Maxillary Tuberosity Research Articles

Objective: Rehabilitation of the atrophic posterior maxilla is challenging due to insufficient bone quantity and quality. Conventional approaches, such as sinus floor elevation or onlay bone grafting, are associated with higher morbidity, longer treatment times, and increased complications. Pterygoid implants offer a less invasive alternative, utilizing dense cortical bone in the pterygoid apophysis and posterior maxillary tuberosity to provide distal anchorage and full-arch prosthetic support, while avoiding the need for sinus augmentation. Clinical evidence indicates high survival rates, making them a reliable option for posterior maxillary rehabilitation. Materials and Methods: This prospective clinical study included 15 patients (aged 49–78 years) with unilateral posterior maxillary tooth loss that was unsuitable for conventional implants. Each patient received one pterygoid implant and two compressive implants. Preoperative planning included CBCT scans. Surgical procedures involved flap elevation, precise drilling, and manual insertion with high insertion torque. Immediate prosthetic loading was performed within seven days. Postoperative care included antibiotics, analgesics, chlorhexidine mouthwash, and oral hygiene instructions. Implant failure was defined as detectable mobility or conditions requiring removal. Results: All 45 implants (15 pterygoid and 30 compressive) survived over the 12-month follow-up, with no failures observed at 3, 6, or 12 months. Survival rates were 100% for both implant types, and no differences were noted across follow-up periods. Conclusions: Pterygoid implants demonstrate high survival rates and represent a predictable, minimally invasive option for posterior maxillary rehabilitation. Proper preoperative planning and surgical expertise are essential, and further long-term studies are recommended to confirm standardized protocols and durability.

Control of the pterygomaxillary junction (PMJ) fracture is critical in Le Fort I osteotomy. We tested whether a directed PMJ disjunction (osteotome-assisted intermediate release) improves fracture quality, symmetry, and alignment versus direct downfracture. Single-center retrospective comparative cohort (January 2019-April 2025). Two hundred five consecutive patients underwent Le Fort I: directed disjunction (n=127) or direct downfracture (n=78). Postoperative cone-beam computed tomography at day 90-110 was scored with a bilateral ten-point map. Primary outcomes were per-side quality (poor/good/excellent) and a patient-level overall quality status (poor/fair/good/very good/excellent). Inclusive and strict "clean-cut," symmetry, and alignment were predefined. Group comparisons used chi-square or Fisher's exact tests (two-sided α=0.05). Directed disjunction shifted side-level quality toward inferior, contained patterns: "excellent" 59.1% vs 6.4% (right) and 48.0% vs 12.8% (left); "poor" 22.0% vs 91.0% and 29.9% vs 85.9% (all p<0.001). Patient-level status improved (poor 38.6% vs 98.7%; excellent 37.8% vs 1.3%; p<0.001). Perfect symmetry rose to 49.6% vs 1.3% and correct alignment to 61.4% vs 1.3% (p<0.001). Maxillary tuberosity involvement decreased from 60.3%/56.4% (right/left) without disjunction to 2.4%/5.5% with disjunction. Inclusive and strict clean-cut were higher with directed disjunction (69.3% vs 37.2% and 53.5% vs 9.6%; p<0.001). Within a standardized early postoperative window, directed PMJ disjunction was associated with superior fracture quality, greater bilateral coordination, and fewer undesired trajectories than downfracture. Adoption of a targeted release and standardized reporting is supported. Interpretation is limited by the retrospective single-center design and focus on fracture behavior without complication or long-term outcome analysis.

A 35-year-old woman presented to the dental clinic complaining of pain and mobility in tooth 21. Clinical and radiographic (CBCT) examination revealed a horizontal root fracture apical to the cementoenamel junction, loss of the labial plate of bone, and periapical pathosis. Atraumatic tooth extraction was performed using a periotome, followed by thorough curettage to remove periapical pathosis. Drilling was performed and an immediate implant was placed. A collagen membrane was sutured to the buccal soft tissue, and a connective tissue graft harvested from the maxillary tuberosity was positioned at the coronal area of the soft tissue. Xenograft bone particles were added into the gap space between the implant and collagen membrane. Immediate temporization was performed using the patient’s own crown after adjustment of the cervical contour with composite. At baseline, buccal bone thickness was 0 mm at the crest and 3 mm from crest, and 0.3 mm at 6 mm from the crest. Nine months postoperatively, buccal plate thickness increased to 1.46 mm at crest, 2.39 mm at 3 mm, and 2.53 mm at 6 mm from the crest. The pink esthetic score was excellent, with complete papillae and natural soft tissue contour, color, and texture compared to reference tooth (tooth 11). Immediate implant placement and temporization in an infected Type II socket with buccal bone loss can achieve favorable esthetic and functional outcomes when meticulous infection control, hard and soft tissue management, and immediate provisionalization are employed.

