ANATOMICAL

LANDMARKS IN
RELATION TO COMPLETE
DENTURES

INTRODUCTION
Complete dentures are artificial substitutes for living
tissues that have been lost. For harmony of living
tissues & non-living material (dentures) to co-exist for
reasonable periods of time, the dentist must fully
understand the anatomy of the landmark structures
of the dentures.
The clinical application of this knowledge determines:
The selective placement of forces by the denture
bases upon the supporting tissues.
The form of the denture borders that will be
harmonious with the normal function of the limiting
structures that surround them.
Both the above are developed during preliminary &
final impression procedures.
2

ORAL MUCOUS MEMBRANE

The bone of upper and lower edentulous

jaws, and the oral cavity is lined with a soft
tissue that is known as mucous membrane.
Denture bases rest on the mucous
membrane, which serve as a cushion
between denture base and supporting bone.
The mucous membrane composed of :(i) Mucosa
(ii) Sub Mucosa
3

(1) Mucosa :

Mucosa is formed by stratified squamous epithelium

cells.
There is subjacent narrow layer of connecting tissue to
the mucosa, known as lamina propria.

(2) Sub mucosa :

Sub mucosa is formed by connective tissue.

Connective tissue varies in character from dense to
loose alveolar tissue and also varies considerably in
thickness.
It may contain glandular, fat or muscle cells.
Sub mucosa transmit the blood and nerve supply to the
mucosa.
Sub mucosa attaches to the periosteal covering of the
4
bone.

CLASSIFICATION OF ORAL MUCOSA

Depending on its location in mouth, oral mucosa
classified
into three categories

MASTICATORY MUCOSA
LINING MUCOSA
SPECIALISED MUCOSA
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(i) Masticatory
mucosa :

In edentulous patients, it
covers the crest of
alveolar ridge and the
hard palate.
It is characterized by well
defined keratinized layer
on its outermost surface.

(ii) Lining mucosa :

It forms the covering of

lips, cheeks, vestibular
spaces, alveolingual
sulcus, soft palate, ventral
surface of the tongue and
an unattached gingival
fold on the slope of the
residual ridge.
It is devoid of keratinized
layer and freely movable
with the tissue .
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(iii) Specialized
mucosa :

It covers the dorsal

surface of the tongue.

This mucosal covering is

keratinized and includes
the specialized papillae
on the upper surface of
the tongue.
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Anatomical landmarks can be

diffrentiated as:
Limiting areas

MAXILLARY
supporting areas

Labial frenum
Labial vestibule
Primary
Relief
Buccal frenum
Residual ridge
Incisive papilla
Buccal vestibule
Hard palate
Median palatal
Hamular/
raphe
Pterygomaxillary notch
Torus palatinus
Posterior palatal seal region

Secondary
Maxillary tuberosity
Rugae

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MANDIBLE
Limiting areas
areas
Labial frenum
Primary
Relief
Labial vestibule
Buccal shelf
Crest of ridge
Buccal frenum
Mylohyoid ridge
Buccal vestibule
Torus mandibularis
Lingual frenum
Mental foramen
Alveololingual sulcus
Genial tubercles
Pterygomandimular raphe

supporting

Secondary
Retromolar pad
Residual alveolar
ridge

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MAXILLARY LANDMARKS

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CORREALTION OF
ANATOMIC
& DENTURE
LANDMARKS

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ANATOMIC LANDMARKS READING AN

IMPRESSION
1. Labial frenum
1. Labial notch
2. Labial vestibule
2. Labial flange
3. Buccal frenum
3. Buccal notch
4. Buccal vestibule
4. Buccal flange
5. Coronoid bulge
5. Coronoid contour
6. Residual alveolar ridge
6. Alveolar groove
7. Maxillary tuberosity
7. Maxillary tubercular
8. Hamular notch
fossa
9. Posterior palatal seal
8. Pterygomaxillary seal
region
9. Posterior palatal seal
10.Fovea palatinae
10.Fovea palatinae
11.Median palatine raphe 11.Medan palatal groove
12.Incisive papilla
12.Incisive fossa
13.Rugae region
13.Rugae
15

LIMITING STRUCTURES
LABIAL FRENUM
Fold of mucous membrane at the midline.
Normally a single band, may consist of two or more fibrous
bands.
Contains no muscle & has no action of its own.
Starts superiorly in a fan shape & converges as it descends
to its terminal attachment to the labial side of the ridge.
When activated, it creates the labial notch in the denture
base.
Action of the lip in this area is mainly vertical, so the labial
notch is usually narrow.
Labial notch must be just wide & deep enough to allow the
frenum to pass through it without manipulation of the lip; to
be taken into consideration in the relief for this attachment.
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 Wide notch may result in loss of seal, especially if

patient has a short & active lip.
A shallow bead can be formed around the notch to
help perfect the seal.
Used as a centering guide while placing the
impression tray.
Activation of frenum to record the anterior region
is when the upper lip is elevated & extended out,
downward & inward.

