MANDIBLE

Dr Honey Arora
Post Graduate Student
Department of Prosthodontics and Implantology

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CONTENTS
INTRODUCTION
OSTEOLOGY
MUSCLE ATTACHMENT OF THE MANDIBLE
GROWTH AND DEVELOPMENT
MANDIBLE IN COMPLETE DENTURE

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 INTRODUCTION
The mandible is derived from Latin word
mandibula, "jawbone“.
Also referred as inferior maxillary bone
Is the largest and strongest bone of the face, serves
for the reception of the lower teeth. It consists of a
curved, horizontal portion, the body, and two
perpendicular portions, the rami.

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OSTEOLOGY OF MANDIBLE

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 BODY OF MANDIBLE

corpus mandibulae
The body is curved somewhat like a horseshoe
and has two surfaces and two borders.
 2 surfaces – External
Internal
 2 borders – Superior or Alveolar
Inferior

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 STRUCTURES ON THE EXTERNAL SURFACE
MENTAL FORAMEN-
It lies below the interval between the premolar
teeth, on the either side, midway between the upper and
lower borders of the body.
It is the passage of the mental vessels and nerve.
descends slightly in edentulous individuals
Absence of mental foramen and accessory mental
foramina has also been
reported.[1][2]
shape of the MF was oval in
most of the cases.[3] [4]
Central African Journal of Medicine
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MENTAL PROTUBERANCE-
It is a median triangular projecting area in the
lower part of the midline.
- The inferolateral angles of the protuberance from the
mental tubercules.

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EXTERNAL OBLIQUE LINE
It is a faint ridge running backward and upward
from each mental foramen and is continuous with the
anterior border of the ramus.

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INCISIVE FOSSA
It is a depression that lies just below the
incisor teeth on the either side of the symphysis.

(no. 11 is incisive fossa)

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 STRUCTURES ON THE INTERNAL SURFACE
MENTAL SPINES (GENIAL TUBERCULE / GENIAL APOPHYSIS)
There are 2 pairs of spines .
1. Superior pair of spine –. It gives origin to the Genioglossi and
2. Inferior pair of spines – lies immediately below the first pair, gives
origin of the Geniohyoid.
SPECIAL CASES
- May be fused to form a single eminence.
- A median foramen and furrow
are sometimes seen above
the mental spines( spinous
Foramen)[6]

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ATTACHMENT OF ANTERIOR BELLY OF
DIGASTRIC
It is an oval depression on the either side of the
mid line jus below the mental spines for the
attachment of anterior belly of digastric .

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MYLOHYOID LINE
It extends upward and backward on either side from the
lower part of the symphysis .(figure b)
 It gives origin to the mylohyoid.
 posterior part of this line - gives attachment to a small part
of the superior constrictor and to the pterygomandibular
raphe.
-Above the anterior part of this line - is a smooth
triangular area against which
the sublingual gland rests.
 below the hinder part, an
oval fossa for the submaxillary
gland.

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13
 STRUCTURES PRESENT AT THE BORDERS
SUPERIOR OR ALVEOLAR BORDER –
 wider behind than in front
 is hollowed into cavities, for the reception of the teeth;
these cavities are sixteen in number.
 outer lip of the superior border - on either side, the
buccinator is attached as far
forward as the first molar tooth.

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INFERIOR BORDER
 rounded, longer than the superior, and thicker in front
than behind.
 point where it joins the lower border of the ramus - A
shallow groove; for the FACIAL ARTERY , may be
present.

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 RAMUS OF MANDIBLE
ramus mandibulæ; perpendicular portion
The ramus is quadrilateral in shape, and has
two surfaces, four borders, and two processes

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 LATERAL SURFACE

- Lateral surface is flat and marked by

oblique ridges at its lower part.
 It gives attachment nearly
the whole of its extent to the
masseter.

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 MEDIAL SURFACE

MANDIBULAR FORAMEN
It provides entrance for the inferior alveolar
nerve and vessels.

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LINGULA OR LINGULAE MANDIBULAE
it is a sharp spine present in front of
mandibular foramen opening .
 It gives attachment to the spenomandibular ligament

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MYLOHYOID GROOVE
From the lower and back part of the lingulae
mandibulae is a notch from which the mylohyoid
groove runs obliquely downward and forward.
 It lodges the mylohyoid vessels and nerve.

