Kinetics of orofacial muscles in c.d. dr barman /orthodontic courses by Indian dental academy

THE CONCEPTS OF
KINETIC OF
OROFACIAL MUSCLES
IN COMPLETE
DENTURE
PROSTHODONTICS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Educationwww.indiandentalacademy.com

INTRODUCTION
“Nothing is more fundamental to
treating patient than knowing the
anatomy” – Jeffrey.P.Okeson23
www.indiandentalacademy.com

(We) prosthodontist treat patients with artificial
substitutes that restore the natural teeth and/or
replace missing teeth and craniofacial tissues. So,
we are responsible to introduce life in the artificial
substitutes (prosthesis). A prosthesis can be called
as a successful prosthetic therapy when it can fulfill
the following the requirements.
1.Compatibility with the surrounding oral
environments.
2.Restoration of masticatory efficiency within limits
3.Ability to function in harmony during mastication,
speech respiration and deglutition.
4.Esthetics acceptability
5.Prevention of that which remainwww.indiandentalacademy.com

Out of the aforementioned requirements,
No. 5 is a challenge to the prosthodontist.
To meet these requirements and
challenge the prosthodontist must have
proper knowledge of the basic anatomy
and physiology of the orofacial structure
and sound understanding of biophysics
and biomechanics of the supporting
structures of the prosthesis.

“Muscles are of primary interest because it
performs mechanical works” 24
. The
kinematics and relative movements of
orofacial muscles are responsible for facial
expression in projecting the personality and
characteristic of the individual. Muscles that
produce movement of the mandible, hyoid
bone, the tongue, lips, cheeks, soft palate,
oro-pharynx, in turn help in mastication,
speech, respiration and deglutition. These
muscles are also responsible to keep the
mandible in rest position and maintain health
and comfort of the stomatognathic systemwww.indiandentalacademy.com

The muscles of facial expression,
muscles of the tongue, the suprahyoid
muscles, the muscles of soft palate and
pharyngeal muscles are primarily
involved in determining the extent of the
border and contour of the polished basal
seat of the removable prosthesis and
also in positioning of the teeth.
Therefore, the proper handing of these
muscles during any prosthodontic
procedure is an essential act to make
use of the muscular movement to serve
the purposes of the prosthesis.www.indiandentalacademy.com

The aim of this seminar is to understand the
kinematics and relative motions of the
orofacial musculature.
Within the context of the seminar, I will
discuss the kinetic of orofacial muscles and
analyze their relevant prosthodontic
significance with emphasis in relation to
removable complete denture therapy; since
the retention, stability, support and
esthetics of this type of prosthesis are
mainly facilitated by the underlying hard
and associated soft tissues

SOME TERMINOLOGIES
Kinetic – pertaining to or producing motion3
/
relating to and resulting from motion28
Kinetics – The scientific study of the turnover or
rate of change or specific factor in the body,
commonly expressed as units of amount per
unit time. 3
Chemical kinetics3
– the study of the rates and
mechanism of chemical reactions
Kinematics- The phase of mechanics that deals
with possible motion of a material body (GPT)27
Kinesilogy attempts to explain the manner in
which movement of the body occur by
considering collective areas of information from
anatomy, physics and mechanics” 29

Fascia (FASH – e a, fascia = bandage)- the
term applied to a sheet or broadband of
fibrous connective tissues underneath the
skin or around muscles and organs of the
body.
Fasciculi – bundle of muscle
Tendon and aponeuroses - extension of
connective tissue beyond muscle cells that
attach the muscle to bone or other muscle
Ligaments - dense, regularly arranged
connective tissues that attach bone to bone

Isotonic contraction – As the contraction
occurs, the muscle shortens and pulls
on another structure such as bone to
produce movement. During such
contraction, the tension remains
constant and energy is expended.
Isometric contraction: Muscle length
does not shortens but the tension
greatly increases. This type of
contraction does not produce any
movement. www.indiandentalacademy.com

MUSCLES
OF
OROFACIAL
COMPLEX

The muscles of the orofacial complex
are of skeletal and striated type and
voluntary in nature.. The skeletal
muscles of this regions are responsible
for different functional and non
functional movements. Muscle fibers
are mixture of type I (slow) and type II
(fast) fibers in varying proportions that
reflect the function of that muscles.
The slow muscle fibers have a well-
developed aerobic metabolism and are
therefore resistance to fatigue. The fast
muscle fibers are capable of quick
contraction but fatigue more rapidly.www.indiandentalacademy.com

GROWTH AND DEVELOPMENT

The muscles of the mouth
and related structures are
derived from the mesoderm
of the branchial arches .
About the sixth seek of
embryonal life, the muscles
of these arches, which are
innervated by certain cranial
nerves, undergo modification
and migration but retain their
original cranial nerve supply.
The muscles of mastication,
the tensor veli palatini tensor
tympani, anterior belly of the
digastric, and mylohyoid, are
derived from the first
branchial arch and are
supplied by the mandibular
brach of the trigeminal (Vth
cranial) nerve.

The muscles of facial expressions are derived
from the second or hyoid arch, innervated by the
Facial (VIIth cranial) nerve
From the third and fourth arches, develop the
pharyngeal, laryngeal, and the other palatal
muscles, which are supplied by the
Glossopharyngeal (IXth), Vagus (Xth cranial)
and the cranial portion of the Spinal Accessory
(XIth cranial) nerves.
The muscles of the tongue(hypoglossal cord)
and extrinsic muscles of eyes however, are
derived from the condensed somites those are
formed from the myoblast cells located close to
the neural plate. The tongue muscles are
supplied by the Hypoglossal (XIIth cranial)
nerve.

AGING AND MUSCLE TISSUE
Beginning at about 30
years of age, a
progressive loss of
skeletal muscle mass
that is largely replaced
by fat. Accompanying
the loss of muscle
mass, there is a
decrease in maximal
strength and a
diminishing of muscle
reflexes. www.indiandentalacademy.com

KINETIC OF OROFACIAL MUSCLES
“Fundamentally, any functional movement is a result of
muscular contraction.”14
Facial movements – facial movements are the result of
the automatic coordinated effort of many muscles in
different functional capacities executed in the cerebral
cortex.
SENSORY CORTEX MOTOR CORTEX

Movement occurs through paired muscular activity.
In order for a muscle to contract, its opponents must
relax. Individual muscles may function by being (1)
prime movers (2) antagonists, (3) fixators, or (4)
synergists.
The movements of the
skeletal parts can be
explained using the
lever system :
Class I
Class II
Class III

Prime movers are actually responsible
for the movement, whereas
antagonists are those muscles, which
produce opposing movements. Thus in
closing the mouth, the inframandibular
muscles relax and the three closing
muscles of mastication contract ; in
opening of the mouth the reverse
action takes place

Fixation muscles establish a stable basis
by steadying a structure. For example the
infrahyoid muscles steady the hyoid bone
so that the suprahyoid muscles may
contract lowering the mandible.
A synergist ( “to work together” )muscle
aids the prime mover in it’s action. For
example, the internal pterygoid muscle is
a synergist of masseter muscle in that it
helps it to elevate the mandible.

ANATOMY IN ACTION - INTERPLAY
OF MUSCLE AND BONE
For any facial movements, there
must be a frame; that frame is
the skull. In the anatomic region
concerned with these
movements, there exist a fixed
bone region and a movable
bone region. The two points of
anchorage are the anterior part
of the cranium and the sternum,
and between are synergistic
groups of muscles that move the
skin and bone to alter
expression. Between these
anchors, the mandible and the
hyoid bone are suspended.www.indiandentalacademy.com

The two condyles of the mandible articulate with
the cranium in the mandibular fossae of the
temporal bones. These articulations provide
certain leverage advantages as well as control
and limitation of mandibular movement. Further
limitation is placed on the movements of the
mandible by the teeth and by muscle
attachments. The hyoid bone, smaller than the
mandible but of a similar shape, is situated in
front of the throat at the root of the tongue. It is
called the tongue bone because it supports the
tongue and serves as an origin of attachment for
some of its muscles. It is not articulated with any
other bone. Its movements are dependent upon
muscular activity.

Some of these functions are
of a vegetative nature,
common to all animals,
such as breathing,
mastication, and deglutition,
while others, equally highly
specialized, are
characteristic of man, such
as speech and facial
expression.
The pyramidal area14-16
housing these two movable
bones, their articulators, and the muscle
attachments is of extreme significance because of
the multiple functions, which take, place in whole or
in part therein.

