4. Available bone
• Is the amount of bone in the edentulous area
considered for implantation.
• It is measured in height length angulation
and crown- implant ratio.
anatomy
5. ANATOMICAL LIMITATION
OF IMPLANT PLACEMENT
• Minimum distance between
implant and indicated structure
الزرع بين المسافة من األدنى الحد
و
45. Endosseousimplant (fixture)
• Is a surgical component that interfaces with
the bone of the jaw or skull to support a
dental prosthesis such as a crown, bridge,
denture, facial prosthesis or to act as an
orthodontic anchor.
51. Four ganglions in the trigeminal nerve
• 1- Ciliary
• 2- Pterygopalatine
• 3-Otic
• 4-Submandibular
52. Interior view of the human brain, with
مسمى
the cranial nerves labelled
1 Smell (I)
2 Vision (II)
3 Eye movement (III, IV, VI)
4 Facial sensation (V)
5 Facial expression (VII)
6 Hearing and balance (VIII)
7 Oral sensation, taste, and
salivation (IX)
8 Vagus nerve (X)
9 Shoulder elevation and
head-turning (XI)
10 Tongue movement (XII)
60. Trigeminal nerve
• is a nerve responsible
for sensation in the
face and certain
motor functions
such as biting
and chewing.
Is a mixed nerve
61.
62.
63. Trigeminal nerve branches
• It is the largest of the cranial nerves .
has three major branches:
• the ophthalmic nerve (V1).
• the maxillary nerve (V2).
• the mandibular nerve (V3).
64. Trigeminal nerve branches
• The ophthalmic and maxillary
nerves are purely sensory.
• The mandibular nerve has both
cutaneous and motor functions
65. motor functions
• Muscles of mastication
• masseter
• temporalis
• medial pterygoid
• lateral pterygoid
• Others
• tensor veli palatini
• mylohyoid
• anterior belly of digastric
• tensor tympani
73. The ophthalmic nerve (V1)
• It is the smallest of the three divisions of the
trigeminal.
• Passes forward along the lateral wall of the
cavernous sinus.
• Entering the orbit, through the superior
orbital fissure.
79. carries sensory information from
• 1-the scalp and forehead.
• 2-the upper eyelid.
• 3-the conjunctiva and cornea of the eye.
• 4-the nose (including the tip of the nose, except
alae nasi).
• 5-the nasal mucosa.
• 6-the frontal sinuses.
• 7-parts of the meninges (the dura and blood
vessels).
84. Exits the cranium via foramen
rotundum ,and divided by location
facial
infraorbital
pterygopalatine
intracranial
85. The maxillary nerve (V2)
• Exits the cranium via foramen rotandum of
the greater wing of the sphenoid.
• Travels at the superior most aspect of the
pterygopalatine fossa just posterior to the
maxilla
86. Branches divided by location
• Branches divided by location:
• - inter-cranial
• -pterygopalatine.
• - infraorbital
• -facial
87. Branches:
• – Within the cranium - middle meningeal
nerve providing sensory innervation to the
duramater
• – Within the pterygopalatine fossa -
• • Zygomatic nerve
• • Pterygopalatine nerves
• • Posterior superior alveolar nerve
88. Within the pterygopalatine fossa
• – Pterygopalatine nerves:
• • Palatine branches branches- greater (anterior) and lesser
• (middle or posterior) palatine nerves
• – Greater palatine: travels through the pterygopalatine
• canal and enters the palate via the greater palatine
• foramen. Innervates palatal tissue from premolars to
• soft palate. Lies 1cm medial from 2nd nd molar region
• – Lesser palatine: emerges from lesser palatine foramen
• and innervates the mucous membranes of the soft palate
• and parts of the tonsillar region
89. Within the pterygopalatine fossa
– Pterygopalatine nerves:
• Orbital branches - supplies periosteum of
the orbits
• • Nasal branches - supplies mucous
membranes of superior and middle conchae,
lining of posterior ethmoid sinuses, and
posterior nasal septum.
90. Within the pterygopalatine fossa
• – Nasopalatine nerve - travels across the roof
of nasal cavity giving branches off to the
anterior nasal septum and floor of nose.
Enters incisive foramen and provides palatal
gingival innervation to the premaxilla
91. • Within the pterygopalatine fossa -
• – Zygomatic nerve:
• • Zygomaticofacial nerve - skin to cheek prominence
• • Zygomaticotemporal nerve - skin to lateral forehead
• – Pterygopalatine nerves:
• • Serves as communication for the pterygopalatine
ganglion and the maxillary nerve .
