Postnatal Growth of the

Maxillary Complex

Presented by :
Heena Malik
 CHARACTERISTIC OF BONE GROWTH

Bone formation occurs by 2 methods of differentiation of

mesenchymal tissues that may be of mesodermal or
ectomesenchymal origin.
Accordingly 2 types of bone growth is normally seen.

1) Intra-membranous ossification:
The transformation of mesenchymal connective tissue

usually in membranous sheets, into osseous tissues.

 2) Endochondral ossification:
• The conversion of hyaline cartilage into bone
• The cartilage ‘ is then replaced by endochondral bone
accounting for indirect bone growth
• Maxilla is a membranous bone
and development/growth of
maxilla is completed early
when compared to mandible.

• Maxilla cannot be considered

as a separate bone, it has to be
nasomaxillary complex
because of close association or
attachment of maxilla to
cranial base.
• Maxilla (especially
width) also
follows closely
neural growth
curve more than
general growth
curve in
scammon’s curve.
 Growth Of Nasomaxillary Complex is Produced By
Following Mechanism:

• Displacement/ Translation

• Growth at sutures

• Surface remodeling
DISPLACEMENT/ TRANSLATION

• Change in the spatial position of a bone can occur by two

types of translation.

Primary or active displacement is the movement of bone due to

its own growth.

A passive or secondary displacement occurs when the growth of

one bone results in a change in the spatial position of an
adjacent bone.
Primary Displacement
• Is also seen in the forward direction
occurs due to growth of maxillary
tuberosity in the posterior direction.This
results in the whole maxilla being carried
anteriorly.

• Then the amount of this forward Primary Displacement

displacement is equal to the amount of
posterior lengthening.

• Periosteal surface of the tuberosity

receives continuous deposits of new
bone and results in horizontal
lengthening of the maxillary arch.

Primary Displacement
 Secondary Displacement
• Nasomaxillary complex grows
by secondary translation
during primary dentition
period.

• As the maxilla is attached to Secondary Displacement

the cranial base, growth
occurring at cranial base
(chiefly middle cranial
fossa) produces a passive/
secondary displacement of
nasomaxillary complex in a
downward and forward
Secondary Displacement
direction.
 GROWTH AT SUTURES

It is a complex system of sutures through which all the bones are in contact

The maxilla is connected to the cranium and cranial base by a number of

sutures.

• These sutures include:

a)Fronto- nasal suture
b)Fronto- maxillary suture
c)Zygomatico- maxillary suture
d)Zygomatico- temporal suture
e)Pterygo- palatine suture
• According to the weinmann and sicker, these sutures
are oblique and more or less parallel to each other.
This allows the downward and forward repositioning
of maxilla as growth occurs at these sutures.
• As the growth of soft tissue occurs, the maxilla is
carried downward and forward. This leads to opening
up space at the sutural attachment. New bone is
formed on either side of the suture.
• Thus overall size of the bones increases on either side.
Hence a tension related bone formation occurs at the
sutures.
 SURFACE REMODELING

• In addition to the growth occurring at the sutures,

massive remodelling by bone deposition and
resorption occurs to bring about:

a) Increase in size
b) Change in shape of bone
c) Change in functional relationship
• Growth in height ----- Vertical

• Growth in width ----- transverse

• Growth in length ----- A - P

GROWTH IN MAXILLARY HEIGHT:
The palatal growth follows the principle of the expanding “ V” . Resorption
occur on the floor of nasal cavity and deposition on the oral side of palatal
vault. This moves palate in downward direction. However, depth of palatal vault
continues to increase with age, expanding in a ‘V’ shape.

GROWTH IN MAXILLARY WIDTH

Occurs during the first 5 yrs of life, mostly at
intermaxillary and midpalatal sutures.
 THE ORBIT

• As demonstrated by experiments, the development of

the orbital cavity requires the primordium for eye.
• Thus eye serves as an important functional matrix for
the development of orbit.
• The lateral surface of the orbit undergoes
resorption.
• The superior and inferior surface along
with the floor undergo apposition.
• This leads to lateral movement of the
orbit along with the eyeballs.
 THE NASAL CAVITY

• The lateral surface undergo resorption

along with the floor of nasal cavity.
• Apposition takes place on the medial
surface leading to lateral enlargement of
the nasal cavity.
GROWTH THEORIES
1)Genetic Theory
2)Sutural Theory
3)Cartilaginous Theory
4)Functional Matrix Theory
GENETIC THEORY

• 1950’s to 1970’s
• Mainly based on observations
• No evident scientific data
• Lacked scientific understanding and soon
replaced by other theories.
SUTURAL THEORY
• Proposed by Sicher in 1995

• A/C to Sicher “ The primary event in sutural

growth is the proliferation of the connective
tissue between the two bones. If sutural tissue
proliferates, it creates the space for
appositional growth at the border of the
bones”.
Cranial vault grows by sutural Forces the bone of the vault to
connective tissue that move away from each other

A/c to sicher, paired parallel

sutures

Attach facial areas to the skull

and cranial base region

Push the naso -maxillary

complex

Downward and forward

CARTILAGINOUS THEORY
• Proposed by James Scott

• A/C to scott “ Intrinsic growth controlling factors are present in

cartilage and periosteum with sutures being only secondary”.

• Cartilaginous sites throughout the skull as primary centres of

growth.

Nasal septal cartilage – responsible for the growth of

maxilla.

Spheno-occipital synchondrosis cartilage – responsible for

the growth of cranial base.
Nasal septal cartilage – responsible for the growth of maxilla.

Spheno-occipital synchondrosis cartilage – responsible for the growth of

cranial base.
 FUNCTIONAL MATRIX CONCEPT
Given by: MELVIN
MOSS

FUNCTIONAL MATRIX SKELETAL UNIT

A related skeletal unit that acts

Tissues and spaces that biomechanically to protect
completely perform a function and /or support its functional
matrix
 SKELETAL UNIT

FUNCTIONAL MATRIX

Microskeletal
Macroskeletal
Eg- In maxilla
Eg- Endocranial
(orbital, pneumatic,
surface of calvaria
palatal and basal)
Periosteal Capsular
Eg- teeth and Eg- orofacial,
muscles neurocranial
 REFERENCES

• Textbook of orthodontics ( Gurkeerat singh)

• Contemporary orthodontics ( proffit)
THANK YOU