VISIBLELIGHT-CUREDDENTUREBASEMATERIAL

The initial hand adaptation was a technique that could not 3. Hickey JC, Zarb GA, Bolender CL. Boucher’s prosthodontic treatment for
edentulous patients. 9th ed. St Louis: CV Mosby Co, 1985;298.
be completely contralled although the resin was adapted in 4. Langer A. The validity of maxillo-mandibular records made with trial and
the same way for each sample. The large standard deviation processed acrylic resin bases. J PROSTHET DENT 1981;45:253-8.
in each group indicates the wide variation in adaptation. A 5. Rahn AO, Boucher LJ. Maxillofacial prosthetics, principles and concepts.
Philadelphia: WB Saunders Co, 1970;94.
larger sample size may be needed to show more significant 6. Beumer J III, Curtis TA, Firtell DN. Maxillofacial rehabilitation, prosth-
differences. odontic and surgical considerations. St Louis: CV Mosby Co, 1979;226.
The casts used in this study were duplicates of a machined 7. Go11 GE, Smith DE. Technique for fabrication of the mandibular denture
over the staple bone implant using a permanent heat-cured base. J PROS-
metal die. The surface of these casts was smooth and regu- THET DENT 1985;53:820-4.
lar; therefore, it was easier to adapt Triad resin to these casts 8. Koslen RH. Technique to restore staple bone implants with semiprecision
than to a clinical cast that might not be as smooth. attachments. J PROSTHET DENT 1986;56:466-9.
9. Craig RC. Restorative dental materials. 7th ed. St Louis: CV Mosby Co,
1985;478-9.
CONCLUSIONS 10. Tuckfield WJ. Acrylic resins in dentistry. Part II: their use for denture
1. When a baseplate is being made with the Triad system, construction. Aust J Dent 1943;47:1-26.
11. Woelfel JB, Paffenbarger GC. Method of evaluating the clinical effect of
if excessive moisture is present in the stone cast, further
warping a denture: report of a case. J Am Dent Assoc 1959;59:250-60.
vacuum adaptation will not reduce the volume of the voids 12. Craig RC. Restorative dental materials. 7th ed. St Louis: CV Mosby Co,
on the internal surface of the baseplate. 1985;492-3.
13. McCabe JF, Wilson HJ. The use of differential scanning calorimetry for
2. Vacuum adaptation of the Triad resin to a dry cast with
the evaluation of dental materials. Part. II: denture base materials. J Oral
a rubber dam in addition to hand adaptation is recom- Rehabil 1980;7:235-43.
mended to reduce the voids. 14. Ogle RE, Sorensen SE, Lewis EA. A new visible light-cured resin system
applied to removable prosthodontics. J PROSTHET DENT 1986;56:497-506.
15. Stewart KL, Rudd KD, Kuebker WA. Clinical removable partial prosth-
Appreciation is extended to Dentsply International Inc. for odontics. St Louis: CV Mosby Co, 1983;149.
donating the Triad Denture Base Resin material used in this study. 16. Phillips RW. Science of dental materials. 8th ed. Philadelphia: WB
Saunders Co, 1982;77-8.
REFERENCES
Reorint reouests to:
1. Graser GN. Completed bases for removable dentures. J PROSTHET DENT DR. JAMES ‘S. BRUDVIK
1978;39:232-6. UNIVERSITY OF WASHINGTON
2. Heartwell CM Jr, Rahn AO. Syllabus of complete dentures. 3rd ed. Phil- SCHOOL OF DENTISTRY
.adelphia: Lea & Febiger, 1980;238-9. SEATTLE, WA 98195

An investigation of the anatomic position of the posterior

palatal seal by ultrasound
Rajeev M. Narvekar, B.D.S., M.S.,* and Marc B. Appelbaum, D.D.S.**
Temple University, School of Dentistry, Philadelphia, Pa.

