Anatomical Landmarks In Relation to Complete Denture Construction

Mohammad Zakaria Nassani DDS, PhD

Al-Farabi College for Dentistry and Nursing Prosthetic Dental Sciences Department

Introduction
The knowledge of various maxillary and mandibular

anatomical landmarks is essential for successful design and construction of complete dentures. These landmarks: a) act as positive guides to the limits of the dentures b) guide in locating various areas of primary functions like relief areas, primary and secondary stress-bearing areas, retentive areas, peripheral seal areas, etc.

Introduction
Dentures made with proper understanding of these

landmarks help in achieving the objectives of: Mastication Esthetics Phonetics Preservation of remaining tissues

Landmarks common to maxillary and mandibular foundations

1.

The alveolar ridge: This is a ridge of the bone in which the teeth, when present, were embedded.

Landmarks common to maxillary and mandibular foundations

1.

The alveolar ridge:

Landmarks common to maxillary and mandibular foundations

2.

Frenum: It is a fibrous fold of mucous membrane attaching the cheeks and lips to the maxillary and mandibular mucosa limiting the motion of the cheeks and lips There is one labial and two buccal frena. All the frena must have complete freedom of motion through the groove or space provided in the denture.

Frenum

Landmarks common to maxillary and mandibular foundations

3.

Vestibule: Labial and buccal vestibules house the labial and buccal flanges of the denture. Labial vestibule is a space bounded by the labial aspect of the residual ridge, the mucolabial fold and the orbicularis oris muscle. It runs from the labial frenum to the buccal frenum Buccal vestibule extends from the buccal frenum posteriorly up to the hamular and massetric notches as respectively. Labial and buccal flanges of a complete denture must be properly extended and contoured for proper lip-support, comfort of the patient, and avoiding dislodgement of the denture.

Labial and buccal vestibules

Maxillary Landmarks

Maxillary Landmarks
1.

Incisive papilla: it is a pear-shaped elevation of soft tissues situated at the midline and covering the incisive or nasopalatine canal. Just posterior to the crest of the anterior ridge, is the exiting point of the nasopalatine nerves and vessels, which requires a relief in the finished dentures, so as to avoid burning sensation to the patient.

Maxillary Landmarks
2.

3.

Rugae: are raised areas of dense connective tissue radiating from the median suture in the anterior third of the hard palate. It is considered a secondary stress bearing area. Palatine vault: It is formed anteriorly by the hard palate and posteriorly by the soft palate, and bounded laterally by lingual surfaces of the alveolar ridge.

Maxillary Landmarks
4.

Midpalatine raphe (median suture): It is covered with

mucous membrane and a little submucosal tissue. It requires a selective relief within the denture to avoid rocking of the denture . If relief is not provided, it acts as a fulcrum area and results in soreness as well as unstable dentures. If it is very prominent, it is called (Torus palatinus) and surgical removal is necessary.

Maxillary Landmarks
5.

Fovea palatine: These are small pits, found at the midline, just posterior to the junction of hard and soft palate, always in soft tissues and are used in the location of the posterior palatal seal area (post-dam).

Maxillary Landmarks
5.

Maxillary Tuberosity: it is a bulbous extension of the residual ridge in the 2nd and 3rd molar regions, terminating in the hamular notch (the most distal part of the maxillary alveolar process) It should be covered by the denture as it is important for retention.

Maxillary Landmarks
7.

Hamular notch (pterygoid notch): Notch formed by the maxilla and a part of sphenoid bone, located just posterior to maxillary tuberosity. It is used as a landmark for correct extension of the posterior border of denture. It is also used as a seal area, since it is filled with soft tissues which can be compressed as there are no muscles or ligaments to prevent the placement of extra pressure. It is disto-lateral termination of the denture base.

Hamular notch (pterygoid notch)

Maxillary Landmarks
8.

Vibrating line in posterior palatal seal area: It is an imaginary line that extends between the fovea palatine and the hamular notches It is located in the area at the junction of the soft and hard palate where movement is seen when the patient says Ahhhh. From this line the posterior extension of the denture is determined (The distal edge of the denture ends at or before this line).

Vibrating line in posterior palatal seal area

Mandibular Landmarks

Mandibular Landmarks
1.

Lingual frenum: It is a fold of mucous membrane which can be seen when the tongue is raised and attaches the tongue to the floor of the mouth.

Mandibular Landmarks
1.

Lingual frenum: It is very active and often presents a very broad attachment close to the crest of the ridge. It must be accommodated in the denture.

Mandibular Landmarks
2.

Alveolingual sulcus: a trench or groove in folds of mucous membrane found at the lingual aspect of the mandible It houses the lingual flange of the denture

Mandibular Landmarks
2.

Alveolingual sulcus: The anterior portion of the lingual flange is called the sublingual crescent area The length and width of the denture border in this area is critical in maintaining the peripheral seal and is effected by the position of the tongue The movement of the tongue and displaceability of the floor of mouth determine the length of the flange in this area

Mandibular Landmarks
3.

Retromolar pad: It is a small pear- shaped bulge of the mucous membrane at the posterior end of the mandibular alveolar ridge.

Mandibular Landmarks
3.

