The coronoid process (or simply “crown”) of an uncrowned tooth can differ in its appearance and characteristics depending on the level of crown formation at the time of injury. At any given time, there are at least three levels of crowns: base, upper, and pus-filled. If the tooth is in a perfect state of health, then all three will appear in the same visible way on the tooth.
Coronoid Process: Anatomy
The basic anatomy of the tooth consists of three different bone components: the cricoarytenoid bone (also known as the central area or uppers), the dentin, and the mandible. The uppers also articulate with the front of the dentin, called a proboscis, and the mandible is the hinge that closes on the backside of each tooth.
The most common and well-known aspect of the coronoid process comes from a deep dive of the jaws. In this case the tooth is exposed and the jaw is fully extended into the air. The oral cavity is viewed in a deep dissection under a general anesthetic. Often enough the patient will not feel a thing! From here the dentist uses local anesthesia and gently presses on the nerve roots of each tooth with pneumatic force to bring the tooth straight up and out of its socket. Often enough the entire process takes less than one hour.
Phases of Coronoid Process
In a normal bite, the uppermost mandible of the lower jaw (the “molars”) keeps itself straight by the effects of a counterclockwise rotation of the mandible. The two upper teeth come together at the top of this “counter-clockwise rotation” of the mandible. We call them “apsidal” teeth. Each of these teeth has a “proximal” or lateral process. These are the teeth that grow furthest away from the base area of our jaws.
The next phase of the coronoid process is the formation of a pocket between the upper and lower teeth. This pocket is a undecagonal or triangular shape. This shape and the subsequent growth of mucous tissue, bone, and cartilage make the endodontic or lower jaw more solid and less inclined to contract than the upper jaw. This process is eminence.
Once the eminence is complete the last phase of the coronoid process is the formation of a new bone or tissue structure at the base of our skull, known as the temporal bone. This bone connects the two upper parts of our jaws and helps hold them together. The temporo-elastic cartilage that forms the temporal bone has three components. One component is the thicker, longer rigid part, the second component is flexible and thin and the last component is also very long and flexible. This flexible part, or the flexor, holds the upper part of our jaws in place and holds it in place until the natural lengthening of our jaws occurs.
Facet Fractures in Sports
The articular surface of our temporal bone is particularly prone to damage due to the pressure caused by chewing. The mechanics of a typical mandibular fracture (or elbow dislocation) are caused by the force with which the upper and lower jaw are pushed together. This force, if it is strong enough, can rip through the articular surface and into the underlying bone. This can occur when the upper jaw is open as in the case of a baseball throw, or if the athlete smiles broadly in order to maintain contact with the ball while making a catch.
When an athlete suffers a simultaneous dislocation of both ulnar and radial teeth, it is termed “ulnar subluxation”. These types of fractures usually require the involvement of a plastic or metal plate placed over the affected tooth for stability. In addition to this treatment, the affected teeth may need fixing with a crown. Both ulnar and radial subluxations are very common in sportspeople. This can lead to a high degree of pain and disability.
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