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R.D.GARDI MEDICAL COLLEGE &
HOSPITAL
Department of Anatomy
Anatomical considerations for Dental
implants
By:- Guided by:-
...
Anatomical Considerations
For Dental Implants
By;
Dr. Saurabh Anand Thawrani
B.D.S,
Diploma Advanced Oral Implantology (Pu...
IMPLANTS ???
An implant is a medical device manufactured to
replace a missing biological structure, support a
damaged bio...
Types Of Dental Implants
How does an Implant works???
• Dr. prof. Per-Ingvar Brånemark was
a Swedish orthopaedic surgeon
and research professor, to...
Advantages of Implant
Reduce the load on the
remaining oral structures/teeth
by offering independent support
and retention...
Anatomical considerations
Maxilla
•Maxillary Arch Morphology
•Maxillary Sinus
•Muscle Attachments
•Innervation of Maxilla...
Maxillary Arch Morphology
 The osseous morphology of dentoalveolar process is
influenced by masticatory forces, transmitt...
Maxillary Sinus
The pneumatic cavity occupying body of maxilla.
It is the largest of the paired paranasal sinus in adult...
Muscle Attachments
• BUCCINATOR 
Origin :- From base of alveolar process, opp. The
first, second & third molar of both j...
• LEVATOR LABII SUPERIORIS 
 Origin :- From infra orbital margin above infra orbital
foramen.
 Insertion :- Skin of upp...
Innervation Of Maxilla
POSTERIOR SUPERIOR ALVEOLAR NERVE 
The nerve arises within the pterygopalatine fossa,
courses dow...
INFRA ORBITAL NERVE 
Continuation of the maxillary division of the Trigeminal
nerve.
It leaves ptrygopalatine fossa by ...
MIDDLE SUPERIOR ALVEOLAR NERVE 
Its the branch of infra orbital nerve given off
through the infra orbital groove.
The n...
PALATINE NERVES 
 The greater & lesser palatine nerves supply the hard & the
soft palate.
 They exit pterygopalatine fo...
Blood Supply
 The mucoperiostium of anterior maxilla supplied by branches of
INFRA ORBITAL & SUPERIOR LABIAL ARETY ( BRAN...
Mandibular Arch Morphology
The mandible is a strong, arched bone, fused at the
midline ( mental symphysis) & is the only ...
The slight depression located superior to anterior
extent of mylohyoid ridge is sublingual fossa,
which houses sublingual...
Mandibular Canal
 The mandibular foramen through which the inferior alveolar
nerovascular bundle enters the mandible is l...
Symphysis Region
At the anterior sufrace of midline.
A triangular protuberance.
The base of triangle is continous with ...
Muscle Attachments
• LINGUAL OR MEDIAL ATTACHMENTS
 Mylohyoid muscle
 Genioglossus
 Medial Pterygoid
 Lateral Pterygoi...
MYLOHYOID MUSCLE 
The main muscle of floor of mouth
ORIGIN :- Entire length of mylohyoid lines.
INSERTION :- The most ...
GENIOGLOSSUS 
Forms bulk of tongue.
ORIGIN :- From superior genial tubercles
INSERTION :- Ant. Fibres into dorsal of t...
MEDIAL PTERYGOID 
ORIGIN :- Medial surface of lateral pterygoid plate
of sphenoid bone, a small slip originates from
max...
LATERAL PTERYGOID 
ORIGIN :-Upper head-roof of infra temporal fossa,
lower head-lateral surface of lateral plate of the
...
TEMPORALIS 
Fan shaped muscle
ORIGIN :- Bone of temporal fossa and temporal
fascia.
INSERTION :- Coronoid process of m...
MENTALIS MUSCLE 
 ORIGIN :- Periostium of mental tubercles.
 INSERTION :- Skin of chin.
 ACTION :- Raises & protrudes ...
Blood Supply
The major artery supplying > INFERIOR ALVEOLAR
ARTERY.