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LABIAL VESTIBULE
Extends between the right & left buccal freni or
between the area of the right & left first
premolars if the freni are absent.
In this region, 3 objectives are apparent:
1. The impression must supply sufficient support to
the upper lip to restore its relaxed contour,
means the thickness of the flange must be
developed according to the amount of bone that
has been lost from the labial side of the ridge.
2. Must have sufficient height to reach the
reflecting mucous membrane without distorting
it.
3. There must be no interference of the labial
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flange with the action of the lip in function.

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ORBICULARIS ORIS
MUSCLE
Main muscle of the lip.
Lies in front of & rests upon the labial flange (denture
border between the labial frenum & the buccal frenum) &
teeth of a denture.
Its fibers pass horizontally through the lips, so careful
border molding is necessary because its easy to
overextend the impression.
Has only an indirect effect on the extent of an impression
& the denture base ( direction of fibers).
Its tone depends on the support it receives from the
thickness of the labial flange & the position of the arch of
the teeth.

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21

BUCCAL FRENUM

Consists of a single or double fold of mucous membrane.

Broad & fan shaped.
May be totally absent or in an entirely different location.
Along with its associated muscles of expression, it
creates the buccal notch, which is nearly always wider
than the labial notch because more clearance is needed
for the muscle activity.
Caninus (levator anguli oris) attaches beneath the
buccal frenum & affects its position.
Orbicularis oris pulls it forward.
Buccinator pulls it backward.
Buccal notch should be broad enough to allow this
movement.
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 Denture border should be functionally molded to

fit exactly the depth & width of the frenum when
its in function, being moved by the 3 muscles
that are associated with it.
Activation of the frenum to record the cheek is
elevated & then pulled outward, downward &
inward & moved backward & forward to simulate
movement of the upper buccal frenum.

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25

MODIOLUS

Most of the muscles of expression converge at the corner of

the mouth to form a nodule called the modiolus.
Buccal frenum is part of the continuous band of tissue going
from the maxilla through the modiolus to the buccal frenum on
the mandible.
Major muscles in this area are :
Buccinator
Orbicularis oris
Levator anguli oris
Depressor anguli oris
Zygomaticus major
Risorius
Platysma
Levator labii superioris
26

 Due to the frequent activity of the buccal frenum

& the modiolus, the border thickness of the buccal
notch should be fairly thin (>2mm).
If the ridge is flat, a wider border may be
necessary for better peripheral seal, as well as lip
& cheek support to improve aesthetics.

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BUCCAL VESTIBULE
Extends from the buccal frenum to the hamular or
pterygomaxillary notch.
At the distal end of the residual ridge is the
alveolar tubercle, which produces a depression at
the distal end of the alveolar groove.
Its extent can be deceiving because the ramus
obscures it when the mouth is wide open, so
should be examined with the mouth as nearly
closed as possible.
Size of the buccal vestibule varies with the
Contraction of the buccinator muscle,
Position of the mandible,
Amount of bone lost from the maxilla.
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29

Width of the buccal border is usually 2-3mm to 35mm (or more) in the tuberosity area.
Width of the buccal vestibule is reduced when the
mandible moves forward or to the opposite side ,
also when masseter muscle contracts under heavy
closing pressures.
Thickness of the tuberosity area depends on
Size of the tuberosity,
Proximity of the coronoid process during functional
movements (coronoid bulge),
Masseter muscle,
Ramus.
If its thick, the ramus will push the denture out of
place during opening or lateral movements of the
mandible.
30

 Buccinator fibers are horizontal & are relatively flaccid

in the areas of origin(buccal alveolar bone apical to
the molars), so its easy to overextend the
impression.

A histologic section of the mucous membrane lining

the vestibular spaces depicts ;
relatively thin, nonkeratinized epithelium.
submucosal layer is thick & contains large amounts
of loose areolar tissue.
For this reason, labial or buccal flanges can easily be
overextended or underextended.
Buccal flange is border molded when the cheek is
extended outward, downward & inward.
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32

HAMULAR OR PTERYGOMAXILLARY NOTCH

Situated between the maxillary tuberosity & the hamulus of

the medial pterygoid plate.
2mm wide.
Necessary to locate as identifies the important distal end of
the denture back of the tuberosity.
Accomplished by using a mouth mirror so that the edge drops
into a definite depression.
Also, submucosa of the mucous membrane is thick & made
up of loose areolar tissue.

