Complete dentures

Dimensions and displacement patterns of the

posterior palatal seal

Sidney I. Silverman, D.D.S.*

New York University, College of Dentistry, New York, N. Y.

1 his report is the first of a two-part study designed to test the hypothesis that the
retention and stability of a complete maxillary denture will be increased by extend-
ing the posterior denture border beyond the “vibrating line,” generally located at
the junction of the hard and soft palate. This study will demonstrate the feasibility
of the dorsal extension of the border area for a selectively variable distance to the
vibrating line and of the mediolateral extension from the right to the left hamular
process.
The second part of this study is an experimental investigation to evaluate the
effect of the extension in providing additional retention of dentures. It will test the
effectiveness of the extension when all other contributing biologic, mechanical,
functional, and esthetic factors relevant to denture occlusion are relatively constant.
The hypothesis is predicated in part on the basis of the commonly accepted con-
tentionl that denture borders should terminate on soft displaceable tissue to create
a border seal and to, thereby, increase resistance to displacing forces. The hypothesis
is further designed to test the long standing dictum that, “The vibrating line of the
soft palate, which is the ideal posterior border of the denture, is usually located on,
slightly anterior to, or slightly posterior to the fovea palatinae.“2 This assertion has
been published many times and is taught in most schools.
The study also examines some morphologic and neurophysiologic characteristics
of the soft palate. These findings indicate that it is biologically feasible and clinically
appropriate to extend the posterior border of the denture so that it contacts the soft
tissue continuously during function in a similar manner as when the lips and the
associated vestibules contact the labial flange of a denture.

Read in part before the Greater New York Academy of Prosthodontics, New York, N. Y.
This investigation was supported by a grant from the Rehabilitation Services Administra-
tion, Department of Health, Education and Welfare, Social and Rehabilitative Service, RSA-
56T70.
*Professor and Chairman, Department of Removable Prosthodontics.

470
iz!:E255 Dimensions and displacement patterns 471

The experience and data for this study have been accrued over 15 years. During
this period, more than 500 dentures with posterior borders similar in part or in
whole as described were constructed. The data were recorded on the last 92 patients
of this series who were treated by a standardized procedure during the years 1967
and 1968. The 500 subjects, including the 92 in this study, have worn their dentures
with clinically acceptable comfort and function, indicating that lengthening the
denture is at least feasible and is consistent with accepted criteria.
The 92 dentures were examined for a period of two years after completion. The
findings describe the degree and frequency of modification of denture length and the
condition of the soft palate morphology during the re-examination period.

REiVlEW OF THE LITERATURE

More than 50 publications dating from 1920, describe or evaluate techniques
relating to the location of the posterior border of the upper denture. Many of these
articles are like those cited below. Some authors indicate the hazards of extending
the border beyond the vibrating line; some are concerned with varying the design
by which the soft glandular tissues covering the hard palate in the region anterior
to the vibrating line are displaced3-5; nearly all of the articles discuss the displace-
ment of the soft tissues as the critical factor in the posterior palatal seal technique;
and only a few articles discuss the neurophysiologic and psychologic considerations
of extending the posterior border. 6 Some articles discuss the gross and microscopic
anatomy of the muscles and the mucosa of the soft palate and their adnexa.7
None of the articles report the purposeful extension of the posterior border be-
yond the fovea palatini-oriented flexion line. Only in those articles describing pros-
theses for acquired and congenital defects of the palate are there references to the
employment of muscle activity of the soft palate and the pharynx for shaping the
denture base.8 In these prostheses, the tissues of the soft palate not only engage in
retention of the prosthesis, but the muscles must be conditioned to new functional
movements during respiration, speech, and/or deglutition.

MORPHOLOGIC AND PHYSIOLOGIC BASIS FOR STUDY

The hypothesis for extending the denture border more posteriorly to contact the
soft palate during function is supported by the following morphologic, neurophysio-
logic, and radiographic considerations.

