種植義齒的解剖學(xué)基礎(chǔ)-華西口腔醫(yī)院課件

種植義齒的解剖學(xué)基礎(chǔ)種植義齒的解剖學(xué)基礎(chǔ)1種植義齒的解剖學(xué)基礎(chǔ)頜骨的系統(tǒng)解剖缺牙后頜骨的應(yīng)用解剖種植義齒的解剖學(xué)基礎(chǔ)頜骨的系統(tǒng)解剖2頜骨的系統(tǒng)解剖解剖學(xué)特點組織學(xué)特點與種植義齒有關(guān)的重要結(jié)構(gòu)頜骨的系統(tǒng)解剖解剖學(xué)特點3Frontalviewadulthumanskull.1.frontbone2.parietalbone3.squamaofoccipitalbone4.greaterwingofsphenoidbone5.temporalbone6.nasalbone7.maxillarybone8.zygomaticbone9.mandibularboneFrontalviewadulthumanskull4Lateralviewadulthumanskull.1.frontbone2.parietalbone3.squamaofoccipitalbone4.greaterwingofsphenoidbone5.temporalbone6.nasalbone7.maxillarybone8.zygomaticbone9.mandibularboneLateralviewadulthumanskull5上頜骨的解剖學(xué)特點上頜骨的骨結(jié)構(gòu)上頜骨的血供上頜骨的神經(jīng)分布上頜骨的肌肉附著上頜骨的解剖學(xué)特點上頜骨的骨結(jié)構(gòu)6上頜骨的骨結(jié)構(gòu)一體

前面：尖牙窩、眶下孔、切牙窩

后面：顴牙槽嵴、上頜結(jié)節(jié)上面：眶下溝內(nèi)面：上頜竇裂孔

上頜骨的骨結(jié)構(gòu)一體7四突

額突：前篩竇顴突：顴牙槽嵴腭突：硬腭、切牙孔、腭溝

牙槽突：牙槽窩、篩狀板上頜骨的骨結(jié)構(gòu)四突上頜骨的骨結(jié)構(gòu)8Rightmaxilla,lateralaspect.Rightmaxilla,lateralaspect.9Rightmaxilla,medialaspect.Rightmaxilla,medialaspect.10Rightmaxilla,posterioraspect.Rightmaxilla,posterioraspe11Rightmaxilla,superioraspect.Rightmaxilla,superioraspect12Hardpalate.Onrightside,emptysocketsofalveolarprocessHardpalate.Onrightside,em13Variationofinfraorbitalcanalandforamen,markedbyaprobe.Variationofinfraorbitalcana14上頜骨的血供頜內(nèi)動脈（翼腭部）

上牙槽后動脈

眶下動脈

上牙槽中、前動脈

蝶腭動脈

鼻腭動脈

腭降動脈

腭大動脈上頜骨的血供頜內(nèi)動脈（翼腭部）15Themaxillaryarteryanditsbranches.Themaxillaryarteryanditsb16上頜骨的神經(jīng)分布三叉神經(jīng)（上頜神經(jīng)）蝶腭神經(jīng)：鼻腭神經(jīng)、腭前神經(jīng)

顴神經(jīng)眶下神經(jīng)上牙槽后神經(jīng)上牙槽中神經(jīng)上牙槽前神經(jīng)上頜骨的神經(jīng)分布三叉神經(jīng)（上頜神經(jīng)）17Themaxillarynerve.A.foramenrotundumB.meningealn.C.ganglionicn.D.zygomaticn.E.posteriorsuperioralveolarn.F.infraorbitaln.G.middlesuperioralveolarn.H.anteriorsuperioralveolarn.

Themaxillarynerve.18Thesensorynervesupplytothepalate.A.thenasopalatinenervesB.thegreaterpalatinenervesC.thelesserpalatinenervesThesensorynervesupplytoth19Thebranchesofthemaxillarynerveviathepterygopalatinegangion.pterygopalatinegangion.nasopalatinen.posteriorsuperiornasaln.greaterpalatinen.lesserpalatinen.pharyngealn.Thebranchesofthemaxillary20上頜骨組織學(xué)特點

承力顯著部位，骨質(zhì)增厚致密

三大支柱結(jié)構(gòu)：尖牙、顴突、翼突牙槽骨骨質(zhì)：厚、松

外板：骨密質(zhì)薄、小孔中間：骨松質(zhì)內(nèi)板：固有牙槽骨（篩狀板）致密唇頰側(cè)骨板較腭側(cè)薄上頜骨組織學(xué)特點

承力顯著部位，骨質(zhì)增厚致密21HorizontalsectionthroughleftmaxillarevealingthethreeDimensionaltruss.maxillarysinuswithseptaatleft;nasalfloor(palate)atright.CaninebuttressZygomaticbuttressTuberosity-pterygoidbuttressCaninebuttressZygomaticbuttressTuberosity-pterygoidbuttress

