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6 Anatomic and Biological Principles for Implant Placement
Kyle D. Hogg
6.1 Principles
Possessing a thorough knowledge of oral and maxillofacial anatomical structures is a prerequisite to providing safe, effective, and predictably successful implant surgery. Accurate assessment of a patient's anatomy during a pre‐surgical evaluation is vitally important not only to develop a comprehensive plan of treatment, but also to limit the potential risks of surgical complications. Comprehensive medical histories, patient interviews, and clinical exams should be supplemented by conventional two‐dimensional radiography and three‐dimensional imaging, where indicated, to provide the surgeon with sufficient information regarding pertinent anatomy. This chapter will provide an overview of important anatomical structures of the head and neck, focusing on the osteology, vascularity, innervation, and musculature of the region. (For more information on the placement of dental implants in proximity to specific vital anatomical structures please refer to Chapters 7 and 8.)
6.1.1 Osteology
The skull is the skeletal structure of the head that serves to protect the brain and support the face. In the adult, the skull consists of 22 individual bones (8 paired bones, 6 single bones), 21 of which are immobile and combined into a single unit. The 22nd bone is the mandible, which, uniquely, is the only moveable bone of the skull. The skull can be further subdivided into the cranial bones (numbering 8) and facial bones (numbering 14). The cranial bones collectively form the cranial vault, which protects the brain and houses both middle and inner ear structures. The facial bones support the facial structures, form the nasal cavity and the orbit, and house the teeth. The facial bones are of particular importance in relation to dentofacial aesthetics and implantology, with the paired bones of the maxilla, palatine, and zygomatic arches as well as the single bone of the mandible routinely involved in implant treatment. Table 6.1 gives a summary of the bones comprising the skull [1]. Figures 6.1–6.3 show for skull osteology schematics and articulation.
Table 6.1 Osteology summary.
Source: Norton, N. (2007). Netter's Head and Neck Anatomy for Dentistry. Philadelphia: Saunders Elsevier. ©2007, Elsevier.
| Bone | Paired | Single | Cranial/Facial | Articulation |
|---|---|---|---|---|
| Frontal | X | Cranial | Maxilla, zygomatic, sphenoid, parietal, ethmoid, nasal, lacrimal | |
| Parietal | X | Cranial | Temporal, frontal, parietal, occipital, sphenoid | |
| Temporal | X | Cranial | Mandible, zygomatic, sphenoid, parietal, occipital | |
| Occipital | X | Cranial | Temporal, atlas (C1), parietal, sphenoid | |
| Sphenoid | X | Cranial | Maxilla, ethmoid, palatine, vomer, frontal, parietal, temporal, occipital, zygomatic | |
| Ethmoid | X | Cranial | Maxilla, palatine, vomer, nasal, lacrimal, inferior nasal concha, frontal, sphenoid | |
| Zygomatic | X | Facial | Maxilla, frontal, temporal | |
| Maxilla | X | Facial | Maxilla, zygomatic, frontal, sphenoid, ethmoid, palatine, vomer, nasal, lacrimal, inferior nasal concha | |
| Palatine | X | Facial | Maxilla, palatine, vomer, inferior nasal concha, ethmoid, sphenoid | |
| Vomer | X | Facial | Maxilla, palatine, ethmoid, sphenoid | |
| Nasal | X | Facial | Maxilla, nasal, frontal | |
| Lacrimal | X | Facial | Maxilla, frontal, ethmoid, inferior nasal concha | |
| Inferior nasal concha | X | Facial | Maxilla, palatine, lacrimal, ethmoid | |
| Mandible | X | Facial | Temporal |
Figure 6.1 Osteology of the skull (exploded view).
Source: sciencepics/Shutterstock.com.
Figure 6.2 Osteology of the skull (frontal view).
Source: sciencepics/Shutterstock.com.