It enters medial aspect of ramus of mandible &
cours...
Why anatomical considerations?
THE BEAUTY OF IMPLANTS
CLINICAL CONCLUSION
Implant placement is not a complicated
procedure.... If one has an adequate knowledge
of the ANATOMIC...
Thank you 
Anatomical considerations for dental implants
Anatomical considerations for dental implants
Anatomical considerations for dental implants
Anatomical considerations for dental implants
Anatomical considerations for dental implants
Anatomical considerations for dental implants
Anatomical considerations for dental implants
Anatomical considerations for dental implants
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Anatomical considerations for dental implants

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Anatomical considerations for placing dental implants.
all the basic anatomical landmarks and considerations which are to be taken care off before and while placing a dental implant.
any type of implant it may be...wether endossous or subperiosteal or tranosteal.
lack of knowledge of basic anatomy will never lead to success of implant.

Published in: Health & Medicine

Anatomical considerations for dental implants

  1. 1. R.D.GARDI MEDICAL COLLEGE & HOSPITAL Department of Anatomy Anatomical considerations for Dental implants By:- Guided by:- Dr. Saurabh Thawrani Dr. Manish Patil
  2. 2. Anatomical Considerations For Dental Implants By; Dr. Saurabh Anand Thawrani B.D.S, Diploma Advanced Oral Implantology (Pune), Diploma Laser Dentistry (Italy), Diploma Infection Control (U.S.A), Member Infection Control Committee (Egypt), Fellow Royal Society of Public Health (U.K.), M.Sc. Medical Anatomy,…
  3. 3. IMPLANTS ??? An implant is a medical device manufactured to replace a missing biological structure, support a damaged biological structure, or enhance an existing biological structure. A dental implant (also known as an endosseous implant or 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.
  4. 4. Types Of Dental Implants
  5. 5. How does an Implant works??? • Dr. prof. Per-Ingvar Brånemark was a Swedish orthopaedic surgeon and research professor, touted as the “father of modern dental implantology.”  Discovered OSSEOINTEGRATION. • Osseointegration defined as : "the formation of a direct interface between an implant and bone, without intervening soft tissue" May 3, 1929 – Dec. 20, 2014
  6. 6. Advantages of Implant Reduce the load on the remaining oral structures/teeth by offering independent support and retention to crowns, bridgework and overdentures. Preserve natural tooth tissue by avoiding the need to cut down adjacent teeth for conventional bridgework. Preserve bone and significantly reduce bone resorption and deterioration that results in loss of jawbone height. Reduce the need for subsequent restorative intervention of adjacent teet Last for a much longer time than conventional restorations on teeth. Loose fitting dentures can be replaced with improved support, stability and retention with implant overdentures & will help control/improve facial contours that result in minimizing premature wrinkles. Allow you to chew your food better and speak more clearly.
  7. 7. Anatomical considerations Maxilla •Maxillary Arch Morphology •Maxillary Sinus •Muscle Attachments •Innervation of Maxilla •Blood Supply Mandible •Mandibular Arch Morphology •Mandibular Canal •Symphysis Region •Muscle Attachments •Innervation of Mandible •Blood Supply
  8. 8. Maxillary Arch Morphology  The osseous morphology of dentoalveolar process is influenced by masticatory forces, transmitted to alvelous through teeth & PDL.  The maxillary post. Teeth are inclined buccally 5 to 10 degrees, opposing mandibular are inclined lingually.  This transverse curvature of dental arches “ THE CURVE OF WILSON”  This inclination of opp. Dentition is considered in planning treatment for implant cases proper allingment & adequate bone support.  During mastication the palatal portion of ant. Maxillay alveolus receives osteogenic stimulation through tensional forces trasmitted by PDL, & Labial plate receives minimal tensile forces.  CASES LACKING POST. OCCLUSAL STOPS & LABAIL PLATE HAS EXCESSIVE COMPRESSION PRESSURE LEADING TO RESORPTION.
