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Indian Dental Academy: will be one of the most relevant and exciting

training center with best faculty and flexible training programs

for dental professionals who wish to advance in their dental

practice,Offers certified courses in Dental

implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic

Dentistry, Periodontics and General Dentistry.

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Final anatomic landmarks/ online orthodontic courses Final anatomic landmarks/ online orthodontic courses Presentation Transcript

  • INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  • CONTENTS-CONTENTS-  IntroductionIntroduction  DefinitionDefinition  Supporting structuresSupporting structures 1. Bone1. Bone 2.Mucous membrane2.Mucous membrane  Peripheral or limiting structuresPeripheral or limiting structures www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Anatomy of limiting structures in maxillaryAnatomy of limiting structures in maxillary regionregion  Anatomy of supporting structures inAnatomy of supporting structures in maxillary regionmaxillary region  Anatomy of limiting structures inAnatomy of limiting structures in mandibular regionmandibular region  Anatomy of supporting structures inAnatomy of supporting structures in mandibular regionmandibular region  ConclusionConclusion  ReferencesReferences www.indiandentalacademy.comwww.indiandentalacademy.com
  • INTRODUCTION-INTRODUCTION- If dentures and their supporting tissuesIf dentures and their supporting tissues are to coexist for a reasonable length of time,are to coexist for a reasonable length of time, the prosthodontist must fully understand thethe prosthodontist must fully understand the macroscopic and microscopic anatomy ofmacroscopic and microscopic anatomy of edentulous mouth of the patient.edentulous mouth of the patient. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Anatomic landmark-Anatomic landmark- ““ a recognizable anatomic structurea recognizable anatomic structure used as a point of reference.”used as a point of reference.” GPT-8GPT-8  In both maxilla and mandible anatomicIn both maxilla and mandible anatomic landmarks has been divided in-landmarks has been divided in- -supporting structures-supporting structures -peripheral or limiting structures-peripheral or limiting structures www.indiandentalacademy.comwww.indiandentalacademy.com
  • Supporting structuresSupporting structures  Def-Def- ““Those areas of maxillary andThose areas of maxillary and mandibular edentulous ridges that aremandibular edentulous ridges that are considered best suited to carry theconsidered best suited to carry the forces of mastication when denturesforces of mastication when dentures are in function.” (GPT-8)are in function.” (GPT-8) www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Maxillary and mandibular denturesMaxillary and mandibular dentures transfer occlusal loads to these so calledtransfer occlusal loads to these so called supporting structures .supporting structures .  The ultimate support for a denture isThe ultimate support for a denture is provided by the underlying bone which isprovided by the underlying bone which is covered by mucous membrane. Support iscovered by mucous membrane. Support is provided by maxillae and palatine boneprovided by maxillae and palatine bone in case of maxillary denture. Forin case of maxillary denture. For mandibular denture support is providedmandibular denture support is provided by mandible.by mandible. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  In both maxilla and mandible type of boneIn both maxilla and mandible type of bone and mucous membrane overlying it, differsand mucous membrane overlying it, differs from area to area.from area to area.  Each type of tissue found in oral cavityEach type of tissue found in oral cavity has its own characteristic ability to resisthas its own characteristic ability to resist external forces depending on its natureexternal forces depending on its nature and histological makeup i.e type of boneand histological makeup i.e type of bone and mucous membrane.and mucous membrane.  Stress bearing and relief areasStress bearing and relief areas www.indiandentalacademy.comwww.indiandentalacademy.com
  • Hard tissues-Hard tissues-             The requirement of ideal support is theThe requirement of ideal support is the presence of tissues that are relativelypresence of tissues that are relatively resistant to remodeling and resorptiveresistant to remodeling and resorptive changes.changes.           Minimizing the pressures in thoseMinimizing the pressures in those regions, which are most susceptible toregions, which are most susceptible to resorption and directing the forcesresorption and directing the forces towards those regions, which are relativelytowards those regions, which are relatively resistant to resorption can help to maintainresistant to resorption can help to maintain healthy residual ridges.healthy residual ridges. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  2 types of bones are seen2 types of bones are seen -compact or cortical bone-compact or cortical bone -cancellous or trabecular bone-cancellous or trabecular bone www.indiandentalacademy.comwww.indiandentalacademy.com
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  • Difference in ridge resorption inDifference in ridge resorption in compact and cancellous bone-compact and cancellous bone-  It has been suggested that bone resorptionIt has been suggested that bone resorption at any site is a chemotactic phenomenon,at any site is a chemotactic phenomenon, that is it is initiated by release of somethat is it is initiated by release of some soluble factors that attract circulatingsoluble factors that attract circulating monocytes to the target site. Osteoclasts,monocytes to the target site. Osteoclasts, the cells responsible for bone resorption arethe cells responsible for bone resorption are nothing but modified monocytes.nothing but modified monocytes.  Degree of mineralization is less inDegree of mineralization is less in cancellous bone, so effects of resorptioncancellous bone, so effects of resorption are more pronounced in cancellous bone.are more pronounced in cancellous bone. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Oral Mucous MembraneOral Mucous Membrane -- The bone of upper and lower edentulousThe bone of upper and lower edentulous jaws, and the oral cavity is lined with a softjaws, and the oral cavity is lined with a soft tissue that is known as ‘mucous membrane’.tissue that is known as ‘mucous membrane’. Denture bases rest on the mucousDenture bases rest on the mucous membrane, which serve as a cushion betweenmembrane, which serve as a cushion between denture base and supporting bone.denture base and supporting bone. The mucous membrane composed of :-The mucous membrane composed of :- (i) Mucosa(i) Mucosa (ii) Sub mucosa(ii) Sub mucosa www.indiandentalacademy.comwww.indiandentalacademy.com
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  • 1)1) MucosaMucosa: -: - Mucosa is formed by stratifiedMucosa is formed by stratified squamous epithelium cells.squamous epithelium cells. There is subjacent narrow layer ofThere is subjacent narrow layer of connecting tissue to the mucosa, knownconnecting tissue to the mucosa, known asas laminalamina propriapropria.. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 2)2) Sub mucosaSub mucosa:: -- Sub mucosa is formed by connective tissue.Sub mucosa is formed by connective tissue. Connective tissue varies in character fromConnective tissue varies in character from dense to loose alveolar tissue and also variesdense to loose alveolar tissue and also varies considerably in thickness.considerably in thickness. It may contain glandular, fat or muscle cells.It may contain glandular, fat or muscle cells. Submucosa transmit the blood and nerveSubmucosa transmit the blood and nerve supply to the mucosa.supply to the mucosa. Sub mucosa attaches mucosa to theSub mucosa attaches mucosa to the periosteal covering of the bone.periosteal covering of the bone. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Some parts of the masticatorySome parts of the masticatory mucosa are without a distinct submucousmucosa are without a distinct submucous layer, yet dense connective tissue of thelayer, yet dense connective tissue of the lamina propria firmly binds the mucosa tolamina propria firmly binds the mucosa to underlying periosteum. Although not asunderlying periosteum. Although not as effective in providing resiliency, thiseffective in providing resiliency, this connective tissue layer serves as aconnective tissue layer serves as a protective base for the mucosa.protective base for the mucosa. www.indiandentalacademy.comwww.indiandentalacademy.com
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  • Classification of oral mucosa-Classification of oral mucosa- Depending on its location in mouth, oralDepending on its location in mouth, oral mucosa classified into three categories –mucosa classified into three categories – Oral mucous membrane Masticatory Lining Specialized www.indiandentalacademy.comwww.indiandentalacademy.com
  • Limiting structures-Limiting structures-  The functional anatomy of mouth determines theThe functional anatomy of mouth determines the extent of the basal surface of denture.extent of the basal surface of denture.  The denture base should include the maximumThe denture base should include the maximum surface possible within the limits of the health andsurface possible within the limits of the health and function of the tissues it covers and contacts i.e itfunction of the tissues it covers and contacts i.e it should cover all the available basal seat tissuesshould cover all the available basal seat tissues without interfering in action of any of the structureswithout interfering in action of any of the structures that contact or surround it.that contact or surround it.  The anatomy in consideration is anatomy inThe anatomy in consideration is anatomy in function rather than descriptive anatomy.function rather than descriptive anatomy.www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Term ‘Border area’ refers to the mucosal surfaceTerm ‘Border area’ refers to the mucosal surface area which contacts the denture borders andarea which contacts the denture borders and surrounds the spaces which are occupied bysurrounds the spaces which are occupied by denture flanges.denture flanges.  Border molding procedures are used to recordBorder molding procedures are used to record limiting structures properly. There are 2 mainlimiting structures properly. There are 2 main objectives of border molding in recording theobjectives of border molding in recording the limiting structures-limiting structures- 1. to establish correct flange length and1. to establish correct flange length and border thicknessborder thickness 2. to achieve retention through border seal.2. to achieve retention through border seal. www.indiandentalacademy.comwww.indiandentalacademy.com
  • LIMITING STRUCTURES INLIMITING STRUCTURES IN MAXILLARY REGIONMAXILLARY REGION www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Labial frenumLabial frenum  Labial vestibuleLabial vestibule  Buccal frenumBuccal frenum  Buccal vestibuleBuccal vestibule  Hamular notchHamular notch  Vibrating linesVibrating lines  Fovea palatinaeFovea palatinae www.indiandentalacademy.comwww.indiandentalacademy.com
  • 1. Labial frenum1. Labial frenum  Term frenum or frenulum refers to aTerm frenum or frenulum refers to a connecting fold of mucous membraneconnecting fold of mucous membrane serving to support or retain a part.serving to support or retain a part.  labial frenum, is a fold of mucouslabial frenum, is a fold of mucous membrane extends from the labial mucousmembrane extends from the labial mucous membrane reflection area to or towardsmembrane reflection area to or towards the slop or crest of residual ridge at thethe slop or crest of residual ridge at the median line.median line. www.indiandentalacademy.comwww.indiandentalacademy.com
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  •  It divides the labial vestibule intoIt divides the labial vestibule into approximately equal but asymmetrical leftapproximately equal but asymmetrical left and right labial vestibule.and right labial vestibule.  It starts superiorly in a fan shape andIt starts superiorly in a fan shape and converges as it descends to its terminalconverges as it descends to its terminal attachment on the labial side of the ridge.attachment on the labial side of the ridge.  It contains no muscle and has no actionIt contains no muscle and has no action of its own.of its own. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The action of the lip inThe action of the lip in this area is mainlythis area is mainly vertical so the labialvertical so the labial notch in maxillarynotch in maxillary denture must be justdenture must be just wide and deep enoughwide and deep enough to allow the frenum toto allow the frenum to pass through it.pass through it.  The denture bordersThe denture borders should not only be cutshould not only be cut lower but also havelower but also have less thickness adjacentless thickness adjacent to labial notch.to labial notch. www.indiandentalacademy.comwww.indiandentalacademy.com
  • House classifiedHouse classified frenal attachment infrenal attachment in 3 classes-3 classes-  class1- high inclass1- high in maxilla or low inmaxilla or low in mandible withmandible with respect to crest ofrespect to crest of ridge.ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  class 2- mediumclass 2- medium www.indiandentalacademy.comwww.indiandentalacademy.com
