Universidad Austral de Chile

conocimiento y naturaleza

Anatoma aplicada a la implantologa Oral

Pedro Aravena
Facultad de Medicina UACh Doctor(c) en Cs. Mdicas

anatoma aplicada a implantes dentales

- Ciruga con rpido avance ltimos treinta aos1. - Alta tasa de xito, depende de factores del cirujano,

rehabilitacin y del paciente.

- Uno de los factores ms importantes es un conocimiento

exhaustivo de la anatoma2:
maxilar: senos maxilares y fosas nasales mandbula: nervio dentario inferior y mentoniano

1. Assael LA.. J Oral Maxillofac Surg 2008;66:611-2. 2. Greenstein G, Cavallaro J, Tarnow D. J Periodontol 2008;79:1833-46

anatoma maxilar
- Conceptos generales

- Seno maxilar
- Tuberosidad del Maxilar - proceso pterigoide

anatoma mandbula
- Conceptos generales - Canal mandibular

- Foramen mentoniano
- Canal incisivo - Foraminas linguales

anatoma maxilar

seno maxilar

3845mm

2535mm

Gary Greenstein et al. J Periodontol. 2008 Oct;79(10):1833-46.

3645mm

28,5m m

Gary Greenstein et al. J Periodontol. 2008 Oct;79(10):1833-46.

membrana de Schneider grosor: 0,3 a 0,8 mm

Gary Greenstein et al. J Periodontol. 2008 Oct;79(10):1833-46. Mogensen C, Tos M. Rhinology 1977;15:129-140.

Solar P. et al. Clin Oral Impl Res 1999. 10:34:44;79(10):1833-46.

Ella B. et al. Int J Oral Maxillofac Implants 2008;23;10471052

Y.-H. Hong & S.-K. Mun Int. J. Oral Maxillofac. Surg. 2011; 40: 758

septo seno maxilar

- Descrito por Underwood en 1910.

- Origen embriolgico, se propone por una proyeccin del infundbulum del etmoides.

Neugebauer, J. et al. .Evaluation of maxillary sinus anatomy by cone beam CT prior to sinus floor elevation. Int. J. Oral Maxillofac. Implants., 25(2):258-65, 2010.

tuberosidad del maxilar - proceso pterigoide

tuberosidad del maxilar - proceso pterigoide

The Pterygoid Plate Implant: A Solution for Restoring the Posterior Maxilla.

Stuart L Groves Int J Periodont Rest Dent. 1994:14:513-523.

Stuart L Groves Int J Periodont Rest Dent. 1994:14:513-523.

autor

ao

n implantes

meses

% exito

Bahat O Balshi TJ
Balshi TJ Pearrocha M

1992 1999
2005 2009

72 356
164 68

214 54
6-54 12-69

93 88,2
96,3 97,05

Ridell A

2009

22

144

100

Bahat O. Int J Oral Maxillofac Implants 1992. 7(4) 459-7 Balshi TJ et al.. Int J Oral Maxillofac Implants 1999. 14(3):398-406 Balshi TJ et al.. Int J Oral Maxillofac Implants 2005. 20(6) 946-52 Pearrocha M et al. Int J Oral Maxillofac Implants 2009. 24(4):720-6

Ridell A et al. Int J Oral Maxillofac Implants 2009; 20(1) 94-8

Mandbula

Canal mandibular (dentario inferior)

SUAZO IC. et al. Aspectos biomtricos del canal mandibular. Int. J. Morphol., 25(4):811-816

Canal mandibular bfido

n= 700 hemimandbulas prevalencia: 5% (n=35)

SCHILLING, L. J. et al. Int. J. Odontostomat., 4(3):207-213, 2010.

Rango de distorsin de exmenes radiogrficos en localizacin de canal mandibular

Sonick M et al.. Int J Oral Maxillofac Implants 1994;9: 455-460.

Rango de distorsin de exmenes radiogrficos en localizacin de canal mandibular

La radiografa panormica presenta un 66% de

sensibilidad y 38% de especificidad en la pesquisa del canal mandibular, por lo cual no permite predecir algn dao al nervio alveolar inferior en ciruga de terceros

molares.