Background: The objectives of complete denture prosthodontics are to restore the function and esthetics that were provided by the lost natural dentition and the supporting structures.1 Insertion of a denture does not mark the end of, but it needs regular follow-up.2 During follow-up visits, patients might present with mucosal ulcers in different regions of the oral cavity. Most common location of these ulcers need to be evaluated during follow up visits to address the complaints appropriately and ensure patient comfort. Objective: To determine the frequency and common location of traumatic mucosal ulceration caused by a complete denture in an edentulous patient during follow-up visits.Methodology: A descriptive cross-sectional study was conducted in the Department of Prosthodontics, Sardar Begum Dental College, Peshawar, from August to December 2024. A total of 121 systemically healthy patients aged 45–75 years, requiring conventional maxillary and mandibular complete dentures, were recruited through non-probability consecutive sampling. Complete dentures were fabricated following standard procedures under a prosthodontist's supervision. Patients were recalled on the 1st, 3rd, and 5th days after insertion and subsequently at weekly intervals. At each visit, traumatic ulcerations and their locations were recorded, and necessary denture adjustments were made. Comfort was defined as absence of complaints and ulcerations.Results: Among 121 patients (mean age 59.1 ± 5.7 years), most were male (65.3%) and urban residents (73.6%). The mean number of visits was 2.88 ± 1.14. Ulcerations occurred most often at the labial frenum (21.5%), maxillary tuberosity (17.4%), and buccal frenum (14.9%), while the lingual frenum/sublingual flange area was least affected (1.7%). Stratification showed no significant association of ulceration with age, gender, or education, but a significant association was found with residence, with urban patients more frequently affected (p = 0.041).Conclusion: Traumatic ulcerations were most common at the labial frenum and maxillary tuberosity, with urban patients more frequently affected. Attention to high-risk areas during denture fabrication and adjustment can improve patient comfort and clinical outcomes.

This study aimed to investigate the survival impact and predictive factors of cervical lymph node metastasis (CLNM) in patients with maxillary gingival squamous cell carcinoma (MGSCC). This retrospective study included 81 patients with MGSCC who underwent radical surgery from 2008 to 2018. Pathological CLNM was observed in 24 patients, prevalently in levels IB and II on the ipsilateral side. Cox proportional hazards model analysis revealed histologic grade, CLNM, and local recurrence as independent prognostic factors for 5-year disease-specific survival. Multivariate analysis identified tumoral spread to the gingivobuccal sulcus and the maxillary tuberosity as independent risk factors for CLNM. CLNM is associated with poor survival in patients with MGSCC. Primary tumors extending into the gingivobuccal sulcus or maxillary tuberosity may predict CLNM, particularly at levels IB and II. These findings may provide valuable insights for optimizing neck management strategies.

The loss of interdental papillae in the anterior maxilla presents significant esthetic and functional challenges. This report introduces a refined, tunnel-like surgical technique using a vestibular access incision for three-dimensional papilla augmentation ('Papilla Reconstruction via Incision and Submucosal Mobilization' [PRISM]). Three patients (seven sites) with deficient papillae underwent treatment involving connective tissue grafts (CTGs) from the lateral palate and maxillary tuberosity. The technique aimed to enhance surgical access, preserve vascular integrity, and facilitate atraumatic graft placement. Outcomes were assessed through clinical indices (Papilla Presence Index), volumetric analysis via STL superimposition, and patient-reported esthetic and comfort scores. After 6 months, all sites demonstrated successful healing, significant volumetric gain (vertical: 0.8-1.7 mm; horizontal: 0.8-1.4 mm), and improved patient satisfaction. The proposed approach represents a promising option for papilla reconstruction, combining the advantages of a tunnel technique with a dual-graft harvesting strategy. The loss of interdental papillae in the anterior maxilla presents significant esthetic and functional challenges. This report introduces a refined, tunnel-like surgical technique using a vestibular access incision for three-dimensional papilla augmentation ('Papilla Reconstruction via Incision and Submucosal Mobilization' [PRISM]). Three patients (seven sites) with deficient papillae underwent treatment involving connective tissue grafts (CTGs) from the lateral palate and maxillary tuberosity. The technique aimed to enhance surgical access, preserve vascular integrity, and facilitate atraumatic graft placement. Outcomes were assessed through clinical indices (Papilla Presence Index), volumetric analysis via STL superimposition, and patient-reported esthetic and comfort scores. After 6 months, all sites demonstrated successful healing, significant volumetric gain (vertical: 0.8-1.7 mm; horizontal: 0.8-1.4 mm), and improved patient satisfaction. The proposed approach represents a promising option for papilla reconstruction, combining the advantages of a tunnel technique with a dual-graft harvesting strategy.

