 Retention:

The ability of the denture to resist forces displacing the denture in the direction(s)
opposite to the path of insertion  away from tissues .

 Ability of the denture to resist dislodgment ( to stay inside patient mouth )

Forces like sticky food

or gravity ( in maxilla )
Path of insertion always toward tissues , perpendicular to supporting structures

 Support:

The ability of the denture to resist tissue-ward movement

 prevent sinking of denture toward tissues  resist movement of denture in same

direction of path of insertion

Like during biting forces ( occlusal forces )

 Stability:

The ability of the denture to resist dislodgment forces that are not parallel to the path of
insertion axis

 The ability of the denture to resist lateral (sideways movement) horizontal forces

 Maxilla have better support & retention & stability than mandible

1. Maxillary denture bearing area 24 cm2 < mandibular 14 cm2

 the palate in the maxilla more surface area  better support & retention
2. mandibular denture  heavy musculature and tongue movement less retention
& stability

 in the mandible we mainly depend on the undercuts of tissues  difficult to

achieve peripheral seal

 maxilla have better peripheral seal

 Introduction

 Dentures contact mucosa with a continuum of compressibility and movement that

varies between
 each arch,
 among areas within the arch
 and among patients.

Tissues under denture have different properties and different compressibility

So consider this during recording this tissue  and during denture construction
 Short-term and long-term health of the contacting tissues is influenced by
 the methods used to capture these tissues
 and the final adaptation of the denture bases in function

 Maximum extension of the denture base increases surface area and spreads the
“pressure” of mastication and tooth contacts during swallowing over a greater
surface area

 but we should keep this in harmony with surrounding structures

Why to maximized coverage??  to increase surface area  so decrease pressure

per unit area ( Pascal law )

 One can regard the intaglio surface of a denture as comprising two areas:

1. a stress-bearing (or supporting) area

it’s the resistance of the forces we apply it toward a specific structure (

provide support )

2. a peripheral (or limiting) area

the structure that determines the extension of the denture and provides
retention.
 Relief structure : the structures that cant withstand the occlusal forces  the
denture shouldn’t be in intimate contact with them otherwise it will
cause trauma

-------------------------------------------------------------------------------------

Supporting structures

(Denture bearing area/Denture foundation )

 so these area provide support for denture  prevent denture from moving toward them

( Standing on floor vs standing on spong )

 The foundation for dentures is made up of bone and covering soft tissues
 The denture base rests on the mucous membrane, which serves as a cushion between
the denture base and the supporting bone

Mucosa is sandwiched between denture and bone underneath  so we need to reduce

the stress on this mucosa  primary stress bearing areas??

 Primary stress-bearing areas generally have thicker mucosa and/or underlying bone
that is less subject to resorption because it is cortical bone
1. primary stress bearing area in maxilla :

a. horizontal portion of hard palate ( palatine process of maxilla & 2 palatine

bones )  on either sides of mid palatal raphe

 cortical bone underneath  minimal resorption after extraction

 flat ( forces will be perpendicular on it )
 lined with keratinized mucosa that is firmly attached to the bone  can
withstand pressure

b. The Firm Tuberosity on each side

firm ‫منستخدمها فقط اذا كانت‬

 Because some time we have fibrous tubrosity  have fibrous
tissues  not suitable for support

Firmness of tuberosity come from bone not mucosa

2. secondary stress bearing area :

a. Crest of the residual ridge although it has keratinized layer

 it consists of spongy bone ( cancellous bone )  undergo resorption (

after extraction & long time denture wearing )

 it is not a flat area

b. rugae area : part of hard palate supported by underlying cortical bone

 located on inclined surface ( not flat )

 & thin mucosa

----------------------------------------------------------------------------------------------------------------------------
 Mucous membrane

The mucous membrane is composed from

1. Mucosa:
 Stratified squamous epithelial cells
 Lamina propria

2. Submucosa:

 Connective tissue ➔Provides resiliency

So if we have thin submucosa  less resiliency  easily traumatize

 Varies in:
1. Character from dense to loose areolar tissue
2. Thickness

It contains
 glands,
 fat,
 muscle fibers,
  transmits the blood and nerve supply to the mucosa.

If the mucous membrane is attached to bone, the attachment occurs between the
submucosa and periosteal covering of bone.

So primary stress bearing area should have thick submucosa & keratinized  less traumatized

 The Mucosa : we have two types in the oral cavity:

1. Lining mucosa: covering cheeks and lips. Non Keratinized, thin and easily
traumatized.

2. Masticatory mucosa:

Mucosa covering the residual alveolar ridge and palate,

it’s attached to the underlying periosteum,

 When it is not attached denture instability can be a problem.