  •  class 3- freniclass 3- freni encroach onencroach on the crest ofthe crest of the ridge andthe ridge and may interferemay interfere with denturewith denture seal, mightseal, might requirerequire surgicalsurgical correction.correction. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Vertical incisiveVertical incisive pads-pads-  When lip is raisedWhen lip is raised and pulledand pulled horizontally forward,horizontally forward, a pad ofa pad of submucosal softsubmucosal soft tissue in the shapetissue in the shape of vertical column isof vertical column is sometimessometimes observed on eachobserved on each side of maxillaryside of maxillary labial frenum, arelabial frenum, are known as verticalknown as vertical incisive pads.incisive pads. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  These are attachments of the superiorThese are attachments of the superior incisive muscles, which course up fromincisive muscles, which course up from their attachments.their attachments.  The basal surface of labial flange of theThe basal surface of labial flange of the denture should be relieved to allow fordenture should be relieved to allow for these attachments.these attachments. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Anterior nasal spine-Anterior nasal spine-  It is not a limiting structure under normal circumstances, but in instances of severe ridge resorption, the anterior labial border of denture should be relieved to avoid impingement upon the mucosa overlying the anterior nasal spine, which frequently becomes a prominent, knife edged, limiting structure. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Labial vestibuleLabial vestibule  The portion of the oralThe portion of the oral cavity that is boundedcavity that is bounded on one side by theon one side by the teeth , gingiva andteeth , gingiva and alveolar ridge (oralveolar ridge (or residual ridge) and onresidual ridge) and on the other by the lipsthe other by the lips anterior to the buccalanterior to the buccal frenum.frenum. GPT-8GPT-8 •The labial vestibule is divided into a left and rightThe labial vestibule is divided into a left and right labial vestibule by the labial frenum.labial vestibule by the labial frenum. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Three objectives which are apparentThree objectives which are apparent in the labial vestibular region are-in the labial vestibular region are- 1.1. The thickness of the labial flange of the finalThe thickness of the labial flange of the final impression must be developed according to theimpression must be developed according to the amount of bone that has been lost from theamount of bone that has been lost from the labial side of the ridge.labial side of the ridge. 2.2. The labial flange of the impression must haveThe labial flange of the impression must have sufficient height to reach the reflecting mucoussufficient height to reach the reflecting mucous membrane of the vestibular space, but shouldmembrane of the vestibular space, but should not over extend it.not over extend it. 3.3. There must be no interference of the labialThere must be no interference of the labial flange with action of the lip in function.flange with action of the lip in function. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The main muscle of theThe main muscle of the lip, which forms the outerlip, which forms the outer surface of the labialsurface of the labial vestibule, is the orbicularisvestibule, is the orbicularis oris.oris.               It’s tone depends onIt’s tone depends on the support it receives fromthe support it receives from the labial flange and thethe labial flange and the position of the teeth.position of the teeth.               Because the fibers runBecause the fibers run in a horizontal direction, thein a horizontal direction, the orbicularis oris has only anorbicularis oris has only an indirect effect on the extentindirect effect on the extent of an impression and henceof an impression and hence on the denture base.on the denture base. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Buccal frenumBuccal frenum  Buccal frenum is aBuccal frenum is a fold of mucousfold of mucous membrane, extendsmembrane, extends from the buccalfrom the buccal mucous membranemucous membrane reflection area to orreflection area to or towards the slop ortowards the slop or crest of residualcrest of residual ridge.ridge. • The buccal frenum forms the dividing line betweenThe buccal frenum forms the dividing line between the labial and buccal vestibulesthe labial and buccal vestibules.. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  It is sometimesIt is sometimes a single fold ofa single fold of mucousmucous membrane,membrane, sometimessometimes double, and indouble, and in some mouth,some mouth, broad and fanbroad and fan shaped.shaped. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Three muscles are attached in this regionThree muscles are attached in this region 1.1. The levator anguli oris (caninus) muscle attachesThe levator anguli oris (caninus) muscle attaches beneath the frenum and affects it’s position.beneath the frenum and affects it’s position. 2.2. The buccinator pulls it backward.The buccinator pulls it backward. 3.3. Orbicularis oris pulls it forward.Orbicularis oris pulls it forward. However Sicher states categorically thatHowever Sicher states categorically that muscles are never found in these folds, whichmuscles are never found in these folds, which contain a variable amount of loose connectivecontain a variable amount of loose connective tissue between two layers of mucous membrane.tissue between two layers of mucous membrane. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Because of muscle attachments, itBecause of muscle attachments, it requires more clearance for its action( inrequires more clearance for its action( in both horizontal and vertical direction) thanboth horizontal and vertical direction) than the labial frenum does.the labial frenum does.  Inadequate provision for the buccalInadequate provision for the buccal frenum or excess thickness of the flangefrenum or excess thickness of the flange distal to the buccal notch can causedistal to the buccal notch can cause dislodgement of the denture when thedislodgement of the denture when the cheeks are moved posteriorly as in broadcheeks are moved posteriorly as in broad smile.smile. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  It records in the impression as a buccal notch which is properly relieved and molded. • It should be cresentric in form, rather thanIt should be cresentric in form, rather than ‘V’ shaped.‘V’ shaped. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Buccal vestibuleBuccal vestibule  ItIt is defined asis defined as ““the portion of oral cavitythe portion of oral cavity that is bounded on one side by the teeth,that is bounded on one side by the teeth, gingiva and alveolar ridge (residualgingiva and alveolar ridge (residual alveolar ridge) and on the lateral side byalveolar ridge) and on the lateral side by the cheek posterior to the buccal frenula”.the cheek posterior to the buccal frenula”. GPT-8GPT-8 www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The buccalThe buccal vestibule liesvestibule lies opposite theopposite the tuberositytuberosity and extendsand extends from thefrom the buccalbuccal frenum to thefrenum to the hamularhamular notch.notch. www.indiandentalacademy.comwww.indiandentalacademy.com
  • The size of the buccal vestibule varies withThe size of the buccal vestibule varies with  contraction of the buccinator muscle,contraction of the buccinator muscle,  the position of the mandible, andthe position of the mandible, and  the amount of bone lost from the maxilla.the amount of bone lost from the maxilla. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The extent of the buccal vestibule can beThe extent of the buccal vestibule can be deceiving because the coronoid processdeceiving because the coronoid process obscures it when the mouth is openedobscures it when the mouth is opened wide. Therefore it should be examinedwide. Therefore it should be examined with the mouth as nearly closed aswith the mouth as nearly closed as possible.possible.  This space usually is higher than anyThis space usually is higher than any other part of the border.other part of the border. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The size and shape of the distal end ofThe size and shape of the distal end of the buccal flange of the denture mustthe buccal flange of the denture must be adjusted according to the ramusbe adjusted according to the ramus and the coronoid process of theand the coronoid process of the mandible.mandible. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Coronomaxillary SpaceCoronomaxillary Space -- (J.Prosthet.Dent 1987:57; 186-190.(J.Prosthet.Dent 1987:57; 186-190. N.S.Arbree, A.A.Yurkstas, and J.H.Kronman.)N.S.Arbree, A.A.Yurkstas, and J.H.Kronman.)  Definition:- The coronomaxillary space is thatDefinition:- The coronomaxillary space is that anatomic region that lies medial to the coronoidanatomic region that lies medial to the coronoid process and lateral to the maxillary tuberosity.process and lateral to the maxillary tuberosity. www.indiandentalacademy.comwww.indiandentalacademy.com
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  •  Terms used to identify the coronomaxillaryTerms used to identify the coronomaxillary space,are :-space,are :-  1- Buccal space or vestibule,1- Buccal space or vestibule, 2- Buccal pocket,2- Buccal pocket, 3-3- Tuberosity sulcusTuberosity sulcus 4- Distobuccal angle of the vestibule,4- Distobuccal angle of the vestibule, 5- Buccal sulcus,5- Buccal sulcus, 6- Buccal pouch,6- Buccal pouch, 7- Buccal mucous membrane reflection7- Buccal mucous membrane reflection region,region, 8- Postmalar area,8- Postmalar area, 9-9- Retrozygomatic spaceRetrozygomatic space.. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Clinical ImplicationsClinical Implications:-:-  To get the maximum retentive qualities of theTo get the maximum retentive qualities of the prosthesis, each patient should be evaluated forprosthesis, each patient should be evaluated for variation in the coronomaxillary space size duringvariation in the coronomaxillary space size during mandibular opening, as the size of the space ismandibular opening, as the size of the space is primarily influenced by the action of the coronoidprimarily influenced by the action of the coronoid process.process. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  In someIn some patients coronoidpatients coronoid process appearsprocess appears to flare laterallyto flare laterally at its height. Forat its height. For these patientsthese patients space oftenspace often remain same orremain same or becomes widerbecomes wider during opening ofduring opening of the mouth.the mouth. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The coronoidThe coronoid Process may beProcess may be relatively straight orrelatively straight or constricting medially .constricting medially . For these patientsFor these patients opening of theopening of the mandible can resultmandible can result in narrowing of thein narrowing of the space.space. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  If the space narrowsIf the space narrows during opening, anyduring opening, any horizontal overextensionhorizontal overextension into the space wouldinto the space would result in denture baseresult in denture base contact and loss ofcontact and loss of retention.retention.  In this region borderIn this region border molding proceduremolding procedure should include openingshould include opening and closing, togetherand closing, together with protrusion, andwith protrusion, and lateral movements oflateral movements of the jaw.the jaw. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  If coronomaxillaryIf coronomaxillary space broadens orspace broadens or remains of same size onremains of same size on opening, the functionalopening, the functional filling of this space withfilling of this space with the denture flangethe denture flange becomes important.becomes important. border molding should notborder molding should not be done with open wide,be done with open wide, protrude, or any lateralprotrude, or any lateral movements.movements. •Here a gentle molding of the region is done byHere a gentle molding of the region is done by pulling the cheek out, down and inwards.pulling the cheek out, down and inwards. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Microscopic features of labial andMicroscopic features of labial and Buccal vestibuleBuccal vestibule -- - The mucous membrane lining of vestibule isThe mucous membrane lining of vestibule is relatively thin.relatively thin. - The submucosal layer is thick and containsThe submucosal layer is thick and contains large amount of loose areolar tissue and elastic fiber.large amount of loose areolar tissue and elastic fiber. - The mucosa of the vestibular space isThe mucosa of the vestibular space is classified as lining mucosa.classified as lining mucosa. - Mucosa is devoid of keratinized layer and isMucosa is devoid of keratinized layer and is freely movable with the tissue to which it is attachedfreely movable with the tissue to which it is attached because of the elastic nature of the lamina propria.because of the elastic nature of the lamina propria. www.indiandentalacademy.comwww.indiandentalacademy.com