BackgroundMaxillary tuberosity and buccal plate fractures are common complications observed during routine extractions of upper third molars in daily dental practice. The study aimed to evaluate the association between buccal and palatal cortical bone thickness around upper third molars, the dimensions of the maxillary tuberosity, and the anatomical characteristics of the upper third molars.MethodsThis retrospective cross-sectional study analyzed 227 cone beam computed tomography (CBCT) scans retrieved from the archives of the University Dental Hospital of Sharjah (UDHS). Measurements included the buccal and palatal cortical bone thickness surrounding the upper third molars. The width, height, and length of the maxillary tuberosity were also evaluated, along with the anatomical features of the third molars. Data were analyzed using SPSS. Descriptive statistics, t-test, ANOVA, ANCOVA, and Pearson’s correlation were applied.ResultsThe palatal cortical bone was significantly thicker than the buccal cortical bone (p = 0.011). The mean width, height, and length of the maxillary tuberosity were 8.78 ± 1.897 mm, 8.86 ± 3.262 mm, and 4.86 ± 1.490 mm, respectively. Males exhibited significantly greater mean tuberosity width and length compared to females (p < 0.001). Buccal cortical bone thickness positively correlated with tuberosity height (p < 0.001) and negatively with tuberosity width (p = 0.004). ANCOVA showed significant effects of root number (F = 3.107, p = 0.047) and age group (F = 2.854, p = 0.025) on buccal cortical bone thickness, with no significant interaction between gender and jaw side (p > 0.05). Additionally, a significant difference in tuberosity width (p = 0.002) was also observed across age groups. Furthermore, a positive correlation was found between tuberosity height and the root length of the associated upper third molar (p < 0.001).ConclusionsThe anatomical dimensions of the maxillary tuberosity and surrounding cortical bone of upper third molars were influenced by age, while sex affected only tuberosity dimensions. Additionally, correlations among upper third molar anatomy, cortical bone thickness, and tuberosity dimensions highlight the importance of thorough anatomical assessment and CBCT analysis to minimize surgical complications during upper third molar extractions.

This study aimed to evaluate total maxillary arch distalization using three different skeletal anchorage systems—Mini Screw-Assisted Keleş Slider (MKS), infrazygomatic crest (IZC) screw, and maxillary tuberosity (MT) screw—through finite element analysis (FEA). A 3D cranio-maxillary model including dentition, periodontal ligament, and alveolar bone was constructed. For the MKS and IZC groups, forces were applied at three vertical heights (0 mm, 3 mm, and 6 mm apically), while the MT group involved three directional applications: buccal, palatal, and combined bucco-palatal. This design yielded nine distinct simulation scenarios. Tooth movements were assessed along the x (transverse), y (sagittal), and z (vertical) axes, and Von Mises stress distributions were analyzed in surrounding structures. In the MKS group, the first scenario showed the greatest molar crown displacement, while the third had the highest root-level movement. The ninth MT scenario yielded the most palatal crown displacement of incisors, while the sixth IZC scenario showed the greatest root movement. Apical force applications (MKS and IZC at 3–6 mm) allowed controlled displacement suited for Class II Division 2 malocclusions. In contrast, archwire-level and MT scenarios produced patterns favorable for Class II Division 1 cases. Anchorage type and force direction significantly affected distalization outcomes.

