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Anatomia radiologica a mandibulei edentate

“madibula” deriva din greaca provine de la”mander” - a mesteca a


Ce vom studia?
1. Canalul manibular ( bifurcarea si formarea canalului retromolar (in 40 procente conform
studiilor), ramuri accesorii de la nervul milohioidian
2. Foramenul manibular /lingula (pozitia lui in raport cu planul ocluzal, pozitia
tridemensionala, daca e edentat poate de luat alte repere)
3. Foramenul mentonier: pozitia lui- intre premolari, la virful premolarului 2
foramenul mandibular accesor
1. Si deoarece noi vorbim de mandubula edentata am studiat deasemenea tipuri de arofii ,
Fosa submandibulara, si deoarece grefarea autigena reprezinta un standart de aur vom
studia surse endoorale menton, ram (linia oblica externa), torusul mandibular, exostoze
• a debutat in Egipt 1600 i. Hr ( Papirusul Chirurgical Edwin Smith ) This treatise shows that the heart, its vessels, liver, spleen, kidneys,
hypothalamus, uterus and bladder
Anatomia
• 5-4 secol i. Hr , Grecia. Hippocratic Compus : functia rinichilor, valvei tricuspide. Aristotel: disectii pe animale si biologia evolutionista, respectiv
antica aparitia anatomia comparatva
• 75 BCE Herophilus teaches anatomy, Alexandria, Egypt; performs dissections of human bodies, pe criminali executati(600 de prizonieri, pentru ce a
fost apoi acuzat). A adus anatomia mai aproape de realitate: a contrazis teoriile lui Aristotel ca inima e “seat of inteligence” si a demonstrat ca
creierul este centrul inteligentei, difenrenta dintre artere si vene, + alte condtatari juste, in special in sistemul nervos
Trecere de la antica • ca. 150 Galen dissects apes, monkeys, cows, dogs writes treatises on human anatomy. Iormațiile din aceste volume au devenit temelia pentru lumea
la medievala medicala pentru următorii 1300 de ani până când au fost contestat de Vesalius și Harvey în secolul al XVI-lea
• ca. 600-1100 Knowledge of Greek anatomical treatises lost to Western Europeans, but retained in Byzantium and the Islamic world. Islamic scholars
translate Greek anatomical treatises into Arabic.
• 1100s-1500s Galen’s anatomical treatises translated from Arabic into Latin, later from the Greek originals.

• 1235 First European medical school founded at Salerno, Italy where human bodies are publicly dissected.
• 1316 Mondino de’Liuzzi stages public dissections, Bologna, Italy; writes “Anatomia” carte care a fost utilizata in
universitati 250 ani.
Anatomia • 1450s Moveable type invented; Gutenberg Bible printed (1455). Copperplate engraving invented.
medievala • 1490 Anatomical theater opens in Padua, Italy. Perioada cind anatomia a
fost studiata din carti si
• 1491 First illustrated printed medical book published in Venice, Johannes de Ketham, Fasciculus medicinae. disectii de animale
• ca. 1500-1540 Earliest printed illustrated anatomies.
• 1510 Leonardo da Vinci dissects aproximativ 30 human beings, makes anatomical drawings
• 1543 First profusely illustrated printed anatomy, Vesalius’ De Humani Corporis Fabrica. Vesalius a negat în mod deschis învățăturile anatomice
ale lui Galen care se bazează pe observațiile altor mamifere, nu ale corpurilor umane. A contribuit cel mai mult la dezvoltarea anatomiei
datorita disectiei minutioase in loc să se concentreze asupra lucrării altor savanți ai timpului în recuperarea textelor antice Hippocrates,
Galen și alții (pe care o mare parte din comunitatea medicală a fost concentrată în acel moment)
• 1670s-1690s Schwammerdam, Ruysch and others start making anatomical specimens and museums.
Bidloo starts movement toward greater anatomical realism.
First art academies founded; anatomy is a key part of the curriculum.
• Egipt 1600 i. Hr - treatise shows that the heart, its vessels, liver, spleen, kidneys, hypothalamus, uterus and bladder
• 5-4 secol i. Hr , Grecia. Hippocratic Compus : functia rinichilor, valvei tricuspide. Aristotel: disectii pe animale si biologia evolutionista, respectiv aparitia anatomia comparatva
• 75 BCE Herophilus teaches anatomy, Alexandria, Egypt; performs dissections of human bodies, pe criminali executati. A adus anatomia mai aproape de realitate: a contrazis teoriile lui Aristotel ca inima e “seat of inteligence” si a demonstrat ca creierul este centrul inteligentei,
Anatomia difenrenta dintre artere si vene, + alte condtatari juste, in special in sistemul nervos
• ca. 150 Galen dissects apes, monkeys, cows, dogs writes treatises on human anatomy. Iormațiile din aceste volume au devenit temelia pentru lumea medicala pentru următorii 1300 de ani până când au fost contestat de Vesalius și Harvey în secolul al XVI-lea