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  • Hamular notchHamular notch  Hamular notch is aHamular notch is a displaceable area,displaceable area, about 2mm wideabout 2mm wide between thebetween the tuberosity of thetuberosity of the maxilla and themaxilla and the hamular process ofhamular process of the medial pterygoidthe medial pterygoid plateplate.. Also called as pterygomaxillary notchAlso called as pterygomaxillary notch www.indiandentalacademy.comwww.indiandentalacademy.com
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  • Clinical SignificanceClinical Significance --  This notch is used as a boundary of the posteriorThis notch is used as a boundary of the posterior border of the maxillary denture, back of theborder of the maxillary denture, back of the tuberosity.tuberosity.  The impression should not end on the tuberosity,The impression should not end on the tuberosity, otherwise it will result in nonretentive dentureotherwise it will result in nonretentive denture because peripheral seal is not possible inbecause peripheral seal is not possible in nonresilient area of tuberosity.nonresilient area of tuberosity.  The tissue in the centre of the deep part of theThe tissue in the centre of the deep part of the hamular notch, can be safely displaced by thehamular notch, can be safely displaced by the posterior palatal border of the denture to help inposterior palatal border of the denture to help in achieving a seal in this region called asachieving a seal in this region called as pterygo-pterygo- maxillary seal.maxillary seal. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The tip of the pterygoid hamulus is 2-3 mmThe tip of the pterygoid hamulus is 2-3 mm posteromedial to the distal limit of maxillaryposteromedial to the distal limit of maxillary residual ridge. However it may be located on theresidual ridge. However it may be located on the line with crest of ridge or sometimes even lateralline with crest of ridge or sometimes even lateral to this line.to this line.  This variation is significant in that it affects theThis variation is significant in that it affects the length and the direction of pterygomaxillary seallength and the direction of pterygomaxillary seal so it becomes very important to determine theso it becomes very important to determine the location of hamulus by palpation.location of hamulus by palpation. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  PterygomaxillaryPterygomaxillary seal occupiesseal occupies the entire widththe entire width of hamularof hamular notch. The sealnotch. The seal begins atbegins at pterygomaxillarypterygomaxillary notch andnotch and usually extendsusually extends 5-7 mm5-7 mm anteromedially.anteromedially. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Also overextensions at the hamularAlso overextensions at the hamular notches will not be tolerated because ofnotches will not be tolerated because of pressure on the pterygoid hamulus andpressure on the pterygoid hamulus and interference with the pterygomandibularinterference with the pterygomandibular raphe.raphe.  Special care should be taken in theSpecial care should be taken in the grossly resorbed alveolar ridge, wheregrossly resorbed alveolar ridge, where hamular notch disappears and raphehamular notch disappears and raphe becomes more prominent.becomes more prominent. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  When the mouth isWhen the mouth is opened wide, theopened wide, the pterygomandibularpterygomandibular raphe is pulledraphe is pulled forward. If the dentureforward. If the denture extends too far intoextends too far into the hamular notch,the hamular notch, the mucousthe mucous membrane coveringmembrane covering the raphe will bethe raphe will be traumatizedtraumatized www.indiandentalacademy.comwww.indiandentalacademy.com
  • Review of LiteratureReview of Literature -- Aust.Dent.J.1981:26;218-21.Aust.Dent.J.1981:26;218-21. B.C.W.BarkerB.C.W.Barker, After dissection of, After dissection of cadaver heads and observation ,he gavecadaver heads and observation ,he gave a note i.e. Little or no movements occursa note i.e. Little or no movements occurs in the mucosa here. Dissection ofin the mucosa here. Dissection of submucosal structure related to the notchsubmucosal structure related to the notch showed variation in arrangements andshowed variation in arrangements and form which did not conform entirely withform which did not conform entirely with textbook descriptions.textbook descriptions. www.indiandentalacademy.comwww.indiandentalacademy.com
  • PterygomandibularPterygomandibular RapheRaphe --  PterygomandibularPterygomandibular raphe or ligament originatesraphe or ligament originates from the pterygoid hamulusfrom the pterygoid hamulus of the medial pterygoidof the medial pterygoid lamina and attaches to thelamina and attaches to the distal end of the mylohyoiddistal end of the mylohyoid ridge.ridge.  It is partly, origin ofIt is partly, origin of buccinator muscle laterallybuccinator muscle laterally and superior constrictorand superior constrictor muscle medially.muscle medially. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Palatine fovea region-Palatine fovea region-  The fovea palatinae are indentationsThe fovea palatinae are indentations near the midline of the palate in posteriornear the midline of the palate in posterior region formed by coalescence of severalregion formed by coalescence of several mucous membrane ducts.mucous membrane ducts.  They are very prominent in someThey are very prominent in some individuals, whereas in others they areindividuals, whereas in others they are barely visible or may be absent.barely visible or may be absent. www.indiandentalacademy.comwww.indiandentalacademy.com
  • www.indiandentalacademy.comwww.indiandentalacademy.com
  • Usually theUsually the posteriorposterior vibrating line isvibrating line is found ,2 mmfound ,2 mm anterior to theanterior to the foveae palatine,foveae palatine, but they can bebut they can be found on orfound on or anterior to theanterior to the vibrating line.vibrating line. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Review of LiteratureReview of Literature ((1) J Prosthet Dent: 1975; 33,504-510.1) J Prosthet Dent: 1975; 33,504-510. T.L.LyeT.L.Lye conducted clinical, radiographicconducted clinical, radiographic and histological studies of fovea palatine andand histological studies of fovea palatine and concluded that, fovea palatine were positionedconcluded that, fovea palatine were positioned 1 .31 mm in front of the vibrating line in 70% of1 .31 mm in front of the vibrating line in 70% of the cases.the cases. Histologically, complex nerve endingsHistologically, complex nerve endings were found just anterior to the fovea andwere found just anterior to the fovea and spreading to the soft palate.spreading to the soft palate. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Dental.J.1983:28; 166-70.Dental.J.1983:28; 166-70.  A clinical study was conducted byA clinical study was conducted by S.B.KengS.B.Keng andand ROWROW A.MA.M.,on edentulous patients to determine the distance of the.,on edentulous patients to determine the distance of the vibrating line to the fovea palatine. The results indicated thatvibrating line to the fovea palatine. The results indicated that the vibrating line is located 2.62 mm. (mean of 160 subjects)the vibrating line is located 2.62 mm. (mean of 160 subjects) anterior to the fovea palatine.anterior to the fovea palatine.  There was a significant correlation between the distances ofThere was a significant correlation between the distances of vibrating line to the fovea for different type of soft palatevibrating line to the fovea for different type of soft palate contour. Soft palate with deep slope (class III) has thecontour. Soft palate with deep slope (class III) has the vibrating line at or just in front of the fovea, while class IIvibrating line at or just in front of the fovea, while class II medium contour was 2.3 m.m. anterior to fovea, and class Imedium contour was 2.3 m.m. anterior to fovea, and class I flat contour of the soft palate line located approximately 4flat contour of the soft palate line located approximately 4 m.m. anterior to the fovea palatine.m.m. anterior to the fovea palatine. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Fovea palatini and posterior borderFovea palatini and posterior border of dentureof denture  According to Boucher as fovea palatini are close toAccording to Boucher as fovea palatini are close to vibrating line and always in soft tissues, whichvibrating line and always in soft tissues, which makes them an ideal guide for location of posteriormakes them an ideal guide for location of posterior border of denture.border of denture.  According to Winkler fovea palatini should be usedAccording to Winkler fovea palatini should be used only as guidelines to the placement of posterioronly as guidelines to the placement of posterior palatal seal. The dentist who observes the foveapalatal seal. The dentist who observes the fovea and utilizes these anatomic landmarks as posteriorand utilizes these anatomic landmarks as posterior extent of denture base can deprive his patients ofextent of denture base can deprive his patients of several millimeters up to a centimeter or more ofseveral millimeters up to a centimeter or more of tissue coverage depending on the palataltissue coverage depending on the palatal configuration.configuration. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  AnteriorAnterior vibrating line-vibrating line-  Anterior vibrating lineAnterior vibrating line is an imaginary lineis an imaginary line located at the junctionlocated at the junction of the attachedof the attached tissues overlying thetissues overlying the hard palate and thehard palate and the movable tissues ofmovable tissues of the immediatelythe immediately adjacent soft palate.adjacent soft palate. Vibrating lines of palate-Vibrating lines of palate- www.indiandentalacademy.comwww.indiandentalacademy.com
  •  This can be located either by valsulvaThis can be located either by valsulva maneuver or by instructing patient to saymaneuver or by instructing patient to say “ah” with short vigorous bursts.“ah” with short vigorous bursts.  Due to projection of posterior nasal spineDue to projection of posterior nasal spine anterior vibrating line is not a straight lineanterior vibrating line is not a straight line between hamular processes.between hamular processes.  At the midline it usually passes about 2 mmAt the midline it usually passes about 2 mm in front of the fovea palatinae.in front of the fovea palatinae. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Posterior vibrating line is an imaginary line at thePosterior vibrating line is an imaginary line at the junction of the aponeurosis of tensor veli palatinijunction of the aponeurosis of tensor veli palatini muscle and the muscular portion of the softmuscle and the muscular portion of the soft palate.palate.  It represents the demarcation between that partIt represents the demarcation between that part of the soft palate that has limited or shallowof the soft palate that has limited or shallow movement during function and the remainder ofmovement during function and the remainder of soft palate that is markedly displaced duringsoft palate that is markedly displaced during function.function.  Posterior vibrating line is visualized byPosterior vibrating line is visualized by instructing the patient to say “ah” in a normalinstructing the patient to say “ah” in a normal unexaggerated fashion.unexaggerated fashion. www.indiandentalacademy.comwww.indiandentalacademy.com
  • • The distal end of the upper denture must extend at least to vibrating lines. In most instances the denture should end 1-2 mm posterior to vibrating lines.  Direction of the vibrating line usually varies accordingDirection of the vibrating line usually varies according to the shape of palate ; the higher the vault , the moreto the shape of palate ; the higher the vault , the more abrupt and forward the vibrating line. In a mouth withabrupt and forward the vibrating line. In a mouth with flat vault , the vibrating line is usually farther posteriorflat vault , the vibrating line is usually farther posterior and has a good curvature, affording a broader PPSA.and has a good curvature, affording a broader PPSA.  TheThe M.M.HouseM.M.House classification is customarily used toclassification is customarily used to designate the shape of the soft palate and itdesignate the shape of the soft palate and it describes the amount of posterior tissue that willdescribes the amount of posterior tissue that will accept the posterior palatal seal –accept the posterior palatal seal – www.indiandentalacademy.comwww.indiandentalacademy.com
