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Anatomical Considerations

When placing dental implants, it is crucial to avoid damaging key anatomical structures and to adhere to specific spatial guidelines to ensure successful outcomes. Here is a summary of important anatomical considerations and spatial requirements:

  1. Inferior Alveolar Nerve and Distance from Critical Structures: Maintain a distance of 2.5-3 mm from the apex of the implant to the inferior alveolar nerve or the floor of the maxillary sinus to avoid nerve damage and complications (Misch, 2008).
  2. Mental Nerve: Avoid placing implants immediately anterior to the mental foramen due to the potential presence of an anterior loop. A safety zone of at least 4 mm should be maintained to prevent nerve injury (Misch, 2008).
  3. Blood Vessels: Be cautious of nearby blood vessels such as the sublingual artery (a branch of the lingual artery) and the submental artery (a branch of the facial artery), which are close to the lingual cortical plates. To prevent perforation, the lingual flap should be reflected to the level of the implant depth (Kumar, 2011).
  4. Floor of the Mouth: Protect the floor of the mouth by managing the lingual flap adequately to avoid perforating the lingual plate and damaging surrounding vessels (Jovanovic, 2012).
  5. Nasal Cavity and Maxillary Sinuses: Ensure sufficient distance from the nasal cavity and maxillary sinuses to prevent complications (Hornsby, 2008).
  6. Adjacent Teeth: Maintain a minimum distance of 1.5 mm between the implant margin and adjacent teeth to avoid interference and complications (Wennerberg & Albrektsson, 2009).
  7. Distance Between Implants: Implants should be placed at least 3 mm apart to ensure proper bone integration and avoid interference (Brånemark et al., 1991).
  8. Interocclusal Space: Ensure a minimum of 7 mm of interocclusal or inter-arch space for proper prosthetic placement and function (Pikos, 2000).

 

When is bone augmentation required?

  • Insufficient Bone Volume: Caused by atrophy or trauma.
  • Bone Loss from Periodontal Disease: Necessary to restore structural integrity.
  • Preparation for Implants: Ensuring a stable foundation for implant placement.

 

Types of Bone Defect

Localised ridge defects can be classified based on the type of deficiency as follows (Seibert, 1983):

  • Class I: Reduced buccolingual width of the ridge with normal apicocoronal height.
  • Class II: Reduced apicocoronal height of the ridge with normal buccolingual width.
  • Class III: Combined loss of both buccolingual width and apicocoronal height.