antica

• 1235 First European medical school founded at Salerno, Italy where human bodies are publicly dissected.
• 1316 Mondino de’Liuzzi stages public dissections, Bologna, Italy; writes “Anatomia” carte care a fost utilizata in universitati 250 ani.
• 1491 First illustrated printed medical book published in Venice, Johannes de Ketham, Fasciculus medicinae.
• ca. 1500-1540 Earliest printed illustrated anatomies.
• 1510 Leonardo da Vinci dissects aproximativ 30 human beings, makes anatomical drawings
• 1543 First profusely illustrated printed anatomy, Vesalius’ De Humani Corporis Fabrica. Vesalius a negat în mod deschis învățăturile anatomice ale lui Galen care se bazează pe observațiile altor mamifere, nu ale corpurilor umane. A contribuit cel mai mult la dezvoltarea
Anatomia anatomiei datorita disectiei minutioase in loc să se concentreze asupra lucrării altor savanți ai timpului în recuperarea textelor antice Hippocrates, Galen și alții (pe care o mare parte din comunitatea medicală a fost concentrată în acel moment)
• 1670s-1690s Schwammerdam, Ruysch and others start making anatomical specimens and museums.
medievala Bidloo starts movement toward greater anatomical realism.
First art academies founded; anatomy is a key part of the curriculum.

Anatomia
moderna
Scurt istoric al radiologiei

Fizicianul german Wilhelm Röntgen este recunoscut ca descoperitor de raze X în


1895, deoarece el a fost primul care le studiază sistematic, deși nu este primul
care și-a observat efectele. El este și cel care le-a dat denumirea de "raze X" ,altii
le-au denumit "raze Röntgen“.
Prima utilizare a razelor X în condiții clinice a fost făcută de John Hall-Edwards în
Birmingham, Anglia, la 11 ianuarie 1896, când a radiografiat un ac lipit în mâna
unui asociat . La 14 februarie 1896, Hall-Edwards a fost de asemenea primul care
a utilizat raze X într-o operație chirurgicală.

Hand mit Ringen (Hand with Rings): print of Wilhelm


Röntgen's first "medical" X-ray, of his wife's hand,
taken on 22 December 1895 and presented Wilhelm Rontgen
to Ludwig Zehnder of the Physik Institut, University
of Freiburg, on 1 January

X-ray

n. Hr. 1000 2000


The earliest experimenter The first known human to
thought to have be killed by X-rays was
(unknowingly) produced X- Clarence Dally who had
rays was actuary William spent a number of years
Morgan. In 1785 he working on Thomas Edison’s
presented a paper to the X-ray light bulb. After years Experimental work and
Royal Society of London X-rays were found Crookes of work, his hair fell out and development of equipment
describing the effects of tubes, Wilhelm Roentgen, the his skin erupted in lesions in the 1950s resulted in
passing electrical currents experimental discharge scientist who discovered X- that wouldn’t heal. While 1913 The Coolidge X-ray commercially available
through a partially tubes invented around rays, was awarded the very Edison cancelled the bulb, tube was invented during machines in the early 1960s.
evacuated glass tube, 1875, by scientists first Nobel Prize in Physics Dally continued working the following year by The panoramic technique Cone beam technology was
producing a glow created by investigating the cathode in 1901. He refused to take with X-rays. Burns on his William D. Coolidge. It made originated from the need to first introduced in the
X-rays.[12] This work was rays, which are patents out related to his hands became cancerous, possible the continuous image the jaws, but it was European market in 1996 by
further explored by energetic electron beams discovery because he and he had both of his arms emissions of X-rays. X-ray also applied to other QR s.r.l. (NewTom 9000)
Humphry Davy and his that were first created in wanted humankind as a amputated. He died in 1898 tubes similar to this are still anatomic regions, before CT and into the US market in
assistant Michael Faraday. the tubes. whole to benefit. at the age of 39. in use in 2012. became available 2001.[2