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35

POSTERIOR PALATAL SEAL

Defined as the soft tissues along the junction of
the hard & soft palates on which pressure within
the physiologic limits of the tissues can be applied
by a denture to aid in the retention of the
denture.
Divided into 2 separate but confluent areas based
upon anatomical boundaries:
Postpalatal seal - extends medially from one
tuberosity to the other.
Pterygomaxillary seal- extends through the
pterygomaxillary notch continuing 3-4 mm
anterolaterally approximating the mucogingival
junction.
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Primary purpose is retention of the maxillary

37

SOFT PALATE

The posterior border of the denture and the posterior

palatal seal are two of the most critical areas for the
maxillary denture retention.

In most instances, the denture should end distal to

the hard palate, but it should not extend too far
otherwise there will be irritation to the muscle of
the soft palate.

The M.M.House classification is customarily used to

designate the shape of the soft palate and it
describes the amount of posterior tissue that will
accept the posterior palatal seal
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Class I More than 5mm of

movable tissue available
for post damming .
It is ideal for retention.
Class II 1-5 mm of movable
tissue available for post
damming.
In this type retention
is usually possible.
Class III Less than 1 mm
movable tissue available
for post damming.
Retention is usually
poor in this class.
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VIBRATING LINE
The posterior palatal seal area lies between the anterior &
posterior vibrating lines.
The anterior vibrating line is an imaginary line located
at the junction of the attached tissues overlying the
hard palate & the moveable tissues of the immediately
adjacent soft palate.
Not to be confused with the anatomic junction of the hard
& soft palate as its always on the soft palate.
Marks the beginning of motion in the soft palate when the
patient says ah.
Due to the projection of the posterior nasal spine, it is not
a straight line between the two hamular processes.
At the midline, it usually passes 2mm in front of the fovea
palatinae, forming the Cupids bow.
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41

 Location by 2 methods :
1. Have the patient perform the Valsava
Maneuver. This will position the soft palate
inferiorly at its junction with the hard palate.
2. Visualize the area while instructing the patient
to say ah with short, rigorous bursts.

42

 Microscopically,
submucosa in the region
contains glandular tissue.
However, because the soft
palate does not rest
directly on bone, the
tissue for a few mms on
either side of the vibrating
line can be repositioned in
a controlled manner in the
impression procedure to
improve the Posterior
palatal seal.
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 The posterior vibrating line is an imaginary line

at the junction of the aponeurosis of the tensor veli
palatini muscle & the muscular portion of the soft
palate.
Represents the demarcation between that part of
the soft palate that has limited or shallow
movement during function & the remainder of the
soft palate that is markedly displaced during
functional movements.
Visualized by instructing the patient to say ah in
short bursts but in a normal, unexaggerated fashion.
Marks the most distal extension of the denture base.

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45

STRESS BEARING AREAS

RESIDUAL ALVEOLAR RIDGE
POSTERIOR ALVEOLAR RIDGE
Primary stress-bearing area in the maxilla.
Why ?
Mucous membrane covering the crest of the residual ridge is firmly
attached to the periosteum of the bone by the connective tissue of the
submucosa.
Stratified squamous epithelium is thickly keratinized.
Submucosa is devoid of fat or glandular cells but is characterized by dense
collagenous fibers that are contiguous with the lamina propria.
Submucosal layer,though relatively thin in comparison with other parts of
the mouth, is still sufficiently thick to provide adequate resiliency for
primary support for the upper denture.
Outer surface of the bone is compact in nature, being made of haversian
systems.

46

 Impression procedures should take advantage of

the nature of this tissue when one provides for
additional stress to be placed on the crest of the
ridge.
Artificial teeth will be placed near this ridge so
that leverage will be minimal under the
circumstances.

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MICROSCOPIC FEATURES OF RESIDUAL RIDGES

The mucous membrane

covering the crest of the ridge
is attached to the periosteum
of the bone by the connective
tissue of the sub mucosa.
The stratified squamous
epithelium is thickly
keratinized.
The sub mucosa is devoid of
fat or glandular cells and it
is characterized by dense
collagenous fibers that are
contiguous with lamina
propria.

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49

ANTERIOR ALVEOLAR
RIDGE
Secondary area of support as seems to
be more susceptible to resorption.
Care must be taken to capture this area
with little or no pressure.