  • Class IClass I – More than 5mm of– More than 5mm of movable tissue available formovable tissue available for post damming .post damming .  ideal for retention.ideal for retention. Class IIClass II – 1-5 mm of movable– 1-5 mm of movable tissue available for posttissue available for post damming.damming.  retention is usually possible.retention is usually possible. Class IIIClass III – Less than 1 mm– Less than 1 mm movable tissue available formovable tissue available for post damming.post damming.  Retention is usually poor.Retention is usually poor. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 1. Irving R. Hardy and Krishan K. Kapur. Posterior border seal –Its rationale and importance J Prosthet Dent.1958;8;386-397 • Due to the relative instability of the denture base materials generally used, we have to take added precaution of scoring the cast at the deepest point of the posterior palatal seal to counteract the warpage of the denture. • If this bead causes any irritation when the denture is worn, it can be buffed off very easily, and it may make the difference between excellent and merely passable retention. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 2.2. J prosthet.Dent.1971;25,470-488.J prosthet.Dent.1971;25,470-488. Sidney I. Silverman-Sidney I. Silverman-  He did a study on 500 patients whoHe did a study on 500 patients who required complete denture. The clinicalrequired complete denture. The clinical findings were evaluated during speechfindings were evaluated during speech swallowing and respiratory posture.swallowing and respiratory posture.  Silverman concluded that completeSilverman concluded that complete maxillary denture can be extended for anmaxillary denture can be extended for an average of 8.2 mm. dorsally to the vibrating line.average of 8.2 mm. dorsally to the vibrating line.  The extension varies from 4 to 12 mm.The extension varies from 4 to 12 mm. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 3.3. J.Prosthet.Dent1973:23:484-93.J.Prosthet.Dent1973:23:484-93. William E. AvantWilliam E. Avant did this study to do comparisondid this study to do comparison of different type of palatal seal in relation ofof different type of palatal seal in relation of complete denture retention.complete denture retention.  Conclusions of this study were –Conclusions of this study were – 1.1. A posterior palatal seal is necessary forA posterior palatal seal is necessary for optimum retention of maxillary completeoptimum retention of maxillary complete dentures.dentures. 2.2. Each type of posterior palatal seal tested inEach type of posterior palatal seal tested in this study increased retention effectively.this study increased retention effectively. 3.3. No one type of posterior palatal seal thatNo one type of posterior palatal seal that was tested ,proved to be superior than other.was tested ,proved to be superior than other. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 44) J.Prothet .dent.1975:34; 605-13.) J.Prothet .dent.1975:34; 605-13. H.NikoukariH.Nikoukari did a study at school of dentistry, Mashad,did a study at school of dentistry, Mashad, Iran.Iran. This study was designed to measure the dimension andThis study was designed to measure the dimension and displacement pattern of the posterior palatal seal in differentdisplacement pattern of the posterior palatal seal in different palatal shapes .The effect of different materials on thepalatal shapes .The effect of different materials on the displacement of tissue in the posterior palatal area were alsodisplacement of tissue in the posterior palatal area were also evaluated .evaluated .  It was concluded that the best posterior palatal seal can beIt was concluded that the best posterior palatal seal can be achieved by using green modeling compound or korecta waxachieved by using green modeling compound or korecta wax no 4 .no 4 .  For establishing the posterior palatal seal area ,the posteriorFor establishing the posterior palatal seal area ,the posterior border should only be scraped on the cast for betterborder should only be scraped on the cast for better adaptation.adaptation.  No apparent changes of tissue displacement were found inNo apparent changes of tissue displacement were found in different palatal shapes. However width of the posterior palataldifferent palatal shapes. However width of the posterior palatal seal area in flat palate was greater than deep and mediumseal area in flat palate was greater than deep and medium palate.palate. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 5.5.Journal of prosthetic dentistry 2003;12 :265-270Journal of prosthetic dentistry 2003;12 :265-270 Behnoush RashediBehnoush Rashedi andand Vicki KVicki K PetropoulosPetropoulos, conducted a, conducted a survey of U.S. dental schools in 2001 ,to determine thesurvey of U.S. dental schools in 2001 ,to determine the concepts, techniques used for establishing the post palatalconcepts, techniques used for establishing the post palatal seal Results from this survey show thatseal Results from this survey show that  Combinations of clinical methods were most frequentlyCombinations of clinical methods were most frequently taught for locating the vibrating line.taught for locating the vibrating line.  The phonation of the “ah” sound was the most popularThe phonation of the “ah” sound was the most popular single method taught for locating the vibrating line.single method taught for locating the vibrating line.  Most dental schools (87.5%) teach students to carveMost dental schools (87.5%) teach students to carve the posterior palatal seal on maxillary master cast.the posterior palatal seal on maxillary master cast.  Most dental school (93.9%) take the compressibility ofMost dental school (93.9%) take the compressibility of the palatal tissue into consideration when carving the depth ofthe palatal tissue into consideration when carving the depth of posterior palatal seal in maxillary master cast.posterior palatal seal in maxillary master cast. www.indiandentalacademy.comwww.indiandentalacademy.com
  • ANATOMIC LANDMARKSANATOMIC LANDMARKS OF ORAL CAVITY ANDOF ORAL CAVITY AND THEIR SIGNIFICANCE INTHEIR SIGNIFICANCE IN COMPLETE DENTURECOMPLETE DENTURE PATIENTSPATIENTS DR. PRASOONDR. PRASOON SHUKLASHUKLA www.indiandentalacademy.comwww.indiandentalacademy.com
  •  IntroductionIntroduction  DefinitionDefinition  Supporting structuresSupporting structures 1. Bone1. Bone 2.Mucous membrane2.Mucous membrane  Peripheral or limiting structuresPeripheral or limiting structures  Anatomy of limiting structures inAnatomy of limiting structures in maxillary regionmaxillary region www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Anatomy of supporting structures inAnatomy of supporting structures in maxillary regionmaxillary region  Anatomy of limiting structures inAnatomy of limiting structures in mandibular regionmandibular region  Anatomy of supporting structures inAnatomy of supporting structures in mandibular regionmandibular region  ConclusionConclusion  ReferencesReferences www.indiandentalacademy.comwww.indiandentalacademy.com
  • Anatomy of supportingAnatomy of supporting structuresstructures in maxillaryin maxillary region-region- www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The foundation for dentures is madeThe foundation for dentures is made up of bone of the hard palate and residualup of bone of the hard palate and residual ridge, covered by mucous membrane. Theridge, covered by mucous membrane. The denture base rests on the mucousdenture base rests on the mucous membrane, which serves as a cushionmembrane, which serves as a cushion between the base and the supportingbetween the base and the supporting bone.bone. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Residual alveolar ridge-Residual alveolar ridge- DefinitionDefinition (According to GPT-8) –(According to GPT-8) – ““The portion of the alveolar ridge and itsThe portion of the alveolar ridge and its soft tissue covering ,which remainssoft tissue covering ,which remains following the removal of teeth.”following the removal of teeth.”  The socket that surrounds the rootThe socket that surrounds the root of each natural tooth is called alveolusof each natural tooth is called alveolus and the bony ridge that supports the teethand the bony ridge that supports the teeth is the alveolar ridge.is the alveolar ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  When the naturalWhen the natural teeth are removed, theteeth are removed, the alveoli begin to fill upalveoli begin to fill up with the new bone. Atwith the new bone. At the same time bonethe same time bone around the margins ofaround the margins of tooth sockets begin totooth sockets begin to shrink away.shrink away.  This shrinkage orThis shrinkage or resorption is rapid atresorption is rapid at first six weeks of toothfirst six weeks of tooth removal, and itremoval, and it continues at acontinues at a reduced rate throughout the life and is responsiblereduced rate throughout the life and is responsible for the formation of RAR.for the formation of RAR. www.indiandentalacademy.comwww.indiandentalacademy.com
  • The alveolar ridges vary greatly in size,The alveolar ridges vary greatly in size, shape and their ultimate form. This isshape and their ultimate form. This is dependent on the following factorsdependent on the following factors --  Variation in bone size and its degreeVariation in bone size and its degree of calcification in individuals.of calcification in individuals.  Teeth show wide individual variationTeeth show wide individual variation in size. Large teeth are supported by bulkyin size. Large teeth are supported by bulky ridges and smaller teeth by narrow ones.ridges and smaller teeth by narrow ones.  The amount of bone lost prior to theThe amount of bone lost prior to the extraction of teeth.extraction of teeth.  The amount of alveolar process removedThe amount of alveolar process removed during extraction of teeth.during extraction of teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Rate and degree of resorption: - During theRate and degree of resorption: - During the first six weeks after the extraction of teeth, thefirst six weeks after the extraction of teeth, the rate of resorption is rapid, thereafter it continuesrate of resorption is rapid, thereafter it continues throughout the life at an ever decreasing pace.throughout the life at an ever decreasing pace.  The effect of previous denture: - ill fittingThe effect of previous denture: - ill fitting denture, or dentures with occluding naturaldenture, or dentures with occluding natural teeth, may cause rapid resorption of the alveolarteeth, may cause rapid resorption of the alveolar process in the areas where they causeprocess in the areas where they cause excessive pressure or lateral stresses.excessive pressure or lateral stresses.  The relative length of the time for whichThe relative length of the time for which different parts of the jaw has been edentulous.different parts of the jaw has been edentulous.  Person’s general health.Person’s general health. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  According to size RAR can be-According to size RAR can be- -large-large -medium-medium -small-small www.indiandentalacademy.comwww.indiandentalacademy.com
  • large medium small www.indiandentalacademy.comwww.indiandentalacademy.com
  •  According to shape RAR can be-According to shape RAR can be- - smooth- smooth - irregular- irregular - knife edge- knife edge - flat- flat www.indiandentalacademy.comwww.indiandentalacademy.com
  • IrregularSmooth Knife-edgeFlat www.indiandentalacademy.comwww.indiandentalacademy.com
  • Types of Alveolar ridges, palateTypes of Alveolar ridges, palate formation and their significanceformation and their significance Alveolar Ridge shape ‘square to gently rounded Flat Palate With small ridge ’tapering or V’ Shaped www.indiandentalacademy.comwww.indiandentalacademy.com
  • square to gently rounded This is mostThis is most favorable kind offavorable kind of ridge because –ridge because –  The centre ofThe centre of the palate presentsthe palate presents an almost flatan almost flat horizontal area andhorizontal area and this will aid inthis will aid in retention.retention.  The roomyThe roomy sulcus allows for thesulcus allows for the development of gooddevelopment of good peripheral seal.peripheral seal. Flat surface  The well developed ridges resist lateral and anteroposteriorThe well developed ridges resist lateral and anteroposterior movement of the denture.movement of the denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • tapering or V’ Shaped • It is usuallyIt is usually associated with thickassociated with thick bulky ridges. This isbulky ridges. This is an unfavorablean unfavorable formation.formation. The forces ofThe forces of adhesion andadhesion and cohesion are not atcohesion are not at right angles toright angles to surface whensurface when counteracting thecounteracting the normal displacingnormal displacing forces of gravity.forces of gravity. V’ shaped www.indiandentalacademy.comwww.indiandentalacademy.com
  • (iii) Flat palate with small(iii) Flat palate with small ridgesridges This is anThis is an unfavorable formationunfavorable formation because –because – – The illThe ill developed ridges dodeveloped ridges do not resist lateral andnot resist lateral and anterior-posterioranterior-posterior movement of themovement of the denture.denture. – Shallow SulcusShallow Sulcus do not form a gooddo not form a good Peripheral seal.Peripheral seal. Shallow Flat Palate www.indiandentalacademy.comwww.indiandentalacademy.com