X-rays were discovered by The first use of an X-ray for The first X-ray (or Emil Grubbe (1875-1960), a During the 1920s, both men 1971 Housfield a inventat
accident when German clinical purposes was by roentgenogram) was of student at Hahnemann and woman sought X-ray as tomografia computerizata
scientist Wilhelm Conrad John Hall-Edwards in Roentgen’s wife’s hand, Medical College in Chicago, a way to remove unwanted axiala
Roentgen (27 March 1845 Birmingham, England, on 11 complete with wedding noticed that the skin from hair. However, when safer,
January 1896, when he X- ring, in 1895. His wife was his hand would fall off after weaker X-rays only
rayed a needle stuck in the less than impressed and putting his hand in an X-ray temporarily removed hair,
hand of his associate. He declared: “I have seen my machine. He suggested stronger X-rays were
was also the first to use X- death!” trying the rays on a breast- applied. Unfortunately,
rays in a surgical operation. cancer patient, Rose Lee, patients soon experienced
who was diagnosed as serious injuries, including
hopeless. Her cancer shrank bone loss, skin tissue
and seemed to remit. scarring, disfigurements,
Radiotherapy was born. vascular lesions,
hyperpigmentation, and
hypopigmentation. While
the FDA banned X-ray hair
removal in the 1940s, many
months and years later,
many previous patients
developed cancers.
• After one of his assistants working on his X-ray project showed signs of illness, Thomas Edison said, “Don’t talk to
me about X-rays. I am afraid of them.”
• Pregnant women should not have X-rays except for an emergency. Exposure of the fetus to X-rays can increase the
risk of the child developing leukemia.
• A recent study found that children who received a radiation dose of a least 30 mGy (milligray) from a CT scan to
the bone marrow had three times the risk of leukemia compared to those who received a dose of 5 mGy or less.
• There is no threshold which radiation is considered totally safe. Even small doses of gamma and X-rays increase
cancer risks, although by a small amount.
• The common chest X-ray can be used to diagnose pneumonia, lung cancer, or pulmonary edema. An abdominal X-
ray can detect bowel or intestinal obstruction, free air, and free fluid. X-rays can also detect gallstones or kidney
stones.
• The International Agency for Research on Cancer (IARC), which is a part of the World Health Organization,
classifies X-ray and gamma radiation as a “known human carcinogen.”
• Young women and teenagers who had many X-rays to monitor scoliosis have been found to be at increased risk for
developing breast cancer later on.
• Exposure from a dental X-ray is roughly the same as being exposed to 1 day of environmental background
radiation.
• An X-ray on the spine is equivalent to 6 months of exposure to naturally occurring background radiation. A CT on
the spine is equivalent to 2 years’ worth.
• Our understanding of the double-helix shape of DNA was provided in part by x-ray crystallography—a technique in
which x-rays bounce off the three-dimensional pattern of atoms within a crystal lattice to form a shadow image of
its structure. In the early 1950s, a British researcher name Rosalind Franklin took the x-ray photos that first
showed DNA’s structure, but died before she could share the Nobel Prize with the men more generally given
credit for discovering the shape of the “secret of life”—James Watson and Francis Crick.
• http://drawbridgedds.com/PM_PDF/Cone_Beam_Tomographic_Imaging.pdf
Nervul are cel mai mare diametru si este situat in partea
inferioara a canalului
Anatomia orificiului mentonier
Refiune de grefare
• Linia oblica extena:
• Dificulatati la rezectia manibulara datorita cantitatii mare de os
• Torusul mandubular
OPG
• Reprezinta o zonograma cu grosimea stratului evidentiat de la 1 cm in
sectorul frontal si 1,5-2 in zona laterala
• Tot ce nu se afla in zona data, nu apare pe renghen sau apare neclar
Avantaje
• Analiza documentata a ADM + sinusurile cu posibila elaborare a unui plan de tratament
• Radiatie si pret mic
Dezavantaje
• Clasa 2 sau 3 extrema face imposibila analiza optima segmentului mandiburar si maxilar anterior
simultan
• Rapotul focus-obiect si obiect-film nu este identic in toate punctele si din cauza asta factorul de
marire variaza=== deformare de la 30-70%
Masurari directe precise sunt imposibile(poate indirect prin metoda proportiei)
• Suprapunerea altor structuri normale decit cele studiate si mimarea ulterioara a unei patologii
(chiar daca este o zonografie- oricum se obtine prin sumarea structurilor trecute de fluxul de raza
X) respectiv antomia radiologica nu coincide cu anatomia normala

OPG
Ce noi obserbam pe OPG?
16. Procesul coronoid 17 condilul 20 creasta temporala a mandibulei
21. Linia oblica 22 canalul mandibular 23. foramenul mentonier 24
dorsum of the tongue 25 compact bone of inferior border of mandible
+ raportul unitatiolor odontoparadontale/creasta edentata cu canalul
edentat
CT reprezinta examenul paraclinic neinvaziv ce ofera o imagine
tridimensionala (plan frontal, sagital si orizontal) sau planul panoramic
indicat de doctor a tesutului dur folosit pentru diacnosticul si planificarea
tratamentului corect cit in chirurgie, atit si in endodontie, tratamentul
disfunctiilor temporo-mandibulare cit si tratamentul ortodontic.