Keratinized  So for support we need masticatory mucosa

 Residual ridge mucosa

 Keratinized mucosa➔ Remaining gingival tissue ( so keratinized ) after extraction ➔

Excellent stress-bearing capacity
 The surgeon should pay attention to maintain all of this available gingival tissue
when closing the extraction sites

 On the crest of the ridge ➔ in a healthy mouth, it is firmly attached to the

periosteum of the bone by the connective tissue of the submucosa

If Greater bone resorption ➔ Loosely attached mucosa ( more lose connective

tissue ) ➔ Movable (displaceable) tissue ➔ Unfavourable denture situation! 
stability ??

 displaceablity is always bad even if minor

If Greater bone resorption ➔ Increase compressibility of the tissue ( thicker

submucosa with loose c.t ) ➔Unfavourable denture situation!  support ??

 We need some sort of compressibility but not too much

 Thicker submucosa is good but excessive thickness is bad and lead to

compressible or displaceable tissues
We see this tissues with advanced resoption ( older age , or very long time since extraction )

Compressible & displaceable tissues is not good for denture

When the submucosal layer is thin ➔ Soft tissues will be less resilient ➔ the mucous
membrane will be easily traumatized ➔ Relief

When the submucosal layer is loosely attached or inflamed ➔more displaceable and
compressible mucosa

As the mucous membrane extends from the crest along the slope of the residual
ridge to the vestibular reflection ( buccal & labial ) it loses its firm attachment to
the underlying bone.
  The more loosely attached mucous membrane in this region has a nonkeratinized
or slightly keratinized epithelium, and the submucosa contains loose connective
tissue and elastic fibers.

While the hard palate is all keratinized

 This tissue does not withstand the forces of mastication as well as the mucous
membrane covering the crest of the ridge

------------------------------------------------------------------------------------------------------------

Residual ridge

 Varies in size and shape between individuals

 U arch forms
 square arch forms
 V arch forms
 After teeth extraction, the width and height of the residual alveolar ridge change (
resoption ) ➔Greatest ( fastest ) in the first 6 to 12 months  but it continues at a
reduced rate throughout life.

‫ الى‬3 ‫اذا اجاك مريض خالع اسنانو حديثا الزم نستنى لبين ما تخلص فترة ذوبان العظم السريعة ( عاالقل منستنى من‬
‫ النو لو بلشنا مباشرة بعد الخلع او فترة قصيرة بعد الخلع وعملنا طقم بهاي الفترة‬... ‫ شهور ) بعدين منبلش نعمل طقم‬6
‫رح يكون في تغيير كبير بشكل العظم تحت الطقم بسبب الرزوبشن السريع و رح يبطل الطقم راكب كويس و رح نحتاج‬
‫وقتها نعمل طقم جديد‬

 The ridge crest is a secondary supporting area ( support )

 The lateral walls of the ridges ➔ Give stability against denture lateral displacement
and create the peripheral seal

 there are different patterns of resorption in maxilla and mandible and this depends on the
angulation of roots and alveolar process:
 maxillary roots directed palatally (lingually), resorption will be upward inward
(from the buccul and labial side toward the lingual side)  the maxilla become
smaller.

( The maxillary anterior alveolar ridge is proclined ➔ Resorption of the ridge creates
a smaller maxillary base ( resoption at crest and labially and buccally )

 importance of this info  when we construct denture we will set teeth labial and
buccal to residual ridge ( in their original position before resoption ) ‫تشرح الحقا‬

 Mandibular roots are directed facially,  resorption will be downward outward 

mandible become larger.

( The mandibular dentition is positioned significantly lingual to the basal bone of the
mandible ➔ Resorption creates a denture-bearing area that is in a more buccal
position with a flatter and wider mandibular base

 this progressive change of the edentulous maxilla and mandible makes many
patients appear prognathic (Like Class 3 malocclusion).

 Outward positioning of the mandible and inward positioning of the maxillae ➔

Jaw relationships appear prognathic
 Hard palate
1. The two palatine processes of the maxilla (anteriorly)
2. the palatine bone (posteriorly)

 form the foundation for the hard palate and provide considerable surface area and
support for the denture  Covered by keratinized epithelium of varying thickness

1. Horizontal portion

2. Medial palatal suture (11)➔submucosa is extremely thin➔mucosa is not resilient ➔

easily traumatized if compressed ➔ Relief
 On either sides of the raphe: 

 Anterolaterally ➔ Submucosa contains adipose tissue

 Posterolateral ➔ Submucosa contains salivary glands

The horizontal part provides the primary support area for the denture

3. Rugae area (13)

• Mucosal ridges on the anterior third of the palate

• Participate in speech and in suction in children

• Secondary support area why ??

