anatomical Landmarks


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anatomical Landmarks for a safe dental implant placement

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anatomical Landmarks

  1. 1. Landmarks of maxilla. Median palatine suture. Nasal fossa. Nasal septum. Anterior nasal spine. Incisive foramen. Lateral fossa. Maxillary sinus. Malar bone. Maxillary tubrosity. Hamular process. Nasolacremal duct. Dr. Amr Saad
  2. 2. 1- Median palatine suture: Appears as a vertically oriented radiolucent line in true image projections through the midline. Usually prominent between the two central incisor roots at young individuals. Dr. Amr Saad
  3. 3. 1- Nasal septum: (17)Appear as a radio-opaque line separates the two nasal fossa in the midline.2- Anterior nasal spine(16) Appears as a v-shaped radio-opaque structure in the midline above the incisive foramen.3- Incisive foramen:(12) or the anterior palatine fossa, it usually appears as a prominent radiolucent area above/or between the roots of two central incisors. It usually appears as a rounded or oval in shape doesn’t not exceed 6mm in diameter. Dr. Amr Saad
  4. 4. Nasal cavities Nasal septum Anterior nasal spineMedian palatine suture Dr. Amr Saad
  5. 5. Maxillary anterior region Nasal septum Nasal fossa Nasal spine Incisive foramen Nose Median palatine sutureDr. Amr Saad
  6. 6. facial view palatal view f c e a da = nasal septum e = incisive foramenc = nasal fossa f = median palatald = anterior nasal spine sutureDr. Amr Saad
  7. 7. facial viewDr. Amr Saad Nasal septum
  8. 8. facial viewDr. Amr Saad Nasal fossa
  9. 9. palatal viewDr. Amr Saad Incisive foramen
  10. 10. palatal viewDr. Amr Saad Median palatal suture
  11. 11. Dr. Amr Saad Soft tissue of the nose
  12. 12. a b dRed arrow points to Red arrows = lip linePeriapical lesion (post-endo) Dr. Amr Saad
  13. 13. d f Blue arrow = chronic periapicalRed arrow = mesiodens periodontitis. Tooth # 9 is(supernumerary tooth) non-vital (trauma) and needs Dr. Amr Saad endo.
  14. 14. The red arrows point to the soft tissue of the nose. The green arrows identify the lip line.Dr. Amr Saad
  15. 15. 5-Maxillary sinus:The maxillary sinus with its thin bony walls, its thin mucosa, and its vast air space, produce an extremely dark image deep to the maxillary teeth.Its outlines, particularly its floor, are clearly delineated by delicate radiopaque lines. Dr. Amr Saad
  16. 16. 1-Body of zygoma 6-Apices of roots 7-floor of the sinus 8-Septum of the sinusNotice the well-demarcated RL area related to upper 5 Dr. Amr Saad
  17. 17. In general the floor of the sinus is approximately coincidental with the location of the apices of the roots of the upper teeth,(bicuspids and first two molars).But there is often as much as two or even three millimeters of maxillary bone between the root ends and sinus floor. Dr. Amr Saad
  18. 18. In other cases the sinus floor dips so deeply between the roots of themaxillary teeth that the latter appear to project into it for as much asone half of their length. Dr. Amr Saad
  19. 19. Pneumatization. Expansion of sinus wall into surrounding bone, usually in areas where teeth have been lost prematurely. Increases with age. Dr. Amr Saad
  20. 20. Maxillary Canine Floor of nasal fossa Maxillary sinus Lateral fossa NoseDr. Amr Saad
  21. 21. facial view a a c c b ba = floor of nasal fossab = maxillary sinus (a & b form inverted Y)c = lateral fossaDr. Amr Saad
  22. 22. facial viewFloor of nasal fossa (red arrows) and anterior borderof maxillary sinus (blue arrows), forming the inverted Dr. Amr Saad (upside down) Y.
