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p the operator and provides enough landmarks to act as positive guide during denture construction. This subject can be discussed under: [ I ] Extra-oral landmarks of prosthetic importance. [ II ] Intra-oral landmarks of prosthetic importance: a) In the maxilla. b) In the mandible. [ III ] Border structures that limit the periphery of the denture: a) In the maxilla. b) In the mandible. [ IV ] Anatomy and physiology of the T.M. J. and mandibular movements. [ I ] Extra-oral Landmarks Of Prosthetic Importance: Landmark Description 1- Inter-pupillary line - Imaginary line running between the two pupils of the eye when the pt. is looking straight forward. 2- Ala-tragus line (Camper's line) - Imaginary line running from the Inferior border of the ala of the nose to the superior border of the tragus of the ear. - Imaginary line running from the outer canthus of the eye to the superior border of the tragus of the ear. - Depression that extends from the ala of the nose in a downward and lateral direction to the corner of the mouth. - The transitional epithelium between the mucous membrane of the lip and the skin. Significance - Establishing the anterior Occlusal plane of the artificial teeth of the denture. - Establishing the posterior Occlusal plane of the artificial teeth of the denture. - Locating the position of the condyles.
3- Canthus-tragus line
4- Naso-labial sulcus
- After extraction of teeth it becomes accentuated and should be restored by complete denture. - After extraction disappears in the upper lip and becomes accentuated in the lower& should be restored by a complete denture. - It determines the Angle of Classification: 1- Angle class [I]: Normal ridge relationship. 2- Angle class [II[: Retruded mandibular position. 3- Angle class [III]: Protruded maxillo-mandibular relation ship. Significance - After extraction of teeth it becomes flattened and should be restored by a complete denture. - After extraction of teeth it becomes downwards and should be restored by a complete denture. - (Angular Chilitis): Inflammation and ulceration as a result of: 1- Prolonged edentulism.
5- Vermillion border
6- Mento-labial sulcus
Landmark 7- Philtrum
Description - Diamond-shaped area between the center of the upper lip and the base of the nose. - The point of meeting of facial muscle fibers.
8- Modiolus
Fig.1: A, The Philtrum, naso-labial sulcus, commissure of the lips& mento-labial sulcus. B, Modiolus and Orbicularis Oris muscle.
Fig.2: Profile view showing the relation of the upper and lower anterior teeth and the curvature of mento-labial sulcus [ II ] Intra-oral landmark of prosthetic importance: A- In the Maxilla: Landmark Description 1- Residual ridge - The portion of the alveolar process& it's soft tissue covering that remains after extraction. 2- Maxillary tuberosity - Bony prominence located posterior to the upper 3rd molar.
Significance - It covers by a dense connective tissue fibers so, it can be act as a 1ry stress bearing area. - Aid in support, retention and stability of the complete denture. - When it is large: 1- Relieved. 2- Modify the path of insertion. (unilateral enlargement). 3- Surgical removal. - When it is prominent it should be relieved. - Lack of relief cause: 1- rocking of the denture due to bone resorption. 2- Tissue ulceration. 3- Mid-line denture fracture.
4- Incisive papilla
- After extraction of teeth it migrates to the crest of the ridge. - It should be relieved to avoid the burning sensation of the palate. - 2ry stress bearing area. - Prevent forward movement of the denture. - If it is sensitive or prominent it should be relived. - It should be: 1- Relieved. 2- Surgical removal. - It determines the posterior extension of the upper complete denture to be 2mm posterior to it.
Fig.3: A, Diagram of the upper arch. B, Diagram of the lateral surface of the maxilla.
5- Palatine rugae
- It is irregular elevations radiates from the midline of the anterior part of the palate.
6- Torus palatinus
- Bony prominence present at both sides of the midline of the palate. - Two openings of minor salivary glands present in both sides of the midline posterior to junction of hard and soft palate.
7- Fovea palatinae
B- In the Mandible:
Description - The portion of the alveolar process& it's soft tissue covering that remains after extraction.
Significance - Don't used as 1ry stress bearing area Covered by movable fibrous connective tissue. - Don't Provide stability or support. - It is a limiting structure to the complete denture and not extend to it. - Used as 1ry stress bearing area: 1- Perpendicular to the vertical masticatory force. 2- Formed from compact bone. 3- provide support. - Lack of relief numbness of the lower lip.
- Bony ridge running downward and forward from ramus to reach mental foramen. - Bony area extends between the external oblique ridge and the residual ridge.
4- Mental foramen
- It's located on the Buccal surface of the mandible between the roots of 1st and 2nd premolar.
5- Retromolar pad
- Shock absorbent. - Gives retention not support. - Determine the level of the Occlusal plane. - It should be: 1- Relieved. 2- Surgical removal. - It should be relieved during complete denture construction. - Represent the attachment of geniohyiod and genioglossus muscles. - If it's prominent, it should be relieved.
6- Torus mandibularis
- Bony prominence located at the inner surface of premolar area. - Irregular bony ridge of median surface of the mandible which the Mylohyoid muscle attached. - Two bony projections present at the median surface of mandible at midline of each side of symphesis.