  •  UnsupportedUnsupported alveolar soft tissuesalveolar soft tissues are frequently foundare frequently found in the edentulousin the edentulous anterior maxillaanterior maxilla which has beenwhich has been opposed by anopposed by an island of naturalisland of natural anterior teeth with ananterior teeth with an edentulous posterioredentulous posterior mandible.mandible.  During masticationDuring mastication the upper denturethe upper denture ‘see-saws’ leading to‘see-saws’ leading to disproportionatedisproportionate resorption.resorption. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Soft tissues areSoft tissues are compressiblecompressible and the dentureand the denture developsdevelops increasingincreasing instability.instability.  Excessive softExcessive soft tissue needstissue needs surgicalsurgical removal.removal. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Microscopic features of residual ridgesMicroscopic features of residual ridges  The mucous membrane isThe mucous membrane is attached to theattached to the periosteum of the bone byperiosteum of the bone by the connective tissue ofthe connective tissue of the sub mucosa.the sub mucosa.  The stratified squamousThe stratified squamous epithelium is thicklyepithelium is thickly keratinized.keratinized.  The sub mucosa isThe sub mucosa is devoid of fat or glandulardevoid of fat or glandular cells and it iscells and it is characterized by densecharacterized by dense collegenous fibers that are contiguous with laminacollegenous fibers that are contiguous with lamina propriapropria.. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The outer surface of bone in the region of crest of RAR (most coronal portion of ridge) is usually compact in nature. This compact bone in combination with tightly attached keratinized mucous membrane makes crest of RAR histologically best able to provide primary support for the denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • RAR- a primary stress bearingRAR- a primary stress bearing areaarea ??????  According to Prosthodontic Treatment forAccording to Prosthodontic Treatment for Edentulous Patients by Zarb and Bolender-Edentulous Patients by Zarb and Bolender- ““the bone in this region is subject tothe bone in this region is subject to resorption, which limits it’s potential forresorption, which limits it’s potential for support, unlike the palate, which is resistantsupport, unlike the palate, which is resistant to resorption. Because of this, ridge crestto resorption. Because of this, ridge crest should be looked on as a secondaryshould be looked on as a secondary supporting area.”supporting area.” www.indiandentalacademy.comwww.indiandentalacademy.com
  •  TheyThey ConsiderConsider ““horizontalhorizontal portion ofportion of hard palatehard palate lateral tolateral to midline” asmidline” as primaryprimary supportingsupporting area forarea for denture.denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  In a patientIn a patient where tooth werewhere tooth were extracted longextracted long time backtime back (years), ridge(years), ridge becomesbecomes smaller and crestsmaller and crest of ridge in manyof ridge in many cases iscases is completelycompletely devoid of smoothdevoid of smooth cortical bonycortical bony surface.surface.  Horizontal part of palate lateral to midline shouldHorizontal part of palate lateral to midline should definitely be considered a primary stress bearing areadefinitely be considered a primary stress bearing area in these patients.in these patients. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Palatal region-Palatal region- Rugae area-Rugae area-  Rugae are the raised area of dense connectiveRugae are the raised area of dense connective tissue radiating from the median suture in thetissue radiating from the median suture in the anterior one third of the palate.anterior one third of the palate.  Consists of series of ridges in the anterior part ofConsists of series of ridges in the anterior part of the hard palatethe hard palate  Mucosa is keratinized and the submucosa isMucosa is keratinized and the submucosa is fibrousfibrous  In the area of the rugae, the palate is set at anIn the area of the rugae, the palate is set at an angle to the residual ridge and is rather thinlyangle to the residual ridge and is rather thinly covered by soft tissue.covered by soft tissue. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  This area contributes to the stress-bearingThis area contributes to the stress-bearing role as well as to retention although in arole as well as to retention although in a secondary capacity.secondary capacity.     It resists forward movement of denture.It resists forward movement of denture.     It should be recorded without pressure, if itIt should be recorded without pressure, if it distorts while making impression it can rebounddistorts while making impression it can rebound and unseat the denture.and unseat the denture.  These folds of the mucosa play an importantThese folds of the mucosa play an important role in speech so dentures should reproduce thisrole in speech so dentures should reproduce this contour making it very comfortable for thecontour making it very comfortable for the patient.patient. www.indiandentalacademy.comwww.indiandentalacademy.com
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  • Mid palatine raphe-Mid palatine raphe-  This presents as slightlyThis presents as slightly elevated bony ridge alongelevated bony ridge along the midline of hard palate.the midline of hard palate.  Adequate relief should beAdequate relief should be provided in this area as-provided in this area as- - mucosa covering the- mucosa covering the raphe is extremely thin andraphe is extremely thin and is traumatized easily.is traumatized easily. -mucosa is less resilient-mucosa is less resilient than that covering the ridgesthan that covering the ridges so it can act as fulcrumso it can act as fulcrum along which denture rocksalong which denture rocks when vertical forces arewhen vertical forces are applied.applied. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  This areaThis area provides primaryprovides primary support tosupport to denture as itdenture as it offers maximumoffers maximum resistance toresistance to resorption.resorption. Horizontal portion of hard palate lateral toHorizontal portion of hard palate lateral to midline-midline- www.indiandentalacademy.comwww.indiandentalacademy.com
  • Lateral surface of hard palateLateral surface of hard palate It isIt is divided individed in  anterolateral part containinganterolateral part containing adipose tissue in submucosaadipose tissue in submucosa  posterolateral part containingposterolateral part containing glandular tissue.glandular tissue. Both of these areas are displaceable theyBoth of these areas are displaceable they do not provide significant support to thedo not provide significant support to the denture but this region should be covereddenture but this region should be covered to provide retention.to provide retention. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Anteriolateral View Posteriolateral View www.indiandentalacademy.comwww.indiandentalacademy.com
  •  These areas should be recorded inThese areas should be recorded in resting conditionresting condition because when they arebecause when they are displaced in the final impression, they tenddisplaced in the final impression, they tend to return to natural form within theto return to natural form within the completed denture base, and creating ancompleted denture base, and creating an unseating force on the denture or causingunseating force on the denture or causing soreness in the patients mouth. Forsoreness in the patients mouth. For recording these tissue in undistorted form,recording these tissue in undistorted form, proper relief should be given in the finalproper relief should be given in the final impression tray.impression tray. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Incisive papilla-Incisive papilla-  This coversThis covers the incisivethe incisive foramen andforamen and is located inis located in the midlinethe midline immediatelyimmediately behind andbehind and betweenbetween centralcentral incisors.incisors. www.indiandentalacademy.comwww.indiandentalacademy.com
  • ProsthodonticProsthodontic significances:significances:  It lies nearer toIt lies nearer to the crest of thethe crest of the ridge as resorptionridge as resorption progresses. Thusprogresses. Thus the location of thethe location of the incisive papillaincisive papilla gives an indicationgives an indication as to the amount ofas to the amount of resorption that hasresorption that has taken place.taken place.        www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Incisive papillaIncisive papilla acts as a guide foracts as a guide for antero-posteriorantero-posterior positioning of thepositioning of the teeth, theteeth, the labial surfaces oflabial surfaces of the centralthe central incisors areincisors are usually 8-10 mmusually 8-10 mm in front of thein front of the papilla.papilla. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  IncisiveIncisive papilla is usedpapilla is used to locate theto locate the midline of themidline of the dental arch.dental arch. www.indiandentalacademy.comwww.indiandentalacademy.com
  • The nasopalatine nerves and blood vessels passThe nasopalatine nerves and blood vessels pass through the foramen, and care should be taken thatthrough the foramen, and care should be taken that the denture base does not impinge on them.the denture base does not impinge on them.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 1. 1.  Harold R. Ortman, and Ding H. TsaoHarold R. Ortman, and Ding H. Tsao :Relationship of the incisive papilla to:Relationship of the incisive papilla to the maxillary central incisors. Jthe maxillary central incisors. J Prosthet Dent 1979;42; 492-496Prosthet Dent 1979;42; 492-496  A study on 38 maxillary casts found that theA study on 38 maxillary casts found that the average distance between the most anterioraverage distance between the most anterior point of maxillary central incisors and mostpoint of maxillary central incisors and most posterior point of the incisive papilla was 12.454posterior point of the incisive papilla was 12.454 mm .mm . www.indiandentalacademy.comwww.indiandentalacademy.com
  • 2.J.prosthet.Dent 1981:45;592-97.2.J.prosthet.Dent 1981:45;592-97. F.MovroskoufisF.Movroskoufis andand G.M.RetechieG.M.Retechie did a study atdid a study at dental school London ,UK.dental school London ,UK. An investigation of 64 angleAn investigation of 64 angle skeletal class I dental studentsskeletal class I dental students showed that the incisive papillashowed that the incisive papilla provides a stable anatomicprovides a stable anatomic landmark for arranging the labiallandmark for arranging the labial surface of the central incisorssurface of the central incisors labial surface is 10.2mmlabial surface is 10.2mm anterior to the posterior border ofanterior to the posterior border of the papilla.the papilla. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 3) Journal Indian Dent.Asso.1984:56;425-28.3) Journal Indian Dent.Asso.1984:56;425-28. Kharat D.U. and Madan R.S. carried out a study onKharat D.U. and Madan R.S. carried out a study on 200 subjects (108 men,98 women) of different age group200 subjects (108 men,98 women) of different age group ranging 20-65 years ,to determine the distances fromranging 20-65 years ,to determine the distances from incisal edge of the maxillary central incisor to theincisal edge of the maxillary central incisor to the papilla.papilla.  The findings of the study showed that the meanThe findings of the study showed that the mean distance of maxillary incisal edge to the incisive papilladistance of maxillary incisal edge to the incisive papilla was 8.16was 8.16 ++ 1.26 mm for men and 7.411.26 mm for men and 7.41 ++ 0.98 mm for0.98 mm for women.women.  Conclusion of their study was, the distance fromConclusion of their study was, the distance from maxillary incisal edge to the incisal papilla in dentulousmaxillary incisal edge to the incisal papilla in dentulous men is more than the women and this distance remainsmen is more than the women and this distance remains constant throughout the life.constant throughout the life. www.indiandentalacademy.comwww.indiandentalacademy.com
  • ((4) J.Prosthet.Dent.4) J.Prosthet.Dent. 1987:57;712-141987:57;712-14 A.M.H.graveA.M.H.grave andand P.J.BeckerP.J.Becker compared thecompared the position of incisive papilla,position of incisive papilla, in between the two groupsin between the two groups in their study. The firstin their study. The first group consisted of existinggroup consisted of existing complete upper dentures ofcomplete upper dentures of 67 patients(34 men,3367 patients(34 men,33 women). And anotherwomen). And another group consisted of castgroup consisted of cast obtained from the 60 youngobtained from the 60 young adults.adults. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The results of the study suggests that theThe results of the study suggests that the labial surface of the maxillary incisorslabial surface of the maxillary incisors should be 12-13 mm from the posteriorshould be 12-13 mm from the posterior border of the incisive papilla. Theseborder of the incisive papilla. These measurements was significantly smaller inmeasurements was significantly smaller in the sample of dentures examined , whichthe sample of dentures examined , which suggests a tendency for anterior teeth to besuggests a tendency for anterior teeth to be placed too far posteriorly in artificial denture.placed too far posteriorly in artificial denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • (5) J.prosthet.Dent. 1989:61;51-53. H.F. Grove and L.Cristensen did a study on 58 subjects to determine the orthographic distances from the posterior of the incisive papilla to the line intersecting the distal contact point of the maxillary canine. In 92% of subjects the posterior point of incisive papilla was approximately 3mm anterior to the line between the distal points of the canines. Neither gender, age, nor maxillary arch form affected this distance.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 6.G.C.K. Lau and R.F.K.Clark: the6.G.C.K. Lau and R.F.K.Clark: the relationship of the incisive papilla to therelationship of the incisive papilla to the maxillary central incisors and caninemaxillary central incisors and canine teeth in southern Chinese. Prosthetteeth in southern Chinese. Prosthet Dent 1993; 70; 86-93Dent 1993; 70; 86-93                 distance of central incisor to the midpoint ofdistance of central incisor to the midpoint of the incisive papilla - 9.17mmthe incisive papilla - 9.17mm               distance of central incisor to the posteriordistance of central incisor to the posterior point of the incisive papilla -12.71mmpoint of the incisive papilla -12.71mm                www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Relationship of canine to the incisive papilla.Relationship of canine to the incisive papilla. The intercanine lines in 57.3% passedThe intercanine lines in 57.3% passed through the middle third , in 12.25% passedthrough the middle third , in 12.25% passed through the anterior third and in 32.7% of all thethrough the anterior third and in 32.7% of all the subjects passed through the posterior third ofsubjects passed through the posterior third of incisive papilla.incisive papilla.                 All the similar above measurements wereAll the similar above measurements were also made in Angle’s class1, class 2 and class 3also made in Angle’s class1, class 2 and class 3 jaws. The differences among these were foundjaws. The differences among these were found statistically insignificant.statistically insignificant.  Results showed that there is little differenceResults showed that there is little difference between various ethnic groups.between various ethnic groups. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Also calledAlso called malar process ismalar process is located oppositelocated opposite the first molarthe first molar region and isregion and is commonly seencommonly seen in mouth that hasin mouth that has been edentulousbeen edentulous for long.for long. Zygomatic process-Zygomatic process- www.indiandentalacademy.comwww.indiandentalacademy.com