Anatomic factors
The anatomy of the soft palate reveals a symmetrical and a radial distribution
of the muscles and their fibers. The soft palate is part of a dual valve system which
separates the oropharynx from the oral space and the nasopharynx from the nasal
space (Figs. 1 to 5). This valving action may be schematically compared to the
telescopic shutter action of the lips as they project backward and forward in a
tubular and conical manner while they open and close.
The function of the soft palate in these dual valving actions requires freedom
of movement in three dimensions or planes of space, i.e., superoinferiorly, medio-
laterally, and anteroposteriorly. A denture which contacts the soft palate then must
conform to the requirements for freedom of movement of the palate. Therefore, an
 472 Silverman J. Prosth. Dent.
May, 1971

Fig. Fig. 2

Fig. 1. A midsagittal section of the head demonstrates the air passage (narrow tube) and the
food passage (wide tube) in the orofacial pharyngeal structures.
Fig. 2. A horizontal section of the head at the level of the commissure of the lips and dorsum
of the tongue demonstrates a horizontal cross section of the air and food passages in the naso-
pharyngeal and oropharyngeal spaces.

impression should be made when the soft palate is placed at a desired denture
border position. This functional position of the soft palate may be achieved when
the patient, seated in the upright position, flexes his head 30 degrees forward (Fig.
6) and places his tongue under tension against either the handle of the impression
tray (Fig. 7) or the dentist’s finger which is held in the region of the upper maxillary
incisors. The tongue should be retained in a state of tension within the arch form,
and should not protrude beyond the lips.

Neurophysiologic factors
The soft palate as a component of an oropharyngeal valve may be considered as
the analogue of the upper lip and the distal part of the dorsum of the tongue as the
analogue of the lower lip. The soft palate and tongue thus contact and separate as
they protrude backward and forward to selectively permit food and air to pass the
fauces for swallowing, speech, and respiration. The neurologic control for the valv-
ing action is mediated by the ninth and tenth cranial nerves for the palate and
tongue (these nerves have both high somatic conscious and visceral automatic
components) and by the twelfth cranial nerve which is dominated by the somatic
conscious motor component. It is this latter phenomenon, wherein the rich con-
scious nerve control of the tongue muscles prevails, that makes it possible for the
 Dimensions and displacement patterns 473

Fig. 3 Fig. 4

Fig. 3. A posterior view of a vertical incision in the pharyngeal muscle wall reveals the pharyn-
geal spaces and the epiglottis.
Fig. 4. A posterior view with the posterior pharyngeal muscle wall separated widely reveals
the epiglottis, the posterior part of the tongue, the oral space, the uvula and soft palate, and
the nasal spaces.
Fig. 5. The posterior view of the oral and nasal pharyngeal spaces demonstrates the nasal
septum, the nasal spaces, and the flexed soft palate.
 474 Silverman J. Prosth. Dent.
May, 1971

Fig. 6 Fig. 7

Fig. 6. The head is tipped forward, and the tongue is placed in a position to move the soft
palate downward and forward.
Fig. 7. The tongue is pushed against the tray handle in the position of the incisor teeth (note
that the tongue is never protruded beyond the lips) to place the soft palate in a flexed posi-
tion for impressions.

patient to respond to verbal and tactile stimuli to alter the position of the con-
tiguous muscles of the soft palate. Even though there is a large proportion of
visceral components in the ninth and tenth cranial nerves, it does not imply that
the soft palate cannot be conditioned to respond appropriately to the denture which
encroaches upon its environment. It merely suggests that more time may be re-
quired to condition the soft palate tissue to adapt to the presence of the denture
which initiates a gag reflex.
The physical stimuli of the denture base must be inhibited or suppressed so that
the posterior border can become an extension of the patient’s biologic self in the
same manner as the other borders. To facilitate the patient’s adjustment to the
denture touching the soft palate, the border should be convex in contour on both
the tongue and soft-palate sides. This recommendation is supported by Litvak,
Silverman, and Garfinkels in a recent study wherein patients identified objects with
many line angles in the mouth more readily than those with few line angles. Thus,
the sharp line angle on the posterior border of many dentures makes it more difficult
for the patient to inhibit the conscious awareness of the denture in the mouth.