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MANDIBULAR CANAL
The mandibular canal is a canal within the
mandible that contains the inferior alveolar nerve
,inferior alveolar artery, and inferior alveolar veins.
runs obliquely downward and forward in the ramus

then horizontally forward in the body

communicates with alveoli

by small openings

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Types of mandibular canal [5]
1. TYPE III - the canal is located close to the lower
border of the mandible is the most common,
2. TYPE II -the canal is noted between the apices of the
first and second molars and the lower border of the
mandible
3. TYPE I -the canal is in close contact with the apices
of the first and the second molars

Hell Period 1990

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LOWER BORDER –
Is marked by oblique ridges on each side, for the
attachment of the Masseter laterally, and the
pterygoideus internus medially; the
sphenomandibular ligament is attached to the angle
between these muscles.

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ANTERIOR BORDER –
Is thin above, thicker below, and continuous with
the oblique line.
POSTERIOR BORDER –
Is thick, smooth, rounded, and covered by the
parotid gland.

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UPPER BORDER –
Is thin, and is surmounted by
 2 processes -
the coronoid in front
the condyloid behind,
 separated by a deep concavity, the mandibular notch.

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 CONDYLOID PROCESS
processus condyloideus
Is thicker than the coronoid, and consists of two
portions: the condyle, and the constricted portion which
supports it, the neck.
It forms the articular surface for articulation with
articular disk of tempromandibular joint.

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THE CONDYLE
 It presents an articular surface for
articulation with the articular disk
of the temporomandibular joint
 At the lateral extremity of the
condyle is a small tubercle for the
attachment of the
temporomandibular ligament.

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THE NECK –
The neck is flattened from backward, and
strengthened by ridges which descend from the
forepart and sides of the condyle.
 Its posterior surface is convex
 its anterior surface presents a depression for the
attachment of the Pterygoideus externus.

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 CORONOID PROCESS
processus coronoideus
Is a thin, triangular eminence, which is
flattened from side to side and varies in shape and size.
The Coronoid process (from Greek korone, "like a
crown")

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 BORDERS

anterior border - is convex and is continuous below

with the anterior border of the ramus.
posterior border- is concave and forms the anterior
boundary of the mandibular notch.

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 SURFACES
Lateral Surface - affords insertion to the Temporalis
and Masseter.
Medial Surface -provides insertion to the Temporalis
and presents a ridge from apex till last molar
Between This Ridge And The Anterior Border - is a
grooved triangular area, the upper part of which gives
attachment to the Temporalis, the lower part to some
fibers of the buccinator.

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 SYMPHYSIS MENTI
It is the faint ridge on the median
line of the external surface of the
mandible.
This ridge divides below and
encloses a triangular
eminence, the mental protuberance,
the base of which is depressed
in the center but raised on either
side to form the mental tubercule.
It serves as the origin for the
Geniohyoid and the Genioglossus
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 ANGLE OF MANDIBLE
It is the junction of the lower border of the ramus of
the mandible with the posterior border of body of
mandible
Provides attachment
- Masseter laterally
- the Pterygoideus internus medially
- the stylomandibular ligament
is attached to the angle
between these muscles.

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 LYMPHATICS
Sub-mandibular: run along the underside of the jaw
on either side, drains the structures in the floor of the
mouth also drain mandibular teeth except the central
incisors.
Sub-mental: These nodes are just below the chin.
They drain the central incisors and midline of lower lip
and tip of the tongue.

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 NERVE SUPPLY
mainy by the 3rd division of trigeminal nerve ->
mandibular nerve
INFERIOR ALVEOLAR NERVE, branch of the
mandibular division -> enters mandibular foramen
and runs forward in the mandibular canal, supplying
sensation to the teeth->at mental foramen the nerve
divides into two terminal branches: incisive and
mental nerves-> The incisive nerve runs forward in the
mandible and supplies the anterior teeth. The mental
nerve exits the mental foramen and supplies sensation
to the lower lip.
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MUSCLE ATTACHMENT TO THE
MANDIBLE