• • Carries postganglionic secretomotor fibers
through the zygomatic branch to the lacrimal gland .
92. • Infraorbital canal branches
– Middle superior alveolar (MSA):
• • Provides innervation to the maxillary
• -alveolus ,
• -buccal gingiva,
-periodontal ligament
- and pulpal tissue for the premolars only
93. Infraorbital canal branches
Anterior superior alveolar (ASA):
• Branches 6-8mm posterior to the infraorbital
nerve exit from infraorbital foramen.
• • Provides innervation to:
• -the maxillary alveolus,
• -buccal gingiva,
• -periodontal ligament,
• -and pulpal tissue for the canines, lateral and
central incisors
97. carries sensory information from
• 1-the lower eyelid and cheek.
• 2-the nares and upper lip.
• 3-the upper teeth and gums.
• 4-the nasal mucosa.
• 5-the palate and roof of the pharynx.
• 6-the maxillary, ethmoid and sphenoid sinuses
• 7-parts of the meninges.
137. Maxillary Bone
• consist of upper palate of mouth or maxilla .
• or two halves that are fused at the
intermaxillary suture to form the upper jaw.
• which is also a fusion of two halves at the
mandibular symphysis.
139. Components
• Each half of the fused maxillae consists of:
• The body of the maxilla
• Four processes
• The zygomatic process
• The frontal process of maxilla
• The alveolar process
• The palatine process
• Infraorbital foramen
• The maxillary sinus.
156. maxillary sinus
• The anterior maxillary sinus wall houses the
infraorbital nerve, which runs through the
infraorbital canal along the roof of the sinus
and sends branchs to the soft
tissues of the cheek.
157. The thinnest portion of the anterior
wall is above the canine tooth
• called the canine fossa, which is an ideal
entry site for addressing various disease
processes of the maxillary sinus.
212. • 1- controls the muscles of facial expression.
• 2- and functions in the conveyance of taste
sensations from the anterior two-thirds of
the tongue and oral cavity.
• 3- It also supplies preganglionic
parasympathetic fibers to several head and
neck ganglia.
213. The facial nerve is the seventh (VII)
of twelve paired cranial nerves.
214. Branches
• 1-Temporal branch of the facial nerve
• 2-Zygomatic branch of the facial nerve
• 3-Buccal branch of the facial nerve
• 4-Marginal mandibular branch of the facial
nerve
• 5-Cervical branch of the facial nerve
• 6-Occipital branch
220. chorda tympani
• * - functions in the conveyance نقل وسيلة of
taste sensations from the anterior two-thirds
of the tongue.
• -Submandibular gland
• -Sublingual gland
221. Greater petrosal
• *It also supplies preganglionic
parasympathetic fibers to several head
and neck ganglia.including:-
• - the nasal gland,
• - palatine gland,
• - lacrimal gland,
• - and pharyngeal gland.
222. Greater petrosal
• It also provides parasympathetic innervation
• - to the sphenoid sinus,
• - frontal sinus,
• - maxillary sinus,
• - ethmoid sinus and nasal cavity.
235. carries sensory information from
• 1-the lower lip,
• 2- the lower teeth , pulp , PL , alveolar bone
and gums.
• 3-the chin and jaw (except the angle of the
jaw, which is supplied by C2-C3).
• 4-parts of the external ear.
• 5-and parts of the meninges
236. The mandibular nerve carries
•touch/position .
*pain/temperature.
*sensation from the
mouth .
237. Taste from chorda tympani
• *It does not carry taste sensation (chorda
tympani is responsible for taste).
• *but one of its branches, the lingual nerve
• carries multiple types of nerve fiber that do
not originate in the mandibular nerve .
239. Mandibular Nerve
– Branches:
The main trunk
• Branches of the undivided nerve
• Branches of the anterior division
• Branches of the posterior division
241. Mandibular branches
• – The sensory and motor roots emerge from
the foramen ovale of the greater wing of the
sphenoid
• – Initially merge دمج outside of the skull and
divide about 2-3mm inferiorly
242. The undivided nerve:
• – Nervus spinosus - innervates mastoids
and dura.
• – Medial pterygoid- innervates medial
pterygoid muscle.
• Branches into
• – Tensor veli palatini
• – Tensor tympani
243. Closing and opening the jaw
• Closing of the mandible is performed by
• -the masseter.
-temporalis,
- and medial pterygoid muscle
• The jaw opens at the temporomandibular
joint by traction on the mandibular neck by
the lateral pterygoid muscle.