Radiographic factors
The cineradiographic and radiographic examinations of patients demonstrate
the range of motion of the soft palate during speech, swallowing, and respiration
(Figs. 8 to 17). The position of the head and the placement of the tongue in the
incisal region also affect the position of the soft palate.
Anatomic considerations support the contention that tipping the head and the
tension of the tongue tip cause the soft palate to be held in a functionally displaced,
more-anterior position during the impression procedure. The tipping of the head
allows the mandible to translate anteriorly. This action passively moves the soft
 Dimensions and displacement patterns 475

Fig. 8. A radiograph of the skull demonstrates the junction of the shadow of the posterior
palatal border and the vertical shadow of the pterygoid plates of the sphenoid bone. This
junction is the fulcrum about which the soft palate is flexed, i.e., it rises and descends during
function.

palate downward and anteriorly because of the indirect soft-tissue attachment to

the body of the mandible. However, the active movement of the soft palate down-
ward, forward, and medially is achieved by the palatoglossus muscle. This muscle
lies in the anterior fauces and inserts obliquely into both the body of the soft palate
and the tongue. The contraction of the powerful palatoglossus muscle in interaction
with the tensor aponeurosis creates an angular depression on the ventral side of the
soft palate which looks like a curved Gothic arch with the apex at the midline of
the palate and the sides extending laterally, downward, and backward from the
oral cavity. The “V” shaped depression is the inferior angle on the soft palate
de:scribed by Starch, Silverman, and Landal in a cineradiology study (Fig. 18) .
These depressions are visible as ridges on the impression, and they determine the
location of the posterior vibrating line as used in this study (Figs. 19 and 20) .
The tipping of the head by bending the neck also provides the patient with an
ea.sily maintained patent airway. In addition, gravity directs the debris, saliva, and
excess impression material forward in the mouth rather than posteriorly to the
pharynx where an inappropriately timed and often uncontrolled swallow reflex may
be initiated.

PROCEDURES
Clinical procedure for determining the posterior palatal seal
Preliminary impressions are made which include the hamular process and ex-
tend beyond the fovea palatini for at least 3/4 inch. The impression tray should not
contact the soft palate, and it should allow a free flow of the impression material
posteriorly. The patient’s head is held in the erect position while the tray is placed
in the mouth, and then the head is tipped forward approximately 30 degrees from
the vertical position before the tray is positioned. The dentist should hold the pa-
 476 Silverman J. Prod. Dent.
May, 1971

Fig. 9 Fig 10

Fig. 9. A radiograph shows the curvature of the soft palate, tongue, and posterior pharyngeal
wall during respiratory rest.
Fig. 10. Cephalometric tracings of Fig. 9 show the contours of the tissues during rest.

Fig. I Fzg. 12

Fig. 11. A radiograph demonstrates the contours of the tongue, soft palate, and posterior wall
of the pharynx during phonation of the sound e.
Fig. 12. A cephalometric tracing of the radiograph in Fig. 11.

tient’shead in this flexed position until the impression procedure is completedll to

insure the forward movement of the soft palate.
When the tray is properly positioned, the patient is instructed to push the tip of
the tongue with vigor against the tray handle which has been formed to approxi-
mate the position of the incisor teeth. The dentist’s index finger may also be used
as a guide to the patient for the placement of the tongue. The patient is instructed
 Vdume 25 Dimensions and displacement patterns 477
Number 5

Fig. 13 Fig. 14

Fig. 13. A lateral radiograph demonstrates the position of the tongue, soft palate, and pharynx
when the patient pushes the tongue forcefully against the finger tip held at the incisor edge
position while the head is in the erect position.
Fig. 14. A cephalometric tracing of the radiograph in Fig. 12 demonstrates the position of the
tongue, soft palate, and posterior pharyngeal wall.

