种植义齿的解剖学基础-华西口腔医院课件

种植义齿的解剖学基础种植义齿的解剖学基础1种植义齿的解剖学基础颌骨的系统解剖缺牙后颌骨的应用解剖种植义齿的解剖学基础颌骨的系统解剖2颌骨的系统解剖解剖学特点组织学特点与种植义齿有关的重要结构颌骨的系统解剖解剖学特点3Frontalviewadulthumanskull.1.frontbone2.parietalbone3.squamaofoccipitalbone4.greaterwingofsphenoidbone5.temporalbone6.nasalbone7.maxillarybone8.zygomaticbone9.mandibularboneFrontalviewadulthumanskull4Lateralviewadulthumanskull.1.frontbone2.parietalbone3.squamaofoccipitalbone4.greaterwingofsphenoidbone5.temporalbone6.nasalbone7.maxillarybone8.zygomaticbone9.mandibularboneLateralviewadulthumanskull5上颌骨的解剖学特点上颌骨的骨结构上颌骨的血供上颌骨的神经分布上颌骨的肌肉附着上颌骨的解剖学特点上颌骨的骨结构6上颌骨的骨结构一体

前面：尖牙窝、眶下孔、切牙窝

后面：颧牙槽嵴、上颌结节上面：眶下沟内面：上颌窦裂孔

上颌骨的骨结构一体7四突

额突：前筛窦颧突：颧牙槽嵴腭突：硬腭、切牙孔、腭沟

牙槽突：牙槽窝、筛状板上颌骨的骨结构四突上颌骨的骨结构8Rightmaxilla,lateralaspect.Rightmaxilla,lateralaspect.9Rightmaxilla,medialaspect.Rightmaxilla,medialaspect.10Rightmaxilla,posterioraspect.Rightmaxilla,posterioraspe11Rightmaxilla,superioraspect.Rightmaxilla,superioraspect12Hardpalate.Onrightside,emptysocketsofalveolarprocessHardpalate.Onrightside,em13Variationofinfraorbitalcanalandforamen,markedbyaprobe.Variationofinfraorbitalcana14上颌骨的血供颌内动脉（翼腭部）

上牙槽后动脉

眶下动脉

上牙槽中、前动脉

蝶腭动脉

鼻腭动脉

腭降动脉

腭大动脉上颌骨的血供颌内动脉（翼腭部）15Themaxillaryarteryanditsbranches.Themaxillaryarteryanditsb16上颌骨的神经分布三叉神经（上颌神经）蝶腭神经：鼻腭神经、腭前神经

颧神经眶下神经上牙槽后神经上牙槽中神经上牙槽前神经上颌骨的神经分布三叉神经（上颌神经）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上颌骨组织学特点

承力显著部位，骨质增厚致密

三大支柱结构：尖牙、颧突、翼突牙槽骨骨质：厚、松

外板：骨密质薄、小孔中间：骨松质内板：固有牙槽骨（筛状板）致密唇颊侧骨板较腭侧薄上颌骨组织学特点

承力显著部位，骨质增厚致密21HorizontalsectionthroughleftmaxillarevealingthethreeDimensionaltruss.maxillarysinuswithseptaatleft;nasalfloor(palate)atright.CaninebuttressZygomaticbuttressTuberosity-pterygoidbuttressCaninebuttressZygomaticbuttressTuberosity-pterygoidbuttress

HorizontalsectionthroughCani22FramesandTrussesofskull,frontalview.FramesandTrussesof23FramesandTrussesofskull,lateralview.FramesandTrussesofskull,la24Supportingpillarsofthemaxillaryskeleton.Supportingpillarsofthemaxi25上颌骨与种植有关的重要结构上颌窦

最大的鼻旁窦：12.8ML一底：鼻面一尖：颧突四壁：前、后、上、下壁下壁与上后牙关系密切上颌骨与种植有关的重要结构上颌窦26Lateralviewofthemaxillaryteethinsituwithinthealveolus.Lateralviewofthemaxillary27上颌骨与种植有关的重要结构上颌窦下壁与上后牙的关系

