INDERPRASTHA DENTAL COLLEGE AND HOSPITAL

BIOLOGICAL CONSIDERATIONS OF
MAXILLARY IMPRESSIONS
 UNDER THE GUIDANCE OF:
Dr. Pankaj Datta
Dr. Suprabha Rathee

Submitted by:
SHIVANI (6086076)
CONTENTS

1.Introduction
2.Definition
3.Supporting structures
• Bone
• Mucous membrane
4.Peripheral or limiting structures
5.Anatomy of peripheral structures in maxillary region
6.Anatomy of supporting structures in maxillary region
7.References
Introduction

 If dentures and their supporting tissues are to coexist for a

reasonable length of time, the dentist must fully understand the
macroscopic and microscopic anatomy of the supporting and
limiting structures involved.
 A thorough understanding of their role will determine,
1.the selective placement of forces by the denture bases on the
the supporting tissues
2.the form of denture borders that will be harmonious with the
normal function of limiting structures around them.
Anatomic landmark

 “A recognizable anatomic structure used as a point of reference”

(GPT 8)

 In both maxilla and mandible anatomic landmarks have been

divided into-
1.supporting structures
2.peripheral or limiting structures
A.)SUPPORTING STRUCTURES:

“Those areas of maxillary and mandibular edentulous ridges that are

considered best suited to carry the forces of mastication when
dentures are in function”
(GPT-8)

 Dentures transfer occlusal load to these so called supporting

structures.
 The ultimate support for a denture is provided by underlying bone
which is covered by mucous membrane. Support is provided by
maxillae and palatine bone in case of maxillary denture. For
mandibular denture support is provided by mandible.
Hard tissues (bone):

 The requirement of ideal support is the presence of tissues that are

relatively resistant to remodeling and resorptive changes.

2 types of bones are seen-

-compact or cortical bone
-cancellous or trabecular bone
Ridge resorption in compact and
cancellous bone:
 It has been suggested that bone resorption at
any site is a chemotactic phenomenon, that is
initiated by release of some soluble factors that
attract circulating monocytes to the target site.
Osteoclast , the cells responsible for bone
resorption are nothing but modified monocytes.
 Degree of mineralization is less in cancellous
bone, so effects of resorption are more
pronounced in cancellous bone.
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 base rest on the mucous membrane , which serve as a
cushion between denture base and supporting bone

 The mucous membrane is composed of :

-Mucosa
-Submucosa
 Mucosa:
 Mucosa is formed by stratified squamous epithelium cells.
 There is subjacent narrow layer of connecting tissue to the mucosa ,
known as lamina propria.

Submucosa:
 It is formed by connective tissue.
 Connective tissue varies in character from dense to loose areolar
tissue and also varies considerably in thickness.
 It may contain glandular, fat or muscle cells.
 Submucosa transmit the blood and nerve supply to the mucosa.
 Submucosa attaches mucosa to the periosteal covering of the
bone.
 Classification of oral mucosa:
Depending on its location in mouth, oral
mucosa classified into 3 categories-
-Masticatory: attached gingiva and hard palate
-Lining: under surface of tongue, floor of
mouch,buccal mucosa, alveolar process, soft
palate.
-Specialized: tongue
A)ANATOMY OF
LIMITING
STRUCTURES
A)Limiting structures:

 The functional anatomy of mouth determines

the extent of the basal surface of denture.
 The denture base should include the maximum
surface possible within the limits of the health
and function of the tissues it covers and
contacts i.e. it should cover all the available
basal seat tissues without interfering in action of
any of the structures that contact or surround it.
 The term border area refers to the mucosal surface area
which contacts the denture borders and surrounds the
spaces which are occupied by denture flanges.
 Border moulding procedures are used to record limiting
structures properly. There are mainly 2 objectives of
border moulding in recording the limiting structures-
1.to establish correct flange length and border thickness
2.To achieve retention through border seal
Limiting structures in maxillary
region:
1.labial frenum
2.labial vestibule
3.buccal frenum
4.buccal vestibule
5.hamuar notch
6.Fovea palatinae
7.Vibrating lines and PPSA
1.Labial frenum:

 It is a fold of mucous membrane in

median line.
 It starts sup. in a fan shape and
converges as it descends to its
terminal attachment on the labial
side of the ridge.
 It contains no muscle and has no
action of its own.
 It divides the labial vestibule into
approx. equal but asymmetrical
left and right labial vestibule.
 The labial notch in the labial
flange of the denture must be
just wide enough and just
deep enough to allow the
frenum to pass through it
without manipulation of the lip.