  23. 23. facial viewLateral fossa. The radiolucency results from adepression above and posterior to the lateralincisor. To help rule out pathology, look for anintact lamina dura surrounding the adjacent teeth. Dr. Amr Saad
  24. 24. The maxillary sinus The black arrows indicatesurrounds the root of the the floor of the nasal fossa. canine, which may be The maxillary sinus (red misinterpreted as arrows) has pneumatized Dr. Amr Saad pathology. between the 2nd premolar and first molar
  25. 25. Maxillary Premolar region Sinus septum Zygomatic process Maxillary sinusDr. Amr Saad
  26. 26. facial view da c c d a a = malar process c = sinus septum d = maxillary sinus Dr. Amr Saad
  27. 27. facial view Malar (zygomatic) process. U or j-shaped radiopacity, often superimposed over the roots of the molars, especially when using thebisecting-angle technique. The red arrows define the lower border of the zygomatic bone. Dr. Amr Saad
  28. 28. 6- Malar bone: Or the zygomatic process. The inferior portion of the malar bone appears as a Radiopaque u-shaped structure related to the roots of the first maxillary molar. It represents the attachment of the zygomatic bone to the maxilla.7- Maxillary tuberosity: Appears as a Radiopaque structure that extends distally and upward from posterior to maxillary sinus. It represents the end of maxilla. Dr. Amr Saad
  29. 29. 9- Hamular process: It is a bony spine projecting from the pterygoid process of the sphenoid bone. It appears as a Radiopaque spine that recorded on radiographs distal to the tuberosity of the maxilla and extends downward.10- Coronoid process of the mandible: Appears as a triangular Radiopaque structure projected into the same general area of maxillary Periapical film projections distallySaad the maxillary teeth. Dr. Amr to
  30. 30. Maxillary Molar Region Zygoma Maxillary sinusPterygoid plate Hamular process Coronoid process Maxillary tuberosity Dr. Amr Saad
  31. 31. facial view e e g g d d c f c a f a ba = maxillary tuberosity* e = zygoma (dotted lines)b = coronoid process f = maxillary sinusc = hamular process g = sinus recessd = pterygoid plates* image of impacted third molar superimposed Dr. Amr Saad
  32. 32. facial viewMaxillary Tuberosity. The rounded elevationlocated at the posterior aspect of both sidesof the maxilla. Aids in the retention ofdentures. Dr. Amr Saad
  33. 33. facial viewCoronoid process. A mandibular structure sometimesseen on the maxillary molar periapical film when usingthe bisecting angle technique with finger retention(The mouth is opened wide, moving the coronoid downand forward). Note the supernumerary molar. Dr. Amr Saad
  34. 34. facial viewHamular process (black arrows) and pterygoidplates (purple arrows). The hamular process is anextension of the medial pterygoid plate of thesphenoid bone, positioned just posterior to themaxillary tuberosity. Dr. Amr Saad
  35. 35. The zygomatic process (green arrows) is a prominentU-shaped rationality. Normally the zygomatic boneposterior to this is very dense and Radiopaque. In thispatient, however, the maxillary sinus has expanded intothe zygomatic bone and makes the area more radiolucent(red arrows). The coronoid process (orange arrow), thepterygoid plates (blue arrows) and the maxillarytuberosity (pink arrows) are also identified. Dr. Amr Saad
  36. 36. 1- Floor of nasal cavity,2- Laterobasal border of nasal cavity,3- Maxillary sinus, 4- Floor of thesinus,5- Septum dividing the sinus, Dr. Amr Saad 11- Alveolarcrest.
