ORTHO CHP 3 EARLY STAGES OF DEVELOPMENT

iii.

b
i.
ii.

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Outline

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2.

3.

4.

Prenatal Influences on Facial Development

Embryologic

Late Fetal + Birth

Infancy and Early Childhood: The Primary Dentition Years

Physical Development in Preschool Years

Maturation of Oral Functions

Eruption of Primary Teeth

Late Childhood

Physical Development in Late Childhood

Eruption of Permanent Teeth

Eruption Sequence and Timing

Space Relationships in Incisors Replacement

Prenatal Influences On Facial Development

1. During embryologic development
a
Intro:
i.
Nearly all tissues of the face and neck (including
skeletal and muscular) originate in ectoderm.
ii.
2 stages:
a. Migration: neural crest cells migrate downward
beside the neural tube and laterally under the
surface ectoderm
b. Differentiate into tissues and organs

iv.

v.

vi.

Stages of Embryonic Craniofacial development:

Neural Crest Cell Problems
Mainly from 3rd stage of development: neural crest
cell origin and migration
At the completion of neural crest cell migration in 4th
week of embryonic life, neural crest form practically
all loose mesenchymal tissue in the facial region
that lies between surface ectoderm and underlying
forebrain and eye and most of the mesenchyme in
the mandibular arch.
Altered neural crest development also has been
implicated in mandibulofacial dystosis (Treacher
Collins syndrome) and hemifacial microsomia.
Treacher Collins syndrome: both maxilla and
mandible are underdeveloped as a result of a
generalized lack of mesenchymal tissue
Hemifacial microsomia: lack of tissues on affected
side of face.
a. Deformed external ear and both mandibular
ramus and associated soft tissues (muscle,
fascia) are deficient or missing.
b. Arises from early loss of neural crest. The cells
with the longest migration to the lateral and
lower areas of face are most affected.
c. Neural crest cells migrating to lower regions are
important in great vessels formation; defects in
aorta, pulmonary artery, aortic arch (tetralogy of
Fallot) are common in hemifacial microsomia.
Facial Cleft Problems
a. Most common congenital defect involving the
face and jaws.
b. Clefts arise during the fourth developmental
stage.
c. Lip cleft: failure of fusion between median and
lateral nasal processes and the maxillary
prominence, which occurs during 6th week of
development
1.
Lip clefts occur lateral to midline on either or both

2.

sides.
Since fusion during primary palate formation
creates lip and the alveolar ridge containing central
and lateral incisors, it is likely an alveolar notch will
accompany a cleft even in the absence of cleft in
secondary palate.
d. Closure of secondary palate by elevation of the

palatal shelves follows that of primary palate by

2 weeks.
1.
About 60% with cleft lip also have palatal cleft
2.
An isolated cleft of secondary palate arises after lip
closure completes
Incomplete fusion of secondary palate, which produces a notch in its
posterior extent (bifid uvula), indicates a very