REMOVABLE PROSTHODONTICS

SECTION EDITORS

LOUIS BLATTERFEIN S. HOWARD PAYNE GEORGE A. ZARB

Current concepts of lingual flange design

Bernard Levin, D.D.S., M-Ed.”
University of Southern California, School of Dentistry, Los Angeles, Calif

1 he correct design of the lingual flange of a the lingual space, (2) the various concepts of design-
complete denture continues to challenge the skill and ing the lingual flange, (3) patient selection, (4) a
imagination of the dental profession. Owing to technique for achieving an optimum lingual flange,
limited mobility of the muscles, frena, and membra- and (5) patient management and adjustments.
nous attachments, the buccal and labial flanges are
more easily managed. Unfortunately, the floor of the THE ANATOMY OF THE LINGUAL SPACE
mouth rises and falls like the tides of the sea, The anatomy of the lingual vestibule and border
lengthening and widening the protean lingual vesti- extensions has been described with great detail and
bule. accuracy by Edwards and Boucher,j Martone,” Bar-
Tilton,’ Fournet and Tuller,’ Tench,3 and others rett and Haines,? and others. Nevertheless, inade-
have described impression methods that emphasize quate lingual flanges are commonly observed. Lack
careful border molding and the development of a of awareness of the direction and force of muscle
border seal. Tilton’ wrote that border molding function and the true limits of the lingual vestibule,
“ . . . ends at a point where the border tissues seat the highly changeable nature of the denture space,
firmly, but lightly, against the denture periphery and the retention possible by muscular forces can
when the border tissues are in extreme function.” result in failure.
However, the border seal can be lost by an ingress of Figs. 1 and 2 show the most important anatomic
air between the denture and tissues when the Iloor of structures involved in developing the lingual border.
the mouth drops to a lower level. An ideal solution The genioglossus muscle is powerful and active and
would be to fabricate a denture with flanges that it is not possible to interfere with its movements.
lengthen and widen as the denture space changes. Fortunately, it is a rather narrow muscle. The largest
Krol’ described a technique that achieved this effect structure of the floor of the mouth is the mylohyoid
to a certain extent with the use of a flexible tube on muscle. The sublingual gland lies between the mylo-
the border of both maxillary and mandibular den- hyoid muscle and the base of the tongue. Nagle and
tures. He reported that the dentures were very Sear? and others have shown that when the mylo-
retentive but the flexible border broke down after 1 hyoid muscle contracts, the sublingual glands are
or 2 years. For the present, a lingual flange design is raised and all or most of the lingual vestibule is
needed that can be managed with current knowl- obliterated. The retromylohyoid fossa is bordered
edge, materials. and technology. anteriorly by the mylohyoid muscle, posterolaterally
It must be emphasized that a correct lingual by the superior constrictor muscle, and posterome-
flange in itself cannot ensure a successful result. dially by the palatoglossus muscle. The mylopharyn-
Tongue posture, character of the saliva, relation of gcw buccopharyngeus, and glossopharyngeous
the teeth to the ridges, occlusal plane, vertical parts of the superior constrictor muscle are thin and
dimension, occlusion, and the like form only a easily displaced. The palatoglossus muscle and the
partial list of the requirements for an acceptable anterior pillar of the fauces (not shown) move
denture. This article will review: (1) the anatomy of forward when the tongue is in protrusion and greatly
reduce the retromylohyoid space.h
Read before the Academy of Denture Prosthetics, Daytona Brach,
The styloglossus muscle is rather inferior and
Fla. medial in placement as related to the lingual flange.
*Professor, Department of Restorative Dentistry. The geniohyoid and hyoglossus muscles are medial

242 MARCH 1981 VOLUME 45 NUMBER 3 0022.39130X1/030242 + llt01.10/00 1981 The C. V. Mosby Co.
CURRENT CONCEPTS OF FLANGE DESIGN

SUBMANDIBULAR DUCT
SUI~MANDIB~LAR GLAND

GENIOGLOSSUS M.
BUCCINATOR M.

MYLOPHARYNGEUS PART.
IS. CONSTRICTOR M.) GENIOHYOID M.