  37. 37. 1- Zygomatic process, 2- body of zygoma, 6- Maxillary sinus, 7-floor of the sinus, 9- Max. tuberosity, 10- alveolar crest, 11- Coronoidprocess. Dr. Amr Saad
  38. 38. 11- Nasolacrimal duct:It almost seen in occlusalview of the maxilla as around radiolucent areasuperimposed on theposterior region of thehard palate. Dr. Amr Saad
  39. 39. 1-Anterior nasal spine, 2-Boundries of nasal cavity,3-Nasal septum, 4-Nasal cavity,5-Nasal bone, 6-Maxilary sinus,7-Zygomatic process, 8-Nasolacremal duct. Dr. Amr Saad
  40. 40. Panoramic view 1-Nasal septum, 2-Nasal cavity, 3-Orbit,4-Border of nasal cavity, 6-Maxillary sinus,8-Incisive foramen, 9-Anterior nasal spine Dr. Amr Saad
  41. 41. 1- Nasal septum, 7- Maxillary sinus,8-Orbit, 9-Nasal bone,10-Anterior nasal spine,11-Border of nasal cavity,13- Shadow of hyoid bone.Dr. Amr Saad
  42. 42. Landmarks of Mandible.Dr. Amr Saad
  43. 43. Landmarks of Mandible. Lingual foramen Genial tubercles. Mental ridge. Mental foramen. Mental fossa. External oblique line. Internal oblique line. Mylohyoid line or ridge. Mandibular foramen. Inferior dental canal. Submandibular gland fossa. Interdental nutrient canals. Pharyngeal space. Dr. Amr Saad
  44. 44. Lingual foramen: Is set in the midline deep to the root apices of the anterior teeth. It appears as a small radiolucent dot at the symphysis area. It usually surrounded with a Radiopaque structure. Dr. Amr Saad
  45. 45. Genial Tubercles: Or the superior and inferior mental spines.They are four in number located toward the inferiolingual border of the mandible and are mostly 2 on each side of the midline, although in some instances they coalesce as a single radiopaque outcrop of the mandible.They appear as a radiopaque circle that surrounds the lingual foramen, just below the apices of the incisors.Anatomically genyoglossal muscle attached to the superior two while the genyohyoid muscle attached to the inferior two. Dr. Amr Saad
  46. 46. Mental ridge: It is a bony prominence found on the labialaspect of the mandible near its inferior border and extendedfrom the premolar region to the symphysis area on which ittakes an upward turn as it approach it. It appears as aradiopaque line below the apices of anterior teeth. Dr. Amr Saad
  47. 47. Mandibular Incisors regionMental ridge Mental fossa Genial tubercles Lingual foramen Dr. Amr Saad
  48. 48. lingual view facial view d c a ba = lingual foramen c = mental ridgeb = genial tubercles Dr. Amr Saad d = mental fossa
  49. 49. lingual viewLingual foramen. Radiolucent “hole” in center of genial tubercles. Lingual nutrient vessels pass through this foramen.Dr. Amr Saad
  50. 50. lingual view Genial tubercles. Radiopaque area in the midline,midway between the inferior border of the mandible andthe apices of the incisors. Serve as attachments for thegenioglossus and geniohyoid muscles. May haveradiolucent hole in center (lingual foramen), but not onthis film. Note double rooted canine (red arrows). Dr. Amr Saad
  51. 51. facial view Mental ridge.Dr. Amr Saad
  52. 52. facial view Mental fossa. This represents a depression on thelabial aspect of the mandible overlying the roots of the incisors. The resulting radiolucency may be Dr. Amr Saad mistaken for pathology.
  53. 53. Nutrient canals The orange arrows above identifynutrient canals. They are most often seen inolder persons with thin bone, and in thosewith high blood pressure or advancedperiodontitis. Dr. Amr Saad
  54. 54. Mental foramen(3) It appears as aradiolucent ill-definedarea between the apicesof the bicuspids. Itrepresent the anteriorterminates of themandibular canal. Dr. Amr Saad
  55. 55. 6- Caries.7- Prepared cavity.8- Enostosis.9- Mental foramen. Dr. Amr Saad
  56. 56. Mental Fossa (6):It is a slight depression in the bone one the labial aspect of the mandible. It appears as a faint radiolucent structure related to anterior area. Notice: 7 is cervical burnout Dr. Amr Saad
  57. 57. Mandibular Premolar region a = mylohyoid ridge b = mandibular canal c = submandibular gland fossa d = mental foramenDr. Amr Saad
  58. 58. facial view lingual view b a d cb = mandibular canal a = mylohyoid ridged = mental foramen (internal oblique) c = submandibular gland fossaDr. Amr Saad
  59. 59. facial viewMental foramen. Usually located midway betweenthe upper and lower borders of the body of themandible, in the area of the premolars. Maymimic pathology if superimposed over the apexof one of the premolars.Dr. Amr Saad
  60. 60. Mandibular Molar region a = external oblique ridge b = mylohyoid ridge c = mandibular canal d = submandibular gland fossaDr. Amr Saad
  61. 61. facial view lingual view a b c da = external oblique ridge b = mylohyoid ridgec = mandibular canal d = submandibular gland fossa Dr. Amr Saad
  62. 62. External oblique line:(6) It is a Radiopaque line extending from anterior border of the ramus of the mandible and descends to the third molar area. 7-Internal oblique line, 7-Mylohyoid line, 9-Mandibular canal, Dr. Amr Saad
  63. 63. facial viewExternal oblique ridge. A continuation of theanterior border of the ramus, passing downward andforward on the buccal side of the mandible. Itappears as a radiopaque line which usually endsanteriorly in the area of the first molar. Serves asan attachment of the buccinator muscle. (The redarrows Saad Dr. Amr point to the mylohyoid ridge).
