Clinical Anatomy for Oral Implantology

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Louie Al-Faraje. Clinical Anatomy for Oral Implantology

TO THE ANONYMOUS DONORS

CONTENTS

DEDICATION

Discovery of pulmonary circulation

Writings

PREFACE

Acknowledgments

1. ARTERIES, VEINS, AND INNERVATION OF THE MAXILLA AND THE MANDIBLE

External Carotid Artery

Maxillary Artery

Pterygopalatine Fossa

Boundaries and communications of the pterygopalatine fossa1–3

Surgical importance of the anatomy of the pterygopalatine fossa

Veins of the Head

Pterygoid venous plexus

Trigeminal Nerve

Maxillary nerve (CN V2)

Mandibular nerve (CN V3)

References

2. MUSCLES OF FACIAL EXPRESSION AND MASTICATION

Muscles of Facial Expression

Muscles of Mastication

3. POSTERIOR MAXILLA

Greater and Lesser Palatine Foramina

Greater Palatine Artery and Nerve

Surgical importance in oral surgery

The Maxillary Sinus. Development

Bony structure

Drainage

Innervation and blood supply

Sinus membrane

Sinus septa

Incidence of maxillary septa

Surgical importance in oral implantology

Underwood’s septa

Partial perpendicular septa

Partial horizontal septa

Complete septation of the maxillary sinus

Clinical management of maxillary septa

Evaluation of the maxillary sinus on CT scans

The Buccal Fat Pad

Development and anatomy

Structures in the buccal fat pad

Function

Pathology of the buccal fat pad

Clinical uses. Esthetic surgery

Reconstructive surgery

Oral implantology

Use of the buccal fat pad during sinus augmentation

Technique

Contraindications

Trauma. Traumatic herniation (pseudolipoma)

Pseudoherniation

Traumatic herniation into the maxillary sinus

Surgical complications during oral/implant surgeries

Inadequate Bony Structure in the Posterior Maxilla

Al-Faraje technique for sinus elevation using the crestal approach

References

4. ZYGOMATIC BONE

Anatomy of the Zygomatic Bone

Surfaces. Lateral surface

Temporal surface

Orbital surface

Processes

Borders

Muscle attachments

Preoperative Radiographic Examination of the Zygoma

CBCT imaging

Stereolithographic models

Anatomical Basis for Zygomatic Implants

Measuring angular and linear distances of the maxilla and the zygoma

Results of the study

Landmarks and measurements

Results

Internal structure of zygoma

Results

Zygomatic Implant Treatment Considerations. Indications for zygomatic implants

Number of implants

Biomechanical considerations

Zygomatic Implant Preoperative Steps

Zygomatic Implant Presurgical CT Scan Evaluation

Topography of the anterior wall of the temporal fossa

Interarch relationship

Residual alveolar bone width and height in the posterior maxilla

Zygomatic bone dimensions and density

The path of the zygomatic implant body

The maxillary sinus

Zygomatic implant length

Residual alveolar bone width and height

Zygomatic Implant Surgical Procedure

Surgical preparation of the patient

Incision and flap

Alveoloplasty

Implant placement

Determine the starting point for the zygomatic implant

Determine the exit or apical point for the zygomatic implant

Connect the starting point and the exit point

Create a sinus window

Zygomatic implant osteotomy preparation

Determine the distance between the starting point and the apex

Determine the distance within the zygomatic bone available for implant engagement

Place cover screws or abutments

Aftercare

References

5. ANTERIOR MAXILLA

The Nasal Cavity. Bony structure of the nose

Lining of the nose

Blood supply of the nasal cavity

Innervation of the nasal cavity

Infraorbital Foramen

Surgical importance in oral implantology

Maxillary Incisive Foramen and Canal

Morphology

Evaluation of maxillary incisive foramen and canal on CT scans

Surgical importance in oral implantology

Grafting the incisive canal (incisive canal deflation)