HorizontalsectionthroughCani22FramesandTrussesofskull,frontalview.FramesandTrussesof23FramesandTrussesofskull,lateralview.FramesandTrussesofskull,la24Supportingpillarsofthemaxillaryskeleton.Supportingpillarsofthemaxi25上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜竇

最大的鼻旁竇：12.8ML一底：鼻面一尖：顴突四壁：前、后、上、下壁下壁與上后牙關(guān)系密切上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜竇26Lateralviewofthemaxillaryteethinsituwithinthealveolus.Lateralviewofthemaxillary27上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜竇下壁與上后牙的關(guān)系

上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜竇下壁與上后牙的關(guān)系28Relationshipbetweenmaxillarysinusandteeth.(Spongytrabeculaeremovedtoshowrelationofsinusfloortoroots.)Relationshipb29Relationshipbetweenmaxillarysinusandteeth.(Thereisadeepalveolarrecessofthesinus.)Relationshipbet30Extremeexpansionofmaxillarysinus.Extremeexpansionofmaxillary31Buccolingualsectionsthroughupperfirstpremolar.Buccolingualsectionsthrough32Buccolingualsectionsthroughuppersecondpremolar.Buccolingualsectionsthrough33Buccolingualsectionsthroughuppersecondpremolar.Buccolingualsectionsthrough34Towbuccolingualsectionsthroughupperfirstmolar.A.Throughmesiobuccalroot.B.Throughdistobuccalandlingualroots.Towbuccolingualsectionsthro35Towsectionsthroughuppersecondmolar.A.Throughmesiobuccalroot.B.Throughdistobuccalandlingualroots.Towsectionsthroughupperse36Buccolingualsectionthroughupperthirdmolar.

Buccolingualsectionthroughu37Horizontalsectionthroughupperjawabovenasalfloor.(Defectsofboneatfloorofmaxillarysinuscorrespondtorootapicesofupperteeth.)

Horizontalsectionthroughup38上頜骨與種植有關(guān)的重要結(jié)構(gòu)切牙孔

兩上中切牙之間，鼻腭神經(jīng)骨性倒凹

上前牙唇區(qū)(切牙窩)上頜骨與種植有關(guān)的重要結(jié)構(gòu)切牙孔39上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜骨與上前牙的關(guān)系上頜骨與種植有關(guān)的重要結(jié)構(gòu)40Labiolingualsectionsthroughupperfirstinsicor.Labiolingualsectionsthrough41Labiolingualsectionsthroughuppersecondinsicor.Labiolingualsectionsthrough42Labiolingualsectionsthroughuppercanine.Labiolingualsectionsthrough43Maxillaryincisorregion.Maxillaryincisorregion.44Maxillarycanineregion.Maxillarycanineregion.45Maxillarypremolarregion.Maxillarysinus(B.Maxillarysinus)Maxillarypremolarregion.Maxi46Maxillarymolarregion.Maxillarysinus(B.Maxillarysinus)Maxillarymolarregion.Maxilla47下頜骨的解剖學(xué)特點下頜骨的骨結(jié)構(gòu)下頜骨的血供下頜骨的神經(jīng)分布下頜骨的肌肉附著下頜骨的解剖學(xué)特點下頜骨的骨結(jié)構(gòu)48下頜骨的骨結(jié)構(gòu)下頜體

外面：頦孔、外斜線、頦隆突

內(nèi)面：頦棘、內(nèi)斜線

上緣：牙槽窩

下緣：下頜支

前突：喙突

后突：髁狀突

內(nèi)面：下頜孔、下頜隆突

外面：嚼肌粗隆下頜骨的骨結(jié)構(gòu)下頜體外面：頦孔、外斜線、頦隆突49Mandible,outersurface,rightangle.Mandible,outersurface,righta50Rightmandibularhalf,medialsurface.Rightmandibularhalf,medial51Rightmandibularramus,superomedialaspect.Rightmandibularramus,supero52Mandible,posterioraspect.Mandible,posterioraspect.53Manibularbone,superioraspect.(Onrightsideareemptysocketsofalveolarprocess.)Manibularbone,super54下頜骨的血供

頜內(nèi)動脈（下頜部）

下牙槽動脈

頦動脈

下頜舌骨肌動脈下頜骨的血供

頜內(nèi)動脈（下頜部）55Themandibulararteryanditsbranches.Themandibulararteryandits56下頜骨的神經(jīng)分布三叉神經(jīng)（下頜神經(jīng)）

