Anatomy of The Maxilla and Mandible and Anatomical Safety Zones

R.D.
GARDI MEDICAL COLLEGE & HOSPITAL

Department of Anatomy
Module 1 - Bone Biology, Anatomy and

Wound Healing
Healing mechanisms and bone physiology
Anatomical Considerations for Dental Implants
Anatomy of the Maxilla and Mandible and

Anatomical Safety Zones
Pharmacology for Implant Dentistry
By:Dr. Saurabh Thawrani
Guided by:Dr. Manish Patil
Anatomical Considerations For

Dental Implants
By; Dr. Saurabh Anand Thawrani

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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
Implants

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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.

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Types of Dental Implants

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How does an implant work?

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Dr. prof. Per-Ingvar Brnemark was a Swedish

orthopaedic surgeon and research professor,
touted as the 'father of modern dental
implantology.'
Discovered Osseointegration.
Osseointegration is defined as : 'the formation of
a direct interface between an implant and bone,
without intervening soft tissue'
May 3, 1929 Dec. 20, 2014
Advantages of Implant

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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.
Anatomical Considerations

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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
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
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mandibular are inclined lingually.
This inclination of opp. Dentition is considered in planning treatment for

implant cases proper allingment & adequate bone support.
osteogenic stimulation through tensional forces trasmitted by PDL, & Labial
This transverse curvature of dental arches THE CURVE OF WILSON
During mastication the palatal portion of ant. Maxillay alveolus receives

plate receives minimal tensile forces.
Cases Lacking Post. Occlusal Stops & Labail Plate Has Excessive
Compression Pressure Leading To Resorption.
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
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high.
amount of vertical bone height available for endosseous implant placement

in post. Maxilla.
sinus epithelium (schneiderian membrane) is thin but tightly bound to
Expansion of maxillary sinus into alveoulus represents a major factor in
As teeth are lost maxillary sinus may expand into vacated alveolus. The
underlying periosteum.
The sinus distance from the crest of ridge is called as the sub antral space.
( S.A. 1 TO S.A. 4)

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Muscle Attachments
BUCCINATOR
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Origin: From base of alveolar process, opp. The first, second and third
molar of both jaws.
Insertion: Angle of mouth, orbicularis oris.
Action: Presses cheek against molar teeth, works with tongue tokeep food
between occlusal surface, expels air out from oral cavity, UNILATERAL
FUNCTION -> Draws mouth to one side.
During placement of implant, one must avaoid injury to it as it may lead
improper masticatory functions, accumulation of food, improper speech,
facial expression may get affected.
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.
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LEVATOR ANGULI ORIS

Origin: Maxilla , below infra orbital foramen.

Insertion: Skin at corner of mouth.
The Infra Orbital Nerve & Vessels arise between these two muscles, one
Action: Raises angle of mouth, helps form nasolabial furrow.

must avoid injury to them, by being Careful during flap reflection & Implant
Placement.

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Innervation of Maxilla
POSTERIOR SUPERIOR ALVEOLAR NERVE
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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
This Nerve may get injured during sinus augmentation.
cheek.
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.
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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."
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.
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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.
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.
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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.

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Blood Supply
The mucoperiostium of anterior maxilla supplied by branches of infra
orbital & superior labial arety ( branch of facial arery)
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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 blood supply of maxilla is mantained by anastomoses present in the soft
The soft palate is supplied by lesser palatine aretry.

palate.
Thus one should be careful during flap reflection, implant palacement,
grafting procedures & ridge augmentations.

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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
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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.
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

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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.
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 &
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anteriorly, then courses horizontally, laterally, usually just below the root
it curves superiorly.

apices of the 3rd molar teeth. As the canal approaches the mental foramen,
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.
Symphysis Region
At the anterior sufrace of midline.
A triangular protuberance.
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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.

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Muscle Attachments
LINGUAL OR MEDIAL ATTACHMENTS

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Mylohyoid muscle
Genioglossus
Medial Pterygoid
Lateral Pterygoid
Temporalis
BUCCAL OR FACIAL ATTACHMENTS

Mentalis muscle
Buccinator
Masseter
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.
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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.
GENIOGLOSSUS
Forms bulk of tongue.
ORIGIN :- From superior genial tubercles
INSERTION :- Ant. Fibres into dorsal of tongue from root to tip. Post. fibres
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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
MEDIAL PTERYGOID
ORIGIN :- Medial surface of lateral pterygoid plate of sphenoid bone, a
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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.
LATERAL PTERYGOID
ORIGIN :- Upper head-roof of infra temporal fossa, lower head-lateral
surface of lateral plate of the pterygoid process.
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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.
TEMPORALIS
Fan shaped muscle
ORIGIN :- Bone of temporal fossa and temporal fascia.
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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.
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.
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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.

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Bloody Supply
The major artery supplying > INFERIOR ALVEOLAR ARTERY.
It enters medial aspect of ramus of mandible & courses downward &
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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 specially should be careful in the anterior region as there is anastomosis
from the opposite side.

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Why anatomical considerations?

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The Beauty of Implants

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Clinical Conclusion
Implant placement is not a complicated procedure. If one has adequate
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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.
Thank you.
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Anatomy of The Maxilla and Mandible and Anatomical Safety Zones

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R.D.

GARDI MEDICAL COLLEGE & HOSPITAL

Module 1 - Bone Biology, Anatomy and

Anatomical Considerations for Dental Implants