上颌骨与种植有关的重要结构上颌窦下壁与上后牙的关系28Relationshipbetweenmaxillarysinusandteeth.(Spongytrabeculaeremovedtoshowrelationofsinusfloortoroots.)Relationshipb29Relationshipbetweenmaxillarysinusandteeth.(Thereisadeepalveolarrecessofthesinus.)Relationshipbet30Extremeexpansionofmaxillarysinus.Extremeexpansionofmaxillary31Buccolingualsectionsthroughupperfirstpremolar.Buccolingualsectionsthrough32Buccolingualsectionsthroughuppersecondpremolar.Buccolingualsectionsthrough33Buccolingualsectionsthroughuppersecondpremolar.Buccolingualsectionsthrough34Towbuccolingualsectionsthroughupperfirstmolar.A.Throughmesiobuccalroot.B.Throughdistobuccalandlingualroots.Towbuccolingualsectionsthro35Towsectionsthroughuppersecondmolar.A.Throughmesiobuccalroot.B.Throughdistobuccalandlingualroots.Towsectionsthroughupperse36Buccolingualsectionthroughupperthirdmolar.

Buccolingualsectionthroughu37Horizontalsectionthroughupperjawabovenasalfloor.(Defectsofboneatfloorofmaxillarysinuscorrespondtorootapicesofupperteeth.)

Horizontalsectionthroughup38上颌骨与种植有关的重要结构切牙孔

两上中切牙之间，鼻腭神经骨性倒凹

上前牙唇区(切牙窝)上颌骨与种植有关的重要结构切牙孔39上颌骨与种植有关的重要结构上颌骨与上前牙的关系上颌骨与种植有关的重要结构40Labiolingualsectionsthroughupperfirstinsicor.Labiolingualsectionsthrough41Labiolingualsectionsthroughuppersecondinsicor.Labiolingualsectionsthrough42Labiolingualsectionsthroughuppercanine.Labiolingualsectionsthrough43Maxillaryincisorregion.Maxillaryincisorregion.44Maxillarycanineregion.Maxillarycanineregion.45Maxillarypremolarregion.Maxillarysinus(B.Maxillarysinus)Maxillarypremolarregion.Maxi46Maxillarymolarregion.Maxillarysinus(B.Maxillarysinus)Maxillarymolarregion.Maxilla47下颌骨的解剖学特点下颌骨的骨结构下颌骨的血供下颌骨的神经分布下颌骨的肌肉附着下颌骨的解剖学特点下颌骨的骨结构48下颌骨的骨结构下颌体

外面：颏孔、外斜线、颏隆突

内面：颏棘、内斜线

上缘：牙槽窝

下缘：下颌支

前突：喙突

后突：髁状突

内面：下颌孔、下颌隆突

外面：嚼肌粗隆下颌骨的骨结构下颌体外面：颏孔、外斜线、颏隆突49Mandible,outersurface,rightangle.Mandible,outersurface,righta50Rightmandibularhalf,medialsurface.Rightmandibularhalf,medial51Rightmandibularramus,superomedialaspect.Rightmandibularramus,supero52Mandible,posterioraspect.Mandible,posterioraspect.53Manibularbone,superioraspect.(Onrightsideareemptysocketsofalveolarprocess.)Manibularbone,super54下颌骨的血供

颌内动脉（下颌部）

下牙槽动脉

颏动脉

下颌舌骨肌动脉下颌骨的血供

颌内动脉（下颌部）55Themandibulararteryanditsbranches.Themandibulararteryandits56下颌骨的神经分布三叉神经（下颌神经）

前股：颊神经

后股：下牙槽神经、颏神经

舌神经下颌骨的神经分布三叉神经（下颌神经）57Themandibularnerveanditsbranches.Themandibularnerveanditsb58Themandibularnerve.Meningealbranch.Medialpterygoid.Anteriortrunk.Sensorybuccaln.Sensoryauriculotemporaln.Lingualn.Inferioralveolarn.Motormylohyoidn.Tympaniobranch.Themandibularnerve.59下颌骨组织学特点表层为骨密质；内部为骨松质，且在一定部位排列成轨道牙槽缘内外皮质厚，内无大骨髓腔前牙唇侧骨板较舌侧薄双尖牙颊侧骨板与舌侧接近磨牙颊侧骨板较厚下颌骨组织学特点表层为骨密质；内部为骨松质，60Trajectoriesofthemandible.Trajectoriesofthemandible.61下颌骨与种植有关的重要结构下颌管

与内斜线平行后2/3偏向于下颌体、支内侧前1/3偏向于下颌体外侧内容：下牙槽动脉、神经管嵴距下颌骨与种植有关的重要结构下颌管62Sagittalsectionthroughlowerjaw.(Notecloserelationofapicesofthethirdmolartomandibularcanal.)Sagittals63Sagittalsectionthroughlowerjaw.(Notepresenceofspongybonebetweenrootsofallteethandmandibularcanal.)Sagittalsectionthroughlo64A.Sagittalsectionthroughlowerjawofayoungindividual.(Notecloserelationofallposteriorteethtomandibularcanal.)