Fig. 15 Fig. 16

k
\

Fig. 15. A radiograph demonstrates the position of the tongue, soft palate, and posterior
pharyngeal wall when (1) the tongue is pushed against the finger tip at the incisal edge
portion, (2) the head is tipped forward, and (3) the neck is markedly flexed.
Fig, 16. A cephalometric tracing of the radiograph in Fig. 15 demonstrates the position of
t’he tongue, soft palate, and posterior pharyngeal wall.

to release the tension in the tongue briefly, and the other borders are functionally
molded. Then the patient restores the firm tension of the tongue against the incisal
guide until the impression material sets. The patient should not protrude the tongue
b’eyond “the incisal edges of the teeth” at any time during the impression procedure.
47% Silverman J. Prosth. Dent.
May, 1971

Fig. 17. A composite of cephalometric tracings shows the range of motion of the soft palate
in the sagittal plane. Phonation elevates the soft palate upward and posteriorly to demon-
strate its superior and posterior functional limit. The placement of the tongue when sucking
or when pushing forward moves the soft palate downward and forward.

If the tongue is excessively protruded, the soft palate will for-shorten the posterior
border of the impression to the anterior flexion line.
The completed impression should provide a negative representation of the
mucosa including the hamular process, the tissue between the anterior (flexion)
line, and a secondary or posterior flexion line. The tissues are marked with indelible
pencil to verify their Iocation on the impression (Fig. 2 1) .
The hamular notch is located on each side with a T burnisher. A dot is marked
with pencil on the soft tissue mound over the hamular process on both the right and
left sides. A pencil line is drawn along the anterior flexion line between the dots as
the patient vocalizes the sound ah with abrupt vigorous bursts. This line is in the
region of the fovea palatini and is located approximately where the hard and soft
palates are joined (Fig. 22).
A second line is marked over the flexion line created when the patient vocalizes
ah, ah, ah in brief bursts of soft speech. This flexion line separates the posterior
segment of the soft palate which elevates rapidly from an anterior segment which
merely vibrates in situ but does not substantially elevate (Fig. 23). This vibrating
area lies between the flexion lines anteroposteriorly and is between the two hamular
processes mediolaterally.
The tissues are made “damp dry” before they are marked with the indelible
pencil. The complete impression is replaced in the mouth, and the patient is again
required to say ah, ah, ah and then to push the tongue forward as described pre-
viously. When the impression is removed, the markings should transfer to the tissue
surface (Fig. 24).

Measurement recording procedure

The indelible penciled dot spreads on the damp dry surface of the mouth to a
circle which has a diameter ranging from 1 to 3 mm., with an average of 2 mm. The
lines joining the hamular processes at the anterior and posterior flexion lines also
spread an average of 2 mm. in width over their entire length. Thus, when the im-
pression was reseated into contact with the tissues, the lines were transferred with
some spreading (Fig. 24). Sulfide and silicone rubbers were used because of the
\‘olume 25 Dimensions and displacement patterns 479
Number 5

Fig. 18. Two frames from a cineradiologic sequence during swallowing demonstrating the
1:ensor area and the inferior angle of the soft palate which is a ridge form on the impression.

ease with which they could be reseated on the tissues after they were removed from
the mouth. The lines and dots were redrawn before measurments were made at the
midpoints of the enlarged markings.
A Boley gauge was used to measure the distance between the hamular markings
(Fig. 25). The distance between the hamular processes was divided on the posterior
flexion line at the midsagittal point. Two other sagittal points were marked on the
 480 Silverman J. Prosth. Dent.
May, 1971

Fig. 19. The impression surfaces of two casts demonstrating the anterior flexion line (broken),
and the ridge crest (solid) indicates the posterior flexion line at the inferior angle of the soft
palate.

