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Sadao Sato:
Introduction
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mandible, chewing, swallowing, speaking and tition, speech, respiration, facial expression,
bruxing behavior, are now regarded as the most and posture as well as stress management.
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R. Slavicek • The Masticatory Organ
Evolutionary Aspects of
Craniofacial Bones
The base ot the skull that part which con The base of the skull, the part that connects the
nects the skull vault and the facial skull skull vault and the facial skull, changed dramatical
changed dramatically during the processes of
ly during human evolution. Comparison of a mod
ern human skull with that of a modern ape reveals
human evolution.
some striking differences :!*" (Fig. 2). The human
neurocranium with its vertical forehead, bulbous
occiput, rounded cranial vault, and centrally locat
ed foramen magnum appears to constitute the
upright posture of the skull, although the viscero
cranium in humans seems to be significantly small
er and wider than that in apes. The inferior projec
tion of the mastoid process in human beings is rela
ted in part to the flexure of the cranial base. The
geometry and mechanics of the cranial base flexure
are determined by the spheno-occipital region of
the cranial base.
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Sphenoid Bone
The sphenoid bone comes from the word ispheni
meaning wedge, as it forms a wedge between the As they are wedge between the face
face and the brain. The sphenoid bone plays a vital and the brain.
role in craniofacial morphology. It is joined by the
occipital, ethmoid and frontal bone, and is consi
dered to be an essential element of the mid-sagittal
cranial base. The sphenoid bone is a principal cen
tral bone of the skull chat is formed by cartilage. It
provides early protection of capsular attachments
for vital organs and also plays a role in the early
development of the skull, both phylogenetically
and ontogenetically.
It is also a major superstructure for the attachments
of masticatory muscles, principally the temporalis
on the greater wings, the superior belly of the exter
nal pterygoid in the horizontal portion of the
greater wing (wherein both pterygoids arise from
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R. Slavicek • The Masticatory Organ
Occipital Bone
The occipital bone is slightly funnel-shaped, with a
latge opening known as the foramen magnum. The
basilar process is triangular in shape and is distin
guished by an outer cortex and by inner cancellous
bone. It is hollowed out in adults by the sphenoidal
sinus. In youngsters, up to puberty, it is separated
It is separated from the sphenoid body by a from the sphenoid body by a synchondrosis known
synchondroses known as the spheno-occipital as the spheno-occipital synchondrosis.
Vomer Bone
The vomer bone consists of two small flanges of
bone that conform with the underside of the body
of the sphenoid. It is important because of the nasal
septum and its attachments to the palatine and
maxillary bones. Aside from serving as a buttress for
the upper jaw to receive shear forces, it is an impor
tant site of downward growth of the human face
(Fig. 10).
In great apes, the cranial base is less flexed in In great apes, the cranial base is less flexed in the
the sagitcal plane. sagittal plane, and the base of the vomer is posi
tioned further anteriorly. The vomer plays an
important role as a transmitter of dynamic forces
from the cranial base to the maxillary complex.
Temporal Bone
In the dynamic mechanism of the craniofacial skele
ton, the temporal bone is the most important one
because of its anatomical position. The temporal
bones are located in the lateral-most aspect of the
skull and fit in the space between the occipital, pari
etal and sphenoid bones (Fig. 11). The temporal
bone's squamosal suture is fan-shaped and flaps
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over che parietal bone at its junction with the squa The temporal boneis squamosal suture is fan
ma (Fig. 12).
shaped and flaps over the parietal bone at its
The temporal bone is the keystone of the cranium junction with the squama.
because several muscles affect its movements. One
of the key factors in dysfunction of the cran-
iomandibular system is distortion and displacement
of che temporal bone. The temporal bone consists of
three main parrs: che internal petrous portion, the
external squama and che mastoid sections. Squama
gives a zygomatic process, which extends forward
and articulates with the malar bone and acts as the
shock absorber for the TMJ. Jn die cranial scheme,
the temporal bone articulates wich che occiput,
parietals, sphenoid, malar and mandibular
condyles. Its primary motion is derived from the
occiput, which gently moves the temporal bones
into internal and external rotation during the respi
ratory phases of expiration and inspiration, respec
tively.
Two of the primary muscles of mastication, tempo- Two of the primary muscles of mastication,
ralis and masseter muscles, have a direct influence temporalis and masseter muscles, have a
on the movement of the temporal bone. The large
direct influence on the temporal bone move
fan-shaped cemporalis parcly originates in the tem
ment.
poral squama and inserts in the mandible at the
coronoid process and its anterior border.