  64. 64. Internal oblique line(6): It appears as a Radiopaque line descends downward and forward from Coronoid process; in a more horizontal position; stop at the third molar area or become continuous with the Mylohyoid line. Its place below the external oblique line. Dr. Amr Saad
  65. 65. Mylohyoid line or ridge(7)It is a Radiopaque line below the external oblique line and it is the anterior continuity of the internal oblique line.It extend downward and forward from the ramus of the mandible to the bicuspid areas. Dr. Amr Saad
  66. 66. lingual view Mylohyoid ridge (internal oblique). Located onthe lingual surface of the mandible, extendingfrom the third molar area to the premolar region.Serves as the attachment of the mylohyoidmuscle. Dr. Amr Saad
  67. 67. Inferior dental canal; (9,2),Mandibular canal, orinferior alveolar canal. Its characteristic image istherefore likely to be aradiolucent passage alongthe mandible just deep tothe roots of the teeth,terminating at the mentalforamen and bounded byRadiopaque marginsrepresenting the walls ofthin cortical bone boundingthe canal. Dr. Amr Saad
  68. 68. facial view Mandibular (inferior alveolar) canal. Arises at themandibular foramen on the lingual side of the ramus andpasses downward and forward, moving from the lingualside of the mandible in the third molar region to thebuccal side of the mandible in the premolar region.Contains the inferior alveolar nerve and vessels. Dr. Amr Saad
  69. 69. Submandibular gland fossa(4): It is a depression on the lingual aspect of the mandible on which submandibular glands are present. It appears as a zone of radiolucency below the lower molars. Dr. Amr Saad
  70. 70. lingual view Submandibular gland fossa. A depression onthe lingual side of the mandible below themylohyoid ridge. The submandibular gland islocated in this region. Due to the thinness ofbone, the area being very radiolucent. The factthat it occurs bilaterally helps to differentiate itfrom pathology. Dr. Amr Saad
  71. 71. b a d c a = external oblique ridge b = mylohyoid ridge c = mandibular canal d = submandibular gland fossaDr. Amr Saad
  72. 72. The external oblique ridge (red arrows) andthe mylohyoid ridge (blue arrows) usually runparallel with each other, with the externaloblique ridge always being higher on the film. Dr. Amr Saad
  73. 73. The mandibular canal (red arrows identify inferior borderof canal) usually runs very close to the roots of themolars. Note the extreme dilaceration of the roots ofthe third molar (green arrow). The film at right shows “kissing” impactions located atthe superior border of the canal. Dr. Amr Saad
  74. 74. 9-buccal & lingual compact bone 10-genial tubercle 11-Mental foramenDr. Amr Saad
  75. 75. 1-Inferior border of the mandible 4-Mental fovea 2-Mental protuberance 5- Mental foramen 3-Digastric fovea 12-Radiolucency created by the lipDr. Amr Saad
  76. 76. 1,2- compact bone of mandible 4- mental fovea,5-mental foramen, 6-mylohyoid line,7-submandibular gland fossa, 8-hyoid bone,12-lip radiolucencyDr. Amr Saad
  77. 77. 1-external oblique line, 3-mental foramen, 4-madibular canal, 5-inferior border of the mandible.Dr. Amr Saad
  78. 78. Edentulous patient 1-mandibular foramen, 2-coronoid process,3-zygomatic arch, 4-cervical vertebra,7-mental foramen, 8-mandibular canal Dr. Amr Saad
  79. 79. Thank YouDr. Amr Saad