Abstract
Objective: Recently, regenerative medicine has been introduced in implant treatment; however, there is no anatomical evidence for the influence of alveolar mucosal incisions on the success or failure of treatment. In this study, we carried out an anatomical investigation of the vasculature; in particular, we investigated the arterial network in the lower alveolar mucosa and its nutrient artery and discussed the method of alveolar mucosal incision based on the anatomy.
Methods: Seven fresh cadavers were systemically injected with a lead oxide-gelatin mixture, and the stereographic vasculature of the lower alveolar mucosa was observed both macroscopically and radiographically. In addition, the facial artery and sublingual artery were macroscopically investigated in 15 embalmed cadavers.
Results: Blood was supplied to the lingual alveolar mucosa and the buccal alveolar mucosa by the sublingual artery and the facial artery, respectively. In the superficial layer of the alveolar mucosa, the arterial network was observed in a random pattern, while in the deeper layer of the alveolar mucosa, axial arteries were observed toward the crest of the alveolus. There was poor artery communication between the left and right arteries in the central regions of the buccal and lingual alveolar mucosa. Furthermore, there was negligible artery connection between the buccal and lingual alveolar mucosa in the crest of toothless jaws, and an avascular zone of approximately 2 mm was observed on angiographic study. The sublingual artery was derived from the submental artery in 67% of the cases.
Conclusion: The arterial network of the buccal and lingual alveolar mucosa forms the axial artery. It is desirable to use the alveolar mucosal flap for all the layers, considering the vascular anatomy. After making an incision in the crest of the alveolus in the toothless jaw, a flap margin of width 1 mm should be cut off in order to avoid necrosis of the margin. In cases involving bleeding of the floor of the mouth, the submental artery or facial artery should first be ligated.
