Patients expectations are considered as main factor in designing of prosthesis for

giving a successful treatment. They usually approach us with common complaints of poor
masticating ability, difficulty in speech, esthetics etc. They expect a good prosthesis
which is well retained in mouth for a long duration and work efficiently during
stomatognathic function (mastication, phonation ,etc). Importance of extension of
17
complete dentures has been well established for various reasons. Hardy and kapoor
emphasized the fact that retention and stability obtained by adhesion and cohesion resist
the forces, which are directed in vertical direction. But the main source of retention and
stability for forces in horizontal direction is by good peripheral seal. It is usually obtained
by labial and buccal seal. In the posterior region it is mainly by the posterior palatal seal.

DEFINITIONS 29: -
1) POSTERIOR PALATEL SEAL: -the seal area at the posterior border of maxillary
denture.
2) VIBRATING LINES: - a imaginary line across the posterior part of the palate marking
the division between the movable and immovable tissues of soft palate. This can be
identified when the movable tissues are in function.
3) Fovea Palatini: -two small spot /depression in the posterior aspect of the palate, one on
each side of the midline, at /near the attachment of the soft palate to the hard palate.

ANATOMY:
I ) SOFT PALATE :-
It is a movable, muscular fold, suspended from the posterior border of the hard
palate. It separates the nasopharynx from oropharynx, and is often looked upon as a
traffic controller at the crossroads between the food and air passages. The soft palate has
two surfaces, anterior and posterior; and two borders, superior and inferior.
The anterior surface is concave and is marked by a median raphe and posterior
surface by floor of the nasal cavity. The superior border is attached to the posterior border
of the hard palate, blending on each side with the pharynx. The inferior border is free
and bounds the pharyngeal isthmus from its middle portion there hangs a conical
projection ,called the uvula. From each side of the base of uvula, two curved folds of
mucous membrane extend laterally and downwards. The anterior fold is called the
Platoglassal arch (anterior pillar of fauces). It contains the Palatoglossus muscle and
reaches the side of tongue at the junction of its oral and pharyngeal parts. This fold forms
the lateral boundary of the Oropharyngeal isthmus (isthmus of fauces). The posterior fold
is called Palatopharyngeal arch (posterior polar of fauces).
The soft palate is a fold of mucous membrane containing the following parts.
Palatal aponeurosis
Muscles
Mucous glands
Taste buds
Muscles of soft palate: -
1) TENSOR VELI PALATINI: - it is a flat thin triangular muscle. It takes its origin from
scaphoid fossa, spine of sphenoid, lateral wall of auditory tube. It inserts into coil
around hamular notch and attach into palatine aponeurosis. It mainly helps in
tightening of soft palate.
2) LEVATO VELI PALATINE: - it is thick round muscle. Its origin is from petrous part
of temporal bone, medial aspect of auditory tube. It finally meets the muscle of the
opposite side and forms a sling .It helps in raising soft palate and closes oropharynx.
3) PALATOGLOSSUS: -it takes its origin from oral surface of palatine aponeurosis and
insets into tongue. It mainly assists in closing of isthmus facium during deglutition.
4) PALATOPHARYNGEUS: - arises as 2 fasciculus’s- posterior fasiculi arises from
palatine aponeurosis and anterior fasiculi from posterior border of hard palate. It
inserts into lamina of thyroid cartilage, wall of the pharynx and its median raphe. It
helps in pulling up the wall of pharynx shortens it during swallowing.
5) MUSCULUS UVULAE: -it is a bilateral structure. It arises from posterior nasal spine
of palatine bone, palatine aponeurosis. It inserts into mucosa of uvulae and helps in
pulling contracting uvulae upwards.
Nerve supply of soft palate:-
1) MOTOR .N:- all the muscles of soft palate are supplied by pharyngeal plexus of
accessory nerve except tensor veli palatine which is supplied by mandibular nerve.
2) GENRAL SENSORY :- by palatine nerve of maxillary nerve and glossopharyngeal.
3) SPECIAL SENSORY : - lesser palatine n(branch of facial nerve)
4) SECRETOMOTOR NERVE : - lesser palatine nerve (facial nerve )
Blood Supply: - soft palate is mainly supplied by maxillary a, facial a, ascending
pharyngeal a.

II) STRUCTURES RELATED TO POSTERIOR PALATAL SEAL: -

rd
1) Palatine Aponeurosis :- it is a tendinous sheet, located on anterior 2/3 of soft
palate. It is tendon extension of tensor veli palatini attached to lower surface of hard
palate. The angle of attachment of aponeurosis to hard palate determines the activity of
soft palate, greater the angle of attachment greater the activity.
2) Hamular process:- it is located 2-4 mm posterio-medial to distal limit of maxillary
residual ridge. It affects the length and direction of pterygomaxillary seal. It is covered by
mucous membrane and should not be covered by denture.
3) Median palatal raphe: - it overlies midpalatal suture. PPS placement at PNS should
be judicious. If midpalatal tissue is prominent it should be recorded properly and PPS
should be extended into this tissue. A prominent chord (from PNS to palatine
aponeurosis) is frequently found and is to be relieved adequately.
4) Fovea palatini:- it is a clinically visible pit in palate.It is the orifice of openings of
palatal glands which is unique to humans. There is lot of difference of opinion on the
location of fovea palatini and anterior vibrating line: -
 1952(SICHER) fovea palatine is located just posterior to location of hard and soft
palate .
 1958(NAGLE AND SEARS)- FP mark the posterior limit of Hard palate.
 1961(FENN AND ASSOCIATES),1966 (ANDERSON AND STOVER)- FP located
in glandular region of soft palate.
 1970(SWENSON )- vibrating line is 2mm in front of FP
 1971(SILVERMAN) PPS can be extended 8.2mm distal to vibrating line for retention
and stability.
 1975 (LEY)6: - a study was done on 100 subjects who were evaluated clinically,
radiographically, histologically. They observed that, fovea palatini were found to be
separated from each other by 3.5 mm. Nerve innervation was found to begin just anterior
to fovea and spread towards soft palate. The mean position of vibrating line is 1.31 mm
behind fovea but posterior limit of denture can be extended an additional of 2mm before
soft tissue movement is sufficient to break the seal. In 13.04% of patient s FP was found
to be posterior to anterior vibrating line. In 17.39% of patients FP was coinciding with
anterior vibrating line. In 69.57% of patients it was found to be anterior to the anterior
vibrating line.
5) Saliva :- if patient shows thick ropy saliva then a thin line is scribed on master cast.
This ridge on denture maintains the seal even with slight displacement.