  9. 9. Maxillary Sinus The pneumatic cavity occupying body of maxilla. It is the largest of the paired paranasal sinus in adults average capacity of 12 to 15 ml Average dimension 23mm wide, 34 mm ant. Post. & 33mm high. Expansion of maxillary sinus into alveoulus represents a major factor in amount of vertical bone height available for endosseous implant placement in post. Maxilla. As teeth are lost maxillary sinus may expand into vacated alveolus. The sinus epithelium (schneiderian membrane) is thin but tightly bound to underlying periosteum. The sinus distance from the crest of ridge is called as the sub antral space. ( S.A. 1 TO S.A. 4)
  10. 10. Muscle Attachments • BUCCINATOR  Origin :- From base of alveolar process, opp. The first, second & third molar of both jaws. Insertion :- Angle of mouth, orbicularis oris. Action:- Presses cheek against molar teeth, works with tongue to keep food between occlusal surface, expels air out from oral cavity, UNILATERAL FUNCTION Draws mouth to one side. During placement of implant one must avoid injury to it as it may lead improper masticatory functions, accumulation of food, improper speech, facial expression may get affected.
  11. 11. • LEVATOR LABII SUPERIORIS   Origin :- From infra orbital margin above infra orbital foramen.  Insertion :- Skin of upper lip, alar cartilages of nose.  Action :- Elevates upper lip, dilates nostrils, raises angle of mouth. • LEVATOR ANGULI ORIS   Origin :- Maxilla , below infra orbital foramen.  Insertion :- Skin at corner of mouth.  Action :- Raises angle of mouth, helps form nasolabial furrow.   THE INFRA ORBITAL NERVE & VESSELS ARISE BETWEEN THESE TWO MUSCLES, ONE MUST AVOID INJURY TO THEM, BY BEING CAREFULL DURING FLAP REFLECTION & IMPLANT PLACEMENT.
  12. 12. Innervation Of Maxilla POSTERIOR SUPERIOR ALVEOLAR NERVE  The nerve arises within the pterygopalatine fossa, courses downward & forward passing through pterygomaxillary fissure & enters posterior maxilla. This nerve supplies SINUS, MOLARS, BUCCAL GINGIVA & ADJOINING PORTION OF CHEEK. THIS NERVE MAY GET INJURED DURING SINUS AUGMENTATION.
  13. 13. INFRA ORBITAL NERVE  Continuation of the maxillary division of the Trigeminal nerve. It leaves ptrygopalatine fossa by passing through inferior orbital fissure to enter floor of orbit. It runs through infra orbital groove & then in infra orbital canal, and exits the orbit through infra orbital foramen to give cutaneous branches to lower eye lid, ala of nose & skin. IN CASES OF MAXILLARY SINUS DISORDERS THE SITE OF INFRA ORBITAL FORAMEN BECOMES TENDER LEADING TO INFLAMMATION OF INFRA ORBITAL NERVE, IMPROPER PLACEMENT OF IMPLANT MAY EVEN LEAD TO PARASTHESIA.
  14. 14. MIDDLE SUPERIOR ALVEOLAR NERVE  Its the branch of infra orbital nerve given off through the infra orbital groove. The nerve runs downward & forward in lateral wall of sinus to supply maxillary premolars. ANTERIOR SUPERIOR ALVEOLAR NERVE  Branch of infra orbital arises within infra orbital canal. Runs laterally within sinus wall, then curves medially to pass beneath the infra orbital foramen. Supplies the maxillay anterior teeth.
  15. 15. PALATINE NERVES   The greater & lesser palatine nerves supply the hard & the soft palate.  They exit pterygopalatine fossa through superior opening of pterygopalatine fossa descending palatine canal.  Runs forward in a groove on inferior surface of hard palate to supply palatal mucosa as incisor teeth.  The nerve communicates with nasopalatine nerve. NASOPALATINE NERVE   The nerve leaves the pterygopalatine fossa through sphenopalatine foramen lacated in medial wall of fossa.  It enters nasal cavity & supplies portions of lateral & superior aspects of nasal cavity.