B.Buccolingualsectionthroughlowersecondpremolar.A.Sagittalsectionthrough65种植义齿的解剖学基础-华西口腔医院课件66下颌骨与种植有关的重要结构颏孔

位置：第二双尖牙下方65.6—78.4%

距离：距牙槽嵴16.1/14.3mm

方向：后上骨性倒凹

下前牙舌侧，磨牙区舌侧下颌骨与种植有关的重要结构颏孔67

Lateralviewofthemandibularteethinsituwithinthealveolusandtheirrelationshipwiththemandibularcanal.cmandibularcanal.mandibularforamenMentalforamenLateralviewofthemandibu68下颌骨与种植有关的重要结构下颌管与下牙的关系下颌骨与种植有关的重要结构下颌管与下牙的关系69Labiolingualsectionthroughlowerleftsecondinsicor.Labiolingualsectionthroughl70Labiolingualsectionthroughlowerleftcanine.Labiolingualsectionthroughl71Baccolingualsectionthroughlowerleftsecondpremolarandthroughmentalcanalandforamen.

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

canal(A.Mandibularcanal)Mandibularpremolarregion.Man78Mandibularmolarregion.Mandibular

canal(A.Mandibularcanal)Mandibularmolarregion.Mandib79缺牙后颌骨的应用解剖缺牙区牙槽骨的解剖学特点缺牙区软组织的解剖学特点缺牙后颌骨的应用解剖缺牙区牙槽骨的解剖学特点80种植义齿的解剖学基础-华西口腔医院课件81缺牙区牙槽骨的解剖学特点缺牙区牙槽骨的形态缺牙区牙槽骨的质地缺牙区牙槽骨的解剖学特点缺牙区牙槽骨的形态82缺牙区牙槽骨的形态牙槽骨的形态改变牙槽骨的分类缺牙区牙槽骨的形态牙槽骨的形态改变83牙槽骨的形态改变垂直性及水平性吸收70-80%

1-3月/2年Pietrotovsk

嵴顶偏向舌侧，嵴高度降低以根尖的垂直位置显著，嵴断面呈抛物线形、方形、尖形Pietrotovsk和Massler（1967）上颌骨嵴顶:上内；下颌骨嵴顶前部:后内;后部:颊侧牙槽骨的形态改变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牙槽骨的分类Lekholm和Zarb分类(根据牙槽骨残余量):A级：大部分牙槽骨尚存；B级：发生中等程度的牙槽骨吸收；C级：发生明显的牙槽骨吸收，仅基底骨尚存；D级：基底骨已开始吸收；E级：基底骨已发生重度吸收。牙槽骨的分类Lekholm和Zarb分类(根据牙槽骨残余量)87Classificationofthedegreeofresorptionofedentulousjaws,accordingtoLekholmandZarb(1985).VirtuallyintactalveolarridgeMinorresorptionofthealveolarridgeAdvancedresorptionofthealveolarridgeInitialresorptionofthebaseofthedentalarchExtremeresorptionofthebaseofthedentalarchClassificationofthedegreeo88缺牙区牙槽骨的质地牙槽骨的质地改变牙槽骨的质量分级缺牙区牙槽骨的质地牙槽骨的质地改变89牙槽骨的质地改变牙缺失后，牙槽骨板消失，被致密的骨小梁型骨结构替代。牙槽骨的质地改变牙缺失后，牙槽骨板90牙槽骨的质量分级Lekholm和Zarb:

根据骨皮质和骨松质的比例关系及骨松质的密度1级：颌骨几乎完全由均质的骨密质构成；2级：厚层的骨密质包饶骨小梁密集排列的骨松质；3级：薄层的骨密质包饶骨小梁密集排列的骨松质；4级：薄层的骨密质包饶骨小梁疏松排列的骨松质；牙槽骨的质量分级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缺牙区软组织的解剖学特点软组织的厚度软组织的部位软组织的类型软组织的性质缺牙区软组织的解剖学特点软组织的厚度106软组织的厚度上颌缺牙区的软组织厚于下颌，以上颌结节为著选择基桩穿龈部分长度形成良好的生物屏障软组织的厚度上颌缺牙区的软组织厚于107软组织的部位应为义齿主承托区植入部位勿过于偏唇及舌侧软组织的部位应为义齿主承托区108软组织的类型要有一定量的纤维束，以利于种植体颈部的生物性附着。软组织的类型要有一定量的纤维束，109软组织的性质软组织的松软及活动性如过度活动，应进行固定处理。软组织的性质软组织的松软及活动性110总结总结111展望系统解剖应用解剖

上颌窦、下颌管、颏孔检查方法

全景、CT、三维重建

展望系统解剖112谢谢谢谢113种植义齿的解剖学基础种植义齿的解剖学基础114种植义齿的解剖学基础颌骨的系统解剖缺牙后颌骨的应用解剖种植义齿的解剖学基础颌骨的系统解剖115颌骨的系统解剖解剖学特点组织学特点与种植义齿有关的重要结构颌骨的系统解剖解剖学特点116Frontalviewadulthumanskull.1.frontbone2.parietalbone3.squamaofoccipitalbone4.greaterwingofsphenoidbone5.temporalbone6.nasalbone7.maxillarybone8.zygomaticbone9.mandibularboneFrontalviewadulthumanskull117Lateralviewadulthumanskull.1.frontbone2.parietalbone3.squamaofoccipitalbone4.greaterwingofsphenoidbone5.temporalbone6.nasalbone7.maxillarybone8.zygomaticbone9.mandibularboneLateralviewadulthumanskull118上颌骨的解剖学特点上颌骨的骨结构上颌骨的血供上颌骨的神经分布上颌骨的肌肉附着上颌骨的解剖学特点上颌骨的骨结构119上颌骨的骨结构一体

前面：尖牙窝、眶下孔、切牙窝

后面：颧牙槽嵴、上颌结节上面：眶下沟内面：上颌窦裂孔

上颌骨的骨结构一体120四突

额突：前筛窦颧突：颧牙槽嵴腭突：硬腭、切牙孔、腭沟

牙槽突：牙槽窝、筛状板上颌骨的骨结构四突上颌骨的骨结构121Rightmaxilla,lateralaspect.Rightmaxilla,lateralaspect.122Rightmaxilla,medialaspect.Rightmaxilla,medialaspect.123Rightmaxilla,posterioraspect.Rightmaxilla,posterioraspe124Rightmaxilla,superioraspect.Rightmaxilla,superioraspect125Hardpalate.Onrightside,emptysocketsofalveolarprocessHardpalate.Onrightside,em126Variationofinfraorbitalcanalandforamen,markedbyaprobe.Variationofinfraorbitalcana127上颌骨的血供颌内动脉（翼腭部）

上牙槽后动脉

眶下动脉

上牙槽中、前动脉

蝶腭动脉

鼻腭动脉

腭降动脉

腭大动脉上颌骨的血供颌内动脉（翼腭部）128Themaxillaryarteryanditsbranches.Themaxillaryarteryanditsb129上颌骨的神经分布三叉神经（上颌神经）蝶腭神经：鼻腭神经、腭前神经

颧神经眶下神经上牙槽后神经上牙槽中神经上牙槽前神经上颌骨的神经分布三叉神经（上颌神经）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上颌骨组织学特点

承力显著部位，骨质增厚致密

三大支柱结构：尖牙、颧突、翼突牙槽骨骨质：厚、松

外板：骨密质薄、小孔中间：骨松质内板：固有牙槽骨（筛状板）致密唇颊侧骨板较腭侧薄上颌骨组织学特点

承力显著部位，骨质增厚致密134HorizontalsectionthroughleftmaxillarevealingthethreeDimensionaltruss.maxillarysinuswithseptaatleft;nasalfloor(palate)atright.CaninebuttressZygomaticbuttressTuberosity-pterygoidbuttressCaninebuttressZygomaticbuttressTuberosity-pterygoidbuttress

HorizontalsectionthroughCani135FramesandTrussesofskull,frontalview.FramesandTrussesof136FramesandTrussesofskull,lateralview.FramesandTrussesofskull,la137Supportingpillarsofthemaxillaryskeleton.Supportingpillarsofthemaxi138上颌骨与种植有关的重要结构上颌窦