前股：頰神經(jīng)

后股：下牙槽神經(jīng)、頦神經(jīng)

舌神經(jīng)下頜骨的神經(jīng)分布三叉神經(jīng)（下頜神經(jīng)）57Themandibularnerveanditsbranches.Themandibularnerveanditsb58Themandibularnerve.Meningealbranch.Medialpterygoid.Anteriortrunk.Sensorybuccaln.Sensoryauriculotemporaln.Lingualn.Inferioralveolarn.Motormylohyoidn.Tympaniobranch.Themandibularnerve.59下頜骨組織學(xué)特點表層為骨密質(zhì)；內(nèi)部為骨松質(zhì)，且在一定部位排列成軌道牙槽緣內(nèi)外皮質(zhì)厚，內(nèi)無大骨髓腔前牙唇側(cè)骨板較舌側(cè)薄雙尖牙頰側(cè)骨板與舌側(cè)接近磨牙頰側(cè)骨板較厚下頜骨組織學(xué)特點表層為骨密質(zhì)；內(nèi)部為骨松質(zhì)，60Trajectoriesofthemandible.Trajectoriesofthemandible.61下頜骨與種植有關(guān)的重要結(jié)構(gòu)下頜管

與內(nèi)斜線平行后2/3偏向于下頜體、支內(nèi)側(cè)前1/3偏向于下頜體外側(cè)內(nèi)容：下牙槽動脈、神經(jīng)管嵴距下頜骨與種植有關(guān)的重要結(jié)構(gòu)下頜管62Sagittalsectionthroughlowerjaw.(Notecloserelationofapicesofthethirdmolartomandibularcanal.)Sagittals63Sagittalsectionthroughlowerjaw.(Notepresenceofspongybonebetweenrootsofallteethandmandibularcanal.)Sagittalsectionthroughlo64A.Sagittalsectionthroughlowerjawofayoungindividual.(Notecloserelationofallposteriorteethtomandibularcanal.)

B.Buccolingualsectionthroughlowersecondpremolar.A.Sagittalsectionthrough65種植義齒的解剖學(xué)基礎(chǔ)-華西口腔醫(yī)院課件66下頜骨與種植有關(guān)的重要結(jié)構(gòu)頦孔

位置：第二雙尖牙下方65.6—78.4%

距離：距牙槽嵴16.1/14.3mm

方向：后上骨性倒凹

下前牙舌側(cè)，磨牙區(qū)舌側(cè)下頜骨與種植有關(guān)的重要結(jié)構(gòu)頦孔67

Lateralviewofthemandibularteethinsituwithinthealveolusandtheirrelationshipwiththemandibularcanal.cmandibularcanal.mandibularforamenMentalforamenLateralviewofthemandibu68下頜骨與種植有關(guān)的重要結(jié)構(gòu)下頜管與下牙的關(guān)系下頜骨與種植有關(guān)的重要結(jié)構(gòu)下頜管與下牙的關(guān)系69Labiolingualsectionthroughlowerleftsecondinsicor.Labiolingualsectionthroughl70Labiolingualsectionthroughlowerleftcanine.Labiolingualsectionthroughl71Baccolingualsectionthroughlowerleftsecondpremolarandthroughmentalcanalandforamen.

Baccolingualsectionthroug72Baccolingualsectionthroughdistalrootoflowerleftfirstmolar.Baccolingualsectionthroughd73Baccolingualsectionthroughdistalrootoflowerleftsecondmolar.Baccolingualsectionthroughd74BaccolingualsectionsthroughlowerleftthirdmolarBaccolingualsectionsthrough75Mandibularincisorregion.Mandibularincisorregion.76Mandibularcanineregion.Mandibularcanineregion.77Mandibularpremolarregion.Mandibular

canal(A.Mandibularcanal)Mandibularpremolarregion.Man78Mandibularmolarregion.Mandibular

canal(A.Mandibularcanal)Mandibularmolarregion.Mandib79缺牙后頜骨的應(yīng)用解剖缺牙區(qū)牙槽骨的解剖學(xué)特點缺牙區(qū)軟組織的解剖學(xué)特點缺牙后頜骨的應(yīng)用解剖缺牙區(qū)牙槽骨的解剖學(xué)特點80種植義齒的解剖學(xué)基礎(chǔ)-華西口腔醫(yī)院課件81缺牙區(qū)牙槽骨的解剖學(xué)特點缺牙區(qū)牙槽骨的形態(tài)缺牙區(qū)牙槽骨的質(zhì)地缺牙區(qū)牙槽骨的解剖學(xué)特點缺牙區(qū)牙槽骨的形態(tài)82缺牙區(qū)牙槽骨的形態(tài)牙槽骨的形態(tài)改變牙槽骨的分類缺牙區(qū)牙槽骨的形態(tài)牙槽骨的形態(tài)改變83牙槽骨的形態(tài)改變垂直性及水平性吸收70-80%