50

HARD PALATE
It is formed by palatine processes of maxilla and
palatine bone.
Most of the hard palate forms the primary stress
bearing area of maxillary denture.
It provides supports to the soft tissues which increase
the surface area of maxillary denture and hence
increase the retention of the denture.
Soft tissue covering the hard palate varies
considerably in thickness & consistency in different
locations even though the epithelium is keratinized
throughout.
Antero-laterally , submucosa contains adipose tissue.
Postero-laterally , submucosa contains glandular
tissue.
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 In the U shaped palate the flat portion resists

vertical displacement while the rounded U portion
resists both vertical and lateral forces of
displacement.

52

GLANDULAR REGION ON THE

PALATE
On either side of the midline in the posterior
part of the hard palate.
Should be covered by the denture to aid in
retention, but not be expected to provide
support.
Mucous glands in this region should not be
subjected to significant occlusal forces from
dentures which interfere with their function.
Mucous glands are relatively thick, & they cover
the blood vessels & nerves coursing forward in
the palate from the greater palatine foramen.
53

Histological appearance of hard

palate

54

MAXILLARY TUBEROSITY
Is the distal aspect of the posterior ridge, which
sometimes require vertical reduction because they
contact the pear-shaped pad at the correct vertical
dimension of occlusion.
More often, it requires lateral reduction because the
coronoid process of the mandible is in close contact
during opening & lateral jaw movements & there is
inadequate space for a correctly extended buccal flange.
If surgery is not feasible, it may be possible to cover the
tuberosity with a thin casting of chrome alloy, its twice
as strong as gold & can be finished to a scant 0.3mm;
gold must be cast 0.6mm thick & is also more expensive.
In some patients, the tuberosity form remains & the bone
is replaced with fibrous connective tissue, which when
excessive is advantageous to remove to enhance
stability.
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56

RUGAE
Secondary stress-bearing area, since it can resist
forward movement of the denture.
Irregularly shaped raised rolled areas of dense
connective tissue radiating from the midline in
the anterior one-third of the palate.
Are often compressed or distorted from an illfitting denture & should be allowed to return to
their normal form prior to impression making,
either by leaving the dentures out for a few days
or more practically with the use of tissue
conditioners.
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58

RELIEF AREAS
INCISIVE PAPILLA
Pad of fibrous connective tissue overlying the bony exit of
the nasopalatine canal which carries the nasopalatine
blood vessels & nerves incisive foramen.
Located on the median line immediately behind & between
the central incisors.
Its location gives an indication of the amount of residual
ridge resorption & thus is an aid in determining the vertical
dimension & the proper position of the teeth.
Located on the center of the ridge after resorption has
occurred in mouths that have been edentulous for a long
time.
Relief should be provided in every denture to avoid any
interference with the blood & nerve supply.
Denture pressure on the papilla can cause paresthesia,
59
pain, burning sensation & other vague complaints.

60

Compact Bone

Nasopalatine
Nerve and Vessels

Submucosa

Mucosa

61

MEDIAN PALATAL SUTURE

The junction of the palatine processes of the
maxillae is often raised & covered with only a thin
layer of submucosa. Mucosal layer is practically in
contact with the underlying bone. For this reason,
the soft tissue covering it is non-resilient.
Little or no stress can be placed in this region during
impression making or in the completed denture.
Otherwise, the denture will tend to rock over the
center of the palate when vertical forces are applied
to the teeth as it will act as a fulcrum point.
Also, this region is highly sensitive & excessive
pressure can create excruciating pain.
Proper relief is essential for accommodation of the
histological nature of this tissue.
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63

Histological appearance

64

FOVEA PALATINE
Fovea palatine are small indentations on each
side of the midline of the distal end of the palate.
Formed by a coalescence of several mucous
gland ducts.
Close to the vibrating line.
Always in soft tissue, which makes them an ideal
guide for the location of the posterior border of
the denture.

65

TORUS PALATINUS
A hard bony enlargement that occurs in the midline of
the roof of the mouth.
Occurs in about 20% of the population.
One type is almost entirely soft tissue, loose & flabby.
Other type has a thin layer of mucosal tissue covering
the bone.
Extent of the torus can be determined by palpation.
Its size & shape vary greatly.
It may be a small one, which can be easily relieved with
pressure indicating paste or a very large growth that
should be surgically removed.
Relief provided in the palate should confirm accurately
to the shape of the hard area.
Generally, more convex the hard area, more relief will
66
be required.