CLASSIFICATION OF SOFT PALATE

Before recording the PPS it is very important to classify the type of soft palate the
patient has. It determines precautions needed to be taken for specific type of soft palate.
While classifying soft palate the head position should be in upright position. There are
various classification-
Palatal throat form given by HOUSE: -
I) Class I: - large and normal in form, with a relatively immovable band of resilient
tissue 5-12 mm distal to a line drawn across distal edge of the tuberosities.
II) Class II: - medium size and normal in form, with relatively immovable resilient
band of tissue 3-5 mm distal to a line drawn across the distal edge of the
tuberosities.
III) Class III: - usually accompanies a small maxilla. The curtain of soft tissues turns
down abruptly 3-5 mm anterior to a line drawn across the palate at the distal edge
of the tuberosities.

LEYS classification of soft palate: - based on angle of soft palate

I) Class I:- soft palate horizontal with minimum muscular activity and wide PPS but
not deep. It has a more favorable prognosis.
II) Class II:- the angle of attachment lies between class I and class II .
III) Class III: - it has a more acute contour in relation to hard palate. It is usually seen
with v –shaped hard palate. It has a small PPS but is quite deep.

Classification of PPS based on soft palate configuration (BERNARD LEVIN)-

Class I:- Greater then 5 mm of movable tissue available for post damming. It is the ideal
for retention. Usually thin denture base is advisable.
Class II: - 1-5 mm of movable tissue available for post damming, good retention is
usually possible. A medium thickness of denture base is quite adequate.
Class III: - less than 1mm of movable tissue available for post damming. Retention is
usually poor. In such cases a thick denture base id needed.

POSTERIOR PALATAL SEAL

It is the seal area at the posterior border of maxillary denture. It can be divided
into 2 areas: Pterygomaxillary seal
Post palatal seal.

PTERYGOMAXILLARY SEAL
It extends through Pterygomaxillary notch continuing 3-4 mm anterolaterally,
approximating the mucogingival junction. It occupies entire width of hamular notch
(loose connective tissue lying between Pterygoid Hamulus of the sphenoid bone and
distal portion of maxillary tuberosity). The notch is covered by pterygomaxillary fold
(extend from posterior aspect of tuberosity to retromaolar pad). This fold influences the
posterior border seal if mouth is wide open during final impression procedure.

POST PALATAL SEAL

It is the area between the anterior and posterior vibrating line found medially from
one tuberosity to other. It appears to be as a cupids bow.
VIBRATING LINES:- these are imaginary lines which delineate the PPS. There are 2
vibrating lines viz,
25,33
A) Anterior vibrating line : - it demarcates zone of transition between no movement
of the tissue overlying hard palate and some movement of the tissues of soft palate. It
serves as anterior border of PPS. It extends laterally into pterygomaxillary notch. It is not
a straight line due to presence of PNS. It always occurs in soft palate.
SEARS:P - it is not the junction of hard and soft palate.
LEY: -anterior vibrating line is 1.31 mm posterior to fovea palatine.
GERALD .S. WINTRAUB: - it is usually located in the junction of hard and soft palate.
Methods of eliciting anterior vibrating line: -
-Valsalva maneuver-ask patient to blow gently through nose with nostrils closed using
finger.
-Sharry’s method -ask patient to say ‘ah’ with short vigorous bursts.
25,23
B) Posterior vibrating line :- imaginary line at the junction of the aponeurosis of the
tensor veli palatini muscle and the muscular portion of the soft palate. It demarcates the
part of soft palate that has limited /shallow movement during function (quivers) and the
reminder of soft palate that is markedly displaced during functional movements. It is
elicited by asking the patient to say ‘ah’ in short bursts in a normal, unexaggerated
fashion posterior vibrating line marks the most distal extension of denture base.

RATIONAL AND IMPORTANCE OF POSTERIOR PALATAL SEAL

Addition of PPS transforms a base with adhesive retention into very stable base
with resistance to horizontal forces. It forms a partial vacuum only when subjected to
force and enhance retention and stability. The partial vacuum created does not damage
oral structures and lasts for a very short duration. A care should be taken not to do
excessive border seal as it occurs with over scrapping. It leads to constant heavy pressure
and interference of blood supply and ultimately leading to destruction of supporting
structures. Adequate distal extension of denture base with physiologic limit help’s in
increasing surface area coverage. Recording of PPS is whole and sole job of dentist and
not of a technician.

