K.L.

E SOCIETY`S INSTITUTE OF DENTAL SCIENCES, BANGALORE

DEPARTMENT OF PROSTHODONTICS

SEMINAR TOPIC :
BIOLOGICAL CONSIDERATIONS IN MAXILLARY
IMPRESSION

PRESENTED BY:
Dr Drishti Nagi
Post graduate student
K.L.E SOCIETY`S INSTITUTE OF DENTAL SCIENCES, BANGALORE
DEPARTMENT OF PROSTHODONTICS

This is to certify that seminar was presented by Dr Drishti Nagi titled “

BIOLOGICAL CONSIDERATIONS IN MAXILLARY IMPRESSION ” on
30/10/2021.

Place: Bangalore Head of Department

Date: Dept. of Prosthodontic

 BIOLOGICAL CONSIDERATIONS IN MAXILLARY IMPRESSION
Introduction
• Complete dentures are artificial substitute for living tissues that
have been lost
• The dentures must replace the form of the living tissues as
closely as possible
• To construct a prosthesis , the dentist should have a
understanding of components, structure and qualities of tissues
that will support the proposed prosthesis
• For harmony between living structure and non living structure
to coexist for a reasonable time , dentist must understand the
macroscopic and microscopic anatomy of all the denture
bearing area
Macroscopic anatomy
• Denture Foundation : the oral anatomy available to support a
denture ( GPT9)
• Denture Supporting Structures : the tissues (teeth and/or
residual ridges) that serve as the foundation for removable
partial or complete dentures ( GPT 9 )
• Foundation – hard palate + residual ridge
• Mucous membrane - serves as a cushion

Mucous membrane :
Mucous Membrane – Mucosa + Submucosa
The submucosa is formed by CT that varies in character from dense
to loose areolar tissue and also varies in considerable in thickness
Submucosa – glandular , fat , muscle cells
Stratified squamous epithelium
Keratinised

Submucosa :
1. The thickness and consistency of sub mucosa are largely
responsible for support that the mucous membrane affords a
denture as submucosa makes most the bulk of mucous
membrane
2. In healthy pts, the submucosal layer is sufficiently thick to
provide resiliency for supporting complete dentures and that
bone covering the crest of the upper ridge is often compact . It
is firmly attached to the muco periostium to withstand pressure
of dentures
 3. When submucosal layer is thin or non existant – the soft tissues
will be non resilient and the mucous membrane will be easily
traumatised
4. When the submucsa layer is loosely attached to periosteum or
it is inflamed or edematous , tissues are easily displacable and
stabilty and support of dentures are adversely affected

MUCOSA

MASTICATORY LINING SPECIALISED

Masticatory mucosa
 Maxillary denture bearing

Support Limit Relief

Factors that influence the form and size of supporting bone include :
1. Its original size and consistency
2. Person’s general health
3. Severity and location of periodontal disease
4. Forces accruing from wearing of dental prosthesis
5. Surgery at the time of removal of teeth
6. Relative duration of edentulism
7. Anatomical features of denture bearing area

Primary stress bearing area :

1. Horizontal portion of hard palate
2. PL slopes of the residual alveolar ridges
Secondary stress bearing area :
1. Rugae
2. Maxillary tuberosity
3. Crest of the residual alveolar ridges

Hard palate :
The horizontal portion of the hard palate lateral to the midline acts
as the primary support area
Trabecular pattern in the bone

Keratinised mucosa
PL SLOPES : glandular tissues provide support - vertical forces
transmitted here
Crest of ridge :
• covered with thick fibrous connective tissue
• Its mucous membrane is firmly attached to the periosteum of
bone by connective tissue
• Stratified squamous epithelium is highly keratinized
• Submucosa contains dense collagenous fibers that are
contiguous with the lamina propria
Composed of Compact bone

Rugae :
• These are irregular mucosal folds located in the anterior 1/3 rd
region of the palatal mucosa radiating from median suture
 • They act as a secondary support area.-
Tuberosity :
• It is a bulbous extension of the residual ridge in the second and
third molar region.
• The posterior part of the ridge and the tuberosity areas are
considered as one of the most important areas of support
because they are least likely to resorb

Relief areas : incisive papilla

• It is a pad of fibrous connective tissue overlying the orifice of
the nasopalatine canal.
• Nasopalatine nerves & vessels exit to the palate at right angles
to the margins of this bony fossa
• Significance :Relief should be provided to avoid any pain or
soreness as compression may lead to obliteration of the lumen
and in turn lead to parasthesia in this region

