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1. Age and sample features of a structure of the top jaw

It is necessary to notice, that the external structure of the top jaw is studied in detail enough (Sparrows of Century P, 1936; Kolesnikov L.L., Mihajlov S.S., 2008; Gajvoronskij I.V., 2014). The question on individual variability of a jaw in whole (Smirnov V.

G, 1968 is To a lesser degree investigated; Kuznetsova L.V., 1970; Smirnov V. G, Persin h.p., 2007) and especially its alveolar process. Thus, as note G. Avila et al. (2010), data on specific features of a structure of a jaw allow to execute «the individualised treatment» patients.

According to P.Balakirev from co-workers. (1941), a certain disproportion of growth of the top jaw, and also a prepterygoid part of the basis of a skull at length is observed. At the expense of growth in seams at early children's age there is a shift of the top jaw forward and downwards (X. ., 2004).

J.F. Gaudy et al. (2011) notice, that verhnecheljustnaja the bone has the form of the wrong triangular pyramid bridged to a malar bone.

According to N.R.Nuvahova (2011), it is possible to allocate two forms of the top jaw: narrow both high; wide and low. The narrow and high form has the minimum width in a combination to the maximum height. The wide and low form of a jaw has the maximum width and the minimum height.

The body of the maxilla has forward, orbital, nasal and infratemporal surfaces. A lobby name a surface located between infraorbital edge and an alveolar process. The distance from infraorbital edge to an infraorbital foramen fluctuates from 3,5 to 22 mm, from
The middle of a nasal cutting to an infraorbital foramen from 7 to 24 mm, from top of an alveolar process to an infraorbital foramen - from 18 to 40,5 mm. Approximately in 6 % of cases there are smaller on the size additional infraorbital foramens. According to W. Kurlej et al. (1983), in 4,8-5,4 % of cases full closing of an infraorbital foramen is observed. As a whole, on infraorbital foramen position the big influence renders a structure of a facial skull.

The orbital surface of the top jaw is simultaneously bottom wall of an orbit. The infratemporal surface participates in formation infratemporal and krylonebnoj fossas. The nasal surface together with other bones of a facial skull forms lateralnuju a nasal cavity wall. The frontal process is bridged to frontal, plaintive and nasal bones. The malar process settles down in a place othozhdenija forward, orbital and infratemporal surfaces of the top jaw. From an alveolar eminence of 1 th top molar tooth in a direction to a malar process of the top jaw there is a crest transferring to it chewing pressure from the big molars (Sparrows of Century P, 1936).

J.F. Gaudy et al. (2011) consider, that all zadne-lateral surface of the top jaw is expedient for parting on two parts: the first - slightly concave, verhnecheljustno-malar fossa forming with a malar bone; the second - corresponding to a hillock of the top jaw.

The alveolar process of the top jaw forms an arched osteal shaft - an alveolar arch in which alveoluses of a teeth are located. It has two surfaces: external and internal. An external surface - rough, on it alveolar eminences which correspond to tooth sockets are defined.

Forms and the sizes of alveoluses depend on a group accessory of a teeth. In alveoluses of a multirooted teeth there are interalveolar septums.

In tooth sockets there is the smooth osteal plate covered with a periosteum to which the copular apparatus of a teeth is attached.

A.T.Busygin (1962) notices, that osteal and compact plates of an alveolar process
The top jaw are powerful foundations which can perceive an appreciable masticatory stress.

In connection with developments, prorezyvanija and dedentitions there is a structural reorganisation of an alveolar process of the top jaw. The length of an alveolar arch varies from 35 mm at the newborn to 58 mm at the adult person (Andronesku A, 1970). Parametres of that part of an alveolar arch where incisors and canines are located, are enlarged with the years by 5,5 mm. The sizes of the site carrying premolar tooths, on the contrary, decrease for 3 mm. The part where molar tooths are located, is enlarged by 20 mm. At loss of a teeth there is an atrophy of their alveoluses, at full absence of a teeth atrophic processes affect an alveolar process entirely.

Processes of growth of an alveolar process of the top jaw in height not always proceed synchronously. Even at an orthognathic occlusion the alveolar process can develop variously, and degree of its development and the form make appreciable impact on position of a teeth in dentitions (Zhulev E.N., 1995).

Presence of anatomic and functional interrelation of an alveolar process with dentitions is proved. So, at a teething there is an appreciable reorganisation of all alveolar process (Kalamkarov H.A., 2004). According to N.A.Astakhov from co-workers. (1940), the alveolar process of the top jaw is only secondary superstructure which develops simultaneously with growth of roots of a teeth and disappears after their loss. However some authors notice, that in the course of an embryogenesis development of an alveolar process occurs irrespective of an intergnathic bone (Krishtab S.I., 1984).

Masticatory stress depression on lateral departments of an alveolar process at loss of a teeth in the given area conducts to the expressed atrophy of an alveolar process of the top jaw. In some cases rapprochement of a bottom of a genyantrum and a crest of an alveolar process, thus height of an alveolar process becomes perceptible makes from one to several
Millimetres. The age factor has not smaller value for degree of an atrophy of an alveolar process. So, at persons of the first period of mature age (21-35 years) even in the absence of a several lateral teeth, the minimum height of an alveolar process makes 9,5 mm. Thus in the second period of mature age the height of an alveolar process is insignificant (Jaremenko A.I. from co-workers., 2012).

L.E.Kudryavtsev, L.A.Ljakisheva (1974) notice, that from each party of the top jaw is on 8 dentoalveolar segments. The jaw form, an order of a dentoalveolar segment, and also length of a root influence remoteness of roots of a teeth from external and internal surfaces of an alveolar process. Some shift of roots of a teeth in a vestibular direction in reztsovo-maxillary and klykovo-maxillary segments is observed. Roots of premolar tooths of the top jaw are located on identical distance from predoor and lingual surfaces of corresponding segments. In connection with presence skuloverhnecheljustnogo a crest roots of the big molars are displaced orally.