MOVEMENTS OF FACIAL EXPRESSION
Studies of the evolution of facial
expression in man indicate that there is
practically no facial expression in the
newborn infant. It becomes manifold and
definite as the infant’s conscious and
intelligent reactions to the surrounding
world increase.14

THE FACIAL MUSCLES OF EXPRESSION
Muscle Origin Insertion Action Innervation
Frontalis
(Front =
forehead)
Galea
aponeuroti
ca
Skin
superior
to
supraorbit
al line
Draws scalp
forward, raises
eye brows, and
wrinkles skin of
forehead
horizontally
Facial (VII)
nerve
Occipitalis
(occipito =
base of
skull)
Occipital bone
and
mastoid
process of
temporal
bone
Galea
aponeurot
ica
Draws scalp
backward
(Facial (VII)
nerve
Orbicularis
oris
(Orb =
circular;
or=
mouth
Muscle fibers
surroundin
g opening
of mouth
Skin at corner
of mouth
Closes lips,
compresses
lips against
teeth, protrudes
lips, and shapes
lips during
speech.
Facial (VII)
nerve

Zygomaticus
major
Zygomatic =
cheek bone;
major =
greater
Zygomatic bone
Skin at angle of
mouth and
orbicularis
oris
Draws angle of mouth
upward and outward
as in smiling o
laughing
Facial (VII)
nerve
Levator labii
superioris
(levator = raises
or elevates;
labii = lip;
superioris =
upper)
Superior to
infraorbital
foramen of
maxilla
Skin at angle of
mouth and
orbilaris oris
Elevates (raises) up per
lip
Facial (VII)
nerve
Depressor labii
inferioris
(depressor =
depresses or
lowers;
inferioris =
lower
Mandible Skin of lower lip
Depresses (lowers)
lower lip
Facial (VII)
nerve
Buccinator
(bucc = cheek)
Alveolar processes
of maxilla and
mandible and
pterygomandibu
lar raphe
(fibrous band
extending from
the pterygoid
hamulus to the
mandible)
Orbicularis oris
Major cheek muscle;
compresses cheek
as in blowing air out
of mouth and
causes cheeks to
cave in, producing
the action of
sucking
Facial (VII)
nerve

Mentalis
(mentum = chin)
Mandible Skin of chin
Elevates and protrudes
lower lip and pulls
skin of chin up as in
pouting
Facial (VII)
nerve
Platysma
(platy = flat,
broad)
Fascia over
deltoid and
pectoralis
major
muscles.
Mandible
muscles
around
angle of
mouth and
skin of lower
face
Draws outer part of
lower lip downward
and backward as in
pouting; depresses
mandible
Facial (VII)
nerve
Risorius
(risor = laughter)
Fascia over
parotid
(salivary)glan
d
Skin at angle of
mouth
Draws angle of mouth
laterally as in
tenseness
Facial (VII)
nerve
Orbicularis oculi
(Ocul = eye)
Medial wall or
orbit
Circular path
around orbit
Closes eye
Facial (VII)
nerve
Corrugator
supercilli
(corrugo =
wrinkle;
supercilium
= eyebrow)
Medial end of
superciliary
arch of
frontal bone.
Skin of eyebrow
Draws eyebrow
downward as in
frowning
Facial (VII)
nerve
Levator
palpebrae
superioris
(palpebrae =
eyelids)
Roof of orbit
(lesser wing
of sphenoid
bone)
Skin of upper
eyelid
Elevates upper eye lid
Oculomotor (III)
nerve.

These muscles are further characterized
by the insertion of delicate fiber and
tendon attachments into the skin and
mucosa of the lips and by their rich
innervations and blood supply.
These muscles are directly subjacent to
the freely movable skin. When they
contract, the elastic skin is folded at right
angles to the direction of the pull of the
muscles.

By repeated contraction of the
muscles that are inserted directly
into the cutis. Wrinkles develop into
grooves or dimples. These grooves
become deeper with advancing age
because of the loose of elasticity of
the skin.

For the purposes of description the
muscles of facial expression may be
divided into the following groups:
(1) the muscles of the forehead,
(2) the muscles of the eyelids and
eyebrows,
(3) the muscles of the nose, and
(4) the muscles of the lips and cheeks.

Muscles of the forehead: the frontalis is a large, flat
quadrilateral muscle having no bony attachment. It
originates from the galea aponeurotica of the scalp
and is inserted into the skin under the eyebrows and
the skin over the root of the nose.
Its broad fibers blend in
with other muscle fibers
in the orbital region. The
contraction of this
muscle is responsible for
the transverse line of the
forehead and the raising
of the eyebrows, giving
an expression of
surprise, amazement, or
fear. www.indiandentalacademy.com

Muscles of the eyelids and eyebrows: The
orbicularis oculi surrounds the eye, and its
contraction closes the eyelid, pulls down the
eyebrow, and raises the cheek. The latter
two actions are responsible for the “cow feet”
wrinkles in the corner of the eye.

MUSCLES THAT MOVE THE EYEBALLS EXTRINSIC MUSCLES
Muscles Origin Insertion Action Innervations
Superior rectus
(superior = above;
rectus = in this case,
muscle fibers running
parallel to long axis of
eyeball)
Tendinous ring
attached to bony or
bit around optic
foramen
Superior and central
part of eyeball
Rolls eyeball upward Oculomotor(III) nerve
Inferior rectus
(inferior = below)
Same as above Inferior and central
part of eye ball
Rolls eyeball
downward
Oculomotor (III)
Lateral rectus Same as above Lateral side of eyeball Rolls eyeball laterally Oculomotor (VI)
Medial rectus Same as above Medial side of eyeball Rolls eyeball medially Oculomotor (III)

Superior oblique
(oblique = in this
case, muscle fibers
running diagonally
to long axis of eye
ball
Same as above Eyeball between
superior and lateral
recti
Rotares eyeball on
its axis; directs
cornea downward
and laterally; note
that is moves
through a ring of
fibrocartilaginous
tissue called the
trochlea (trochlea =
pulley)
Trochlear (IV) nerve
Inferior oblique Maxilla (front of
orbital cavity)
Eyeball between
inferior and lateral
recti
Rotates eyeball on
its axis; directs
cornea upward and
laterally
Oculomotor (III)
nerve

The corrugators is the chief muscle
controlling the movements of the eyebrow.
A supercilious look of an individual is the
result of the contraction of this muscle.
The eyebrows are pulled downward and
medially, resulting in vertical wrinkles of
the forehead.

MUSCLES OF THE NOSE REGION:
The four muscles of the nose
are very delicate and feeble.
They are the procerus,
nasalis, dilatoris naris, and
depressor septi nasi
The procerus has its origin in
the bridge of the nose,
inserting into the skin
between the eyebrows, the
glabella. When it contracts, it
tends to pull the eyebrows
downward, and wrinkles occur
over the bridge of the nose.

The nasalis muscle draws the
wing of the nose toward the
septum. The nares of the
nose are compressed by this
action, and this compression
may be observed during the
crying of an infant or the
utterance of certain speech
sounds.
The nostrils are dilated by the
action of the two dilatores
naris, and the depressor septi
nasi draws the septum
downward, flattening the
philtrum of the maxillary lip and
narrowing the nostril.

MOVEMENTS OF LIPS AND CHEEKS MUSCLES
The range may be from
the quiet warmth of a
smile to uproarious
laughter, but in either
expression, the muscles
of the lips and cheeks
play a dominant role, and
their action is frequently
accompanied by a
brightening or lighting up
of the eyes.
Emotion of joy – Joy or happiness may be reflected in
individuals in varying degrees, depending upon the intensity
of the emotion experienced and the emotional level of the
person.

Smile – “Physically and psychologically a
smile enhances ones outward appearance
and tend to improve self-confidence and
feeling self-worth” in general, the movements
associated with a smile are lifting or raising
motions, producing upward lines which are
characteristic of laughter. A smile may be
slight and of momentary duration, or it may
be intense and prolonged. It may be
unaccompanied by sound or it may be a
facial overtone during speech resulting in the
modifications of certain speech sounds.

In smiling, there is contraction of the
zygomaticus major (antagonist:
orbicualris oris), which draws the
modiolus, and the angle of the mouth
upward and backward. The quardatus
labii superioris (antagonist: orbicularis
oris) elevates the maxillary lip, the
corner of the mouth, and the ala nasi.
The risorius (antagonist : orbicularis
oris) works in synergistic action with
the buccinator and draws the angle of
the mouth backward, producing a
grinning expression which may not of
pleasant quality. Its action is
associated with smiling and speech
but not laughter. www.indiandentalacademy.com

The fibers of the orbicularis oris muscle
occupy the entire width of the lips. They
extend from the angles of the mouth and
run medially across the midline to insert
into connective tissue and skin in the ridge
area of the philtrum and the septum of the
nose. the bulk of the orbicularis oris
muscle is made up of a continuation of the
fibers of the buccinator muscle as well as
all the muscles that insert into the lips.

The arrangement
and movement of the
fibers are similar in
both lips.The
convergence of the
fibers at the angle of
the mouth is known
as the modiolus. 14
Muscles radiate from
the modiolus like an
array of fans.7

A smile may terminate with the face returning to a
state of repose and the modiolus assuming its
neutral position. This termination is brought about
by the simultaneous contraction of the orbicularis
oris muscle and the relaxing of all the muscles
contributing to the smiling expression.
When the face is in repose, the mandible is in a
physiologic rest position. As smiling occurs, the
elevating actions of the smiling musculature,
working synergistically with the three elevator
muscle raise the mandible and retrude it slightly
toward the vertical dimension of occlusion,
diminishing the interocclusal distance.

Laughing: The smile, instead of terminating,
many progress to accelerated proportions in
the activity of laughter, which is characterized
by the opening of the mouth and separation
of the teeth.
Lightoller 14
, in describing laughter, says that
the modioli are drawn cranially and laterally
and the maxillary lip forms a straight or
somewhat orally convex line stretching from
modiolus to modulus. He suggests that the
maxillary teeth are exposed as far laterally as
the first molar and cranially as far as the
gingivae, and even this may be exposed.

The distance between the nasal septum
and the red marking of the maxillary lip is
very much decreased, and the nasolabial
fold is deepened, concaved orally, and
extended downward to the rima oris, its
cranial portion becoming more horizontal
in direction. The mandibular lip is bowed
downward, with marked oral concavity, but
the mandibular teeth are only slightly
exposed or may not be seen.

Emotion of distress – In distress, the mouth is firmly closed.
The rima oris is reduced in size to a narrow, cranially bowed
slit with the corners of the mouth extending downward.
This is caused by (1) the tensing
of the muscles inserted in to the
modioli which fixes the modioli
and (2) the pushing of the
mandibular lip under and against
the maxillary lip by the superior
and inferior portions of the
orbicularis oris muscle. The
mandibular lip becomes broader
laterally and, in so doing,
produces creases the continue
into the curved depression of the
rima oris. This action makes it
appear that the angle of the
mouth has been dragged
downward and laterally.

