LANDMARKS OF THE SKULL

Skull is composed of 22 bones. Some of these are single and some are paired Group into two categories: one group surrounds the brain and one group forms the face The following eight bones make up the neurocranium, the bones surrounding the brain:
Frontal brain (single) Sphenoid bone (single) Ethmoid bone (single) Occipital bone (single) Temporal bone paired) Parietal bone (paired)

Neurocranium bones
Frontal brain (single) Parietal bone (paired) Occipital bone (single)

Sphenoid bone (single) Ethmoid bone (single) Temporal bone (paired)

PAIRED BONES SINGLE/UNPAIRED -maxillae -mandible -palatines -vomer -inferior nasal conchae -ethmoid -nasals -frontal -lacrimals -sphenoid -zygomatics -occipital -temporals -parietals

MAXILLAE
Entire upper jaw Contributes to the formation of the upper portion of the face, nose, orbits and hard palate

PALATAL BONE
Makes up the floor of the nose

Muscles of mastication

 Muscle of mastication move the mandible They include four pairs of muscles: masseter, temporalis, medial pterygoid and lateral pterygoid muscles There are five different ways the mandible moves: elevate, depress, retrude, protrude and lateral excursions

Temporalis Muscle
Fan-shaped, large but flat muscle with both vertical anterior (and middle) fibers and more horizontal posterior fibers.
Innervation: temporal branches of the mandibular division of the 5th nerve Origin: arises from the entire temporal fossa which comprised of the squamous part of temporal bones and the greater wing of the sphenoid bones and the adjacent portions of the frontal and parietal bones Insertion: Inserts on the coronoid process of the mandible Action:
Anterior & middle vertical fibers elevation of the mandible Posterior fibers retraction of the mandible

Medial Pterygoid Muscle

Located on the medial surface of the ramus It is active during protrusion Innervations: nerve vagus Origin: arises mainly from the medial surface of the lateral pterygoid plate and the pterygoid fossa between the medial and lateral pterygoid plates of the sphenoid bone. Insertion: inserts on the medial surface of the mandible in a triangular region at the angle and on the superior adjacent portions of the ramus just above the angle Action: elevates the mandible and for lateral positioning of the mandible

Masseter Muscle
Largest, most superficial, bulky and powerful of the muscles of mastication Origin: arises from the inferior and medial surfaces of the zygomatic bone, the zygomatic process of the maxillae, and the temporal process of zygomatic bone. From here it extends inferiorly and posteriorly towards its insertion Insertion: inserts on the inferior lateral surface of the ramus and angle of the mandible Action: elevates the mandible and applies great power in crushing food.

Lateral pterygoid muscle

Has the fibers aligned most horizontally Short, thick, somewhat conical muscle located deep in the infratemporal fossa and is the prime mover of the mandible Origin: arise from two heads, both located on the sphenoid bone
Superior head smaller, attached to the infratemporal surface of the greater wing of the sphenoid bone. Active during various jaw-closing movements only, such as chewing Inferior head larger, attached to the adjacent lateral surface of the lateral pterygoid plate on the sphenoid bone. Active during the jaw-closing movements and protrusion only.

 Insertion: inserts on the depression on the front neck of the condyloid process called the pterygoid fovea, and into the anterior margin of the articular disc. Actions:
to protrude the mandible To depress the mandible Contralateral abduction. When only one lateral pterygoid contracts, it pulls the condyle on that side medialward and anteriorly, moving the body of the mandible and its teeth toward the opposite side.

 SUPRAHYOID -geniohyoid -mylohyoid -stylohyoid -digastric

INFRAHYOID - sternohyoid - thyrohyoid - sternothyroid - omohyoid

Temporomandibular Joint

Temporomandibular Joint
Joint or articulation is the connection between two separate parts of the skeleton. Craniomandibular joint/temporomamdibular articulation between the mandible and two temporal bones Three articulating parts of temporomandibular joint:
1. mandibular condyle 2. articular fossa and articular eminence (tubercle) of the temporal bone 3. articular disc

Articulating parts of the condyle

fossa

condyle meniscus

Articular disc Articular eminence

Retrodiscal pad

condyle

Lateral pterygoid muscle

Articular Disc
0val fibrous plate found between the condyle head and the mandibular fossa. It is avascular, semi-rigid, biconcave disc which serves to adopt the bony surface of the joint during functional activity. 1. inferior synovial cavity (condylo-discal) is the lower cavity between the condylar head and the disc. 2. superior synovial cavity (temporo-discal) is the upper cavity between the temporal bone and the disc.