This report describes a clinical case involving a minimally traumatic tooth extraction followed by immediate implant placement in the region of an upper premolar, associated with alveolar grafting using a synthetic biomaterial and an autogenous graft harvested from the maxillary tuberosity. A 38-year-old male patient presented with a vertical root fracture in tooth 25. Atraumatic extraction was performed, followed by alveolar curettage and immediate placement of a conical implant (Ø 3.5 × 13 mm). The buccal gap was filled with hydroxyapatite combined with β-tricalcium phosphate and autogenous bone graft obtained from the maxillary tuberosity. An immediate provisional acrylic resin crown was installed with occlusion deactivated. After six months, a definitive zirconia crown with a lithium disilicate infrastructure was fabricated and cemented. Immediate post-extraction implant placement has emerged as an effective treatment strategy, particularly in esthetic zones, allowing for preservation of bone and gingival architecture, reduction of physiological resorption, and enhanced esthetic predictability. The immediate approach, when combined with biomaterials and autogenous grafts, proved to be effective for both functional and esthetic rehabilitation in this case, ensuring preservation of peri-implant tissues and yielding an excellent clinical outcome.

This case series was aimed primarily at evaluating the outcomes of a reconstructive technique employing autogenous bone grafting using maxillary tuberosity (MT) donor sites for the management of extraction sockets adjacent to large incisive foramena (IFs) in the anterior maxillary region, with the purpose of addressing challenges associated with implant placement. In this series of four cases, we applied a reconstructive technique utilizing autogenous bone grafting using MT donor sites. Patients underwent a postoperative maintenance program, clinical examinations, and completion of a questionnaire to assess changes in the neurosensory function of the nasopalatine nerve. Study outcomes included the extent of bone reconstruction, postoperative neurosensory function of the nasopalatine nerve, and overall patient satisfaction. Cases were followed for a mean of 23.5±0.5 months. The technique consistently resulted in predictable bone reconstruction, either with delayed or immediate implantation and provisionalization. IF enucleation and reconstruction of the damaged extraction sockets resulted in no abnormal postoperative pain or paresthesia, and yielded high patient satisfaction. The use of autogenous bone grafts from the MT provides an optimal and simple solution for the management of extraction sockets adjacent to large IFs. Our findings illustrate the potential efficacy of this technique in complex scenarios associated with high esthetic implications, which should be further evaluated in future clinical trials.

Bony mucoperiosteal flap in bony impacted upper third molar surgery.

Background: Soft tissue augmentation procedures using connective tissue grafts (CTGs) produce varied outcomes due to differences in the histological composition of grafts from different sites and techniques. This study aimed to compare the histologic composition of CTG harvested by de-epithelization vs. a single-incision technique from the palate. Methods: Forty-five subjects (aged 25-45) scheduled for mucogingival surgeries were divided into 3 groups: Group I (de-epithelialized free gingival graft), Group II (maxillary tuberosity graft), and Group III (single-incision technique). A 2 x 2 mm tissue sample was taken from the antero-superior part of the graft and analyzed using hematoxylin &amp; eosin or Picrosirius red staining to assess collagen and adipose content under a polarizing microscope. Results: Preoperative donor site thickness was greater in Group II than in Groups I and III (P &lt; .001). Collagen area and bundle thickness were significantly higher in Group I compared to Groups II and III (P &lt; .05, P &lt; .001). Adipose tissue content was higher in Group III. Epithelium remnants were observed in 66.67%, 80%, and 13.3% of Groups I, II, and III, respectively (P &lt; .05). Conclusion: Fibrous tissue content was higher in superficial mucosal tissues, while deeper palatal tissues showed more adipose tissue.Cite this article as: Narayan I, Baron TKA, Shah R, Thomas R, Cheruvathoor JG, Gowda TM. A comparative analysis of collagen fiber and adipose content in the connective tissue procured from different harvesting sites using different harvesting techniques: A cross-sectional study. Essent Dent. 2025, 4, 0012, doi: 10.5152/EssentDent.2025.25012.