Inadequate Bony Structure in the Anterior Maxilla

Clinical management of maxillary alveolar bone deficiency

References

6. POSTERIOR MANDIBLE

Inferior Alveolar Canal/Nerve

Surgical importance in oral implantology

Preventing injury to the IAN

Guided surgery

Mandibular Ramus

Block graft harvesting from the ramus buccal shelf11–16

The Mental Nerve and Its Anterior Loop. Mental nerve evaluation checklist to avoid injury

Mental nerve location and path

Flap-releasing incisions in close proximity to the mental nerve

Mental foramen height (buccal plate location vs intraosseous location)

Anterior loop of the mental nerve (clinical importance for implant placement and chin block harvest)

Mental nerve consideration in extensive resorption

Submandibular Fossa

Arterial bleeding in the mandible

Lingual artery

Sublingual artery

Facial artery

Submental artery

Implant treatment planning in the posterior region of the mandible

Checklist for avoiding submandibular fossa perforation

Lingual Nerve

Preventing injury to the lingual nerve29–33

Inadequate Bony Structure in the Posterior Mandible. Resorption pattern and treatment planning

Clinical Management of Mandibular Alveolar Bone Deficiency

Bone augmentation procedures for Class IIIA mandibular alveolar ridge deficiency. Alveolar ridge splitting using pedicled sandwich plasty

Bone augmentation procedures for Class IV mandibular alveolar ridge deficiency. IAN and mental nerve repositioning

References

7. ANTERIOR MANDIBLE

Mandibular Incisive Canal

Sublingual Region

Cross section

Implant treatment planning in the anterior area of a resorbed mandible

Sublingual artery

Role of the sublingual arteries

Accessory canals

Lateral lingual canals

Avoiding hemorrhage in the sublingual region

Genioglossus Muscle

Harvesting a Block Graft from the Anterior Mandible

Inadequate Bony Structure in the Anterior Mandible. Resorption pattern and treatment planning

Clinical management of alveolar bone deficiency of the anterior mandible

References

8. BONE DENSITY AND ADJACENT TEETH

Bone Density

Bone density types

Achieving optimum initial stability in various bone density types

Management

Adjacent Teeth/Roots

Symptoms

Prevention

Management. During implant placement

After implant placement and pulpal damage

Conclusion

References

9. ANATOMY FOR SURGICAL EMERGENCIES

Intrasurgical Bleeding

Bleeding sources

Soft tissue bleeding

Bony bleeding

Main blood vessel bleeding

Hemorrhage of the Floor of the Mouth. Etiology

Symptoms

Management. Airway management

Bleeding management

Prevention of arterial injury to the floor of the mouth

Protocol for management of hemorrhage of the floor of the mouth8–12

Instruments and materials for bleeding and airway control

Cricothyrotomy. Procedure (Fig 9-16)

Nerve Injury. Guidelines for prevention of nerve injury

Symptoms of nerve injury

Classification of nerve injury

Management of nerve injury16,17

References

10. TOPOGRAPHIC ANATOMY OF THE MAXILLA AND THE MANDIBLE

11. VENIPUNCTURE

Anatomy of the Systemic Circulation

Arteries and Veins of the Upper Limb. Arteries of the upper limb

Veins of the upper limb

Clinical significance

Vascular walls

Primary veins for venipuncture

Venous Physiology

INDEX

Отрывок из книги

We are respectful of and deeply indebted to the six anonymous individuals whose cadaver sections are shown in this book. They have made a donation to science that will enrich the fundamental knowledge base of human anatomy and will benefit today’s students and clinicians of oral implantology. Future generations can then build on this foundational knowledge.

I have done all in my power to preserve, protect, and maintain the dignity of these individuals. We did not know them in life but studied them in death; whoever they were, we honor their remains and dignify their gift.

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Yellow bullet—nerve; red bullet—artery; blue bullet—vein.

The anatomy of the pterygopalatine fossa is especially important for the following surgeries:

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