Applied Anatomy Related To Complete Denture-Maxilla Mandible

DR .
Reddy
PIDC.DEPARTMENT OF PROSTHODONTICS
At the end of the lecture, the student

should be able to
Describe the complete denture terms &
consequences of edentulousness (C1)
Outline the clinical and laboratory steps
involved in fabrication of complete
denture (C4)
Recall the applied anatomy of the
denture bearing areas (C1)
Differentiate stress bearing areas, stress
relief areas ,supporting structures
&limiting structures(C4)
DEFINTION:
COMPLETE DENTURE :A dental prosthesis that
replaces all of the natural dentition and associated
structures of maxilla and mandible. It may be supported
by mucosa or sometimes by dental implants.
Esthetic.
Improve mastication.
Improve speech.
Function without interferences.
Preservation of oral structures.
Maintenance of health & comfort.
CD includes:
Conventional
Immediate
Overdenture
Single denture
Implant Supported CD
Parts of Complete Denture

A) Denture Base: which cover the edentulous
tissue area and carries the artificial teeth
B) Teeth: which are attached to the denture base
for the purpose of chewing, esthetic,
phonetics..etc
CD has three surfaces:

Polished surface :The outer surface of the denture
and in contact to the muscle of cheek and tongue
Fitting Surface: The inner surface of the denture
that contact to the oral mucosa
Occlusal Surface: A surface of posterior teeth or
occlusion rim that is intended to make contact
with opposing occlusal surface
The anatomical landmarks in the maxilla

are:
Limiting structures:
Labial frenum
Labial vestibule
Buccal frenum
Buccal vestibule
Hamular notch
Posterior palatal seal area
SECONDARY STRESS
BEARING AREAS:AREAS
PRIMARY STRESS BEARING AREAS:AREAS
Hard palate
Postero- lateral slopes of
residual alveolar ridge.
Rugae
Maxillary tuberosity
Relief areas:
Incisive papilla
Cuspid eminence
Mid- palatine raphe
Fovea palatina.
SUPPORT FOR THE

MAXILLARY DENTURE:
DENTURE
The ultimate support for the
maxillary denture is the bone of
the two maxillae and the
palatine bone. The palatine
processes of the maxillae are
joined together at the midline in
the median suture.
10
RESIDUAL RIDGE:
The shape and size of the alveolar
ridges change when the natural teeth
are removed. The alveoli become
mere holes in the jawbone and begin
to fill up with new bone, but at the
same time the bone around the
margins of the tooth sockets begin to
shrink away. This shrinkage, or
resorption, is rapid at first, but it
continues at a resorbed rate
throughout life.
11
Labial frenum
The maxillary labial frenum is a
fold of mucous membrane at the
median line.
No muscle attachment.
This band of tissue starts
superiorly in a fan shape and
converges as it descends to its
terminal attachment on the labial
side of ridge.
12
Labial Vestibule: thickness of labial flange. . .

This anterior region of maxillary basal seat extends
from one buccal frenum to the other on the labial side.
The major muscle in this area is orbicularis oris.
oris
13
Three objectives are apparent:

1. The impression must supply sufficient support to the
upper lip to restore the relaxed contour.
2. The labial flange of the impression must have sufficient
height to reach the reflecting mucous membrane of the
labial vestibular space.
3. There must be no interference of the labial flange with the
action of lip in function.
14
Buccal Frenum:
The buccal frenum is
sometimes a single fold of
mucous membrane, sometimes
double, and in some mouths,
broad and fan shaped.
Associated muscles are:
Buccinator
Orbicularis oris
Levator anguli oris
15
Buccal Vestibule: thickness of distal end of buccal flange. . .

The buccal vestibule extends from the buccal frenum to the
hamular notch.
It is influenced by the buccinator and the modiolus. And
distally by the coronoid process.
16
Hamular Notch:
The hamular notch is a
displaceable area about 2mm
wide , between the tuberosity of
the maxilla and the hamulus of
the pterygoid plate.
17
Vibrating Line Of The Palate/posterior palatal seal :

This is an area at or distal to the junction of hard and soft
palate where movement occurs when patient says ah.
This generally is not a line and should be described rather as
an area.
The area may also be identified by Valsalva maneuver by
asking the patient to close his nose using his fingers and
asking him to blow gently through the nose .
Enhances retention & maintain the peripheral seal of the
maxillary denture
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18
Posterior vibrating line that is 412mm or on an average is 8.2

mm dorsally to the hard and soft
palate junction. In most
instances the denture should end
1 or 2mm posterior to the
vibratory line .
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19
Hard palate:
anterolatreally
posterolaterally primary
stress bearing area.
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20
Rugae
Raised areas of dense
connective tissue in the anterior
1/3 of the palate.
This area resists anterior
displacement of the denture and
is a secondary support area.
21
Maxillary Tuberosity:
The maxillary tuberosities are the distal aspects of the
posterior ridges.
Is an important denture support
area.
It also provides resistance to
horizontal movements of the
denture.
22
Incisive papilla
Is a pad of fibrous connective tissue
overlying the orifice of the nasopalatine
canal.
Pressure in this area will cause a
disruption of blood flow and
impingement on the nerve, causing the
patient to complain of pain or a burning
sensation.
The denture should be relieved over this
area.
23
Bone of the basal seat