INTERNAL SURFACE 36
EXTERNAL SURFACE

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 MUSCLE ORIGIN AND BLOOD & ACTION & CLINICAL
INSERTION NERVE SIGNIFICANCE
SUPPLY
MASSETER ORIGIN – Blood supply Elevation and
musculus Zygomatic arch Masseteric retraction of the
masseter Artery mandible
( Greek word Nerve supply: Antagonist muscle –
chewing , Masseteric platysma
associated INSERTION – Nerve
with anger ) Coronoid process
and ramus of
mandible

TEMPORALIS ORIGIN – Blood supply : Elevation and

musculus Temporal line on the Deep temporal retraction of the
temporalis parietal bone of the artery mandible
skull Nerve supply: Antagonist muscle -
Mandibular platysma
INSERTION – nerve
Coronoid process of
mandible

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 MUSCLE ORIGIN AND BLOOD & ACTION
INSERTION NERVE SUPPLY
MEDIAL ORIGIN – Blood supply: Elevates
PTERYGOID Medial surface of lateral Medial pterygoid mandible, closes
musculus pterygoid plate of artery jaw, helps lateral
pterygoideus sphenoid, palatine bone , Nerve supply: pterygoids in
internus pterygoid fossa Medial pterygoid moving the jaw
Nerve from side to side
INSERTION –
Inner surface of ramus ,
Angle of the mandible
LATERAL ORIGIN – Blood supply: Depresses
PTERYGOID • Superior head: lateral Lateral pterygoid mandible,
m. surface of the greater artery Protrude
pterygoideus wing of the sphenoid Nerve supply: mandible, side to
externus • Inferior head: lateral lateral pterygoid side movement of
surface of the lateral Nerve mandible
pterygoid plate

INSERTION –
neck of the mandibular
condyle , articular disk of
the TMJ
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 MUSCLE ORIGIN AND BLOOD & ACTION
INSERTION NERVE SUPPLY
DEPRESSOR ORIGIN – Blood supply: Depresses the
ANGULI • along the oblique line of Facial artery mouth as in
ORIS mandible Nerve supply: frowning
(musculus • lateral aspect of mental Mandibular branch
depressor tubercle of the mandible of facial Nerve
anguli oris)
INSERTION –
modiolus

DEPRESSOR ORIGIN – Blood supply: Draws the lip

LABII Oblique line of mandible, Facial artery downward and
INFERIORIS between symphysis and Nerve supply: laterally
musculus mental foramen Mandibular branch
depressor labii INSERTION – of facial Nerve
inferioris Skin of the lower lip

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 MUSCLE ORIGIN AND BLOOD & ACTION
INSERTION NERVE SUPPLY
BUCCINATOR ORIGIN – Blood The buccinator
musculus Posterior alveolar process supply : compresses the
buccinator of maxilla and mandible Buccal artery cheeks against the
Nerve supply: teeth and is used in
buccal branch acts such as
of facial nerve blowing. It is an
INSERTION – assistant muscle of
modiolus mastication
(chewing).

ORBICULARIS ORIGIN – Blood supply : Narrows orifice of

ORIS Near midline on anterior Facial artery mouth, purses lips
surface of maxilla and Nerve supply: and puckers lip
mandible and modiolus buccal branch of edges
at angle of mouth facial nerve

INSERTION –
Mucous membrane of
margin of lips and raphe
with buccinator at
modiolus
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 MUSCLE ORIGIN AND BLOOD & ACTION
INSERTION NERVE SUPPLY
MENTALIS ORIGIN – Blood elevates and
(so named Symphysis of mandible supply : wrinkles skin of
because it is Buccal artery chin, protrudes
associated with Nerve supply: lower lip
thinking or mandibular
concentration branch of facial
and use to INSERTION –
Skin of chin nerve
express doubt)

PLATYSMA ORIGIN – Blood supply : Draws the corners

subcutaneous tissue of branches of the of the mouth
infraclavicular and Submental inferiorly and
supraclavicular regions artery and widens it (as in
Suprascapular expressions of
artery sadness and fright).
Nerve supply: Also draws the skin
INSERTION – cervical branch of the neck
base of mandible; skin of of the facial superiorly when
cheek and lower lip; nerve teeth are clenched
angle of mouth;
orbicularis oris

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 MUSCLE ORIGIN AND BLOOD & ACTION
INSERTION NERVE SUPPLY
GENIOGLOSSUS ORIGIN – Blood supply: Inferior fibers
musculus Superior part of mental Lingual arteryprotrude the
genioglossus spine of mandible Nerve supply: tongue, middle
fibers depress the
Hypoglossal tongue, and its
nerve superior fibers draw
INSERTION – the tip back and
Dorsum of tongue and down
body of hyoid