PTERYGOMANDIBULAR

ALVEOLAR N.

PTERYGOID M.’ ’ BUCCOPHARYNGEUS PART.

P ( S. CONSTRICTOR M.)
a\
0c USC’80 STYLOGLOSSUS M.

Fig. 1. The anatomic structures associated with the lingual flange of a complete denture.

BUCCINATOR M.

GLAND

SUBMANDIBULAR
DUCT

MYLOHYOID M.
HYOGLOSSUS M.

LINGUAL N.

FACIAL ARTERY
SUBMANDIBULAR

LINGUAL ARTERY
HYPOGLOSSAL N.

HYOID BONE

0c USC’80 DIGASTRIC M.

Fig. 2. A cross section of the mandible and associated structures just distal to the first
molar.

to the lingual flange. The medial pterygoid muscle is identified. The submandibular (Wharton’s) duct can
a powerful and active elevator but usually is located be blocked by an overextended denture flange but
too far distally to affect the form of the lingual this is a rare phenomenon. It has occurred in two
flange. The lingual nerve is close to the sublingual patients treated by the author and resulted in
gland and apparently close to the denture flange, but backup of salivary secretions and large swellings
problems from denture irritation have not been under the mandibles.

THE JOURNAL OF PROSTHETIC DENTISTRY 243

 LEVIN

Fig. 3. The usual appearance of the lingual vestibule

when the mandibular residual ridge is highly resorbed.

Fig. 5. Top, The residual ridge and associated structures

give the appearance of very little lingual vestibular space.
Bottom, The lower denture with long flanges has been in
successful service for 6 years.

glands are ,prominent and may flow laterally onto

and over the ridge. The base of the tongue, in
contact with the retromylohyoid fossa and lateral
aspect of the retromolar pad, usually obliterates the
vestibule. It appears that the potential space for the
lingual flange is minimal or perhaps nonexistent
(Figs. 4 to 6). However, the great difference in the
appearance of the lingual denture space and the size
of the denture flange requires reevaluation of the
anatomic findings.
The high attachment, size, and activity of the
genioglossus muscle require a short border, but the
Fig. 4. The denture that was fabricated for the patient in outline of the anterior area can vary considerably
Fig. 3. Top, Note the length of the lingual flange. Bottom,
(Figs. 4 to 6). The largest area, influenced by the
Note the thickness of the border of the lingual flanges.
The denture has been in continuous service for 9 years. mylohyoid muscle and sublingual gland, can have
quite a long flange owing to the angle of attachment
and the displaceability of these structures (Figs. 6
When the mouth is opened wide, the appearance and 7). The small protuberances (Fig. 8), which
of a flat edentulous ridge can be very misleading and occasionally appear on the mylohyoid border,
very discouraging (Fig. 3). The floor of the mouth is reviewed by Simmonds and Jones,9 are related to
often slightly lower than the crest of the ridge, or anatomic apertures in the mylohyoid muscle. If
even at the same level or higher. The sublingual unilateral, usually no correction is needed; if bilater-

244 MARCH 1981 VOLUME 45 NUMBER 3

CURRENT CONCEPTS OF FLANGE DESIGN

Fig. 8. A denture with protuberances on the mylohyoid

border of the lingual flange.

Fig. 6. Top, The residual ridge and associated structures

give the appearance of a small lingual vestibular space.
Boffom, Note the size of the flanges on the lower denture,
which has been worn for 6 years.

Fig. 9. The lingual vestibule is palpated to determine the

tonicity and movement of the floor of the mouth.

variations and anomalies are such that the flange

length and width vary greatly. In general, most
lingual flanges are too short and narrow compared to
the potential vestibular space when the muscles are
in normal function.

