anatomical Landmarks for a safe dental implant placement

1. Landmarks of maxilla.
 Median palatine suture.
 Nasal fossa.
 Nasal septum.
 Anterior nasal spine.
 Incisive foramen.
 Lateral fossa.
 Maxillary sinus.
 Malar bone.
 Maxillary tubrosity.
 Hamular process.
 Nasolacremal duct.
Dr. Amr Saad

2. 1- Median palatine suture:
Appears as a vertically
oriented radiolucent line
in true image projections
through the midline.
Usually prominent
between the two central
incisor roots at young
individuals.
Dr. Amr Saad

3. 1- Nasal septum: (17)Appear as
a radio-opaque line
separates the two nasal fossa
in the midline.
2- Anterior nasal spine(16)
Appears as a v-shaped
radio-opaque structure in
the midline above the
incisive foramen.
3- Incisive foramen:(12) or the
anterior palatine fossa, it
usually appears as a
prominent radiolucent area
above/or between the roots
of two central incisors. It
usually appears as a
rounded or oval in shape
doesn’t not exceed 6mm in
diameter.
Dr. Amr Saad

4. Anterior nasal spine
Dr. Amr Saad
Nasal cavities Nasal septum
Median palatine suture

5. Dr. Amr Saad
Maxillary anterior region
Nasal septum
Nasal fossa
Nasal spine
Incisive foramen
Nose
Median palatine suture

6. Dr. Amr Saad
e
f
a = nasal septum
c = nasal fossa
d = anterior nasal spine
e = incisive foramen
f = median palatal
suture
a
d
c
facial view palatal view

7. Dr. Amr Saad Nasal septum
facial view

8. Dr. Amr Saad
Nasal fossa
facial view

9. Dr. Amr Saad
Incisive foramen
palatal view

10. Dr. Amr Saad Median palatal suture
palatal view

11. Dr. Amr Saad
Soft tissue of the nose

12. Dr. Amr Saad
Red arrow points to
Periapical lesion (post-
endo)
a
d
b
Red arrows = lip line

13. Dr. Amr Saad
Red arrow = mesiodens
(supernumerary tooth)
d
f
Blue arrow = chronic periapical
periodontitis. Tooth # 9 is
non-vital (trauma) and needs
endo.

14. Dr. Amr Saad
The red arrows point to the soft tissue of the
nose. The green arrows identify the lip line.

15. 5-Maxillary sinus:
The maxillary sinus with
its thin bony walls, its
thin mucosa, and its vast
air space, produce an
extremely dark image
deep to the maxillary
teeth.
Its outlines, particularly its
floor, are clearly
delineated by delicate
radiopaque lines. Dr. Amr Saad

16. 1-Body of zygoma
6-Apices of roots
7-floor of the sinus
8-Septum of the sinus
Dr. Amr Saad
Notice the well-demarcated RL area related to upper 5

17. In general the floor of the sinus is
approximately coincidental with the
location of the apices of the roots of the
upper teeth,(bicuspids and first two
molars).
But there is often as much as two or even
three millimeters of maxillary bone
between the root ends and sinus floor.
Dr. Amr Saad

18. In other cases the sinus floor dips so deeply between the roots of the
maxillary teeth that the latter appear to project into it for as much as
one half of their length.
Dr. Amr Saad

19. Dr. Amr Saad
Pneumatization. Expansion of sinus wall into
surrounding bone, usually in areas where
teeth have been lost prematurely.
Increases with age.

20. Dr. Amr Saad
Maxillary Canine
Floor of nasal fossa
Maxillary sinus
Lateral fossa
Nose

21. Dr. Amr Saad
a = floor of nasal fossa
b = maxillary sinus
c = lateral fossa
(a & b form inverted Y)
a
c
b
a
c
b
facial view

22. Dr. Amr Saad
Floor of nasal fossa (red arrows) and anterior border
of maxillary sinus (blue arrows), forming the inverted
(upside down) Y.
facial view

23. Dr. Amr Saad
Lateral fossa. The radiolucency results from a
depression above and posterior to the lateral
incisor. To help rule out pathology, look for an
intact lamina dura surrounding the adjacent teeth.
facial view

