Department of Preclinical Prosthodontics

Anatomical Landmarks

Anatomical Landmarks - Maxillary Edentulous Foundation

1. Labial Frenum It is a fold of mucous membrane in the midline It contains no muscle and has no action of its own It starts superiorly in a fan shape and converges as it descends to its terminal attachment on the labial side of the ridge The labial notch in the labial flange of the denture should be just wide enough to allow the frenum to pass through it

2. Labial Vestibule The labial vestibule is divided into left & right vestibules by the labial frenum. The mucous membrane lining the vestibule is a relatively thin lining mucosa. The submucosa is thick & contains a large amount of areolar tissue & elastic fibers The Orbicularis oris forms the outer surface of the labial vestibule. The fibers of the Orbicularis oris run in a horizontal direction & anastomose with the fibers of the Buccinator . The labial vestibule lodges the labial flange of the denture. Over extended flanges impinge on the mucosa and may lacerate it, or tend to get dislodged during functional movements made by the patient
Boundaries :

Anteriorly Posteriorly Medially Laterally 3. Buccal Frenum

: : : :

Labial mucosa , Orbicularis oris Labial slope of residual alveolar ridge Labial Frenum Buccal Frenum, Buccal vestibule

It is a single or double fold of mucous membrane that forms a dividing line between the labial & buccal vestibules
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Department of Preclinical Prosthodontics

Anatomical Landmarks

The Orbicularis oris pulls the buccal frenum forward The Buccinator pulls it backwards The Levator anguli oris takes attachment beneath the frenum The buccal frenum requires more clearance for its action

4. Buccal Vestibule Lies opposite the tuberosity & extends from the buccal frenum to the hamular notch It is lined by lining mucosa The root of the zygoma lies opposite the first molar region and becomes prominent with the ridge resorption. So relief over this area is given to prevent soreness to the underlying tissue The size & shape of the buccal vestibule is determined by the Ramus , the coronoid process of the mandible & the Masseter The buccal vestibule lodges the buccal flange of the denture Over extended flanges impinge on the mucosa and may lacerate it, or tend to get dislodged during functional movements made by the patient Overly thick flanges cause buccal fullness in appearance Note : The Buccal Vestibule should be examined with the mouth as nearly closed as possible
Boundaries :

Anteriorly Posteriorly Laterally Medially

: : : :

Buccal Frenum Hamular notch Buccal mucosa, Fibers of Buccinator , Modiolus Buccal slope of residual alveolar ridge

5. Maxillary Tuberosity Bulbous extension of the residual alveolar ridge in the 2nd & 3rd molar regions The maxillary tuberosity terminates in the hamular notch
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Department of Preclinical Prosthodontics

Anatomical Landmarks

Fibrous enlargements & excess tissues prevent the proper location of the occlusal plane and may intervene with the lower denture. Therefore excess tissue around the enlarged tuberosity must be surgically excised. Maxillary posterior teeth arrangement should end just anterior to the tuberosity area.

6. Pterygomaxillary Notch / Hamular Notch It is situated between the tuberosity & the hamulus of the medial pterygoid plate The mucous membrane consists of thick submucosa made of loose areolar tissue The tissue in the deepest part of the hamular notch can be displaced by the posterior palatal border of the denture to achieve posterior palatal seal. It forms the distal limit of the buccal vestibule It marks the distal most extension of the maxillary denture base.

7. Posterior Palatal Seal Area The soft tissue along the junction of the hard & soft palates on which pressures within physiological limits can be applied by a denture to aid in retention of the denture The Posterior Palatal Seal extends medially from one tuberosity to the other Laterally , the Pterygomaxillary seal extends through the Pterygomaxillary notches The Posterior palatal seal area lies between the Anterior & Posterior Vibrating lines Marks the distal extension of the maxillary denture base. Overextension may cause intolerance in the patient and result in gagging. Vibrating Line The Vibrating Line is an imaginary line across the posterior part of the palate marking the division between the movable and immovable tissues of the soft palate. This can be identified when the movable tissues are functioning individual says ah The Posterior Vibrating Line extends from one hamular notch to the other. Both the Vibrating Lines are always on Soft Tissue.
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- GPT

The Anterior vibrating line marks the beginning of motion in the soft palate when the

Department of Preclinical Prosthodontics

Anatomical Landmarks

Distally, the denture should at least extend up to the posterior vibrating line. Ideally it should extend around 2mm beyond the PVL for better retention.