IMPORTANCE AND FUNCTION OF POSTERIOR PALATAL SEAL

1) It maintains contact of denture with soft tissue during functional movements of
stomatognathic system (mastication, deglution and phonation etc.)
2) Decreases gag reflex.
3) Decreases food accumulation with adequate tissue compressibility.
4) Decrease patient discomfort of tongue with posterior part of denture.
5) Compensation of volumetric shrinkage that occurs during the polymerization of
PMMA.
6) Permits normal movement of muscles and ligaments.
7) Increases retention and stability by creating a partial vacuum.
8) Increased strength of maxillary denture base.21

ANTOLINO COLON et al (1982) 15 performed analysis of PPS and the palatal form as
related to the retention of complete dentures. Retention of complete dentures is related to
–factors of impression surface, factors of occlusal surface, factors related to polished
surface.
The authors evaluated the retentive value of different types of PPS and the effect
of palatal form on retention of complete dentures. They evaluated the retention of
complete denture at 3 different points anterior, middle and posterior with 3 different
palatal seal from (no palatal seal, 0.5 mm scribed lines, scrapping of cast at vibrating
lines). The maximum forces applied was 17 lb. It was found that:-
 Anterior attachment needed the greatest amount of force to dislodge the base, the
posterior attachment needed the least.
 Middle attachment showed more variability of forces needed to dislodge the bases. It
was influenced by the form of the palate, the type of PPS and weight of the bases.
 The middle location is the most reliable region for testing of c.d.
 The form of palate has direct influence on retention of c.d and will aid in the selection
of type of PPS (as the base angle increases less force was required to dislodge the
base)
 As the base angle increase less need for an extended PPS.
 The difference in the force required to dislodge denture with and without PPS was
statistically significant in anterior region, which is most important because during
speech and mastication anterior teeth may come in contact.
PARAMETERS OF PPS
Posterior palatal seal has specific characteristics with different parameters viz:-
1) Size.
2) Shape
3) Location
4) Displacibility.

1)Size :- HARDY AND KAPOOR (1958) claimed that on an average, the dimension of
PPS was 2mm at the midpalatal region and hamular notch and 4mm at the greatest
curvature region of PPS. But wide range of variation was also found.
SILVERMAN23 performed a study on 92 patients evaluating the PPS clinically
radiographically, histologically and he found the following findings:-
 The greatest mean anteroposterior width of PPS is 8.0 mm (with 5-12 mm of range).
 The mean width was found to be different for right (8.2mm) and left side (8.1mm).
 The interhamular notch was found to be 35.8 mm (25-48mm range)
 The interhamular notch distance was found to be different for males (37.1mm) and
females (35.6mm)

24
2) Shape Of Pps: - ROGER WINLAND, JOHN .M. YOUNG (1975) performed a
survey to evaluate the forms of shapes of PPS used in various schools of United States in
1975. They found that five different forms of PPS were commonly used:
 Single bead scribed on the posterior vibrating line.
 Double line scribed in the anterior and posterior vibrating line.
 Butterfly shaped PPS.
 Butterfly shaped PPS with notching of posterior vibrating line.
 Butterfly shaped PPS with notching of Hamular notch.
 Variations used with different shaped soft palate based on the classification.
Class I –a butterfly shaped PPS with 3-4 mm wide.
Class II – PPS is narrow with 2-3 mm of width.
Class III – a single beading made on the posterior vibrating line.
3) Location :- location of PPS is not consistent and show lot of variation but on an
average anterior vibrating line is 1.31 mm distal to fovea palatini .

4) Displacement /Compressibility:-lot of variation has been found within the PPS . But
low compressibility has been observed in midpalatal raphe and hamular notch region.
High compressibility has been in the lateral part of cupids bow. It variation depends on
the form of palatal vault: -
Class I palate –shallow PPS.
Class II palate – medium PPS
Class III palate – deep PPS.
But how much is the question and remained unanswered?

FACTORS INFLUENCING PPS

The accuracy of PPS reproduction in complete denture depends on various factors
viz:-
 Configuration of hard palate.
 Investing medium
 Factors involved in processing of acrylic resin.
 Denture base thickness.
 Head position.

1) CONFIGURATION OF HARD PALATE :- Hard palate has been classified by

various authors :
Nichols – Tapering
Square
Arched /flat
Heartwell ,Elinger Shay – based on different slopes,
V- shaped Flat
U- shaped High
Medium
 Swenson gave additional parameters for basic classification – prominent midline
sutures, tori.
JOHNSON ET AL( 1986) studied various parameters of hard palate and concluded that
 Mean tissue contact area is 34.3 cm2.
 When viewed anterioposteriorly there were three major forms of classification
Flat anteriorly bur curved posteriorly –5%
Mildly inclined anteriorly and curved in center and posteriorly- 69%
Steep anterior inclination curved both centrally and posteriorly-12%
 When viewed mesiodistally there were three major classification: -
Flat palate (< ¼ th inch deep from the crest of ridge) - 4%.
U- shaped (¼ - ½ th inch deep from the crest of ridge ) - 93%.
V- shaped palate (> ½ inch deep from the crest of ridge) - 3%
H.NIKOUKARI (1975) 22: - evaluated width of PPS in different palatal form and they found that: -
Type of palate A B C D E F G
(In mm) (In mm) (In mm) (In mm) (In mm) (In mm) (In mm)
Deep palate 4.5 7.4 5.5 4.5 5.5 7.5 5.0