MOVEMENTS OF TONGUE MUSCLES
One of the most versatile and complex of
the structures of the stomatognathic
system is the tongue. It is the main organ
of taste, the chief articulator in speech,
and an all-purpose organ in the processes
of mastication and deglutition.

Muscles Origin Insertion Action Innervation
Genioglossus
Geneion = chin;
glossus =
tongue
Mandible
Undersurface of
tongue and
hyoid bone
Depresses
tongue and
thrusts it
forward
(protraction)
Hypoglossal (XII)
nerve
Styloglossus
(stylo = stake or
pole; styloid
process of
temporal
bone)
Styloid process of
temporal
bone
Side and
undersurface
to tongue
Elevates tongue
and draws it
backward
(retraction)
Hypoglossal (XII)
nerve
Palatoglossus
(palato = palate)
Anterior surface of
soft palate
Side of tongue
Elevates posterior
portion of
tongue and
draws soft
palate down
on tongue
Pharyngeal plexus
hyoglossus
Body of hyoid
bone
Side of tongue
Depresses
tongue and
draws down
its sides
Hypoglossal (XII)
nerve

permit wide range of
movements, varied in
both strength and
direction, and rapid and
numerous changes in
form.Movements of the
tongue are facilitated by
salivary lubrication.
Lessening of such
lubrication creates a
slowdown in the
customary deft and rapid
tongue activities
occurring in eating and
speech.
The root of the tongue is attached to the soft palate, pharynx,
hyoid bone, and epiglottis, while the tip, sides, and dorsum are
free. The extrinsic muscles (genioglossus, hyoglossus,
styloglossus and glossopalatinus) of the tongue,

During the process of mastication, the tongue
serves as a greeter, a moistener, a shock
absorber, a bracer, a guide, a taster, a crusher,
sorter, a mixer, and a disposer.
In speech, the autonomous and passive
movements of the tongue permit its arching in
conjunction with actions of the pharynx and oral
cavity to form resonators.15
The tongue also acts
with the teeth and hard and soft palates as the
articulatory agent responsible for the production
of vowel sounds and the majority of consonants.

The great adaptability of the tongue is
apparent when teeth are lost and when
missing teeth are replaced . With the loss
of teeth, the takes over their role in the
comminution of food with hard palate in
the mortar and pestle type of crushing
action. with the insertion of denture, the
tongue begins an immediate
accomodation to the new perimeters set
by the appliance ,thus ensuring that the of
eating and speaking may be continued.

It should be noted that the tongue assumes various positions.
Although combine action of extrinsic muscle are related to tongue
position; the palato glossus muscle is closely associated with
tongue position.
Wright classified the tongue positions as follows31
Class I – The tongue lies in the floor of the mouth with the tip
forward and slightly below the incisal edges of the mandibular
anterior teeth. It is considered as normal tongue position.
Class II – the tongue is flattened and broadened but the tip is in a
normal position.
Class III – The tongue is retracted and depressed into the floor of
the mouth with the tip curled upward, downward and assimilated in
to the body of the tongue. Hypoglossus muscle action may be
more strong than styloglossus in this position.
In prosthodontic treatment planning, these positions as well as the
tongue’s size, rate and range of movement, are all factors
requiring consideration15

MUSCLES THAT MOVE THE MANDIBLE,
FLOOR OF THE MOUTH AND THE HEAD
The muscle of mastication in association with
inframandibular muscles can produce varying
degree of mandibular movement in several
direction. The kinetic of these muscles help to
perform mastication, swallowing and speech and
also aid in respiration and expression of emotion.
The other major muscle such as
sternocleidomastoid and posterior cervical
muscles play a major role in stabilizing the skull
and enabling controlled movement of the
mandible to be performed.
Therefore, it is indeed important to know in details
about these muscles and their relevant
movements.

MUSCLES OF MASTICATION
Four pairs of muscles make up a group called
the muscles of mastication:
(1) Masseter, (2) temporalis, (3) medial
pterygoid, and (4) lateral pterygoid.

MASSETER
The masseter is a rectangular muscle that originates from
the zygomatic arch and extends downward to the lateral
aspect of the lower border of the ramus of the mandible. Its
insertion on the mandible extends from the region of the
second molar at the inferior border posteriorly to include the
angle. It is made up of two portion or head: (1) the
superficial portion, which consists of fibers that run
downward and slightly backward, and (2) the deep portion,
which consists of fibers that run in a peredominantly vertical
direction.

As fibers of the masseter contract, the mandible is
elevated and the teeth are brought into contact.
The masseter is a powerful muscle that provides
the force necessary to chew efficiently. Its
superficial portion may also aid in protruding the
mandible. When the mandible is protruded and
biting force is applied, the fibers of the deep portion
stabilize the condyle against the articular
eminence.

TEMPORALIS
The temporalis is a large, fan
shaped muscle that originates from
the temporal fossa and the lateral
surface of the skull. Its fibers
come together as they extend
downward between the zygomatic
arch and the lateral surface of the
skull to form a tendon that inserts
on the coronoid process and
anterior border of the ascending
ramus. It can be divided into three
distinct areas according to fiber
direction and ultimate function

The anterior portion consists of fibers that are
directed almost vertically
The middle portion contains fibers that run
obliquely across the lateral aspect of the skull
The posterior portion consists of fibers that are
aligned almost horizontally, coming forward
above the ear to join other temporalis fibers as
they pass under the zygomatic arch

When the temporal muscle contracts it elevates the
mandible and the teeth are brought into contact. If
only portions contract the mandible is moved
according to the direction of these fibers that are
activated. When the anterior portion contracts, the
mandible is raised vertically. Contraction of the middle
portion will elevate and retrude the mandible. Function
of the posterior portion is somewhat controversial.
Although it would appear that contraction of this portion
would retrude the mandible,

DuBrul25
suggest that the fibres below the
root of the zugomatic process are the only
significant one; therefore contraction will
cause elevation and only slight retrusion.
Because the angulation of its muscle
fibres varies, the temporalis is capable of
co-ordinating closing movements. Thus it
is significant positioning muscle of the
mandible.

MEDIAL PTERYGOID
The medial (internal)
pterygoid originates from the
pterygoid fossa and extends
downward, backward, and
outward to insert along the
medial surface of the
mandibular angle. When its
fibers contract, the mandible is
elevated and the teeth are
brought into contact. This
muscle is also active in
protruding the mandible.
Unilateral contraction will bring
about a mediotrusive
movement of the mandible.

LATERAL PTERYGOID
The lateral pterygoid is divided and identified
as two distinct and different muscles, which
is appropriate because their functions are
nearly opposite. The muscles are described
as the inferior lateral and the superior lateral
pterygoids.

Inferior lateral pterygoid: The inferior lateral pterygoid originates
at the outer surface of the lateral pterygoid plate and extends
backward upward, and outward to its insertion primarily on the
neck of the condyle. When the right and left inferior lateral
pterygoids contract simultaneously, the condyles are pulled
down the articular eminences and the mandible is protruded.
Unilateral contraction creates a mediotrusive movement of that
condyle and causes a lateral movement of the mandible to the
opposite side. When this muscle functions with the mandibular
depressors, the mandible is lowered and the condyles glide
forward and downward on the articular eminences.

SUPERIOR LATERAL PTERYGOID
The superior lateral pterygoid is considerable smaller than the
inferior and originates at the infratemporal surface of the
greater sphenoid wing, extending almost horizontally,
backward, and outward to insert on the articular capsule, the
disc and the neck of the condyle. The exact attachment of the
superior lateral pterygoid to the disc is somewhat debated.
Although some authors 30
suggest no attachment, most studies
reveal the presence of the muscle and disc attachment.
LITERATURE

Although the inferior lateral pterygoid is
active during opening the superior
remains inactive becoming active only in
conjunction with the elevator muscles.
The superior lateral pterygoid is especially
active during the power stroke and when
the teeth are held together. The power
stroke refers to movements that involve
closure of the mandible against
resistance, such as in chewing or
clenching the teeth together.

It is to note that the pull of the lateral pterygoids
on the disc and condyle is in a significantly
medial direction. As the condyle moves more
forward, the medial angulation of the pull of
these muscles becomes even greater. In the
wide-open mouth position, the direction of the
muscle pull is more medial. It is interesting to
note that approximately 80% of the fibers that
make up both lateral pterygoid muscles are slow
muscle fiber (type I) 23
This suggests that these
muscles are relatively resistant to fatigue and
may serve to brace the condyle for long periods
of time without difficulty.

It is essential for a prosthodontist to be fully
aware not only of the basic mandibular
movements and positions but also of functional
patterns of movements, in which variations may
occur because of emotional state or physiologic
needs. These varying patterns may be noted in
either extent of movement or rate of speed at
which it takes place. Such motion patterns are
dislodging forces which must be anticipated in
the design of any that must absorb them and still
maintain a degree of stability and retention.

MUSCLES OF THE FLOOR OF THE ORAL CAVITY

SUPRAHYOID & INFRAHYOID MUSCLES
The infrahyoid muscles are
the sternohyoid,
sternothyroid, omohyoid and
thyrohyoid muscles. They
depress the hyoid bone and
larynx and fix the hyoid bone
so that the suprhyoid muscles
may act upon the mandible.
These muscles suspend the hyoid bone, lower the mandible,
and have prosthodontic significance in relation to physiologic
rest position. speech, facial expression, mastication and
deglutition. The suprahyoid muscles consist of the digastric,
stylohyoid, mylohyoid and geniohyoid muscles. They are
depressors of the mandible and elevators of the hyoid bone.