1-3月/2年P(guān)ietrotovsk

嵴頂偏向舌側(cè)，嵴高度降低以根尖的垂直位置顯著，嵴斷面呈拋物線形、方形、尖形Pietrotovsk和Massler（1967）上頜骨嵴頂:上內(nèi)；下頜骨嵴頂前部:后內(nèi);后部:頰側(cè)牙槽骨的形態(tài)改變垂直性及水平性吸收84Fallschüssel’s(1986)classificationofresorptionoftheedentulousmaxilla.

Theanteriorsegmentofthemaxillaispresented:Class0DentulousridgeClassⅠWide,highalveolarprocessClassⅡNarrow,highalveolarprocessClassⅢSharp,highalveolarprocessClassⅣWidealveolarprocesswithreducedheightClassⅤCompletelyresorptedalveolarprocessClassⅠClassⅡClassⅢClassⅣClassⅤFallschüssel’s(1986)classific85Atword’sclassificationofboneresorption.ClassⅠTooth-bearingalveolus.ClassⅡAlveolusafterextraction.

Theactualstagesofboneresorptionarepresentedinthefollowingfourclasses:ClassⅢHighalveolarprocess.ClassⅣHigh,narrowalveolarprocess.ClassⅤRounded,flatalveolarprocess.ClassⅥConcave,flatalveolarprocess.ClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥAtword’sclassificatio86牙槽骨的分類Lekholm和Zarb分類(根據(jù)牙槽骨殘余量):A級：大部分牙槽骨尚存；B級：發(fā)生中等程度的牙槽骨吸收；C級：發(fā)生明顯的牙槽骨吸收，僅基底骨尚存；D級：基底骨已開始吸收；E級：基底骨已發(fā)生重度吸收。牙槽骨的分類Lekholm和Zarb分類(根據(jù)牙槽骨殘余量)87Classificationofthedegreeofresorptionofedentulousjaws,accordingtoLekholmandZarb(1985).VirtuallyintactalveolarridgeMinorresorptionofthealveolarridgeAdvancedresorptionofthealveolarridgeInitialresorptionofthebaseofthedentalarchExtremeresorptionofthebaseofthedentalarchClassificationofthedegreeo88缺牙區(qū)牙槽骨的質(zhì)地牙槽骨的質(zhì)地改變牙槽骨的質(zhì)量分級缺牙區(qū)牙槽骨的質(zhì)地牙槽骨的質(zhì)地改變89牙槽骨的質(zhì)地改變牙缺失后，牙槽骨板消失，被致密的骨小梁型骨結(jié)構(gòu)替代。牙槽骨的質(zhì)地改變牙缺失后，牙槽骨板90牙槽骨的質(zhì)量分級Lekholm和Zarb:

根據(jù)骨皮質(zhì)和骨松質(zhì)的比例關(guān)系及骨松質(zhì)的密度1級：頜骨幾乎完全由均質(zhì)的骨密質(zhì)構(gòu)成；2級：厚層的骨密質(zhì)包饒骨小梁密集排列的骨松質(zhì)；3級：薄層的骨密質(zhì)包饒骨小梁密集排列的骨松質(zhì)；4級：薄層的骨密質(zhì)包饒骨小梁疏松排列的骨松質(zhì)；牙槽骨的質(zhì)量分級Lekholm和Zarb:91ClassificationofbonequalityaccordingtoLekholmandZarb(1985)ClassⅠJawconsistsalmostexchishivesofhomogeneouscompactbone.ClassⅡThickcompactbonesurroundshighlytrabecularcore.ClassⅢThincorticalbonesurroundshighlytrabecularcore.ClassⅣThincorticalbonesurroundsloose,spongycore.Classificationofbonequal92Classificationofbonequality(Misch1990)Classificationof93GroupAClassificationofBoneQuality(MischandJudy,1987,1990)GroupAClassificationofBo94 GroupBClassificationofBoneQuality(MischandJudy,1987,1990) GroupBClassificationof95GroupCClassificationofBoneQuality(MischandJudy,1987,1990)GroupCClassificationofBo96GroupDClassificationofBoneQuality(MischandJudy,1987,1990)GroupDClassificationofBo97Class1Class2GroupAClassificationofthePartiallyEdentulousJaw.MischandJudy(1987)Class1Class2GroupACla98Class3Class4GroupAClassificationofthePartiallyEdentulousJaw.MischandJudy(1987)Class3Class4GroupACla99Class1Class2GroupBClassificationofthePartiallyEdentulousJaw.MischandJudy(1987)Class1Class2GroupBClas100Class3Class4GroupBClassificationofthePartiallyEdentulousJaw.MischandJudy(1987)Class3Class4GroupBCla101Class1Class2GroupCClassificationofthePartiallyEdentulousJaw.MischandJudy(1987)Class1Class2GroupCClas102Class3Class4GroupCClassificationofthePartiallyEdentulousJaw.MischandJudy(1987)Class3Class4GroupCClas103Class2Class1GroupDClassificationofthePartiallyEdentulousJaw.MischandJudy(1987)Class2Class1GroupDClas104Class3Class4GroupDClassificationofthePartiallyEdentulousJaw.MischandJudy(1987)Class3Class4GroupDClass105缺牙區(qū)軟組織的解剖學(xué)特點軟組織的厚度軟組織的部位軟組織的類型軟組織的性質(zhì)缺牙區(qū)軟組織的解剖學(xué)特點軟組織的厚度106軟組織的厚度上頜缺牙區(qū)的軟組織厚于下頜，以上頜結(jié)節(jié)為著選擇基樁穿齦部分長度形成良好的生物屏障軟組織的厚度上頜缺牙區(qū)的軟組織厚于107軟組織的部位應(yīng)為義齒主承托區(qū)植入部位勿過于偏唇及舌側(cè)軟組織的部位應(yīng)為義齒主承托區(qū)108軟組織的類型要有一定量的纖維束，以利于種植體頸部的生物性附著。軟組織的類型要有一定量的纖維束，109軟組織的性質(zhì)軟組織的松軟及活動性如過度活動，應(yīng)進(jìn)行固定處理。軟組織的性質(zhì)軟組織的松軟及活動性110總結(jié)總結(jié)111展望系統(tǒng)解剖應(yīng)用解剖

上頜竇、下頜管、頦孔檢查方法

全景、CT、三維重建

展望系統(tǒng)解剖112謝謝謝謝113種植義齒的解剖學(xué)基礎(chǔ)種植義齒的解剖學(xué)基礎(chǔ)114種植義齒的解剖學(xué)基礎(chǔ)頜骨的系統(tǒng)解剖缺牙后頜骨的應(yīng)用解剖種植義齒的解剖學(xué)基礎(chǔ)頜骨的系統(tǒng)解剖115頜骨的系統(tǒng)解剖解剖學(xué)特點組織學(xué)特點與種植義齒有關(guān)的重要結(jié)構(gòu)頜骨的系統(tǒng)解剖解剖學(xué)特點116Frontalviewadulthumanskull.1.frontbone2.parietalbone3.squamaofoccipitalbone4.greaterwingofsphenoidbone5.temporalbone6.nasalbone7.maxillarybone8.zygomaticbone9.mandibularboneFrontalviewadulthumanskull117Lateralviewadulthumanskull.1.frontbone2.parietalbone3.squamaofoccipitalbone4.greaterwingofsphenoidbone5.temporalbone6.nasalbone7.maxillarybone8.zygomaticbone9.mandibularboneLateralviewadulthumanskull118上頜骨的解剖學(xué)特點上頜骨的骨結(jié)構(gòu)上頜骨的血供上頜骨的神經(jīng)分布上頜骨的肌肉附著上頜骨的解剖學(xué)特點上頜骨的骨結(jié)構(gòu)119上頜骨的骨結(jié)構(gòu)一體

前面：尖牙窩、眶下孔、切牙窩

后面：顴牙槽嵴、上頜結(jié)節(jié)上面：眶下溝內(nèi)面：上頜竇裂孔

上頜骨的骨結(jié)構(gòu)一體120四突

額突：前篩竇顴突：顴牙槽嵴腭突：硬腭、切牙孔、腭溝

牙槽突：牙槽窩、篩狀板上頜骨的骨結(jié)構(gòu)四突上頜骨的骨結(jié)構(gòu)121Rightmaxilla,lateralaspect.Rightmaxilla,lateralaspect.122Rightmaxilla,medialaspect.Rightmaxilla,medialaspect.123Rightmaxilla,posterioraspect.Rightmaxilla,posterioraspe124Rightmaxilla,superioraspect.Rightmaxilla,superioraspect125Hardpalate.Onrightside,emptysocketsofalveolarprocessHardpalate.Onrightside,em126Variationofinfraorbitalcanalandforamen,markedbyaprobe.Variationofinfraorbitalcana127上頜骨的血供頜內(nèi)動脈（翼腭部）