24. Dr. Amr Saad
The maxillary sinus
surrounds the root of the
canine, which may be
misinterpreted as
pathology.
The black arrows indicate
the floor of the nasal fossa.
The maxillary sinus (red
arrows) has pneumatized
between the 2nd premolar and
first molar

25. Dr. Amr Saad
Zygomatic
process
Sinus septum
Maxillary sinus
Maxillary Premolar region

26. Dr. Amr Saad
a = malar process
c = sinus septum
d = maxillary sinus
a c
d
d
c
a
facial view

27. Dr. Amr Saad
Malar (zygomatic) process. U or j-shaped
radiopacity, often superimposed over the roots
of the molars, especially when using the
bisecting-angle technique. The red arrows define
the lower border of the zygomatic bone.
facial view

28. 6- Malar bone: Or
the zygomatic process. The
inferior portion of the malar
bone appears as a
Radiopaque u-shaped
structure related to the roots
of the first maxillary molar. It
represents the attachment of
the zygomatic bone to the
maxilla.
7- Maxillary tuberosity:
Appears as a Radiopaque
structure that extends distally
and upward from posterior to
maxillary sinus. It represents
the end of maxilla.
Dr. Amr Saad

29. 9- Hamular process: It is a
bony spine projecting from the
pterygoid process of the
sphenoid bone. It appears as a
Radiopaque spine that
recorded on radiographs
distal to the tuberosity of the
maxilla and extends
downward.
10- Coronoid process of the
mandible: Appears as a
triangular Radiopaque
structure projected into the
same general area of maxillary
Periapical film projections
distally to the maxillary teeth.
Dr. Amr Saad

30. Dr. Amr Saad
Maxillary Molar Region
Maxillary sinus
Zygoma
Pterygoid plate
Hamular
process
Coronoid process Maxillary tuberosity

31. Dr. Amr Saad
g
d
a
e
f
a = maxillary tuberosity* e = zygoma (dotted lines)
b = coronoid process f = maxillary sinus
c = hamular process g = sinus recess
d = pterygoid plates
* image of impacted third molar superimposed
c
facial view
d
b
a
e
c f
g

32. Dr. Amr Saad
Maxillary Tuberosity. The rounded elevation
located at the posterior aspect of both sides
of the maxilla. Aids in the retention of
dentures.
facial view

33. Dr. Amr Saad
Coronoid process. A mandibular structure sometimes
seen on the maxillary molar periapical film when using
the bisecting angle technique with finger retention
(The mouth is opened wide, moving the coronoid down
and forward). Note the supernumerary molar.
facial view

34. Dr. Amr Saad
Hamular process (black arrows) and pterygoid
plates (purple arrows). The hamular process is an
extension of the medial pterygoid plate of the
sphenoid bone, positioned just posterior to the
maxillary tuberosity.
facial view

35. Dr. Amr Saad
The zygomatic process (green arrows) is a prominent
U-shaped rationality. Normally the zygomatic bone
posterior to this is very dense and Radiopaque. In this
patient, however, the maxillary sinus has expanded into
the zygomatic bone and makes the area more radiolucent
(red arrows). The coronoid process (orange arrow), the
pterygoid plates (blue arrows) and the maxillary
tuberosity (pink arrows) are also identified.

36. Dr. Amr Saad
1- Floor of nasal cavity,
2- Laterobasal border of nasal cavity,
3- Maxillary sinus, 4- Floor of the
sinus,
5- Septum dividing the sinus, 11- Alveolar
crest.

37. Dr. Amr Saad
1- Zygomatic process, 2- body of zygoma, 6- Maxillary sinus, 7-
floor of the sinus, 9- Max. tuberosity, 10- alveolar crest, 11- Coronoid
process.

38. 11- Nasolacrimal duct:
It almost seen in occlusal
view of the maxilla as a
round radiolucent area
superimposed on the
posterior region of the
hard palate.
Dr. Amr Saad

39. Dr. Amr Saad
1-Anterior nasal spine, 2-Boundries of nasal cavity,
3-Nasal septum, 4-Nasal cavity,
5-Nasal bone, 6-Maxilary sinus,
7-Zygomatic process, 8-Nasolacremal duct.

