Surgical Anatomy of Periodontium and Related Structures (61) periodontal surgery Surgical Anatomy of Periodontium and Related Structures (61)

Surgical Anatomy of the Periodontium And Related Structures

Surgical Anatomy of the Periodontium And Related Structures

Knowledge of the anatomy of the Periodontium and the hard and soft structures is essential. Mandible. Maxilla. Muscles. Anatomic Spaces.

MANDIBLE Mandibular canal(Inferior alveolar nerve and vessels). Mental Foramen(mental nerve and vessels) closer to second premolar. Lingual nerve. External oblique ridge may limit resective osseous therapy. Retromolar triangle. Area occupied by glandular and adipose tissue. Mylohyoid ridge(inner side of mandible)

Inner side of the mandible

Maxilla The alveolar process The Palatine process The zygomatic Process The frontal Process.

MAXILLA Incisive canal(incisive papilla and vessels emerging through the canal). Greater Palatine foramen( opens 3-4mm anterior to post. Border of the hard palate) including all the nerves and vessels emerging from it and run anteriorly. Submucosa contains Palatal glands which protects the underlying vessels and nerve.

MAXLIIA Maxillary tuberosity. Maxillary Sinus. Maxillary or mandibular tori.

Muscles Several muscles may be encountered during performing flaps Particullary in mucogingival surgery. Mentalis, incisve labii inferioris, depressor anguli oris, incisivenlabii superioris and buccinator. They have bony attachment and they provide mobility to lips and cheeks

Anatomic spaces Surgical invasion of these areas may result in dangerous infections because these spaces contain loose connective tissues and can be distended by inflammatory fluid and infection.

ANATOMIC SPACES Surgical invasion may result in dangerous infections and should be avoided. Canine fossa. Buccal Space. Mental space. Masticator space. Sublingual, submental and submandibular space.

Anatomic spaces Infection is dangerous in submental and submandibular spases Canine fossa.Infection lead to swelling of the upper lip and upper and lower eyelid closing the eye. Buccal space (between buccinator and masstere muscle). Infection leads to sweeling of the cheek. Mental space. Infection lead to sweeling of chin Masticator space.infection result in sweeling of the face and trismus and pain. Sublingual space results in pain around the toungue &swallowing.

Conclusions In the mandible, the position of the mandibular nerve must be ascertained before implant placement so that there is no risk of damage. 2mm space should be present between the coronal border of the nerve and the apex of the implant. Mental nerve should be considered during implant placement and mucoginival surgery.

concclusion During extraction of the third molar, take care of the lingual nerve.

conclusion In the maxilla, the nasopalatine nerves and vessels are of little important if they are included in the surgery. However, involvement of the greater palatine artery should be avoided becouse of significant hemorrage that could occur if it is severed. Maxillary sinus extent has to evaluated during treatment planing for implants.