30 yr man

CBCT 90300

3D visualmethods

Skull with cavitiestendinous

insertions; ligamentsprojection of thenerves and vessels; their arrangement

Topographicrelation betweenstructures

IK

mandibula

palato-quadratum

hyomandibulare

hyoidealeVI

23456

IIIIIIIVV

1

Capsula ethmoidea

Capsula opticaCapsula

otica

Vertebrae occipitales

Arcus branchialesIK

Neurocranium and Viscerocranium (splanchnocranium)

Formation of splanchnocranium from branchial archesIK

desmocranium chondrocranium

IK

Edwin Stephen Goodrich1868-1946

The evolution of living organisms

Studies on the Structure & Development of Vertebrates

Development of the skull basis

Week 6IK

Holoprosencephaliapříklad: Cyclopia

Acraniapříklad: AnencephaliaIK

otocephalia, otoencephalia, agnathiaIK

Postnatal growth finalized bone forms; later also arrangements of

the bone tissue

Skull vault (cap) ! ? !

maxilla

mandibulaIK

Brain growth; ossification of synchondrosis sphenooccipitalis; expanding of eye bulb, muscle drawing; nasal septum growth; teeth eruption

The main events determining skull form

Growth types:General – to 70% final size 6 yrCranial – to 80% final size 6 yrFacial – to 80% final size 6 yrIK

neonatus

27 years

1 year

juvenileExternal form changes

face width - starts to growth earlier face length – finish to growth later

IK

Growth of skull basis1 yr os frontale (sinus frontalis)4 yr cribriform lamina of ethmoidal bone7 yr spheno-ethmoid,-frontal; fronto-sphenoid

resorptive areae – around lacerum foramen, jugular fossa, medial lamina of pterygoid process

nazozygomaxillar complex – from sutures surroundingmaxilla

infrazygomatic crest –sutura palatina transversa after EnlowIK

see: www.lf1.cuni.czor: http://anat.lf1.cuni.cz/aindex.html

IK

http://www.lf1.cuni.cz/http://anat.lf1.cuni.cz/aindex.html

*IK

Jawsγνάθος

(gnathos)

MaxillaMandibulalower facesegment

FORMgenetic determination

INNER STRUCTUREpressure and tension of the musclec surrounding mandible; teeth

eruption

FORMATIONfunctional demands and fusion of the primordia developed before

REMODELLATION DUE TO AGEchanged functional conditions, hereditary influences

IK

maxilla growth eventsventrokaudallyunder influence of frontomaxillaris, zygomaticomaxillaris, pterygopalatina sutures

around axis crossing interalveolar septum between lateral deciduous incisor and caninus

(„opening bridge“)incisiva et intermaxillaris sutures

septum nasiinfluence to surrounding structures

postnatallysutura palatina mediana (7-19 yr about 5 mm)

IK

Crista infrazygomaticazygomaticoalveolarisIK

MaxillaCorpusProc. frontalisProc. zygomaticusProc. AlveolarisProcessus palatinus

Sinus maxillaris(antrum Highmori) –opened to skullnasal cavity as a hiatus maxillaris

Fossa lacrimalisFossacaninaIK

Musclesare not insertedto fossacanina !!IK

1

2

3

45

6

7 8

910

11

1215

16

13 14V2IK

V2

canalis sinuosus (Pardanaudi)IK

IK

A M Shelley, V E Rushton & K Horner: Canalis sinuosus mimicking a periapical inflammatory lesionBritish Dental Journal 186, 378 - 379 (1999) Published online: 24 April 1999

IK

Palatum durumIK

week 6.5 IK

Palatal processesare mutually fusedone week laterin women than men

week 10IK

IK

EruptionIK

IK

8 mm

Hrbolková linie Vzdálenost od řezákového bodu ke spojnici mezi hroty špičáků Tubercular line Distance between incisale point and line connecting tops of canini

