PROSTHODONTICS

PROF BAZIRGAN, BLOCK I

Relevant anatomy of the denture-bearing area & its environment

The oral cavity extends from lips anteriorly, via the cheeks and retromolar segments laterally
& the anterior pillar of fauces posteriorly, to the oropharynx.
Superiorly the vestibules, edentulous ridges & hard and soft palates are important anatomical
landmarks, while the vestibules, ridges, floor of mouth and tongue are significance inferiorly.

The denture-bearing are is contained within the oral cavity, which is of variable
dimension and shape depending on the activity of its muscular environment. Complete
dentures must be contained within this environment.

External aspects of the oral cavity

Lips

The lips are muscular valves of the oral cavity which are covered on the facial surface by skin
and on the internal surface by mucous membrane; these two components meet at the
vermilion border.

The later is an anatomical feature peculiar to man. The extent of border shown may have a
bearing on aesthetic aspects of any prosthesis and is critically dependent on the support
provided to the lips by the incisor teeth, as is the restoration of an acceptable profile.

A feature of the restored upper lip is the philtrum, the verticle lateral borders of which may be
associated, inferiorly, with the distal margins of the upper central incisors. The philtrum is
often not seen in complete denture wearers whose appliances do not adequately restore the
labial facial curtain, with consequent reduction in the aesthetic quality of the dentures.

Vestibules

These potential spaces exist between the lips and cheeks and the alveolar ridges. They are
interrupted by folds of mucous membrane, connecting lips and cheeks to the ridges, called
frena. Other folds contain muscle fibres and these muscle attachments

Cheeks

These muscular lateral borders of the oral cavity extend from the modioli anteriorly to the
mucosa overlying the ascending rami of the mandible posteriorly. They are continuous with
the upper & lower vestibules. As with the lips, the cheeks are lined externally by skin and
internally by mucosa, some of which may be keratinized at about the level of the occlusal
plane.

Lingual sulci and the floor of the mouth

The lingual vestibules have the tongue as a medial border while the floor of the mouth has the
mylohyoid muscle as an inferior border and the ventral surface of the tongue as a superior
border (4). In the midline the lingual frenum is seen and this may be attached to the lingual
aspect of the resorbed ridge.

1
Hard Palate

This has, as its bony base, the palatal process of the maxillae and the horizontal plates of the
palatine bones. The midline region of the palate considered to be free of post-extraction bony
changes. The hard palate exhibits prominences, namely the rugae and the incisive papilla, the
latter being of importance in biometric positioning of upper incisor teeth of complete upper

Soft Palate

This is the posterior continuation of the hard palate. It has a muscular skeleton comprising 5
paired muscles: tensor palate, levator palate, palatoglossus, palatopharyngeus, and muscularis
uvulae. The first four pairs are conjointly associated with mastication, respiration, deglutition
and speech.

2
 Anatomy and Physiology In Relation to
Complete Denture Construction
→ The knowledge of oral anatomy and physiology will help the operator and provides
enough landmarks to act as positive guide during denture construction.

→ This subject can be discussed under:

[ I ] Extra-oral landmarks of prosthetic importance.
[ II ] Intra-oral landmarks of prosthetic importance:
a) In the maxilla.
b) In the mandible.
[ III ] Border structures that limit the periphery of the denture:
a) In the maxilla.
b) In the mandible.
[ IV ] Anatomy and physiology of the T.M. J. and mandibular movements.

[ I ] Extra-oral Landmarks Of Prosthetic Importance:

Landmark Description Significance
1- Inter-pupillary line - Imaginary line running between the - Establishing the anterior Occlusal plane
two pupils of the eye when the pt. is of the artificial teeth of the denture.
looking straight forward.

2- Ala-tragus line - Imaginary line running from the - Establishing the posterior Occlusal
(Camper's line) Inferior border of the ala of the nose to plane of the artificial teeth of the denture.
the superior border of the tragus of the
ear.

3- Canthus-tragus line - Imaginary line running from the outer - Locating the position of the condyles.
canthus of the eye to the superior border
of the tragus of the ear.

4- Naso-labial sulcus - Depression that extends from the ala - After extraction of teeth it becomes
of the nose in a downward and lateral accentuated and should be restored by
direction to the corner of the mouth. complete denture.

5- Vermillion border - The transitional epithelium between - After extraction disappears in the upper
the mucous membrane of the lip and the lip and becomes accentuated in the
skin. lower& should be restored by a complete
denture.

