Speaker: Dr. Vladimir Todorovic, DDS, MSc, PhD, ITI fellow, Serbia

Topic: Anatomical Considerations for Implant Placement in the Anterior Maxilla & Mandible

Dental implant treatment has become a routine in every day dental

practice. Even though implant placement in the anterior maxilla or mandible

is regarded as a safe procedure, intraoperative complications may occur due

to a presence of anatomical variations. Furthermore, we witness that general

dentists place more and more implants every year, often with questionable

anatomical knowledge and surgical experience, which may also contribute to

an increased number of complications.

The purpose of this lecture was to indicate the presence of anatomical

variations and the importance of 3-D imaging for the treatment planning.

In the anterior maxilla, focus is always on the aesthetic outcome.

However, we have to understand some anatomical limitations that may lead

to an aesthetic failure (i.e. gingival recessions). In order to have long-time

stable results a certain rules have been proposed, such as minimal facial

bone thickness of 2 mm. Nevertheless, in what percent of cases is that

possible? When placing implants in positions of central incisors, one has to

take into consideration the presence of the incisive canal, as well as its

dimensions and shape.

The anterior mandible is considered as a safe zone for placing

implants. There are many popular treatment concepts, presented from

different implant companies (such as ``All-on-4``, ``Pro-arch``, ``Neo-Arch``

etc.), that were introduced in order to have a full rehabilitation and at the

same time avoid the injury of the mandibular nerve. All mentioned concepts

have a similar protocol - a massive reduction of the alveolar bone prior to

implant placement in order to have sufficient inter-occlusial space. However,

many anatomical alterations have to be considered in this region, such as the

anterior mandibular lingual defects, the midline mandibular lingual canal and

the anterior loop of the inferior alveolar nerve.

Dental practitioners have to be aware that Intraoperative

complications during dental implant surgery occur and in some cases might

be a life threatening. To avoid this scenario a meticulous planning using 3-D

imaging and sound knowledge of the anatomy and its possible variations are

mandatory.