上牙槽后動脈

眶下動脈

上牙槽中、前動脈

蝶腭動脈

鼻腭動脈

腭降動脈

腭大動脈上頜骨的血供頜內(nèi)動脈（翼腭部）128Themaxillaryarteryanditsbranches.Themaxillaryarteryanditsb129上頜骨的神經(jīng)分布三叉神經(jīng)（上頜神經(jīng)）蝶腭神經(jīng)：鼻腭神經(jīng)、腭前神經(jīng)

顴神經(jīng)眶下神經(jīng)上牙槽后神經(jīng)上牙槽中神經(jīng)上牙槽前神經(jīng)上頜骨的神經(jīng)分布三叉神經(jīng)（上頜神經(jīng)）130Themaxillarynerve.A.foramenrotundumB.meningealn.C.ganglionicn.D.zygomaticn.E.posteriorsuperioralveolarn.F.infraorbitaln.G.middlesuperioralveolarn.H.anteriorsuperioralveolarn.

Themaxillarynerve.131Thesensorynervesupplytothepalate.A.thenasopalatinenervesB.thegreaterpalatinenervesC.thelesserpalatinenervesThesensorynervesupplytoth132Thebranchesofthemaxillarynerveviathepterygopalatinegangion.pterygopalatinegangion.nasopalatinen.posteriorsuperiornasaln.greaterpalatinen.lesserpalatinen.pharyngealn.Thebranchesofthemaxillary133上頜骨組織學(xué)特點

承力顯著部位，骨質(zhì)增厚致密

三大支柱結(jié)構(gòu)：尖牙、顴突、翼突牙槽骨骨質(zhì)：厚、松

外板：骨密質(zhì)薄、小孔中間：骨松質(zhì)內(nèi)板：固有牙槽骨（篩狀板）致密唇頰側(cè)骨板較腭側(cè)薄上頜骨組織學(xué)特點

承力顯著部位，骨質(zhì)增厚致密134HorizontalsectionthroughleftmaxillarevealingthethreeDimensionaltruss.maxillarysinuswithseptaatleft;nasalfloor(palate)atright.CaninebuttressZygomaticbuttressTuberosity-pterygoidbuttressCaninebuttressZygomaticbuttressTuberosity-pterygoidbuttress

HorizontalsectionthroughCani135FramesandTrussesofskull,frontalview.FramesandTrussesof136FramesandTrussesofskull,lateralview.FramesandTrussesofskull,la137Supportingpillarsofthemaxillaryskeleton.Supportingpillarsofthemaxi138上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜竇

最大的鼻旁竇：12.8ML一底：鼻面一尖：顴突四壁：前、后、上、下壁下壁與上后牙關(guān)系密切上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜竇139Lateralviewofthemaxillaryteethinsituwithinthealveolus.Lateralviewofthemaxillary140上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜竇下壁與上后牙的關(guān)系

上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜竇下壁與上后牙的關(guān)系141Relationshipbetweenmaxillarysinusandteeth.(Spongytrabeculaeremovedtoshowrelationofsinusfloortoroots.)Relationshipb142Relationshipbetweenmaxillarysinusandteeth.(Thereisadeepalveolarrecessofthesinus.)Relationshipbet143Extremeexpansionofmaxillarysinus.Extremeexpansionofmaxillary144Buccolingualsectionsthroughupperfirstpremolar.Buccolingualsectionsthrough145Buccolingualsectionsthroughuppersecondpremolar.Buccolingualsectionsthrough146Buccolingualsectionsthroughuppersecondpremolar.Buccolingualsectionsthrough147Towbuccolingualsectionsthroughupperfirstmolar.A.Throughmesiobuccalroot.B.Throughdistobuccalandlingualroots.Towbuccolingualsectionsthro148Towsectionsthroughuppersecondmolar.A.Throughmesiobuccalroot.B.Throughdistobuccalandlingualroots.Towsectionsthroughupperse149Buccolingualsectionthroughupperthirdmolar.

Buccolingualsectionthroughu150Horizontalsectionthroughupperjawabovenasalfloor.(Defectsofboneatfloorofmaxillarysinuscorrespondtorootapicesofupperteeth.)