Fig. 20. The anterior and posterior flexion lines meet laterally at the pterygoid hamulus.

right and left sides midway between the hamular processes and the midsagittal
plane respectively. A flexible metal or plastic millimeter ruler was adapted to the
contours of the impression, and the distances between the anterior and posterior
flexion lines were measured in each of the, three sagittal planes (Fig. 26) .
Each distance was measured three times to the nearest millimeter, and the most
frequent reading of the three measurements was recorded. The measurements were
rechecked in the finished dentures (Fig. 27) after the adjustment, and they were
consistently close to the original measurement. They rarely exceeded a difference of
more than 2 mm. in any direction. The data presented here were recorded only on
the impressions, but the measurements were verified on the completed dentures.

laboratory procedures
The following standardized procedure was carried out to provide the basis for
a two-year comparative evaluation of the biologic adjustment of the soft palate
tissues to the technique for extending the posterior palatal seal to the more pos-
teriorly located vibrating line.
The cast was poured and scored in the following manner. A pencil line was in-
scribed from hamulus to hamulus midway between the anterior and posterior flexion
lines. A groove was made in the cast along the line to a depth of 1 or 2 mm. The
depth was measured with a periodontal depth probe gauge (Fig. 28). A 1 mm.
groove was used for casts made from firm ridges, and where the soft palate extended
 Volume 25 Dimensions and displacement patterns 481
Number 5

Fig. 21 Fig.

Fig. 21. Indelible pencil markings locate the right and left pterygoid hamuli, the midsagittal
area of the anterior vibrating line, and the posterior vibrating line.
Fig. 22. The anterior vibrating line demonstrates the flexion line when the tongue is pro-
truded excessively.

Fig. 23 Fig. 24

Fiig. 23. The flexion line is demonstrated at the secondary vibrating line when the soft palate
is vibrated with the sounding of a soft ah, ah, ah.
Fig. 24. Representative palatal-seal area markings between the vibrating line and the right
and left hamuli transferred to the impressions and later to the completed denture.

posteriorly on a flat horizontal plane, the 2 mm. depth was used, (1) when ridges
were small and covered with soft movable tissue, (2) when the palatal vault was
high, and/or (3) when the soft palate was at an abrupt angle to the mean horizon-
tal plane of the hard palate.
A shallow scratch mark was placed on the anterior flexion line, and the posterior
flexion line was scored to a depth one half that of the midscore line, i.e., if the mid-
score line was 2 mm. deep, then the posterior line was 1 mm. deep. The cast was
scraped over the entire seal area so that the anterior segment on the cast was sloped
from the scratch mark anteriorly to the deepest portion at the midline (Figs. 29 and
30). The depth of the cast scraping diminishes from the midline to the posterior
vibrating line (Figs. 31 and 32). Th e effect of the scraping is to allow the seal
 482 Silverman J. Pro& Dent.
May, 1971

Fig. 25 Fig. 26

Fig. 25. A measurement is made between the hamular process markings.

Fig. 26. A measurement is made between the anterior and posterior flexion lines.

Fig. 27. The darker area represents the increased length of a denture which terminated at
the anterior vibrating line when extended to the posterior vibrating line.

area on the denture to slightly displace the soft palate with a convex surface not
unlike the ball of the tip of the index finger when it presses gently against the side
of the cheek. Fig. 33 demonstrates the curvilinear contours of the posterior border
in relation to the soft palate.