The meniscus has three parts:

1. anterior band is the thinner anterior segment which is continuous with the ligament fibers of lateral pterygoid muscles. 2. Intermediate band is the connecting part of anterior and posterior bands. 3. Posterior band is the thickened posterior part (bilaminar area) consisting of upper stratum which is attached to the temporal bone and the lower stratum which is attached to the condyle on its medial and lateral borders.

Fibrous capsule/articular capsule (sometimes referred to as capsular ligament) Is a sheet, sac, or tube of tissue that encloses the joint like a tube.
The fibrous capsule is composed of two layers: a. Inner layer (synovial membrane) lines the fibrous capsule. This is a thin layer of tissue that secretes a fluid, synovia, that lubricates the joint. The synovial fluid is a dialysate of blood plasma containing globulin and mucin and is clear, yellowish and viscous fluid. b. Outer layer is thickened on its lateral border to form the temporomandibular ligament.

Ligaments that support the joint

Ligaments are slightly elastic bands of tissue. They support and confine the movement of the mandible to protect muscle from being stretched beyond their capabilities.
a. b. c. d. Capsular ligament Temporomandibular ligament Stylomandibular ligament Spenoidmandibular ligament

TMJanatomy

Temporomandibular joint is described as ginglymoarthrodial joint. Ginglymus (hinge joint) the manner of movement takes place on one plane. Arthrodial is one in which the principal movement is gliding. Two types of movements: 1. Gliding type occurs between the articular disc and the articular surface of the temporal bone. 2. Hinge type occurs between the inferior surface of the anterior disc and the head of the condyle.

TMJmove

Dynamics & Components of occlusion

OCCLUSION refers to the contact relationships of the teeth resulting from neuromascular control of the masticatory system. It is when the teeth in the mandibular arch come into contact with the teeth in the maxillary arch in a functional relationship.

Keys to Occlusion
Molar Relationship a. The distal surface of the distal marginal ridge of the maxillary 1st permanent molar contacts and occludes with the mesial surface of the mesial marginal ridge of the mandibular 2nd molar b. The mesiobuccal cusp of the maxillary 1st molar falls within the groove between the mesial and middle cusps of the mandibular 1st permanent molars. c. The mesiolingual cusp of the maxillary 1st molar seats in the central fossa of the mandibular 1st molar.

Mesiobuccal cusp

- ROTATIONS
Teeth should be free of undesirable rotations.

TIGHT CONTACTS
In the absence of such abnormalities as genuine tooth size discrepancies, contact points should be tight.

 CURVE OF SPEE
A flat occlusal plane should be a treatment goal. Measured from the most prominent of the mandibular 2nd molar to the mandibular central incisor.

Dental Arch Formation

In both dental arches the alignment of teeth follows a parabolic curve. Usually the maxillary arch is larger than mandibular arch resulting in the maxillary cusps overlapping the mandibular cusps when the arches are in maximal occlusal contact.
Lingual Occlusal line

Central Fossa line

Facial Occlusal line Central Fossa line

Purposes of contact relation between teeth of the same dental arch:

A. It protect the gingival papilla in the interproximal spaces, thereby avoiding periodontal involvement which could be destructive. B. The collective activity of all teeth in contact shoulder to shoulder stabilizes each tooth in the dental arch.

Three segments of tooth alignment in the arches:

1. anterior segment a curve line including the anterior teeth ending at the labial ridge of the canine middle segment a straight line including the distal portion of the canines, the premolars & the buccal ridge of the mesiobuccal cusp of the 1st molar posterior segment - a straight line from the buccal cusp of the 1st molar, the line remaining in contact with buccal surfaces of the 2nd & 3rd molars.

2.

3.

Phases in the development of dental arches:

Phase 1 the 1st permanent molars (cornerstones) take their places immediately posterior to the deciduous 2nd molars.

Phase ll - central incisors & lateral incisors develop lingually to deciduous anterior roots.

Phase lll the premolars come in anterior to the 1st permanent molars, taking the place of deciduous molars.

Phase lV the canines or keystones take the place of the deciduous canine.

Phase V the jaws develop sufficiently as the individual approaches maturity to accommodate the 3rd molars distal to the 2nd molars.

Compensating Curvatures of the Dental Arches

1. Bonwill Equilateral Triangle - the angles of the triangle are placed at the center of each condyle and at the mesial contact areas of the mandibular central incisors.

2. Curve of Spee a curve alignment observed at the cusps & incisal ridges of the teeth as seen from the point opposite the 1st molars. Anteroposterior relation of the teeth viewed from the lateral aspect.