  •  SomeSome denturesdentures require reliefrequire relief over the areaover the area to aid into aid in retention andretention and to preventto prevent soreness ofsoreness of underlyingunderlying structures.structures. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Maxillary tuberosity-Maxillary tuberosity-  MaxillaryMaxillary tuberositytuberosity representsrepresents most distalmost distal portion ofportion of maxillarymaxillary alveolaralveolar ridge.ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The tuberosityThe tuberosity region oftenregion often hangs abnormallyhangs abnormally low whenlow when maxillary posteriormaxillary posterior teeth are retainedteeth are retained after mandibularafter mandibular molars are lostmolars are lost and not replaced,and not replaced, the max. teeththe max. teeth extrude bringingextrude bringing the tuberosity withthe tuberosity with them.them.  Often the low hanging tuberosity prevents properOften the low hanging tuberosity prevents proper location of occlusal plane.location of occlusal plane.www.indiandentalacademy.comwww.indiandentalacademy.com
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  •  Most oftenMost often tuberositytuberosity enlargements areenlargements are only fibrous inonly fibrous in nature.nature.  In either caseIn either case invasion ofinvasion of interalveolarinteralveolar space in thespace in the tuberosity areatuberosity area may prevent themay prevent the posteriorposterior extension ofextension of denture .denture . www.indiandentalacademy.comwww.indiandentalacademy.com
  • Review of literature-Review of literature- 1.JADA vol. 103, Dec 1981,1.JADA vol. 103, Dec 1981, 894. Ryle A. Bell, and894. Ryle A. Bell, and Richardson.Richardson. 2.Quintessence international2.Quintessence international 1987 :18;465. Sherif E,1987 :18;465. Sherif E, John unger and Carl StoneJohn unger and Carl Stone  They have presentedThey have presented techniques of non surgicaltechniques of non surgical managemant ofmanagemant of overhanging tuberosities foroverhanging tuberosities for CD patients.CD patients.  Overhanging tuberosities in these cases reduced intermaxillary space to less than 3 mm. This space did not allow for the adeqate thickness of U and L acrylic denture bases. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Before the recordBefore the record bases werebases were constructed, theconstructed, the tuberosities weretuberosities were outlined on the cast.outlined on the cast. In these areasIn these areas either type-3 goldeither type-3 gold alloy or co-cr alloyalloy or co-cr alloy was used aswas used as denture basedenture base material in place ofmaterial in place of acrylic resin.acrylic resin. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 3.J.Prosthet.Dent.3.J.Prosthet.Dent. 2004;92:128-31.2004;92:128-31. Leonard Garth LoweLeonard Garth Lowe presented a clinical reportpresented a clinical report for the non surgicalfor the non surgical management ofmanagement of bilateralbilateral undercut in tuberosityundercut in tuberosity region. They maderegion. They made decision to incorporatedecision to incorporate flexible flanges in theflexible flanges in the undercuts using resilientundercuts using resilient silicon lining materialsilicon lining material toto allow adequate height andallow adequate height and thickness of the denturethickness of the denture flangeflange.. www.indiandentalacademy.comwww.indiandentalacademy.com
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  • Sharp spiny processes-Sharp spiny processes-  There are sharp spiny processes onThere are sharp spiny processes on max. and palatal bone that are normallymax. and palatal bone that are normally deeply covered by soft tissues but indeeply covered by soft tissues but in patients with considerable RAR resorptionpatients with considerable RAR resorption these processes irritate soft tissues .these processes irritate soft tissues .  Canal leading from a posterior palatineCanal leading from a posterior palatine foramen often has a sharp overhangingforamen often has a sharp overhanging edge that may irritate palatal mucosa.edge that may irritate palatal mucosa. www.indiandentalacademy.comwww.indiandentalacademy.com
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  • Torus palatinus-Torus palatinus-  Seen as a hard bony enlargement that occursSeen as a hard bony enlargement that occurs in midline of the roof of mouth is called torusin midline of the roof of mouth is called torus palatinus.palatinus.  Seen in nearly 20% of populationSeen in nearly 20% of population  2 types2 types -almost entirely soft tissue, loose and flabby-almost entirely soft tissue, loose and flabby - thin layer of mucosal tissue covering the bone- thin layer of mucosal tissue covering the bone  Dentures require relief over this area to aidDentures require relief over this area to aid retention and prevent soreness of the underlyingretention and prevent soreness of the underlying tissues.tissues. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  A smoothA smooth rounded smallrounded small torus does nottorus does not normally createnormally create much problemmuch problem as dentureas denture plate may beplate may be cut away tocut away to avoid tori oravoid tori or can becan be extended overextended over it with properit with proper relief.relief. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  A large,A large, irregular, lobbedirregular, lobbed tori should betori should be treatedtreated surgically assurgically as cutting away thecutting away the denture platedenture plate significantlysignificantly reduces denturereduces denture retention andretention and also leads toalso leads to excessive ridgeexcessive ridge resorptionresorption.. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Mandibular anatomicMandibular anatomic landmarkslandmarks www.indiandentalacademy.comwww.indiandentalacademy.com
  • Limiting structures-Limiting structures- Labial frenum-Labial frenum- • Is a fold of mucous membrane at the median line. • It divides the labial vestibule into left and right labial vestibule. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The mandibular labialThe mandibular labial frenum contains afrenum contains a band of fibrousband of fibrous connective tissue thatconnective tissue that helps to attach thehelps to attach the orbicularis orisorbicularis oris muscle.muscle.  Therefore the frenumTherefore the frenum is quite sensitive andis quite sensitive and active, and theactive, and the denture must bedenture must be fitted carefully aroundfitted carefully around it to maintain a sealit to maintain a seal without causingwithout causing soreness.soreness. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Labial vestibule-Labial vestibule-  The labial vestibule is divided into left and right labial vestibule by the labial frenum. •  The mucous membrane lining the labial vestibule is relatively thin and is classified as lining mucosa. www.indiandentalacademy.comwww.indiandentalacademy.com
  •     The muscles of the lowerThe muscles of the lower lip pull actively across thelip pull actively across the denture border, polisheddenture border, polished surfaces, and teeth.surfaces, and teeth.  When the patient’sWhen the patient’s mouth opens wide, themouth opens wide, the orbicularis oris muscleorbicularis oris muscle becomes stretched,becomes stretched, narrowing the sulcus.narrowing the sulcus.  This would displace theThis would displace the mandibular denture if themandibular denture if the flange is unnecessarilyflange is unnecessarily thick. Mandibular denturesthick. Mandibular dentures and, hence, impressionsand, hence, impressions will always be narrowest inwill always be narrowest in the anterior labial region.the anterior labial region.www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The extent ofThe extent of denture flange in thisdenture flange in this region often is limitedregion often is limited because of thebecause of the muscles that aremuscles that are inserted close to theinserted close to the crest of ridge. Thecrest of ridge. The mentalis muscle ismentalis muscle is particularly active inparticularly active in this region.this region. Mentalis muscle Origin – crest of ridge, Insertion – chin Action – raises the lower lip www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The tone of theThe tone of the skin lower lipskin lower lip and orbicularis orisand orbicularis oris depends on thedepends on the thickness of thethickness of the flange and positionflange and position of the teeth.of the teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • John L. ShannanJohn L. Shannan. The mentalis muscle in. The mentalis muscle in relation to edentulous mandibles.relation to edentulous mandibles. J Prosthet Dent.1972;27;477-484J Prosthet Dent.1972;27;477-484  A study by dissecting 50 frozen cadavers,A study by dissecting 50 frozen cadavers, the following observations were established.the following observations were established.                 The thinner the mandible in a superior-The thinner the mandible in a superior- inferior direction, the nearer the origin of theinferior direction, the nearer the origin of the mentalis muscle will be to crest of the residualmentalis muscle will be to crest of the residual ridge.ridge.  The origin of the mentalis muscle isThe origin of the mentalis muscle is covered by the tissue (basal) surface of thecovered by the tissue (basal) surface of the lower denture and that the mentalis muscle canlower denture and that the mentalis muscle can complicate the development of the lower labialcomplicate the development of the lower labial flange of lower complete dentures.flange of lower complete dentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Space should be made in the labial flangeSpace should be made in the labial flange of lower individualized impression trays toof lower individualized impression trays to accommodate the mentalis muscle before theaccommodate the mentalis muscle before the final impression is made.final impression is made.  Each patient should be instructed toEach patient should be instructed to elevate his chin and protrude his chin andelevate his chin and protrude his chin and lower lip, as in pouting, during the primarylower lip, as in pouting, during the primary impression-making procedures.impression-making procedures.               The lower lip should not be mechanicallyThe lower lip should not be mechanically elevated by the dentist, because this procedureelevated by the dentist, because this procedure will not produce the same alteration in thewill not produce the same alteration in the impression as the mentalis muscle will underimpression as the mentalis muscle will under its own actionits own action www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Buccal frenum-Buccal frenum- • The buccal frenum forms the dividing line between the labial and buccal vestibule.  Frenum may be single or double, broad U shaped or sharp V shaped. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Is an active frenum as the fibres of the triangularis, zygomaticus and caninus muscles converge here to form a strong but movable base from which the orbicularis oris and buccinator may operate as antogonists.  It should be relieved to prevent displacement of the denture during function. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Buccal vestibule-Buccal vestibule-  The buccal vestibule extends posteriorly from the buccal frenum to the outside back corner of the retromolar pad.  The buccal flange, which starts immediately posterior to the buccal frenum, swings wide into the cheek and is nearly at right angles to the biting force  The impression is widest in this region. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The extent ofThe extent of buccal vestibule isbuccal vestibule is influenced by theinfluenced by the buccinator muscle,buccinator muscle, which extends fromwhich extends from the modiolusthe modiolus anteriorly to theanteriorly to the pterygomandibularpterygomandibular raphe posteriorly andraphe posteriorly and has its lower fibereshas its lower fiberes attatched to theattatched to the buccal shelf andbuccal shelf and external obliqueexternal oblique ridge.ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Extension ofExtension of distobuccal border atdistobuccal border at the end of buccalthe end of buccal vestibule is influencedvestibule is influenced by masseter muscleby masseter muscle activity.activity.  When the masseterWhen the masseter contracts, it’s anteriorcontracts, it’s anterior fibres alters the shapefibres alters the shape and size of theand size of the distobuccal end ofdistobuccal end of lower buccal vestibulelower buccal vestibule by pushing inwardby pushing inward against the buccinatoragainst the buccinator muscle and suctorialmuscle and suctorial pad of fat.pad of fat. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Action of masseterAction of masseter depends upon –depends upon – 1.1. origin of masseterorigin of masseter on zygomatic archon zygomatic arch  The distobuccalThe distobuccal borders of mandibularborders of mandibular denture must convergedenture must converge rapidly to avoidrapidly to avoid displacement bydisplacement by contracting forces.contracting forces. 2.2. relative size of masseterrelative size of masseter 3.3. shape of the mandibleshape of the mandiblewww.indiandentalacademy.comwww.indiandentalacademy.com
