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CompleteDenturesAnatomyoftheDentureFoundationAreas:FoundationforOralfacialRehabilitation

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CompleteDenturesAnatomyoftheDentureFoundation
Areas
Athoroughknowledgeoftheanatomyofthedenturebearingsurfacesisparamounttodesigningandfabricatingfunctionaldentures.The
functionalanatomyofthedenturefoundationareasofthemaxillaandmandibleispresentedindetailinparticular,therelationshipofthese
anatomicstructuresthatimpactretention,stabilityandsupport.

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CompleteDentures
ANATOMYOFTHEDENTUREFOUNDATIONAREASCOURSETRANSCRIPT
1.2.AnatomyoftheDentureFoundationAreasEleniRoumanas,DDSDivisionofAdvancedProsthodontics,BiomaterialsandHospital
DentistryUCLASchoolofDentistryandFrankLaucielloDDSIvoclarVivadentThisprogramofinstructionisprotectedbycopyright.No
portionofthisprogramofinstructionmaybereproduced,recordedortransferredbyanymeanselectronic,digital,photographic,
mechanicaletc.,orbyanyinformationstorageorretrievalsystem,withoutpriorpermission.
2.EDENTULOUSANATOMYInordertoproperlyconstructadenture,onemustunderstandtheanatomyandphysiologyoftheedentulous
patient.Athoroughknowledgeoftheoriginsandkineticsofthemusclesofmastication,facialexpression,tongueandfloorofthemouthis
essential.
3.KeyConceptsinProsthodonticsRetention:ResistancetoverticaldisplacementawayfromthebearingsurfacesStability:Resistanceto
lateraldisplacementSupport:FactorsofthebearingsurfacesthatabsorborresistforcesofocclusionWhenthekeyanatomiclandmarks
andtheirrolewithrespecttoretention,stability,support,preservationandestheticsaremastered,denturescanbefabricatedasintegral
partsofeachpatientsoralcavityandnotjustmechanicalartificialsubstitutes.
4.Factorsthatimpacttheabove:Thenatureofthebearingmucosaattachedvs.unattacheddegreeofkeratinizationBonecontoursand
retromolarpadheightandcontourofalveolarridgepresenceoftoriresorptionpatternsMuscleattachmentsfrenumfloorofmouth,
mylohyoid,retromylohyoidspacetonguepostureSalivaflowratespalatalglandsandposteriorpalatalsealeffectonretentionDisease
factorscandida,angularcheilitis,epulisfissuratum
5.LabialfrenumBuccalvestibuleBuccalfrenumMaxillaAnatomicLandmarksFrenumarefoldsofmucousmembraneanddonotcontain
significantmusclefibers.Highfrenumattachmentswillcompromisedentureretentionandmayrequiresurgicalexcision(frenectomy).
Buccalvestibulewhenproperlyfilledwiththedentureflangegreatlyenhancesstabilityandretention.
6.IncisivepapillaCanineeminenceMaxillaAnatomicLandmarksCanineeminanceThisprominentboneprovidesdenturesupport.A
squarearchpreventsadenturefromrotatingandisthusthebestfordenturestability.IncisivepapillaIsapadoffibrousconnectivetissue
overlyingtheorificeofthenasopalatinecanal.Pressureinthisareawillcauseadisruptionofbloodflowandimpingementonthenerve,
causingthepatienttocomplainofpainoraburningsensation.Thedentureshouldberelievedoverthisarea.
7.Post.PalatalSealAreaTuberosityMaxillaAnatomicLandmarksTuberosityisanimportantprimarydenturesupportarea.Italso
providesresistancetohorizontalmovementsofthedenture.PosteriorPalatalSealAreaIsdistaltothejunctionofthehardandsoftpalate
atthevibratingline.