  16. 16. Blood Supply  The mucoperiostium of anterior maxilla supplied by branches of INFRA ORBITAL & SUPERIOR LABIAL ARETY ( BRANCH OF FACIAL ARERY)  The buccal mucoperiostium of maxilla is supplied by vessels of POSTERIOR SUPERIOR ALVEOLAR, ANTERIOR SUPERIOR ALVEOLAR & BUCCAL ARTERIES.  The mucoperiostium of hard palate is supplied by BRANCHES OF GREATER PALATINE & NASOPALATINE ARTERIES.  The soft palate is supplied by LESSER PALATINE ARETRY.  THE BLOOD SUPPLY OF MAXILLA IS MANTAINED BY ANASTOMOSES PRESENT IN THE SOFT PALATE.   THUS ONE SHOULD BE CAREFUL DURING FLAP REFLECTION, IMPLANT PALACEMENT, GRAFTING PROCEDURES & RIDGE AUGMENTATIONS.
  17. 17. Mandibular Arch Morphology The mandible is a strong, arched bone, fused at the midline ( mental symphysis) & is the only movable bone of the face & performs work of mastication. In the inner surface of mandible the area adjacent to the roots of third molar, the mylohyoid line or ridge is there, which courses inferiorly & anteriorly. It continues to inferior border of mandible in between the genial tubercles & diagastric fossa. The ridge is formed due to origin to mylohyoid muscle offering important horizontal reinforcement to mandible. The concavity inferior to mylohyoid ridge is submandibular fossa related to anterior surface of deep portion of submandibluar gland.
  18. 18. The slight depression located superior to anterior extent of mylohyoid ridge is sublingual fossa, which houses sublingual gland. The palpation of this region is necessary before implant placement to determine shape of ridge & extent of submandibular fossa. While operating in the lingual region of posterior mandible the proximity of lingual nerve should be seen, as after exiting the pterygomandibular space next to medial surface of mandible, lingual nerve passes superficially under the mucosa on the periostium of lingual alveolar plate.
  19. 19. Mandibular Canal  The mandibular foramen through which the inferior alveolar nerovascular bundle enters the mandible is located on inner aspect of ramus.  The mandibular canal passes from the mandibular foramen inferiorly & anteriorly, then courses horizontally, laterally, usually just below the root apices of the 3rd molar teeth. As the canal approaches the mental foramen, it curves superiorly.  In the vertical dimensions the canal may be in a high, low or intermediate location within the mandibular body.  At distal aspect of first molar, canal is at its lowest point, so  safest place in post. Mandible to place implant.  The mean distance from inf. Border to lowest point along course of mandibular canal is 5.9 ±2.2mm with range of 2 – 11 mm.  The canal is rarely greater than 6mm below mental foramen.
  20. 20. Symphysis Region At the anterior sufrace of midline. A triangular protuberance. The base of triangle is continous with inferior border of mandible, projects laterally on each side as mental tubercle. Above the mental tubercles & lateral to mental protuberance, lies a small concavity for transmission of accessory nerves & blood vessels. This fossa is seen as small roughened elevation for attachment of MENTALIS MUSCLE.
  21. 21. Muscle Attachments • LINGUAL OR MEDIAL ATTACHMENTS  Mylohyoid muscle  Genioglossus  Medial Pterygoid  Lateral Pterygoid  Temporalis • BUCCAL OR FACIAL ATTACHMENTS  Mentalis muscle  Buccinator  Masseter
  22. 22. MYLOHYOID MUSCLE  The main muscle of floor of mouth ORIGIN :- Entire length of mylohyoid lines. INSERTION :- The most post. Fibers insert into the body of hyoid bone, while other meet in the midline to form a median raphe. INTRA & EXTRA ORAL STRUCTURES ABOVE THIS MUSCLE ARE INTRA ORAL, AND BELOW ARE EXTRA ORAL ACTION :- Raise hyoid bone & floor of mouth, depresses the mandible if hyoid bone is fixed. INNERVATION :- Mylohyoid nerve ( motor branch)> Inferior alveolar nerve.