According to A.T.Busygin (1962), in various parts of the top jaw the structure of compact and spongiform substance essentially differs. So, the greatest quantity of compact substance contains in a frontal process (98,5-99,3 %), the least - in an alveolar process (30-37 %); in a jaw body - approximately 85 % of compact substance, in a malar process - 91-95 %, in palatal - 77-79 %. Thus in an alveolar process there is the most powerful layer of spongiform substance. The greatest clump of thick beams of spongiform substance is observed also in a frontal process, an alveolar process at level of the big molars and in an average third of firm sky.

Clump of plates of the compact substance distributing on the top jaw of a strain, arising at otkusyvanii and nutrition chewing, and further transferring them on other bones bridged to it, have received the name "buttresses". Allocate 4 pairs symmetric buttresses top chlejusti: frontonasal, malar, krylonebnye and palatal.

As is known, the body of the maxilla contains a pneumatic cavity - verhnecheljustuju a sinus which formation at adults comes to an end only with a wisdom teething (Gajvoronskij I.V. from co-workers., 1996). The parametres characterising the sizes and the form of genyantrums, possess individual and age variability. The minimum volume of a genyantrum makes 15 sm3, maximum - 35-40 sm3 (Sparrows of Century P, 1936). Thus the given parametre authentically is more at men (about 16 sm3), than at women (12,5 sm3) (Kostomanova N.G., 1958; Nikitjuk D.B., 1983).

According to J.A.Klimovets's (1955) classification, genyantrums on pneumatization degree can be systematised on three groups: well pnevmatizirovannye, sredne pnevmatizirovannye and it is weak pnevmatizirovannye. The volume of the sinuses concerning the first group, makes not less than 18 sm3. Such sinuses extend in malar and alveolar processes of the top jaw. Also in this group weakly expressed dog fossa, the smoothed zigomatico-alveolar crest and well developed hillock of the top jaw are observed.

The second group is made by sinuses in volume from 11 to 18 sm3. In the given group the dog fossa also is weakly expressed. The third group is made by sinuses in volume from 4,0 to 11,0 sm3, in it well expressed dog fossa is observed, and malar and alveolar bays practically are not expressed.

The great value in practical stomatology has position of a bottom of a genyantrum concerning a bottom of a nasal cavity. According to D.E.Tanfileva (1964), it essentially changes with the years. So, at children till 14 years in 85 % a bottom of sinuses above a bottom of a nasal cavity. At 26 % of adults a bottom of a nasal cavity below a bottom of sinuses, above - at 47 % and at one level - at 27 %. The number of the sinuses located below a bottom of a nasal cavity, at the age of 21-30 years makes 40 %, at the age of 41-50 years it is enlarged to 60 %, then decreases aged 51­60 years, and at senile age reaches 67,5 %. Thus after 30 years the quantity of the sinuses located flush with a bottom of a nasal cavity gradually decreases. Thus, lowering of level of a bottom of genyantrums occurs simultaneously to intensifying of function of the chewing apparatus.

Position of a bottom of a genyantrum substantially defines its volume. So, N.G.Kostomanova (1958) notices, that if the bottom has high position, the sinus volume fluctuates from 1,8 to 11,7 sm3, at a locating of a bottom of a sinus flush with a bottom of a nasal cavity, its volume fluctuates from 4,3 to 22,2 sm3, and at lower position of a bottom - from 3,9 to 26

3

Sm3.

The important applied value in practical stomatology and cheljustnoyolitsevoj surgeries has a parity of a bottom of a genyantrum with apexes of roots of a teeth. A.S.Ivanov, A.K.Iordanishvili (1988) is cited by data according to which in 25,8 % of cases at women and in 20 % of cases at men of an apex of roots of canines are at a genyantrum, in other cases - at the bottom nasal course. As a whole, the distance from apexes of roots of canines to the bottom a genyantrum is on the average equaled 3,1±0,1 mm and does not depend on a floor. The distance from apexes of roots of molars to the bottom a genyantrum fluctuates from 1,2 to 9,7 mm and 7,4 mm are on the average peer. At level of the second top small molar of value of the given parametre average 4,6 mm. At level of a medial buccal root of the first top big molar this size is peer 4,5 mm, a distal root - 3,8 mm, at level of a medial buccal root of the second top molar - 4,2 mm, at level of a distal buccal root of the second top molar - 3,6 mm. On the right the received value of the given indicator characterising distance between apexes of buccal roots of teeth and a bottom of a genyantrum, authentically it is less, than at the left. At level of the first big molar the apex of a palatal root will defend from a bottom of a genyantrum on the average on 2,0 mm, an apex of a palatal root of the second big molar - on 3,6 mm, and an apex of a palatal root of the first small molar - on 3,3 mm.

Thus, it is obvious, that the anatomic structure of the top jaw is studied now in detail enough, except for a problem of its individual variability: variabilities of a structure of an alveolar process and genyantrums at loss of a teeth, data about which can be
Are used at planning of treatment-and-reabilitation actions at patients with the okkljuzionno-caused diseases of the chewing apparatus.

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Scientific source GAJVORONSKAYA Maria Georgievna. ANATOMO-CLINICAL SUBSTANTIATIONS of TREATMENT of the OKKLJUZIONNO-CAUSED DISEASES of the CHEWING APPARATUS. The dissertation on competition of a scientific degree of the doctor of medical sciences. St.-Petersburg - 2014. 2014

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