Contraction of this muscle exerts powerful down
ward and anterior force on the squama when the
posterior teeth occlude. This force has the effect of This force will have an effect of causing an
causing external rotation, i.e. the superior border of external rotation.
the squama moves anteriorly and iacerally while the
mastoid tips move superiorly, posteriorly and medi
ally. The mandibular condyles compensate by mov The mandibular condyles compensate by
ing posteriorly and medially within the glenoid moving posteriorly and medially within the
fossa.
glenoid fossa.
Internal rotation of the temporal follows a move
ment that is the direct opposite of external rotation.
The mastoid tips move inferiorly, anteriorly and Ia
cerally while the superior border of the squama
moves posteriorly and medially. The condyle com
pensates in anterior and lateral position within the
fossa,
Concraction of the sternoclcidomastoid, splenius Contraction of the sternocleidomastoid,
capitis, longis capitis and digastric muscles will splenius capitis, longis capitis and digastric
induce internal temporal rotation. The stylohyoid
muscles will induce an internal temporal
and styloglossus muscles provide balancing move-
rotation.
menc of the temporal bone. The muscular attach
ments have their otigin in the styloid processes.
During contraction they inhibit and balance che
movemenc of the temporal bone. The articulation
between the temporal squama and the parietal
bone is referred to as a shindylesis joint (joint with a
long bevel). This architectural design provides a
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R. Slavicek • The Masticatory Organ
Dental malocclusion with mandibular dis gliding porentiai for jamming, especially when the
placement will disrupt the temporomandibu- temporalis muscle goes into a spasm. Dental mal
lar joint function, which in turn causes tem occlusion with mandibular displacement will dis
rupt the function of the temporomandibular joint,
poral bone distortion.
which in turn causes distortion of the temporal
bone'14'.
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external rotation, the midline bones go into flexion. Tooth extraction, deflective contact of poste
Tooth extraction, deflective contact of posterior rior teeth, deviation of occlusal plane, hyper-
teeth, deviation of the occlusal plane, hypertonicity
conicity of cranio-mandibular-hyoid-cervical
of the craniomandibular-hyoid-cervical connection
connection of the muscles, clenching and
of muscles, clenching and bruxism, and many other
factors may cause minor to major bone malalign- bruxism, and many other factors may cause a
ment. slight to major bone malalignment.
structure.
Occiput-Spheno-Maxillary Complex
with the Vomer bone
The maxillary bone articulates directly with 45% of The maxillary bone articulates directly with
cranial bones. Sutural attachments are shared with 45% of the cranial bones.
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R. Slavicek • The Masticatory Organ
cal dimension.
dimension. Lack of the vertical dimension as a result
of inadequate normal eruption of natural dentition
or loss of molar and bicuspid teeth or severe attri
tion of the occlusal biting surface and inadequate
tooth contact reduces the amplitude of spheno-basi-
iar flexion and affects cranial motion (extension
lesion).
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results in anceroinferior pushing of the maxilla. The The rotating movement of the sphenoid bone
vomer has a direct effect on the rotation of the sphe is transmitted to the mandible through the
noid, as the sphenoid and vomer are communicat
vomer, which results to the anteroinferior
ing with the rostrum of the inferior surface of the
pushing of the maxilla.
sphenoid and the wing of the vomer. In addition,
the rotating movement of the sphenoid bone is
indirectly transmitted to the maxilla because the
inferior border of the vomer is connected to the
maxillopalarine process and the nasal crest of the
palatine horizontal plate. This is how the move
ment of cranial bones affects the maxilla, especially
when the pushing direction of the maxilla changes
in relation to the rotating direction of the cranial
base; this would indicate growth of the maxilla. For
example, rotation of the sphenoid bone is flexion.
This would influence the rotating force of the wing
of the vomer, which is posteroinferior, prevenring
anterior pushing of the maxilla. Instead, it would
move inferiorly. On the other hand, when the rota
tion of the sphenoid bone is extension, rotation of
the vomer will be anterior, and the maxilla will be
strongly pushed anteriorly. The pushing movement
of the maxilla affords adequate space in the posteri
or portion of the upper teeth, allowing growth of
the posterior border of the maxillary tuberosity.
The direction of displacement of the maxilla is
influenced by the dynamic states of the occiput-
spheno-ethmoidal connection of the cranial base.
There are three types of maxillary growth secondary
to displacement of the maxillary complex: transla
tion with the frontal bone, vertical elongation, and
anterior rotation (Precious et al!!7', 1987) (Fig. 15).