These are voluntary muscles but act reflexively
and, during mandibular rest position, are in
balance with the supramandibular muscles. The
interocclusal distance is due to the equal tonicity
of the supramandibular and the inframandibular
muscles. As compared with the closing muscles
of the mandible, these are very small and weak.
They are used for rapid movements and those of
long duration. In old age, the supramandibular
muscles increase in tonicity, while the
inframandibular muscles decrease.

The vertical tug of war which takes
place in the opening and closing
movements of the mandible is
produced by the elevators of the
mandible (the temporalis masseter,
and internal pterygoid) and the
depressor of the mandible (the
geniohyoid mylohyoid and digastric)
the external pterygoid muscles move
the mandible forward, while the
posterior fibers of the temporalis
retrude the mandible. The external
pterygoid and the elevators opposite
them produce the side to side or
lateral movements. These movements
are basic and are governed
neurologically by a central regulator,
which receives impulses through the
various physiologic reflex arcs.

MUSCLES THAT MOVE THE HEAD

Mandibular movements are limited and modified
by the temporomandibular articulations
posteriorly and the teeth anteriorly. The
mandible assumes various positions, which
serve as starting, limiting, and returning points in
its complex physiologic activities. Those on to
vertical plane are physiologic rest position and
vertical dimension of occlusion. Those on a
horizontal plane are centric relation (which also
has a vertical component) and right and left
lateral and protrusive positions. All of these
mandibular movements and positions occur
within the perimeter of extreme movements,
which the mandible is capable of performing.

POSTERIOR CERVICAL MUSCLES
The head rests upon the atlas,
the uppermost vertebra of the
spinal column, in positional
unbalance because the center
of gravity of the head is not
directly over the atlas, but
anterior to it, in the
approximate region of the
temporomandibular articulation.
The weight of the projecting
mandible and teeth suspended
from this region lies about in
the center of the entire
polyfunctional pyramid, 14-16
thus
contributing to this unbalance.

The structures responsible for
maintaining the head in balance are
the posterior cervical muscles
working antagonistically to the
supramandibular and
inframandibular muscles.
Thus, if one falls asleep in an
upright position, and the
musculature controlling this balance
relaxes, gravity pulls the head
forward and the mandible down.
The posterior cervical muscles
function continuously approximately
two-thirds of each day, maintaining
the heavy head in balance.
They are also responsible for the many and delicate positioning of
the head associated with the activities of expression, eating,
breathing, vision, hearing, gait, and posture.
Prosthodontically, little concern is evidenced for these muscles as
contrasted with the interest displayed in their antagonists.

MUSCLES THAT MOVES THE SOFT PALATE
Levator veli palatani
Levetor = rouses
Velum = veil
Palato -palat
Petrous portion of
temporal bone
and medial wall
of auditory
tube
Blend with
corresponding
muscle of
opposite side
Rlevate soft palate
during
swallowing
Pharyngeal plexus
Tensor veli palatini
Tensor makes
tense
Medial pterigoid
plate of
sphenoid bone,
spine of
sphenoid,
lateral wall of
auditory tube
Palatine
oponeuosis
and palatine
bone
Tenses (tightens
soft palate
during
swallowing
Mandibular branch
of trigeminal
(V) nerve
Muscular avule
(urulac urula)
Posterior border of
the hard palate
and palatine
oporeurosis
Uvula Tenses (tighten and
raises uvula )
Pharyngeal plexus
Platoglossus
(palato = plate;
glossus =
tongue
Anterior surface of
soft palate
Side of tongue Elevates posterior
portion of
tongue and
draws soft
palate down on
tongue
Pharyngeal plexus
Palatopharyngeus
(pharyngo =
pharynx
Posterior border of
hard palate
and palatine
aponeurosis
Posterior border of
thyroid cartilage
and lateral and
posterior wall of
pharynx
Elevates larynx and
pharynx and
helps close
nasopharynx
during
Pharyngeal plexus

Musculature of the soft palate is divided into two functional
groups, the depressors and elevators. The depressors are
extrinsic muscles, the glossopalatinus and pharyngopalatinus,
which extend laterally, and inferiorly into the tongue and
pharynx, of which they are an integral part. The contraction of
these muscles elevates the tongue, pharynx, and larynx and
depresses the soft palate, thus narrowing the isthmus of the
fauces.
The elevators of the soft
palate, the tensor and
lavator veli palatini and the
musculus uvulae, are
primarily contained within
the soft palate.

The tensor veli palatini, as the name implies,
flattens tenses, and lowers the soft palate and at
the same time opens the Eustachian tube. The
levator veli palatini raises the soft palate increases
its arch, and articulates the velum border with the
posterior wall of the pharynx. The musclulus uvulae
shortens. Tenses, and raises the uvula.

Based on the degree of flexure the soft palate makes
with the hard palate and the width of the palatal seal
area, soft palate can be classified 31
Class I : the soft palate is rather horizontal and
demonstrates little muscular movement.
Class II: The soft palate turns downward at about a
45 degree angle to the hard palate and the amount
of potential tissue coverage for the palatal seal is
less than for class I.
Class III: The soft palate turns downward sharply at
about a 70-degree angle just posteriorly to the hard
palate. Since this is the most acute relation the soft
palate makes with the hard palate, the musculature
must make the most elevation to effect
velopharyngeal closure. So, the available space for
coverage by the posterior border and this is
considered as the least favorable soft palate form.

The kinetic
of the soft
palate in
coordination
with tongue
muscle and
muscle of
pharynx
and larynx
play a major
role during
the process
of eating,
breathing
and speechwww.indiandentalacademy.com

MUSCLES OF PHARYNX
Circular layer
Inferior
constrictor
(inferior = below;
constrictor =
decreases
diameter of a
lumen
Cricoid and
thyroid
cartilages of
larynx.
Posterior median
raphe of
pharynx
Constricts
inferior
portion of
pharynx to
propel a
bolus into
esophagus
Pharyngeal
plexus
Middle
constrictor
Greater and
lesser cornu
of hyoid
bone and
stylohyoid
ligament.
Posterior median
raphe of
pharynx
Constricts
middle
portion of
pharynx to
propel a
bolus into
esophagus
Pharyngeal
plexus
Superior
constrictor
(Superior =
above)
Pterygoid
process,
pterygomand
ibular raphe,
and
mylohyoid
line of
mandible
Posterior median
raphe of
pharynx
Constricts
superior
portion of
pharynx to
propel a
bolus into
esophagus
Pharyngeal
plexus

Longitudinal
layer
Stylopharyngeus
(stylo = stake or
pole; styloid
process of
temporal
bone;
pharyngo =
pharynx )
Medial side of
base of
styloid
process.
Lateral aspects of
pharynx and
thyroid
cartilage
Elevates larynx
and dilates
pharynx to
help bolus
descend.
Glossopharyngeal
(IX) nerve.
Salipingopharyng
eus
(salping =
pertaining to
the auditory
or uterine
rube)
Inferior portion of
auditory
(Eustachian)
tube
Posterior fibers of
palatopharyn
geus muscle.
Elevates superior
portion of
lateral wall of
pharynx
during
swallowing
and opens
orifice of
auditory
(Eustachian)
tube
Pharyngeal plexus
Palatopharyngeus
(palato = palate)
Soft palate
Posterior border
of thyroid
cartilage and
lateral and
posterior wall
of pharynx
Elevates larynx
and pharynx
and helps
close
nasopharynx
during
swallowing
Pharyngeal plexus

MUSCLES OF LARYNX
Extrinsic
Omohyoid
(omo = relationship
to the
shoulder;
byoedes = U-
shaped; per
taining to hyoid
bone)
Superior border of
scapula and
superior
transverse
ligament.
Body of hyoid bone
Depresses hyoid
bone
Branches of
ansacervicalis
nerve (C1-C3)
Sternohyoid
(sterno = sternum)
Medial end of
clavicle and
manubrium of
sternum
Body of hyoid bone
Depresses hyoid
bone
Branches of
ansacervicalis
nerve (C1-C3)
Sternoothyroid
(thyro = thyroid
gland )
Manubrium of
sternum
Thyroid cartilage of
larynx
Depresses thyroid
cartilage
Branches of
ansacervicalis
nerve (C1-C3)
Thyrohyoid
Thyroid cartilage of
larynx
Greater cornu of
hyoid bone
Elevates thyroid
cartilage and
depresses
hyoid bone
Branches of
ansacervicalis
nerve (C1-C2)
and
descending
hypoglosal
(XII) nerve

Intrinsic
Cricothyroid
(crico = cricoid
cartilage of larynx)
Anterior and lateral
portion of cricoid
cartilage of larynx
Anterior border of
inferior cornu of
thyroid cartilage of
larynx and posterior
part of inferior border
of lamina of thyroid
cartilage
Produces tension
and congation of
vocal folds
External laryngeal
branch of vagus (X)
nerve
Posterior
cricoarytenoid
(arytaina = shaped
like a jug)
Posterior surface of
cricoid cartilage
Posterior surface of
muscular process of
arytenoids cartilage
of larynx.
Opens glottis
Recurrent laryngeal
branch of vagus (X)
nerve
Lateral cricoary
tenoid
Superior border of
cricoid cartilage
Anterior surface of
muscular process of
Closes glottis
Recurrent laryngeal
branch of vagus (X)
nerve
Arytenoids
Posterior surface
and lateral border of
one arytenoids
cartilage
Corresponding parts
of opposite
Closes glottis
Recurrent laryngeal
branch of vagus (X)
nerve
Thyroaryytenoid
Inferior portion of
angle of thyroid
cartilage and middle
of cricothyroid
ligament
Base and anterior
surface of arytenoids
cartilage
Shortens and
relaxes vocal folds.
Recurrent laryngeal
branch of vagus (X)
nerve

The process of eating can be divided into
(1) premasticatory (2) masticatory
(3) swallowing activities associated with the
intake of food and preparation for its entrance
into esophagus.
The premasticatory phage begins before the act
of eating start.
The masticatory phage is a series of highly
coordinated functions in the process of chewing
food or swallowing and digestion

SWALLOWING (DEGLUTITION)
Swallowing is a series of coordinated muscular
contractions that moves a bolus of food from the
oral cavity through the esophagus to the
stomathic. It consists of voluntary, involuntary
and reflex muscular activity.
Stabilization of the mandible is an important part
of swallowing. The mandible must be fixed so
that contraction of the suprahyoid and infrahyoid
muscles can control proper movement of the
hyoid bone needed for swallowing. The normal
adult swallow that uses the teeth for mandibular
stability has been called the somatic swallow.
When teeth are not present, as in the infant, the
mandible must be braced by other means. In
the infantile swallow, or visceral swallow, the
mandible is braced by placing the tongue
forward and between the dental arches or gum
pads.