CONCEPTS OF DESIGNING THE LINGUAL

FLANGE
The conventional methods of developing the lin-
gual borders have produced satisfactory dentures,‘-”
but the degree of retention and stability has been
Fig. 7. A denture with a long flange in the region of the dependent on the skill of the dentist. It is possible but
mylohyoid muscle. not probable that arbitrary movements and/or fin-
ger manipulations can capture all the nuances of
al, the necessary reduction is easily accomplished individual muscle function. Pendleton” has stated,
with pressure-indicating paste, usually without loss “There appears to be but one method to establish
of border seal. The muscles associated with the denture base outline scientifically, accurately and
retromylohyoid fossa seem to have modest force and adequately. This method is done by permitting the
activity, as the retromylohyoid flange is usually the tissues to establish their own associations by forming
longest flange (Figs. 4, 5, 7, and 8). The anatomic the impression material to their own individual

THE IOURNAL OF PROSTHETIC DENTISTRY 245

 LEVIN

Fig. 10. A mouth mirror is used to evaluate the displace- Fig. 12. The wax extensions indicate where the borders
ability and the vestibular space of the retromylohyoid of the lingual flange can be extended.
fossa.

Fig. 13. The soft wax may be used to determine potential

Fig. 11. A typical lower denture with thin and underex- advantages of sublingual extensions and/or wider
tended borders. borders.

functional requirements.” Procedures for obtaining cepts of anatomy must also include studies of the
“dynamic impressions ” have been described by Car- muscles which limit the denture space, including the
lile,” Schultz,‘” Shanahan,13 Chase,14 Trude et al.,‘j direction and range of action in which these muscles
and others. The use of tissue-conditioning material, function. The authors described how muscle forces,
as reported by Chase,‘” has been received favorably, mainly the tongue and buccinator muscle, are used
especially since the impression material has the to “fix” the mandibular denture.
added benefit of improving the oral mucosa. Retention from muscle activity can easily be
Another useful concept for improving the lingual incorporated when designing the width and form of
flange design is the incorporation of additions, made the lingual flange. The basic concepts of Fish’* were
possible by the study of the anatomy between the unique in their time and called attention to the
tongue and ridge. Lawson’” has described the anteri- polished surface of the denture. Besides the impres-
or sublingual fold space and suggests a procedure to sion of the basal seat, Fish recommended the adap-
thicken this area so seal is not lost when the tongue is tation of the movable muscular tissues of the lips,
relaxed. Brill, Tryde, and Cantor” have described cheeks, and tongue to the polished surfaces, the latter
the “lower denture space” and have explained its to be molded into a series of inclined planes. Each
importance and utility, especially in extensively inclined plane comes into contact with a muscle at
resorbed ridges. For this procedure, traditional con- an angle that pushes the denture into place (Fig. 2).

246 MARCH 1981 VOLUME 45 NUMBER 3

CURRENT CONCEPTS OF FLANGE DESIGN

Fig. 14. The lingual border of the preliminary impres- Fig. 16. Outline for the custom impression tray.
sion tray should be widened and often lengthened with
utility wax.

Fig. 17. The finger positions used when the lingual

Fig. 15. An acceptable preliminary impression. flange is border molded.

Brill et al.‘!’ have shown that the retention of a conventional denture is difficult enough but must be
mandibular denture by classic physical forces can be especially astute when the mouth presents difficulties
more than doubled by active muscle fixation. Thin and a “different” flange design is indicated.
denture borders are commonly used and are certain- Usually conventional denture design is preferred.
ly best when the ridge is normal, but do not provide Many patients have adequate ridges and respond
the patient with the best border seal if the ridge is well to conservative treatment. Some patients have
inadequate. Lott and Levin”’ have reviewed the poor ridges but extraordinary coordination. They
physical forces of denture retention and demon- can be called “oral acrobats,” as they can wear
strated the clinical advantages of thicker borders. anything, including someone else’s denture!
There is another type of patient who has inade-
PATIENT SELECTION quate dentures but is not having any apparent
Collett?’ has described the complexities of the difficulties. There is often a strong temptation to
denture patient and stated, “The patient may be improve the basal coverage and/or make other
motivated to adjust to his completed dentures or he changes. All too often, the neuromuscular mecha-
may be motivated to maladjust to them.” No matter nism rebels against these changes. Usually, it is best
what technique is used and no matter how skillfully to duplicate the previous denture or, at most, make
all the procedures are performed, failures will occur very conservative improvements. If the compromised
if motivational factors are negative and if interper- denture fails, the patient can be reevaluated for
sonal relations are inadequate. Patient selection for a alternate treatment.