Horizontalsectionthroughup151上頜骨與種植有關(guān)的重要結(jié)構(gòu)切牙孔

兩上中切牙之間，鼻腭神經(jīng)骨性倒凹

上前牙唇區(qū)(切牙窩)上頜骨與種植有關(guān)的重要結(jié)構(gòu)切牙孔152上頜骨與種植有關(guān)的重要結(jié)構(gòu)上頜骨與上前牙的關(guān)系上頜骨與種植有關(guān)的重要結(jié)構(gòu)153Labiolingualsectionsthroughupperfirstinsicor.Labiolingualsectionsthrough154Labiolingualsectionsthroughuppersecondinsicor.Labiolingualsectionsthrough155Labiolingualsectionsthroughuppercanine.Labiolingualsectionsthrough156Maxillaryincisorregion.Maxillaryincisorregion.157Maxillarycanineregion.Maxillarycanineregion.158Maxillarypremolarregion.Maxillarysinus(B.Maxillarysinus)Maxillarypremolarregion.Maxi159Maxillarymolarregion.Maxillarysinus(B.Maxillarysinus)Maxillarymolarregion.Maxilla160下頜骨的解剖學(xué)特點下頜骨的骨結(jié)構(gòu)下頜骨的血供下頜骨的神經(jīng)分布下頜骨的肌肉附著下頜骨的解剖學(xué)特點下頜骨的骨結(jié)構(gòu)161下頜骨的骨結(jié)構(gòu)下頜體

外面：頦孔、外斜線、頦隆突

內(nèi)面：頦棘、內(nèi)斜線

上緣：牙槽窩

下緣：下頜支

前突：喙突

后突：髁狀突

內(nèi)面：下頜孔、下頜隆突

外面：嚼肌粗隆下頜骨的骨結(jié)構(gòu)下頜體外面：頦孔、外斜線、頦隆突162Mandible,outersurface,rightangle.Mandible,outersurface,righta163Rightmandibularhalf,medialsurface.Rightmandibularhalf,medial164Rightmandibularramus,superomedialaspect.Rightmandibularramus,supero165Mandible,posterioraspect.Mandible,posterioraspect.166Manibularbone,superioraspect.(Onrightsideareemptysocketsofalveolarprocess.)Manibularbone,super167下頜骨的血供

頜內(nèi)動脈（下頜部）

下牙槽動脈

頦動脈

下頜舌骨肌動脈下頜骨的血供

頜內(nèi)動脈（下頜部）168Themandibulararteryanditsbranches.Themandibulararteryandits169下頜骨的神經(jīng)分布三叉神經(jīng)（下頜神經(jīng)）

前股：頰神經(jīng)

后股：下牙槽神經(jīng)、頦神經(jīng)

舌神經(jīng)下頜骨的神經(jīng)分布三叉神經(jīng)（下頜神經(jīng)）170Themandibularnerveanditsbranches.Themandibularnerveanditsb171Themandibularnerve.Meningealbranch.Medialpterygoid.Anteriortrunk.Sensorybuccaln.Sensoryauriculotemporaln.Lingualn.Inferioralveolarn.Motormylohyoidn.Tympaniobranch.Themandibularnerve.172下頜骨組織學(xué)特點表層為骨密質(zhì)；內(nèi)部為骨松質(zhì)，且在一定部位排列成軌道牙槽緣內(nèi)外皮質(zhì)厚，內(nèi)無大骨髓腔前牙唇側(cè)骨板較舌側(cè)薄雙尖牙頰側(cè)骨板與舌側(cè)接近磨牙頰側(cè)骨板較厚下頜骨組織學(xué)特點表層為骨密質(zhì)；內(nèi)部為骨松質(zhì)，173Trajectoriesofthemandible.Trajectoriesofthemandible.174下頜骨與種植有關(guān)的重要結(jié)構(gòu)下頜管

與內(nèi)斜線平行后2/3偏向于下頜體、支內(nèi)側(cè)前1/3偏向于下頜體外側(cè)內(nèi)容：下牙槽動脈、神經(jīng)管嵴距下頜骨與種植有關(guān)的重要結(jié)構(gòu)下頜管175Sagittalsectionthroughlowerjaw.(Notecloserelationofapicesofthethirdmolartomandibularcanal.)Sagittals176Sagittalsectionthroughlowerjaw.(Notepresenceofspongybonebetweenrootsofallteethandmandibularcanal.)Sagittalsectionthroughlo177A.Sagittalsectionthroughlowerjawofayoungindividual.(Notecloserelationofallposteriorteethtomandibularcanal.)

B.Buccolingualsectionthroughlowersecondpremolar.A.Sagittalsectionthrough178種植義齒的解剖學(xué)基礎(chǔ)-華西口腔醫(yī)院課件179下頜骨與種植有關(guān)的重要結(jié)構(gòu)頦孔

位置：第二雙尖牙下方65.6—78.4%

距離：距牙槽嵴16.1/14.3mm

方向：后上骨性倒凹

下前牙舌側(cè)，磨牙區(qū)舌側(cè)下頜骨與種植有關(guān)的重要結(jié)構(gòu)頦孔180

Lateralviewofthemandibularteethinsituwithinthealveolusandtheirrelationshipwiththemandibularcanal.cmandibularcanal.mandibularforamenMentalforamenLateralviewofthemandibu181下頜骨與種植有關(guān)的重要結(jié)構(gòu)下頜管與下牙的關(guān)系下頜骨與種植有關(guān)的重要結(jié)構(gòu)下頜管與下牙的關(guān)系182Labiolingualsectionthroughlowerleftsecondinsicor.Labiolingualsectionthroughl183Labiolingualsectionthroughlowerleftcanine.Labiolingualsectionthroughl184Baccolingualsectionthroughlowerleftsecondpremolarandthroughmentalcanalandforamen.