Medium palate 5.0 8.5 6.0 5.0 6.0 8.0 5.0

Flat palate 6.5 10.0 6.5 6.0 6.5 9.0 6.0

GLAZIER (1980) established a definite relation between height of ridge and PPS.
Various other features of palate which may affect PPS are –taper of residual ridge, arch
shape, arch size, depth, breath and length.
JOHNSON (1987) 19: - evaluated the distortion of PPS in complete denture fabricated for
various palatal forms after processing. They found that
 The increasing order of distortion due to processing error- v-shaped palate <u-shaped
palate <flat palates.
 Opening of PPS after processing was from hamular notch to hamular notch in flat
palate. In case of u and v shaped palate the opening starts from the midpalatal suture
region to 2/3 rd the distance.
8
2) INVESTMENT MEDIUM: - SYKORA.O, SUTOW.E.J (1996) compared high
expansion dental stone with type III dental stone (buff stone ) with respect to
adaptation of PPS. High expansion dental stone produced a better adaptation of PPS
than Type III dental stone.
3) CURING METHOD: - the cause of dimensional change of PPS are:
Polymerization shrinkage (8 vol%).
Linear shrinkage during cooling (0.44%).
Differences in co-efficient of linear expansion of resin and gypsum lead to
formation of internal stress.
SULORE.O, SUTOW.E.J (1993) found that continuous injection technique exhibited
least opening at PPS as compared to conventional trial packing method.
GAYLE.A.L et al (2001):-33 advised use of anchored polymerization technique which
showed significant reduction in marginal gap (0.3- 0.1mm) at palatal region.
4) DENTURE BASE THICKNESS: - the effect of thickness of denture base on pps has
been interpreted with contradictory statements:-
WOELFEL (1960)- “ Thin maxillary dentures distort more than thick ones. It occurs
mainly due to inability of weaker denture bases to resist deformation”.
B. LEVIN -advices use of thin denture base for class I soft palate(pps is not deep but
wide-so thin denture base lead to more deformation) and thicker denture base for class III
soft palate(pps is deep but not wide so use of thick denture base is not critical), medium
thickness for class II soft palate.
5) EFFECT OF HEAD POSITION ON PPS: -
SILVERMANN (1971)- described the effect of head on the PPS recording. The
impression of soft palate should be in its most functionally depressed position. The
maximum depression (downward and forward position) of the soft palate will be recorded
when the FH plane is 300 below the horizontal plane and tongue is firmly positioned
against the mandibular anterior teeth. A properly positioned maxillary tray handle can
serve as a substitute for missing incisors. At no time should the patient protrude the
tongue beyond the approximated position of the incisal edges, as this will foreshorten the
posterior border of the final impression. The head and tongue position translate the
mandible anteriorly. The soft palate will then be passively brought downward and
forward due to the indirect attachments of the mandible and the insertion of the
palatoglossus muscle into the side of the tongue. Flexion of the head also contributes to
moving excess impression material and saliva out of the mouth, rather than progressively
down the pharynx, while maintaining the 300 flexion of the head and anterior tongue
position, the pt is asked to rotate the head so that all functional positions of the soft palate
are recorded.

EFFECT OF PPS ON STRENGTH OF MAXILLARY DENTURE BASE

J.A VON FRANHOFER ER AL (1987) 21: - performed a study to evaluate effect of PPS
on flexural strength of maxillary denture. They recorded the fracture load and fracture energies. PPS has
shown to strengthening effect on flexural resistance for medium and shallow vault palate.
Palatal vault Fracture load (kg) Fracture energy (kg .cm)

Shallow 143.2 17.9 14.93.1

(With PPS ) 178.021.0 19.4 6.1

Medium 224.2  75.8 26.11 13.6

(With PPS ) 237.0  22.5 31.6  5.6
Deep 195.9  26.6 24.6  5.0
(With PPS) 160.8  31.8 18.3  7.9

METHODS OF RECORDING PPS

Classification of techniques of recording PPS: -
Hardy and kapoor (1958) 17
I Functional: - final impression is bordered molded in PPS area with soft stick
modeling compound / wax by sucking and bubbling movements performed by patients.
II Semi functional: - border molding is done by the dentist.
III Empirical technique: - developed on the cast by grooving the cast to the desired
depth.
Different methods of recording PPS: -
1) Conventional method 34,14.
2) Fluid wax technique 25.
3) Ultrasound technique 11.
4) Arbitrary scrapping 30.
5) Use of teaching aid with modified denture base desings to locate PPS5.

Precautions to be taken before making impression

1) Impression tray extension should be 1-2 mm distal to the expected PPS.
2) Prior to wash impression adequately perform border molding of PPS area.
3) Classify soft palate and hard palate to determine the precaution to be taken.
4) Laboratory technician cannot create PPS and it is the sole responsibility of dentist.
5) Impression compound is used to record PPS and it should be done in 2 applications
since: - Thick areas contact first.
Heaviest areas of compound slumps.
6) Advice the patient to rinse an astringent mouth wash to remove any stringy saliva.
7) Dry mucosa before marking PPS.

When to record the PPS ?

There are 2 school of thoughts for when to record the PPS
a) Before try-in –provide the patient with psychological confidence.
b) After try-in –prevent displacement of occlusal rim in posterior region leading to
occlusal error in 2nd molar region (due to improper seating of bases during jaw
relations).

I) CONVENTIONAL APPROACH: -
1. WINKLER – ask patient to have astringent mouthwash (to remove stringy saliva) &
keep his head upright. Dry the PPS area with gauge and palpate for Hamular process
using T-burnisher /mouth mirror. Mark them with indelible pencil and make sure denture
does not cover them. T-burnisher is passed along posterior angle of maxillary tuberosity
until it drops into pterygomaxillary notch (do not confuse with depression found on
residual ridge usually found at times). Extend the mark from pterygomaxillary notch 3-4
mm anterolateral to maxillary tuberosity approximating mucogingival junction. This
completes marking of pterygomaxillary seal. Ask patient to say “ ah” in short bursts, in
unexaggerated fashion. Observe movement of soft palate and mark posterior vibrating
line, and then connect it to pterygomaxillary seal. Advice patient not to close mouth (to
prevent smudging of markings). The resin /shellac tray is then inserted into the mouth
and seated firmly into tray and transfer markings on master cast by placing it into cast.
Later trim excess found on tray.
Mark anterior vibrating line using
a) T-burnisher (by checking the compressibility in width and depth) –usually
termination of glandular tissue usually coincides with anterior vibrating line
b) Valsalva meanuer: - place special tray in mouth and get the markings on tray which is
later transferred to master cast.
The area of cast before the anterior and posterior vibrating lines is usually narrow in
mid-palatal region due to the presence of posterior nasal spines.
Master cast is scored using a Kinsley scraper. Deepest area of seal is located on
either side of midline (1/3rd distance from posterior vibrating line). It is scrapped
approximately 0.5-1.0 mm (due to limited compressibility) within out line of cupids bow.
Scrape cast to a depth of about ½ the amount to which the palatal tissue in that area can
be compressed. Then add additional amount of resin on tray over scraped area and try-in
patients mouth asking him to say ‘ah’, then check for gap between tray and soft palate. If
gap is found then repeat scrapping till adequate seal is attained.
Advantage: -
a) Highly retentive trial bases give good jaw relation.
b) Give psychlogical confidence to patient that retention will not be a problem in final
denture.
c) Dentist is able to determine the retention of final denture.
d) Patient will be able to realize the posterior extent of denture, which may ease the
adjustment period.
Disadvantages: -
a) Not physiological technique and therefore depends upon accurate transfer of viability
line and careful scrapping.
b) Potential for over compression is great /high.