THE JOURNAL OF PROSTHETIC DENTISTRY 247

 LEVIN

Fig. 18. An acceptable retromylohyoid border molding. Fig. 20. The completed border-molded tray must dis-
play adequate retention during moderate mouth openings
and tongue movements.

Fig. 19. Acceptable lingual border molding.

The usual candidate for the fully extended and Fig. 21. Often, rubber-base impression material is pre-
ferred owing to the lingual undercuts and the occasional
modified flange design is the patient who has an mylohyoid protuberances.
inadequate ridge and has not had success with one or
more conventional dentures. Patient education is
extremely important and the patient must under- great deal of variation in displaceability. The area of
stand and agree to the changes that will be made in displacement usually will be the least in the anterior
the new dentures. Models of ridges, large photo- region and will increase gradually, in a distal direc-
graphs, sample dentures, and any other types of tion. It is important to evaluate the prominence and
visual aids are important because verbal explana- sharpness of the mylohyoid ridge. Robert?” has
tions are difficult to present. It is imperative that the explained how a prominent mylohyoid ridge can
patient be informed that even though a special seriously interfere with developing a correct lingual
design is advisable, a return to a conventional flange and has described a relatively simple surgical
denture form is easily accomplished if difficulties are correction. A mouth mirror should be placed in the
encountered. Hirsch, Levin, and Tibe? have retromylohyoid fossa (Fig. 10) and the patient asked
reported the benefits of taking a “nonauthoritarian” to make some moderate tongue movements. The
approach to denture treatment. amount of vestibular space is often surprising.
The most important examination is the digital A useful diagnostic aid is the evaluation of the
one, as the visual inspection is very misleading (Figs. high and low positions of the floor of the mouth. The
3, 5, and 6). It is necessary to palpate the lingual patient who has the least movement has the best
vestibule (Fig. 9) and evaluate the tonicity and prognosis because it is easier to establish and main-
activity of the floor of the mouth. There is usually a tain a border seal. Patients with square jaws and

MARCH 1981 VOLUME 43 NUMBER 3

CURRENT CONCEPTS OF FLANGE DESIGN

Fig. 22. A generous amount of wax is added to the trial Fig. 23. The contouring of the polished surface of the
denture. flanges is complete when the wax ceases to flow and the
shiny wax surfaces indicate good tissue contact.

short, thick necks usually will have a hyoid bone that can be extended are easily observed (Fig. 12). The
moves very little during speech and swallowing. wax is chilled in cold water, the denture is reinserted,
Patients with tapering jaws and longer necks usually and the increase, no change, or decrease in retention
will have a hyoid bone that has much more move- is noted. The improvement is often surprising. If the
ment. An excellent diagnostic aid is to feel the floor improvement is minimal or the patient indicates a
of the mouth in function. The index finger should dislike for the longer borders, much knowledge has
touch the floor of the mouth at about the first molar been gained and little time has been lost. If the
region, with the maxillary denture in place. The digital examination discloses some potential sublin-
patient is asked to swallow. The finger also can be gual space, more wax may be added to create
placed further anteriorly and posteriorly so that favorable inclined planes. As before, hard swallow-
various regions can be evaluated for potential border ing and light tongue movements produce the best
length, width, and sublingual extensions. results (Fig. 13). If the wax additions improve the
A very efficient and sometimes dramatic proce- denture and the patient response is favorable, tem-
dure for exploring the possibilities of both border porary additions can be made with self-polymerizing
extensions and lingual contouring is the use of soft resin if further patient evaluation is necessary or a
wax. Bosworth synthetic occlusal plane wax* is new denture is planned.
convenient as it softens easily and adheres well to the
denture. The flow is easily controlled by the degree ACHIEVING AN OPTIMUM LINGUAL
of softening and the wax has enough body to extend FLANGE
borders and create favorable inclines. This method The dynamic impression concept”-‘j is often the
cannot be used if the denture borders are extremely method of choice for a highly resorbed ridge, but is
deficient. The procedure is to lightly flame a $uffi- most effective when used with transitional or com-
cient amount of wax to add an entire lingual border pleted dentures. Therefore, a practical impression
to the denture. Very often, the lingual flange is thin technique is necessary initially, and may even be
and underextended (Fig. 11). A sufficient amount of quite adequate for the final prosthesis.
wax is used so the lingual sulcus will be filled A correctly extended lingual flange js necessary for
completely. The patient is instructed to close, swal- an intact border seal. PrieskeY’ has explained the
low hard a few times, and lick the lower lip. If the need for selecting a preliminary impression tray that
denture is removed carefully, the wax will be dis- inclines medially in the lingual molar region so it
torted only a little, if at all. It may be necessary to does not interfere with the mylohyoid muscle.
trim away excess wax and repeat the procedure. The Among others, Caulk’s Rimlock edentulous trays*
wax borders are examined, and regions where they have correct anatomic contours, but the thin lingual