Incisive foramen
located beneath the incisive
papilla
with resorption it lies nearer to
the crest of the ridge determining
amount of the resorption
Relief area
24
Fovea palatinae
Two small pits or depressions
in the posterior aspect of the
palate, one on each side of the
midline, at or near the
attachment of the soft palate to
the hard palate.
Guide for posterior border of
denture.
25
Mid- palatine raphe :

A rather narrow, low elevation in the centre of the hard palate
that extends from the incisive papilla posteriorly over the
entire length of the mucosa of the hard palate.
26
Median palatine suture:

Covered by thin sub mucosa
non resilient
Denture tends to rock if not
relieved
27
Zygomatic process:
location
opposite 1st molar region
Resorption - Nocticeable
Relief Area
(Soreness of the underlying tissues)
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28
Torus palatinus:
A hard bony enlargement that occurs in the midline of the roof of the
mouth.
Should be relieved.
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29
Coronoid bulge
The patient is instructed to open wide, protrude and go into
lateral movements.
The width of the distobuccal flange will then be contoured by
the anterior border of the coronoid process.
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30
Ideal maxillary ridge:

Abundant keratinized attached tissue
Square arch
Palate U-shaped in cross-section
Moderate palatal vault
Absence of undercuts
High frenum attachments
Well-defined hamular notches
31
Supporting structures
Residual alveolar ridge
Buccal shelf area
Limiting structures
Retromolar pad
labial and buccal frenum
lingual frenum
Alveololingual sulcus
Retromylohyiod curtain
Masseteric notch
32
Relief areas
Crest of residual alveolar ridge
Mental foramen
Genial tubercles
Torus mandibularis
33
Bone of the basal seat

External Oblique ridge
A ridge of dense bone from
the mental foramen, coursing
superiorly and distally to
become continuous with the
anterior region of the ramus.
This line is the attachment site
of the buccinator muscle and an
anatomic guide for the lateral
termination of the buccal flange
of the mandibular denture.
34
Mylohyoid ridge:
Runs along lingual surface of
mandible
Anteriorly ridge lies close to
inferior border of mandible &
becomes progressively higher
on posterior body of mandible
Mylohyoid muscle ,that form
floor of mouth , attaches to
ridge
Mucous membrane overlying a
sharp & irregular ridge will be
easily traumatized by denture
unless relief is given
35
Mental Foramen
The anterior exit of the
mandibular canal and the
inferior alveolar nerve.
In cases of severe residual ridge
resorption, the foramen occupies a
more superior position and the
denture base must be relieved to
prevent nerve compression and
pain.
36
Buccal Shelf Area between

mandibular buccal frenum and anterior
edge of the massater muscle
Boundaries:
Medially crest of residual ridge
Laterally external oblique ridge
Distally retromolar pad(inferior part of
buccinator is attached to it)
Bone is covered with cortical bone ;
shelf lies at right angle to vertical
occlusal force
This region is a primary stress bearing
area in mandibular arch.
9-7-2014
37

High rate of resorption when excessive pressure is
applied to this area.
.
underlying bone is cancellous.
Generally relieved
Covered by fibrous connective tissue
Not favorable as primary stress
bearing area
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38
Mental foramen
Mental nerve & vessels may be compressed by denture base unless relief is provided
Genial tubercles
With resorption genial tubercles become increasingly prominent
making denture usage difficult
Superior one gives attachment to genioglossus ,inferior one to
geniohyoid
Torus mandibularis
Bony prominence usually found bilaterally & lingually
near 1st & 2nd premolars
Covered by thin mucosa (needs to be surgically removed)
39
Limiting structures
Labial frenum
mucous membrane without
significant muscle fibers)
40
Labial vestibule
Runs from labial frenum to buccal
frenum
Limited inferiorly by mucous
membrane reflection , internally by
residual ridge , labially by lips
Mentalis is active muscle in this region
Extent of denture flange is limited
because of muscle innervated close to
crest of ridge
Orbicularis oris is attached to
mandibular labial frenum; unlike
maxillary labial frenum it is active &
sensitive
.
41
Buccal frenum
Buccal frenum connects as a
continuous band through the
modiolus at the corner of the
mouth up to the buccal frenum
attachment on maxilla.
42
Buccal vestibule
Extends posteriorly from buccal frenum to retro molar pad
Impression is widest in this region( buccal flange swings wide into
the cheek & is nearly at right angles to the biting force )
Extent of buccal vestibule is influenced by buccinator muscle
It extends from modiolus anteriorly to pterygomandibular raphae
posteriorly & has its lower fibres attached to the buccal shelf and
external oblique ridge
Buccal frenum overlies depressor anguli
oris
Fibres of buccinator are attached to the
frenum
43
Retromolar pad:
One constant, relatively unchanging