  • Distal extension-Distal extension-  The distal extension ofThe distal extension of denture of denture isdenture of denture is limited bylimited by 1.1. the ramus of mandiblethe ramus of mandible 2.2. by the buccinator muscleby the buccinator muscle fibers and pterygo-fibers and pterygo- mandibular raphemandibular raphe 3.3. superior constrictorsuperior constrictor musclemuscle 4.4. lateral bony boundaries of retromolar fossaelateral bony boundaries of retromolar fossae which are formed by continuation of intrenal andwhich are formed by continuation of intrenal and external oblique ridgeexternal oblique ridge www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Overextension of denture in thisOverextension of denture in this region compresses these structuresregion compresses these structures leading to soreness and compromisedleading to soreness and compromised function of buccinator.function of buccinator.  Desirable distal extension isDesirable distal extension is slightly to these bony prominencesslightly to these bony prominences and also includes retromolar pad areaand also includes retromolar pad area to provide a soft tissue seal.to provide a soft tissue seal. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Retromolar pad-Retromolar pad-  This is a triangular soft pad of tissues at the distalThis is a triangular soft pad of tissues at the distal end of lower ridge.end of lower ridge. Definition – “a mass of tissue comprised of non-keratinized mucosa located posterior to retromolar papilla and overlying loose glandular connective tissue”. GPT-8  This freely movable area should be differentiated from pear shaped pad. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Pear shaped pad- this is the most distal extension of attached keratinized mucosa overlying the mandibular ridge crest formed by the scarring pattern after extraction of most posterior molar. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The glandularThe glandular retromolar padretromolar pad is basically anis basically an mandibularmandibular extension ofextension of palatal glandularpalatal glandular mass.mass. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Its mucosa isIts mucosa is composed of a thin,composed of a thin, nonkeratinizednonkeratinized epithelium, and inepithelium, and in addition to loose alveolaraddition to loose alveolar tissue, its submucosatissue, its submucosa containscontains 1.1. glandular tissue,glandular tissue, 2.2. fibers of the buccinatorfibers of the buccinator and superior constrictorand superior constrictor muscles,muscles, 3.3. the pterygomandibularthe pterygomandibular raphe, andraphe, and 4.4. terminal part of theterminal part of the tendon of the temporalistendon of the temporalis www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The action of these muscles limitsThe action of these muscles limits the extent of the denture and preventsthe extent of the denture and prevents placement of extra pressure on theplacement of extra pressure on the distal part of the retromolar pad duringdistal part of the retromolar pad during impression procedures, because ofimpression procedures, because of this, the denture base should extendthis, the denture base should extend approximately one half to two thirdsapproximately one half to two thirds over the retromolar pad.over the retromolar pad. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Alveolingual sulcus-Alveolingual sulcus-  This is the space between residualThis is the space between residual ridge and tongue. It extends fromridge and tongue. It extends from lingual frenum to retromylohyoidlingual frenum to retromylohyoid curtain.curtain.  Border is considered in followingBorder is considered in following regions-regions- - anterior region- anterior region -middle region-middle region -posterior region-posterior region www.indiandentalacademy.comwww.indiandentalacademy.com
  • Anterior region-Anterior region-  Extends fromExtends from lingual frenum to thelingual frenum to the point where mylohyoidpoint where mylohyoid ridge curves aboveridge curves above the level of sulcus.the level of sulcus.  Here in this region aHere in this region a depression, thedepression, the premylohyoid fossaepremylohyoid fossae can be palpated andcan be palpated and correspondingcorresponding eminenceeminence premylohyoidpremylohyoid eminence can be seeneminence can be seen on impression.on impression. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Anterior alveolingual sulcus of bothAnterior alveolingual sulcus of both the sides together is called sublingualthe sides together is called sublingual crescent space.crescent space. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Ligual frenum-Ligual frenum-  It is a mucosal foldIt is a mucosal fold which originates at thewhich originates at the midline of undermidline of under surface of the tonguesurface of the tongue and often terminatesand often terminates at the sublingualat the sublingual salivary caruncles.salivary caruncles.  In other instances, itIn other instances, it crosses and bisectscrosses and bisects the sublingualthe sublingual crescent space andcrescent space and attaches onto theattaches onto the lingual aspect oflingual aspect of mandibular ridge.mandibular ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Just beneath theJust beneath the lingual frenumlingual frenum genioglossus musclegenioglossus muscle is found whichis found which originates fromoriginates from superior genialsuperior genial tubercles.tubercles.  It is a powerful andIt is a powerful and active but fortunatelyactive but fortunately narrow muscle.narrow muscle. Anterior fibers of thisAnterior fibers of this muscle when tensedmuscle when tensed raises up from floorraises up from floor of mouth and impingeof mouth and impinge on lower dentureon lower denture base.base. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Sublingual folds –  formed by the superior surface of the sublingual glands and the ducts of the submandibular glands. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Middle region-Middle region-  This region extends fromThis region extends from premylohyod fosa to the distal end ofpremylohyod fosa to the distal end of mylohyoid ridge.mylohyoid ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Mylohyoid muscleMylohyoid muscle originates from wholeoriginates from whole length of mylohyoidlength of mylohyoid ridge. Mylohyoid ridgeridge. Mylohyoid ridge runs obliquelyruns obliquely downwards anddownwards and forwards from belowforwards from below the 3the 3rdrd molar region tomolar region to the median line belowthe median line below genial tubercles but itgenial tubercles but it is sharp and distinct inis sharp and distinct in molar region andmolar region and becomes almostbecomes almost indiscernible anteriorly.indiscernible anteriorly. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  It is thin butIt is thin but wide musclewide muscle forming muscularforming muscular floor of mouth.floor of mouth.  Anteriorly fibresAnteriorly fibres of mucle on eachof mucle on each side join eachside join each other mediallyother medially and posteriorlyand posteriorly they continue tothey continue to hyoid bone to behyoid bone to be inserted there.inserted there.  Till premolar region muscle lies deep toTill premolar region muscle lies deep to sublingual salivary gland, so does not effect denturesublingual salivary gland, so does not effect denture borders except indirectly.borders except indirectly.www.indiandentalacademy.comwww.indiandentalacademy.com
  •  As we pass distally and reach molarAs we pass distally and reach molar region mylohyoid ridge and attachedregion mylohyoid ridge and attached muscle becomes quite superficial,muscle becomes quite superficial, effect of mylohyoid muscle on lingualeffect of mylohyoid muscle on lingual flange of denture is more pronouncedflange of denture is more pronounced in this region than anterior region.in this region than anterior region.  During swallowing mylohyoid muscleDuring swallowing mylohyoid muscle contracts raising floor of mouth.contracts raising floor of mouth. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  In relaxed state mylohyoidIn relaxed state mylohyoid muscle is a thin sheet ofmuscle is a thin sheet of muscle and does not resistmuscle and does not resist impresssion material so it isimpresssion material so it is very easy to carry impressionvery easy to carry impression material into the undercutmaterial into the undercut below mylohyoid ridge. Thisbelow mylohyoid ridge. This overextension can not beoverextension can not be tolerated by tissues in function.tolerated by tissues in function.  Lingual flange should beLingual flange should be made to slope towards themade to slope towards the tongue, parallel to mylohyoidtongue, parallel to mylohyoid muscle when it is contracted,muscle when it is contracted, well beyond the palpablewell beyond the palpable portion of mylohyoid ridge butportion of mylohyoid ridge but not in the undercut.not in the undercut. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  When middle ofWhen middle of lingual flange is made tolingual flange is made to slope towards theslope towards the tongue, it can extendtongue, it can extend below the level ofbelow the level of mylohyoid ridge. Thismylohyoid ridge. This way tongue rests on theway tongue rests on the top of flange and aids intop of flange and aids in stabilizing it. In additionstabilizing it. In addition this slope providesthis slope provides space for floor of mouthspace for floor of mouth to be raised duringto be raised during function withoutfunction without displacing the denture.displacing the denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  When the mylohyoid muscle is relaxedWhen the mylohyoid muscle is relaxed there is space between the flange and floorthere is space between the flange and floor of mouth but contact is reestablished whenof mouth but contact is reestablished when the floor of mouth is raised.the floor of mouth is raised.  If lingual border stops above theIf lingual border stops above the mylohyoid ridge, border seal can not bemylohyoid ridge, border seal can not be achieved and also vertical forces will causeachieved and also vertical forces will cause soreness at the mylohyoid ridge.soreness at the mylohyoid ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Posterior region-Posterior region-  Here the flangeHere the flange passes intopasses into retromylohyoid space.retromylohyoid space. This is pouch shapedThis is pouch shaped area is posterior toarea is posterior to mylohyoid musclemylohyoid muscle attachment.attachment.  Term retromylohyoidTerm retromylohyoid space was given byspace was given by Edward and BoucherEdward and Boucher in 1942.in 1942. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  It is no longerIt is no longer influenced by theinfluenced by the action of theaction of the mylohyoid musclemylohyoid muscle and so flange canand so flange can turn laterallyturn laterally towards body oftowards body of mandible to fill themandible to fill the fossa andfossa and complete typical Scomplete typical S form of theform of the correctly shapedcorrectly shaped lingual flange.lingual flange. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  RetromylohyoidRetromylohyoid fossa is boundedfossa is bounded posteriorly byposteriorly by retromylohyoidretromylohyoid curtain.curtain.  PosterolateralPosterolateral portion of curtainportion of curtain overlies superioroverlies superior constrictor muscleconstrictor muscle and posteromedialand posteromedial portion covers theportion covers the palatoglossal musclepalatoglossal muscle and lateral surface ofand lateral surface of tongue.tongue. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The medial pterygoidThe medial pterygoid muscle lies behindmuscle lies behind sup. constrictorsup. constrictor muscle. Contraction ofmuscle. Contraction of medial pterygoid canmedial pterygoid can cause a bulge in thecause a bulge in the wall of retromylohyoidwall of retromylohyoid curtain.curtain.  Denture border shouldDenture border should extend posteriorly toextend posteriorly to contact curtain whencontact curtain when tip of tongue is placedtip of tongue is placed against front part ofagainst front part of upper RAR asupper RAR as protrusion of tongueprotrusion of tongue causes curtain tocauses curtain to move forward.move forward. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Inferior wall ofInferior wall of retromylohyoidretromylohyoid curtain overliescurtain overlies submandibularsubmandibular gland Whichgland Which fills the gapfills the gap betweenbetween superiorsuperior constrictorconstrictor muscle andmuscle and most distalmost distal attachment ofattachment of mylohyoidmylohyoid muscle.muscle. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Anatomy of supportingAnatomy of supporting structures-structures- www.indiandentalacademy.comwww.indiandentalacademy.com