*Harry J. Bosworth Co., Chicago, IL. *L. D. Caulk Co., Milford. DE.

THE JOURNAL OF PROSTHETIC DENTISTRY 249

 LEVIN

border-molding procedures for the lingual flange are

always difficult. Many suitable border-molding
materials and techniques have been recommended,
but the choice should always depend on the dentist’s
experience and preferences.
The relatively easy to form buccal and labial
borders are completed first. I prefer to place the
border-molding material on the retromylohyoid
border, insert the tray, hold the tray firmly in place
with two fingers of one hand, and push the tongue
down and wriggle it from side to side with the index
finger of the other hand. Simultaneously, the patient
is asked to push and wriggle the tongue (Fig. 17).
The tongue does not leave the confines of the mouth
but all the muscles in the floor of the mouth are in
function. It is often necessary to trim away excess
material or add material if deficient. With practice,
the border molding can be done with relative ease
(Fig. 18). The 0pposit.e side is done separately.
The border-molding material is then added to the
remaining lingual region of the tray. The functional
movements are completed as described previously,
and usually satisfactory borders are achieved (Fig.
19). The genioglossus muscle and lingual frenum
require additional freedom so the border material is
softened in this limited area only and then molded
Fig. 24. The completed dentures. with the tongue in various protruded positions. At
this point, the border-molded tray must exhibit
borders should always be thickened and often border seal and should have adequate retention as
lengthened with red utility wax (Fig. 14). The wax the patient opens and makes moderate tongue move-
modifications are needed to displace the soft sublin- ments (Fig. 20). Inadequate retention will require
gual glands and to carry the impression material into reevaluation of the borders as the final impression
the entire space of the lingual vestibule. Heavy- material will rarely correct the deficiency. A 3 to 4
bodied irreversible hydrocolloid is an excellent mate- mm layer of softenecl Bosworth wax on the entire
rial, as its firm consistency will carry to the deepest lingual flange and the basic border-molding proce-
parts of all the vestibules, and moderate manipula- dure (Fig. 17) can identify any regions that may be
tions and tongue movements can produce rounded overextended or underextended. The choice of the
and correctly extended borders (Fig. 15). The subse- final impression material is not important, but
quent preliminary cast should display all the usual rubber-base impression material is sometimes desir-
anatomic landmarks, and the correct borders for a able owing to the undercuts in the retromylohyoid
custom impression tray can be outlined with ease fossa and the occasional mylohyoid protuberances
(Fig. 16). (Fig. 21).
Border molding with a custom tray is necessary to The trial-denture visit is critical as it is the most
provide coverage of the total bearing areas, to clear convenient time to institute corrective measures if
frena, to prevent muscle and attachment interfer- any deficiencies are observed. Accurately fitting
ence, and to obtain a border seal. The labial and baseplates are an absolute necessity. If the mandibu-
buccal borders rarely affect the border seal as the lips lar trial denture has poor retention and stability, a
and cheeks will drape on labial and buccal flanges relatively simple yet effective procedure has been
and create a facial seal. On the lingual flange, the described by Lott and Levin.Z” This technique
tongue will have a draping effect in some positions employs a soft wax to increase the width of the
but the lingual space changes greatly during func- borders, obtain horizontal extensions into the sublin-
tional movements. This is the major reason why the gual space, and create favorable inclines. The origi-