Flexion motion of. the cranial base causes vertical
elongation of the maxillary complex. This is com
monly seen in the development of a Class III skele
tal frame. Extension of the cranial base causes ante
rior rotation of the maxillary complex. This is relat
ed to the development of a Class II skeletal frame.
Translation of the maxilla (anteroposrerior) with the
frontal bone to which it is attached below the
frontal sinus shifts the maxilla in forward direction.
The maxilla is passively displaced due to expansion
of the middle cranial fossa, the anterior cranial base,
and the forehead, without the growth process of
maxilla itself being directly involved. Vertical elon
gation of maxillary complex and the formation of
the alveolar process increase the height of the max
illa.
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R. Slavicek • The Masticatory Organ
Temporo-Mandibular Complex
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FH-MP
This determines the position of the denture frame in
the craniofacial skeleton and is an important index
to determine the functional adaptation capacity of
the mandible to occlusion. When the FH-MP is
high, the functional adaptation capacity due to
anterior rotation of the mandible to the occlusion is
low.
Usually, when the mandible shows excellent adap
tation capacity due to its growth, it displays pro
trusive rotation. However, when the adaptation
capacity is poor, it usually displays a retruded rota
tion. In case of protrusive rotation with bone
remodeling of the inferior border of the mandible,
there is a minimal change in the FH-MP angle
while the AB plane and the MP angle decrease due
to the protrusive position of the mandible (Fig. 2L).
In case of retruded rotation, the FH-MP angle
increases, with minimal changes in the AB-MP
angle. This presents the so-called high angle condi
tion.
PP-MP
It is the angle formed between the palatal plane
(PP) and the mandibular plane (MP). This shows
the basic morphology of the denture frame. When
this is increased, like the FH-MI* it does not induce
protrusive rotation of the mandible as a functional
response; rather it adapts to the occlusion through
backward rotation. Although the PP-MP and the
FH-MP are nearly the same, the significant differ
ence lies in the descent of the palatal plane due to
the protrusive rotation of the maxilla. This is usual
ly observed in patients with mandibular distocclu-
sion associated with deep overbke.
OP-MP
This is the angle of the occlusal plane (OP) and the
mandibular plane (MP). Normally, the occlusal
plane and the mandible have a functional relation
ship in order to maintain the OP-MP angle with
neuromuscular function. In other words, when the
occlusal plane changes to parallel or slightly hori
zontal during the growth process, the mandibular
plane also moves in parallel to it. Even if the
occlusal plane is changed to horizontal, the
mandible reacts to maintain the OP-MP angle by
rotating protrusively in response to the occlusal
plane.
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R. Slavicek • The Masticatory Organ
OP-MP/PP-MP
This is the ratio of the OP-MP angle to the PP-MP
angle. In effect, it shows the positional relationship
of the denture frame and the occlusal plane. The
value of a normal occlusal plane is 0.54; which is
the basic morphology of the denture frame. If it
exceeds 0.60 it is presumed that there is a deviation
of the occlusal plane and that the mandible is not
adapting to it. In an occlusal plane of less than 0.5,
the posterior vertical dimension is insufficient,
which leads to a retruded mandible brought about
by the inhibition of the mandibular condyfar
growth due to a chronic compression load.
AB-MP
This is the angle formed between the AB plane, the
point of A and B, and the mandibular plane (MP).
It reveals the anterior border of the denture frame
and the anteroposterior relationship of the lower
and upper jaws. This usually shows the anterior dis
placement of the mandible due to its forward rota
tion. When there is over-eruption in the molar part,
the mandible avoids the posterior interference
through protrusive displacement. Persistent push
ing of the molar in posterior discrepancy allows pro
trusive displacement to occur continuously, which
somehow affects the mandibuiar condyle growth
and alters the denture frame morphology.
There is a mutual relationship between the change
of the occlusal plane and the change of the AB
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A'-P1
h is the distance between the A' and P1. This repre
sents the anteroposterior diameter of the maxillary
basal bone. The A'-P in a 6-year-old child with a
normal occlusion is 44.1 mm. and this gradually
increases during growth. At the age of 13 years it
becomes 50.0 mm. and is nearly consistent there
after.
The increase of A'-P1 is brought about by the
growth of the bone in che posterior border of the
maxillary tuberosity. However when the growth in
this part is decreased, the A'-P' angle is sustained,
leading to an insufficient space in the posterior den
tition, resulting in posterior discrepancy.