GENIOHYOID ORIGIN – Blood supply : Elevates the

musculus Inferior mental spine on Lingual artery tongue, depress
geniohyoideus the inner surface of the Nerve supply: the mandible ,
symphi C1 and helps in
Hypoglossal deglutition
nerve
INSERTION –
Body of hyoid bone

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 MUSCLE ORIGIN AND BLOOD & NERVE ACTION
INSERTION SUPPLY
ANTERIOR ORIGIN – Blood supply: Opens the jaw
BELLY OF digastric fossa anterior belly - when the masseter
DIGASTRIC (mandible) Submental branch of and the temporalis
musculus facial artery; are relaxed.
digastricus
Nerve supply:
mandibular division
INSERTION – (V3) of the trigeminal
Intermediate tendon (CN V) via the
(hyoid bone) mylohyoid nerve
MYLOHYOID ORIGIN – Blood supply : Raises oral cavity
musculus inner surface of mylohyoid branch of floor, elevates
mylohyoideus mandible off the inferior alveolar hyoid, elevates
mylohyoid line artery tongue, depresses
Nerve supply: mandible
mylohyoid nerve
INSERTION –
body of hyoid bone
and median raphe

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 MUSCLE ORIGIN AND BLOOD & NERVE ACTION
INSERTION SUPPLY
SUPERIOR ORIGIN – Blood supply: deglutition
CONSTRICTOR pterygoid hamulus, Ascending pharyngeal
pterygomandibular artery and tonsillar
raphe, posterior end of branch of facial artery
the mylohyoid line of the Nerve supply:
mandible, and side of pharyngeal plexus of
tongue. nerves(IX , X and
INSERTION – cervical sympathetic
median raphe of pharynx ganglion )
and pharyngeal tubercle.

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 LIGAMENT ORIGIN AND INSERTION DESCRIPTION

STYLOMANDIBULAR ORIGIN – Paired , it is the

LIGAMENT Apex of styloid process of the thickening of parotid
temporal bone fascia,
from its deep surface
some fibers of the
Styloglossus take origin.
INSERTION –
to the angle and posterior
border of the angle of
mandible
SPHENOMANDIBUL ORIGIN – • paired; pterygoid fascia
AR the ligament that attaches to thickening and is a
LIGAMENT the spine of the sphenoid remnant of the Meckel's
bone superiorly cartilage
• limit distension of the
mandible in an inferior
INSERTION – direction.
the lingula of the mandible • its related to lateral
inferiorly pterygoid (laterally )
and medial pterygoid
(medially)

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PTERYGOMANDIBULAR passes between the tip of medial surface - covered
RAPHE (LIGAMENT) the hamulus of the by the mucous
Tendinous band of pterygoid bone and the membrane.
buccopharyngeal fascia internal surface of the lateral surface - is
mandible at a point just separated from the
posterosuperior to the ramus of the mandible
posterior limit of the by a quantity of adipose
mylohyoid ridge tissue.
posterior border- gives
attachment to the
superior pharyngeal
constrictor muscle.
anterior border attaches
to the posterior edge of the
buccinator

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 GROWTH AND
DEVELOPMENT

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Prenatal
Week 6 - Intramembranous ossification center develops lateral to Meckel's
cartilage.
Week 7 - Coronoid process begins differentiating.
Week 8 - Coronoid process fuses with main mandibular mass.
Week 10 (approx) - Both condylar and coronoid processes are recognizable
and anterior portion of Meckel's cartilage begins to ossify.
Weeks 12-14 - Secondary cartilages for the condyle, coronoid, and symphysis
appear.
Weeks 14-16 - Deciduous tooth germs start to form.

Birth
At birth mandible still has separate right and left halves.

Postnatal
Year 1 - Fusion of right and left halves of mandible at the symphysis.
Infancy and childhood - Increase in both size and shape of the mandible;
eruption and replacement of teeth.
Year 12-14 - All permanent teeth emerged except third molars.
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 BODY OF MANDIBLE
 The mandible makes its structure in the sixth week of
foetal life.
 It is ossified in the fibrous membrane covering the outer
surfaces of Meckel's cartilages, derrivative of first brachial
arch
 These cartilages form the cartilaginous bar of the mandibular
arch and are two in number, a right and a left.