Although swallowing is one continuous act, for purposes
of discussion it is divided into three stages. 23
First Stage: The first stage of swallowing is voluntary
and begins selective parting of the masticated food into
a mass or bolus. This separation is performed mostly
by the tongue. The bolus is placed on the dorsum of the
tongue and pressed lightly against the hard palate.
The tip of the tongue rests
on the hard palate just
behind the incisors. The
lips are sealed and the
teeth are brought together.
The presence of the bolus
on the mucosa of the palate
initiates a reflex wave of
contraction in the tongue
that presses the bojus
backward. As the bolus
reaches the back of the
tongue, it is transferred to
the pharynx.

Second stage: Once the bolus has reached the pharynx a
peristaltic wave caused by contraction of the pharyngeal
constrictor muscles carries it down to the esophagus.
The soft palate rises to touch the posterior pharyngeal
wall, sealing off the nasal passages. The epiglottis blocks
the pharyngeal airway to trachea and keeps the food in
the esophagus.
During this stage of swallowing,
the pharyngeal muscular activity
opens the pharyngeal orifices of
the Eustachian tubes, which are
normally closed. It is estimated
that these first two stages of
swallowing together last about 1
second

Third stage: the third stage of swallowing consists of
passing the bolus through the length of the esophagus and
into the stomach. Peristaltic waves carry the bolus down
the esophagus. The waves take 6 to 7 seconds to carry
the bolus through the length of the esophagus. As the
bolus approaches the cardiac sphincter, the sphincter
relaxes and lets it enter the stomach.
It the upper section of the
aesophagus, the muscles are
mainly voluntary and can be
used to return food to the
mouth when necessary for
more complete mastication.
In the lower section the
muscles are entirely
involuntary. www.indiandentalacademy.com

CLINICAL APPLICATIONS OF CONCEPT OF
KINETIC
The diagnostic phase:
Diagnosis begins when the Prosthodontist first
views his patient. At this moment, he receives
immediate mental impressions relative to the
patient’s general physical appearance, age, gait
posture, coloring, facial contours, etc. These
are observations based on external signs and
symptoms revealed in surface anatomy.
Changes in surface anatomy which are caused
by loss of support from natural tissues or their
artificial substitutes are evident when an
adequate diagnosis is made.

Some of the external evidences of
loss of supporting structures are
sunken cheeks, flattened lips,
decrease in the width of the
vermilion border of the lips,
increased depth of folds and
grooves in the face, and a decrease
of occlusal vertical dimension,
producing changes in facial
proportions and bringing the nose
closer to the chin.

However, lack of support may not
always be the entire cause of some
of the sings and symptoms apparent
in surface anatomy. Inherited
tendencies can exert strong
influences on surface markings,
such as folds and grooves or lip
contours. It is important to
determine whether surface markings
are the result of supportive loss or
are inherited characteristics of the
individual.

This will affect the
prosthodontic treatment
because any attempt to
provide support artificially
where there has been no
loss of support will result in
eradication of natural
contours, which are
characteristic of the patient.
Pre-extraction photographs of the patient are aids in
making this evaluation.
Losses of elasticity of the skin and muscular tonicity
are also apparent in studying skin texture and tone and
result from loss of supporting structures.www.indiandentalacademy.com

External evidences of temperament and
tension – In general, the direction of the lines of
the face can be taken as indicative of the
individual’s emotional makeup or temperament.
A person with a happy disposition, accustomed
to smiling and laughing has facial lines with the
upward cast characteristic of mirth. 18
Conversely, the person with a dour personality
is likely to have facial lines with a downward
slant associated with sorrow or grief.

Observation of these facial markings in the
initial diagnosis provides a clue to the
temperament of the patient and suggests
problems, which may be encountered in
determining the proper amount of support by
the denture for the facial structures in order to
preserve or minimize certain facial lines.
Symptoms of stresses or tensions are frequently
apparent in the surface anatomy of the face and
neck. These symptoms include taut lines about
the mouth, tightly compressed lips, teeth held
almost continuously in contact with a resultant
loss of vertical dimension of occlusion, and
strained musculature in the neck region.

OTHER INDICATION FROM
SURFACE ANATOMY
The eyes are frequently the most
expressive features of the face.
They may gain in attractiveness in
the aging process, while the mouth
may become less attractive.
Although distant from the mouth,
the eyes do have significance in
prosthodontic diagnosis and
treatment. Asymmetry of the face
may be apparent in the eyes, since
their shape contributes to the
general contour of the face.
This involves the muscle attachments within the oral
cavity, the strength and amount of tongue activity, and the
dislodging forces that may be exerted on dentures by the
muscles of facial expression and craniomandibular
muscles.

Any asymmetry of the eyes observed in diagnosis should
be noted so that necessary allowances can be made
when the pupils of the eyes are used as reference points
in building occlusion rims or in positioning teeth.
Thus far, external signs and
symptoms apparent in the first
view of the static surface
anatomy have been considered.
However, when the patient
begins to speak, a new source of
diagnostic aids becomes
available. For it is then that he
begins to reveal himself as a
distinct personality, characterized
by individual habits of facial
expression, speech, and
mannerisms.

The speech and facial expressions of the patient
may be studied during the initial interview. An
analysis of these functions, to be meaningful, must
be based on a normal unstrained performance.
The patient must be put at ease, and his interest
must be directed toward his own problems. in
recounting these, he is likely to become
concerned to the extent of dropping any strained
or false mannerisms of expression. The request
“Tell me about your teeth” generally accomplishes
this purpose.
During the patient’s response a twofold evaluation
is made: the first is based upon factual information
supplied by the idea content of the spoken words
the second is based on the quality of voice and
speech plus the many and varied movements of
the face accompanying the speech performance.

SPEECH AND PATIENT
CLASSIFICATION
Speech sometimes serves as an aid in the initial
classification of the patient 18
. Rapid jerky speech
is frequently characteristic of the hysterical
patient. The exacting patient often displays
forcefulness and abrupt speech qualities in
placing his question and stating his demand .In
contrast to these patients, the speech of the
philosophic or indifferent patient is less forceful
and of the more even rate. The indifferent patient
frequently has monotone quality in his speech,
which may occur as a result of his lack of interest
and certainly reflects the absence of enthusiasm.www.indiandentalacademy.com

SPEECH DEFECTS
Many persons are not aware that they have
speech defects. Preoperative speech
recordings during the preliminary interview
enable the patient to hear his own voice as it
sounds to others and to note defects of which he
may not have been aware
Some speech defects are accompanied by
changes in facial expression, and they result
from (1) a defective dentition (2) defective
dentures (3) ill health or (4) geriatric changes.

A patient who has lost most of the teeth and has
never had them replaced reflects speech
modifications. During the period in which the
teeth have been lost, he has been forced to
make certain adaptive movements to
compensate for these losses in order to continue
to engage in understandable speech. The ability
to accommodate when oral structures are lost is
evidenced by the fact that people with no teeth
or with ill-fitting dentures continue to speak and
to be understood.

EFFECTS OF LOSS OF TEETH ON OTHER SPEECH
ARTICULATORS
The loss of posterior teeth results in
spreading of the tongue. The loss of
anterior teeth and supporting structures
reduces lip support. The failure to replace
missing teeth causes a drifting of
remaining teeth and changes in occlusion.
Thus, three of the main articulators in
speech (tongue, lips, and teeth) have
been modified. The fundamental role of
these articulators is in the production of
conosonantal sounds, which require
impedance or checking of the airstream to
occur. www.indiandentalacademy.com

DEFECTS IN PRONUNCIATION OF
CERTAIN CONSONANTS
Even under ideal conditions, i.e. when a speaker
has a full complement of natural teeth in near
normal positions, the consonants s and z present
more difficulty in pronunciation and are less pleasing
to the ear than any other consonants. 18
It follows,
therefore, that the consonants s and z are of major
concern in prosthodontic treatment. Defects in their
pronunciation by denture patients may be caused by
(1) the inability of the tongue and lips to perform
precise, firm movements in directing the stream of
air, (2) too large an interocclusal distance (3)
missing or malpositioned teeth (4) wide diastemas,
(5) lack of auditory acuity.

Defects in the pronunciation of the
consonants f and v are most often caused
by the inability of the mandibular lip to
contact the maxillary incisors properly.
Observation should be made of the length
and position of the maxillary anterior teeth
while the patient is saying “five” and
“valve” or words which contain these
labiodental sounds. The teeth should
come into slight end-to-end contact with
the center of the mandibular lip.