最大的鼻旁窦：12.8ML一底：鼻面一尖：颧突四壁：前、后、上、下壁下壁与上后牙关系密切上颌骨与种植有关的重要结构上颌窦139Lateralviewofthemaxillaryteethinsituwithinthealveolus.Lateralviewofthemaxillary140上颌骨与种植有关的重要结构上颌窦下壁与上后牙的关系

上颌骨与种植有关的重要结构上颌窦下壁与上后牙的关系141Relationshipbetweenmaxillarysinusandteeth.(Spongytrabeculaeremovedtoshowrelationofsinusfloortoroots.)Relationshipb142Relationshipbetweenmaxillarysinusandteeth.(Thereisadeepalveolarrecessofthesinus.)Relationshipbet143Extremeexpansionofmaxillarysinus.Extremeexpansionofmaxillary144Buccolingualsectionsthroughupperfirstpremolar.Buccolingualsectionsthrough145Buccolingualsectionsthroughuppersecondpremolar.Buccolingualsectionsthrough146Buccolingualsectionsthroughuppersecondpremolar.Buccolingualsectionsthrough147Towbuccolingualsectionsthroughupperfirstmolar.A.Throughmesiobuccalroot.B.Throughdistobuccalandlingualroots.Towbuccolingualsectionsthro148Towsectionsthroughuppersecondmolar.A.Throughmesiobuccalroot.B.Throughdistobuccalandlingualroots.Towsectionsthroughupperse149Buccolingualsectionthroughupperthirdmolar.

Buccolingualsectionthroughu150Horizontalsectionthroughupperjawabovenasalfloor.(Defectsofboneatfloorofmaxillarysinuscorrespondtorootapicesofupperteeth.)

Horizontalsectionthroughup151上颌骨与种植有关的重要结构切牙孔

两上中切牙之间，鼻腭神经骨性倒凹

上前牙唇区(切牙窝)上颌骨与种植有关的重要结构切牙孔152上颌骨与种植有关的重要结构上颌骨与上前牙的关系上颌骨与种植有关的重要结构153Labiolingualsectionsthroughupperfirstinsicor.Labiolingualsectionsthrough154Labiolingualsectionsthroughuppersecondinsicor.Labiolingualsectionsthrough155Labiolingualsectionsthroughuppercanine.Labiolingualsectionsthrough156Maxillaryincisorregion.Maxillaryincisorregion.157Maxillarycanineregion.Maxillarycanineregion.158Maxillarypremolarregion.Maxillarysinus(B.Maxillarysinus)Maxillarypremolarregion.Maxi159Maxillarymolarregion.Maxillarysinus(B.Maxillarysinus)Maxillarymolarregion.Maxilla160下颌骨的解剖学特点下颌骨的骨结构下颌骨的血供下颌骨的神经分布下颌骨的肌肉附着下颌骨的解剖学特点下颌骨的骨结构161下颌骨的骨结构下颌体

外面：颏孔、外斜线、颏隆突

内面：颏棘、内斜线

上缘：牙槽窝

下缘：下颌支

前突：喙突

后突：髁状突

内面：下颌孔、下颌隆突

外面：嚼肌粗隆下颌骨的骨结构下颌体外面：颏孔、外斜线、颏隆突162Mandible,outersurface,rightangle.Mandible,outersurface,righta163Rightmandibularhalf,medialsurface.Rightmandibularhalf,medial164Rightmandibularramus,superomedialaspect.Rightmandibularramus,supero165Mandible,posterioraspect.Mandible,posterioraspect.166Manibularbone,superioraspect.(Onrightsideareemptysocketsofalveolarprocess.)Manibularbone,super167下颌骨的血供

颌内动脉（下颌部）

下牙槽动脉

颏动脉

下颌舌骨肌动脉下颌骨的血供

颌内动脉（下颌部）168Themandibulararteryanditsbranches.Themandibulararteryandits169下颌骨的神经分布三叉神经（下颌神经）

