Clinical Anatomy re levant to complete de nture construction Mouth preparation for C/C de ntures

Extra-oral anatomy

Dr D. C. Attrill

Circumoral musculature
A. B. C. D. E. F. G. H.

Skeletal classification sy stem: note changes in nasolabial profiles

Incis ivus la bi i sup. Ob icul ar is or is m. Incis ivus la bi i i nf. Dep ressor an gu li or is Levat or a ng ul i o ris Zyg oma tic us m. Modi ol us Buccin ato r m.

Extra-oral Key anat omica l landmarks

Interpupillary line Inner and outer canthus (eye) Tragus (ear) Alar (nose) Nasolabial groove Mental groove Philtrum Mental groove Nasolabial angle Vermillion border lipstick line

Reference points used in C/C construction (extra-oral)

Alar tragal line (A -P occlusal plane) Interpupillary line (Horizontal occlusal plane) Lip support
Naso-labial angle Philtrum

Occlusal plane heights

Contributes to face height/support

Maxilla Key anatomical landmarks

Intra-oral anatomy

Labial/Buccal sulcus Frenae Incisive papilla (incisive canal and contents) Rugae Fovea palatinae Hard/soft palate junction Tuberosity(s) Hamular notches Midline raphe Alveolar ridge (mid palatal fissure) (Torus palatinus)

Torus palatinus (note well defined fovea palatinae)

Alma Gauge Upper incisor tips 8-10 mm anterior to incisive papilla

Palatal cleft, residual fistula. Note changes in normal architecture

Periphery of maxillary denture key landmarks

ABCD-

Frenal notch Incisivus m. Lev. Ang. Oris Buccal frenal notch

EFG-

Zygoma Buccinator Ptery gomandibular raphe

Mandibular denture and associated anatomy

A B C D E F G H R

Masseter m. Buccinator m. Modiolus Obicularis Oris Tongue Ptery gomandibular raphe Superior Constrictor Medial ptery goid m. Ascending Ramus

Prominent lingual frenum care needed with denture extension & impressions

High mentalis m. attachment, little depth of sulcus

Mandible Key anatomical landmarks

Labial/Buccal sulcus Lingual sulcus Frenae Retromolar pads anterior portion stable Mental foramen Floor of mouth musculature Genial tubercles Tongue Alveolar ridge Buccal shelf Internal and external oblique ridges (Torus mandibularis)

Torus mandibularis potential denture support problem

Mandibular denture and associated anatomy buccalaspect

Ridge assessment - Atwood

I Dentate High profile, rounded IV VI High profile, sharp Low profile, rounded Basal bone II III Immediately post extraction V

A B C

Mentalis m. Incisivus labii inf.m. Depressor labii inf m.

D E F

Depressor anguli oris m. Mental foramen Buccinator

Atwood DA (1971): JPD 26:266-79

Musculature
MOM

Musculature

Masseter Temporalis Medial pterygoid Lateral pterygoid

anterior belly digastric mentalis Tongue

FOM musculature G enioglossus G eniohyoid Mylohy oid (S up constrictor) Buccinator P latysma fibres

Sagittal plane ex cursions dent ate

Mandibular movements

Posselts envelope o f mov ement

B C D E F Maximal intercuspation ICP RCP Extent of hinge opening Maximal opening Maximal protrusion

Dotted line habitual open/close

NB In C/C patients, ICP(B) and RCP(C ) should be coincident

Coronal plane excursions

Christensens phenomenon

A B C D

RCP Right lateral excursion Maximal opening Left lateral excursion

Posterior disclusion in protrusion IN THE DENTATE individual This concept must be avoided in C/C, otherwise will result in denture imbalance/instability

Positioning teeth
Considerations for edent ulous patients Concepts of t he ne utra l zone

Neutral zone or zone of minimal conflict particularly important for mandibular -/C dentures Note the importance of the shape (depth & width) of mandibular flanges

Mouth preparation for C/C dentures

Mouth preparation for C/C de ntures: Aspects to consider

S oft tissues E limination of stomatitis
Denture hygiene Tissue conditioners Occasionally assessment for systemic factors (i.e. haematology etc.)

S oft tissue surgery

Fraenectomy Soft tissue debulking Removal of hyperplastic tissue etc.

Mouth preparation for C/C de ntures: Aspects to consider

H ard tissues E xtraction of symptomatic retained roots Bony exostosis remov al i.e. tori Augmentation
Ridge augmentation Implants

Tissue conditioners
Use of Viscogel

Aims of tissue conditioning

S hort term procedure only U se of a tissue conditioner to stabilise or improv e the health of denture bearing area prior to definitiv e impressions for a new denture Indications include;
stomatitis exacerbated by ill fitting dentures following surgery to remove roots etc.

Viscogel 3 components 1. Powder 2. Liquid 3. Separator (applied to areas of denture y ou dont want it to stick to)

Acceptable dent ure clea nsing re gimes

Soft linings (Viscogel, Coe comfort) Rinsing; Soap & water Alkaline hypochlorite (Dent ural/Milton ) for 20 mins (evening) NO ALKALINE PEROXIDE (STERADENT) CLEANSERS