structure on the mandibular denture
bearing surface is the retromolar pad .
The bone beneath does not resorb
secondary to the pressure associated
with denture use.
44
Boundaries:
Posteriorly --- tendons of temporalis
Laterally ---- buccinator
Medially --- pterygomandibular raphae & superior
constrictor
The action of these muscles limits the extent of denture &
prevents placement of extra pressure on the distal part of retro
molar pad during impression making --- denture base should
extend approx. one half to two third over retromolar pad
45
Retromolar papilla:
Small pear shaped area just anterior to the retromolar pad
Residual scar formed after 3rd molar extraction
Denture should extend at distal end of papilla
46
Retromylohyoid fossa:
Lies at the distal end of alveololingual
sulcus , posterior to mylohyoid muscle
Bounded by:
Anteriorly --- retromylohyoid curtain
Posterolateraly --- superior conatrictor
Posteromedially --- palatoglossas & lateral
surface of tongue
Inferiorly --- sub mandibular gland
Denture boarder should extend posteriorly to
contact the retromylohyoid curtain when tip
of tongue is placed against the front part of
upper residual ridge
47
Lingual frenum:
When tip of tongue is elevated a fold of mucous membrane is seen
lingual frenum overlies the genioglossus muscle, which takes origin
from the superior genial spine.
Should be registered in function (at rest --- much lower , but at
function quite close to the crest)
48
Alveololingual sulcus:
Space between residual ridge and tongue
Consists of three regions:

anterior region
middle region
posterior region
Retromylohyoid eminence
Premylohyoid eminence
49
Anterior region:
Extends from lingual frenum to pterygomylohyoid
fossa ,where the mylohyoid ridge curves above the level
of sulcus
Lingual border of impression in this region should extend
down to make contact with mucous membrane floor of
mouth when tip of tongue touches upper incisors
50
Middle region :
Extends from premylohyoid fossa to distal end of mylohyoid ridge
Lingual flange should slope medially towards tongue . This sloping helps
in:
Tongue rests over flange stabilizing denture
Provides space for raising the floor of mouth with out displacing denture
The peripheral seal is maintained during function
51
Posterior region:
Here flange passes into retromylohyoid fossa
It is no longer influenced by action of mylohyoid muscle(flange can turn
laterally towards ramus to fill the fossa & complete typical S form of the
correctly shaped lingual flange
52
S shaped alvelolingual sulcus
53
MassetericGroove
The action of the masseter
muscle reflects the buccinator
muscle in a superior and
medial direction.
The distobuccal flange of the
denture should be contoured
to allow freedom for this
action otherwise the denture
will be displaced or the
patient will experience
soreness in this area.
54
Retromylohyoid space
lies at the distal end of the alveololingual
sulcus.
The retromylohyoid space is very
important for denture stability and
retention.
55
Ideal mandibular ridge:

Well defined retromolar pad
Blunt mylohyoid ridge
Deep retromylohyoid space
Low frenum attachments
Absence of undercuts
Abundant attached keratinized
mucosa
56
Principle goal
CONCLUSION
Muller De Van
The preservation of that which remains is of utmost importance

And not the meticulous replacement of that which has been lost.
57

Applied Anatomy Related To Complete Denture-Maxilla Mandible

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Applied Anatomy Related To Complete Denture-Maxilla Mandible

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DR .

At the end of the lecture, the student

Parts of Complete Denture

CD has three surfaces:

The anatomical landmarks in the maxilla

SUPPORT FOR THE

Labial Vestibule: thickness of labial flange. . .

Three objectives are apparent:

Buccal Vestibule: thickness of distal end of buccal flange. . .

Vibrating Line Of The Palate/posterior palatal seal :

Posterior vibrating line that is 412mm or on an average is 8.2

Bone of the basal seat

Mid- palatine raphe :

Median palatine suture:

Ideal maxillary ridge:

Bone of the basal seat

Buccal Shelf Area between

One constant, relatively unchanging

Consists of three regions:

S shaped alvelolingual sulcus

Ideal mandibular ridge:

The preservation of that which remains is of utmost importance

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