8. Fovea Palatinae These are two indentations near the mid palatine raphe, present one on either side of the midline. They are always present in soft tissue. They do not mark the junction of the hard & soft palates They are present very close to the Posterior Vibrating line , either anterior or posterior to it. They serve as an ideal guide for locating the posterior border of the maxillary denture.

9.Median Palatal Raphe Formed by the union of the palatine processes of the maxillae & the union of the palatine bone It extends from the incisive papilla to the distal end of the hard palate The submucosa is extremely thin in this region and the mucosa is practically in contact with the underlying bone The mucosa overlying the mid palatine suture is non resilient and this region has to be relieved

10. Palatal Rugae This is the Secondary Stress Bearing Area of the Maxilla. The palate is set at an angle to the residual ridge & is covered with keratinized epithelium. It contains folds of fibrous connective tissue.

11. Incisive Papilla Situated on a line immediately behind and between the maxillary central incisors Nasopalatine nerves & blood vessels pass through the incisive foramen, which is located beneath the incisive papilla.
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Department of Preclinical Prosthodontics

Anatomical Landmarks

Relief should be provided to the incisive papilla to prevent impingement of the denture on the nasopalatine nerves & blood vessels. Location of the incisive papilla on the ridge indicates the amount of resorption that has occurred in the residual ridge.

12.

Residual Alveolar Ridge The ridge is covered by stratified squamous epithelium and contains submucosa containing dense collagen fibers. The submucosal layer provides adequate resiliency to support the maxillary denture It is the Primary Stress Bearing Area of the Maxilla

Department of Preclinical Prosthodontics

Anatomical Landmarks

Anatomical Landmarks - Mandibular Edentulous Foundation

1. Labial Frenum Contains a band of fibrous connective tissue that helps to attach the Orbicularis oris. The labial frenum is quite sensitive and active. The denture should have adequate relief around it to maintain a seal without causing soreness. The frenum is best demonstrated by forward pull of the lower lip

2. Labial Vestibule Runs from labial frenum to buccal frenum on either side of the midline Depth of the sulcus is determined by the turn of the mucobuccal fold The Mentalis muscle is active in this region Boundaries : Anteriorly Posteriorly Laterally : : : Labial mucosa , Mucolabial fold, Orbicularis oris Labial slope of mandibular residual alveolar ridge Buccal Frenum, Buccal vestibule

The labial vestibule lodges the labial flange of the denture. The depth & width of the vestibule should be accurately recorded to prevent over extensions and overly thick flanges in the final denture which may cause impingement onto the soft tissue, or lip fullness respectively

3.Buccal Frenum Overlies the Depressor anguli oris muscle May be seen as single or multiple folds of mucous membrane Reflects in an antero-posterior direction towards the slope of the crest of the alveolar mucosa distal to the canine region Adequate relief should be provided in this region so as to have a maximum seal , avoiding over extensions so as not to displace the denture when the lip is moved.
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Department of Preclinical Prosthodontics

Anatomical Landmarks

4. Buccal Vestibule Extends from buccal frenum to the posterior distal corner of the retromolar pad Zarb & Bolender Extent is influenced by the Buccinator muscle. The Masseter influences the disto buccal edge of the buccal vestibule & forms the Masseteric Notch Winkler The buccal vestibule should be recorded correctly in the impression making procedures by guiding the patient to give the correct functional movements so as to record the functional width and depth of the vestibule and also the Masseteric notch on the distobuccal flange to prevent dislodgement of the denture during functional movements made by the patient.

5.Buccal Shelf Area It is a horizontal shelf of bone seen along the buccal slope of the residual alveolar ridge The Buccinator attaches to the External oblique ridge of the buccal shelf The area between the mandibular buccal frenum and the anterior ridge of the Masseter is called as the Buccal Shelf or the Buccal Flange Area The Buccal shelf is very wide and present at nearly right angles to the direction of the vertical occlusal forces, thereby offering excellent resistance to these forces. This is the Primary Stress Bearing area of the Mandible Boundaries Anteriorly Distally Laterally Medially 6.External Oblique Ridge Smooth ridge seen on the buccal surface of the body of the mandible : : : : Buccal Frenum Retromolar Pad External Oblique Ridge Crest of residual alveolar ridge

Department of Preclinical Prosthodontics

Anatomical Landmarks

Extends from anterior border of ramus and diminishes in prominence in the inferior & anterior region towards the mental foramen If the denture flanges are overextended till the anterior border of the ramus, the denture impinges on the Buccinator and adjacent tissues, which results in soreness & limits the function of the Buccinator

7.Retromolar Pad It is a triangular soft pad of tissue at the distal end of the lower ridge It is covered by thin non keratinized epithelium Contents Fibers of the Buccinator Fibers of the Superior Constrictor of the Pharynx Pterygomandibular raphe Tendon of the Temporalis Glandlar Tissue Loose Areolar Tissue

It determines the posterior limit of the mandibular denture . Must be covered by the denture to attain a perfect border seal posteriorly. The Pterygomandibular raphe limits the extension of the denture border posteriorly.

