A dental implant is a tooth replacement with a titanium “root” implant into bone and attached crown

Known for its durability, implant survival rates have been reported to be approximately 94% at 15 years

Implants may limit or prevent mandibular/maxillary bone loss; maintain stability of adjacent, natural teeth; and enable approximately normal “bite force,” all of which contribute to improved quality of life

Potential risks or concerns with implants can include expense, negative outcomes associated with any surgery (e.g., infection, incorrect placement, procedure failure), possible need for bone grafting, and length of healing time (possibly a 6- to 12-month process)

Not all patients are eligible candidates; conditions that inhibit bone development and healing (which may include but are not limited to blood clotting disorders, metabolic bone diseases, active involvement in certain types of cancer treatment, and heavy smoker) can be exclusionary for some individuals

Implant surgery requires a detailed understanding of oral cavity anatomy and surrounding areas to troubleshoot for potential complications and to maximize likelihood of success

The evolution of patient imaging technology such cone beam computed tomography (CBCT) has allowed clinicians to assess the anatomy more effectively for implant surgery planning and determine quality of implant placement

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  Benefits of CBCT—smaller size of imaging device compared with traditional computerized tomography (CT), reasonable cost for quality images (sagittal, frontal, and transverse plane assessment), excellent submillimeter spatial resolution (ideal for imaging of the oral region), and lower radiation dose than traditional CT

A large, dense facial bone

Composed of 2 pieces of thick cortical bone—a lingual plate and a buccal plate

Teeth are contained in the horseshoe-shaped body

Nerves associated with this bone are supplied by the mandibular division of the trigeminal nerve (CN V), and their accompanying arteries are maxillary artery branches

The inferior alveolar nerve enters the mandible at the mandibular foramen and terminates as the incisive and mental nerve branches at its distal end

The incisive branch of the inferior alveolar nerve provides sensation to the mandibular premolars, canines, incisors, and related periodontal ligaments

The lingual nerve may lie along the lingual tuberosity of the mandible as it enters the oral cavity

The buccal nerve often lies on the buccal shelf of the mandible

Awareness of proximity of these nerves to tooth implant location helps the clinician avoid problematic surgical outcomes such as nerve lesions

Inferior alveolar artery with branches (see Figure 22-3 )

Lingual and facial arteries (branches off the external carotid artery)

Accessory foramina can be seen with imaging of the area near the mental spines (genial tubercles) of the mandible

These foramina are variable in number and location and are known as superior and/or inferior lingual (genial spinal) foramina

Branches of the lingual artery, vein, and nerve have been identified entering the superior lingual (genial) foramina

Branches of the sublingual artery and vein or the submental vessels and branches of the mylohyoid nerve have been identified entering the inferior lingual (genial) foramina

Awareness of this specific anatomy is important for placement of mandibular incisor implants because accidental injury from implant misplacement could create a hemorrhage followed by upper airway obstruction (or aspiration), which could be potentially life-threatening

Venous drainage from the mandibular region typically proceeds to the internal jugular vein