8.MaxillaAnatomicLandmarksRugaeRugaeraisedareasofdenseconnectivetissueintheanterior1/3ofthepalate.Thisarearesists
anteriordisplacementofthedentureandisasecondarysupportarea.HamularNotchthisnarrowcleftextendsfromthetuberositytothe
pterygoidmuscles.Thepterygomandibularligamentattachestothepterygoidhamuluswhichisathincurvedprocessattheterminalendof
themedialpterygoidplateofthesphenoidbone.Thehamularnotchiscriticaltothedesignofthemaxillarydenture.Impropermoldingof
thisareacouldleadtosorenessandlossofretention.HamularNotch
9.CoronoidprocessMaxillaAnatomicLandmarksFoveapalatinaCoronoidprocessthepatientisallowedtoopenwide,protrudeandgo
intolateralmovements.Thewidthofthedistobuccalflangewillthenbecontouredbytheanteriorborderofthecoronoidprocess.Fovea
palatinausuallytwo,slightlyposteriortothejunctionofthehardandsoftpalates.Minorsalivaryglandsintheposteriorthirdofthe
hardpalatethetissueisveryglandularanddisplaceable.Theimpressionsurfacemayappearirregularastheglandularsecretionswill
adheretotheimpressionmaterial.Minorsalivaryglands
10.MaxillaAnatomicLandmarksZygomaticoalveolarcrestZygomaticoalveolarcrestthecresthasbeenlikenedtothebuccalshelfinthe
mandibleasastressbearingarea.However,themucosalcoverageisusuallyverythinandalthoughtheboneisingoodpositionforstress
bearing,themucosaisnotconsidereddesirableforthispurpose(thinmucosa).
11.Hardpalateconsistsofthetwohorizontalpalatineprocessesandappearstoresistresorption.Forthisreasonitisaprimarysupport
areaforthemaxillarydenture.Theconfigurationofahighpalateisnotconducivetothestabilityandsupportofadentureduetothe
inclinedplanes.Midlinepalatalsutureextendsfromtheincisivepapillatothedistalendofthehardpalate.Theoverlyingmucosaistightly
attachedandthin,reliefisusuallyrequiredtopreventsoreness.Theunderlyingboneisdenseandoftenraisedformingatoruspalatinus.
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Majorpalatineforamentheorificeoftheanteriorpalatinenerveandbloodvessels.Reliefinthisareaisusuallynotrequiredduetothe
abundantoverlyingtissues.MaxillaAnatomicLandmarksMidlinepalatalsutureMajorpalatineforamenHardpalate
12.IdealMaxillaryRidgeAbundantkeratinizedattachedtissueSquarearchUshapedincrosssectionModeratepalatalvaultAbsenceof
undercutsFrenalattachmentsdistalfromcrestalridgesasmuchaspossibleWelldefinedhamularnotches
13.ExcellentprognosisGoodprognosisPoorprognosisVerypoorprognosisDentureprognosisbasedonanatomicfindings:
14.MandibleAnatomicLandmarksFrenaBuccalshelfMylohyoidridgeRetromolarpadSublingualcrescentLabialvestibuleBuccal
VestibuleMassetergrooveRetromylohyoidLingualsulcus
15.MandibleAnatomicLandmarksLabialfrenumhistologicallyandfunctionallythesameasinthemaxilla,mucousmembranewithout
significantmusclefibers.LabialflangespaceLabialFrenum
16.MandibleAnatomicLandmarksLabialvestibuleLabialvestibulelimitedinferiorlybythementallismuscle,internallybytheresidual
ridgeandlabiallybythelip.Mentaliselevatestheskinofthechinandturnsthelowerlipoutward.dictatesthelengthandthicknessofthe
labialflangeextensionofthelowerdenture.MENTALISMUSCLEOrigincrestofridgeInsertionchinActionraisesthelowerlip
17.MandibleAnatomicLandmarksAlveolarridgeisasecondarysupportarea.Highrateofresorptionwhenexcessivepressureisapplied
tothisarea.Buccalfrenumhistologicallyandfunctionallythesameasinthemaxilla.BuccalFrenumBuccalFrenumAlveolarRidge
18.MandibleAnatomicLandmarksBuccalShelfborderedexternallybytheexternalobliquelineandinternallybytheslopeoftheresidual
ridge.Thisregionisaprimarystressbearingareainthemandibulararch.BuccalshelfThebuccalshelfisaprimesupportareabecauseitis
paralleltotheocclusalplaneandtheboneisverydense.Thesetwofactorsmakeitrelativelyresistanttoresorption.
