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orthodontics > normal and abnormal facial growth > Flashcards

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
Q

at what age do deciduous teeth start to erupt?

A

-6 months

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26
Q

when is the deciduous dentition normally completed by?

A

age 3

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27
Q

when is root formation completed after the tooth erupts?

A

18 months after

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28
Q

when do deciduous teeth calcify?

A

in utero

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29
Q

when do deciduous teeth begin to exfoliate and when do they complete permanent eruption and what is the exception?

A

-6 years
-13 yrs
-except 8s

30
Q

when is root formation of permanent teeth normally completed after eruption?

A

3 years after

31
Q

permanent teeth are bigger then deciduous teeth, how is this facilitated?

A

-erupted into bigger arch
-decidious had spacing
-jaw growth

32
Q

discuss the buccal width of dec and perm teeth and what is the purpose?

A

-dec teeth have wider buccal teeth
=leeway space
-allows space for canines and pre-molars to erupt

33
Q

why is the leeway space in the lowers larger?

A

-allows 1st perm molars to erupt into class position- will be slightly further forward that the upper 1st molars

34
Q

when do perm teeth finish erupting?

A

when they occlude with each other

35
Q

what can late growth of the mandible cause in early 20s?

A

lower inscisor crowding

36
Q

what is an abnormality of the calvarium (incomplete skull)

A

craniosynotosis

37
Q

what is craniosynotosis?

A

premature fusion of the sutures of the calvarium- causing abnormal head shapes

38
Q

what is a abnormality of the nm complex and pro-facial musculature?

A

cleft lip and palate

39
Q

when does the lip form?

A

around 5-6 weeks in utero

40
Q

how is the upper lip formed and alveolus ?

A

by maxillary processes

41
Q

how does the palate form?

A

when the palatal shelves flip from vertical to horizontal and fuse- around 8 weeks in utero

42
Q

what is the most common craniofacial birth defects?

A

CL and P

43
Q

what’s more common in
CLP
CP
CL

A

males
females
males

44
Q

what is more common unilateral or bilateral ?

A

unilateral- LHS more common

45
Q

what causes CLP?

A

-genetic factors
-envirnomental factors- smoking, maternal age, alcohol

46
Q

how is CLP classified?

A

LAHSHAL system

47
Q

how are cleft lips diagnosed before birth?

A

ultrasound at 20 weeks- easier to diagnose CL than CP

48
Q

what happens if CLP goes unnoticed after birth?

A
  • will cause problems feeding- not enough food taken in by baby and will cause failure to thrive.
49
Q

what are general problems that CLP cause?

A

-breathing
-feeding
-speech
-hearing
-bullying
-learning difficulties

50
Q

what are dental problems that CLP can cause?

A

-facial appearance
-hypodontia
-supernumeraries
-hypoplastic teeth
-high caries rate

51
Q

when are CL surgeries performed in UK?

A

-at 3 months
-as lip and nose are more developed
-anaesthesia risk reduced

52
Q

when are CP surgeries performed in UK?

A

6-9 months
-to get better functioning muscles before speech starts to develop

53
Q

what is the main dental problem with CLP?

A

-higher caries risk

54
Q

what should be done due to higher caries risk of CLP?

A

PREVENTION

-OHI
-regular dental visits
-diet advice
-fluoride varnish
-fissure sealants
-duraphat

55
Q

what other surgery may be required for CLP ?

A

-alveolar bone grafting

56
Q

what are the reasons for alveolar bone grafts?

A

-facilitate tooth eruption
-support teeth
-provide stability to cleft segment
-close fistula
-reduce need for prosthetic teeth at cleft site
-improve aesthetics

57
Q

when are bone grafts complete?

A

8-10 yrs

58
Q

when do they take radiographs before grafts?

A

age 7
-when 1/2-2/3rds of canine roots are formed

59
Q

what teeth are commonly missing in clp?

A

upper 2s - or very small in size

60
Q

if upper 2s are present what may be done?

A

earlier bone graft to assist aligning upper 2s

61
Q

why is pre-alveolar bone graft orthodontics performed?

A

use removable appliances to:
-improve surgical access
-reveal true extent of fistula

62
Q

what else may orthodontists do pre-surgery?

A

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
Q

when are extractions carried out?

A

2 months before to allow tissues to heal before surgery

64
Q

what does an alveolar bone graft involve?

A

take distant bone and adding it to the cleft site

65
Q

what other orthodontic management may be necessary after surgery?

A

-fix alignment
-fix hypodontia-prosthetics

must always have retention to prevent relapse

66
Q

what is Orthognathic surgery?

A

-to fix deficient maxillaries that arise after CLP surgery
-pt may have class III malocclusion

67
Q

what are the risk of Orthognathic surgery?

A

-relapse due to splits of soft tissue-due to scarring
-compromise speech

68
Q

what is an alternative to orthgnatic surgery?

A

distraction osteogenesis

69
Q

what is distraction osteogenesis?

A

slow movement of skeletal pattern change- gradual stretching of soft tissues

70
Q

what are the differences in outcomes of os and dog?

A

neither have been proved to have better outcome

71
Q

how can feeding affect child?

A

communication between nasal and oral cavity- may require special bottle which ejects fluid

72
Q

how can breathing affect child?

A

-babies breathe whilst feeding
-CLP often cause nasal obstructions

orthodontics (5 decks)

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