[Studies on internal structure of children's maxilla. 1. Shape and size of corpus maxillae in cross-section (author's transl)].
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Alveolar Process↗
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[Study of internal reaction on the maxilla by orthopedic force].
For the purpose of analyzing deformations and movements in the maxilla loaded by orthopedic force to the maxillary first molar, a three dimensional finite element model of the maxilla was constructed. For modelling of the maxilla, the right side of an adult Indian skull was used. Constructed model was composed of 1,108 solid elements and 1,195 nodes. Materials of this model was composed of compact bone, cancellous bone, teeth and sutures. Constraint condition was fixed adjacent bone side surrounded by sutures. Load was directed from upward to downward 30 degree, changing every 30 degree reference to occlusal plane. Volume of load were weighed at 1 kg for each directions. Results 1. At upward load, stress was transmitted through the lateral wall of the maxillary sinus. The posterior portion of the maxilla was displaced more upward than anterior. Each process of the maxilla and the maxillary sinus was deformed, however, there was no stress on the orbitary surface. 2. At upward 60 degree load, the maxilla was compressed simply to the direction of load. At the upward 30 degree load, it was compressed backward-downward and rotated clockwise together with bending. 3. At backward load, the maxilla was moved backward and rotated clockwise. At downward 30 degree load, the maxilla was moved backward-downward and rotated clockwise. Both loads bended anterior portion of the maxilla and compressed posterior portion. The center of rotation or bending fell on the line joining the frontal process and the zygomatic process. 4. Of all five directions, backward load showed the maximum value of displacement and upward showed the minimum. Concerning with the absolute value of principal stress, backward load showed the maximum and upward 60 degree load showed the minimum. 5. Concerning with the principal stress value of sutures, compressive stress were distributed equally at upward load. However, as the load went to downward direction, it caused stress concentration. Especially, compressive stress in the pterygopalatine suture and transverse palatine suture, extensive stress in the midpalatal suture were especially great.
Adult↗
Prenatal growth pattern of the human maxilla.
Regarding maxillofacial morphogenesis there has been a long debate on the growth of the maxillary structure. Using 120 normal fetal maxillae of gestational ages from 16 to 41 weeks, palatal radiograms and frontal histologic sections were made. We have observed two pairs of accentuated growth areas in the fetal maxillae and named them primary growth centers to formulate the maxillary trapezoid (MT) by radiologic image. The MT is formed by four primary growth centers that are best demonstrated by palatal radiograms of the fetal maxilla as well as by frontal histologic sections. The dimensional increase in the MT during the fetal period is documented and statistically analyzed. From this series of results, we have suggested that the growth centers which demarcate the MT are the basic structures of the developing human maxilla. It was also found that the four primary growth centers are the most active sites for maxilla formation until 20 weeks of gestation and thereafter the growth of the maxilla is enhanced by the participation of the intramembranous bone formation along the periphery. This was in contrast to the central primary growth centers that have already finished maturation in the early fetal period and remain only as a peripherally radiating arrangement of thick trabecular bones.
Bone Development↗
[Studies on the development and growth of the human maxilla--special references to the anterolateral, infratemporal and orbital surfaces].
Morphological and macroscopical studies were made on the lateral surface of the human maxilla. The materials consist of 128 cases of human fetuses ranging from the fourth to the tenth month and 306 cases of human juveniles and adults. The earliest month in which the loci with the scientific name (Nomina Anatomica) of the maxilla was observed was as follows; the frontal process, zygomatic process, anterior nasal spine and the nasal notch were first observed on the fourth fetal month. The infraorbital foramen and anterior lacrimal crest were first observed in some cases on the fourth fetal month and in all cases on the fifth fetal month. The infraorbital suture, lacrimal notch and alveolar process were first observed on the fifth to the sixth fetal month. The infraorbital sulcus and infraorbital canal were first formed on the fifth to the seventh fetal month. The following loci on the lateral surface of the maxilla which are related to the development of the maxillary teeth were first observed after birth as follows; the alveolar foramina were first observed in 3 to 7 years after birth and the maxillary tuberosity was first observed in 6 to 7 years after birth. The canine fossa was first observed in 6 years after birth. As far as the development of the maxilla is concerned, the frontal process and infraorbital margin were first observed and secondly the alveolar part was observed and finally the maxilla body which involved the maxillary sinus was formed.