Defects in the pronunciaton of the
consonants t and d are often due to
placement of the maxillary anterior teeth
too far palatally. These linguopalatal
sounds are produced when the tongue
articulates against the maxillary teeth and
palate. Therefore, if the tongue contacts
the teeth and palate too soon, the sound
cannot be made properly

FACIAL EXPRESSION
There are many reasons for including
facial expression in the functional analysis
of the patient. Movements of facial
expression are generally habitual. They
are frequently vigorous movements
employing muscles adjacent to dentures
and can, therefore, exert dislodging
pressures. The activity of facial
expression is engaged in many hours of
the day, as is speech. A deteriorating
dentition or unsightly dentures can be
responsible for an individual acquiring
compensatory facial expressions to
conceal a dental deformity.www.indiandentalacademy.com

SIGNIFICANT FACIAL MOVEMENT
Certain types of facial movements have
particular significance in treatment
planning.
Exaggerated movements of the cheeks,
lips and tongue during speech must be
noted so as to incorporate them in the
dentures.

HABITUAL FACIAL EXPRESSION
“Masticatory muscle hyperactivity is thought to
produce muscle pain and tension headaches and
can cause excessive wear or breakage of
restorative dental materials used in the treatment
of prosthodontic patients. The quantification and
identification of this type of activity is an important
consideration in the preoperative diagnosis and
treatment planning phase of prosthodontic care.” 9
Habitual facial expressions employing
exaggerated movements of the elevators and
depressors of the lips can be dislodging forces to
dentures unless these movements are recognized
and allowances are made for them.

DIAGNOSTIC EVALUATION OF THE
EDENTULOUS MOUTH
Three acts are performed almost
simultaneously in the examination of an
edentulous mouth: (1) observation, (2)
interpretation (3) visualization .
All these three act should be thoroughly
evaluated for a (i) Evidence of a structural
loss (ii) Structural changes (iii)
Relationship changes,

The amount of space between the residual
alveolar ridge and the lips during functional
activities must be considered in relation to the
denture flanges. Dentures are frequently
constructed with the lips in repose and without
regard for overactive mentalis muscles. These
muscles, when functioning, will reduce the labial
vestibular space and tend to dislodge the
mandibular denture. 10
The overfilling of this
vestibular space with the denture flanges and
malpositioning of the teeth can have a marked
effect on speech, particularly in plosive and f
and v sounds. If overfilled, it will eradicate the
normal mentolabial sulcus.
LITERATUREwww.indiandentalacademy.com

MODIOLUS
In an edentulous mouth, the modioli assume a sagging
position, become less active, diminish in size, and change in
shape. This malposition and loss of tonicity caused by lack of
tooth support can produce leakage of food liquids, and saliva
at the corners of the mouth and result in angular cheilosis and
a downward cast in these regions. A digital examination of
the modiolus is made by placing the index finger in the buccal
pouch or vestibule on the inner surface of the cheek
and the thumb on the outer
surface of the cheek and directing
the patient to swallow.
Observations of these highly
functional landmarks should be
made in relation to their size,
development and flexibility.

The mandibular denture should be visualized in relation to
the allowance necessary to accommodate for this muscle
mass. The modioli can be used to an advantage in
stabilizing the maxillary dentures by placement of the
maxillary premolars in a position above them. Thus, during
functional activities involving elevation of the lips, there are
fixing and elevation of the modioli and uplifting of the
maxillary denture. By directing the patient
to smile, the Prosthodontist can
use the modioli as reference
point in determining the occlusal
plane to develop the smiling line.
The application of these two
principles changes the shape of
the mouth by uplifting its corners
and creating more pleasant
contours www.indiandentalacademy.com

The tongue is a powerful and extremely
adaptable organ. Observation of the
position of the tongue should be made with
the mouth relaxed and about half open. If
the tongue is in a retruded position, it may
dislodge the mandibular denture by raising
the lingual flanges and permitting air to get
under them. However, it the tongue is in a
forward position, resting on the mandibular
anterior ridge, it will serve as a stabilizer to
the mandibular denture. Because of the
great adaptability of the tongue, patients
may be trained by conditioning exercises to
reposition the tongue from an unfavorable
to a more favorable position.www.indiandentalacademy.com

During swallowing, the teeth serve as
limiting boundaries to the inward
movements of the cheeks and lips and to
the upward and outward movements of
the tongue and sublingual structures. The
region housing the teeth and alveolar
supporting structures has been called
variously “the neutral zone”, “a dead
space” and “the potential denture space”

This space is difficult to located because of (1)
the changes in the alveolar ridge, (2) the
approximation of the tongue and cheeks in their
attempts to fill this region, (3) the reorientation of
muscular attachments which changes the
structural relationships, (4) the constantly
changing shape and position of the tongue
during functional activities and (5) the closed
position of the lips during certain of these
activities.

The structures under the tongue are of
concern particularly when they are in an
abnormal functional relationship to the
mandibular ridge. Because of the
comparative delicacy of these structures, they
are difficult to record without displacement.

When these unfavorable conditions are observed,
consideration must be given to them both before
and during the construction of dentures.
The size or form of the hard palate and its relation
to soft palate should be observed and interpreted.
As the residual alveolar
ridge becomes smaller,
these sublingual
structures become
more dominant in their
functional relation to
the residual ridge.

CLINICAL APPLICATION OF
CONCEPTS OF KINETIC
The recording phase:
The recording phases can be considered as a
continuous diagnostic phage since they permit to
learn more about the patient as the procedures
are performed. They furnish the opportunities to
observe patients willingness and ability to carryout
instruction, reflex responses healing capacities
and his adaptability possibilities. 19
The recording phases start with the making of
primary impression followed by border moulding
and making of final impression and registration of
jaw registration records.

IMPRESSION
The impression procedures must adhere to the
following biological principles (Boucher C.O) 5
dictated by the anatomy and physiology of the
edentulous mouth so as to enhance the
retention, stability and support of a denture.
1.The impression is extended to include all of the
basal seat within the limits of the health and
functions of the supporting and limiting tissues.
2.The borders are in harmony with the anatomic
and physiologic limitations of the oral structures.

3.A physiologic type of border-moulding procedure
is performed by the prosthodontist or by the
patient under the guidance of the prosthodontist.
4.Proper space for the selected final impression
material is provided within the impression tray.
5.Selective pressure is placed on the basal seat
during the making of the final impression.
6.The impression can be removed from the mouth
without damage to the mucous membrane of the
residual ridge.

7.A guiding mechanism is provided for
correct positioning of the impression tray
in the mouth.
8.The tray and final impression are made of
dimensionally stable materials.
9.The external shape of the final impression
is similar to the external form of the
completed denture.

PRIMARY IMPRESSION
When a primary impression is made for
preparation of a custom tray for final
impressions, the objectives are to all areas to be
covered by the adjacent landmarks with an
impression material that is accurate and
incorporate the minimum of tissue
displacement. So the right (stock) tray should
be selected and modified (and border should be
beaded with soft wax) to fulfill our objectives.
The impression tray should be approximately 6
mm. larger then the outside surface of the
residual alveolar ridge when alginate is chosen
as the impression material.www.indiandentalacademy.com

The maxillary impression should include
the hamular notches, fovea palatina,
entire buccal vestibule, including the
aforementioned retrotubercle sulcus,
fernum attachments, palate and entire
labial vestibule. The mandibular
impression should include the retromolar
pads. The buccal shelf areas, the external
oblique ridges, frenum attachments
sublingual space, retromylohyoid space,
the posterior mucous membrane floor of
the mouth to include and be below the
mylohyoid line and the entire labial and
buccal vestibules.

All the functional movement of the lips,
cheeks and the tongue should be
recorded by allowing the patient to do the
same movement during impression
making after the tray is stabilized. Any
exaggerated movements that are noted
during diagnostic phage must be recorded
in the same way.

BORDER MOULDING AND FINAL IMPRESSION
Schematic presentation of border moulding

Schematic presentation of border moulding

The border moulded final impression
tray should be so formed that it
supports the cheeks and lips in the
same manner as the finished denture
will do. The lingual surface of the
mandibular tray should be shaped so
that it guides the tongue into the
same position it will occupy in relation
to the finished denture. 24

It should be possible for the patient to wipe with
the tip of the tongue across the vermilion border
of the upper lip with the tray in place in the
mouth without noticeable displacement of the
tray. An approximate 0.5 mm of border
moulding material should be removed from
around the border and final impression is made.
All the functional movement of the tongue
cheeks and lips should be recorded in the same
way as in the primary impression.

RECORDING OF MAXILLOMANDIBULAR RELATION
Provisional vertical dimension of physiologic rest
position
In recording maxillomandibular relation by physiologic
method, the vertical dimension of the rest position is
first registered. It is the vertical separation of the two
jaws, which exist when the entire mandibular
musculature is in a state of tonic contraction. After
each of the functional activities of swallowing,
speaking, and breathing the patient’s mandible
assumes a resting position by being suspended by the
equal tonicity of its musculature. When the lips are in
slight contact with each other facial measurements are
recorded between two landmarks, the base of the
nose and the mentolabial sulcus. This measurement
is a provisional reference point from which the
recording of the vertical dimension of occlusion may
be related. www.indiandentalacademy.com

SWALLOWING
The act of swallowing is used initially because it
provides a more natural action to determine the
height of the mandibular occlusion rim. The
occlusal surface of the mandibular occlusion rim
is uniformly softened in a warm water bath, and
the occlusion rim is placed in the patient’s
mouth. With the maxillary occlusion rim in
place, the patient is asked to swallow several
times. The space between the tow facial
reference points is determined and recorded.
The swallowing procedure should be repeated if
necessary. The occlusion rims are removed
from the patient’s mouth, and separated

Phonetics: certain
speech sounds may serve
as an aid in recording
physiologic rest position.
Speech containing ‘m’
sounds brings the lips
together and positions the
mandible in physiologic
rest. The patient is
instructed to say a series of
m sounds until he
experiences fatigue
sensations at which time a
measurement is made.
Breathing: Facial measurements obtained immediately
after the patient has inhaled and exhaled several times
serve as additional aids in recording physiologic rest
position. www.indiandentalacademy.com

Vertical dimension of occlusion
Provisional vertical dimension of occlusion can be
obtained using speech activities similar to those
used in recording the physiologic rest positions.
Phonetics
The patient is asked to count rapidly from 45 to 70
observation should be made by standing slightly to
the side of the patient. During the speech
performance, there should be 3-4 mm. gap
between the two occlusal rims. It is important to
observe for any interferences that can occur
during the utterance of s sound as in 46, 56, 66….
If interference is noted, the occlusion rims should
be reduced in height until there is a slight
clearance when the patient makes the s sounds.