The denture borders should not
only be cut lower, but also
have less thickness adjacent to
labial notch.
2.Labial vestibule:

 The portion of the oral

cavity that is bounded on
one side by the teeth ,
gingiva and alveolar
ridge(or RAR) and on the
other side by the lips
anterior to the buccal
frenum.

(GPT-8)
-3 main objectives are apparent in the labial vestibule region are:

1.)The thickness of the labial flange of the final impression must be

developed according to the amount of bone that has been lost from
the labial side of the ridge.
2.)The labial flange of the impression must have sufficient height to
reach the reflecting mucous membrane of the vestibular space, but
should not overextend it.
3.)There must be no interference of the labial flange with action of the
lip in function.
 The main muscle of the lip, which
forms the outer surface of the
labial vestibule, is the orbicularis
oris.
 Its tone depends on the support it
receives from labial flange and
the position of the teeth.
 Because the fibers run in a
horizontal direction, the orbicularis
oris has only an indirect effect on
the extent of an impression and
hence on the denture base.
3.Buccal frenum:

 Buccal frenum is a fold of mucous

membrane , extends from the
buccal mucous membrane
reflection area to or towards the
slope or crest of RAR.
 It is sometimes a single fold of
mucous membrane, sometimes
double and in some mouth broad
and fan shape.
 Three muscles are attached in this
region
 1.the levator anguli oris(caninus)
muscle attaches beneath the
frenum and affects its position.
 2.the buccinator pulls it backward.
 3.orbicularis oris pulls it forwards.
 Because of muscle attachment , it
requires more clearance for its
action (in both horizontal and
vertical direction) than labial frenum
does.
 Inadequate provision for the buccal
frenum or excess thickness of the
flange distal to buccal notch can
cause dislodgement of the denture
when the cheeks are moved
posteriorly as in broad smile.
 It records in the impression as a
buccal notch which is properly
relieved and molded.
 It should be cresentric in form , rather
than V shaped.
4.Buccal vestibule:

 It is defined as “the portion of oral cavity that is bounded on one

side by the teeth, gingiva and alveolar ridge (RAR) and on the
lateral side by the cheek posterior to the buccal frenum”
(GPT-8)
The size of the buccal vestibule varies with
1contracton of buccinators muscle.
2.Position of the mandible
3.Amount of bone lost from maxilla.
 The extent of buccal vestibule can be deceiving because the
coronoid process obscures it when the mouth is opened wide.
Therefore it should be examined with mouth as nearly closed as
possible.
 This space is usually higher than any other part of the border.
 The size and shape of the distal end of the buccal flange of the
denture must be adjusted according to the ramus and the coronoid
process of the mandible.
Microscopic features of labial and
buccal vestibule:
 The mucous membrane lining of
vestibule is relatively thin.
 The submucous layer is thick and
contains large amount of loose
areolar tissue and elastic fibers.
 The mucosa of the vestibular
space is classified as lining mucosa
 Mucosa is devoid of keratinized
layer an s freely movable with the
tissue to which it is attached
because of the elastic nature of
the lamina propria.
5.Hamular notch:

 It is situated between the

tuberosity of maxilla and the
hamulus of medial pterygoid
plate.
 It is used as a boundary of the
posterior border of the maxillary
denture back of the tuberosity.
 The posterior palatal seal must be
placed through the center of the
deep part of the hamular notch,
since no muscle or ligament
attachment is present at a level to
prevent the placement of extra
pressure.
 This notch is used as a boundary of the posterior border of the
maxillary denture, back of the tuberosity.
 The impression should not end on he tuberosity, otherwise it will result
in non retentive denture because peripheral seal is not possible in
non resilient area of tuberosity.
 The tissue in the center of the deep part of the hamular notch ,can
be safely displaced by the posterior palatal border of the denture to
help in achieving a seal in this region called pterygomaxillary seal.
 The tip of the pterygoid hamulus is 2-3 mm posteromedial to the
distal limit of maxillary residual ridge. However it may be located on
the line with crest of ridge or sometimes even lateral to this line.
 The variation is significant in that as it affects the length and the
direction of pterygomaxillary seal so it becomes very important to
determine the location of hamulus by palpation.
 Pterygomaxillary seal occupies the entire width of hamular notch.
The seal begins at pterygomaxillary notch and usually extends 5-7
mm anteromedially.
 Also, overextensions at the hamular notches will not be tolerated
because of pressure on the perygoid hamulus and interference with
pterygomandibular raphae
 Special care should be taken in the grossly resorbed alveolar ridge ,
where hamular notch disappears and raphae becomes more
prominent.
 When the mouth is opened wide ,the pterygomandibular raphae is
pulled forward. If the denture extends too far into the hamular
notch, the mucous membrane covering the raphae will be
traumatized.
6.Palatine fovea region:

 The fovea palatinae are

indentations near the midline of
the palate in posterior region
formed by coalescence of several
mucous membrane ducts.
 They are very prominent in some
individuals whereas in others they
are barely visible or may be
absent.