19.Buccalshelfarea(areawithinthedottedlines).Thegreatertheaccesstothebuccalshelfthemoresupportthereisavailableforthe
denture.Accessisdeterminedbytheattachmentofthebuccinator.BuccalShelf
20.BuccalShelfThesizeandpositionofthebuccalshelfvariesrelativetothedegreeofalveolarridgeresorption.Moderateresorption
SevereresorptionDentateMandibleNoresorption
21.MandibleAnatomicLandmarksExternalObliqueLinearidgeofdensebonefromthementalforamen,coursingsuperiorlyanddistally
tobecomecontinuouswiththeanteriorregionoftheramus.Istheattachmentsiteofthebuccinatormuscleandananatomicguideforthe
lateralterminationofthebuccalflangeofthemandibulardenture.ExternalObliqueLine
22.MandibleAnatomicLandmarksMentalForamentheanteriorexitofthemandibularcanalandtheinferioralveolarnerve.Incasesof
severeresidualridgeresorption,theforamenoccupiesamoresuperiorpositionandthedenturebasemustberelievedtopreventnerve
compressionandpain.
23.Oneconstant,relativelyunchangingstructureonthemandibulardenturebearingsurfaceistheretromolarpad(dottedline).Thepad
containsglandulartissue,looseareolarconnectivetissue,thelowermarginofthepterygomandibularraphe,fibersofthebuccinator,and
superiorconstrictorandfibersofthetemporaltendon.Thebonebeneathdoesnotresorbsecondarytothepressureassociatedwithdenture
use.Itisoneoftheprimarysupportareas.RetromolarPad
24.MandibularAnatomicLandmarksMasseterGroovetheactionofthemassetermusclereflectsthebuccinatormuscleinasuperiorand
medialdirection.Thedistobuccalflangeofthedentureshouldbecontouredtoallowfreedomforthisactionotherwisethedenturewillbe
displacedorthept.willexperiencesorenessinthisarea.MasseterGrooveMasseterGroove
25.SuprahyoidMusclesFunctioninelevationofthehyoidboneandthelarynxanddepressionofthemandible.DigastricStylohyoid
MylohyoidGeniohyoidMylohyoidmuscleformsthemuscularfloorofthemouth.Arisesfromthemylohyoidridgeofthemandible.
Determinesthelingualflangeextensionofthedenture.MandibularAnatomicLandmarks
26.MylohyoidRidgeNotethepositionofthemylohyoidridgeasitvariesrelativetothedegreeofalveolarridgeresorption.Moderate
resorptionSevereresorptionDentateMandibleNoresorption
27.MylohyoidRidgePalpatethemylohyoidridgetodetermineitscontour,sharpnessanddegreeofundercut.
28.Geniotubercle(MentalSpines)presentontheanteriorsurfaceofthemandibleandserveastheattachmentsitesofthegenioglossusand
geniohyoidmuscles.Inpts.withsevereridgeresorptionthegeniotuberclesmaycausediscomfortiftheyareexposedtothedenturebase.
MandibularAnatomicLandmarksGenialTubercles
29.Lingualfrenumoverliesthegenioglossusmuscle,whichtakesoriginfromthesuperiorgenialspineSublingualFoldsformedbythe
superiorsurfaceofthesublingualglandsandtheductsofthesubmandibularglandsMandibularAnatomicLandmarksSublingualfolds
LingualFrenum
30.MandibularAnatomicLandmarksRetromylohyoidspaceliesatthedistalendofthealveolingualsulcus.Boundedmediallybythe
anteriortonsilarpillar,posteriorlybytheretromylohyoidcurtainwhichisformedposteriorlybythesuperiorconstrictormuscle,laterallyby
themandibleandpterygomandibularraphe,anteriorlybythelingualtuberosityofthemandibleandinferiorlybythemylohyoid
muscle.***Theretromylohyoidspaceisveryimportantfordenturestabilityandretention.