67

 Although its better to remove a very large torus, it

may be contraindicated due to physical or
psychological reasons.
In this case, use of 1.5 mm wide & 1mm deep bead
on the inside of the denture around the torus may
suffice for adequate retention.
If the ridge is large, a roofless denture can be used,
especially if the opposing arch is another denture.
In any case when the torus is large, the patient
must be informed that the retention of the denture
will be compromised if surgery cannot be
performed.
68

POSTERIOR PALATINE AREA

Thickly covered by soft tissue that does not need

to be relieved except in extreme cases of
resorption.
These tissues should be recorded in a resting
condition because when they are displaced in the
final impression, they tend to return to normal
form within the completed denture base, creating
an unseating force on the denture or causing
soreness in the patients mouth.
Proper relief aids in recording the tissues in an
undistorted form.
69

ZYGOMATIC PROCESS
The zygomatic (or malar) process is located
opposite the first molar region & usually does not
warrant any special consideration except when
the ridge is very flat; it should be relieved( its
mucosal covering tends to be very thin).
Some dentures require relief over this area to aid
retention & prevent soreness of the underlying
tissues.

70

SHARP, SPINY PROCESSES

Frequently found on the maxillary & palatal

bones, deeply covered with soft tissue.
In patients with considerable resorption of the
residual alveolar ridge, these sharp spines
irritate the soft tissues left between them & the
denture base.
Should be relieved.

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MANDIBULAR LANDMARKS

72

CORRELATION OF ANATOMIC
& DENTURE LANDMARKS

73

ANATOMIC LANDMARKS

1. Labial frenum
2. Labial vestibule
3. Buccal frenum
4. Buccal vestibule
5. Residual alveolar ridge
6. Buccal shelf
7. Retromolar pad
8. Pterygomandibular raphe
9. Retromylohyoid fossa
10.tongue
11.Alveolingual sulcus
12.Lingual frenum
13.Premylohyoid eminence

READING AN IMPRESSION

1.
2.
3.
4.
5.
6.

Labial notch
Labial flange
Buccal notch
Buccal flange
Alveolar groove
Buccal flange which covers
the buccal shelf
7. Retromolar pad
8. Pterygomandibular notch
9. Lingual flange with
extension into
retromylohyoid fossa
10.Inclined plane for the
tongue
11.Lingual flange
12.Linugal notch
13. Premylohyoid eminence
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LABIAL FRENUM
Usually a single narrow band, but may consist of
two or more bands of fibrous connective tissue.
Helps to attach the orbicularis oris; therefore, the
frenum is quite sensitive & active & must be
carefully fitted to maintain a seal without causing
soreness.
Activity of this area tends to be more vertical, so
should be narrow in the denture.
Usually shorter & wider than the maxillary labial
frenum.
Creates the labial notch in the impression.
To record the activation of the frenum in lower
anterior region by extension of lower lip
outward,
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upward & inward.

76

LABIAL VESTIBULE
Is the sulcus between the buccal freni, or between the first
premolars, if the freni are absent or in an unusual location.
In the denture, labial flange extends between the labial
frenum & the buccal frenum.
This flange is limited in extension because the fibers of
orbicularis oris & incisivus labii inferioris muscles run fairly
close to the crest of the ridge.
Major muscle is the orbicularis oris; its fibers are mainly
horizontal, so one must be careful not to overextend the
impression in this area.
Mentalis muscle originates from the mental tubercles &
inserts in the lower lip; a vertical muscle which may be very
active in some patients; careful border molding is required.
Excessive activity in this area often results in a short flange
which may not provide a seal for the finished denture.
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 Impression space is determined by the turn of the

mucolabial fold.
Length & thickness of the labial flange in the labial
vestibules vary with the amount of the tissue that has been
lost.
The tone of the skin of the lip & of the orbicularis oris
depend on the thickness of the flange & the position of the
teeth.
The drape of the lips & cheeks create a facial seal. This is
why its possible to have a denture with an open or short
flange(often used for immediate dentures) & still have good
retention.
In general, a thick border creates a better seal than a thin
border.
Wider borders tend to create favourable inclined planes &
reduce the potential of losing peripheral seal. However,
care must be taken to use the thicker borders with
discretion, since they may cause discomfort,81poor

BUCCAL FRENUM
Usually in the area of the first premolar.
Maybe a single band but is often two or more
bands.
Oral activities in this area are horizontal as well as
vertical, so wider clearance is usually needed.
Contour of the denture will be a little narrower in
this area due to the activity of the depressor anguli
oris.
Connects through the modiolus; these fibrous &
muscular tissues pull actively across the denture
borders, polished surfaces & teeth.
Therefore, denture should be extended less in this
region & the impression must be functionally
trimmed to have the maximum seal & 82yet not so
great an extension as to displace the denture when

 To record frenum activation cheek is lifted outward,

upward, inward, backward & forward to simulate
movement of the lower buccal frenum.