Adolescent↗
Effects of sagittal expansion in noncleft macerated human maxillae.
The effects of sagittal expansion with a cemented expansion appliance were studied in nine noncleft macerated human maxillae ranging from 1-10 years. It was found that opening of the premaxillo-maxillary suture did occur in the youngest maxilla. Movement of the incisor roots through the labial cortical plate was observed in seven specimens. In one maxilla, dislocation of the maxillary tuberosity occurred. The results of this investigation suggest that it seems questionable that sagittal expansion using cemented appliances in noncleft human maxillae will in most instances result in breaking the ossification of the premaxillo-maxillary suture together with the interlocking serrations.
Child↗
Influence of cleft palate on growth of the maxilla in mouse embryos.
Cortisone acetate (7.5 mg on day 12, or 4 X 2.5 mg on days 12-15) and single dose of 6-aminonicotinamide (0.5 mg on day 14) were administered to pregnant females of random bred strain H-Velaz mice. The width of the alveolar arch of the developing maxilla was measured in drawings of the roof of the mouth of 600 fixed embryos taken between days 16 and 19. The width of the maxilla of experimental embryos with a closed secondary palate was the same as in the control embryos throughout the observation period, whereas the maxilla of all embryos with cleft palates was wider than in the controls. Final expansion of the maxilla was the same in all experimental groups.
6-Aminonicotinamide↗
Control of vertical position of the maxilla in orthognathic surgery: clinical application of the sandwich splint.
The Le Fort I osteotomy can be used to change the position of the maxilla in all three dimensions. A presurgically fabricated occlusal splint is used to reproduce the planned sagittal and transverse position of the maxilla. Various methods for determining the proper vertical position have been described. The major difficulty in vertical control when these techniques are used is the sagittal change of the lower reference point as the maxilla is advanced. The relative error in the vertical plane increases with larger sagittal movements. The sandwich splint technique, with two stable intraoral reference points, can be used to ensure proper vertical positioning of the maxilla. This method enables exact measurement of the vertical dimension during cast surgery and in the operating room. Vertical measurements are based on the relationship between the mandible and skull base. This distance remains constant during splint fabrication and when the splint is used at surgery. Postoperatively, the mandible can be rotated into the new centric occlusion.
Dental Occlusion, Centric↗
[Changes in the TMJ after moving of total maxilla upward and mandibular autorotation procedures].
Upward moving of total maxilla and mandibular autorotation procedures are new operations for correction of Long Face Syndrome and other maxillary deformities. What distance could maxilla be move upward and it's effect on TMJ had rarely been reported. This paper reports our study results using cephalometric analysis, measurement of TMJ position in preoperatively and postoperatively and clinical evaluation of TMJ. 1. The moving of maxilla upward should not go beyond the limit of 5 mm. If moving maxilla upward is more than 5 mm, the mandibular autorotation procedure should be avoided. 2. In this limit of 5 mm TMJ could adapt new position and doesn't produce pathological changes.
Dental Occlusion↗
Prenatal skeletal maturation of the human maxilla.
Previous investigations on the prenatal development of the human maxilla have focused mainly on the elevation and fusion of the soft tissue palatal shelves. The bony development has received only sporadic attention. The aim of the present investigation was to analyze and set up bony developmental stages in the human maxilla, as knowledge of normal skeletal developmental course, which has never been elucidated, is the prerequisite to understanding the abnormal course of development. The present study was based on a radiographic and histochemical investigation of maxillae from 104 human embryos and fetuses from the first half of the prenatal period. A marked regularity in the maxillary ossification pattern was observed, and consequently seven maturity stages, Max I-Max VII, were described. The material was divided according to these stages and related to general fetal size (crown-rump length) and to general fetal maturation (composite number of ossified bones in hand and foot). The material available did not justify a description of skeletal development of the maxilla as a function of CRL or CNO.
Humans↗
[Maxilla in harmonious face. A cephalometric study in adult Greeks].