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Their proximal or cranial ends are connected with the
ear capsules, and their distal extremities are joined to
one another at the symphysis by mesodermal tissue.

MALLEUS

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INCUS 51
Meckel’s cartilage has a close, relationship to the
mandibular nerve, at the junction between posterior
and middle thirds, where the mandibular nerve divides
into the lingual and inferior alveolar nerve.

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The lingual nerve passes forward, on the medial side
of the cartilage, while the inferior Alveolar lies lateral
to its upper margins & runs forward parallel to it and
terminates by dividing into the mental and incisive
branches.

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 LINGULA is replaced by fibrous tissue, which persists to
form the sphenomandibular ligament & the perichondrium
of the cartilage persist as sphenomallular ligament.
 Between the lingula and the canine tooth the cartilage
disappears, while the portion of it below and behind the incisor
teeth becomes ossified and incorporated with this part of the
mandible.

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REMANATS OF MECKEL CARTILAGE
Greater part of Meckel’s cartilage disappears without
contributing to the formation of mandible.
Small part of cartilage near the midline is the site of
endochondral ossification. Here it calcifies and is
destroyed by chondroblasts and are replaced by
connective tissue and then by bone.
Small irregular bones known as mental ossicles develop
in it and by the end of first year fuse with the
mandibular body.
At the same time two halves of mandible unite by
ossification of the symphyseal fibrocartilage.
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The ramus of the mandible develops by a rapid spread of
ossification backwards into the mesenchyme of the first
branchial arch diverging away from Meckel’s cartilage.
This point of divergence is marked by the mandibular
foramen.

Mandible of human embryo 95 mm. long. Outer aspect. Nuclei of

cartilage stippled.
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Somewhat later, accessory nuclei of cartilage make
their appearance:
a wedge-shaped nucleus in the condyloid process and
extending downward through the ramus.
a small strip along the anterior border of the coronoid
process.
.

Mandible of human embryo 95 mm. long. Outer aspect. 57

Nuclei of cartilage stippled.
The condylar cartilage:
Carrot shaped cartilage appears in the region of the
condyle and occupies most of the developing ramus. It
is rapidly converted to bone by endochondral
ossification (14th. WIU) it gives rise to -> Condyle
head and neck of the mandible.
 The posterior half of the ramus to the level of inferior
dental foramen

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The coronoid cartilage:
It is relatively transient growth cartilage center ( 4th. -
6th. MIU). it gives rise to -> Coronoid process.
 The anterior half of the ramus to the level of inferior
dental foramen

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GROWTH OF MANDIBLE

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Growth of the mandible

I. Growth by secondary cartilage

II. Development of the alveolar process

III. Subperiosteal bone appositionand bone resorption

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I. Growth by secondary cartilage
( mainly condylar cartilage )
Increase in height
of the mandibular ramus

Increase in the over all length

of the mandible

Increase of the inter condylar

distance

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 II DEVELOPMENT OF ALVEOLAR PROCESS
 bone apposition occurs at the crest of the alveolar process and
the fundus of the alveolus contributing to the growth of
mandible in height.

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III. Subperiosteal bone apposition and bone
resorption:
Bone deposition Bone resorption Result in

External surface Inner surface of Increase the

of the mandible the mandible transeverse
dimension
Posterior border Anterior border Adjust the
of the ramus of the ramus thickness of the
ramus
Anterior border Posterior border Displacement of
of the coronoid of the coronoid the coronoid
process process process
Chin region ‫ــــــــــــــــــــــــ‬ Modeling of the
lower face 64
COMPLETE DENTURES

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 ANATOMICAL LANDMARK
 The available area of support from an edentulous mandible is 14 cm2 while

the same for the edentulous maxilla is 24cm2 .

The landmarks can be broadly grouped into:

 Limiting structures:
Labial frenum
Labial vestibule
Buccal frenum
Buccal vestibule
Lingual frenum
Alveololingual sulcus
Retromolar pads
Pterygomandibular raphe.
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 Supporting structures:
Buccal shelf area
Residual alveolar ridge

 Relief areas:
 Crest of the residual alveolar ridge
 Mental foramen
 Genial tubercles
 Torus mandibularis.