83

BUCCAL VESTIBULE
Extends from the buccal frenum to the outside
back corner of the retromolar pad & from the
crest of the residual alveolar ridge to the cheek.
Its width & length are mainly dependent on the
buccal shelf & the buccinator muscle.
Adequate support requires that the buccal flange
extends from the outer edge of the buccal shelf
or external oblique line, which can easily be
determined by palpation.
Its length is not critical for peripheral seal
because of the facial seal.
Activation of frenum is recorded when the cheek
is moved outward, upward & inward.
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85

BUCCINATOR MUSCLE
It comprises of 3 muscles with separate
enervation.
Middle fibers constitute the most active muscle
whose function is primarily to control the food
bolus during mastication; also cross through the
modiolus.
Upper & lower fibers are relatively flaccid.
It originates from the posterior buccal area of the
maxillary & mandibular ridges & distally from the
pterygomandibular raphe.
Its lower side attaches in the molar region in the
buccal shelf, which is completely covered in most
situations.
Its action occurs in a horizontal direction,
& so it
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87

MASSETER MUSCLE
REGION

The area influenced by the masseter muscle is lateral to

the pear shaped pad.
This large & powerful elevator lies over the buccinator &
its action usually creates a groove from the base of the
pad to the distobuccal area, called the masseter
groove.
This area must be border molded correctly because
overextension causes soreness & loss of support &
resistance to distal displacement.
Distobuccal corner of the denture must converge rapidly
to avoid displacement because of contracting pressure of
the masseter muscle, whose anterior fibers pass outside
the buccinator in this region.
When the masseter contracts, it alters the shape & size
of the distobuccal end, pushes inward against the
buccinator & suctorial pad of the cheek. 88

 Distobuccal border encounters its action to a greater or

lesser degree depending on the shape of the mandible &
origin of the muscle.
If the ramus has a perpendicular surface & origin of the
muscle on the zygomatic arch is medialward, the muscle
pulls more directly across the distobuccal denture border.
Therefore, it forces the buccinator & tissue inward,
reducing the space in this region.
If the opposite is true, greater extension is allowed on the
distobuccal end.

89

PTERYGOMANDIBULAR RAPHE OR
LIGAMENT
Originates from pterygoid hamulus of the medial
pterygoid lamina & attaches to the distal end of
the mylohyoid ridge.
It is partly the origin of the buccinator laterally &
the superior constrictor medially.
It is quite prominent in some patients & may
even require a notch-like clearance in the
maxillary denture; however most patients dont
require clearance.
A simple wide-open visual & digital inspection will
usually determine whether or not clearance is
necessary.
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LINGUAL FRENUM
Rather shallow, sensitive & resistant.
Should be registered in function because at rest
the height of its attachment is deceptive.
In function, it often comes quite close to the crest
of the ridge, whereas at rest it is much lower.

92

LINGUAL BORDER ANATOMY

Lingual border impression is easily carried down along
the bony surface of the mandible below the mylohyoid
ridge, since the mylohyoid muscle is a thin sheet of
fibers that in a relaxed state will not resist the
impression.
However, this extension cannot be tolerated in function
without displacing the denture, causing soreness &
limiting the function unless the flange is made parallel
with the mylohyoid muscle when it is contracted.

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94

ALVEOLINGUAL SULCUS

Space between the residual ridge & the tongue.

Extends posteriorly from the lingual frenum to the
retromylohyoid curtain.
Part of it is available for the lingual flange of the denture.
It can be considered in 3 regions:
1. Anterior region- extends from the lingual frenum to the place
where the mylohyoid ridge curves down below the level of
the sulcus. At this point, a depression (premylohyoid fossa )
can be palpated, & a corresponding prominence
(premylohyoid eminence) can be seen on impressions.
2. Middle region- extends from the premylohyoid fossa to the
distal end of the mylohyoid ridge. The sulcus curves medially
from the body of the mandible; curvatures caused by the
prominence of the mylohyoid ridge.
3. Posterior region- retromylohyoid space or fossa. Extends from
the end of the mylohyoid ridge to the retromylohyoid curtain.
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96