IK

Sulcus palatinus major; its content

IK

born time:

biphasic growth

topography

month

yryr

yrIK

„Maxillary ductDuctus maxillaris“

Linie patra palatum (palatal line)

Wall ofrecessusfrontalis is thinIK

mandibula growth eventscondyle growth

ramus mandibulae relocation

dorsal margin of ramus appositionforamen mandibulae changes position: symphysis menti

canalis mentalisIK

Latr trias mammal

Jurassicmammal

platypusIK

Canalis alveolaris inferiorformation; formation of the

mandibular body

M.Doskočil: Chrupavka ve vývoji mandibuly. (cartilage in the development of the mandible) Cs.Stomatologie, 1:10-18, 1988 Klepáček, Mazánek et al. 2002

SecondarycartilageIK

Grey 1918IK

rovina okluze occlusal planeprotetická rovina Camper plane

xvodorovná rovinahorizontal plane

M.Doskočil: Chrupavka ve vývoji mandibuly. (cartilage in the development of themandible) Cs.Stomatologie, 1:10-18, 1988

Meckel´s cartilage and cartilaginous derivatives insidemandibular neckIK

ENDIK

aposice

Additions of jaw mass in women are between 9-18 year to less than half of menIK

V principle

IK

mandible growthcondylar growthremodelation (influenced by insertion of m. pterygoideus lat.)

Relocation ramus mandibulaeVertical growth, alveolar formation

Apposition on dorsal surface of ramus mandibulae

Foramen mandibulae ´chages´position: (from level of upperalveolar margine to occlusal plane of the last molar 3-15 yr)

Symphysis mentiVentrally is gradually missing - afer postnatal month 6 is not seen

Canalis mentalisinfluenced by interstitial bone growth and growth of the mandible to widthIK

Podle Čiháka 1997IK

Feature ´rotation´duringdevelopment:Around condyle axisAround imaginaryaxis which isparallel with body ofmandible

matrix rotation (matrix rotation, apparent rotation):

(´shift´ of the superficialjaw layer due to surrounding hard structures)Inner rotation of the

matrix (intramatrix rotation, angular remodelling)(´rotation´ of thespongiosa insidejaws)

Sc. Total rotation of thematrix -rearrangement of jaw IK

IK

red line lomená linka –

přibližný rozsah úponu

hluboké části masseterusupposed

extent of thedeep

masseterpart

IK

IK

Hmatné struktury

Palpable structuresIK

Foramenlinguale ? _ _

FETAL MONTH 3

FETAL MONTH 7

YEAR 1IK

IK

Eaglův syndrom –

osifikace vazu společně s

osifikací lig. stylohyoideum

dráždí n. IXIK

Eruptio dentorum

IK

0.1-0.4 mm

IK

En-En – šířka čelisti

mandible width

Co-Ii-Co –Bonvillův trojúhelník

Bonvill triangleIK

After Lang et al. 2002

Canalis retromolaris A,B,C)

Canalis (foramen) linguale

A

B CIK

The anterior loop (AL) of the mental nerve: length variations from the most anterior loop point to mental foramen. Colours: blue = MIC, red = mental canal (the anterior opening of the mandibular canal) yellow = mandibular canal. 1 = length of the AL (0.00 to 10 mm).

Panoramic radiograph showing extension of the mental nerve beyond the mental foramen boundary as an intraosseous anterior loop (arrows). Juodzbalys G, Wang HL, Sabalys G.: Anatomy of Mandibular Vital Structures. Part II: Mandibular

Incisive Canal, Mental Foramen and Associated Neurovascular Bundles in Relation with DentalImplantology.J Oral Maxillofac Res. 2010 Apr 1;1(1):e3. doi: 10.5037/jomr.2010.1103. eCollection 2010.