ABSTRACTBackground:Implant placement in the pterygoid region has been a complex challenge due to anatomical variability and limited bone availability. Khairnar’s Collectives introduces a novel clinical classification system to streamline predictable pterygoid implant placement, addressing the unique anatomical considerations for successful outcomes.Materials and Methods:This retrospective study analyzed 597 pterygoid implants placed over 6 years. Implants were classified into six types (1–6) with each subtype A and B based on Khairnar’s pterygoid bone classification, which assesses bone in the pterygomaxillary junction (PMJ) by evaluating bone availability in the junction of the maxillary tuberosity, pyramidal process of Palatine bone, and Pterygoid process of the sphenoid bone. Classification helps the clinician gauge vertical and horizontal direction to engage implants in the PMJ. Implant success and failure rates were correlated with anatomical variations for each classification type.Results:The study revealed a significant correlation between anatomical variations and implant success rates. Type 1 and type 2 junctions, with incidences of 36% and 24%, respectively, exhibited a 100% success rate, indicating optimal bone volume and stability for implant placement. Type 3, with an 8% incidence, had one placement failure and two post-placement failures, slightly reducing its success rate. Types 4 and 5, with incidences of 20% and 10%, respectively, faced increased challenges, reporting two and three placement failures respectively, alongside additional post-placement failures. Type 6, the least common at 2%, had the highest failure rates, with two placement failures and one post-placement failure. Overall, anatomical types with adequate bone volume (types 1–3 junction) showed minimal failures, while inadequate bone volume (types 4–6 junction) posed greater difficulties, emphasizing the need for careful preoperative assessment and planning.Conclusion:Khairnar’s pterygoid bone classification provides a comprehensive framework for assessing the anatomical feasibility of implant placement in the pterygoid region. Types 1, 2, and 3 offer predictable outcomes with minimal failures, whereas types 4, 5, and 6 require advanced planning and techniques due to higher failure rates.

Objectives: The purpose of this case study is to report the postoperative evaluation of a case of Mucoepidermoid Carcinoma occurring in the maxilla using CBCT. Case Report: A 44-year-old woman came to the Dental Radiology Installation of the Padjadjaran University Dental and Oral Hospital with complaints of swelling in the right maxillary region since 1 year ago accompanied by pain and could not open her mouth. The patient brought a referral letter for CBCT photos with a clinical diagnosis of Maxillary Tumour Dextra Post Biopsy Excision in the Maxillary Dextra region with HPA Mucoepidermoid Carcinoma a.r Maxillary Dextra. CBCT results showed tooth loss in areas 16, 17, and 18 accompanied by trabeculae loss at the posterior alveolar process support and partial bone thinning at the maxillary tuberosity. The loss of some hard tissue was likely part of the tissue taken for biopsy. The average density in these areas was ± 49 HU. Conclusion: Lesions can be analysed using qualitative and quantitative methods with 3D CBCT.

The number of midlife women seeking orthodontic treatment has significantly increased over the past 40 years. With this rise, orthodontists need to consider the potential impact of menopause on treatment planning. There have been no recent published studies on maxillary trabecular bone changes in humans related to menopause. This study aimed to explore the subject further. This cross-sectional cohort study was composed of qualifying participants with diagnostic maxillary CBCT images who were separated by self report into pre- (N = 21) and postmenopausal (N = 19) groups. The regions of interest were the trabecular bone of the incisive foramen and maxillary tuberosity. All scans were converted into binary images in order to draw all parametric and ratio raw data. The parameters of interest included trabecular bone volume fraction (BVF), trabecular thickness, trabecular number, and trabecular separation. In the incisive foramen subgroup, postmenopausal women showed a significant increase in trabecular separation (0.60 ± 0.25 to 0.84 ± 0.31 mm, P < 0.06). For the maxillary tuberosity subgroup, significant decreases in BV/TV (32.58 ± 15.85 to 17.63 ± 14.38 %, P <0.004), trabecular bone surface/tissue volume (2.66 ± 1.01 to 1.43 ± 1.09 %, P < 0.001) and trabecular separation (0.91 ± 0.39 to 1.58 ± 0.51 mm, P < 0.001) were observed. The findings reveal statistically significant differences in maxillary bone density at the level of the maxillary tuberosity and incisive foramen demonstrated in women who are of preversus post-menopausal status.