A-6'
It is the distance between the A' and 6'. This shows
the protrusive length of the 1st molar in the maxil
lary basal bone. In an individual with a normal
occlusion and without posterior discrepancy, the
distance nearly does not change at all and the 1st
molar position is extremely stable during the
growth period.
However, in a patient with posterior discrepancy,
A'-6 ' decreases because of the eruption of the 2nd
and 3rd molar associated with the mesial move
ment and the vertical pushing on the 1st molar. In
effect, both the mesial movement and supraerup-
tion are forms of posterior discrepancy. The degree
of posterior discrepancy can be estimated with the
A'-6' parameter.
A'67A'-P"
This is the ratio of the values measured above. It
shows the anteroposterior position of the 1st molar
tooth in the maxillary basal bone.
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R. Slavicek • The Masticatory Organ
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Figure 1 a and 1 b: Composition of the craniofacia] complex. The skull consists of several different sophisticated bones that collectively
form a hollow bony shell that houses the brain and sense organs, and provides a base for the teeth and rhe chewing muscles. In the
stage of growth, the bones arc in a flexible state and arc dynamically interrelated. The components also have the ability to adapt to
functions of the skull. The skull functions as a base and a structural framework for rhe first stage of the digestive system and mastica
tory organ. It also serves as an encasement tor the brain and for the sense organs of sight, smell, and hearing. The functional balance of
cranioracial bones is influenced by occlusal functions such as mastication, respiration, speech, clenching and bruxism.
Figure 2a and 2b; Composition of the skull of humans and primates. The connection of the Occipital-Sphenoid-Vbmer-Maxillary bones
in the primate skull (a) shows an expanded and longer antetopostetior dimension than that in humans; (b) the human skull indicates
expansion of the neurocranium and reduction of facial prognathism. A shift in the position of the foramen magnum can be seen due co
the uprighting effect of the skull and the increase in brain size. As a consequence of the great reduction in the anrcroposterior dimen
sions of the viscerocranium, the human skull exhibited wider and more vertical growth than the primate one.
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R. Slavicek • The Masticatory Organ
Figure 3a and 3b: Comparison of cephalogram tracings of human and primate skulls. In contrast to humans, primates have a large
cranial base angle (N-S-Ba) with a posteriorly located foramen magnum and forward translation of the vomer and the maxillary bone.
The modern human face tends to rotate backward and downward underneath the brain case, with the brain developing on the top of
the facia! skeleton. The human cranial base located between the face and the brain assumes a target bend, thereby reducing rhe degree
of flexure (N-S-Ba) compared to that in primates.
Figure 4: Super-imposition of cephaiogram tracings from mod Figure 5: Vcrticalization of the viscerocranium during ontoge-
ern humans and primates. This superimposition indicates how netic growth and development. As rhe viscerocranium increas
the flexure of the ctanial base angle is telated to changes in es in its vertical rather than anteropostenor dimensions, the
the craniofacial skeleton. Reduction of the ctanial base angle facial complex of the modern human creares the necessity of
greatly influences the facial profile and the direction of growth functional mandibular adaptation in order to fit upper and
of the maxillary complex. lower dentitions.
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Figure 6a and 6b: Adaptation of occlusion against vertiealizcd growth of die facial skeleton. Vertical growth of the viscerocninium in
the human skull creates an anterior open bite (a); the maxillary complex translates downward, resulting in posterior contact of the
upper and lower teeth (wedge effect). Functions of the anterior mimic muscles such as the orbicularis oris, mentaiis, depressor and leva-
tor anguli oris, and buccinator muscles, include closing the mandible and helping to adapt the mandible by rotational movement, so
that it fits with the upper and lower occlusal surfaces (b). Patients with weak mimic muscle activity develop an anterior open bite mal-
occlusion, as the mandible cannot adapt through rotation.
Figure 7: Craniofacial connection of the Ocriput-Sphenoid- figure 8: Tcmporo-mandibuiar complex. The mandible is con
Vomer-M axillary bones. The sphenoid bone is located in the nected with the temporal bone through the temporomandibu-
cenrer of the skull and joins with other mid-line bones such as lat joint. The complex is the most dynamic functional unit in
the occiput, ethmoid, and vomer. It is directly connected to the craniofaciu! skeleton. Dynamic movement of this complex
the maxillary bone via the vomer and palatine bones. The influences the state of the Occiput-Spheno-Maxillary complex.
sphenoid bone is also connected to the occipital bone by a syn-
chondrosis known as the spheno-occipital synchondrosis.
which is in dynamic motion during the development of occlu
sion. The dynamic motion of the cranial base is transferred to
the maxillary bone through the vomer bone.