 Usually the posterior vibrating line is

found 2 mm anterior to he fovea
palatine, but they can be found
on or anterior to the vibrating line
7.Vibrating lines of palate:

 Anterior vibrating line: it is an imaginary line located at the junction

of attached tissues overlying the hard palate and movable tissues of
the immediately adjacent soft palate.
 This can be located either by valsulva maneuver or by instructing
patient to say “ah”with short vigorous bursts.
 Due to projection of PNS anterior vibrating line is not a straight line
between hamular processes.
 At the midline it usually passes about 2mm in front of the fovea
palatinae.
 Posterior vibrating line: it is an imaginary line at the junction of the
aponeurosis of tensor veli palatine muscle and the muscular portion
of the soft palate.
 It represents the demarcation between the part of the soft palate
that has limited or shallow movement during function and the
remainder of soft palate that is markedly displaced during function.
 Posterior vibrating line is visualized by instructing the patient to say
“ah” in a normal unexaggerated fashion.
 Direction of vibrating line usually varies according to the shape of
palate. Higher the vault the more abrupt and forward the vibrating
line is usually farther posterior and has a good curvature, affording a
broader PPSA.
B)Anatomy of
supporting structures
in maxilla
 The foundation for dentures is made up of bone of the hard palate
and residual ridge , covered by mucous membrane.
 The denture base rests on the mucous membrane , which serves as
a cushion between the base and the supporting bone
Residual alveolar ridge

 “the portion of the alveolar ridge and its soft tissues covering, which
remains following the removal of teeth”.
(GPT-8)
-The socket that surrounds the root of each natural tooth is called
alveolus and the bony ridge that supports the teeth is the alveolar
ridge.

-When the natural teeth are removed, the alveoli begin to fill up with
the new bone. At the same time bone around the margins of tooth
sockets begin to shrink away
 This shrinkage or resorption is rapid at first six weeks of tooth removal
and it continues at a reduced rate throughout the life and is responsible
for the formation of RAR.

 The alveolar ridges vary greatly in size , shape and their ultimate form.
This is dependent on following factors-
1.variation in bone size and its degree of calcification in individuals.
2.teeth show wide individual variation in size. Large teeth are supported
by bulky ridges and smaller teeth by narrow ones.
3.the amount of bone lost prior to the extraction of teeth.
4.the amount of alveolar process removed during extraction of teeth.
5.The effect of previous denture- ill fitting denture, or dentures with
occluding natural teeth, may cause rapid resorption of the alveolar
process in the areas where they cause excessive pressure of lateral
stresses
6.The relative length of the time for which different parts of the jaw has
been edentulous.
7.person’s general health
 According to size RAR can be-
-large
-medium
-small
 According to shape RAR can be-
 The residual ridge and most of the hard palate are considered the
major or primary stress bearing in the upper jaw.
 The crest of the residual alveolar ridge (after healing from the
surgery) is covered with a layer of fibrous connective tissue, which is
most favorable for supporting the denture base because of its
firmness and position.
 The artificial teeth will be placed near this ridge to leverage will be
minimal.
Microscopic features of residual
ridges
 The mucous membrane is attached to the periosteum of the bone
by the connective tissue of the sub mucosa.
 The stratified squamous epithelium is thickly keratinized
 The submucosa is devoid of fat or glandular cells and it is
characterized by dense collagenous fibers that are contiguous with
lamina propria.
 The submucosa is devoid of fat or glandular cells and it is
characterized by dense collagenous fibers that are contiguous with
lamina propria
 The outer surface of bone
in the region of crest of
RAR (most coronal portion
of ridge) is usually
compact in nature.
 This compact bone in
combination with tightly
attached keratinized
mucous membrane
makes crest of RAR
histologically best able to
provide primary support
for the denture.
RAR-a primary stress bearing area?