ANALYSIS OF THE DATA

Ninety-two patients, 68 women and 24 men, were examined using the clinical
laboratory procedure described herein. The mean distance between the hamular
points was 35.8 mm., and the distances ranged from 25 to 48 mm. (Fig. 34). The
mean distance was 37.1 mm. for the men and 35.6 mm. for the women. The mid-
Volume 25 Dimensions and displacement patterns 483
Number 5

Fig. 29 Fig. 30

Fig. 31 Fig. 32

Fig. 28. The initial groove is measured for the proper depth with a periodontal probe.
Fig. 29. The left anterior quadrant is scored to the predetermined depth.
Fig. 30. The right anterior quadrant is scored to the predetermined depth.
Fig. 31. The left posterior quadrant is scored to the predetermined depth.
Fig. 32. The broken line indicates the deepest scoring area after the fourth quadrant is
scored.

sagittal anteroposterior mean length of the posterior palatal seal area was 8.0 mm.
(Table I). The right sagittal length was 8.2 mm. (Table II), and the left sagittal
length was 8.1 mm. (Table III). The range of measurements was from 5 to 12 mm.
The distributions of these width and length measurements demonstrated a
classic bell curve around the mean values. No significant correlation was found
between the interhamular process distances and the sagittal distances. A scatter-gram
demonstrated no significant distribution in these or any other correlation. The data
indicate only that there is a second flexion line that can be clinically observed and
recorded posterior to the fovea-oriented flexion line and that patients can tolerate
and use prostheses that are extended to this second posterior flexion line.
The data in Tables IV and V from the follow-up study indicate that, of the 74
patients who responded to the two-year follow-up, 88 per cent were comfortable
with the border length as described and the remaining 12 per cent required reduc-
404 Silverman J. Prosth. Dent.
May, 1971

Fig. 33. Schematic ilIustration of curvilinear contours of the denture border in the palatal-
seal area.

tion in length as follows: 7 per cent required from 2 to 3 mm, reduction in Iength
and 5 per cent required less than 2 mm. reduction in length. The reduction areas
were located either in the midsagittal area alone or in either the right or left
posterior border area just medial to the hamular process. It was not necessary to
modify the posterior border lateral to the hamular process in any of the denture
adjustments.
The patients were examined as per the usual office practice. They were re-
examined at least every three months during the first year and at least every six
months during the second year. Most of the patients required other adjustments,
such as occlusal modifications and/or repair procedures. These adjustments were
not tabuIated for this study since they did not affect the findings.

CLINICAL IMPLICATIONS
The extension of the posterior border of the upper denture is indicated especially
for patients who have small residual ridges or who have ridges that are mobile and
displaceable. The extension is useful when the maxillary dental arch is small, nar-
 Dimensions and displacement patterns 405

8.2 8.0 8.1

I I

Fig. 34. Diagrammatic representation of mean measurements.

Fig. 35. Three completed dentures demonstrating different posterior border forms.

row, and high vaulted. The additional border seal is also useful for patients with a
marked retrusion of the mandible or with a mandible that is relatively prognathic
and much larger in bearing areas than the maxillae.
The extension of the base posteriorly (Fig. 35) also has merit in that it increases
486 Silverman

Table I. Range of midsagittal measurements

Mearurement
(mm.) No. Per cent
5 7 7.6
6 8 8.7
7 16 17.4
8 30 32.6
9 19 20.6
10 10 10.9
11+ 2 2.2
92 100.0
Mean = 8.0 mm.

Table II. Range of right sagittal measurements

Measurement
(mm.) No. Per cent
5 3 3.3
6 9 9.7
7 16 17.4
8 22 23.9
9 24 26.1
10 17 18.5
ll+ 1 1.1
92 100.0
Mean = 8.2 mm.

the bearing area of the denture base and reduces the pressure on the residual ridges,
as well as improves the retention of the denture. Furthermore, placement of the den-
ture border more posteriorly reduces the frequency of contact between the border
and the tip of the tongue where the conscious awareness of the denture border is
presumed to have a lower threshold of perception for contour discrimination than
has the posterior third of the tongue.