CLINICAL APPLICATION OF
CONCEPTS OF KINETIC
The final phases of denture
construction
Although certain esthetic factors may be
considered with the face in the static state,
final esthetic determinations should never
be made with the face in repose. The vital
movements associated with speech and
facial expression are actually esthetics in
action. Dentures must serve in harmony
with such functions. Therefore, the mouth
in action must be the testing environment.www.indiandentalacademy.com

LIP SUPPORT
Adequate lip support involves more than a
concern for esthetics physiologically, the
functions of speech, facial expression,
eating and breathing are all affected by it.
The main objectives in establishing
adequate lip support are to obtain and
maintain the natural harmonies of the lips
and cheeks during the complex interplay
of the musculature in functional
performances. 20

The framework of musculature chiefly
responsible for the contours and
movements of the lips is the orbicularis
oris which is composed of the interlacing
fibers of all of the muscles of the lips.
Because of its complexity, Sicher25
has
described the orbicularis oris as a muscle,
which “is only functionally but not
anatomically a unit”. In order to apply the
principle of muscular efficiency ,it
becomes imperative that this functioning
unit be held in the natural position it
occupied during its development when it
was supported by the natural teeth and
supporting structures.www.indiandentalacademy.com

In considering problems of lip support,
more attention is generally accorded to
the maxillary lip than to the mandibular lip.
Pursing and sphincter actions of the lips
and symmetrical outlines of their muscle
fibers may suggest that the two lips
function in a similar fashion. The elevating
action produced in the mandibular lip by
the mentalis muscle is one evidence that
this is not so.

The mandibular lip, bounded laterally by the
labiomarginal sulci, the rima oris above, and the
mentolabial sulcus below, is usually smaller and
more active than the maxillary lip. The relative
sizes, shapes and surface outlines of the two lip
change during functional movements.
The correct support is provided where structural
loss exists by proper positioning of the labial
surfaces of the mandibular anterior teeth. In
instances where a marked resorption of the
residual ridge has occurred, resulting in a lowering
of the reflective tissues of the labial vestibule to a
level with or below the mentolabial sulcus, the
sulcus can be eradicated by overfilling the
vestibular region with the denture flange. This is
not advisable form the standpoint of esthetics or
function. www.indiandentalacademy.com

GUIDELINES FOR DEVELOPING
ADEQUATE LIP SUPPORT
1.The following guides may be used in establishing
adequate lip support.
2.The best aids will be found the information
revealed in study casts and photographs of the
natural teeth.
3.The same dimension and contours of the
functional occlusion rims should be maintained by
the anterior teeth to preserve static dynamic facial
length
4.The arch form of the teeth should follow the arch
form of the residual ridge.

4.The labial surfaces of the teeth should be 8 to 10
mm. in front of incisive papilla and should be out
as far or in front of the labial flange.
5.The midline of the teeth is usually in the same
sagittal plane as the incisive papilla and the
midline of the face.
6.The distance from the necks of the anterior teeth
to the residual ridge is governed by the amount of
resorption of the ridge
7.The incisal edges of the maxillary and mandibular
teeth should approach each other, but not contact,
during the pronunciation of words containing the
sibilants s, z, zh, ch and j

8.The length of the maxillary anterior teeth and the
amount which shows below the lip should be
checked by having the patient say words
beginning with f and v. If the f sounds like v, the
teeth are too long
9.If th, as in these and those, sounds like d, the
teeth are positioned too far palatally
10.The teeth should be positioned until there is no
space between teeth and lips during normal lip
movements in performing these phonetic
functions

SURFACE ANATOMY INDICATIONS OF THE
AMOUNT OF LIP SUPPORT
External evidences which assist in critically
evaluating the amount of lip support provided by
the denture bases and the teeth may be studied
with the face in repose. The corners and the
vermillion borders of the lips, the philtrum, the
mentolabial, nasolabial, and labiomarginal sulci
are surface markings, which must be considered.
Indications of insufficient support include: a
perpetuation of the general appearance of
collapse around the mouth region; a reduction of
the size of the vermillion borders of the lips; a
drooping of the corners of the mouth; a deepening
of the sulci; and an obliteration of the philtrum.

Indications of too much support
include: tensed, stretched
appearance of the lips which
can result in tension lines
around the mouth; distortion of
the philtrum; obliterations of the
sulci; and an eradication of the
natural contours of the lower
part of the face that serve to
correlate that portion with the
upper part of the face. This
correlation is the constant
toward which our esthetic efforts
must be directed. www.indiandentalacademy.com

Maxillomandibular relation records are
verified by observing the phase in repose and in
function.
The amount of support is evaluated in relation to
evidence of collapse of stretched, strained
areas. Lip contours and the approximation of
the lips in phonetic performance are checked
Clinical observations are made of the amount of
tongue space. If the tongue has been crowded,
there is likely to be a space between the teeth
and cheeks in the posterior region, or the teeth
and the lips in the anterior region, or both. The
tongue will appear crowded, humped and
retruded, and there will be apparent difficulty in
swallowing. www.indiandentalacademy.com

If the vertical dimension of occlusion is
decreased, there will be inadequate
tongue space. This condition will cause
frequent “strained” swallowing and a
frequent return to the vertical dimension of
rest position. If strained swallowing
movements are noted, clinical verification
of the interocclusal distance may be made
by having the patient say “sixty six”. More
than likely, there will be evidence of too
much interocclusal distance.

THE POLISHED SURFACES
All three surfaces of the dentures i.e., the impression,
the occlusal and the polished surfaces, should fit the
tissues or the parts of the opposing denture which
they contact. The development of the impressions
and the positioning of the teeth constitute two thirds
of this requirement. The anatomic contouring and
finishing of the polished surfaces make up the
remaining one third.
Contouring of the polished surface in accordance
with the functional anatomy which will be contacting
these surfaces will not only improve the dentures
from the standpoints of esthetics, phonetics, and
comfort, but will also add to the retention and stability
of dentures. 20

The Mandibular Denture:
The mandibular denture is generally more difficult than
maxillary for the Prosthodontist to construct and for the
patient to master. There are several reasons for this:
(1) the mandibular denture is seated on a movable
bone. (2) The available foundational area for the
mandibular denture is about one third of that for the
maxillary denture. (3) The perimeters of the borders of
the mandibular denture are about twice as long as
those of the maxillary denture. (4) The activity of the
tongue, cheeks, and lips has more direct influences
upon the mandibular rather than the maxillary denture

By properly designing the inclined planes of the
denture flanges, and by not placing the lingual
surfaces of the teeth lingual to the flanges, the lips,
cheeks and tongue can serve to keep the denture
in place rather than to dislodge it by resting on or
gliding over the “shelves” of these inclined planes
The buccal surfaces of the buccal flanges should
face outward and upward. The flanges in the
buccal vestibules should extend out over the buccal
shelves and under the buccinator muscles in the
cheeks.

The labial flanges are determined by the position of
the mandibular incisors, which must be in the same
place the natural teeth occupied. The contours of
these flanges and the teeth must give support to
the lip during function. The labial surfaces of the
flanges should not be anterior to the labial surfaces
of the teeth. Between the labial and buccal flanges,
the flange in the buccal notch region should be
narrow to allow for movements of elevating the
corners of the mouth.

The lingual surfaces of the lingual flange
should face inward and upward so that the
borders lie under the tongue. Thus, the
border seal can be maintained during
function, and air cannot get under the
denture.

The maxillary denture: The buccals surfaces should face
outward and downward and should fill the buccal vestibules.
The buccal flanges in the buccal notch regions should be
sufficiently narrow to allow for the freed on of movements of
the modioli and their muscle components.
The labial surfaces should not be anterior to the labial
surfaces of the teeth natural anatomic contours. For better
speech performance and adaptability, the thickness of the
palate should be uniform and as thin as practical for the type
of denture base material used. However, as the palate
slopes toward the alveolar ridges, the thickness will vary
according to the amount of resorption.

Review of literature
Mark A. Pigno and Jeff. J. Funk 12
– Prosthetic
management of a total glossetomy defect after free flap
reconstruction in an edentulous patient: A clinical
report. J. Prosthet Dent. 2003, 89: 119-22
In this report they described the prosthetic treatment for
an edentulous total glossectomy patient with an
unconventional custom impression procedure to
develop and record proper lower lip and cheek support.
The patient was totally edentulous. The resection and
free flap reconstruction had obliterated his mandibular
ridge and buccal/lingual vestibules. The floor of his
mouth was flattened with minimum bulk introduced for
creation of a neotongue. The reconstruction greatly
reduced his oropharyngeal opening. His lower lip
collapsed back into the oral cavity, due to lack of
support and traction on the lower lip originating from
surgical closure of the defect.www.indiandentalacademy.com

David Marmor and James E. Herbertson,2
the use of
swallowing in making complete denture J. Pros Den Vol 19;3:
208-18 March 1968.
They described the use of complicated neuromuscular events
of swallowing in making of functional mandibular impression.
Anatomically and functionally, the mylohyoid muscle forms the
floor of the mouth. The anterior fibers of the muscle are thin
and weak, and have a low attachment below the residual ridge
on the inner surface of the mandible. However, the posterior
fibers are thick and strong, and may be attached to something
as high as the crest of the residual ridge in the molar region.