2. CALOMENI A, E.E.FELDMANN, W.A. KUEBKER (1983) 14: -

Finish the maxillary final impression. Ask the patient to rinse with zinc chlorate-
type mouthwash. Dry PPS with gauze sponge using ladmore plugger. Palpate hamular
notch. Mark the ladmore plugger with color pencil and leave a mark on hamular notch.
Mark posterior vibrating line by using sharry’s method(‘ah’). Then palpate for
displaceable tissue anterior to posterior vibrating line. Do not mark anterior vibrating line
more than 5-6 mm anterior to posterior vibrating line and in midline should be 2-3 mm
anteriorly. Dry the impression and place it back in oral cavity to transfer the marks. Then
scrape the cast 1-1.5 mm at posterior vibrating line tapering anteriorly.

II) FLUID WAX TECHNIQUE: -

Start with locating and transfer of anterior and posterior vibrating line similar to
conventional approach. Then with marking made, final impression is made using ZOE
/impression plaster(not with elastomeric impression material as they are resilient, non
adherent to wax and distort wax when reseated into oral cavity).
Impression waxes used are: -
a) IOWA wax (white)- Dr.Earl. S. Smith.
b) KORECTA wax no.4 (orange)- Dr. O. C. Applegate.
c) K.l physiologic paste (yellow – white)- Dr .C.S Howkins.
d) Adaptol (green) –Dr.Nathen G. Kyne.
The melted wax is painted into the impression surface (within the outline of the seal
area). The wax is applied slightly in excess of the estimated depth and allowed to cool
below mouth temperature to increase its consistency and make it more resistant to flow.
The impression is carried to the mouth and held in place under gentle pressure for 4-6
min & allow time for the material to flow. Take care head position (300 to FH plane).
 After 4 min remove impression tray and trim excess (or) if no tissue contact is
established then add and redo the procedure. Ask the patient not to rinse with cold water
in between the procedure (contraction of tissues and act to decrease flow properties of
wax). Examine the surface morphology of wax at anterior vibrating line. It should be
brief edge, if step is found this indicates poor flow of material.
Advantages: -
a) It is physiologic technique displacing tissues.
b) No over compression of tissues.
c) PPS incorporated into trial denture base for added retention.
d) No mechanical scrapping of cast.
Disadvantage: -
a) Time consuming.
b) Cumbersome procedure: - difficulty in handling material and additional care to be
taken during boxing procedure.

III) ULTRASOUND11: -
Ultrasound refers to sound with frequencies higher than the audible range (20-
20,000 Hz). Sound is a form of mechanical energy propagated in form of waves (series of
condensations and rarefactions) through a medium by motion of particles within the
medium. For medical applications 1 Mhz-20 Mzh are used for non-diagnostic medical
application <1 Mhz are used.
Parts of ultrasound apparatus: -
1. Ultrasound transducer (synthetic ceramic material with piezoelectric properties)
2. Couplant –medium for transmitting ultrasound, as air is poor conductor of sound.
3. Monitor-usually B-mode monitor is used (displays the amplitude of echoes from
anatomic cross section of patient).
Physical effects of ultrasound: -Ultrasonic effects are non-ionizing (do not have
sufficient energy to displace electrons from orbital shell. High-energy ultrasound can
cause burning of tissue (not commonly seen with range of medical use).
Indications:-
1. Patients with only class I, II type of palates as type III palate prevent complete
adaptation of transducer.
Contraindication: -
1. Patients with neuromuscular impairments.
2. Pronounced gag reflex.
Procedure: -
Miniature transducer (10 Mhz linear array) is used along with a real time B-mode
to view image of soft tissue. Mark PPS using conventional method. Place a thin rubber
rd
band on anterior 1/3 of transducer, which serves as an index that would appear in
monitor. Toothpaste is used as a couplant. The transducer is taken intro oral cavity &
initially moved posteriorly to the left of midline to locate hard and soft palate junction.
Once the rubber band is visualized on post vibrating line, there was no display and a
Polaroid picture was made. Then it was moved to right side of palate. The average
distance of posterior vibrating line from junction of hard and soft palate is 2-9mm with
4-6mm wide PPS.

IV) A TEACHING AID FOR VISUALIZATION OFPPS USING A MIDIFIE

BASE TRAY: - JAY STEINBERG (1992) 5
The author describes a TECHNIQUE of preparing a modified base tray for easy
visualization of PPS. Mark a line 15-20 mm anterior to posterior vibrating line. Sprinkle
pink acrylic anterior to it and clear acrylic resin posterior to it. Then mark the PPS in
patient and seat the temporary denture base in mouth to mark the tray for easy trimming
and visualization.
V) ARBITRARY SCRAPING:-
Winkler- Arbitrarily mark anterior and posterior vibrating line and scrape about 1-
1.5mm. It is the least accurate methods used to mark the PPS. Its high potential for over
post-damming is due to its nature of unphysiologic technique of recording.
H.NIKAOUKARI (1975) 22- studied the effect of recording medium on quality of tissue
displacement while registering ppd. They found that PPS can be best achieved using
green stick compound (1.8mm). The ZOE exhibited least displacement to (0.4mm).