IK

Anatomical variations of the mental foramen (MF) position in the horizontal plane in relation to the roots of teeth.Colours: blue = MIC, red = mental canal (the anterior opening of the mandibular canal) yellow = mandibular canal.1 = distance from MF to midline of the mandible (approximate distance 28 mm); 2 = distance from MF to the inferior border of the mandible (14 to 15 mm); 3 = possible MF location zone in the horizontal plane in relation to the roots of teeth; 4 = the shape of MF can be round or oval, the diameter is 1.68 to 3.5 mm; 5 = prevalence location of MF in the horizontal plane for Caucasian population; 6 = prevalence location of MF in the horizontal plane for Mongoloids and African people.

The appearance of the mental foramen on panoramic radiographs: classification by Yosueand Brooks. A = continuous; B = separated; C = diffuse; D = unidentified type.IK

Emergence patterns of the mental canal and mental foramen opening

Colours: blue = MIC, red = mental canal (the anterior opening of the mandibular canal) yellow = mandibular canal. A = superiorly, B = posterosuperiorly; C = labially; D = mesially (anteriorly); E = posteriorly.

Blue: karea betweenmental openingsinterforaminous regionIK

Rearrangement of the innerjaw structurerespectsmasticatingpressure

Hustota spogiosy

IK

Pressureand tensiontrajectories

in mandibleIK

Transfer of pressure

and loadin mandible

after Lang 1995

Trajectorium dentale(to proc. condylaris)

basilare(from corpus to neck as posticum)

marginale(in angulus)

praeceps(to linea mylohyoidea

and to linea obliqua externa)

copolans(incisura mandibulae)

transversum(from proc.coronoideus to angulus)

radiatum(below each alveolus) IK

Postnatal:Width of face isenlarged slowelyand is finishingthat earlyFace high isenlarged more and finish late

After year 40 resorption is up the aposition

Mandible growsvery long

Jaw growth: anteriorotation Physiologic(ventrocaudaly) Total (whole) influences also aktivity of the

surrounding structures(matrix rotation, apparent rotation)

rotation of the matrix: (intramatrix rotation, angularremodelling)IK

IK

cranial growth size about 90%very low pubertal spurt 5-7 year final size

facial growth 6 year cca 80%pubertal spurt is proportional final size

skeletal (general) growth about 6 yearpubertal spurt accelerate cca 70%

final sizeIK

IK

*IK

IK

posterorotation anterorotationIK

Gender differences

between male and female

skullsIK

ageHead

circumference

Born time 34 cm 6 month 43 cm 1 year 47 cm 3 year 50 cm 10 years 53 cm 18 years 56 cm

Proportional growth

•Relation between head/body: newborn 1/4, adult 1/8

•Relation between body/muscles: 22 % in month 3, 35 % after yr 3, 40 % adult man.

energy•newborn: 40 % energy on growth (110 kcal/kg daily); •toddler: 3 % energy on growth (60–90 kcal/kg daily).

IK

http://www.wikiskripta.eu/index.php/Kojenechttp://www.wikiskripta.eu/index.php/Batole

rovina okluze occlusal planeprotetická rovina Camper plane

xvodorovná rovinahorizontal plane

IK

after Deffez1985

Patrová deska

Palate plateIK

Transmitionof the

masticatorypress on

skullstructures

Three buttresses allow face to absorb force

Nasomaxillary(medial) buttress

Zymaticomaxillary(lateral) buttress

Pyterigomaxillary(posterior) buttress

Midfacebuttresses

vertical and horizontal

IK

• Three buttresses allow face to absorb force– Nasomaxillary

(medial) buttress

– Zymaticomaxillary (lateral) buttress

– Pterygomaxillary (posterior) buttress

Midface buttresses

IK

Tractionand tensionlines in skull

baseIK

Traction and tension lines and main fracture lines in skull basisIK

leFort fractures(René Le Fort 1902)

Location of the fracturelines :

• Medial orbit wall

• Lateral orbit wall to sutura frontozygomatica

• Processus pterygoideus

• Basal part of the nasalseptum - septum nasi

• arcus zygomaticus

IK

Le Fortfractures

Le Fort IGeren fractureSubzygomaticIK

Le Fort fractures

Le Fort IIPyramidal,

central, uppersubzygomaticIK

Le Fort fractures

Le Fort IIISuprazygomatic

fractureIK

CondyleUpper

Lower neck

Retromolar (angular)

Through canine, through

mental region

Fracture lines in the mandible

Traction and tension linesIK

TEETH

tooth dens lat.odoús (ὀδoύς), odóntos (ὀδόντος) gr.