6- Mento-labial sulcus - Depression runs horizontally between - It determines the Angle of

the lower lip and chin. Classification:
1- Angle class [I]: Normal ridge
relationship.
2- Angle class [II[: Retruded mandibular
position.
3- Angle class [III]: Protruded maxillo-
mandibular relation ship.
Landmark Description Significance

3
7- Philtrum - Diamond-shaped area between the - After extraction of teeth it becomes
center of the upper lip and the base of flattened and should be restored by a
the nose. complete denture.

8- Modiolus - The point of meeting of facial muscle - After extraction of teeth it becomes
fibers. downwards and should be restored by a
complete denture.

9- Angle of the mouth - Point of meeting between the upper - (Angular Chilitis): Inflammation and
(commissure of the lips) and lower lip. ulceration as a result of:
1- Prolonged edentulism.
2- ↓ vertical dimension of complete
denture.
3- Vitamin B deficiency.

Fig.1: A, The Philtrum, naso-labial sulcus, commissure of the lips& mento-labial sulcus.
B, Modiolus and Orbicularis Oris muscle.

[ II ] Intra-oral landmark of prosthetic importance:

A- In the Maxilla:
4
 Landmark Description
1- Residual ridge - The portion of the alveolar
process& it's soft tissue covering
that remains after extraction.
2- Maxillary tuberosity - Bony prominence located
posterior to the upper 3rd molar.
3- Median palatine raphe - The mucoperiostium that covers
the median palatine suture.
4- Incisive papilla - Pear-shaped elevation present in
the midline behind the 2 centrals.
5- Palatine rugae - It is irregular elevations radiates
from the midline of the anterior
part of the palate.
6- Torus palatinus - Bony prominence present at
both sides of the midline of the
palate.
7- Fovea palatinae - Two openings of minor salivary
glands present in both sides of
the midline posterior to junction
of hard and soft palate.
Fig.3: A, Diagram
of the upper arch.
B, Diagram of the
lateral surface of
the maxilla.
B- In the Mandible:
Landmark Description
Significance
- It covers by a dense connective
tissue fibers so, it can be act as a 1ry
stress bearing area.
- Aid in support, retention and
stability of the complete denture.
- When it is large:
1- Relieved.
2- Modify the path of insertion.
(unilateral enlargement).
3- Surgical removal.
- When it is prominent it should be
relieved.
- Lack of relief cause:
1- rocking of the denture due to bone
resorption.
2- Tissue ulceration.
3- Mid-line denture fracture.
- After extraction of teeth it migrates
to the crest of the ridge.
- It should be relieved to avoid the
burning sensation of the palate.
- 2ry stress bearing area.
- Prevent forward movement of the
denture.
- If it is sensitive or prominent it
should be relived.
- It should be:
1- Relieved.
2- Surgical removal.
- It determines the posterior
extension of the upper complete
denture to be 2mm posterior to it.
Significance
5
 1- residual ridge - The portion of the alveolar
process& it's soft tissue covering
that remains after extraction.
2- External oblique ridge - Bony ridge running downward
and forward from ramus to reach
mental foramen.
3- Buccal shelf area - Bony area extends between the
external oblique ridge and the
residual ridge.
4- Mental foramen - It's located on the Buccal
surface of the mandible between
the roots of 1st and 2nd premolar.
5- Retromolar pad - Pear-shaped area located distal
to the lower 3rd molar.
6- Torus mandibularis - Bony prominence located at the
inner surface of premolar area.
7- Internal oblique ridge - Irregular bony ridge of median
(Mylohyoid ridge) surface of the mandible which
the Mylohyoid muscle attached.
8- Genial tubercle (Mental - Two bony projections present at
spine) the median surface of mandible
at midline of each side of
symphesis.
Fig.4: Diagram
showing the
mandible:
A, Buccal view.
B, Lingual view.
- Don't used as 1ry stress bearing area
→ Covered by movable fibrous
connective tissue.
- Don't Provide stability or support.
- It is a limiting structure to the
complete denture and not extend to
it.
- Used as 1ry stress bearing area:
1- Perpendicular to the vertical
masticatory force.
2- Formed from compact bone.
3- provide support.
- Lack of relief → numbness of the
lower lip.
- Shock absorbent.
- Gives retention not support.
- Determine the level of the Occlusal
plane.
- It should be:
1- Relieved.
2- Surgical removal.
- It should be relieved during
complete denture construction.
- Represent the attachment of
geniohyiod and genioglossus
muscles.
- If it's prominent, it should be
relieved.