MING SHEH CHEN ET AL (1985) 13: - conducted a survey to evaluate the concepts of
PPS being taught. They found that: -
1. A combination of clinical methods was most frequently taught for locating the
vibrating line.
2. The phonation of the “ah” sound was the most popular single method taught for
locating the vibrating line.
3. Seventy –five percent of the dental schools taught that there is one vibrating line per
person.
4. The posterior flexion line was related to the distal termination of the maxillary
denture by dental schools that teach the concept of two vibrating lines.
5. Most dental schools (teach students to carve the PPS on the maxillary master cast.
6. Most dental schools do not use the fovea palatini for locating the distal termination of
the maxillary denture.
7. Most dental schools take the compressibility of the palatal tissue into consideration
when carving the depth of PPS in maxillary master cast.
8. The butterfly pattern was most frequently described to carve the posterior palatal seal
in the maxillary master cast.

PROBLEMS WITH PPS: -

1) UNDEREXTENTION OF DENTURE:-
Most common cause of seal failure .It mainly occurs due to use of fovea palatine
as a guideline for marking anterior and posterior vibrating line. By doing so 4-12 mm of
tissue coverage loss occur leading to decreased retention.
Tissues covering hard palate are firmly attached and the main retention is by
adhesion and cohesion, which is least during function. In case of gaggers who cannot
tolerate denture base far behind in palate, they insist on reduction of denture base and
dentists unsure of his technique complies patients request leading to decreased retention.
 Other related caused are: - improper recognition of anterior and posterior
vibrating line, injudicious trimming of denture border by technicians.It can be overcome
by adding PPS to denture incase there are no other complaints with the denture.

2) OVEREXTENTION:-
It mainly occurs due to overzealous extension of denture base for increased retention by
dentist cause physiological violation of soft palate musculature. It mainly shows with
symptoms of :-Mucosal ulcerations
Painful swallowing
Physiological violation of soft palate muscle
Sharp pain if pterygoid hamulus is covered.
It can be managed by selectively relieving the pressure areas and decrease the
distal length.

3) UNDER POSTDAMMING:- It mainly occur

 Due to improper depth of postdamming,
 Use of improper technique
 Recording PPS in a wide open position –cause toughening of
pterygomandibular ligament which shorten the pterygomaxillary seal.
It can be diagnosed using 2 tests:-
 Seat dentures in mouth ask patient to say ‘ah’ and with mouth mirror view of
any gap during speech.
 Place wet denture base and press slowly in midpalatal region and bubbles
escaping at any point on distal denture border indicates area of under post
damming.

4) OVER POSTDAMMING:-
Commonly occur due to aggressive scraping of cast. If it occurs in
pterygomaxillary seal the denture is displace downward. If moderate over postdamming
is present then mild irritation is found. It can be overcome by selectively relieving
denture border with a carbide bur, followed by light pumicing.
5) MUCOUS RETENTION CYST: -ELLIS (1995)7 Described a clinical report of
mucous retention cyst occurred due to over extended denture border.

6) GAGGING: -commonly encountered and should be managed carefully before

altering any prosthesis. Before attempting to treat gagging carefully check for –
 Thickness of denture base
 Extension
 Postdamming
 Surface finish
 Interocclusal distance
If all these are found correct then other modes of managing gagging should be
undertaken. Effective management of the severe gagger demands sincere interest in the
problem and compassion for the patient. Numerous approaches to managing the sever
gagger appear in the dental literature. They fall into the categories of: -
I Clinical techniques
II Prosthodontic management.
III Pharmacological measures.
IV Psychological intervention.

Clinical management:-
a) Surgical :- Lesslie reported a surgical technique to relieve gagging for the patients
unable to tolerate dentures .The basis for this technique stems from the observation that
persistent gagging results from an atonic and relaxed soft palate rests back on the
pharyngeal wall. This produces a tendency to gagging and nausea that often results in
vomiting. To correct this situation lesslie advocated a surgical intervention to shorten and
tighten the soft palate on healing. The surgery also involved the removal of the uvula;
which was a little longer than normal.
b) Prosthodontic:- to avoid substandard impressions because of gagging, borkin outlines
an impression technique for edentulous patients. It provides greater control of setting
time and discrepancies can be corrected easily. A primary impression is made by use of
stick tray and red modeling compound. The secondary impressions obtained by pouring
kerr impression wax (kerr mfg,co, romuus ,mich) in the tray. The pliable nature of the
wax allows reseating of the tray and border molding until desirable results are obtained.
A technique that employs ordinary marbles was reported by singer as an effective
approach to overcome a patient’s inability to tolerate complete dentures. At the first
appointment the patient is asked to place five marbles in the mouth continuously for one
week except when eating and sleeping. At the second appointment, after one week the
patients ability to tolerate the marbles is evaluated, and he is reassured that he would be
able to tolerate dentures. At the third visit, the primary impression is taken. At the fourth
visit, the lower tray is inserted along with the three marbles in the mouth and a training
bead is placed on the lingual aspect of the lower tray to maintain proper tongue positon.
During the fifth visit, the use of the marble is discontinued and at the sixth visit, jaw
relations are recorded , while the dentures are being constructed the patient continues to
wear the upper and lower base trays in lieu of carrying the marbles. The complete
dentures are inserted in the seventh visit. According to singers marble technique the
patient’s motivation is an indispensable component.
c) Radiographic:- to minimize problems in obtaining dental radiographs in gagging
patients, Richards suggested the use of fast speed film, present the timer, moisten the film
pack and the patients is advised to rinse the mouth with cold water.
d) Psyclologic:- effective method to reduce gagging is diverting the patients attention
from the gagging stimuli. When making impression, Linda recommended manipulating
the oral facial tissues more for psyclologic reasons than for border molding. He also
recommended talking to patient, explaining the critical nature of accurate impressions.
When inserting new dentures, landa suggested that the dentist-engage the patient
in conversation on some topic of special interest, (or) have the patient count rapidly up to
50-100 (or) have the patient read a loud.
Kovats reported a technique that has the patient breathe audible through the nose
and at the same time, rhythmically tap the right foot on the floor. By concentrating on
these activities the patients attention may be diverted away from the gagging stimuli.
A similar technique was described by krol. To divert attention, the patient
instructed to raise his/her muscles become increasingly fatigued, more and more
conscious effect is required to hold the leg up and the patient has difficulty carrying on
conversation, intraoral procedures may be attempted.
Faigenblum discussed that evidences exists that vomiting is impossible during
apnea. To control gagging patient is instructed to prolong the expiratory effort at the
expense of inspiration. This will produce a state of apnea and discourage gagging.
Faigenblum also proposed that a well-reseated and relaxed patient with an empty stomach
is less likely to gag.