Amorim, A. C. et al. I. J. Oral Maxillofac. Surg., 66:256-9, 2008.

foramen mental (mentoniano)

foramen mental (mentoniano)

foramen mental (mentoniano)

n= 22 mandbulas caucsicas (9 hombres)

(valores promedios en milmetros)

27, 6

3,6

(min: 22; max 31)

Nevia, R.F. et al. J Periodontol 2004; 75:1061-1067

3,5

foramen mental (mentoniano)

Bavitz JB (1993) Kuzmanovic DV (2003)

0 a 7,5 mm

0 a1mm 0,1 a 3,3mm

Bavitz JB et al.Int J Oral Maxillofac Implants 1993;8: 563-567. Kuzmanovic DV, et al.Clin Oral Implants Res 2003;14: 464-471. Gary Greenstein et al. J Periodontol. 2008 Oct;79(10):1833-46.

foramen mental (mentoniano)

Al elegir la longitud del implante, se estima tener un margen de seguridad de 2mm en relacin al foramen mental
Greenstein G, Tarnow D. J Periodontol 2006;77:1933-1943. Misch CE. Implant Dentistry, 2nd ed. St Loui: CV Mosby;1999: 347-370.

canal incisivo

Beltran V. et al. Int. J. Morphol., 29(2):543-549, 2011

canal incisivo
Canal incisivo de la mandbula (Mardinger et al., 2000)

autor

ao

n muestras

McDonell
Obradovic

1994
1993

331
105

99
92 dent; 31 desdent

Mraiwa
Jacobs Makris

2003
2002 2010

50
230 TC 180TC

96
94 83,5

Mardinger, O. et al. Surg. Radiol. Anat., 22(3-4):157-61, 2000. Obradovic, O et al. Bull. Group Int. Rech. Sci. Stomatol. Odontol., 36(3- 4):109-13, 1993. McDonnell, D et al.. J. Anat., 184(Pt2):363-9, 1994.

Mraiwa, N et al. Surg. Radiol. Anat., 25(5-6):416-23, 2003

Jacobs, R. et al. Dentomaxillofac. Radiol., 31(5):322-7, 2002. Makris, N. et al. Clin. Oral Implants Res., 21(7):766-71, 2010.

foramen lingual
Vascular canals are often present in the midline and lateral to the midline of the mandible. Gahleitner et al.37 found one to five vascular canals per patient. The mean diameter of the midline canals was 0.7 mm (range, 0.4 to 1.5 mm); the lateral canals in the premolar area were slightly smaller (mean, 0.6 mm). The lin- gual foramen was detected in 99% of the mandibles when evaluating skull dissections.38 However, the fo- ramen was only found on 49% of the periapical films because the angulation of the x-ray beam affected its image. The lingual foramen harbors an artery that corre- sponds to an anastomosis of the right and left sublin- gual arteries.39 Small canals with a diameter <1 mm are unlikely to cause a problem if an osteotomy pene- trates into the foramen.37 However, if there is a larger canal, excessive bleeding could be a complicating fac- tor; thus, consider avoiding implant insertion in the midline.40 If excessive bleeding from an osteotomy in this area occurs, guide pins or the implant fixture it- self can serve as effective methods of tamponade.

Rosano G. Clin. Oral Impl. Res. 20, 2009; 791795. Greenstein G., J Periodontol 2008; 79 (10): 1833-1846

foramen lingual
Vascular canals are often present in the midline and lateral to the midline of the mandible. Gahleitner et al.37 found one to five vascular canals per patient. The mean diameter of the midline canals was 0.7 mm (range, 0.4 to 1.5 mm); the lateral canals in the premolar area were slightly smaller (mean, 0.6 mm). The lin- gual foramen was detected in 99% of the mandibles when evaluating skull dissections.38 However, the fo- ramen was only found on 49% of the periapical films because the angulation of the x-ray beam affected its image. The lingual foramen harbors an artery that corre- sponds to an anastomosis of the right and left sublin- gual arteries.39 Small canals with a diameter <1 mm are unlikely to cause a problem if an osteotomy pene- trates into the foramen.37 However, if there is a larger canal, excessive bleeding could be a complicating fac- tor; thus, consider avoiding implant insertion in the midline.40 If excessive bleeding from an osteotomy in this area occurs, guide pins or the implant fixture it- self can serve as effective methods of tamponade.

60 cadveres: todas presentan foraminas linguales

Rosano G. Clin. Oral Impl. Res. 20, 2009; 791795.

N. Pigadas, P. et al. British Dental Journal 2009; 206(2)

Dubois L, et al. Int J Oral Maxillofac Surg. 2010 Apr;39(4):412-5.