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Applied anatomy
- 2. Introduction Appliedanatomy of maxilla Pterygoid area Applied anatomy of mandible. Retromolar area Summary References
- 3. Normal vs abnormalanatomy 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
- 4. Hollow andcuboid shaped Paired bone with pyramidal base facing medially,separted by nasal fossa. Septum in center,bordered inferiorly ,bilaterally by oral cavity.
- 5. Hollow maxillais covered by a 3 layered mucoperiosteum. Color –purple –red Elastic consistency Thin ,yellow and friable-smokers
- 6. Unrepairable membrane perforation. Sinusand posterior teeth. Pneumatization of sinus.
- 7. Most commoncomplication. 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
- 8. Sinus expansionand faulty Rx planning
- 9. • In casesof resorbed maxilla,sinus is at crest of RAR • Bone level may approximate level of floor of nasal cavity.
- 10. Inferior turbinateis 5mm-9mm above nasal floor. During sinus lift-graft should be kept at least 2mm to avoid ostium blockage.
- 11. Accessory ostia-30- 40percent cases Nasal endoscopy to be safe.
- 12. • 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
- 13. May bechosen by surgeons for implants Goal-engage pterygoid process without bone augmentation- creating abutment for FPD.
- 14. Caution-pterygoid fossa lyingsuperiorly is avoided_severe hemorrhage may occur. Ptergomaxillary butress –an area of increased bone density and volume is responsible for transmitting masticatory forces.
- 15. Anatomic featuresof dentulous and edentulous mandible. The muscles, innervation are of prime importance
- 16. • Severely resorbed mandible-internal obliqueline at level with crest of RAR. • Genial tubercles superior to crestal bone,and exposed neurovascular bundle.
- 17. Implant positionis changed as it relates to axis of bone resorbs. In anterior mandible,onlay bone grafts in 2 stage,or,one stage may be done.
- 18. Tremendous variation seenin mental nerve as it exits the mental foramen.
- 19. Retraction ofalveolar nerve. 3 branches of mental nerve
- 20. Some cliniciansconsider 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.
- 21. Relation ofinferior alveolar canal to 1st 2nd and 3rd molars.
- 22. Injury toIAN 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.
- 23. Lingual nerve-Improperflap reflection may cause an injury. Ipsilateral paresthesia Anaesthesia of innervated mucosa. Loss of taste. reduction of salivary secretion.
- 24. MYLOHYOID Muscle ◦Structures above mylohyoid-intraoral swelling ◦ Sublingual space infection. ◦ Below mylohyoid – ◦ Submandibular space infection.-extraoral swelling
- 25. ◦ Attaches togenial tubercles. ◦ Should not be completely detached - airway obstruction.
- 26. Bounds pterygomandibular space medially,near insertionat medial surface of mandible. Infection can spread to paraphayngeal space-into mediastinum.
- 27. ◦ Fibres insertinto 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
- 28. Insertion isinto 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.
- 29. Complete reflectionof 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.
- 30. Some patientswearing 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.
- 31. Massetric spaceinfection may result. during surgery to expose bone for ramus extension needed for lateral support of sub-periosteal implant.
- 32. Anatomic sitesfor dental implants. Orthodontic anchorage can be derived. Healthy teeth can be moved upto 15 mm within alveolar process without compromising position of remaining dentition.
- 33. Implant placementis 5 mm distal to 3rd molar. Engage between cortical bone ,between mandibular retromolar area and ascending mandibular ramus. Prevent entry into mandibular canal.
- 34. Surgical anatomyof 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.
- 35. Misch 3rdedition Babbush:art and science Maxillary Sinus Membrane Repair: Update on Technique for Large and Complete Perforations Implant Dent 2008;17:24–31) http://jiacd.com/ Human anatomy BD chaurasia 4th edition Snell’s anatomy
Editor's Notes
- #4 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
- #6 Schneiderian membrane or sinus membrane -0.3-0.8mm
- #7 1.2nd pm and 1st molar. 2.Negative pressure during inspiration and lack of fn stimulation by teeth-cause pneumatization of maxillary sinus. Generally, in case of maxillary antroplasties ,sinus membrane is not torn due to elasticity
- #9 .
- #12 Accessory ostia are found in 30-40% cases ,in cases with extremly resorbed maxillas,in which floor of sinus is level with the floor of the nose,it is wise to identify anatomic structures using nasal endoscopy. It helps as pre-op diagnostic tool to allow identification of potential complications with sinus bone grafts,before obliterating the accessory ostium or contaminating the graft.
- #14 An implant in this region ,its path comes from maxillary tuberosity and aims into pterygoid portion of of maxillary bone,passing lateral pterygoid plate medially,pterygoid process posteriorly,and superiorly to avoid pterygoid fossa Placement of any implant in this dangerous zone can cause severe hemorrhage of pterygoid muscles and pterygoid plexus. Pterygomaxillary buttress has an area of increased bone density and volume,responsible for transmitting posterior masticatory forces originating from tuberosity to skull base..
- #22 Posterior mandible is ltd for implant placement because of bone loss and subsequent proximity to IAN and vessels.in dentate indivisuals,distance from mand 1st molar is about 3mm.eg if root length of 1st molar is 12mm,and immd implant is planned ,it is recommended ,that implant is longer than the tooth root….but,if canal is close by,use shorter implant.
- #25 Bilateral swelling-tracheostomy may have to be performed.
- #26 Superior pair is attached to muscle-while making impression of subperiosteal implant ,avoid injury to structure.
- #31 Incisions of these swelling yield no purulent exudate.
- #33 Given by Eugene Roberts .
- #35 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.