8. Pear Shaped Pad / Retromolar Papilla The most distal extension of the attached keratinized mucosa overlying the mandibular ridge crest formed by the scarring pattern following extraction of the mandibular third molar, seen as a small elevation is referred to as the Retromolar papilla

9. Lingual Frenum It is the anterior attachment of the tongue It overlies the Genioglossus muscle which arises from the superior genial tubercle It exhibits different configurations in both height & width The lingual frenum area is shallow & should be registered in function.
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Department of Preclinical Prosthodontics

Anatomical Landmarks

In function it often comes close to the crest of the ridge, though it is much lower in the rest position. Registering it in function determines the exact height of the lingual flange of the denture.

10.Sublingual Fold / Sublingual Cresent area This is a crescent shaped area on the floor of the mouth following the inner wall of the mandible, tapering towards the molars. It is formed by the sublingual gland and the submandibular gland duct (Whartons duct) It is a fold of mucous membrane from the tongue to the residual ridge Should not be recorded in an over compressed state in the impression

11.Mylohyoid Ridge Sharp bony linear elevation found on the lingual side of the body of the mandible Soft tissues overlying the ridge hide its sharpness, which can be found by palpation Thin sharp ridges cause soreness of overlying mucosa in denture wearers.

Mylohyoid muscle Takes attachment form the mylohyoid ridge Forms Floor of the Mouth Takes attachment along the ridge and approaches the level of the alveolar crest posteriorly. Angle of the posterior lingual flange is influenced by this muscle

12.Retromylohyoid Space / Fossa Posterior limit of the alveololingual sulcus Present posterior to the Mylohyoid mscle The lingual flange of the denture moves posteriorly towards the mandible producing a typical S shaped curve in the lingual flange. The fossa extends from the end of the mylohyoid ridge to the retromylohyoid curtain.
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Department of Preclinical Prosthodontics

Anatomical Landmarks

Boundaries Anteriorly Posteriorly : : Mylohyoid ridge , Mylohyoid muscle Retromylohyoid curtain * Posterolateral portion of Retromylohyoid curtain overlies the Superior Constrictor of the Pharynx * Posteromedial portion of Retromylohyoid curtain covers the Palatoglossus muscle & the lateral surface of the tongue Laterally Medially Inferiorly : : : Ramus Disto-lateral surface of Tongue Submandibular gland.

13. Residual Alveolar Ridge Crest of the ridge is covered by fibrous connective tissue The ridge mainly consists of cancellous bone without a cortical plate covering it The overlying mucous membrane is capable of providing good soft tissue support for the denture, but the crest of the ridge cannot withstand vertical occlusal forces. This in unfavorable to be the Primary Stress Bearing area of the mandible It is therefore the Secondary Stress Bearing area of the Mandible

14. Alveololingual Sulcus It is the space between the residual ridge and the tongue It extends from the lingual frenum to the retromylohyoid curtain It consists of three regions Pre-mylohyoid Region / Anterior Region Extends from the lingual frenum to the premylohyoid fossa.The depression seen here corresponds to a prominence in the impression known as Premylohyoid Eminence Mylohyoid Region / Middle Region Extends from Premylohyoid fossa to the distal end of the mylohyoid ridge
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Department of Preclinical Prosthodontics

Anatomical Landmarks

The sulcus curves medially from the body of the mandible. The curvature is because of the prominence of the mylohyoid ridge Post-mylohyoid Region / Posterior Region Flange passes into the retromylohyoid fossa. The flange turns laterally towards the ramus to fill the fossa and give a typical S form. The lingual flange of the tray is shaped to slope towards the tongue to facilitate the impression material to flow below the prominence of the mylohyoid ridge. This permits the distolingual flange of the fabricated denture to extend below the ridge. Else the flange must terminate at the level of the ridge, thereby compromising retention. When the flange of the denture slopes towards the tongue and extends below the mylohyoid ridge, the tongue can rest on top of the flange and can help to stabilize the denture and control it without interfering with the functions of the soft tissues.

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