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R. Slavicek • The Masticatory Organ
figure 9: Connection ot the sphenoid and temporal bones. Figure 10: The dynamic connection of the Sphenoid-Vomer-
The vertical and horizontal portion of the greater wing of the Maxillary bones. The vomer bone plays an important role in
sphenoid and temporal bone are interconnected by a heavy transferring cranial motion to the maxillary bone. Therefore,
butt joint (arrow). The dynamics of the temporal bone influ the motion of the cranial base influences displacement of the
ence the spheno-occipital balance of the cranial base through maxillary bone.
this heavy joint. If the gleooid fossa were to receive compres
sion force from occlusion, especially when the upper and lower
teeth grind strongly during bruxism, the forces would be
transferred to the cranial base via the rotational movement of
the temporal bone.
Figure 1L: Connection of mid-line bones and bilateral tempo Figure 12: Dynamics of the Temporo-Parieral suture. The long
ral bones. The mid-line bones of the cranium undergo a beveled suture of temporo-parietal bones possesses the ability
motion defined as flexion and extension. Two of the mid-line of gliding movement. Reciprocating movements of the surure
bones, the greater wings of sphenoid and occiput, articulate from external forces iidjus: themselves to balance cranial
with the petrous portion of the temporal bone. This petrous bones. The presence of malocclusion will disrupt the temporo-
extension acts as a rotational axis (petro-tempora! axis) during mandibular joint, resulting in mandibular displacement, which
motional activities. in cum causes distortion of the temporal bone.
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R. Slavicek • The Masticatory Organ
Figure 15a-15d: Different types of maxillary bone displacement. There are 3 types of maxillary displacement: translation (b), vertical
elongation (c), and anterior rotation (d), according to the growth study done by Precious et al. (1987). It was suggested chat the dif
ferent types of maxillary displacement were closely related with cranial growth and cranial motion. Increase of the anterior cranial base
causes transiational displacement of die maxillary complex. The flexion motion of the cranial base induces vertical elongation of the
maxilla while extension provides anterior rotation of the maxiila, as shown by an anrerior-upward inclination of the palatal plane on
the cephalogram.
Figure 16: Growth of the- upper jaw and eruption of posterior teeth. Most nf the growth in the anceropostcrior
dimensions of the maxilla originates through bone opposition from the posterior aspect to the maxillary tuberosity.
The initial appositional growth at the tuberosity arises with forward translation of the maxillary complex. Lack of
maxillary translation makes it difficult to provide eruption space for the posterior molars; this creates posterior dis
crepancy.
Figure 17a and 17b: Frontal view of the craniofacial complex. Connection and posture of sphenoid, temporal bone, vomc-r, maxilla, and
mandible are closely interrelated with the dynamic function of occlusion (a). Unilateral over-eruption of posterior teeth creates posterior
interference and induces a mandibular lateral shift. Consequently the individual develops an asymmetrical balance of the craniofacial
complex (b).
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R. Slavicek • The Masticatory Organ
Figure 18a and 18b: Function of occlusion and mandibulur growth, [n the growing facial skeleton, adaptability is primarily located in
the function of dentition and secondarily in the sutures and at the condyles. The growth of the lower face is guided by the function of
Occlusion, followed by secondary condylar growth. Thus, the three-dimensional change of the occlusal plane is an extremely important
determinant of facial growth (a). Horizontalization of the maxillary occlusal plane provides rotational mandibular adaptation, with a
simultaneous reduction in the mandibular plane angle (b).
Figure 19: Denture frame analysis of the lower face. Palatal Figure 20: Longitudinal changes in the denture frame in a
plane (PP), mandibular plane (MP), maxillary occlusal plane normally growing subject. The pattern of mandibular growth
(OP), and AB plane (AB) are used to assess the construction of is closely related to changes in the spatial position and inclina
the lower face. The Frankfort horizontal plane (FH) is used as tion of the upper occlusal plane.
a ctanial reference line.
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Sadao Sato
Figure 2 la and 21b; Longitudinal growth patterns of denture frame in cases developed skeletal Class 111 (a) and Class II open bite (b)
maloccKisions. Alteration of occlusal plane related not only with mandibular posture, but also with dynamic state of the cranial base.
Figure 22a and 22b: Shows two adults with skeletal Class III (a) and skeletal Class II (b) malocdusions. Differences in the length and
angle of cranial base, position and inclination of the occlusal plane, position and posture of the maxilla and mandible, and dento-alveo-
lar vertical height are seen.
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R. Slavicek • The Masticatory Organ
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