ANATOMICAL CONSIDERATIONS IN

MAXILLA FOR ORAL IMPLANTS

Dr Bhanu Praseedha
IMDS
Dept of OMFS
 CONTENTS
• INTRODUCTION
• MAXILLA
ANATOMY
BLOOD SUPPLY
NERVE SUPPLY
• THICKNESS OF GINGIVA AND PALATAL MUCOSA
• NASOPALATINE FORAMEN
• INFRAORBITAL FORAMEN
• GREATER PALATINE FORAMEN
• ANTERIOR NASAL SPINE
• MAXILLARY SINUS
• SEPTA
• PTERYGOID AREA
MAXILLA
BLOOD SUPPLY
NERVE SUPPLY
DENSITY OF BONE
GINGIVA & PALATAL MUCOSA

• Average gingival thickness is 1.56 mm, while mean palatal thickness is 2.8 mm
• Best place to harvest a connective-tissue graft is canine-premolar region
• The thickest graft can be harvested from tuberosity region (i.e., 5 mm)
• The highest of the graft is limited by the position of the greater palatine artery
INCISIVE FORAMEN

• Incisive canals/foramina of Stenson

• 8 to 18mm behind the anterior aspect of floor of nasal fossa.
• 4.6mm wide
• 7.4mm from labial surface
• Angulation of implant
 INFRAORBITAL FORAMEN

• The overall combined distance between IOR & IOF

was 4.1 to 11.5
• Vertical diameter : 1.2 to 4.7 mm
• Transverse diameter : 1 to 5.1 mm
• Any intraoral flap elevation should cease several mm
inferior it, especially in advanced resorption of the
maxilla
• Average height of maxillary sinus is 35 to 45mm
therefore a lateral window extending 15mm from
alveolar cest avoids injury to nerve.
 GREATER PALATINE FORAMEN

• Foramen – opp 3rd molar

• Foramen – mid sagittal plane = 16mm
• Greater palatine artery – 12.7to14.7mm from gingival margin
• Incision – 2mm from the artery
 NASAL CAVITY

Nasal spine may be used to support the maxillary subperiosteal implant

Successful treatment of nasal floor elevation associated with implant placement
was achieved with avg bone height of 7.97+/-1mm.
 MAXILLARY SINUS

• Volume :- 9.5cc to 20cc

(average- 14.75cc)
• Teeth in close proximity :
2nd PM &1st Molar
• Avg height: 3.7mm
• width:2.5mm
• ap depth: 3.7mm
• Scheiderian or sinus membrane thickness - 0.3 to 0.8mm
• Ostium to antral floor 28.5mm.
• Hence, graft not to be filled beyond 15mm during sinus lift
AGE CHANGES

time growth shape

3/12 IU Out pouching in middle
meatus
birth Tubular-2x1x1cm tubular
9yrs 60% of adult size ovoid
12yrs Antral floor parallel to nasal
floor
18yrs Adult size pyramidal
PNEUMATISATION OF MAXILLARY SINUS
• Sinus augmentation addresses vertical insufficiency in the posterior
maxilla.
• Onlay grafting for horizontal insufficiency in anterior maxilla.
Maxillary sinus floor elevation

• The procedure is indicated during free end situations in maxilla.

• Vertical augmentation of posterior maxilla-lateral window technique
• sinus intrusion technique.
 MAXILLARY SINUS SEPTA

• Presence of Septa (Underwood's Cleft), occur in

31.7% at premolar area
• Bony fenestration in the inferior wall or the lateral
wall.
• Schneiderian membrane (generally 0.3 to 0.8mm
thick)
• Tear during lateral window preparation due to less
thickness.
PTERYGOID AREA

Pterygoid implant
Zygoma implant

• Extremely atrophied maxilla

• It is a self tapping titanium implant with a machine surface.
• 8 different lengths of 30-52.5mm.
• Threaded apical part has diameter of 4mm and a crestal part of
4.5mm.
• Implant head has an angulation of 45degrees.
 Zones of maxilla

Bedrossian et al. Fixed-Prosthetic Implant Restoration of the Edentulous Maxilla: A Systematic Pretreatment
Evaluation Method J Oral Maxillofac Surg 66:112-122, 2008
 Zone 1,2 &3 Zone 1&2

Bone missing
from zones
1,2&3

Zone 1 only
 Tilted implants
• Can be placed in areas with greater bone density in nasal fossa and
medial sinus wall.
• In the maxilla, the presence of large sinuses may require the
installation of implants parallel to the anterior sinus walls with distal
inclination.
THANK YOU