前股：颊神经

后股：下牙槽神经、颏神经

舌神经下颌骨的神经分布三叉神经（下颌神经）170Themandibularnerveanditsbranches.Themandibularnerveanditsb171Themandibularnerve.Meningealbranch.Medialpterygoid.Anteriortrunk.Sensorybuccaln.Sensoryauriculotemporaln.Lingualn.Inferioralveolarn.Motormylohyoidn.Tympaniobranch.Themandibularnerve.172下颌骨组织学特点表层为骨密质；内部为骨松质，且在一定部位排列成轨道牙槽缘内外皮质厚，内无大骨髓腔前牙唇侧骨板较舌侧薄双尖牙颊侧骨板与舌侧接近磨牙颊侧骨板较厚下颌骨组织学特点表层为骨密质；内部为骨松质，173Trajectoriesofthemandible.Trajectoriesofthemandible.174下颌骨与种植有关的重要结构下颌管

与内斜线平行后2/3偏向于下颌体、支内侧前1/3偏向于下颌体外侧内容：下牙槽动脉、神经管嵴距下颌骨与种植有关的重要结构下颌管175Sagittalsectionthroughlowerjaw.(Notecloserelationofapicesofthethirdmolartomandibularcanal.)Sagittals176Sagittalsectionthroughlowerjaw.(Notepresenceofspongybonebetweenrootsofallteethandmandibularcanal.)Sagittalsectionthroughlo177A.Sagittalsectionthroughlowerjawofayoungindividual.(Notecloserelationofallposteriorteethtomandibularcanal.)

B.Buccolingualsectionthroughlowersecondpremolar.A.Sagittalsectionthrough178种植义齿的解剖学基础-华西口腔医院课件179下颌骨与种植有关的重要结构颏孔

位置：第二双尖牙下方65.6—78.4%

距离：距牙槽嵴16.1/14.3mm

方向：后上骨性倒凹

下前牙舌侧，磨牙区舌侧下颌骨与种植有关的重要结构颏孔180

Lateralviewofthemandibularteethinsituwithinthealveolusandtheirrelationshipwiththemandibularcanal.cmandibularcanal.mandibularforamenMentalforamenLateralviewofthemandibu181下颌骨与种植有关的重要结构下颌管与下牙的关系下颌骨与种植有关的重要结构下颌管与下牙的关系182Labiolingualsectionthroughlowerleftsecondinsicor.Labiolingualsectionthroughl183Labiolingualsectionthroughlowerleftcanine.Labiolingualsectionthroughl184Baccolingualsectionthroughlowerleftsecondpremolarandthroughmentalcanalandforamen.

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

canal(A.Mandibularcanal)Mandibularpremolarregion.Man191Mandibularmolarregion.Mandibular

canal(A.Mandibularcanal)Mandibularmolarregion.Mandib192缺牙后颌骨的应用解剖缺牙区牙槽骨的解剖学特点缺牙区软组织的解剖学特点缺牙后颌骨的应用解剖缺牙区牙槽骨的解剖学特点193种植义齿的解剖学基础-华西口腔医院课件194缺牙区牙槽骨的解剖学特点缺牙区牙槽骨的形态缺牙区牙槽骨的质地缺牙区牙槽骨的解剖学特点缺牙区牙槽骨的形态195缺牙区牙槽骨的形态牙槽骨的形态改变牙槽骨的分类缺牙区牙槽骨的形态牙槽骨的形态改变196牙槽骨的形态改变垂直性及水平性吸收70-80%

1-3月/2年Pietrotovsk

嵴顶偏向舌侧，嵴高度降低以根尖的垂直位置显著，嵴断面呈抛物线形、方形、尖形Pietrotovsk和Massler（1967）上颌骨嵴顶:上内；下颌骨嵴顶前部:后内;后部:颊侧牙槽骨的形态改变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牙槽骨的分类Lekholm和Zarb分类(根据牙槽骨残余量):A级：大部分牙槽骨尚存；B级：发生中等程度的牙槽骨吸收；C级：发生明显的牙槽骨吸收，仅基底骨尚存；D级：基底骨已开始吸收；E级：基底骨已发生重度吸收。牙槽骨的分类Lekholm和Zarb分类(根据牙槽骨残余量)200Classificationofthedegreeofresorptionofedentulousjaws,accordingtoLekholmandZarb(1985).VirtuallyintactalveolarridgeMinorresorptionofthealveolarridgeAdvancedresorptionofthealveolarridgeInitialresorptionofthebaseofthedentalarchExtremeresorptionofthebaseofthedentalarchClassificationofthedegreeo201缺牙区牙槽骨的质地牙槽骨的质地改变牙槽骨的质量分级缺牙区牙槽骨的质地牙槽骨的质地改变202牙槽骨的质地