Mid palatine raphe :

• It overlies the medial palatal suture; extend from the incisive
papilla to the distal end of the hard palate.
• Covered by thin or non existent submucosa
• Clinical Considerations: During final impression procedure this
raphe is relieved in order to create equilibrium between the
resilient and non-resilient tissues.
Torus palatinus :
• Hard bony enlargement that occurs in the midline of the roof of
the mouth.
• Hyperplastic overgrowth in midpalatine region
• Relief in the denture base is indicated for the less extensive
tori,& surgical removal for the more extensive

Fovea palatinae :
• The fovea is formed by coalescence of the ducts of several
mucous glands
• Foveae Palatinae : two small pits or depressions in the
posterior aspect of the palatal mucosa, one on each side of the
midline, near the attachment of the soft palate to the hard
palate

Cuspid eminence :
• It is a bony elevation on the residual alveolar ridge formed after
extraction of the canine.
• It is located between the canine and first premolar region

Sharp spines :
• Increased ridge resorption – sharp spine in between mucosa
and denture base – irritate the tissues
• The posterior palatal foramen often has a sharp spiny
overhanging edge that may irritate the covering tissues as a
result of pressure from the denture
 • Relief over this area may be required to prevent soreness of the
underlying tissues
Limiting structures :
• Labial frenum
• Labial vestibule
• Buccal frenum
• Buccal vestibule
• Hamular notch
• Posterior palatal seal area.

Labial frenum :
It is a fold of mucous membrane near midline, extends from the
mucosal lining of upper lip to the labial surface of the residual ridge
contains no muscle fibers and have no movements of it own
Significance :
Sufficient relief - cause pain and dislodgement of denture.

Labial vestibule :
Labial Vestibule : the portion of the oral cavity that is bounded on
one side by the teeth, gingiva, and alveolar ridge(in the edentulous
mouth, the residual ridge) and on the other by the lips anterior to
the buccal frenula (GPT9)
In the denture the area that fills this space is known as labial flange.
Significance : The reflection of the mucous membrane superiorly
determines the height of the vestibule.
Buccal frenum :
Fold of mucous membrane that extends from the buccal mucous
membrane reflection area toward the slope or crest of the residual
alveolar ridge
Clinical Consideration : sufficient relief should be given for the
movement of frenum because overriding of function of frenum will
cause pain and dislodgement of denture.

Buccal vestibule :
Buccal Vestibule : the portion of the oral cavity that is bounded on
one side by the teeth, gingiva, and alveolar ridge(in the edentulous
mouth, the residual ridge) and on the lateral side by the cheek
posterior to the buccal frenula
The area of the denture which will fill this space is known as buccal
flange.
The size of the buccal vestibule varies with the:
• Contraction of buccinator
• Position of the mandible
• Amount of bone loss in the maxilla

MOVEMENTS FOR BUCCAL FRENUM

Perfomed unilaterally
Passive : cheek is elevated and pulled outward , downward , inward
Active : patient is asked to pucker the lips and smile
MOVEMENTS FOR BUCCAL FLANGE :
Performed bilaterally
Passive : cheek is pulled outward downward inward
Active : patient is asked to open the mouth wide , close and move
the mandible from side to side
The coronomaxillary space: Literature review and anatomic
description
The coronomaxillary space is that anatomic region that lies medial to
the coronoid process and lateral to the maxillary tuberosity.
The coronomaxillary flange of the maxillary denture is that portion of
the buccal flange that extends from the zygomatic eminence to the
hamular notch

Hamular notch :
Pterygomaxillary Notch :the palpable notch formed by the junction
of the maxilla and the pterygoid hamulus of the sphenoid bone
Narrow cledt of loose CT of 2mm AP

Clinical Consideration: Denture should not extend beyond the

hamular notch, failure of which will result in: Restricted
pterygomandibular raphe movement.
Located by using T-burnisher/ with a mouth mirror where the edge
drops into a definite depression
Posterior Palatal Seal: that portion of the intaglio surface of a
maxillary removable complete denture, located at its posterior
border, which places pressure, within physiologic limits, on the
posterior palatal seal area of the soft palate; this seal ensures
intimate contact of the denture base to the soft palate and improves
retention of the denture;
Posterior Palatal Seal Area: the soft tissue area limited posteriorly by
the distal demarcation of the movable and nonmovable tissues of
the soft palate and anteriorly by the junction of the hard and soft
palates on which pressure, within physiologic limits, can be placed;
this seal can be applied by a removable complete denture to aid in its
retention
Functions of the posterior palatal seal :
• Aids in retention
• Reduces the tendency for gag reflex
• Prevents food accumulation
•  Partial vacuum is  activated beneath maxillary  denture
• Compensates for polymerization shrinkage.
Pterygomaxillary seal :
This is the part of the posterior palatal seal that extends across the
hamular notch and it extends3 to 4 mm anterolaterally to end in the
mucogingival junction on the posterior part of the maxillary ridge.
The posterior extent of the denture in this region should end in the
hamular notch and not extend over the hamular process as this can
lead to severe pain during denture wear