ANTERIOR LINGUAL
VESTIBULE
Also called the sublingual crescent area or anterior sublingual
fold.
Mainly influenced by the genioglossus muscles, lingual frenum
& some anterior portions of the sublingual glands.
Lingual frenum is superimposed over the relatively small but
powerful genioglossus muscles which mainly raise & protrude
the tongue; are attached to the genial tubercles.
Sometimes, the lower ridge is highly resorbed & the genial
tubercles are higher than the crest of the ridge, resulting in
little or no vestibular space.
A sulcus deepening procedure is recommended, but if surgery
is not possible, it is best to try to cover the tubercles as its
not possible to have peripheral seal when the denture border
ends in hard tissues.
Width of this border is ~2mm but may be narrower or wider
depending on the activity & tonicity of the genioglossus
muscles & the lingual frenum.
Lingual border in this region should extend down
97 to make

98

MIDDLE OR MYLOHYOID
VESTIBULE
Is the largest area & mainly influenced by the mylohyoid muscle &
somewhat by the sublingual glands.
Its length & width is determined by the membranous attachment
of the tongue to the mylohyoid ridge & the width of the
hyoglossus muscle & can only be determined by skillful border
molding & impression procedures.
Lingual border is formed by contact with the mylohyoid in a
functional, but not extreme, contracted or elevated position.
When this part is made to slope towards the tongue, it can extend
below the level of the mylohyoid ridge, both of which help the
tongue to rest on top of the flange & aid to stabilize the denture
on the lower ridge.
In addition, the slope in the molar region provides space for the
floor of the mouth to be raised during function without displacing
the lower denture.
Average mylohyoid border is 4-6mm below the mylohyoid ridge.
Fair to good ridge 2-3mm border width.
99
Flat ridge 4-5mm thicker border.

DISTOLINGUAL VESTIBULE
Referred to as the lateral throat form or retromylohyoid
fossa/space.
Boundaries:
Anteriorly - mylohyoid muscle & ramus
Laterally - pear-shaped pad
Posterolaterally - superior constrictor muscle & retromylohyoid
curtain
Posteromedially - palatoglossus muscle
Medially - tongue
The posterior limit of the denture is determined mainly by the
palatoglossus muscle & somewhat by the weaker superior
constrictor muscle. This area is called the retromylohyoid
curtain, a curtain of mucous membrane.
The denture border should be extended to contact the
retromylohyoid curtain when the tip of the tongue is placed
against the front part of the upper residual ridge; the curtain is
pulled forward when the tongue is thrust out. 100

101

1.
2.
.
.

The attachment of the mylohyoid muscle extends 1cm distal

to the end of the mylohyoid ridge, which prevents the
denture from locking against the bone in this region.
2 objectives are accomplished when the lingual flange is
extended into this area:
The border seal is made continuous from the retromolar pad
to the middle region of alveolingual sulcus.
This part of the flange is shaped so that it will guide the
tongue on top of the lingual flange of the denture.
Such a contour assists the patient to control the denture
without interfering with the functions of the soft tissues.
When the flange is developed in this manner, the border of
the lingual flange has a typical S curve when viewed
from the impression surface.
Distal end of the lingual flange is called the retromylohyoid
eminence.
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103

Microscopic anatomy of limiting

structures

104

105

CLASSIFICATION OF THROAT FORM BY

NEIL
Class I lateral throat form.
Indicates that the anatomical structures will accommodate a
fairly long & wide flange; retromylohyoid flange is the
longest.
Thickness varies greatly.
Horizontal border is usually 2-3mm thick, but a thicker border
of 4-5mm should be used for a better seal if the border is flat.
Retromylohyoid curtain area should be thinner, 2-3mm &
rounded & smooth, so as not to interfere with the
palatoglossus muscle.
Class III lateral throat form.
Has minimum length & thickness.
Border usually ends 2-3mm below the mylohyoid ridge or
sometimes just at the ridge.
Class II lateral form is about half as long & narrow as class I &
about twice as long as class III.
Most edentulous mouths have class I & II, class III is rare.
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107

STRESS BEARING AREAS

BUCCAL SHELF AREA
Area between the mandibular buccal frenum & anterior edge of
the masseter muscle.
Boundaries:
Medially crest of the residual ridge
Anteriorly buccal frenum
Laterally external oblique line
Distally retromolar pad
Principal bearing surface, maybe very wide & is at right angles
to the direction of vertical occlusal forces, offering excellent
resistance to them.
Takes the occlusal load off the sharp, narrow crest of the residual
alveolar ridge.
Covered with a good smooth cortical bone, which is usually at
right angles to the occlusal plane.
Ranges from 4-6mm width on an average 2-3mm or less in a
narrow mandible; its upward slope adjacent to the
pad resists
108
distal displacement.