SUMMARY
1. This study was based on the treatment of 500 patients who required complete
maxillary dentures. The last 92 subjects in the series were treated with a standard-
ized experimental procedure to extend the length of a denture farther posteriorly
than usual to a second vibrating line.
2. Impressions were made with the head tipped forward at a 30 degree displace-
ment from the vertical plane, and with the tongue held in tension against the lower
anterior teeth or a tray handle.
3. The study was based upon laboratory dissection, cineradiology, cephalometric
radiology analysis, and clinical examination and treatment. The clinical findings
were evaluated during speech, swallowing, and respiratory rest postures.
4. The 92 subjects were examined for a period of two years after completion.
The results indicate that 88 per cent of the 74 patients who responded for the two-
 Dimensions and displacement patterns 487

Table III. Range of left sagittal measurements

-
Measurement
(mm.) No. Per cent
-
5 3 3.3
6 10 10.9
7 15 16.3
8 27 29.3
9 21 22.8
10 15 16.3
11+ 1 1.1
--
G 100.0
-
Mean = 8.1 mm.

Table IV. Data on all patients in study

-
Patients No.
Treated 92
Recalled 92
Responded for re-examination 74
Total not responding 18
No response due to death 3
No response due to relocation 10
No reason for lack of response 5

Tlmble V. Conditions observed for 74 subjects who responded

-
Conditions No. of patients
Inflamed palate tissues; dentures shortened or modified from
2 to 3 mm. in length 5
No inflamed tissue; demonstrated noninflammatory or nonpathologic
tissue alterations; dentures modified less than 2 mm. 4
No clinical inflammation or tissue modification in palate typography;
no denture changes were required 65

year period of reexamination required no modification in denture border length

and that the dentures functioned very satisfactorily.
5. The critical factors in achieving successful extension of the posterior border
are the 30’ tipping of the head and the placement of the tongue under tension
against the tray handle or against the remaining anterior teeth while the impres-
sion material sets.

CONCLUSIONS
Complete maxillary dentures can be extended for an average distance of 8.2
mm. dorsally to the “vibrating line” or flexion line where the soft palate joins the
hard palate when viewed intraorally. This extension varies from 4 to 12 mm. dor-
sally to a transverse region which I suggest be designated the “posterior vibrating
line,” as differentiated from the “anterior vibrating line” near the hard and soft
palate junction.
488 Silverman

References
1. Tyson, K. W.: Physical Factors in Retention of CompIete Upper Dentures, J. PROSTH.
DENT. 18: 90-97, 1967.
2. Boucher, C. 0.: Swenson’s Complete Dentures, ed. 6, St. Louis, 1970, The C. V. Mosby
Company, p. 372.
3. Geller, J. W.: Prosthetic Dentistry, J. PROSTK. DENT. 10: 33-36, 1960.
4. Collett, H. A.: Complete Denture Impressions, J. PROSTH. DENT. 15: 603-614, 1965.
5. Kolb, H. R.: Variable Denture Limiting Structures of the Edentulous Mouth, J. PROSTH.
DENT. 16: 194-201, 1966.
6. Hardy, I. R., and Kapur, K. K.: Posterior Border Seal-Its Rationale and Importance,
J, PROSTH. DENT. 8: 386-397, 1958.
7. Landa, J. S.: Trouble Shooting in Complete Denture Prosthesis, J. PROSTH. DENT. 9:
978-987, 1959.
8. Harkins, Cloyd, S.: Principles of Cleft Palate Prosthesis, New York, 1960, Columbia
University Press.
9. Litvak, H., Silverman, S. I., and Garfinkel, L.: Oral Stereognosis in Dentulous and
Edentulous Subjects, J. PROSTH. DENT. 25: 139-151, 1971.
10. Starch, C., Silverman, S. I., and Landa, L.: Incompetent Palatal Syndrome “Swallowing,”
J. Dent. Res. July, 1965 (Abst.).
11. Nelson, M.: An Analysis of the Relationship Between Head Posture and Soft Palate
Contours During Impression Procedures; Masters of Science Thesis, 1970, New York
University, College of Dentistry.

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