DENTES

(incisor, canine, premolar, molar

(Y5 “dryopithec“ formula )IK

Gingival border of occlusal plane

Prominentia (swallen tubercle surface)determines direction of tubercle gliding during mastication

Sklovinná lišta spojuje hroty hrbolků a valy

M1IK

Utváření horní čelisti a zubního oblouku

materiál dentálního výběžku se musí spojit s výběžkem

faciálnímIK

after Ash and Ramfjord 1982

Hrbolková linie

Centrictubercle

Centrictubercle

Centralocclusion(points in contact appearto be stops (theyare in maximal

intercuspidation) (point centric)

Dynamicocclusion(tubercles are moved betweenICP and RCP and slightly alsoto sides) (free centric)

After Krause 1969

Lines betweeninner and outertubercles

Hrbolková linie

Occlusal contacts antagonistic teeth during intercuspidation

….jsou mezi opěrnými

a protilehlými hrbolky

acentrictubercle

acentrictubercleIK

Dentalarches

Conics

Closed eclipse(elipsoid form)

Opened eclipse(parabolic form)

Berkovitz a kol. 2002

Jaw forms

Schuenke a kol. 2006

IK

Usual occlusal relation between antagonistic teeth

Edward Hartley Angle (1855 – 1930) american dentist and orthodontist„father of modern orthodontia“Normoocclusio I. classIK

IK

I.

II.

III.

Bite enhancementand formation of the

relations between dentalarches during eruption

^ Ash, M. M. and Stanley J. Nelson, S. J.: Dental Anatomy, Physiology, and Occlusion. 8th edition. 2003

The distance between opposite alveolar margines is increasedyear

year

year

Bite enhancement

Bite enhancement

Bite enhancement

IK

http://en.wikipedia.org/wiki/Tooth_eruption

IK

IK

Berkowitz et al.: Oral Anatomy, Histology and Embryology. 3rd ed.. Mosby 2002Woelfel, Scheid: Dental Anatomy, 6th ed. Williams & Wilkins, 2002Feneis, Dauber: Pocket Atlas of Human Anatomy. Georg Thieme, 2007Weber: Memorix Zahnmedizin. 2nd. ed., Georg Thieme Verlag 2003Schuenke,Schulte,Schumacher: Head and Neuroanatomy. Thieme, 2006Fehrenbach,Herring: Anatomy of the Head and Neck. 3rd ed., Saunders Elsevier, 2007Snell: Clinical Anatomy for Medical Students. Williams and Wilkins, 2004 Moore, Agur: Essential Clinical Anatomy, Williams and Wilkins 2002Lang: Clinical Anatomy of the Masticatory Apparatus and Peripharyngeal Spaces. Stuttgart, Thieme, 1995White, Pharoah: Oral Radiology: Principles and Interpretation 5th ed., Mosby, 2003Bath-Balogh: Workbook for Illustrated Dental Embryology, Histology and Anatomy. 2nded. 2005, SaundersWhaites: Essentials of Dental Radiography and Radiology. 4th ed., 2006Churchill Livingstone Ivo Klepáček, J. Mazánek et al.: Klinická anatomie ve stomatologii. Grada 2002Own archive

see: www.lf1.cuni.czor: http://anat.lf1.cuni.cz/aindex.html

Sources

IK

http://www.lavoisier.fr/gb/livres/index.asp?togo=detail.asp?texte=506213&action=new&select=auteurhttp://www.lf1.cuni.cz/http://anat.lf1.cuni.cz/aindex.html