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 LIMITING STRUCTURES
These are the sites that will guide us in having an optimum
extension of the denture so as to engage maximum surface
area without encroaching upon the muscle actions
Encroaching upon these structures will lead to dislodgement
of thedenture and/or soreness
of thearea while failure to
cover the areas upto the
limiting structurewill imply
decreased retention stability
and support.
68
SUPPORTING/ STRESS BEARING AREA
Masticatory forces produce quite a pressure on the
underlying structures and not everyplace beneath
the denture can take such stress hence we need to
know the areas which can bear the stresses well.
These can be divided into-
1.Primary stress bearing area
2.Secondary stress bearing area

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 PRIMARY STRESS BEARING AREA

These are the areas that are most capable to take

the masticatory load providing a proper support
to the denture.
 Are at right angle and usually do not resorb

easily ( buccal shelf area )

Properties :-
1.Tightly adherent sufficient fibrous connective
tissue with an overlying keratinized mucosa
2.Presence of cortical bone cover
3.Should be at right angles to the vertical occlusal
forces.
4.No underlying structures should be present that will
get harmed due to stress. 70
 SECONDARY STRESS BEARING AREA

Area of edentulous ridge that are greater than or at

right angle to occlusal forces but tend to resorb under load.

 Mandibular:- ridge slopes

Secondary stress bearing area

Secondary stress bearing area

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 RELIEF AREAS
These are the areas which either resorb under constant
load or have fragile structures within or are covered by
thin mucosa which can be easily traumatized
& hence should be relieved.

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 LABIAL FRENUM
Fibrous band extending from
the labial aspect of the residual
alveolar ridge to the lip.
Give attachment to orbicularis oris and incisivus.
Active and sensitive frenum
The activity of this area tends to be vertical so the labial
notch on the denture should be narrow.

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 LABIAL VESTIBULE
 Extends from the labial frenum to the buccal frenum on
each side.
 Potiential space bounded by
- mucolabial fold
- orbicularis oris
- labial aspect of residual alveolar ridge
 Mentalis – quite active in this region.

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CLINICAL SIGNIFICANCE
Extent of denture is limited because of
muscle inserted close to the ridge .
Muscles of lip actively pull across the
denture.(on opening mouth wide orbicularis
muscle is stretched-> narrowing the sulcus
-> displacing denture )
Impression are narrower in this region.
Tone of the skin of lip and orbicularis
depends on the thickness & position of the
flange.
HISTOLOGY
-Epithelium is thin and non-keratinized
- Submucosa – formed by loosely arranged
connective tissue fibre mixed with elastic
and muscle fibre.
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 BUCCAL FRENUM
It overlies the depressor anguli oris muscle

Clinical significance
- Clearance must be achieved in the denture to avoid
dislodgement of the denture

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 LINGUAL FRENUM
Accomodated within
sublingual cresent area .
Vary in width and
height.
Overlies the genioglossus
muscle which takes
origin from mental spine
Fold of mucous
membrane from tongue
to the residual ridge is
sublingual fold.
77
 BUCCAL VESTIBULE
It extends posteriorly form buccal frenum to the retromolar
pad .
Houses the buccal flange
Clinical significance
 Impression is wide in this region
 It is nearly 90 degree to the biting forces , providing denture
with greates surface for the resistance to the vertical occlusal
forces.

78
Buccinator muscle in buccal vestibule
The extent of the buccal flange is highly
influenced by the buccinator muscle, which extends
from
- Modiolus (anteriorly)
- Pterygomandibular raphe ( posteriorly )
Clinical significance:-
 Denture should completely
cover the vestibule and
buccal shelf
 Action of buccinator muscle
moulds the buccal flange.

79
 External oblique ridge
It is a ridge of dense bone extending from jus
above the mental foramen and distally , becoming
continous with anterior border of the ramus
 Gives attachment to buccinator muscled fibres.
Clinical significance:-
- Can be used as guide for extent of denture laterally

80
 Masseter notch
It accomodates the masseter muscle in the
distobuccal area of the denture
Magnitude of its force is exerting the molar region.
Clinical significance :-
 Overextension – soreness of the tissue &
dislodgement of the denture

81
It is recorded by masseter muscle contraction, its
fibres runs ouside and behind the buccinator ->
contraction of masseter ->pushes inward against the
buccinator muscle -> producing bulge.
Movements –
- downward pressure in 2nd premolar region by dentist
and forces exerted by the closing of the mouth.