 I. Palate is set at an angle to the residual ridge
II. Thin mucosa ( at depression areas )

4. Incisive papilla (12)

 Stable position after extraction  use it as reference point to guess original

position of teeth before resoption ( ‫) تشرح الحقا‬

 The submucosa covering the incisive papilla and the nasopalatine canal contains
the nasopalatine vessels and nerves  relief area

 Located at the line behind and between the central incisors

 It lies nearer to the crest of the ridge as resorption progresses  Gives indication
on the amount of resorption

 need Relief ➔ avoid impinging on the nasopalatine vasculature

 Tuberosities

 Dense fibrous connective tissues with minimal compressibility ➔Firm

( use them as primary support area only when firm if not compressed more than 1
mm )

 When no opposing teeth exist in the mandible ➔ hypertrophy ➔Interfere with

mandibular denture  The need for a surgical tuberosity reduction should always be
evaluated
 torus palatines

 Hard bony enlargement that occurs in the midline of the roof of the mouth
 Covered by a thin layer of mucous membrane that is easily traumatized by the denture
base  relief

 If the torus extends posteriorly to the vibrating line ( compromise retention )  it may
need to be surgically reduced in order to achieve a posterior palatal seal and adequate
denture retention
 -------------------------------------------------------------------------------------

Peripheral border tissue (Limiting structures)

The limiting structures of the upper denture can be divided into three areas:

1. the labial vestibule  which runs from one buccal frenum to the other on the labial
side of the ridge;

2. the right and left buccal vestibules  which extend from the buccal frenum to the
hamular notch

3. the vibrating line, which extends from one hamular notch to the other across the palate
 The mucosa of the vestibular spaces is classified as lining mucosa

 Labial vestibule (2)

 Runs from one buccal frenum to the other on the labial side of the ridge

 Divided into left and right vestibule by the labial frenum

 Covered with Lining Mucosa: Non-keratinized Thin mucosa.

Freely movable not attached to periosteum.

 Orbicularis Oris muscle forms the outer surface of the labial vestibule

 It receives support from the labial flange and the position of the anterior teeth

 Labial frenum

 Starts superiorly in a fan shape and converges as it descends to its terminal

attachment on the labial side of the ridge

 It contains no muscle and has no action of its own ➔ Moved by the Orbicularis
oris, zygomatic major and minor and the buccinator muscles ➔ Make space in the
denture border (flange) to accommodate the movements ( notch )
 SO the relief is thin and long relief ( I shape ) to achieve this we should have a
narrow and long labial notch in the denture

 Buccal Frenum (3)

 Forms the dividing line between the labial and buccal vestibules
 A single or double fold or even a broad -fan shape
 The orbicularis oris pulls the frenum forward, and the buccinator pulls it backward
➔Requires more (broad) relief
 Buccal vestibule (4)

 Lies opposite the tuberosity and extends from the buccal frenum to the hamular
notch

 Buccal vestibule size varies with:

1. Contraction of the buccinator muscle ( also horizontal )
2. Position of the mandible (Coronoid process)
3. Amount of bone lost from the maxilla

The size and shape of the distal end of the buccal flange of the denture must
be adjusted to the ramus and the coronoid process of the mandible and to
the masseter muscle

1. When the mandible opens or moves to the opposite side, the width of the
buccal vestibule is reduced.
 2. When the masseter muscle contracts under heavy closing pressures, it
reduces the size of the space available for the distal end of the buccal
flange.

 The extent of the buccal vestibule can be deceiving because the

coronoid process obscures it when the mouth is opened wide 
Therefore it should be examined with the mouth as nearly closed as
possible

 Distal to the buccal frenum and palpable superior to the vestibule is the root of the
zygoma, which is located opposite the first molar region ➔ May require relief when
resorption is extensive

 Hamular notch (8)

 forms the distal limit of the buccal vestibule

 Situated between the tuberosity and the hamulus of the medial pterygoid plate
 It can be palpated with a mouth mirror or T -shaped burnisher
  The mucous membrane of the hamular notch consists of a thick submucosa made
up of loose areolar tissue ➔ compressible ➔Achieve peripheral seal and retention

 The pterygomandibular raphe  covered by mucosa, extends from the hamulus

inferiorly into the retromolar pad of the mandible ➔Move forward when opening the
mouth ( decrease the width of the hamular notch ) ➔ Avoid denture overextension.
 Vibrating line  imaginary line

 Marks the junction between the movable and non -movable part of the soft palate

 Tissue anterior to this line is compressible ➔ Achieve peripheral seal and retention

 The vibrating line is more of an area ( not a line ) and is always on the soft palate

 Lateral border terminates through the hamular notches

 At the midline, it usually passes 1 to 2 mm anterior to the fovea palatinae

 The distal end of the denture should extend to the vibrating line
 Fovea palatinae

 Two small depressions on the posterior aspect of the soft palate

 Coalescence of mucus glands ducts

 Usually located 1-2mm posterior to the vibrating line ( denture so don’t cover fovea
palatinea )

 The distance from the vibrating line may vary but they are always posterior to it

----------------------------------------------------------------------------------------------
  Concept of relief

 Area on the fitting surface of the denture that is reduced ( make space in fitting
surface ) to eliminate pressure  Simply, provide more space between the denture
surface and the tissue  not touching that area

We do relief in

 any area that have nerve endings like incisive papilla

 areas that don’t have submucosa or have thin submucosa  easily traumatized

----------------------------------------------------------------------------------------------

Summery

1. To maximise the success of complete denture treatment, the requirements of

retention, support and stability should be fulfilled

2. Understanding the structure and function of the anatomical landmarks play an

important role in complete denture treatment success and health and disease of the
edentulous patient

3. Relate the anatomy to function and integrate this into the clinical and laboratory
practice