  • The buccal shelf area- •The area between the mandibular buccal frenum and the anterior edge of the masseter muscle is the buccal shelf. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Boundaries-Boundaries- medially- crest of RARmedially- crest of RAR anteriorly- buccal frenumanteriorly- buccal frenum laterally- external oblique ridgelaterally- external oblique ridge distally- retromolar paddistally- retromolar pad  This area may be very wide and is at rightThis area may be very wide and is at right angles to the vertical occlusal forces. Forangles to the vertical occlusal forces. For this reason it offers excellent resistance tothis reason it offers excellent resistance to such forces.such forces. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Buccinator muscle in buccal shelf area-Buccinator muscle in buccal shelf area-  Some of the buccinator fibers areSome of the buccinator fibers are located under the buccal flange in buccallocated under the buccal flange in buccal shelf area because mandibularshelf area because mandibular attachment of this muscle is close to theattachment of this muscle is close to the crest of ridge in molar region.crest of ridge in molar region. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  This attachment isThis attachment is dissimilar to otherdissimilar to other muscle insertionsmuscle insertions insofar as the fibersinsofar as the fibers run anteroposteriorly ,run anteroposteriorly , paralleling the bone,paralleling the bone, denture does notdenture does not resist the contractingresist the contracting force of the muscle,force of the muscle, and thus contractionand thus contraction of the muscle does notof the muscle does not lift the lower denture.lift the lower denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Mucous membrane covering the buccal shelf isMucous membrane covering the buccal shelf is more loosely attached and less keratinized than themore loosely attached and less keratinized than the mucous membrane covering the crest of the residualmucous membrane covering the crest of the residual ridge.ridge.  It also contains a thicker submucosal layer.It also contains a thicker submucosal layer.  The mucous membrane overlying the buccal shelfThe mucous membrane overlying the buccal shelf may not be as suitable histologically to providemay not be as suitable histologically to provide primary support for the denture as the mucousprimary support for the denture as the mucous membrane overlying the crest of the residual ridge.membrane overlying the crest of the residual ridge.  However , the bone of the buccal shelf is coveredHowever , the bone of the buccal shelf is covered by a layer of cortical bone, plus the fact that the shelfby a layer of cortical bone, plus the fact that the shelf lies at right angle to the occlusal forces, makes it thelies at right angle to the occlusal forces, makes it thewww.indiandentalacademy.comwww.indiandentalacademy.com
  •  RELIEF AREAS-RELIEF AREAS- www.indiandentalacademy.comwww.indiandentalacademy.com
  • Residual alveolar ridge-Residual alveolar ridge-  The crest of theThe crest of the residual alveolarresidual alveolar ridge is coveredridge is covered by fibrousby fibrous connective tissue,connective tissue, but in manybut in many mouths themouths the underlying bone isunderlying bone is cancellous andcancellous and without a goodwithout a good cortical bony platecortical bony plate covering it.covering it. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The mucous membrane covering the crest ofThe mucous membrane covering the crest of the residual ridge is covered by keratinizedthe residual ridge is covered by keratinized layer and is attached by its submucosa to thelayer and is attached by its submucosa to the periosteum of the mandible.periosteum of the mandible.  The extent of this attachment variesThe extent of this attachment varies considerably. In some people, the submucosaconsiderably. In some people, the submucosa is loosely attached to the bone over the entireis loosely attached to the bone over the entire crest of the residual ridge, and the soft tissue iscrest of the residual ridge, and the soft tissue is quite movable.quite movable.  In others, the submucosa is firmly attached toIn others, the submucosa is firmly attached to the bone on both the crest and the slopes of thethe bone on both the crest and the slopes of the lower residual ridge.lower residual ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  The mucous membrane of the crest ofThe mucous membrane of the crest of the lower residual ridge, when securelythe lower residual ridge, when securely attached to the underlying bone, is capableattached to the underlying bone, is capable of providing good soft tissue support for theof providing good soft tissue support for the denture.denture.  However, because underlying bone isHowever, because underlying bone is often cancellous, the crest of the residualoften cancellous, the crest of the residual ridge may not be favorable as the primaryridge may not be favorable as the primary stress-bearing area for a lower denture.stress-bearing area for a lower denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  Relative conditions vary from patient toRelative conditions vary from patient to patient, so a choice as to the bestpatient, so a choice as to the best distribution of presssure on the mandibulardistribution of presssure on the mandibular basal seat should be made .basal seat should be made .  If RAR is unfavourable ie sharp spiny andIf RAR is unfavourable ie sharp spiny and full of nutrient canals, masticatory pressuresfull of nutrient canals, masticatory pressures should be transferred only to buccal shelf,should be transferred only to buccal shelf, otherwise residual ridgeotherwise residual ridge can helpcan help in carryingin carrying loads effectively.loads effectively. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Mylohyoid ridge-Mylohyoid ridge-  Soft tissues usually hide sharpness ofSoft tissues usually hide sharpness of mylohyoid ridge.mylohyoid ridge.  Mucous membrane over a sharp orMucous membrane over a sharp or irregular mylohyoid ridge will be easilyirregular mylohyoid ridge will be easily traumatized by denture base, unless relieftraumatized by denture base, unless relief is provided in the denture base.is provided in the denture base. www.indiandentalacademy.comwww.indiandentalacademy.com
  • MENTALMENTAL FORAMEN-FORAMEN-  AAs resorption takess resorption takes place, the mentalplace, the mental foramen will come to lieforamen will come to lie closer to the crest ofcloser to the crest of ridge.ridge.  In these circumstances,In these circumstances, the mental nerve andthe mental nerve and blood vessels may beblood vessels may be compressed by denturecompressed by denture base unless relief isbase unless relief is provided.provided.  Pressure on mentalPressure on mental nerve can causenerve can cause www.indiandentalacademy.comwww.indiandentalacademy.com
  • GenialGenial tuberclestubercles  Like the mentalLike the mental foramina, theforamina, the genial tuberclesgenial tubercles usually lie wellusually lie well away from theaway from the crest of the ridgecrest of the ridge but withbut with resorption genialresorption genial tuberclestubercles becomebecome increasinglyincreasingly prominent.prominent. www.indiandentalacademy.comwww.indiandentalacademy.com
  • Torus mandibularis-Torus mandibularis-  Torus mandibularisTorus mandibularis is a bonyis a bony prominence usuallyprominence usually found bilaterally andfound bilaterally and lingually near thelingually near the first and secondfirst and second premolars midwaypremolars midway between the softbetween the soft tissues of the floor oftissues of the floor of mouth and crest ofmouth and crest of alveolar ridge.alveolar ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  •  In edentulas mouths whereIn edentulas mouths where considerable resorption hasconsiderable resorption has taken place, superior bordertaken place, superior border of the torus may be flush withof the torus may be flush with crest of the residual ridge.crest of the residual ridge.  The torus mandibularis isThe torus mandibularis is coverd by an extremely thincoverd by an extremely thin layer mucous membrane.layer mucous membrane.  It often needs surgicalIt often needs surgical removal because it can beremoval because it can be difficult to provide relief withindifficult to provide relief within the denture for the torusthe denture for the torus without breaking the borderwithout breaking the border seal.seal. www.indiandentalacademy.comwww.indiandentalacademy.com
  • References- www.indiandentalacademy.comwww.indiandentalacademy.com
  • 1. R. T. Hill. Anatomy of interest to the prosthodontist. J Prosthet Dent.1955; 5; 109-111 2. G. A. Lammie. Aging changes and the complete lower denture. J Prosthet Dent.1956; 6; 450-464 3. John O. Neufeld. Changes in the trabecular pattern of the mandible following the loss of teeth. J Prosthet Dent.1958; 8; 685-697 4. Irming R. Hardy and Krishan K. Kapur posterior border seal – its rationale and importance. J Prosthet Dent. 1958; 8; 386-397 5. R. Wheeler Haines and Sidney G. Barrett. The structure of the mouth in the mandibular molar region. J Prosthet Dent. 1959; 9; 962-974 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 6. Joseph S.Landa. Trouble shooting in complete denture prosthesis. Part I. Oral Mucosa and border extension. J Prosthet Dent.1959; 9; 974-987 7. Rovert B. Lytle Soft tissue displacement beneath removable partial and complete dentures. J Prosthet Dent.1962; 12; 34-43 8. Thomas E. J. Shanahan. Stabilizing lower dentures on unfavorable ridges. J Prosthet Dent.1962; 12; 420-424 9. H. R. Kolb. Variable denture-limiting structures of the edentulous mouth. J Prosthet Dent. 1966; 16; 194-201 10. H. R. Kolb. Variable denture limiting structures of the edentulous mouth. J Prosthet Dent. 1966; 16; 202-212 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 11. Donald E. Van Scotter and Louis J. Boucher. The nature of supporting tissues for complete dentures. J Prosthet Dent.1965; 15; 285-294 12. Ellsworth K. Kelly. The prosthodontist, the oral surgeon and the denture-supporting tissues. J Prosthet Dent. 1966; 16; 464-478 13. Philip M Jones and LeRoy K. Nakayama. Surgical experiences of complete denture patients. J Prosthet Dent. 1967; 18; 12-18 14. K. W. Tyson. Physical factors in retention of complete upper dentures. J Prosthet Dent. 1967; 18; 90-97 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 15. Sidney I. Silverman. Dimensions and displacement patterns of the posterior palatal seal. J Prosthet Dent. 1971; 25; 470-488 16. John L. Shannon. The mentalis muscle in relation to edentulous mandibles. J Prosthet Dent. 1972; 27; 477- 484 17. Wlodzimierz Jozefowicz. Cushioning properties of the soft tissues forming the basal seat of dentures. J Prosthet Dent. 172; 27; 471-476 18. L. Lye. The significance of the fovea palatini in complete denture prosthodontics. J Prosthet Dent. 1975; 33; 504-510 19. H. Nikoukari a study of posterior palatal seals with varying palatal forms. J Prosthet Dent. 1975; 34; 605- 613 20. Harold R. Ortman and Ding H. Tsao. Relationship of the incisive papilla to the maxillary central incisors. J Prosthet Dent. 1979; 42; 492-496 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 21. Ming-Sheh Chen. Reliability of the fovea palatini for determining the posterior border of the maxillary denture. J Prosthet Dent. 1980; 43; 133-147 22. Aust.Dent.J.1981:26;218-21.22. Aust.Dent.J.1981:26;218-21. 23. Ian b. Watson and D. Gordon Macdonald. Regional variation in the palatal mucosa of the edentulous mouth. J Prosthet Dent. 1983; 50; 853-859 24. T. E. Jacobson and A. J. Krol. A contemporary of the factors involved in complete denture retention, stability, and support. Part I: Retention. Part II: stability Part III support. J Prosthet Dent. 1983; 49; 5,165,306 25. J.Prosthet.Dent.1987:57;712-1425. J.Prosthet.Dent.1987:57;712-14 26. J.Oral.Rehab.1988:15;133-3926. J.Oral.Rehab.1988:15;133-39.. 27. H. F. Grove and L. V. Christensen. Relationship of the maxillary canines to incisive papilla. J Prosthet Dent. 1989; 61; 51-53 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 28. G. C. D. Kau and R. F. K. Clark. The relationship of the incisive papilla to the maxillary central incisors and canine teeth in southern Chinese. J Prosthet Dent. 1993; 70; 86-93 29. J.Prosthet.Dent.29. J.Prosthet.Dent. 2004;92:128-312004;92:128-31 30. Sheldon Winkler. Essentials of complete denture prosthodontics. 2nd edition 31. Zarb-Bolender Prosthodontic treatment for edentulous patients.12th edition 32. Fenn, liddelow and Gimsons`s :Clinical dental prosthetics. 3rd edition 33. Verrill G. Swenson: Complete dentures 4th edition 34. Charles M. Heartwell: textbook of complete dentures. 5th edition www.indiandentalacademy.comwww.indiandentalacademy.com
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