 According to prosthodontics treatment for edentulous patients by

zarb and bolender-

 “the bone in this region is subject to

resorption,which limits its potential for
support, unlike the palate,whcih is resistant
to resorption. Because of this, ridge crest
should be looked on as a secondary
supporting area”
 They consider “horizontal portion of the hard palate lateral to
midline” as primary supporting area for denture”.
 In a patient where a tooth were extracted long time back,ridge
becomes smaller and crest of ridge in many cases is completely
devoid of smooth cortical bony surface.
 Horizontal part of palate lateral to midline should definitely be
considered as a primary stress bearing area in these patients
Palatal region:

 Rugae area:
 Rugae are raised area of dense
connective tissue radiating from
he median suture in the anterior
one third of the palate
 Consists of series of ridges in the
anterior part of the hard palate
 Mucosa is keratinized and the
submucosa is fibrous
 In the area of the rugae,the
palate is set at an angle to the
residual ridge and is rather thinly
covered by soft tissue.
 This area contributes to the stress bearing role as well as to retention
although in a secondary capacity
 It resist forward movement of denture
 It should be recorded without pressure, if it distorts while Making
impression it can rebound and unseat the denture.
 These folds of the mucosa play an important role in speech so
dentures should reproduce this contour making it very comfortable
for the patient.
Mid palatine raphae

 This present as slightly elevated

bony ridge along the midline of
hard palate
 Adequate relief should be
provided in this area as-
 Mucosa covering the raphae is
extremely thin and is traumatized
easily.
 Mucosa is less resilient than that
covering the ridges so it can act
as fulcrum along which denture
rocks when vertical forces are
applied
 HORIZONTAL PORTION OF HARD PALATE LATERAL TO MIDLINE:
-This area provides primary support to denture as it offers maximum
resistance to resorption
 LATERAL SURFACE OF HARD PALATE:
-It is divided in anterolateral part containing adipose tissue in
submucosa
-Posterolateral part containing glandular tissue

Both of these areas are displaceable they do not provide significant

support to the denture but this region should be covered to provide
retention
 These areas should be recorded in resting condition because when
they are displaced in the final impression, they tend to return to
natural form within the completed denture base, and creating an
unseating force on the denture or causing soreness in the patients
mouth.
 For recording these tissues in undistorted form, proper relief should
be given in the final impression tray.
Incisive papilla

 This covers the incisive foramen

and is located in he midline
immediately behind and
between central incisors
 It lies nearer to the crest of the
ridge as resorption progresses.
Thus the location of the incisive
papilla gives an indication as
to the amount of resorption
that has taken place.
• Incisive papilla acts as a guide for antero
posterior positioning of the teeth, the
labial surfaces of the central incisors are
usually 8-10 mm in front of the papilla.
• Incisive papilla is used to locate the
midline of the dental arch.
• The nasopalatine nerves and blood
vessels pass through the foramen, the
care should be taken that the denture
base does not impinge on them
Zygomatic process-

 Also called malar process is

located opposite the first molar
region and is commonly seen in
mouth that has been edentulous
for long.
 Some dentures require relief over
the area to aid in retention and to
prevent soreness of underlying
structures.
Maxillary tuberosity

 Maxillary tuberosity represents

most distal portion of the maxillary
alveolar ridge.
 The tuberosity region often hangs
abnormally low when maxillary
posterior teeth are retained after
mandibular molars are lost and
not replaced, the max teeth
extrude bringing the tuberosity
with them.
 Often the low hanging tuberosity
prevents proper location of
occlusal plane.
Sharp spiny processes:

 These are sharp spiny processes on

max and palatal bone that are
normally deeply covered by soft
tissues but in patients with
considerable RAR resorption these
processes irritate soft tissues.
 Canal leading from a posterior
palatine foramen often has a
sharp overhanging edge that may
irritate palatal mucosa
Torus palatinus:

 Seen as hard bony enlargement

that occurs in midline of the root
of the mouth is called torus
palatinus.
 Seen in nearly 20% of population
 2 types:
-almost entirely soft tissues ,loose
and flabby
-thin layer of mucosal tissues
covering the bone
Dentures require relief over this area
to aid retention and prevent soreness
of the underlying tissue.
 A smooth rounded small torus does not normally create much
problem as denture plate may be cut away to avoid tori or can be
extended over it with proper relief.
 A large , lobbed tori should be treated surgically as cutting away
the denture plate significantly reduces denture retention and also
leads to excessive ridge resorption
References

 BOUCHER’S prosthodontic treatment for edentulous patients

 Essentials of complete denture prosthodontics SHELDON WINKLER
 Images by google.