These fibers, suspended from the inner surface of the
mandible on both sides, form a sling to raise the tongue-
hyoid-larynx column. The posterior fibers of the mylohyoid
muscle help raise the tongue-hyoid-larynx column and act
as a curtain, which swings both inward, and upward in
swallowing. The posterior part of the mylohyoid muscles
and the tongue-hyoid-larynx column raise more during
swallowing than during speaking. Furthermore, although
talking causes upward movements similar to swallowing,
these movements are not as constant as those found in
swallowing. Therefore swallowing may be used as an index
of the motor activity of tongue-hyoid-larynx column and the
floor of the mouth.

Simmonds Charles R. and Philip M. Jones26
A variation in complete mandibular impression form
related to an anomaly of the mylohyoid muscle, J. Pros
Dent vol. 19, 3: 208-18 Mach, 1968.
They did an investigative study on the prevalence of the
variation in complete mandibular impression. The
mylohyoid eminentiae as they termed, a protuberance or
buldge that occasionally occur in the areas of the
impression commonly called mylohyoid flange. This
bump may extended from the location near the crest of
the ridge to the lingual border of the flange about the area
of the molar.

They concluded that the mylohyoid eminentiae occurs
when a gap exists in the mylohyoid muscle. During
impression making, using swallowing as a functional aid,
the mylohyoid fasciculi move medially and upward. This
contraction and pressure from the impression material
allows the overlying mucous membrane to sag in to the
aperture in the mylohyoid muscle. However, the existence
may be considered clinically unimportant because they can
be altered if necessary without affecting the serviceability of
the denture.

John L. Shannon10
edentulous impression
procedure for region of the mentalis muscles –
Vol 26; 2:130-33,1971
He described a technique for making an
impression in the region of mentalis muscles.

PROCEDURES
1. When the mentalis muscles are clinically evident by palpation or
sight
2. A black modeling compound tray is made in the manner described
by Boucher
3. The anterior portion of the modeling compound tray is examined
in the region of the lingual part of the labial flange. The
impression of the mentalis muscle is outlined and relieved (cut
away) 1 mm. on the lingual surface of the labial flange where the
impression of the mentalis muscle crossed the border.
4. The cut away part of the tray is heated with an alcohol torch,
tempered, and then placed in the patient’s mouth.
5. The patient is asked to pout. This procedure will activate the
mentalis muscles, the lower lip will turn outward, and the skin of
the chin will be elevated. The master cast will allow fabrication of
a basal denture surface which will allow for the action of the
mentalis muscles
The procedure is same when the mentalis muscles are not
clinically evident except in this case two notches approximately
5 mm wide are carved into the lower labial flange of the modeling
compound tray on either side of the midline 6 mm. apart.
BACK

Harold W. Preiskel 8
The posterior lingual extension of complete
lower dentures. J. Pros Den, Vol 19, 5: 452-59, May, 1968
Correct extension of the complete lower denture base is not only
essential for the development of retentive forces to best advantage,
but it is a prerequisite of maximum stability. In most regions of the
oral cavity, the directions of the flanges of complete dentures are
determined by the contours of the underlying bone. However, in the
posterior lingual region, it is necessary to allow the mylohyoid muscle
freedom of movement.
Commonly, the lingual flanges rest on the
mucosa overlying the mylohyoid muscles.
These improperly shaped flanges cause
trauma, and the denture is subjected to a
displacing force whenever the patient moves
his tongue or swallows. As the base may
already be overextended in this region, the
problem is not one of simple extension, and
reduction of the flange will not help matters.
The answer lies in a lingually inclined, fully
extended flange, which allows for freedom of
movement of the mylohyoid muscle.www.indiandentalacademy.com

Lawson W.A. 11
Influence of the sublingual fold on
retention of complete lower denture, J. Pros Den Vol
11; 6: 1038-44 (Nov- Dec) 1961
He described The factor actually governing the
position of the anterior lingual border of the lower
complete denture is the sublingual fold. The denture
border cannot be extended below the highest level of
the mucosa in this region. However, the border can
be extended horizontally backward until contact is
made with the sublingual fold.

Thus, the seal is developed by the floor of the mouth when
the tongue tip is retracted and by the sublingual fold when
the tongue is relaxed in a forward position.
He concluded that the size and position of sublingual folds
vary considerably in different patients. Some are large and
well developed, whereas others are much smaller,
particularly in elderly patients in whom degenerative changes
have occurred. The smaller the fold, the poorer are the
chances of complete success and the greater becomes the
care required to achieve the necessary contact with the
mucosa of the floor of the mouth.www.indiandentalacademy.com

Barred et al 1
– structure of the mouth in the mandibular
molar region and its relation to denture J. Pros Den Vol
12, 5: 835-47, 1962
They dissected on the cadaver to confirm the limiting
structures for extension of the mandibular denture in the
molar region and summarized as
The denture rests on the residual ridges of the
mucoperiosteum and mandible, with its flanges overlying
the origins of the mylohyoid and buccinator muscle
Posteriorly, it extends over the square and triangle and
crosses the retromolar pad.

The yielding triangle allows a
retromylohyoid extension of the denture
and the pad and the construction of a
small post dm, giving excellent seal
Over the anterior border and alveolar crest
of the mandible, the tissues are less
yielding, and this is a region of critical seal
The anterior edges of the masseter and
medial pterygoid muscles lie on either side
of this region
The medial pterygoid muscle prevents any
considerable extension of the denture into
the constrictor square

Wilkinson T. M. 30
– the relationship between the disck and
lateral pterygoid muscle in the human temporomandibular
joint J. Prosthet. Dent. Vol 60: 715-24, 1988
As reported in this article twenty-six human cadaver
temporomandibular joints were dissected to investigate the
insertion of the superior and inferior heads of the lateral
pterygoid muscles and the nature of the attachment of the
foot of the articular disk to the roof of the superior head of
the lateral pterygoid muscle.
The major insertion of the superior head of the lateral
pterygoid muscle is to the condyle at the pterygoid fovea.
In 70% of the joints, the superior head had two insertions.
The major insertion was directly to the fovea and a smaller
accessory insertion, comprising the upper most 20% of the
muscle, terminated under the foot of the disk. These
accessory muscle fibers then blend with the anterior
ligament and run posteriorly to gain insertion into the
condyle. These muscle fibers then blend with the anterior
ligament and run posteriorly to gain insertion into the
condyle. These muscle fibers do not pass through the
capsule and do not insert into the disk. BACKwww.indiandentalacademy.com

SUMMARY
When the kinetics of the
orofacial muscles and
those associated
structure are better
understood, the borders
of the dentures –
including the posterior
palatal seal, the contours
of polished surfaces and
the position of the teeth
are understood to internal
parts of each patients oral
cavity and not just
mechanical artificial
substitutes www.indiandentalacademy.com

REFERENCES
1. Barred et al – structure of the mouth in the mandibular molar region
and its relation to denture J. Pros Den Vol 12, 5: 835-47, 1962
2. David Marmor and James E. Herbertson – the use of swallowing in
making complete denture J. Pros Den Vol 19;3: 208-18 March 1968.
3. Dorland’s Medical Dictionary, 23rd ed. 1983
4. Douglass A. Tenry and Philip Pirtle – Learning to smile : The
neuroanatomic Basis for smile training – J. Esthet. Dent. 2003, 89:
119-22
5. George A. Zarb et al Boucher’s Prosthodontics Treatment for
Edentulous Patient 11th ed.
6. Gerard J. Tora Tora, Nicholas P. Anagnostakos – principles of
anatomy and physiology, 6th ed. 1990
7. Grays Human Anatomy
8. Harold W. Preiskel – The posterior lingual extension of complete
lower dentures. J. Pros Den, Vol 19, 5: 452-59, May, 1968
9. John F. Bowley et al – Mastication muscle activity assessment and
reliability of portable electromyographic instrument, J. Prosthet Dent
2001, 85: 252-60

• John L. Shannon – edentulous impression procedure for region of
the mentalis muscles – Vol 26; 2:130-33,1971
• Lawson W.A. – Influence of the sublingual fold on retention of
complete lower denture, J. Pros Den Vol 11 6: 1038-44 (Nov- Dec)
1961
• Mark A. Pigno and Jeff. J. Funk – Prosthetic management of a total
glossetomy defect after free flap reconstruction in an edentulous
patient: A clinical report. J. Prosthet Dent. 2003, 89: 119-22
• Martone A. L. et al – Anatomy of the mouth and related structure,
Part I, The face, J. Prostho Dent, Martone AL et al 11:1009-1018
(Nov-Dec) 1961
• Martone A.L. et al - The phenomenon of function in complete
denture prosthodontics; Anatomy of the mouth and related structure.
Part II, Musculature of expression J. Pros Den Vol 12: 4-27 (Jan,
Feb) 1962
• Martone A. L. et al - The phenomenon of function in complete
Part III, Functional anatomic consideration, 12:206-219 (March –
April), 1962
• Martone A. L. et al- The phenomenon of function in complete
Part – IV physiology of speech – J. Pros Den 12: 409-19 (May-
June) 1962 www.indiandentalacademy.com

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