40. Panoramic view
1-Nasal septum, 2-Nasal cavity, 3-Orbit,
4-Border of nasal cavity, 6-Maxillary sinus,
8-Incisive foramen, 9-Anterior nasal spine
Dr. Amr Saad

41. 1- Nasal septum, 7- Maxillary sinus,
8-Orbit, 9-Nasal bone,
10-Anterior nasal spine,
11-Border of nasal cavity,
13- Shadow of hyoid bone.
Dr. Amr Saad

42. Dr. Amr Saad
Landmarks of Mandible.

43. Landmarks of Mandible.
 Lingual foramen
 Genial tubercles.
 Mental ridge.
 Mental foramen.
 Mental fossa.
 External oblique line.
 Internal oblique line.
 Mylohyoid line or ridge.
 Mandibular foramen.
 Inferior dental canal.
 Submandibular gland fossa.
 Interdental nutrient canals.
 Pharyngeal space.
Dr. Amr Saad

44. Lingual foramen:
Is set in the midline
deep to the root apices of
the anterior teeth.
It appears as a small
radiolucent dot at the
symphysis area. It
usually surrounded with
a Radiopaque structure.
Dr. Amr Saad

45. Genial Tubercles: Or the superior
and inferior mental spines.
They are four in number located
toward the inferiolingual
border of the mandible and are
mostly 2 on each side of the
midline, although in some
instances they coalesce as a
single radiopaque outcrop of
the mandible.
They appear as a radiopaque
circle that surrounds the
lingual foramen, just below the
apices of the incisors.
Anatomically genyoglossal muscle
attached to the superior two
while the genyohyoid muscle
attached to the inferior two.
Dr. Amr Saad

46. Mental ridge: It is a bony prominence found on the labial
aspect of the mandible near its inferior border and extended
from the premolar region to the symphysis area on which it
takes an upward turn as it approach it. It appears as a
radiopaque line below the apices of anterior teeth.
Dr. Amr Saad

47. Dr. Amr Saad
Mandibular Incisors region
Mental ridge
Genial tubercles Lingual foramen
Mental fossa

48. Dr. Amr Saad
b = genial tubercles
a = lingual foramen c = mental ridge
d = mental fossa
a
b
c
d
facial view
lingual view

49. Dr. Amr Saad
Lingual foramen. Radiolucent “hole” in center
of genial tubercles. Lingual nutrient vessels
pass through this foramen.
lingual view

50. Dr. Amr Saad
Genial tubercles. Radiopaque area in the midline,
midway between the inferior border of the mandible and
the apices of the incisors. Serve as attachments for the
genioglossus and geniohyoid muscles. May have
radiolucent hole in center (lingual foramen), but not on
this film. Note double rooted canine (red arrows).
lingual view

51. Dr. Amr Saad
Mental ridge.
facial view

52. Dr. Amr Saad
Mental fossa. This represents a depression on the
labial aspect of the mandible overlying the roots of
the incisors. The resulting radiolucency may be
mistaken for pathology.
facial view

53. Dr. Amr Saad
The orange arrows above identify
nutrient canals. They are most often seen in
older persons with thin bone, and in those
with high blood pressure or advanced
periodontitis.
Nutrient canals

54. Dr. Amr Saad
Mental foramen(3)
It appears as a
radiolucent ill-defined
area between the apices
of the bicuspids. It
represent the anterior
terminates of the
mandibular canal.

55. Dr. Amr Saad
6- Caries.
7- Prepared cavity.
8- Enostosis.
9- Mental foramen.

56. Mental Fossa (6):
It is a slight depression
in the bone one the
labial aspect of the
mandible. It appears
as a faint radiolucent
structure related to
anterior area.
Dr. Amr Saad
Notice: 7 is cervical burnout

57. Dr. Amr Saad
Mandibular Premolar region
a = mylohyoid ridge
b = mandibular canal
c = submandibular gland fossa
d = mental foramen

58. Dr. Amr Saad
c
b = mandibular canal
d = mental foramen
a = mylohyoid ridge
(internal oblique)
c = submandibular gland
fossa
facial view lingual view
c
a
d
d b

59. Dr. Amr Saad
Mental foramen. Usually located midway between
the upper and lower borders of the body of the
mandible, in the area of the premolars. May
mimic pathology if superimposed over the apex
of one of the premolars.
facial view

60. Dr. Amr Saad
Mandibular Molar region
a = external oblique ridge
b = mylohyoid ridge
c = mandibular canal
d = submandibular gland fossa