Retromolar pad: It should be included in the impression as a seal area for the posterior border of the denture and the occlusal plane should be positioned at the level with the upper twothirds of this pad.

Mandibular Landmarks
4.

External oblique ridge or line: the bony ridge running downward from the anterior border of the ramus of the mandible and outward onto the lateral alveolar process and body

Mandibular Landmarks
5.

Buccal shelf: Buccal shelf is an area between the crest of the alveolar ridge and the external oblique ridge - a boney ridge.

Mandibular Landmarks
5.

Buccal shelf: This forms a good support, should always be included in the basal seat area, and is considered a primary stress- bearing area.

Mandibular Landmarks
6.

Mylohyoid ridge: the region of the lingual surface of the mandible where the mylohyoid muscle is attached

Mandibular Landmarks
Retromylohyoid space: Area posterior to the mylohyoid muscle (distal end of lingual sulcus).
7.

Mandibular Landmarks
8.

Masseteric notch: A notch in the distobuccal area of the denture base accommodates the mesial border of the massetar muscle, which influences the denture border during opening and closing of the mouth.

Mandibular Landmarks
9.

Masseteric notch: Over extension of the denture border at this area results in both soreness and movement of the denture base.

Mandibular Landmarks
10. Mental foramen: Lies on the external surface of the

mandible in between the 1st and the second premolar region.

Mandibular Landmarks
10. Mental foramen:

It should be relieved specially in case it lies close to the residual alveolar ridge due to ridge resorption to prevent parasthesia

Mandibular Landmarks
11. Genial tubercle: a small rounded elevation on the

lingual surface of the mandible on either side of the midline near the inferior border of the body of the mandible, serving as a point of insertion for the geniohyoid muscles

Mandibular Landmarks
11. Genial tubercle:
They are the origins of both genioglossus and geniohyoid muscles.
Lies away from the crest of the ridge. They do not undergo bone resorption They project prominently in resorbed ridges. Adequate denture relief should be provided.

Grouping of the landmarks

Anatomically the edentulous arches can be divided as follow:

Primary stress-bearing areas

Secondary stress-bearing areas

Landmarks of edentulous arches

Relief areas

Border limiting structures

Primary stress-bearing areas

The primary stress-bearing areas are those areas which are best suited to resist vertical forces of occlusion
Maxillary Mandibular

1- Crest of the ridge 2- Flat areas of the palate

1-The buccal shelf

Secondary stress-bearing areas

Secondary stress-bearing areas are those areas which by their histological make-up, or by the nature of their inclined planes, resist lateral forces of occlusion and can also aid in the resistance to vertical forces of occlusion Maxillary 1- Lateral slopes of the palate 2- Rugae 3- Labial and buccal surfaces of the ridge Mandibular 1- Anterior ridge 2- All the ridge slopes

Primary and secondary stress-bearing areas

Primary and secondary stress-bearing areas

Relief areas

Relief areas are those areas which, when subjected to occlusal force, either cause discomfort to the patient or instability of the denture base and eventual resorption of supporting bone.

Maxillary 1- Incisive papilla

2- Median palatal raphe 3- Zygomatic process 4- Torus palatinus 5- Sharp bony prominences

Mandibular 1- Mental foramen

2- Genial tubercles 3- Sharp mylohyoid ridge 4- Crest of the ridge 5- Mandibular tori 6- Sharp bony prominences

Relief areas
Relief areas usually

have fragile structures or are covered by thin mucosa which can be easily traumatized & hence should be relieved.

Maxillary 1- Incisive papilla

2- Median palatal raphe 3- Zygomatic process 4- Torus palatinus 5- Sharp bony prominences

Mandibular 1- Mental foramen

2- Genial tubercles 3- Sharp mylohyoid ridge 4- Crest of the ridge 5- Mandibular tori 6- Sharp bony prominences

Relief areas

Border limiting structures

These are the structures that limit the border extent of the

denture These sites will guide us in having an optimum extension of the denture so as to engage maximum surface area without encroaching upon the muscle actions Encroaching upon these structures will lead to dislodgement of the denture and/or soreness of the area while failure to cover the areas up to the limiting structures will imply decreased retention stability and support.

Border limiting structures

Maxillary 1- Labial frenum 2- Labial vestibule 3- Buccal frenum 4- Buccal vestibule 5- Hamular notch 6- Posterior palatal seal area Mandibular 1- Labial frenum 2- Labial vestibule 3- Buccal frenum 4- Buccal vestibule 5- Masseteric notch area 6- Retromolar pad 7- Lingual frenum 8- Sublingual crescent area 9- Retromylohyoid space 10- Alveolingual fold

Border limiting structures

Border limiting structures

A comparison between edentulous jaws

Maxillary 1.Has more supporting areas

2.Limiting structures are less in number and have a less stronger influence over the denture border

Mandibular 1.Has less supporting area.

2.Limiting structures are more in number and have a stronger influence over the denture border

Concluding remarks

A sound knowledge of the anatomical landmarks of the edentulous jaw is a prerequisite if one has to achieve the objective of constructing a complete denture that has maximum retention, stability and support with preservation of underlying structures with minimum post insertion problems.