The purposes of the above research work were to describe a) the normal size of the maxilla and b) the normal sagittal and vertical position of the upper jaw and to define a) the relationship between the sagittal and vertical maxillary position and b) the way in which the variables concerning the size and position of the maxilla correlate in the harmonious faces with normal occlusions. The material of this study consisted of 276 lateral cephalographs of an equal number of adult Greeks (147 males and 129 females) with normal Angle/Class I occlusion and harmonious face. Five variables were measured (one linear, ANS - PNS and four angular, S-N-ANS, S-N-A, N-S-ANS and N-S-A). Maximum, minimum and mean values as well as standard deviations of each of the above variables were calculated. The range of each variable was divided into three groups (15% low, 70% medium and 15% high values). The qualitative relationship was then studied between the following couples of variables: S-N-ANS and N-S-ANS, S-N-A and N-S-A, S-N-ANS and ANS-PNS, S-N-A and ANS-PNS and lastly S-N-A and S-N-ANS. Factorial analysis of correspondences were finally carried out (Benzécri 1973, 1980) which made possible the identification of the way in which the selected variables were correlated. The main results researched were: 1) The maxilla in males is bigger in size. 2) There was not any difference of the sagittal and vertical maxillary position referring o the anterior cranial base between the sexes. 3) The sagittal position of anterior nasal spine is analogous to A point position. 4) Three different types of the maxilla were found within the normal range based on the selected variables. a) Type A2 was characterised by the medium values of the variables. b) Type A1 was characterised by small upper facial height and high values of forward position of points A and ANS. c) Type A3 was exactly the opposite of the A1 characterised by big upper facial height and low values of forward position of the ANS and A points.
Adult↗
[Atrophy of the mandible and maxilla as complication of treatment and healing of jaw fractures].
The authors discuss in the light of literature data the causes of bone atrophy and report two own cases of extensive atrophy of the mandible and atrophy of the maxilla developed during treatment of their fractures. Parallel mandibular atrophy in a patient aged 67 years was observed 3 years after surgical union of fractured fragments of the edentulous mandible with metal plates. The cause of atrophy is related by the authors to prolonged malnutrition of the patient who had partial gaestrectomy 24 years earlier, and his failure to observe the suggested mandible immobilization during the required length of time. Considerable degree of maxilla atrophy in a 34-year-old man developed during treatment of a Le Fort III maxilla fracture. The atrophy affected mainly the apical base of the alveolar process, and it was observed 4 months after fracture. The cause was not systematic, prolonged without informing the stomatologist, and excessive traction was exerted by the rubber band in the chin-sling used for the treatment of the fracture. The treatment used in this case permitted to restore in the maxilla the proportions of bone structures approaching the normal ones.
Adult↗
A technique for evaluating bony changes in the anterior edentulous maxilla: a modification of a cephalometric analysis.
A modification of a cephalometric analysis is presented for evaluating maxillary bone loss in the edentulous maxilla. The analysis involves tracing a lateral cephalometric radiograph of an edentulous maxilla, identifying the new landmarks, and measuring the appropriate vertical and horizontal distances of the maxilla. Comparison of the measurements for the patient's initial or baseline radiographic analysis with those of the patient's follow-up radiographic analysis identifies the amount of bone loss that has occurred between the two examinations.
Alveolar Bone Loss↗
Skeletal changes in vertical and anterior displacement of the maxilla with bonded rapid palatal expansion appliances.
The purpose of this study was to determine whether anterior and inferior displacement of the maxilla seen with rapid palatal expansion when done with a banded rapid palatal expansion appliance is significantly different from an occlusally bonded rapid palatal expansion appliance. It was hypothesized that the bonded appliance would limit unwanted displacement of the maxilla by producing vertical forces on both arches in a manner similar to a functional appliance. The study was conducted using the bonded appliance on 20 adolescents and comparing the results with those of a banded appliance population--namely, 60 cases from Wertz's study. Lateral cephalometric radiographs were taken before treatment and again after the expansion appliances were removed. The results of this study suggest that the downward and anterior displacement of the maxilla often associated with the banded rapid palatal expansion appliance may be negated or minimized with the more versatile bonded appliance.
Adolescent↗
The behaviour of the maxilla in vertical movements after Le Fort I osteotomy.
In 15 cases of ordinary Le Fort I osteotomy with simultaneous vertical displacement, the behaviour of the maxilla in respect to vertical movement was examined. It was observed that out of 12 maxilla which had been tilted downwards, 10 moved upwards again. One maxilla remained stable and another one moved further downwards. Of 3 cases with upward movement, two remained stable whereas one moved further upwards. Therefore, the authors conclude that the downward displacement especially is unstable and that one has either to overcorrect or search for possibilities of stabilization other than wiring suspension. Since these movements occur during postoperative intermaxillary fixation, no occlusal changes are observed.