61. Dr. Amr Saad
facial view lingual view
b
c
a
b
a = external oblique ridge
c = mandibular canal
b = mylohyoid ridge
d = submandibular gland
fossa
d
d

62. External oblique line:(6)
It is a Radiopaque line
extending from anterior
border of the ramus of
the mandible and
descends to the third
molar area.
7-Internal oblique line,
7-Mylohyoid line,
9-Mandibular canal,
Dr. Amr Saad

63. Dr. Amr Saad
External oblique ridge. A continuation of the
anterior border of the ramus, passing downward and
forward on the buccal side of the mandible. It
appears as a radiopaque line which usually ends
anteriorly in the area of the first molar. Serves as
an attachment of the buccinator muscle. (The red
arrows point to the mylohyoid ridge).
facial view

64. Internal oblique line(6):
It appears as a Radiopaque
line descends downward
and forward from
Coronoid process; in a
more horizontal position;
stop at the third molar area
or become continuous with
the Mylohyoid line. Its
place below the external
oblique line.
Dr. Amr Saad

65. Mylohyoid line or ridge(7)
It is a Radiopaque line
below the external oblique
line and it is the anterior
continuity of the internal
oblique line.
It extend downward and
forward from the ramus
of the mandible to the
bicuspid areas.
Dr. Amr Saad

66. Dr. Amr Saad
Mylohyoid ridge (internal oblique). Located on
the lingual surface of the mandible, extending
from the third molar area to the premolar region.
Serves as the attachment of the mylohyoid
muscle.
lingual view

67. Inferior dental canal; (9,2),
Mandibular canal, or
inferior alveolar canal.
Its characteristic image is
therefore likely to be a
radiolucent passage along
the mandible just deep to
the roots of the teeth,
terminating at the mental
foramen and bounded by
Radiopaque margins
representing the walls of
thin cortical bone bounding
the canal.
Dr. Amr Saad

68. Dr. Amr Saad
facial view
Mandibular (inferior alveolar) canal. Arises at the
mandibular foramen on the lingual side of the ramus and
passes downward and forward, moving from the lingual
side of the mandible in the third molar region to the
buccal side of the mandible in the premolar region.
Contains the inferior alveolar nerve and vessels.

69. Submandibular gland fossa(4):
It is a depression on the
lingual aspect of the mandible
on which submandibular
glands are present.
It appears as a zone of
radiolucency below the lower
molars.
Dr. Amr Saad

70. Dr. Amr Saad
lingual view
Submandibular gland fossa. A depression on
the lingual side of the mandible below the
mylohyoid ridge. The submandibular gland is
located in this region. Due to the thinness of
bone, the area being very radiolucent. The fact
that it occurs bilaterally helps to differentiate it
from pathology.

71. Dr. Amr Saad
a
b
c
d
d
a = external oblique ridge
b = mylohyoid ridge
c = mandibular canal
d = submandibular gland fossa

72. Dr. Amr Saad
The external oblique ridge (red arrows) and
the mylohyoid ridge (blue arrows) usually run
parallel with each other, with the external
oblique ridge always being higher on the film.

73. Dr. Amr Saad
The mandibular canal (red arrows identify inferior border
of canal) usually runs very close to the roots of the
molars. Note the extreme dilaceration of the roots of
the third molar (green arrow).
The film at right shows “kissing” impactions located at
the superior border of the canal.

74. Dr. Amr Saad
9-buccal & lingual compact bone
10-genial tubercle
11-Mental foramen

75. Dr. Amr Saad
1-Inferior border of the mandible 4-Mental fovea
2-Mental protuberance 5- Mental foramen
3-Digastric fovea 12-Radiolucency created by the
lip

76. Dr. Amr Saad
1,2- compact bone of mandible 4- mental fovea,
5-mental foramen, 6-mylohyoid line,
7-submandibular gland fossa, 8-hyoid bone,
12-lip radiolucency

77. Dr. Amr Saad
1-external oblique line, 3-mental foramen,
4-madibular canal,
5-inferior border of the mandible.

78. Edentulous patient
1-mandibular foramen, 2-coronoid process,
3-zygomatic arch, 4-cervical vertebra,
7-mental foramen, 8-mandibular canal
Dr. Amr Saad

79. Thank You
Dr. Amr Saad