246. • Auriculotemporal: all sensory
Transverses the upper part of the parotid gland and
posterior portion of the zygomatic arch
• Branches:
• Communicates with facial nerve to provide sensory
innervation to the skin over areas of the zygomatic,
buccal, and mandibular
• Communicates with the otic ganglion for sensory,
secretory, and vasomotor fibers to the parotid
•
– • • – –
247.
248. The secret nerve fibers from the
facial nerve to trigeminal nerve
• 1-Greater petrosal nerve .
• 2-lesser petrosal nerve .
• 3-Chorda tympani
252. Chorda tympani
• -Submandibular gland
• -Sublingual gland
• -Special sensory taste fibers for the
anterior 2/3 of the tongue.
253. Branches of the anterior division:
• Buccal nerve (long buccal and buccinator):
• Travels anteriorly and lateral to the lateral
pterygoid muscle
• Gives branches to:
• - the deep temporal (temporalis muscle).
• -masseter,
• -and lateral pterygoid muscle
263. Branches of the anterior division:
• – Buccal nerve (long buccal and buccinator):
• Continues to travel in antero-lateral direction
• At level of the mandibular 3rd molar, branches exit
through the buccinator and provide innervation to
the skin of the cheek
• Branches also stay within the retromandibular
triangle providing sensory innervation to the buccal
gingiva of the mandibular molars and buccal
vestibule
264. Branches of the posterior
division:
• Divisions:
• Auriculotemporal
• Lingual
• Inferior alveolar
272. Branches of the posterior division:
• – Auriculotemporal: all sensory
• • Branches:
• – Anterior auricular - skin over helix and tragus
• – External auditory meatus - skin over meatus
and
• tympanic membrane
• – Articular - posterior TMJ
• – Superficial temporal - skin over temporal
region
273. Branches of the posterior division:
•– Lingual:
• • Lies between ramus and medial pterygoid
within the pterygomandibular raphe
• • Lies inferior and medial to the mandibular 3rd
molar alveolus
• • Provides sensation to anterior 2/3rds of tongue,
• lingual gingiva, floor of mouth mucosa, and
• gustation (chorda tympani)
329. Anatomy of the TMJ
• Is the articular surface between the
mandibular condyles and the temporal bone.
• Synovial membranes line the space between
the two bones.
334. components of the TMJ
Mandibular condyles
1-Articular surface of the temporal
bone
2-Capsule
3-Articular disc
4-Ligaments
5-Lateral pterygoid muscle
338. Ligaments
• The stylomandibular ligament,
• sphenomandibular ligament
• capsular ligament support the joint.
• Lateral ligament.
339. Blood and nerve supply
• Blood supply is from the superficial temporal
branch of the external carotid artery.
• Branches from the auriculotemporal and
masseteric divisions of the mandibular nerve
innervate the joint
352. TMJ
•surgical options may consider
include:
• (a) Arthrocentesis — flushing fluid
from the joint and gently stretching it.
353. TMJ
•(b) Arthroscopy — using a
miniature telescoping instrument to diagnose
and repair the joint.
باستخدام
مصغر منظار
لتشخيص
المفص وإصالح
ل
.
364. Barton's bandage
• A Barton's bandage is used to temporarily
stabilize the jaw after a fracture or dislocation.
365. What happens to the TMJ that causes
pain or malfunction?
• Just like with a knee joint, the TMJ can be
damaged in a number of ways, including:
*dislocation.
• adhesion (getting stuck).
• torn muscle or ligaments.
• and derangement (improper relationship to
the disk).
373. TMJ injury can happen as a result of :-
• *degenerative changes in the joint due to
arthritis or other diseases of the joint,
374. Traumatic injury
• *or it can be the result of a traumatic injury
like a
• - car accident,
• - fall,
• - or blow to the jaw.
375. Bruxism
• *TMJ problems can also appear gradually as a
result of clenching the jaws and bruxism
(teeth grinding, usually during sleep).
376. Symptoms
• Patients may complain of earaches,
headaches and limited ability to open their
mouth.
• *They may also complain of clicking or
grating sounds in the joint and feel pain
when opening and closing their mouth.
377. The Joint, the Muscles or Both are
the Problem
•Stress may trigger pain in the
jaw muscles that is very similar
to that caused by TMJ problems..
378. • Affected patients frequently clench or
grind their teeth at night causing painful
spasms in the muscles and difficulty in
moving the jaw.
379. Bite splints or guards are commonly
used to treat TMJ disorders.