109

Microscopic anatomy

110

RETROMOLAR/PEAR-SHAPED
PAD
Distal end of denture is bounded by the anterior border
of the ramus, this pad defines its posterior limit.
This triangular soft pad of tissue must be covered by
the denture to perfect the border seal in the area.
It contains some glandular tissue & some fibers of the
temporal tendon.
Buccinator fibers enter it from the buccal side.
Fibers of the superior pharyngeal constrictor of the
pharynx enter it from the lingual side.
Pterygomandibular raphe enters at its top back inside
corner.
Actions of these structures limit the extent of the
denture & prevent placement of extra pressure on the
retromolar pad during impression procedures or by
reducing the posterior borders of the pad 111
on the cast.

112

RELIEF AREAS
CREST OF THE RESIDUAL RIDGE

Covered by fibrous connective tissue, closely attached to

the bone is favourable for resisting externally applied
forces; but in many mouths the underlying bone is
cancellous & without a good cortical bony plate covering it,
making it unfavourable for stress-bearing.

113

Microscopic anatomy

114

MYLOHYOID RIDGE
Provides for the origin of the mylohyoid muscle.
Distal end is close to the crest of the ridge & the
anterior aspect is close to the lower border of the
mandible.
Soft tissues often hide its sharpness, which can
be found by palpation.
It is important to determine its prominence &
sharpness.
A prominent ridge can seriously interfere with the
development of a correct lingual flange & a sharp
ridge may cause pain, especially during
mastication.
115

116

MYLOHYOID MUSCLE
Largest muscle in the floor of the mouth.
Arises from the whole length of the mylohyoid line,
extending from 1cm back of the distal end of the
mylohyoid ridge to the lingual anterior portion of the
mandible at the symphysis.
Medially the fibers join the muscle fibers from the
mylohyoid muscle of the opposite side.
Posteriorly the fibers continue to the hyoid bone.
Muscle lies deep to the sublingual gland & other
structures about the region of the 2nd premolar, & so
does not affect denture borders in this region except
indirectly.
However, its posterior part in the molar region affects
117 & moving
the lingual impression border in swallowing

118

119

MENTAL FORAMEN
Lies between the first & second premolar region.
Due to ridge resorption, it may lie close to the
ridge.
Should be relieved in these cases as impingement
on the mental nerve & blood vessels can cause
numbness of the lip.

120

GENIAL TUBERCLES
These are a pair of bony tubercles found anteriorly
on the lingual side of the body of the mandible.
Superior one gives attachment to the genioglossus
muscle.
Inferior tubercle gives attachment o the geniohyoid
muscle.
Due to resorption, it may become increasingly
prominent making denture usage difficult.

121

LINGUAL TORI/ TORI

MANDIBULARIS
Bony protuberances usually found in the region
between 1st & 2nd premolars, midway between the soft
tissue of the floor of the mouth & the crest of the
alveolar processes.
Size varies from that of a pea to that of a hazelnut.
Cause is unknown but is sometimes coincident with a
bulbous torus palatinus.
Covered by an extremely thin layer of mucous
membrane & for that reason may be irritated by slight
movements of the denture base.
It is best to cover the tori to the height of contour &
finish the denture borders around the torus as thick as
the tongue will tolerate.
It should be removed surgically if relief cannot be
provided for it inside the denture without breaking the
122
border seal.

123

SUBLINGUAL GLAND
In the premolar region on the lingual side of the
ridge, the sublingual gland rests above the
mylohyoid muscle.
When the floor of the mouth is raised, this gland
comes quite close to the ridge crest, thus
preventing the development of a long flange in
the anterior part.

124

TONGUE
The ever active tongue can easily displace even the
best fitting dentures & the dental acrobat can
manipulate ill-fitting dentures with the greatest of
ease.
Usually matters very little if the tongue is small or
average.
A large tongue can be annoying during impression
procedures but is usually helpful in maintaining the
border seal, provided that the arch form & polished
surfaces do not constrict the tongue or inhibit its
normal movements.

125

 In the normal position, the tongue completely fills the

lower arch with its apex lightly contacting the linguals
of the lower teeth. This is the most favourable position
for maintaining the border seal, which enhances
denture retention.
The retruded position allows an ingress of food & air
& subsequent loss of the peripheral seal; usually
accompanied by a higher floor of the mouth due to
more tenseness in all the associated lingual muscles.
This postural problem can be improved with
counseling & tongue exercises.

126

REFERENCES
Zarb A.G, Bolender L.G, Rickey C.J,
Carlsson G.E BOUCHERS
Prosthodontic treatment for edentulous
patients IX Edition, XII Edition , C.V
Mosby company.
Winkler S . Essentials of Complete
Denture Prosthodontics, II Edition.
Heartwell C M Jr, A O. Rahn Syllabus
of Complete Dentures IV Edition.
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