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Anatomic landmarks of the maxilla and mandible

Limiting areas

Frenum: Folds of mucous membrane, do not contain significant muscle fibres. High frenum attachments will compromise denture retention and may require frenectomy. Labial vestibule: When the vestibule is properly filled with the denture flange, greatly enhances stability and retention.

Buccal frenum: The muscles attached to it are levator anguli oris, buccinator and orbicularis oris. Buccal vestibule: Extends from the buccal frenum to the hamular notch. Thickness of the denture border in this area is determined by coronoid process of the mandible and masseter muscle.

Hamular Notch: It is present between maxillary tuberosity and hamulus of the medial pterygoid plate. The pterygomandibular ligament attaches to the pterygoid hamulus. Capturing the hamular notch in the impression is critical to the retention of the maxillary denture. Improper molding of this area could lead to soreness and loss of retention.

Vibrating line: It is an imaginary line drawn across the palate that marks the beginning of motion in the soft palate when the patient says ah. Extends from one hamular notch to another. Denture border should extend 1-2 mm beyond the vibrating line.

Supporting areas

Canine eminence: This bony eminence provides denture support, prevents the denture from rotating and improves denture stability Incisive papilla: It is a pad of fibrous connective tissue overlying the orifice of the nasopalatine canal. Pressure in this area will cause a disruption of the blood flow and impingement on the nerve, causing the patient to complain of pain or burning sensation. The denture should be relieved over this area

Tuberosity: It is an important primary denture support area. It also provides resistance to horizontal movements of the denture

Coronoid process: the patient is instructed to open wide, protrude and go into lateral movements. The width of the distobuccal flange will then be contoured by the anterior border of the coronoid process. Fovea palatina: two small pits or depressions in the posterior aspect of the palate, one on each side of the midline, at or near the attachment of the soft palate to the hard palate and slightly posterior to the termination of the denture.

Primary stress bearing area : Crest of the residual alveolar ridge Secondary stress bearing area: Rugae Relieving area: Incisive papilla and mid palatine raphe

Ideal maxillary ridge: Abundant keratinized attached tissue Square arch Palate U-shaped in cross-section Moderate palatal vault Absence of undercuts Low frenum attachments Well-defined hamular notches

a. incisive papilla b. palatal rugae c. median palatine raphe d. maxillary tuberosity e. pterygomaxillary notch f. fovea palatini and vibrating line area g. buccal space h. zygomatic process i. residual alveolar ridge j. buccal frenum K. labial frenum

Limiting areas in the mandible

Labial frenum: Fibres of orbicularis oris are attached

Labial vestibule: limited inferiorly by the mentallis muscle. Mentalis: elevates the skin of the chin and turns the lower lip outward. Dictates the length and thickness of the labial flange extension of the lower denture

Buccal frenum: histologically and functionally the same as in the maxilla Buccal vestibule: Extends from the buccal frenum to the retromolar pad

Masseter Groove - the action of the masseter muscle reflects the buccinator muscle in a superior and medial direction. The distobuccal flange of the denture should be contoured to allow freedom for this action otherwise the denture will be displaced or the patient will experience soreness in the area

Retromylohyoid space - lies at the distal end of the alveolingual sulcus. Bounded medially by the anterior tonsilar pillar, posteriorly by the retromylohyoid curtain which is formed posteriorly by the superior constrictor muscle, laterally by the mandible and pterygomandibular raphe, anteriorly by the lingual tuberosity of the mandible and inferiorly by the mylohyoid muscle. ***The retromylohyoid space is very important for denture stability and retention.

The curtain moves upward and backward as the tongue moves upward and backward in swallowing. It moves upward and forward during protrusive and lateral movements of the tongue. The amount of upward and forward movement of the curtain during these protrusive and lateral movements is referred to as the lateral throat form of the mandibular denture. If this movement is slight and the angle formed by the posterior part of the curtain to the retromolar pad is approximately 90 degrees, it is a Class I throat form. Extreme forward movement of the curtain resulting in an angle of 45 degrees or less in Class III throat form and in between the two is Class II throat from

The amount of posterior lingual extension of the base is controlled by the movement of this curtain. Overextension of the denture flange results in the patient complaining of a sore throat or unseating of the denture. Underextension handicaps the tongue in controlling the lower denture and allows ingress of food under the denture. This tissue offers very little resistance to pressure so the operator must be careful not to create a false undercut by displacing it when making the impression.

Supporting areas

Buccal Shelf: bordered externally by the external oblique line and internally by the slope of the residual ridge. This region is a primary stress bearing area in the mandibular arch. The buccal shelf is the primary support area because it is parallel to the occlusal plane and the bone is very dense. These two factors make it relatively resistant to resorbtion.

Buccal shelf area (area within the dotted lines). The greater the access to the buccal shelf the more support there is available for the denture. Access is determined by the attachment of the buccinator.

The size and position of the buccal shelf vary relative to the degree of alveolar ridge resorption

Mental Foramen: the anterior exit of the mandibular canal and the inferior alveolar nerve. In cases of severe residual ridge resorption, the foramen occupies a more superior position and the denture base must be relieved to prevent nerve compression and pain.

One constant, relatively unchanging structure on the mandibular denture bearing surface is the retromolar pad (dotted line). The pad contains glandular tissue, loose areolar connective tissue, the lower margin of the pterygomandibular raphe, fibers of the buccinator, and superior constrictor and fibers of the temporal tendon. The bone beneath does not resorb secondary to the pressure associated with denture use. The retromolar pad is one of the primary support areas.

Genial tubercle: present on the anterior surface of the mandible and serve as the attachment sites for the geniohyoid and genioglossus muscles. In patients with severe ridge resorption, the genial tubercles may cause discomfort if they are exposed to the denture base

Mylohyoid muscle: forms the muscular floor of the mouth. Arises from the mylohoid ridge of the mandible. Determines the lingual flange extension of the denture

Note the position of the mylohyoid ridge as it varies relative to the degree of the alveolar ridge resorption

Primary stress bearing area: Buccal shelf Secondary stress bearing area: Slopes of the residual alveolar ridge Relieving area: Crest of the residual alveolar ridge

Ideal mandibular ridge: Well defined retromolar pad Blunt mylohyoid ridge Deep retromylohyoid space Low frenum attachments Absence of undercuts Abundant attached keratinezed mucosa Adequate alveolar height

a. labial frenum b. residual alveolar ridge c. retromolar pad d. lingual frenum f. external oblique line g. buccal frenum h. masseteric notch