The posterior palatal seal contributes significantly to the retention of a maxillary

complete denture. It is commonly considered to lie on the tissue covering the soft
palate. However, no references are available to substantiate this correlation
between the clinical and anatomic placement. This research used ultrasound
instrumentation as a noninvasive procedure to locate the anatomic structures in
the posterior palatal seal region of 15 maxillary edentulous patients. The posterior
border was determined to lie on the tissue covering the soft palate. (J PROSTHET
DENT 1989;61:331-6.)

he posterior palatal seal is defined as “the soft tis- pressure within the physiologic limits of the tissues can be
sue along the junction of the hard and soft palates on which applied by a denture to aid in the retention of the denture.l
The posterior palatal seal is generally accepted as one of the
most important factors in the retention and stability of a
Submitted in partial fulfillment of the requirements for the degree maxillary complete denture. 2-12 Various techniques to es-
of Master of Science, Temple University, Philadelphia, Pa.
tablish the posterior palatal seal have been advocated by
*Former graduate student, Department of Prosthodontics.
**Former Clinical Associate Professor, Department of Prosthodon- numerous authors. Most of these techniques are valid pro-
tics. cedures, but some are limited by specific clinical

TREJOURNALOFPROSTHETIC DENTISTRY 331


Fig. 1. Technicare OR330 ultrasound instrument,
indications.i3-ia Edwards and Boucher,ig Pendelton,s”, 21
Laney and Gonzalez,5 and Davis22 have studied and thor-
oughly documented the general and minute anatomy of the
region of the posterior palatal seal and its importance in
denture construction.
All commonly used textbooks indicate that the posterior
palatal seal of the maxillary denture covers tissue of the soft
palate. However, no reference substantiates the anatomic
placement of the posterior palatal seal. The “postpalatal
seal” and the “pterygomaxillary seal” comprise the posterior
palatal seal region. The postpalatal seal extends medially
from one tuberosity to the other. Laterally, the pterygomax-
illary seal extends through the pterygomaxillary notch. and
continues 3 to 4 mm anterolaterally, approximating the mu-
cogingival junction.
Through laboratory dissections and pathophysiologic in-
vestigation, the structures beneath the pterygomaxillary seal
can be readily described because it has definite anatomic
landmarks. In contradistinction, the postpalatal seal can
only be clinically described. The exact placement depends
upon the palatal configuration and the physiologically lim-
iting factors of the individual patient.
The technology necessary to investigate the anatomic
structures beneath the postpalatal seal has only recently
been developed. Ultrasound has been used for many years as
a diagnostic tool. However, it has been only within the past
several years that a transducer head small enough to fit into
the mouth has been available. This research used ultrasound
technology to locate the anatomic position of the posterior
palatal seal.
Theory of ultrasound
Sound is a form of mechsmcai energy pi’opaga r~~i : :I :.~-~O
form of waves (series of condensations and rarefactious;
through a medium by motion of particles within :hc medico::.
Ultrasound refers to sound with frequencies higher tian
the audible range (20 to 20,000 l-l~).‘~~,‘?~For diagnostic
medical applications, frequency ranges from 1 mHr to 20
mHz are used, and for nondiagnostic medical appiicationS,
frequencies below 1 mHz are used. Frequency is the nur&ei
of cycles per unit time (1 cycle per second equal:; I heri;z).
Ultrasonic waves of lower frequencies generally have more
penetration into a material because the absorption is 1es.s.
whereas higher frequency waves decay more rapidly inside 3
material, but have greater resolution capabiiity.z,*, “:
Ultrasonic waves are generated inside a.material by means
of a piezoelectric element placed in contact with the surface
of the material. The piezoelectric element is tion “shock ex-
cited” and converts electric energy into mechanical energy in
the form of acoustic waves. A suitable cDuplant fscili’W,es the
oropagation of ultrasonic waves between ihe piezoeiectric
olement and the material.
Basic elements of an ultrasound scanning system include
a transducer (containing the piezoeiectric elementj, an
ntermediate signai-processing stage, and tins& a display
node. The transducer produces a pulse of acoustic waves and
r,hen detects returning echoes, converting them into an elec-
tric signal for amplification and other signa! processing into
a form that may be displayed.
Ultrasonic transducer
The active element of a transducer is a synthetic ceramic
that has piezoelectric properties. The piezoelectric effect is
associated with certain crystal materials that have the eW-
ity to transform mechanical energy into electric energy and
vice versa, for example, quartz, and lithium sulphate. Quartz
crystals are normally used for medical purposes. ‘These ma-
terials, on application of an electric field, change their phys-
ical dimensions as a result of inherent a,nd appiied electric
forces and lead to the mechanical changes in crystal size that
result in transfer of vibrational energy iacoustic rvave~) to
adjacent media.
Couplant
A couplant is necessary between the ultras;mic transducer
and the skin because air is a poor conductor of sound energy.
Regardless of how firmly one presses the transducer Read
against the tissues, a large reflection factor will exist because
of the everpresence of interposed air. .4 water-based COU-
plant provides an air-free path, thus allowing significantly
greater amounts of energy to enter the bod?r.
B mode
In B mode (brightness modulation), the two dlmensione of
the display are a cross section of the patient. 7’h.e brightness
or shade of gray in the display represents the amplitude of
the echoes received from the anatomic cross section of the
patient. The B mode display is the basic disp!sy used in
INVESTIGATION BY ULTRASOUND

