Applied anatomy,physiology for dental implants

APPLIED ANATOMY AND

PHYSIOLOGY FOR DENTAL IMPLANTS

www.asiandentalacademy.org

Above KFC Restaurant main Road

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http://www.asiandentalacademy.org/

INNERVATION

BLOOD SUPPLY

MUSCLE ATTACHMENTS

ANATOMICAL LIMITS



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MYLOHYOID

GENIOGLOSSUS

MEDIAL PTERYGOID

LATERAL PTRYGOID

TEMPORALIS

MANDIBLE

LINGUAL ATTACHMENTS

MUSCLE ATTACHMENTS



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MYLOHYOID MUSCLE



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MEDIAL AND LATERAL PTERYGOID MUSCLE



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TEMPORALIS MUSCLE



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MENTALIS

BUCCINATOR

MASSETER

BUCCAL ATTACHMENTS



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MENTALIS



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MASSETER MUSCLE



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BUCCINATOR

LEVATOR LABI SUPERIORIS

LEVATOR ANGULI ORIS(CANINUS)

MAXILLA



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LOWER JAW UPPER JAW

INFERIOR ALVEOLAR

LINGUAL

NERVE TO MYLOHYOID

LONG BUCCAL NERVE

POST. SUP. ALVEOLAR

INFRAORBITAL

MIDDLE SUP.ALVEOLAR

ANT.SUP.ALVEOLAR

PALATINE

NASOPALATINE

INNERVATION OF JAWS



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TRIGEMINAL NERVE



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MAXILLARY AND INFERIOR ALVEOLAR NERVES



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INFERIOR ALVEOLAR NERVE



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BLOOD SUPPLY

CIRCULATION

CENTRIFUGAL

CENTRIPETAL

PLEXUS

ENDOSTEAL

PERIOSTEAL

PERIODONTAL

GENERAL CONCEPTS

Maxillary and Mandibular blood supply



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ANATOMICAL LIMITS FOR IMPLANT

PLACEMENT

Maxillary anterior region Low quality and quantity

As bone height decreases

the remaining bone

narrows to close

approximation with nasal

cavity, maxillary sinus,

incisive canal.

It is limited to canine

eminence areas. www.asiandentalacademy.org


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CANINE EMINENCE AREA MUCH SUITABLE

FOR IMPLANT PLACEMENT IN MAXILLARY

ARCH



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MAXILLARY POSTERIOR REGION

Due to resorption pattern,

proximity of sinuses and

quality of bone implants are

rarely placed here.

Severe bone resorption and

low palatal vault creates a

difficult situation for implant

procedure.



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MANDIBULAR ANTERIOR REGION This region between mental

foramina has adequate bone

for 4-6 implants.

Minimum of 7 mm from

inferior border of mandible

to the crestal ridge is needed

In resorbed ridge mental

foramina located on top of

the ridge;care is necessary

to prevent damage to it and

possible paresthesia. www.asiandentalacademy.org


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MANDIBULAR POSTERIOR REGION

Implant placement is

difficult in this region

because of presence of

inferior alveolar nerve.

There should be minimum

1mm clearance between the

implant apex and the canal.

Pattern of bone resorption is

almost same on buccal and

lingual side. Pattern of

resorption in crestal region

creates variety of shapes

from sharp edge to flat and

wide. Shorter length

implants are necessary. www.asiandentalacademy.org


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MAXILLARY SINUS AND INFERIOR ALVEOLAR CANAL

ARE THE PRINCIPAL ANATOMICAL SITES LIMITING

THE IMPLANT PLACEMENT



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METABOLISM

STRUCTURE

Bone is highly ordered composite of organic matrix and

inorganic mineral.

Osseous matrix (OSTEOID) is primarily collagen fibers

embedded in ground substance.

During mineralization, small crystals of hydroxyapatite are

densely packed in an ordered array according to collagen

fiber orientation.



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THE PRINCIPAL FACTORS DETERMINING THE

POTENTIAL OF BONE TO SUPPORT AN

IMPLANT

1) The metabolic status of the host.

2) Functional loading history of the implantation site.

3) Surgical trauma during implant placement.

4) Response to local cytokines and growth factors during

the healing phase.

5) Biomechanics during the functional phase.



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CLASSIFICATION OF BONES

WOVEN BONE

LAMELAR BONE

BUNDLE BONE

COMPOSITE BONE



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Dense connective tissue that is composed of lamellar

bone and composite bone.Overall cortical thickness is

dictated by the loading history.

Chronic bruxers, habitual clinsers and others with

high biting strength have relatively large jaws and

thick compacta.

Vascularity

Periostium is a vital connective tissue covering the

cortical bone. Minimum stripping of periostium is an

important part of implant dentistry.

CORTICAL BONE



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Mature trabeculae are composed of lammelar bone.

There is function related tendency for trabeculae to

align along lines of stress (Wolff’s Law).

To maximise the stability during the healing phase,

it is often desirable to engage the opposite cortex

with the apical threads of the implants.