Adolescent↗
A new method of inserting endosseous implants in totally atrophic maxillae.
A new method is described (Sailer, 1988) whereby endosseous implants are inserted in the totally atrophic maxilla, the intermaxillary relationship and vertical dimension corrected and a vestibuloplasty performed during one surgical procedure. The method can also be used to treat minor degrees of maxillary alveolar atrophy. The procedure enables 20 mm-long Titanium screws to be used in totally atrophic maxillae. The following surgical procedures are carried out during one operation: A Le Fort I osteotomy, removal of the mucous membrane of the sinus floor, obturation of the denuded maxillary sinus floor by autologous bone grafts from the iliac crest, simultaneous insertion of Titanium screws, fixation of the down-fractured maxilla by miniplates, and a modified submucous vestibuloplasty. Intermaxillary relationship and vertical dimension can be normalized, and the aesthetic results are excellent. To date 35 implants of which none has been lost, have been placed in 5 patients.
Alveolar Ridge Augmentation↗
Cervical retraction of the maxillae in the Macaca mulatta monkey using heavy orthopedic force.
Heavy, interupted orthopedic forces were employed for the cervical retraction of the maxillae in two Macaca mulatta monkeys. The nature, location and magnitude of resultant movements and remodelling were studied with the help of plaster casts, amalgam implants, lateral cephalometric tracings, and of gross and microscopic study of the skulls themselves. The principal effect of the retractive force was a marked downward and backward rotational movement of the maxillae which carried the maxillary teeth into posterior crossbite and a severe Class III molar relationship. Posterior movement of the tuberosity entirely closed the pterygomaxillary fissure so that the tuberosity impinged upon the pterygoid plates. Like the maxillae, the mandible, premaxilla, and nasal boned also moved downward and backward. These changes increased the vertical dimension of the face and diminished it horizontally leaving a flattened facial profile from the nasal opening to the maxillary incisors. Movement of facial elements posteriorly against an unhielding anterior cranial base imposed a number of other compensatory changes. These included generalized resorption at the craniofacial sutures and sliding of the sutures upon each other. They also involved mutual resorption of the maxillary tuberosity and of the pterygoid plates together with remodelling and lateral extension of the malar bones. Tolerance of the animals and of the localized tissues for these intensive forces suggests a significant role for this form of therapy. Clinical application, however, should be tempered by judicious concern for the vital structures of the pterygomaxillary fissure which could be impinged or strangulated by excessive retrusive force.
Activator Appliances↗
Growth displacement of the maxilla in girls studied by the implant method.
The sutural growth displacement of the maxilla between the ages of 8 and 21 years was studied on 14 series of lateral cephalometric films of girls from the Björk implant sample (Björk 1968). The assessment of growth changes was based on the method of superimposition described by Björk and Skieller (1983) supplemented by a new computerized debugging procedure. A new method for angular measurement of the forward displacement of the maxilla and the mandible is described here. The average forward displacement of the maxilla in relation to the anterior cranial base was 6 degrees from 8.5 to 17.5 years. The average path of displacement was inclined about 45 degrees in relation to the nasion-sella line from 8.5 to 14.5 years, and then changes to almost horizontal. The mean distance between anterior and posterior implant points showed a continuous shortening, totalling 0.6 mm for the period 8.5 to 15.5 years, due to maxillary rotation in the transverse plane. The timing of growth differed between the horizontal and vertical components of the maxillary growth translation. Horizontal displacement peaked at 11 and terminated at 18 years, whereas vertical displacement peaked at 12 and terminated at 15 years of age.
Adolescent↗
The instantaneous transverse changes in the maxilla due to different points of force application.
The effects of different sites of an expansile force on the maxillae of three monkeys were studied. A lateral force of five pounds was delivered directly to four locations on each maxilla. Aluminum rods, rigidly attached to the teeth of each buccal segment, were photographed before and after each force application. The data indicated that the pattern of lateral maxillary displacement is related to the position of the lateral force in relation to the center of resistance of each maxilla.
Animals↗