Fig. 2. Toothpaste is placed on transducer head to act as Fig. 3. Initial intraoral position of transducer head with
couplant to provide intimate contact with palatal tissues. couplant.

static and real-time gray-scale ultrasound imaging. B scan is By using Millsap’s classification,31 the soft palatal config-
the display mode that was used in this investigation. B scan uration of each patient was observed and noted. Only
recording techniques work well in diagnostic ultrasound be- patients with class 1 and 2 soft palatal configurations were
cause of the similarities in acoustic impedence values for soft accepted for this study. Patients with class 3 soft palatal
tissue materials. The small variations in acoustic impedence configurations were not included because the palatal curva-
result in decreased reflection values, hence ultrasonic energy ture precluded the intimate placement of the transducer
propagates completely through the body. head. Patients were also excluded if they had neuromuscu-
lar impairment or a pronounced gag reflex that would have
Physical effects of ultrasound compromised the measurement procedure and proper place-
1. Ultrasonic effects are nonionizing. Unlike X rays, ment of the posterior palatal seal. Before the ultrasound
ultrasonic waves do not possess sufficient energy for moving measurements were performed, a signed consent form was
orbital electrons from one level to another. required from each patient.
2. Heat production from ultrasound can be extensive.
Tissue materials can be burned if sufficient energy is used. Methodology
But present ultrasonic instrumentation uses low levels of The ultrasound instrument (Technicare OR3300, Johnson
energy.26-30 & Johnson, Ramsey, N.J.) used with a 10 mHz linear-array
3. Mechanical vibration effects from high-intensity ultra- miniature transducer gave a real-time B mode image of the
sound can cause tissue breakdown through cavitation ef- soft tissue (Fig. I). The patients were seated in upright po-
fects. However cavitation does not occur at power levels used sition. The name of the patient and the classification of the
for diagnostic ultrasound that are below 100 MW. soft palate was typed onto the screen. Before outlining of the
posterior vibrating line with an indelible pencil, the palatal
Ultrasound and X rays tissues were dried to remove saliva that might prevent clear
A comparison of the ultrasound technique and X-ray pro- transfer marking. The posterior vibrating line was located in
cedures shows two fundamental differences. As mentioned, accordance with a conventionally accepted technique.32 A
ultrasonic waves do not possess sufficient energy to move or- thin rubber band was placed around the anterior third of the
bital electrons from one level to another. Hence they are transducer head to serve as an index that would appear on
nonionizing. Second, X-ray technology is essentially a func- the display mode. Because of the rigid construction of the
tion of density of the tissue providing a 5 % to 8 % variation transducer head, a close approximation to the curvilinear
in soft tissue. Ultrasonic values are proportional to the surface of the palate could not be obtained. Hence, commer-
square root of a product of density and modulus resulting in cially available toothpaste was used as a couplant and placed
a 16% variation for soft tissue. This gives ultrasonic tech- on the head of the transducer to provide intimate approxi-
niques twice the capability in differentiating soft tissue mation to the palatal tissues (Fig. 2). The transducer head
compared with X-ray procedures. with a thin rubber band on the anterior third and the appro-
priate amount of couplant was inserted in the mouth and
MATERIAL AND METHOD carefully moved posteriorly until intimate contact with the
Patient selection underlying tissues was verified (Fig. 3). It was noted that
Fifteen patients were selected from the Temple Univer- gently rocking the transducer head facilitated contact along
sity, School of Dentistry, Department of Prosthodontics. All the length of the palate. Initially, the transducer head was
of the patients selected were edentulous in the maxillae. moved posteriorly to the left of the midline. The junction of

THE JOURNAL OF PROSTHETIC DENTISTRY 333

 Fig. 4. Polaroid photograpb of ultrasound scanning of palate. Arrow on left indica&es
junction between hard and soft palates. Arrow on right indicates image of ru
perimposed on clinically outlined vibrating line, which is seen to lie over soft palate.

