brain grows-causes tension across sutures-and bone is deposited by intra-membraneous ossification

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12
Q

does remodelling occur in the calvarium?

A

yes- bone formation-external
bone resorbs internally

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13
Q

how is bone laid down in the cranial base?

A

-endochondreal ossification

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14
Q

what two areas of synchondroses occurs in the cranial base?

A

sphenoid-occipital- age 13

sphenoethmoidal- age 7

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15
Q

what does the nasomaxiallary complex include?

A

-maxilla
-nasal septum
-zygomatic bones

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16
Q

how does the nm complex grow?

A

by intramembraneous ossification at sutures

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17
Q

does bone remodelling occur in nm growth?

A

yes

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18
Q

as the cranial base grows how does the nm complex move?

A

move the nm complex forward and down

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19
Q

what type of bone growth occurs in the mandible?

A

-endochondreal ossification

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20
Q

do you get surface remodelling in the mandible?

A

yes- so the mandible can grow in a downward and forward position

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21
Q

when is facial growth completed in females?

A

16-17 years

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22
Q

when is facial growth completed in males?

A

17-19 years

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23
Q

what is involved in the facial growth of soft tissues? orofacial musculature

A

-lips
-tongue
-cheeks

-influences dental arches- teeth lie in position of equilibrium lingual/buccal/labial musculature due to forces from tongue cheek and lips

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24
Q

why do we have gum pads and no teeth at birth?

A

for suckling

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25
at what age do deciduous teeth start to erupt?
-6 months
26
when is the deciduous dentition normally completed by?
age 3
27
when is root formation completed after the tooth erupts?
18 months after
28
when do deciduous teeth calcify?
in utero
29
when do deciduous teeth begin to exfoliate and when do they complete permanent eruption and what is the exception?
-6 years -13 yrs -except 8s
30
when is root formation of permanent teeth normally completed after eruption?
3 years after
31
permanent teeth are bigger then deciduous teeth, how is this facilitated?
-erupted into bigger arch -decidious had spacing -jaw growth
32
discuss the buccal width of dec and perm teeth and what is the purpose?
-dec teeth have wider buccal teeth =leeway space -allows space for canines and pre-molars to erupt
33
why is the leeway space in the lowers larger?
-allows 1st perm molars to erupt into class position- will be slightly further forward that the upper 1st molars
34
when do perm teeth finish erupting?
when they occlude with each other
35
what can late growth of the mandible cause in early 20s?
lower inscisor crowding
36
what is an abnormality of the calvarium (incomplete skull)
craniosynotosis
37
what is craniosynotosis?
premature fusion of the sutures of the calvarium- causing abnormal head shapes
38
what is a abnormality of the nm complex and pro-facial musculature?
cleft lip and palate
39
when does the lip form?
around 5-6 weeks in utero
40
how is the upper lip formed and alveolus ?
by maxillary processes
41
how does the palate form?
when the palatal shelves flip from vertical to horizontal and fuse- around 8 weeks in utero
42
what is the most common craniofacial birth defects?
CL and P
43
what's more common in CLP CP CL
males females males
44
what is more common unilateral or bilateral ?
unilateral- LHS more common
45
what causes CLP?
-genetic factors -envirnomental factors- smoking, maternal age, alcohol
46
how is CLP classified?
LAHSHAL system
47
how are cleft lips diagnosed before birth?
ultrasound at 20 weeks- easier to diagnose CL than CP
48
what happens if CLP goes unnoticed after birth?
- will cause problems feeding- not enough food taken in by baby and will cause failure to thrive.
49
what are general problems that CLP cause?
-breathing -feeding -speech -hearing -bullying -learning difficulties
50
what are dental problems that CLP can cause?
-facial appearance -hypodontia -supernumeraries -hypoplastic teeth -high caries rate
51
when are CL surgeries performed in UK?
-at 3 months -as lip and nose are more developed -anaesthesia risk reduced
52
when are CP surgeries performed in UK?
6-9 months -to get better functioning muscles before speech starts to develop
53
what is the main dental problem with CLP?
-higher caries risk
54
what should be done due to higher caries risk of CLP?
PREVENTION -OHI -regular dental visits -diet advice -fluoride varnish -fissure sealants -duraphat
55
what other surgery may be required for CLP ?
-alveolar bone grafting
56
what are the reasons for alveolar bone grafts?
-facilitate tooth eruption -support teeth -provide stability to cleft segment -close fistula -reduce need for prosthetic teeth at cleft site -improve aesthetics
57
when are bone grafts complete?
8-10 yrs
58
when do they take radiographs before grafts?
age 7 -when 1/2-2/3rds of canine roots are formed
59
what teeth are commonly missing in clp?
upper 2s - or very small in size
60
if upper 2s are present what may be done?
earlier bone graft to assist aligning upper 2s
61
why is pre-alveolar bone graft orthodontics performed?
use removable appliances to: -improve surgical access -reveal true extent of fistula
62
what else may orthodontists do pre-surgery?
improve access by: -extract deciduous teeth at cleft site -extract teeth with poor prognosis -extract supernumerary teeth -extract u2s if distal to cleft to allow room for canines
63
when are extractions carried out?
2 months before to allow tissues to heal before surgery
64
what does an alveolar bone graft involve?
take distant bone and adding it to the cleft site
65
what other orthodontic management may be necessary after surgery?
-fix alignment -fix hypodontia-prosthetics must always have retention to prevent relapse
66
what is Orthognathic surgery?
-to fix deficient maxillaries that arise after CLP surgery -pt may have class III malocclusion
67
what are the risk of Orthognathic surgery?
-relapse due to splits of soft tissue-due to scarring -compromise speech
68
what is an alternative to orthgnatic surgery?
distraction osteogenesis
69
what is distraction osteogenesis?
slow movement of skeletal pattern change- gradual stretching of soft tissues
70
what are the differences in outcomes of os and dog?
neither have been proved to have better outcome
71
how can feeding affect child?
communication between nasal and oral cavity- may require special bottle which ejects fluid
72
how can breathing affect child?
-babies breathe whilst feeding -CLP often cause nasal obstructions

orthodontics (5 decks)

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