MARCH 1981 VOLUME 45 NUMBER 3

CURRENT CONCEPTS OF FLANGE DESIGN

nal wax is no longer manufactured but the Bosworth mended because of the probability of overreducing
wax is satisfactory. the borders. The patient is asked to close, swallow
A maximum amount of pink baseplate wax is hard, and lick the lower lip. The denture is removed
removed from the entire lingual and buccal flanges, carefully and regions of overextension will be evi-
with sufficient wax retained to maintain the teeth in dent. This procedure is repeated until all overexten-
position. A generous amount of softened (110” F) sions are eliminated.
Bosworth wax is added to the lingual flange and less Sometimes the patient will complain of tongue
to the buccal flange (Fig. 22). The wax is softened pain or discomfort. A layer of regular-bodied disclos-
further with an alcohol torch, using a brush flame, ing paste is placed on the entire polished surface of
and quickly inserted in the mouth. After a hard close the lingual flange. As before, the patient is asked to
and swallow, the same finger positions and tongue close, swallow hard, and lick the lower lip. The most
movements are used as described for the border- common finding is insufficient clearance for the
molding procedure (Fig. 18). The excess wax will genioglossus muscle and the lingual frenum. The
flow toward the teeth and is easily removed. The wax sublingual extension may be too high occlusally or
is resoftened with the alcohol torch and the proce- extended too far medially. All of these will be evident
dure is repeated one or two times. Also, the anterior in a correct paste record. Reductions should be done
wax is softened and the tongue is protruded as extra conservatively since the procedure is easily
clearance usually is needed for the genioglossus repeated.
muscle and lingual frenun. This procedure is com- The most difficult situation to manage involves
plete when the wax ceases to flow and the shiny the patient who does not have any irritations or
surfaces of the wax indicate good tissue contact (Fig. soreness but complains of the bulk. For this patient it
23). Improved retention and stability are nearly is very important to go over the entire concept of the
always evident and the finished dentures will be flange design, including the advantage of wider
associated with a more favorable prognosis. If no borders and longer extensions, and explain that
improvement is noted or if there is patient discom- modifications can be accomplished easily. It is
fort, the wax is easily reduced or removed. Fig. 24 important to reaffirm that the flanges can be
shows the completed dentures, which were very reduced to any size necessary for comfort, but there is
satisfactory in spite of the highly resorbed ridges and nearly always a concomitant loss in retention and
high attachments. stability. Initially, it is best to reduce all the polished
Similar procedures have been described by Trude surfaces of the lingual flange about 1 mm, but taking
et al.,‘” Bocage and Lehrhaupt,2” and Landes- care not to shorten the borders or change the
man.2” contours. This usually can be done twice without
losing most of the advantages of wider borders and
PATIENT MANAGEMENT AND inclined planes. These appointments should be
ADJUSTMENTS scheduled at least 1 or 2 weeks apart as physical and
The management of the correctly extended lin- psychologic adaptation is often a slow process. Many
gual flanges requires patience and skill as usually patients will respond favorably but some will contin-
adjustments are unavoidable. Tilton’ described his ue to complain of discomfort and will object to the
experiences when he attempted extensions into the length of the borders. Almost all patients will have
buccal and sublingual spaces. This resulted in an had thin and underextended borders for many years.
unplanned program of whittling until he was the Levin et al.,” reported a clinical experiment in
champion whittler of his state. Denture adjustments which 16 edentulous patients were given two dupli-
are much easier since the introduction of the disclos- cate mandibular dentures. One denture was correct-
ing pastes. ly extended and the other was grossly underex-
For border irritations, a heavier disclosing paste tended. The results were that 11 patients preferred
(e.g., Sorenson’s*) is preferred, as the regular paste the broad base, one preferred the minimum base,
will be wiped off upon insertion and removal. Each and four had no preference. In a continuation of this
side is done separately so that placement can be study, Levin* reported responses from a total of 34
made with the least amount of disturbance to the patients, with 25 patients preferring the broad base,
paste. Extreme lingual movements are not recom- four preferring the minimal base, and five with no

*Dental Profile Scale Co.: Fond Du Lac, WI *Unpublished report, 197 1.