Pig. 5. Polaroid photograph of ultrasound scanning of palate for patient kl. Arrow ndi-
cates that vibrating line is at junction of bard and soft palates.

the hard and soft palate was noted on the screen. When the
rubber band was visualized to lie directly over the posterior
vibrating line as marked in the mouth, the visual display was
frozen and a Polaroid picture was made. The accuracy of the
placement of the rubber band around the transducer head in
its overlying relation to the posterior vibrating line was ver-
ified by two observers using a thin blunt probe placed par-
allel to the rubber band. In addition, every scanning proce-
dure was recorded on videotape to permit revisualization.
This procedure was repeated at the midline and to the right
of the midline. This protocol was performed on all 15
patients.
RESULTS
Of the 15 patients scanned by ultrasound, five had class 1
soft palatal configurations and 10 had class 2 soft palates.
The Polaroid photographs were placed in a graphic analyzer
to quantify the distance on Lhe X axis from the reference
point (rubber band) to the anatomic junction ofthe hsrd and
soft palates. (A graphic analyzer is a device that allows dig-
itized measurements from original clinical records such as
photographs, X rays, or ultrasound images to be con?erted
into a series of digits.) In 14 of 15 patients, the posterior -vi-
brating line was found to be on tissues of the soft palate. 7’he
distance from the junction of the hard and soft. paMes var-
ied from a maximum of 4.3 mm to a minimlun of 2 mm, with
a patient average of 2.5 mm (Table I). In one patient, the
posterior vibrating line was found to be on the junciion cf the
hard and soft palates. In an effort to determine sample re-
liability and its unbiased estimation of the population, the
sample statistics were set to a 95% binomial confidence
limit.33 For the 15 patients who were examined, 14 of whom
showed similar results, a 95 !;1 confidence limit yielded con-
fidence values between 68% and 99.33%,

334
IFWESTIGATION BY ULTRASOUND

Table I. Distance from junction of hard and soft palate opening dimensions in some patients made visualization
Posterior to junction of difficult. In all such instances, the procedure was repeated to
Patient Palate
number classification hard and soft palate (mm) obtain a constant and repeatable measurement.
To ensure that the rubber band was directly overlying the
1 2 2.7
clinically marked posterior vibrating line during the scan-
2 1 3.2
ning procedure, two observers verified it by placing a thin
3 2 2.0
blunt probe parallel to the rubber band. In 14 of the 15 pa-
4 2 4.3
5 2 2.0 tients examined, the posterior vibrating line was seen to lie
6 2 3.5 on the tissue covering the soft palate. The average distance
7 1 2.5 from the posterior vibrating line to the junction of the hard
8 1 4.3 and soft palates was 2.9 mm.
9 2 3.6 The average width of the posterior palatal seal is consid-
10 1 3.2 ered to be approximately 4 to 6 mm. Therefore, part of the
11 2 0.0 seal would lie on the glandular posterior third of the hard
12 1 2.8 palate. This location coincides anatomically and histologi-
13 2 2.5
cally with presently accepted techniques for placement of
14 2 3.1
the posterior palatal seal.
15 2 4.0

CONCLUSIONS
The results of this investigation indicate that the posterior
A representative ultrasound image from left to right shows vibrating line lies on the tissue covering the soft palate. This
the hard palate extending onto the soft palate (Fig. 4). In location substantiates the presently taught clinical concepts
patient 11, the clinically outlined posterior vibrating line was regarding the placement of the posterior palatal seal. Accu-
directly over the junction of the hard and soft palates (Fig. rate visualization and demarcation of tbe posterior vibrating
5). line and its concomitant accurate transfer to the master cast
will result in proper positioning of the posterior complete
DISCUSSION denture border.
In the many articles on the techniques and the importance
of locating the posterior palatal seal, there has not been an We acknowledge the invaluable assistance of Barry B. Goldberg,
anatomic substantiation of its position. Only recently, non- M.D., Larry Waldrup, R.D.M.S., and Pamela Foy, R.D.M.S., from
invasive techniques like ultrasound have been used in den- Thomas Jefferson University Hospital, Division of Diagnostic Ul-
tistry to provide sophisticated instrumentation in the diag- trasound, Philadelphia, Pa.
nostic field. In our investigation, every attempt was made to
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336