  23. 23. GENIOGLOSSUS  Forms bulk of tongue. ORIGIN :- From superior genial tubercles INSERTION :- Ant. Fibres into dorsal of tongue from root to tip. Post. fibres into body of hyoid bone. FUNCTION :- Main muscle for tongue protrusion INNERVATION :- Hypoglossal nerve. This muscle should not be completely detached from tubercles as a result... Complete retrusion of tongue AIRWAY OBSTRUCTION
  24. 24. MEDIAL PTERYGOID  ORIGIN :- Medial surface of lateral pterygoid plate of sphenoid bone, a small slip originates from maxillary tuberosity. INSERTION :- Medial surface of angle of mandible. ACTION :- Elevation & side to side movement. INNERVATION :- Nerve to medial pterygoid from mandibular division of trigeminal nerve.
  25. 25. LATERAL PTERYGOID  ORIGIN :-Upper head-roof of infra temporal fossa, lower head-lateral surface of lateral plate of the pterygoid process. INSERTION :-Capsule of Temporomandibular joint in the region of attachment to the articular disc and to the pterygoid fovea on the neck of mandible. ACTION :- Protrusion & side to side movement. INNERVATION :- Masseteric nerve from the anterior trunk of the mandibular nerve.
  26. 26. TEMPORALIS  Fan shaped muscle ORIGIN :- Bone of temporal fossa and temporal fascia. INSERTION :- Coronoid process of mandible and anterior margin of ramus of mandible almost to last molar tooth ACTION :- Elevation & Retraction of mandible. INNERVATION :- Deep temporal nerves from the anterior trunk of the mandibular nerve
  27. 27. MENTALIS MUSCLE   ORIGIN :- Periostium of mental tubercles.  INSERTION :- Skin of chin.  ACTION :- Raises & protrudes lower lip as it wrinkles skin on chin.  INNERVATION :- Marginal branch of facial nerve. MASSETER   ORIGIN :- DUAL ORIGIN -- Superficial head :- Ant. 2/3rd of lower border of zygomatic arch. -- Deep head :- Post. 1/3rd of zygomatic arch & entier deep surface of arch.  INSERTION :- Lateral surface of ramus of mandible.  ACTION :- Elevation of mandible.  INNERVATION :- Masseteric nerve > mandibular division of trigeminal nerve.
  28. 28. Blood Supply The major artery supplying > INFERIOR ALVEOLAR ARTERY. It enters medial aspect of ramus of mandible & courses downward & forward within mandibular canal. Artery branches in premolar region to give 2 terminal branches > INCISIVE ARTERIE & MENTAL ARTERY.  DURING IMPLANT PLACEMENT PROCEDURES ONE MUST AVOID INJURY TO THE ARTERIES AND SPECIALY SHOULD BE CAREFUL IN THE ANTERIOR REGION AS THERE IS ANASTOMOSIS FROM THE OPPOSITE SIDE.
  29. 29. Why anatomical considerations?
  30. 30. THE BEAUTY OF IMPLANTS
  31. 31. CLINICAL CONCLUSION Implant placement is not a complicated procedure.... If one has an adequate knowledge of the ANATOMICAL STRUCTURES. The above slides tells about the anatomical considerations to be taken care off... NOT ANATOMICAL COMPLICATIONS. Care should be taken at time of flap reflections. No uncontrolled forces should be applied. Clean & patient surgery is the key to success.
  32. 32. Thank you 

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