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CREST OF ALVEOLAR RIDGE
Relief area
Microscopically
 Mucous membrane -> keratinized
layer
 submucosa is attached to the
periosteum.
 Covered by fibrous connective
tissue.
 Bone -> cancellous and without
good cortical plate covering.
Clinical significance :-
- Should be relieved during
impression making. 83
 BUCCAL SHELF AREA
Primary stress bearing area
Consist of horizontal shelves 0f bone so
called buccal shelf (by sheldon winkler 2 nd
edition )
Bounded by :-
- medially -> crest of residual
alveolar ridge
- anteriorly -> buccal frenum
- laterally -> external oblique
ridge
- distally -> retromolar pad

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Wide and perpendicular to the vertical occlusal
forces , so offers excellent resistance to such forces ->
serving as primary stress bearing area.
Buccinator muscle fibres runs anteroposteriorly,
paralleling the bone and denture doesnot resist the
contracting forces of the muscle.

85
Microscopically
 Mucous membrane -> loosely attached and less
keratinized than crest of residual ridge
 Thicker submucosal layer
 Fibres of buccinator are found running horizontally in
submucosa
 Bone -> compact thus making it suitable as primary
stress bearing area
 Buccinator fibres -> runs horizontally allows denture
to rest without damage to the muscle or dislodgement
of denture

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 MYLOHYOID RIDGE
Irregular rough, bony crest extending from the 3rd molar region to the
lower border of the mandible
Prominent -> 3rd molar the 2nd bicuspid.
Levels of attachments of mylohyoid muscle :-
- anteriorly-> close to the
inferior border of mandible
- posteriorly ->close to the
alveolar crest

87
Clinical significance :-
 Mucous membrance can be easily traumatized by
denture.
 Area under ridge is undercut
 Lingual flange of the mandible should extend
inferior but not lateral to the mylohoid line

Buccal

Mylohyoid
Ridge

Attachments
To Hyoid
88
 LINGUAL TUBEROSITY
Irregular area of bony prominence at the distal
termination of the mylohyoid line
Prominent -> acts as undercut

89
 MENTAL FORAMEN
It is located on the lateral surface of the mandible, between
the 1st and 2nd bicuspid , halfway between the lower border and the
alveolar crest.
Clinical significance :-
 Extensive loss of alveolar
ridge -> foramen occupies
more superior position.
 Should be relieved over
the foramen
 If not relieved -> can
occlude the mental nerve and
blood vessels -> causing numbness of the lip
90
GENIAL TUBERCULE / MENTAL SPINE
Situated on the lingual aspect of the symphysis area
slightly above the border.
Divided into :-
- superior -> genioglossi attachment
- inferior -> genohoid attachment
Clinical significance:-
 Extensive loss -> superior
positioning of spine ->
soreness -> surgical
procedure indicated.

91
 RETROMOLAR PAD
Pear shaped pad
Triangular soft pad of the tissue at the distal end of the lower
ridge.
Microscopically
- Composed of a thin nonkeratinized epithelium and loose
areolar tissue
 Submucosa contains :
> glandular tissue
> fibres of buccinator and superior constrictor
>pterygomandibular raphe
> tendons of temporalis
92
Clinical significance :-
 Usable guide on the cast for the
distal extension of denture
 Action of the muscles in
retromolar pad , limits the extent
of the denture -> So denture base
should extend approximately ½ to
2/3rd over the retromolar pad.
(zarb-bolender 12th edition )
 Should be covered by denture
(sheldon winkler 2nd )
 Aids in the stability of the denture
by adding another plane to resist
movement of the denture.

93
 RETROMOLAR PAPILLA
Is a small pear shaped area of gingival tissue that
remains fused to the scar after loss of the last molar.
This small , hard pale pear shaped tissue is situated at
the base of the retromolar pad, approximately at the
centre of the ridge.

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LINGUAL VESTIBULE / ALVEOLINGUAL
SULCUS
It can be divided into three areas
 anterior vestibule/sublingual crescent area/ anterior

sublingual fold
 the middle vestibule/ mylohyoid area

 the distolingual vestibule/ lateral throat form/

retromylohyoid fossa

95
Anterior lingual vestibule
 This extends from the lingual frenum to where the

mylohyoid ridge curves down below the level of sulcus.