THE JOURNAL OF PROSTHETIC DENTISTRY 251

 LEVIN

preference. It seems apparent that some patients will 7 Barrett, S. G., and Haines, R. W.: The structure of the
not or cannot adapt their neuromuscular mecha- mouth in the mandibular molar region and its relation to the
denture. J Paosrnm DENT 12:835, 1962.
nisms to larger dentures. For these patients, the
8 Nagle, R. J., and Sears, V. H.: Dental Prosthetics. St. Louis,
denture must be modified to be closer to or even 1958, The C. V. Mosby Co., pp 68, 99.
exact copies of the original dentures. These are the 9 Simmonds, C. R., and Jones, P. M.: A variation in complete
patient’s desires and needs and they should be mandibular impression form related to an anomaly of the
fulfilled.22 Fortunately, the initial conservative mylohyoid muscle. .J PROSTHETDENT 34:384, 1975.
10. Pendleton, E. C.: American Textbook of Prosthetic Dentist-
reduction usually is successful and the return to the
ry, ed 7. Philadelphia, 1942, Lea & Febiger, Publishers,
original border length is rare. p 121.
11. Carlile, E. F.: Functional adaptation of lower denture bases.
CONCLUSION J PROSTHETDENT 1:662, 1951.
The complexities of the troublesome lingual flange 12. Schultz, A. W.: Comfort and chewing efficiency in dentures.
J PROSTHETDENT 1:38, 1951.
can be unraveled by study and recognition of the
13. Shanahan, T. E. J.: Stabilizing lower dentures on unfavor-
dynamic nature of the denture space. Conventional able ridges. J PROSTHETDENT 12:420, 1962.
methods of obtaining lingual borders have not 14. Chase, W. W.: Tissue conditioning utilizing dynamic adap-
always proved satisfactory. Knowledge or regions tive stress. J PROSTHETDENT 11:804, 1961.
where the lingual flange can be extended can some- 15. Trude, G., Olsson, K., Jensen, S. A., Cantor, R., Tarsetano,
J. J., and Brill, N.: Dynamic impression methods. J PROS-
times lead to a more positive and retentive border
THET DENT 15:1023, 1965.
seal. When the ridge is highly resorbed, thicker 16. Lawson, W. A.: Influence of the sublingual fold on retention
lingual borders and incorporation of sublingual of complete lower dentures. J PROSTHET DENT 11:1038,
extensions apparently are advantageous. The use of 1961.
17. Brill, N., Tryde, G., and Cantor, R.: The dynamic nature of
muscle power on correctly contoured inclined planes
the lower denture space. J PROSTHETDENT 15:401, 1965.
will increase denture retention and stability. For 18. Fish, E. W.: Principles of Full Denture Prosthesis, ed 6.
patients who re.ject the “correctly” designed mandib- London, 1964, Staples Press, pp 36-37.
ular denture, it is necessary to modify, thin, or 19. Brill, N., Tryde, G., and Schubeler, S.: The role of extrocep-
shorten the flanges. The conscientious dentist should tors in denture retention. J PROSTHETDENT 9:761, 1959.
use all the current knowledge of lingual flange design 20. Lott, F., and Levin, B.: Flange technique: an anatomic and
physiologic approach to increased retention, function, com-
to improve the comfort and health of his patient.
fort, and appearance of dentures. J PROSTHET DENT 16:394,
I would like to thank McCormick Templeton, Ph.D., Associate 1966.
Professor, Division of Basic Sciences, Head of Anatomy Section, 21. Collett, H. A.: Motivation: A factor in denture treatment,
University of Southern California, School of Dentistry, for his J PROSTHETDENT 17:5, 1967.
help and assistance; and Mr. George Robbins, Dental Illustration 22. Hirsch, B., Levin, B., and Tiber, N.: Effect of dentist
Supervisor, University of Southern California, School of Dentist- authoritarianism on patient evaluation of dentures. J PROS-
ry. for his anatomy drawings. THET DENT 30:745, 1973.
23. Roberts, B. J.: Mylohyoid ridge reductions as an aid to
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