Baccolingualsectionthroug185Baccolingualsectionthroughdistalrootoflowerleftfirstmolar.Baccolingualsectionthroughd186Baccolingualsectionthroughdistalrootoflowerleftsecondmolar.Baccolingualsectionthroughd187BaccolingualsectionsthroughlowerleftthirdmolarBaccolingualsectionsthrough188Mandibularincisorregion.Mandibularincisorregion.189Mandibularcanineregion.Mandibularcanineregion.190Mandibularpremolarregion.Mandibular

canal(A.Mandibularcanal)Mandibularpremolarregion.Man191Mandibularmolarregion.Mandibular

canal(A.Mandibularcanal)Mandibularmolarregion.Mandib192缺牙后頜骨的應(yīng)用解剖缺牙區(qū)牙槽骨的解剖學(xué)特點缺牙區(qū)軟組織的解剖學(xué)特點缺牙后頜骨的應(yīng)用解剖缺牙區(qū)牙槽骨的解剖學(xué)特點193種植義齒的解剖學(xué)基礎(chǔ)-華西口腔醫(yī)院課件194缺牙區(qū)牙槽骨的解剖學(xué)特點缺牙區(qū)牙槽骨的形態(tài)缺牙區(qū)牙槽骨的質(zhì)地缺牙區(qū)牙槽骨的解剖學(xué)特點缺牙區(qū)牙槽骨的形態(tài)195缺牙區(qū)牙槽骨的形態(tài)牙槽骨的形態(tài)改變牙槽骨的分類缺牙區(qū)牙槽骨的形態(tài)牙槽骨的形態(tài)改變196牙槽骨的形態(tài)改變垂直性及水平性吸收70-80%

1-3月/2年P(guān)ietrotovsk

嵴頂偏向舌側(cè)，嵴高度降低以根尖的垂直位置顯著，嵴斷面呈拋物線形、方形、尖形Pietrotovsk和Massler（1967）上頜骨嵴頂:上內(nèi)；下頜骨嵴頂前部:后內(nèi);后部:頰側(cè)牙槽骨的形態(tài)改變垂直性及水平性吸收197Fallschüssel’s(1986)classificationofresorptionoftheedentulousmaxilla.

Theanteriorsegmentofthemaxillaispresented:Class0DentulousridgeClassⅠWide,highalveolarprocessClassⅡNarrow,highalveolarprocessClassⅢSharp,highalveolarprocessClassⅣWidealveolarprocesswithreducedheightClassⅤCompletelyresorptedalveolarprocessClassⅠClassⅡClassⅢClassⅣClassⅤFallschüssel’s(1986)classific198Atword’sclassificationofboneresorption.ClassⅠTooth-bearingalveolus.ClassⅡAlveolusafterextraction.

Theactualstagesofboneresorptionarepresentedinthefollowingfourclasses:ClassⅢHighalveolarprocess.ClassⅣHigh,narrowalveolarprocess.ClassⅤRounded,flatalveolarprocess.ClassⅥConcave,flatalveolarprocess.ClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥAtword’sclassificatio199牙槽骨的分類Lekholm和Zarb分類(根據(jù)牙槽骨殘余量):A級：大部分牙槽骨尚存；B級：發(fā)生中等程度的牙槽骨吸收；C級：發(fā)生明顯的牙槽骨吸收，僅基底骨尚存；D級：基底骨已開始吸收；E級：基底骨已發(fā)生重度吸收。牙槽骨的分類Lekholm和Zarb分類(根據(jù)牙槽骨殘余量)200Classificationofthedegreeofresorptionofedentulousjaws,accordingtoLekholmandZarb(1985).VirtuallyintactalveolarridgeMinorresorptionofthealveolarridgeAdvancedresorptionofthealveolarridgeInitialresorptionofthebaseofthedentalarchExtremeresorptionofthebaseofthedentalarchClassificationofthedegreeo201缺牙區(qū)牙槽骨的質(zhì)地牙槽骨的質(zhì)地改變牙槽骨的質(zhì)量分級缺牙區(qū)牙槽骨的質(zhì)地牙槽骨的質(zhì)地改變202牙槽骨的質(zhì)地