Prosthodontic management:-
Prosthodontic approaches to the patient with the gagging problem involve
technical modification to render the prosthesis more acceptable to the patient . No
alteration, in fixed or removable partial prosthesis, has been reported in the literature to
solve a gagging problem. Excess thickness, over extension or inadequate post dam should
be corrected before more radical modifications in the prosthesis are made.
The smooth, shiny surface of a complete denture is objectable to some patients.
From his clinical experiences, jordan suggested that a matt finish dentures are more
acceptable to patients than a glossy surfaced/well polished dentures. In contrast to
Jordan’s recommendation, feintuch described a technique that after extractions, the
smoothly polished base tray was given to the patient to insert at home. After 2 weeks of
tolerating the toothless base tray, impressions are made. Subsequent appointments were
uneventful.
Krol had discussed the importance of freeway space (interocclusal distance) to the
gag reflex. He determined that the interocclusal distance was inadequate in more than 100
patients with serious gagging. Interocclusal distance was increased by dentures when the
discrepancy was gross. In all instances, an increase in the interocclusal distance restored
the gagging problem. In hypersensitive palate in prosthetic patient, bay combined a over
denture principle with a modification in the shape pf the denture base, soft reline material
was used to engage threaded post in the overlaid teeth. Additionally, the palatal section of
the upper denture remained open, bay claimed excellent retention, reduced bulk and
resolution of the patient-gagging problem.
Pharmacologic measures:-
When clinical and prosthodontic procedures are ineffective , a number of
pharmacological agents have been described as useful in controlling and limiting the
gagging reflex .The drugs used to control gagging may be classified as peripherally
acting or centrally acting drugs .
I) Peripherally acting dugs: -are topically and local anesthetics. They may be applied
in the form of spray, gels or lozenges or by injection. The effectiveness of these agents in
limited to use in those patients who demonstrate only a minor gagging problem. Success
in unlikely with the sever gaggers. The rationale for the use of these drugs is that if the
afferent impulses from sensitive oral tissues are eliminated, the reflex of gagging will not
take place. This procedure /approach may work well to help a gagging patient through a
particular procedure, such as radiograph or impressions .it must be recognized that the
use of these locally acting agents does not provide a long time solution.
Kavotas experienced success in making a maxillary impression by spraying the
entire palate with a topical anaesthetic lincoln injected 10 ml of 190 proof alcohol into
the soft tissue approximately 4mm distal to the lesser palatine foramen ,this causes a
slight sensation of fullness in the pharyngeal wall. The effect of the alcohol is reported to
wear off after a few months.
Appleby and day reported that common table salt can minimize the gag reflex. Salt is
placed on the tongue or in liberal amounts on the palatal region of the denture ,salt may
help gagging patients tolerate complete dentures.
II) Centrally acting drugs:-Centrally acting drugs which eliminate the gag reflex may be
categorized as antihistamines, sedatives and tranquilizer, parasymptholytics and central
nervous system depressants.
Saunder reported the use of intravenous Valium for the problem gaggers. Kramer and
braham recommended the intramuscular injection of jphenergan(wyeth lab’s
philedelphia) and nisentil (roche laboratories). The phenergan exerts a strong
antihistamine ,antisalivary and antiemetic effect. Nisentil provides a strong sedative
effect.
Only one clinical evaluation drug (tigan, beecham laboratories , bristol )as antigagging
agent was found in the dental literature. Prior research on this drug indicated successful
relief of nausea and vomiting in a number of conditions including pregnancy, motion
sickness and labyrinthitis.
Psycologic intervention:- some patient’s difficulty with gagging may be the result of
psychologic stimuli.
I) Hypnosis has been used as a tool to deal with the psychologic etiology of
gagging. Results are described as generally successful. One study states that a
patient (gagger) underwent nine hypnosis sessions before of the time involved,
hypnosis would not be considered a practical approach by many practioners of
patients.
II) Behavioral therapy /modification techniques have been used to treat and control a
variety of hysterical disorders including gagging.

