Prosto lec 2

landmarks without mention the ( the dr only Introduction

of not all avoid any surprise we add the details but to details
for us is important but what them
Knowing the land marks is very important coz it will help in
making the most perfect impression and serve in making CD for
patient.
For getting the most accurate impression of maxillary and
mandibular must have record these things:
1 landmark that dont change position with function (alveolar
ridges and hard palate)
2 landmarks that change their shape with function (frenula and
vibrating line between soft and hard palate)
When u find these things in your cast and patient mouth u will
be glad coz u are going to produce a perfect denture
Extra oral features and landmarks
The anatomical regions that you should know them here are
found at the closure of mouth and they are:
1 philtrum: midline shallow depression of the upper lip
2 labial tubercle: little swelling in the mid-portion of the upper
border of the upper lip
3 vermillion borders: the transitional area of the red tissue
between the upper and lower lip
4 nasolabial groove: furrow of variable depth extend from wing
of ala t the corner of mouth
5 labio mental groove: sharp deep groove that lie between
lower lip and chin
************** The dr did only mention these without asking
about info about them but the pic will show you the exact
location of each one*******

Structure of facial vestibules
We have what we call it the facial vestibules and it is the space
that is bound by the lips and cheeks facially and teeth and
gingiva internally, now we have several structures that are part
of this facial vestibule:
1 fornix of the vestibule: site where the mucous membrane
lining of the lips and cheeks reflect and joins the unattached
gingiva
** Depth of the vestibule is determined by the site of it
** It is limited by a muscle in the upper and lower jaw
called buccinators muscle
** Upper fornix is not supported by other muscle not like the
lower one
2 free gingiva: extends from the gingival margin to the attached
gingiva at level of gingival sulcs
3 attached gingiva: the gingiva that is firmly attached to the
bone and the cementum
4 unattached gingiva: the gingiva that is loosely attached to the
underlying bone continuous with the alveolar mucosa
5 inter dental papilla: part of gingiva located in interdental
space
6 gingival grooves: separator between the free and attached
gingiva and cant found in all patients
7 the upper medial labial frenum or frenulum: folds of mucus
membrane that overlies dense connective tissue (enlargement
in it is associated with the large diastema
** Important note is that the crest must be away from the
frenulum to avoid irritation and to get successful denture with
high rate of stability
8 canine eminence: bony prominence in both maxilla and
mandible that denotes the roots of canine the loss of it in the
upper jaw lead to sagging of the lip with age coz it raise the
upper lip
Alveolar residual ridge
Roots are held by alveolar process once you fully extract the
tooth you will have the alveolar ridge for both mandible and
maxilla with differences:
1 mandible is 4 times faster than maxilla in resorping
2 mandible resorp downward and outward
3 maxilla resorp upward and in ward
Result = force to make cross-bite of the post. Denture to
maintain the denture over residual ridge
** maxillary tuborisity : the most post part of the alveolar ridge
distally to the last molar its importance come as it is a
standpoint of the denture coz it is a stress-bearing area ,
sometimes we should remove it surgically if it was big to avoid
compromise of the opposing denture
** The most distal part of the mandibular arch is called
retromolar pad
Maxillary arch
The area that may affect the fabrication of denture is:
1 incisive papilla: small tubercle located on the palatal side
between the two central incisors cover incisive foramen
contain incisive nerve
** be aware for this area when inserting the denture due to
what it contain so dont make a lot of pressure also it is
important in making the occlusal relation
2 palatine ruage: irregular mucus membrane that extend
bilaterally from the midline of hard palate to the upper six ant
and sometimes to PM and canines
** It was important in the past in the speech and occlusion but
not any more so we dont need it now
3 torus palatines: bony prominence of variable size locate at
the midline of the hard palate
** The cover of it is thin so if pressure is performed there might
be traumatized areas and any enlargement of it may cause
instability of the denture so we surgically remove it
4 mid-palatine raphe: found in the middle of mucousa of the
hard palate covers mid-palatine suture soooooo thin even
minor pressure cause pain so take care in insertion
5 uvula: muscular part (function unknown) but thought it help
in sealing the oral cavity from the nasal cavity not important
structure while fabricating maxilla denture
** it is found that when they do removal of it with soft palate
to stop snoring at night it has low success rate so that
decreased from its significant
6 fovea palatine: 2 depression lies bilaterally to the midline of
the palate at the approximate junction between soft and hard
palate
** Important to identify the vibrating line coz it is located
within 2 mm of it
7 hamular notches: it is a groove that is found between the
haumlar process and the maxillary tuborisity
**hamular process: bony projection of the medial palate of the
pterygoid bone located distally to the maxillary tuborisity
**this notch is the key of making maxillary denture coz the max
extension of the denture is vibrating line which is parallel to it
** this notch can be harmed if the denture hits it due to
containing the tendon of tensor velli palatine muscle so any
damage will lead to mechanical irritation and pain
8 posterior palatal seal area: area of compressible tissue
located anterior to the vibrating line and lateral to the midline
in the posterior third of hard palate
** It is very important in maxillary denture retention
9 vibrating line: not truly anatomical part but it is important in
fabricating the denture due to these reasons:
*considered to be the separating line between the hard and
soft palate
*the maximum post part of the maxillary denture
*it is the distal extent of the posterior palatal seal area
Mandibular arch
We have some features that help in making mandibular
denture and also maxillary in some times and they are:
1 retromolar pad: triangular area of thick mucosa found distally
to the third molar on the crest of the ridge
** Importance comes from (denture extension and plane of
occlusion stand point)
** It must be covered by the denture and the occlusal plane is
at mid or upper third of this pad
2 pterygomandibular raphe fold: extend from the hamulus to
the retromolar pad
** underlies the junction between the buccinator and the
superior constrictor muscle of the pharynx
** Found in the maxillary impression and helps as
determination of the distal extent of the maxillary denture
** Not so important in the mandibular denture fabricating
3 masseter notch: area located buccal to the crest of
mandibular ridge, it is a diagonal directed line that runs from
the depth of the vestibule in the anterior to the crest of the
ridge in posterior
** VIP in denture fabrication coz it is formed due to action of
masseter muscle
** there is a fatty roll tissue covering the buccinators muscle
medial to the masseter muscle this fatty roll must be elevated
properly when making the final impression or there will be an
overextended in the denture
** The overextension will lead to discomfort of patient or the
mandibular denture will become dislodged on opening
4 buccal shelf: located on the mandibular arch surrounded by
these things (bound on the medial side by the crest of residual
ridge + on the lateral side by external oblique ridge + on the
mesial by buccal frenulum +on the distal side by the masseter
muscle + it is just anterior to the pre masseteric notch area)
** The most important point coz it is the primary stress-bearing
area of the mandibular arch
** composed of thick cortical bone visa versa the crest of the
ridge which is thin
5 tongue: located in the floor of the mouth
** It can help us in investigating many systemic disease like
(iron decency anemia + pernicious anemia) coz they can make
changes in it
** Importance of it in fabricating denture resemble in the
activity of it mobility and involvement in the deglutition and
speech
** Lingual papillae: projection that are found at the ant 2/3 of
the dorsum of the tongue responsible for making it rough
** Sulcus limitans: it is the V-shaped area that resemble the
junction between the ant 2/3 and the post 1/3 of the dorsum
also it contain 10-13 large papillae called circumvallate papillae