31.IdealMandibularRidgeWelldefinedretromolarpadBluntmylohyoidridgeDeepretromylohyoidspaceLowfrenumattachments
AbsenceofundercutsAbundantattachedkeratinizedmucosaAdequatealveolarheight
32.MandibleNotethevaryingdegreesofridgewidthandheightMandibularRidgeQualitySupportandretentionwillbeaffected
33.TongueIntrinsicMusclesoriginateandinsertwithinthetongue.ProducechangesintheshapeofthetongueExtrinsicMuscles
originateinstructuresoutsidethetongueandcanmovethetongueandalteritsshapeGenioglossusStyloglossusHyoglossusPalatoglossus
***Thedentureflangesmustbecontouredtoallowthetonguetohaveitsnormalrangeoffunctionalmovements.Retrudedtongueposture
***Approximately35%oftonguesareabnormalineithersize,positionorshape.***Aretrudedtonguepositionisveryunfavorablefor
dentureretentionandfunction.
34.MyologyMusclesofFacialExpressionGenerallydonotinsertinboneandneedsupportfromtheteethforproperfunction.Modiolus
MentalisBuccinatorOrbicularisOrisIncisivusLabiiSuperiorus&InferiorusModiolussituatedlaterallyandslightlysuperiorlytothe
cornerofthemouthisaconcentrationofmanyfibersofthismusclegroup.Thisisanareawhereextrinsicperioralmusclesdecussatetojoin
intrinsicfibersoftheorbicularisorismuscle.Itisaveryforcefulareawhichcaninfluencethelabialflangethicknessofthemaxillary
denture.Buccinatorprovidessupportandmobilityofthesofttissuesofthecheek.Themusclefiberscontractinalineparalleltotheplane
ofocclusion.Asapersonages,tensionislostinthismuscleandpredisposesthemtocheekbiting.
35.MyologyMusclesofFacialExpressionGenerallydonotinsertinboneandneedsupportfromtheteethanddentureflangesforproper
function.ModiolusBuccinatorMentalisIncisivusLabiiSuperiorus&InferiorusOrbicularisOrisMentaliselevatestheskinofthechinand
turnsthelowerlipoutward.Dictatesthelengthandthicknessofthelabialflangeextensionofthelowerdenture.IncisivusLabiiSuperioris&
Inferiorustheiractiononthevestibularfornixaresimilartothatofthementalismuscle.OrbicularisOrisisthesphinctermuscleofthe
mouth.Hasnoskeletalattachments,isacompositemuscle,composednotonlyofintrinsicfibersbutalsoofextrinsicfibersofmanymuscles
thatconvergeatthemodiolus.
36.GenerallydonotinsertinboneandneedsupportfromtheteethanddentureflangesforpropersupportandfunctionImproperlip
supportProperlipsupportprovidedbythepts.newdentureBeforeAfterMusclesofFacialExpression:
37.PostPalatalRegionMusclesofthesoftpalate:TensorvelipalatiniLevatorvelipalatiniMusculusuvulaePalatoglossus
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PalatopharyngeousSoftPalateClassification:Class1Minimalelevationrequiredtoachievevelopharyngealclosure.Mostfavorablepalate
forplacinganadequateposteriorpalatalseal.Class2Wouldrequiremoremuscleactivitytoachieveclosure.Class3Leastfavorable,
requiresconsiderablemuscleactivityforclosureofthenasopharynxandthisactionmakesplacingaposteriorpalatalsealdifficult123
VelopharyngealClosure
38.TheHousePalatalClassificationThegreaterthefunctionalmovementofthesoftpalatethelessfavorabletheHouseClassification
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