Postpalatal seal :
This is a part of the posterior palatal seal that extends between the
two maxillary tuberosities
Vibrating line :
An Imaginary line drawn across the palate extended from one
hamular notch to the other.it is not well defined as a line; therefore
it is better to describe it as an area rather than a line. The direction
of the line varies according to the shape of the palate in the denture.
The posterior border of the denture known as posterior palatal seal
area – GPT 9

The following points should be remembered while recording the

posterior palatal seal:
• The posterior border of the denture should not be placed over the
mid-palatine raphe or the posterior nasal spine.
• If there is a palatine torus, which extends posteriorly so that it
interferes with the posterior palatal seal, then the tori should be
removed.
• The position of the fovea palatinae also influences the position
of the posterior border of the denture. The denture can extend
1-2 mm across the fovea palatinae.
• If a mid-palatine fissure is present, then the posterior palatal
seal should extend in to it to obtain a good peripheral seal.
• In patients with thick ropy saliva, the fovea palatinae should be
left uncovered or else the thick saliva flowing between the
tissue and the denture can increase the hydrostatic pressure
and displace the denture
Anterior vibrating line :
• It is an imaginary line lying at the junction between the
immovable tissues over the hard palate and the slightly
movable tissues of the soft palate
 • It can be located by asking the patient to perform the
"Valsalva" maneuver.
• It can also be measured by asking the patient to say "ah“ in
short vigorous bursts.

Posterior vibrating line :

• It is an imaginary line located at the junction of the soft palate
that shows limited movement and the soft palate that shows
marked movement.
• It is recorded by asking the patient to say "ah" in short but
normal non-vigorous fashion. This line is usually straight

PPS constructed in reference to House classification of palatal

forms.

a. Class-I (5-13mm) large and normal in form with a immovable band

of tissue distal to a line drawn across distal edge of tuberosity.
b. Class-II (3-5mm)med sized normal in form , with a relatively
immovable resilient band distal to tuberosities
c. Class-III (less than 3 mm ) .curtain of tissue tissue turns about
abruptly 3-5 mm anterior to a line drawn across distal edge of
tuberosities ( accompanies a small maxilla )

conclusion
Unless the dentist has a thorough knowledge of the anatomy and
physiology of the supporting structures, complete dentures become
the product of a craftsman who employs only the knowledge of
physics and mechanic.
So the primary objective is to identify which anatomic structure :
Can take up load – support / stress bearing area
Cannot take up the load – relief
Also to correctely identify where the denture should extent in
periphery – limiting structure
References :
• Prosthodontic treatment for edentulous patients in complete
denture – Zarb Bolender – 12th ed
• Textbook of complete dentures – Rahn and Heartwell – 5th ed
• Prosthdontic Treatment for Edentulous Patients, Boucher,
• Complete denture prosthodontics – John Sharry 3rd ed
• Textbook of Prosthodontics – Deepak Nallaswamy – 2nd ed
• Anatomic landmarks in a maxillary and mandibular ridge - A
clinical perspective International Journal of Applied Dental
Sciences 2017; 3(2): 26-29 Mohd. Azeem et al
• Ahmed S, Das G, Rana MH, Reehana. Upper complete denture;
location of vibrating line with reference to fovea palatinae in
determining posterior border. Professional Med J 2018;
25(3):419-423
• J D M I M S U effect of type of soft palate and the antero-
posterior dimension of posterior palatal seal area Pisulkar et al
Vol. 8 No. 3, 2013
• Chen J-H, et al., Investigating the maxillary buccal vestibule,
Journal of Dental Sciences (2013)
• Kumar B, Naz A, Rashid H, Butt AM. Location of the Vibrating
Line with Respect to Fovea Palatini in Class I, Class II and Class
III Soft Palate Types. J Pak Dent Assoc 2016; 25(2): 59-64