Applied anatomy

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Information about Applied anatomy

Published on January 20, 2016

Author: murtazakaderi


1.  Introduction  Applied anatomy of maxilla  Pterygoid area  Applied anatomy of mandible.  Retromolar area  Summary  References

2. Normal vs abnormal anatomy from tooth loss generates a compromised repaired structure both in function and form. Goal will be to develop a view of surgical anatomy as it relates to surgical procedures

3.  Hollow and cuboid shaped Paired bone with pyramidal base facing medially,separted by nasal fossa.  Septum in center,bordered inferiorly ,bilaterally by oral cavity.

4.  Hollow maxilla is covered by a 3 layered mucoperiosteum.  Color –purple –red  Elastic consistency  Thin ,yellow and friable-smokers

5.  Unrepairable membrane perforation.  Sinus and posterior teeth.  Pneumatization of sinus.

6.  Most common complication.  Repair of relatively small (5-10 mm) tears is commonly done using fast resorbing collagen membranes and/or by allowing the sinus membrane to overlap on itself.  A technique using a cross-linked type I collagen membrane for predictable repair of large perforations (> 10 mm) as well as for circumstances in which no membrane is found is described. Implant Dent 2008;17:24–31

7.  Sinus expansion and faulty Rx planning

8. • In cases of resorbed maxilla,sinus is at crest of RAR • Bone level may approximate level of floor of nasal cavity.

9.  Inferior turbinate is 5mm-9mm above nasal floor.  During sinus lift-graft should be kept at least 2mm to avoid ostium blockage.

10.  Accessory ostia-30- 40 percent cases  Nasal endoscopy to be safe.

11. • Incisive canal ,found adjacent to nasal septum ,8-18 mm behind anterior aspect of floor of nasal fossa. • May be at level of crest in resorbed ridges

12.  May be chosen by surgeons for implants  Goal-engage pterygoid process without bone augmentation- creating abutment for FPD.

13.  Caution-pterygoid fossa lying superiorly is avoided_severe hemorrhage may occur.  Ptergomaxillary butress –an area of increased bone density and volume is responsible for transmitting masticatory forces.

14.  Anatomic features of dentulous and edentulous mandible.  The muscles, innervation are of prime importance

15. • Severely resorbed mandible-internal oblique line at level with crest of RAR. • Genial tubercles superior to crestal bone,and exposed neurovascular bundle.

16.  Implant position is changed as it relates to axis of bone resorbs.  In anterior mandible,onlay bone grafts in 2 stage,or,one stage may be done.

17.  Tremendous variation seen in mental nerve as it exits the mental foramen.

18.  Retraction of alveolar nerve.  3 branches of mental nerve

19.  Some clinicians consider Mental nerve to be in Halfway between inferior border of mandible and alveolar ridge.  Generally,it is located slightly inferior toward the border of mandible,although it can be found 1/3rd inferiorly to mandible than superiorly.

20.  Relation of inferior alveolar canal to 1st 2nd and 3rd molars.

21.  Injury to IAN that remains in atrophied bone and does not innervate soft tissues is of less consequence.  Nerves in bone,when in contact with implant ,account for tenderness,even though implant is rigid and healthy.

22.  Lingual nerve-Improper flap reflection may cause an injury.  Ipsilateral paresthesia  Anaesthesia of innervated mucosa.  Loss of taste.  reduction of salivary secretion.

23.  MYLOHYOID Muscle ◦ Structures above mylohyoid-intraoral swelling ◦ Sublingual space infection. ◦ Below mylohyoid – ◦ Submandibular space infection.-extraoral swelling

24. ◦ Attaches to genial tubercles. ◦ Should not be completely detached - airway obstruction.

25.  Bounds pterygomandibular space medially,near insertion at medial surface of mandible.  Infection can spread to paraphayngeal space-into mediastinum.

26. ◦ Fibres insert into condyle, TMJ disk. ◦ Because of angulation of lateral pterygoid muscle,mandibular flexure may be caused –causing alteration in mandibular arch width,pain in patients with sub-periosteal implants

27.  Insertion is into coronoid process of mandible.  Surgical exposure ,medially in ramus may injure tendon of temporalis-while harvesting bone from external oblique ridge,or placing incision for subperiosteal implants.

28.  Complete reflection of mentalis muscles for purpose of extension of subperiosteal implant or symphyseal intraoral graft may result in witch’s chin.  If muscle is completely detached to expose symphysis,then elastic bandage is applied externally to chin for 4 days to help in reattachment of muscle.

29.  Some patients wearing lower sub-periosteal implants c/o episodic swelling and pain at the site of origin of heavymastication or bruxism.  Myositis of detached muscle may cause it.

30.  Massetric space infection may result. during surgery to expose bone for ramus extension needed for lateral support of sub-periosteal implant.

31.  Anatomic sites for dental implants.  Orthodontic anchorage can be derived.  Healthy teeth can be moved upto 15 mm within alveolar process without compromising position of remaining dentition.

32.  Implant placement is 5 mm distal to 3rd molar.  Engage between cortical bone ,between mandibular retromolar area and ascending mandibular ramus.  Prevent entry into mandibular canal.

33.  Surgical anatomy of maxilla and mandible provide foundation required for safe insertion of dental implants.  The anatomy is requisite to understanding of complications that may occur during surgery ,like injury to blood vessels or nerves,as well as post – op complication such as infection.  This information is important for operator, to deal with confidence and to avoid complications.

34.  Misch 3rd edition  Babbush:art and science  Maxillary Sinus Membrane Repair: Update on Technique for Large and Complete Perforations Implant Dent 2008;17:24–31)   Human anatomy BD chaurasia 4th edition  Snell’s anatomy

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