TRABECULAR BONE



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BONE DENSITY CLASSIFICATION

D1.Dense compact

D2.Porous compact (Dense to

thick porous compact and

coarse trabecular)

D3.Coarse trabecular (Porous

compact and fine trabecular)

D4.Fine trabecular.



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Type D1 bone heals with a lamellar bone interface and

has the greatest percentage of bone at the implant body

contact region:about 80%

Type D2 bone heals with woven and lamellar bone,is

adequately mineralized by 4 months,and often has

approximately 70% of bone touching the implant body.

Type D3 bone has about 50%of bone at the implant

interface and benefits from HA on the implant body to

increase this percentage.An additional 2 months (total

6months) is used for initial bone healing to permit a

greater percentage of bone trabecular to form around the

implant in D3 bone.



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Type D4 bone density has the least amount of trabecular

at implant placement.However, an additional time period

for bone healing and incremental loading of bone will

improve the density and result in implant survival to that

of other bone densities.Subantral augmentation is often

required in addition to HA coating and modified surgical

approaches are used.



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PHYSIOLOGICAL ADAPTATION

Bone healing

Modeling It is a surface specific activity (Opposition or Resorption) that

produces a net change in the size

of a bone.

Remodeling -It is a turnover or internal

restructuring of previously existing

bone.It is a coupled tissue

phenomenon



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Activation (A)of osseous precursor cells results in

A sequence of active resorption (R),quiescence or

reversal(Q),and formation(F).the duration of the

A-R(Q)-F remodeling cycle, refer to as SIGMA,is

about 17 weeks in humans. www.asiandentalacademy.org


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BONE IMPLANT INTERFACE

Two basic theories-

1. Fibro-osseous integration by

Linkow, James and Weiss.

2. Osseointegration by Branemark.



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1.FIBRO-OSSEOUS INTEGRATION According to fibro-osseous integration theory

connective tissue, made of well organized collagen

fibers, present between bone and implant.

Collagen fibers functions similarly to Sharpey’s fibers

in natural dentition.

The fibers affect bone remodeling where tension is

created under optimal loading conditions.

Fibers are arranged irregularly,parallel to the implant

body. When forces are applied they are not transmitted

through the fibers therefore bone remodeling cannot be

expected to occur in Fibrointegration. www.asiandentalacademy.org


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Fibrous connective tissue is

interposed between the implant

and bone;the fibrous tissue does

not act as a shock absorber nor

resemble pdl ligament.This non-

mineralized connective tissue

results from local inflammation

with a tendency to proliferate,

gradually increasing implant

mobility.




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2.OSSEOINTEGRATION THEORY

According to this theory direct bone-implant interface is possible

when an implant is allowed to heal in bone undisturbed.

After direct bone-implant interface osseointegration is maintained by

bone remodeling and proper loading.

Other factor affecting successful osseointegration is implant oxide

layer and poor temperature control during drilling procedure.

1st month after implant placement is critical for initial healing. A

minimum 3 months healing in mandible and 6 months in the maxilla

is necessary before applying load.



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1. Woven callus is formed

during stage 1 (6

weeks).

2. Stage 2 (18weeks) is a

period of lamellar

compaction when the

callus matures and

achieves sufficient

strength for loading.




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.STAGE 3 (18 WEEKS)OF HEALING PHASE

AND INTERFACE DEVELOPMENT

BEGINS AT SAME TIME OF

LAMELLAR COMPACTION.THE

CALLUS STARTS TO RESORB,AND

REMODELING OF DEVITALIZED

INTERFACE BEGINS.

4. STAGE4(54 WEEKS)COMPACTA

MATURES BY SERIES OF

MODELING AND REMODELING.

Bone implant interface



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SUMMARY

Physiological principles govern all aspects of implant

healing and long term functions.

An understanding of fundamental physiology,

metabolism and biomechanics of bone is essential for

clinicians placing and restoring this devices. A

thorough physiologic assessment of the patient and the

implantation sites an important part of diagnostic

process.



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SUMMARY

Basic scientific information of healing mechanism of

bone in response to implantation is very essential tool.

A careful study is needed in which biomechanical

properties can be compared with the histological response

resulting from basic differences in implant designs.



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Courses offered:

Rotary Endodontics

Smile Designing

Fellowships

Implantology

Digital Smile Designing


ABOUT ASIAN DENTAL ACADEMY

• #asian dental academy is one of the largest Advanced dental

education center in India.

• It is recognozed by DCI, Asian dental association

• It is acreditated by ISO 9001:2008

• It offres short term and long term courses of Endodontics,

Prosthodontics, and Cosmetics, Implants, Orthodontics,

endodontics, smile designing

• Weekend courses of Implants, Orthodontics, endodontics, Smile

designing, Lasers in Dentistry.



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ABOUT DIRECTOR

• Dr Anil Goud

• Director: Asian Dental Academy

• Vice principal: Nanded Dental College Nanded

• Mentor: GPS smile designing Las Vegas USA



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One of the visionery with clear vision to transform Indian

dentistry to whole new level, has started this finishing

schools since 2010. With vast experience of indian dental

education system. He has introduced on patient training

courses in India


Applied anatomy,physiology for dental implants

Healthcare

Transcript of Applied anatomy,physiology for dental implants