As the demand for autogenous connective tissue grafts (CTGs) continues to grow, this clinical report introduces a 'donor-friendly' and 'graft-efficient' soft tissue harvesting technique. Designed to accommodate a broad range of clinicians, this approach streamlines and simplifies the retrieval of connective tissue grafts from the maxillary tuberosity region. A step-by-step illustrated guide provides surgeons a practical roadmap for the seamless execution of the HOT technique (short for 'Harvesting Oblique Tuberosity'), which is further divided into HOT 1 (regular shape) and HOT 2 (extended shape), depending on the required graft length. By breaking the overall procedure into clearly defined steps, the technique enhances both the predictability and reproducibility of graft outcomes. Additionally, this case series underscores the clinical versatility of the tuberosity replacement graft. Due to the site's typically volume-rich and collagen-dense characteristics, it supports a wide range of applications in soft tissue phenotype modification therapies.

BackgroundFractal analysis is an important descriptor of bone complexity. This pilot study aimed to verify the possibility of using fractal dimension as an additional resource in human identification. A total of 15 pairs of panoramic radiographs were selected from the same individual, each with images acquired at different times (1, 3, and 5 years apart). Initially, seven standardized regions of interest were selected: mandibular head and angle, alveolar bone between the second premolar and first lower molar, symphysis, maxillary tuberosity, anterior nasal spine, and a random region with differentiated trabeculate. This last region was called “the specific trabeculation region” and should represent a particular architecture of the individual under analysis, regardless of the anatomical location. The fractal dimension and mean gray values were calculated to determine the absolute difference between the pairs of examinations.ResultsWhen comparing the panoramas of the same individual, there was no statistical difference (p = 0.067 for fractal dimension and p = 0.251 for mean gray value) for any of the regions tested. The specific trabecular region presented less variability in measurements between times in both analyses. The correlation between fractal dimension and mean gray value was only significant for the angle region (r = 0.542; p = 0.037).ConclusionsIt was concluded that the fractal dimension calculation can be an additional, promising, low-cost, and easy-to-perform resource in forensic human identification processes. Furthermore, this measurement can be performed in the specific trabecular region at the examiner’s discretion, thus facilitating the analysis process.

ABSTRACTObjectiveThe purpose of this study was to measure the association between the Le Fort I osteotomy technique and the pterygomaxillary separation pattern.Materials and MethodsThe sample was comprised of the medical records of 39 patients undergoing orthognathic surgery. The type of Le Fort I osteotomy technique was divided into three groups: (1) traditional Le Fort I; (2) modified Le Fort I in which the osteotome was not applied and (3) modified Le Fort I with the end point in the third molar alveolar region or in the area of the maxillary tuberosity. The pterygomaxillary separation pattern was defined as the region where it occurred and the presence or absence of pterygoid plate and palatine process fractures.ResultsThe study sample consisted of 24 women and 15 men, a ratio of 1.6:1. Regarding the pattern of pterygomaxillary separation, in Group 1 there were 3 cases involving the maxillary tuberosity (25%), 10 cases occurring in the region of the pterygomaxillary junction (83.34%) and 4 cases involving the region of the pterygoid plates (33.34%). In Group 2, there were 2 (13.33%), 9 (60%) and 7 (46.67%), respectively. Although Group 3 had 11 (91.67%), 6 (50%) and 3 (25%), respectively.ConclusionNo statistical difference was observed in the pterygomaxillary separation pattern between the three techniques and when gender and age were analysed.

Maxillary tuberosity dimensions and tooth movement magnitude during distalisation using mini-implants: a preliminary tomographic study

The anatomical peculiarities of the tiger’s skull reflect the ecological and behavioural needs of this predator. The study aims to observe the morphological adaptations that grant it exceptional hunting and survival abilities. The anatomical study was conducted on the skulls of two adult male tigers. The tiger’s skull is wide and rounded, providing a robust base for the attachment of masticatory muscles, which is essential for powerful bites. The sagittal crest, a bony prominence located on the upper part of the skull, serves as an attachment point for the temporal muscles. A distinct process is present on the maxillary tubercle, from which a strong tendon of the masseter muscle originates. The nasal bones are elongated, extending beyond the frontal processes of the maxillae, while the frontal area is elevated in the region of the postorbital processes. The anterior nasal opening is narrow, and the lower margin of the mandible is typically concave, with a prominent mental process. The front part of the mandibular symphysis is concave. Compared to other large felines, tigers have a more rounded skull and a downward-sloping dorsal surface. The tiger’s skull exhibits remarkable morpho-functional adaptations, such as a robust bony head, a prominent sagittal crest, a strong mandible, and well-developed insertions for masticatory muscles. These features are essential for their predatory lifestyle, allowing them to capture and control large prey efficiently.