Clinic pentru a studia preventiv tesutul osos (in regiunea procesului alveolar
sau mucoasei fixe) se putea de folosit ac de anestezie cu stoper (pentru a fi
precishi cu biotipul gingiei+ modelul de studiu ----- EXISTA ASAMETODA DAR
MODERN SE FOLOSECTE CT:
Spre deosebire de imagistica radiologica bidimensionala, folosind CT noi
studiem o mandibula tridimensionala:dimensiunea si morfologia tesut osos,
traectul si raportul canalul mandibular, forma si marimea fosei
submandibulare, condidilul articular, zona cea mai protivita ce poate servi ca
donator sau receptor de transplant.
CT/CBCT + softuri MODENE – usureaza extrem de mult studiu (
obtinem un pseudomodel virtual 3D)--- putem masura dimensiuniea
mezio-distala a defectului pentru a stabili numarul implanturilor, sa masuram tridimensional
pentru a stabili volumul fectului in vederea ugumentarii viitoarei constructii protetice, sa
analiam prezenta si gradul extruziei antagonistilor

• Avantaje
• Nu se deformeaza imaginea-vedem dimensini reale
• Structura 3D--- vedem zone de ponutrenie/subcotare/subtaiate(structura osului) canalul
mandibular + putem creea sabloane astfel incit doar 20-30% au o orientare imaginar cu o
elaborrea unui plan corect de tratament
• Artefacte mai putine de la metal(trebuie de jucat cu contreastul, pasul de taiere)
• Radiatie mica (viziograv 5, OPG 15-30, CBCT 35-90)
Este sau nu necesar? Cu scop de profilaxie sau dispensarizare-radiatie mai mica e 1000 microzid (in an)
• Dezavantaje
• Cost si radiatie
• Putem nu vedea imaginea peretelui vestibulara perimplantar datorita atefactului de la implant.
• Pe CBCT putem vedea si analiza lina milohioida interna ce poate
prouce dificultati la decolarea lamboului sau limitarea accesului
chirurgical
• Linia oblica externa, procesul coronoid, zona mentoniera zone donor,
torusul mandibula
• ATM in ortopedie si ortodontie
• Zona submanibulara: Palpator? Daca este sub plaseul cavitatii bucale
atunci nu vom putea palpa
Concluzie
• OPG determinam procese inflamatorii si gradul lor
• CBCT determinam volumul
Vom studia
• Canalul manibular ( bifurcarea si formarea canalului retromolar (in 40
procente))
• Foramenul manibular (pozitia lui in raport cu planul ocluzal, pozitia
tridem)
Clinic anestezia la spina Spix poate sa fie negativa
• Foramenul mentonier: pozitia lui- intre premolari, la virful
premolarului 2
foramenul mandibular accesor
• Fosa submandibulara
• Daca e edentata poate tipuri de arofii
[1]Importanta foramenului mandibular
! Nu doar anestezie la spina Spix
• sagittal split
• ramus osteotomy, vertical ramus osteotomy, inverted L
• osteotomy, orthognathic surgery, mandibular trauma
• management, eradication of benign and malignant lesions,
• preprosthetic surgery, and nerve injury during inferior
• mandibular nerve block
surse
1. (PDF) Morphological Study of Mandible. Available from:
https://www.researchgate.net/publication/269166006_Morphologi
cal_Study_of_Mandible [accessed Jul 30 2018
• Planul ocluzal poate sa nu fie dreapta stinga in acelasi plan vertical!!!
Respectiv distanta pina la spina spix poate varia stinga dreapta
• Orificu mentonier dublu!!! Repectiv daca masuram de la orificiu distal
si curbura va fi mare, daca mezial, nu vem curbura de loc atunci!!!
• Unii dinti au apex ligualizat, vestibularizat- respectiv e clar ca daca
apexul e in corticala, grosimea corticale in regiunea data va fi egala cu
dispanta apex – peretele respectiv. Deci noi vom masura mai jos/ sus,
nesemnificativ pentru a avea o grosime a corticalei in regiunea data
• Nervul incisiv poate avea originea un pic mai distal, dar mai des la
proeminenta curburii
Unii dinti au apex ligualizat, vestibularizat- respectiv e clar ca daca apexul e in
corticala, grosimea corticale in regiunea data va fi egala cu dispanta apex – peretele
respectiv. Deci noi vom masura mai jos/ sus, nesemnificativ pentru a avea o grosime
a corticalei in regiunea data
In unele cazuri dintii frontali sunt vestibularizati si
sunt in malpozitie!!! Respectiv distanta pina la
cortical vestibulara e mare si pina linguala e mica
Orificiu mentonier dublu