Tuber
The tuber (or maxillary tuberosity) is the posterior and convex bone portion of the maxilla, located distally to the upper third molar. It represents the starting point for the placement of the pterygoid implant in the Bilateral Sinus Solution™ (BSS) technique.
| Maxillary Tuberosity | |
|---|---|
| Position | Posterior to the upper third molar |
| Bone | Upper maxilla |
| Density | D2-D3 |
| Role in BSS | Entry point of the implant |
| Relations | With sphenoid and palatine |
Anatomy
The tuber (maxillary tuberosity) is the posterior and convex bone portion of the maxilla, located distally to the upper third molar. It articulates with the pyramidal process of the palatine bone and the pterygoid processes of the sphenoid. The medial and lateral pterygoid muscles and the buccinator exert tractions that maintain the volume of the tuber even in case of atrophy of the alveolar bone.
From an anatomical point of view, the tuber has the following characteristics:
- It is the most posterior and prominent part of the upper maxilla
- It articulates posteriorly with the pyramidal process of the palatine bone and with the pterygoid processes of the sphenoid
- It presents a posterior convexity that constitutes the posterior wall of the maxillary sinus
- Its medial surface is part of the lateral wall of the nasal fossa
Muscular relations
The tuber is closely related to the pterygoid muscles:
- Medial pterygoid muscle: inserts on the internal face of the pterygoid wing and on the postero-inferior face of the tuber
- Lateral pterygoid muscle: inserts on the lower area of the external face of the pterygoid wing and on the postero-lateral face of the tuber
- Buccinator muscle: represents the lateral wall of the mouth with insertion on the tuber
These muscles exert permanent tractions on the tuberosity and favour the maintenance of its volume for life. For this reason, even in patients with strong resorption of the alveolar bone, the volumes of the tuber generally remain preserved.
Role in the Bilateral Sinus Solution™ (BSS)
In the Bilateral Sinus Solution™ (BSS), the tuber acts as the access point and guide for the pterygoid implant. The implant starts from the maxillary tuberosity, crosses the body of the tuber and the pyramidal process of the palatine bone, to reach and anchor in the cortical plates of the sphenoid. A well-preserved tuber is fundamental for the success of the procedure.
The tuber plays a fundamental role in the Bilateral Sinus Solution™ (BSS) as the access point and guide for the pterygoid implant:
- The implant starts from the maxillary tuberosity
- It crosses the body of the tuber
- It continues through the pyramidal process of the palatine bone
- It reaches and anchors in the cortical plates of the sphenoid
Importance in the pre-operative evaluation
The pre-operative evaluation of the tuber is essential for the success of the pterygoid implant. The cone beam CT allows studying volume and density of the tuberosity. A well-preserved tuber is an excellent predictor of success, while the presence of an included eighth may represent a relative contraindication requiring careful planning.
Before the procedure, the evaluation of the tuber is essential:
- The cone beam CT allows studying volume and density of the tuberosity
- A well-preserved tuber is an excellent predictor of success for the pterygoid implant
- The presence of an included eighth may represent a relative contraindication
Video: the anchorage areas
Zone 18 — 21×4.5 implant in the cortical plates of the sphenoid
The left posterior pillar: bicortical anchorage, torque 100-150 N.
Zone 28 — 21×4.5 implants in posterior basal bone
The right posterior pillar: bone that never resorbs.
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