Curve of Wilson it is the curvature established by the tilting of the mandibular posteriors making the maxillary arch convex and the mandibular arch concave as one views the arches from the front.

Curve of Monsoon the mandibular arch adapts its occlusal surfaces to the curved surface of a segment of a sphere of a 4 inch radius.

All teeth away from the perpendicular to occlusal plane, have various degrees of inclinations. There are two types of tilt to be considered.
A. FACIO-LINGUAL TILT the tooth with the greatest inclination tilting facially is the maxillary central incisors followed next by the mandibular lateral incisors. All teeth tilt facially except the 2nd premolar and the mandibular molar which have lingual inclinations. The straightest teeth (perpendicular to the occlusal plane) having the least tilt are the premolars. MESIO-DISTAL TILT except for the maxillary central incisors and the mandibular central and lateral incisors which may have slight distal tilt, all teeth tilt mesially. The greatest degree of mesial tilt is found in the maxillary canine and the least and slight tilt is that of the premolars.

B.

 MORTAR AND PESTLE DESIGN of some of the occlusal contacts of teeth clearly explains the functional form of the teeth. A good direct example would be the buccal cusps of the mandibular molars in contact with the central sulci of the maxillary molars.

The Facial and Lingual Relations of Each Tooth in One Arch to its antagonist in the Opposing Arch in Centric occlusion

Each tooth has two antagonist except the mandibular central incisors and the maxillary 3rd molars

DEVP OF DENTITION FROM BIRTH TOTHE NEONATE 0 TO 6 MONTHS COMPLETE DEC. DENT. MOUTH OF
The Gum Pads The alveolar arches of an infant at the time of birth are called Gum Pads. These are nothing but greatly thickened oral mucous membrane of the gums, which soon become segmented, and each segment is developing tooth site. They are pink in color and firm in consistency.

THE MOUTH OF THE NEONATE

The maxillary arch is horseshoe-shape and the gum pads tend to extend buccally and labially beyond in the mandible The mandibular arch is posterior to the maxillary arch when the gum pads contact The lower gum pad is U-SHAPE and RECTANGULAR

Relationship of gum pads

Anterior open bite is seen at rest with contact only in the molar region. Tongue protrudes anteriorly through the space.

NEONATAL JAW RELATIONSHIPS

A precise bite or jaw relationship is not yet seen. Therefore, neonatal jaw relationship cannot be used as a diagnostic criterion for reliable prediction of subsequent occlusion in the primary dentition.

PRECOCIOUSLY ERUPTED PRIMARY TEETH

NATAL TEETH - present at birth NEONATAL TEETH erupt during the first month PRE- ERUPTIVE TEETH- erupt during the second or third month 1:1000 and 1:30000 incedence of neo natal and natal teeth

PRIMARY TEETH & OCCLUSION

1. Important factors in the development of the primary teeth:
Calcification

PRIMARY TEETH & OCCLUSION

1. Important factors in the development of the primary teeth:
Eruption

DEVELOPMENT OF PERMANENT DENTITION

1. Calcification

 The deciduous dentition stage starts from the eruption of the first deciduous tooth, usually the deciduous mandibular central incisors and ends with the eruption of the first permanent molar, i.e. from 6 months to 6 years of postnatal life. By 2 years of age, deciduous dentition is usually complete and in full function. Root formation of all deciduous teeth is complete by 3 years of age.

NORMAL SIGNS OF PRIMARY DENTITION

a. Spaced anteriors: Spacing is usually seen in the deciduous dentition to accommodate larger permanent teeth in the jaws b. Primate / simian / anthropoid space: This space is present mesial to the maxillary canine and distal to the mandibular canine.
Most subhuman primates have it through out life and used it for interdigitation of opposing canines. This space is used for

 mesial shift

c. Shallow overjet and overbite.

d. Straight / flush terminal plane relation

PRIMARY TEETH & OCCLUSION

Important factors in the development of the primary occlusion:
Overbite and Overjet

PRIMARY TEETH & OCCLUSION

Important factors in the development of the primary occlusion:
Overbite
Vertical measurement a distance in which the maxillary incisal margin closes vertically past the mandibular incisal margin.

Overjet
Horizontal measurement the distance between the lingual aspect of the max incisors and the labial surface of the mand. incisors

Flush terminal plane When the distal surfaces of maxillary and mandibular deciduous second molars are in the same vertical plane; this is the normal molar relationship in the primary dentition because the mesiodistal width of the mandibular molar is greater than the mesiodistal width of the maxillary molar.
Mesial step distal surface of mandibular deciduous second molar is mesial to the distal surface of maxillary deciduous second molar. Distal step distal surface of mandibular deciduous second molar is more distal than the distal surface of maxillary deciduous second molar, i.e. the upper second molar occludes with two opposite teeth.