Here a depression the premylohyoid fossa can be palpated.
 This is mainly influenced by the genioglossus muscle,

lingual frenum and some part by anterior portion of

sublingual glands .

96
Middle vestibule:

 This is the largest area and is mainly influenced by

mylohyoid muscles and somewhat by sublingual glands.
 The mylohyoid muscle is the largest muscle in the floor of
the mouth whose principal function occurs during
swallowing. Its intra oral appearance is misleading because
the membranous attachment makes the muscle appear to
be horizontal when contracting.

97
 Nagel and sears have shown that at maximum contraction
the fibers are still in a downward and forward direction so
that a denture can be extended below the muscle
attachment along the mylohyioid ridge.
 The lingual borders in the mylohyoid areas are formed by
contact with the mylohyoid muscle in functional, but not
extreme, contracted or elevated positions.
 The average mylohyoid border is 4-6 mm beyond the
mylohyoid ridge in fair to good ridge it is about 2-3 mm . If
the ridge is flat it is often advantageous to make mylohyoid
border thicker (4-5mm or more).

98
Distolingual vestibule:

 The lateral throat form is bounded anteriorly by mylohyoid

muscle, laterally by pear shaped pad, posterolaterally by
superior constrictor, posteromedially by palatoglossus and
medially by tongue.
 The so called “s” curve of the lingual flange of the
mandibular denture results from stronger intrinsic and
extrinsic tongue muscles, which usually place the
retromylohyoid borders more laterally and towards the
retromylohyoid fossa, as the oppose weaker superior
constrictor muscle.

99
 LATERAL THROAT FORM
 The posterior limit of the mandibular denture is determined
mainly by the palatoglossus muscle and somewhat by weaker
superior constrictor muscle this is area is called posterior/
retromylohyoid curtain.
 Neil described this area and noted that the denture could

have three possible lengths, depending on the tonicity,

activity, and anatomic attachments of the adjacent structures-
 Class III lateral throat form has minimum length and
thickness. The border usually ends 2-3 mm below the
mylohyoid ridge or sometimes just at the ridge.

100
 Class I throat form: The horizontal border is usually 2-3
mm thick, but a thicker border of 4-5 mm should be used
for better seal if the ridge is flat. The retromylohyoid
curtain area should be thinner, about 2-3 mm, and very
rounded and smooth.
 Class II throat form is about half as long and narrow as
class I and about twice as long as class III.

101
 COMPARISION BETWEEN EDENTULOUS
MAXILLA AND MANDIBLE
 Maxilla-  Mandible-
1.Has more supporting 1.Has less supporting
areas area.
2.Limiting structures are 2.Limiting structures
less in number and are more in number
have a less stronger and have a stronger
influence over the influence over the
denture border denture border

102
 REFRENCES

1. de Freitas V, Madeira MC, Toledo Filho JL, Chagas

CF. Absence of the mental foramen in dry human
mandibles. Acta Anat (Basel). 1979; 104(3): 353-355.

2. Dharmar S. Locating the mandibular canal in

panoramic radiographs. Int J Oral Maxillofac
Implants. 1997; 12: 113-117.

103
3. Mbajiorgu EF, Mawera G, Asala SA, Zivanovic S.
Position of the mental foramen in adult black
Zimbabwean mandibles: a clinical anatomical study.
Central African Journal of Medicine 1998; 44: 24-30.
4. Gershenson A, Nathan H, Luchansky E. Mental
foramen and mental nerve: changes with age. Acta
Anatomica 1986; 126: 21-8.
5. Zografos J, Kolokoudias M, Papadakis E Dental
School, University of Athens, Greece. Hell Period
Stomat Gnathopathoprosopike Cheir. 1990 Mar;5(1):17-
20.
104
6. Sheller WR and wisewell OB. Lingual foramen on the
mandible. Anat rac 1954; 119 387-390
7. Sheldon winkler 2nd edition OF ESSENTIALSOF
COMPLETE DENTURE PROSTHESIS
8. Charles m. heartwell, Jr, urthur O. Rahn . Syllabus of
complete denture 4th edition
9. Grays anatomy 39th edition
10. Zarb and Bolender 12th edition . Prosthodontic
treatment of edentulous patient

105