Anatomical considerations for placing dental implants. all the basic anatomical landmarks and considerations which are to be taken care off before and while placing a dental implant. any type of implant it may be...wether endossous or subperiosteal or tranosteal. lack of knowledge of basic anatomy will never lead to success of implant.

1. R.D.GARDI MEDICAL COLLEGE &
HOSPITAL
Department of Anatomy
Anatomical considerations for Dental
implants
By:- Guided by:-
Dr. Saurabh Thawrani Dr. Manish Patil

2. Anatomical Considerations
For Dental Implants
By;
Dr. Saurabh Anand Thawrani
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,…

3. IMPLANTS ???
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.

5. Types Of Dental Implants

6. How does an Implant works???
• Dr. prof. Per-Ingvar Brånemark was
a Swedish orthopaedic surgeon
and research professor, touted as
the “father of modern dental
implantology.”
 Discovered OSSEOINTEGRATION.
• Osseointegration defined as : "the
formation of a direct interface
between an implant and bone,
without intervening soft tissue"
May 3, 1929 – Dec. 20, 2014

7. Advantages of Implant
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.

8. Anatomical considerations
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

9. 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 mandibular are inclined lingually.
 This transverse curvature of dental arches “ THE CURVE OF
WILSON”
 This inclination of opp. Dentition is considered in planning
treatment for implant cases proper allingment & adequate
bone support.
 During mastication the palatal portion of ant. Maxillay
alveolus receives osteogenic stimulation through tensional
forces trasmitted by PDL, & Labial plate receives minimal
tensile forces.
 CASES LACKING POST. OCCLUSAL STOPS & LABAIL PLATE HAS
EXCESSIVE COMPRESSION PRESSURE LEADING TO
RESORPTION.

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

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

13. • 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.
• LEVATOR ANGULI ORIS 
 Origin :- Maxilla , below infra orbital foramen.
 Insertion :- Skin at corner of mouth.
 Action :- Raises angle of mouth, helps form nasolabial furrow.
  THE INFRA ORBITAL NERVE & VESSELS ARISE BETWEEN
THESE TWO MUSCLES, ONE MUST AVOID INJURY TO THEM,
BY BEING CAREFULL DURING FLAP REFLECTION & IMPLANT
PLACEMENT.

15. Innervation Of Maxilla
POSTERIOR SUPERIOR ALVEOLAR NERVE 
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 CHEEK.
THIS NERVE MAY GET INJURED DURING SINUS
AUGMENTATION.

16. 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.
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.

17. 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.
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.

18. 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.
 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.

20. Blood Supply
 The mucoperiostium of anterior maxilla supplied by branches of
INFRA ORBITAL & SUPERIOR LABIAL ARETY ( BRANCH OF FACIAL
ARERY)
 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 soft palate is supplied by LESSER PALATINE ARETRY.
 THE BLOOD SUPPLY OF MAXILLA IS MANTAINED BY ANASTOMOSES
PRESENT IN THE SOFT PALATE.
  THUS ONE SHOULD BE CAREFUL DURING FLAP REFLECTION,
IMPLANT PALACEMENT, GRAFTING PROCEDURES & RIDGE
AUGMENTATIONS.

22. 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 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.

23. 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 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.

24. 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
& anteriorly, then courses horizontally, laterally, usually just below
the root apices of the 3rd molar teeth. As the canal approaches the
mental foramen, it curves superiorly.
 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.

25. Symphysis Region
At the anterior sufrace of midline.
A triangular protuberance.
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.

27. Muscle Attachments
• LINGUAL OR MEDIAL ATTACHMENTS
 Mylohyoid muscle
 Genioglossus
 Medial Pterygoid
 Lateral Pterygoid
 Temporalis
• BUCCAL OR FACIAL ATTACHMENTS
 Mentalis muscle
 Buccinator
 Masseter

28. 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.
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.

29. GENIOGLOSSUS 
Forms bulk of tongue.
ORIGIN :- From superior genial tubercles
INSERTION :- Ant. Fibres into dorsal of tongue
from root to tip. Post. fibres 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

30. MEDIAL PTERYGOID 
ORIGIN :- Medial surface of lateral pterygoid plate
of sphenoid bone, a 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.

31. LATERAL PTERYGOID 
ORIGIN :-Upper head-roof of infra temporal fossa,
lower head-lateral surface of lateral plate of the
pterygoid process.
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.

32. TEMPORALIS 
Fan shaped muscle
ORIGIN :- Bone of temporal fossa and temporal
fascia.
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

33. 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.
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.

35. Blood Supply
The major artery supplying > INFERIOR ALVEOLAR
ARTERY.
It enters medial aspect of ramus of mandible &
courses downward & 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 SPECIALY SHOULD
BE CAREFUL IN THE ANTERIOR REGION AS THERE IS
ANASTOMOSIS FROM THE OPPOSITE SIDE.

37. Why anatomical considerations?

38. THE BEAUTY OF IMPLANTS

39. CLINICAL CONCLUSION
Implant placement is not a complicated
procedure.... If one has an adequate 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.

40. Thank you 