PRIMARY TEETH & OCCLUSION

2. Important factors in the development of the primary occlusion:
Occlusal relationships

THE MIXED DENTITION STAGE

This is the period where teeth of both deciduous and permanent dentition are seen. It extends from 6-12 years of age. Most malocclusions make their appearance during this stage.

ERUPTION OF PERMANENT FIRST MOLAR

The first permanent molars erupt at 6 .They play an important role in the establishing and in the function of occlusion, in the permanent dentition. Anteroposterior positioning of the permanent molars is influenced by:

Terminal plane relationship

When the deciduous second molars are in a flush terminal plane, the permanent first molar erupts initially into a cusp-to-cusp relationship, which later transforms into a class I molar relation using the primate spaces. This is brought about by mesial shift of the permanent first molar following exfoliation of

- primary molar and thus making use of the leeway space (late mesial shift).
When the deciduous second molars are in a distal step, the permanent first molar will erupt into a class II relation. This molar configuration is not self correcting and will cause a class II malocclusion despite Leeway space and differential growth. Primary second molars are in a mesial step lead to a class I molar relation in mixed dentition. This may remain or progress to a half or full cusp class III with continued mandibular growth. Early mesial shift in arch with physiologic spacing:

In a spaced arch, eruptive force of the permanent molars causes closing of any spaces between the primary molars or primate spaces, thus allowing molars to shift mesially.

Leeway space of Nance the combined mesiodistal widths of deciduous canine, first and second molars is more than that of the combined mesiodistal width of permanent canine, first and second premolar. The difference between the two is called the leeway space.

BROADBENTS PHENOENON UGLY

DUCKLING STAGE (7-14 YEARS) Diastema is commonly seen in the upper arch, which is usually interpreted by the parents as a malocclusion. Crowns of canines in young jaws impinge on developing lateral inc. roots thus driving the roots medially and causing the crowns to flare laterally. The roots of the central incisors are also forced together thus causing a maxillary midline diastema. The period from the eruption of lateral incisors to canine is termed as the Ugly Duckling stage. It is an unaesthetic metamorphosis, which eventually leads to an aesthetic result. With eruption of canines, the impingement from the roots shifts incisally thus driving the incisor crowns medially, effecting closure of diastema

INCISOR ERUPTION
INCISOR LIABILITY-for incisor to erupt in normal alignment , there is an obligate space requirement in the anterior part of the arches The total sum of the mesio-distal width of four permanent incisor is larger than that of primary incisors by 7.6mm in maxilla and 6mm in the mandible

DEVELOPMENT OF PERMANENT DENTITION

THE FULL PERMANENT DENTITION

Dentition and occlusal adjustment before the middle teens During eruption of succedanaeous teeth many activities occur simultaneously

THE FULL PERMANENT DENTITION

Dentition and occlusal adjustment before the middle teens During eruption of succedanaeous teeth many activities occur simultaneously
The primary tooth resorbs The root of the permanent tooth lengthens The alveolar process increases in height The permanent tooth moves through the bone

FACTORS REGULATING & AFFECTING ERUPTION

If the primary tooth is extracted prior to the onset of permanent eruptive movements the permanent tooth is likely to be delayed in its eruption.

FACTORS DETERMINING TOOTH POSITION DURING ERUPTION

MANDIBLE
The most favorable eruption sequence in the mandible:
Cuspid 1st Bicuspid 2nd Bicuspid 2nd Molar

MAXILLA
The sequence of eruption in the maxilla
1st Bicuspid 2nd Bicuspid Cuspid 2nd Molar

PERMANENT DENTITION
Dimensional Changes
The dental arch perimeter decreases during the late adolescent and young adult periods After 15 years, the dimensional changes seem to show a continued shortening of the perimeter

DENTITIONAL & OCCLUSAL DEVELOPMENT IN THE YOUNG ADULT

Phillips, Reitan and Shafer enumerated the various major factors causing root resorption of permanent teeth:
Physiologic tooth movement Adjacent impacted teeth pressure Periapical or Periodontal inflammation Tooth implantation or replantation Contnuous occlusal trauma Tumor or cyst Metabolic or systemic diseases Idiopathic factors

PATTERN OF ERUPTION
In Maxilla In Mandible : : 6124537 6123457