** Lingual frenulum: mucous membrane fold that anchored the
ventral surface of the tongue to the floor in this area u can see
blood vessel comes from (lingual artery = linguae profundus /
lingual vein = ranine vain) and lingual nerve branch
(((((((So be carefull with handling instruments in this area to
avoid any damage))))))))
6 sublingual folds: located at the floor and on both sides it is
prominent mucous membranous folds
** Sublingual caruncle which is a swelling on the medial end of
each fold where submandibular salivary gland ducts open in the
oral cavity
** With these folds you can see the orifices of the sublingual
salivary glands
7 parotid papilla: mucous membrane swelling that guards the
orifices of the parotid gland
**the orifices are used as a land mark to determine the level of
plane occlusal due to the position
8 internal oblique ridge: located along the inner surface of the
middle to posterior one third of the mandible and it is bony
ridge
** Sometimes they might be sharp so we need to surgically
remove them to avoid any discomfort of the patient
** Importance and care come from the attachment of the
mylohyoid muscles and their influence on the denture flange
9 torus mandibularis: bilateral bony prominence in the inner
surface of mandible at PM teeth
** Usually removed before the denture fabrication start
10 retromylohyoid area: bounded (laterally) by the mandible
and the most ant border of medial petrygoidmuscle (medially)
by tongue
** This area may put us in situation where if we have undercuts
in this fossa area we need to manipulate and adjust the
denture to be suitable in these areas
Important information
1 atrophied mandibles residual ridge resorp at level of genial
tubercle so the denture must be trimmed around the genial
tubercles in these cases
2 dont you ever make a denture while you are seeing
inflammation in patient mouth especially if it was because of
Candida coz it will lead to candidosis
3 dentures for people who avoid cleaning it can be found full of
different type of bacteria and with increased ability to have
fungal and colonized microorganism in it
Done by ahmad fawzi
Study with pleasure