ADDITION PPS TO EXISTING DENTRUE:-

Existing denture may have poor length and depth of PPS . Properly examine
existing denture. If there are other problems in denture viz (vertical dimension, centric,
esthetics etc..) . Then new denture is to be made. IF only PPS is short then correction
should be undertaken. Different authors using different materials have advised various
techniques,
1) Heat cure material:-
Frank r lauciello and salvatore.p.conti(1979) described the technique of correction of c.d
using heat cure material. It can be done where posterior extension is short /poot retention
with improper depth of PPS . Do border molding in PPS area using existing denture and
modify PPS with fluid wax technique. Then mix stone and fill the impression surface of
denture till the acrylic material excluding the border molded and PPS record wax surface.
Make 2 grooves and after it sets perform beading and boxing the cast with 1 st pour(with
separating medium applied) 2nd pour is done to get a full cast . Then remove border
molding material and trim denture border and provide a butt joint for new material.
Reseat the denture on cast and do waxing of new PPS area. During processing flask the
cast halfway only exposing the wax area for 2nd and 3rd pour. Later dewaxing and curing
with heat cure acrylic resin is preferred. Deflask trim and polish the processed denture.
Advantages
 No change in v.d , occlusion.
 Low residual MMA.
2) Self cure acrylic resin:-
mogdham and scmadertt:-18
Advised the use of fluid wax technique. All the steps outlined for locating
marking and placing the wax in the seal area are followed except that this time the wax is
placed on the processed denture base , after the wax has had an adequate chance to flow,
the denture is removed from the mouth. An inedible pencil is used to outline across the
palate, separating the posterior 2/3rd from the anterior region and extend around the
posterior portion of the denture stone is vibrated into the denture wax surface outlined by
the utility wax .After the stone has set the wax is eliminated and the denture cleared ,.The
denture base is ground distal to the anterior vibrating line that has been delineated by the
inedible pencil. care should be exercised not to perforate the polished surface , and a
separating medium is applied to the stone cast. The denture is then replaced on the stone
cast and held firmly with rubber bands, auto polymerizing acrylic powder is sprinkled
between the denture base and then cast while held on vibrator. Monomer is then added
drop wise. This is continued until the void has been completely filled., The cast and
denture are placed in an upright position until the initial set has taken place. They are
then placed in a pressure pot with water (140 0 f) for 20 mins under 30 psi pressure. After
the cast and denture are separated, the excess acrylic is trimmed and the border polished
lightly. If there is any question concerning the presence of free monomer that might
irritate the tissues, the denture should be scored in water for 24-36 hrs. A similar
technique using softened greenstick modeling compound has been suggested by caroll
and shaffer.
Izharul haque ansari(1994)4:-
Using existing denture record PPS using modeling compound and prepare a cast
using putty PVS material. Then cut 2 sprue channels connecting the PPS area. Remove
green stick compound and replace it using auto polymerizing resin.
Yuuji sato(2000)1:-
Earlier techniques used were-
 Using modeling compound
 Direct application of self cure resin on denture
 Use of light cure reline resin supplied as sheets to provide uniform thickness.
The author describes a technique of placing of PPS immediately:- adapt a small sheet
of base plate wax on posterior surface of denture and soften it and seat in mouth and
adapt it against palate to get adequate seal. Adjust the wax extension then adapt putty on
denture and wax in mouth.
Remove denture and putty core from mouth. Roughen the polished surface with
450 angle bevel towards polished surface. Apply adhesive as instructed by the
manufactures of direct relining resin. Reposition the silicone putty core on the denture
and add a low –irritating direct relining resin. And seat it in mouth and press the silicone
putty core lightly until relining resin polymerizes. After resin sets remove silicone putty
core from the denture. Finish and polish the denture.
Authors advice use of cross-linked reline resin, light polymerized reline resins and
dual polymerized reline resins. Care should be taken to completely remove wax from
denture to prevent de-bonding of cured resin

3) Light cure resin:-

aurthur nimmon.(1998)12 identify and mark the vibrating line in the mouth with an
inedible pencil, evaluate the posterior border of the denture in mouth for adequate
extension. Roughen the denture surface in the posterior palatal seal area with a carbide
bur. Apply monomer to the posterior palatal seal and allow the excess to evaporate.
Adapt VLC resin. Place the denture in the mouth and allow it to remain in place for
approximately 3 min. during this time the material will flow.
Position a hand held visible light source near the border of the denture and apply light
directly to the region for several minutes. Remove the air barrier coating (which has a
shiny appearances after curing) with a carbide bur and smooth the junction between the
seal and the polished surface of the denture. Place the denture in the mouth and evaluate
the corrected seal. Check the region with pressure-indicating paste to avoid over
correction.
4) Emergency repair of fractured denture: -
shyh-yuan lee, and steven.m.morgano(1995)3:-advices a technique for emergency repair
of broken denture carefully evaluate the patients denture for adaptation and join broken
pieces using cyanoacrylate cement., relive undercuts ,PPS and roughen the remaining
acrylic. Do border molding using modeling compound where ever borders are deficient .
Partial impression of repair area is made using the aligned denture with polysulfide
material. Do beading and boxing of impression made with denture in place polyether
impression material in undercut areas and rest of impression is poured using stone. Then
remove broken parts of denture and realign denture on cast. Transfer the PPS record from
patient to cast. Bevel the fractured area of denture and prime with bonding agent. Then
apply light cure denture base material on deficient areas, then paint triad air-barrier
coating on the repair sites. Process the denture with the cast for 4 min in light curing unit.
Carefully break the cast and retrieve denture safely and further cure it for 6 mins. Finally
do finishing and polishing.
Advantages:-
 No flasking is required.
 No lab services are required .
 No free MMA monomer.
Disadvantages:-
 Discoloration and low strength.
 Easily stain
 Cannot be used t repair large area of denture due to poor strength.

5) Addition of PPS to metal base complete denture:-

H.edward lyan(1989)9 :- the main disadvantage of metal base is difficulty in correcting
deficient margin , the main source of retention of acrylic to metal was by making holes
and slots .the retention an also be achieved by etching of metal to attain micromechanical
bond. After marking anterior and posterior vibrating line in patients transfer into metal
base. Then check for PPS using modeling plastic impress compound. Then etch the area
of metal base to which acrylic resin is to be attached for PPS. The areas of metal base
other than PPS should be protected from etchant using wax.
Etching can be done using:-
a) Spot chemical etching –acid gel for 10-2- min can be used for base metal alloy.
b) Chemical immersion etching technique / electrochemical etching technique (10%
H2S04 –300 MA , for 3 mins followed by cleaning in 18% HCL in ultrasonic vibrating
chamber10)
Then mix self cure acrylic and apply in layers using brush and seat in oral cavity till it
sets. It is also found that the micromechanical bond strength was above 16.70 Mpa and
3.5 times greater than retention using beads.
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