AnatomiAssistant Professor Akhlas Zeid Ataai

Complete Denture-3rd grade

Prosthetic Dental Department/College of Health and Medical
Technology
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22@Anatomical landmarks
Week 2
The anatomical landmarks in the maxilla are:

Limiting structures:
Labial frenum
Labial vestibule
Buccal frenum
Buccal vestibule
Hamular notch
Posterior palatal seal area

Supporting Structures:

Primary Stress Bearing Areas:-

• Hard palate
• Postero- lateral slopes of residual alveolar ridge.
Secondary Stress Bearing Areas:-
• Rugae
• Maxillary tuberosity
• Alveolar tubercle.
Relief areas:
• Incisive papilla
• Cuspid eminence
• Mid- palatine raphe
• Fovea palatina.

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 Support For The Maxillary Denture:
The ultimate support for the maxillary denture is the bone of the two
maxillae and the palatine bone. The palatine processes of the maxillae
are joined together at the midline in the median suture.

Residual Ridge:
The shape and size of the alveolar ridges change when the natural
teeth are removed. The alveoli become mere holes in the jawbone and
begin to fill up with new bone, but at the same time the bone around
the margins of the tooth sockets begin to shrink away. This shrinkage,
or resorption, is rapid at first, but it continues at a resorbed rate
throughout life.
Labial frenum
The maxillary labial frenum is a fold of mucous membrane at the
median line.
(No muscle attachment).
This band of tissue starts superiorly in a fan shape and converges as it
descends to its terminal attachment on the labial side of ridge.
Labial Vestibule:
This anterior region of maxillary basal seat extends from one buccal
frenum to the other on the labial side.
The major muscle in this area is ( orbicularis oris).
Three objectives are apparent:
The impression must supply sufficient support to the upper lip to
restore the relaxed contour.
The labial flange of the impression must have sufficient height to
reach the reflecting mucous membrane of the labial vestibular space.
There must be no interference of the labial flange with the action of
lip in function.
Buccal Frenum:
The buccal frenum is sometimes a single fold of mucous membrane,
sometimes double, and in some mouths, broad and fan shaped.
Associated muscles are:
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 • Buccinator
• Orbicularis oris
• Levator anguli oris

Buccal Vestibule:
The buccal vestibule extends from the buccal frenum to the hamular
notch.
It is influenced by the buccinator and the modiolus. And distally by
the coronoid process
Hamular Notch:
The hamular notch is a displaceable area about 2mm wide , between
the tuberosity of the maxilla and the hamulus of the pterygoid plate.
Vibrating Line Of The Palate:
This is an area at or distal to the junction of hard and soft palate
where movement occurs when patient says “ah”.
The area may also be identified by “Valsalva maneuver ” by asking
the patient to close his nose using his fingers and asking him to blow
gently through the nose .
Posterior vibrating line
That is 4-12mm or on an average is 8.2 mm dorsally to the hard and
soft palate junction. In most instances the denture should end 1 or
2mm posterior to the vibratory line.
Maxillary Tuberosity:
The maxillary tuberosities are the distal aspects of the posterior
ridges.

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 Anatomical land mark of mandibular arch

Limiting structures:
• Labial frenum
• Labial vestibule
• Buccal frenum
• Buccal vestibule
• Lingual frenum
• Alveololingual sulcus
• Retromolar pads
• Pterygomandibular raphe.
Supporting structures:
• Buccal shelf area
• Residual alveolar ridge
Relief areas:
• Crest of the residual alveolar ridge
• Mental foramen
• Genial tubercles
• Torus mandibularis.
Buccal shelf area
The area between the mandibular buccal frenum and the anterior
edge of the masseter is known as the buccal shelf.
It is bounded medially by the crest of the residual ridge ,
anteriorly by the buccal frenum , laterally by the external oblique
line and distally by retromolar pad.

The buccal shelf forms the primary support for the mandibular
denture as it is made primarily of cortical type of bone.
The buccal shelf area can range from 4-6 mm wide on an average
mandible to 2-3 mm or less in narrow mandible.
The buccal shelf is very wide and is at right angles to the vertical
forces of occlusion. For this reason it offers excellent resistance to
such forces.
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 Crest of the mandibular ridge
The crest is covered by the fibrous connective tissue, but in many
mouths the underlying bone is of cancellous type without a
cortical bony plate covering .
The fibrous connective tissue is favorable for resisting the
externally applied forces,such as the denture. However, with the
underlying cancellous bone this advantage is lost .
Labial Frenum:
This is single narrow band but may consist of 2 or more bands.
The activity of this area tends to be vertical so the labial notch on
the denture should be narrow.
Buccal Frenum:
This is usually in the area of 1st pre molar. The oral activities in
these area are horizontal as well as vertical (ex. Grinning and
puckering) thus needing wider clearance.
The contour of the denture will be little narrower in this area due
to the activity of depressor anguli oris muscle.
Labial Vestibule:
It is the sulcus between the buccal frenums.
The major muscle in this area is orbicularis oris whose fibers are
mainly horizontal thus overextension in this area should be
avoided.
Buccal Vestibule:
The buccal vestibule extends from the buccal frenum posteriorly
to the outside back corner of the retromolar pad and from the
crest of the residual alveolar ridge to the cheek.
Pear Shaped Pad:
The retromolar pad as described by Sicher is described as the
soft elevation of mucosa that lies distal to the third molar.
It contains loose connective tissue with an aggregation of mucous
glands and is bounded posteriorly by the temporalis tendon ,
laterally by the buccinator, and medially by the
pterygomandibular raphe and the superior constrictor.

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 Lingual Vestibule:
It can be divided into three areas
anterior vestibule/sublingual crescent area/ anterior sublingual
fold
the middle vestibule/ mylohyoid area
the distolingual vestibule/ lateral throat form/ retromylohyoid
fossa

Anterior lingual vestibule

This extends from the lingual frenum to where the mylohyoid
ridge curves down below the level of sulcus. Here a depression the
premylohyoid fossa can be palpated.
This is mainly influenced by the genioglossus muscle, lingual
frenum and some part by anterior portion of sublingual glands .

Middle vestibule:
This is the largest area and is mainly influenced by mylohyoid
muscles and somewhat by sublingual glands.
The mylohyoid muscle is the largest muscle in the floor of the
mouth whose principal function occurs during swallowing. Its
intra oral appearance is misleading because the membranous
attachment makes the muscle appear to be horizontal when
contracting.
Nagel and sears have shown that at maximum contraction the
fibers are still in a downward and forward direction so that a
denture can be extended below the muscle attachment along the
mylohyioid ridge.
The lingual borders in the mylohyoid areas are formed by contact
with the mylohyoid muscle in functional, but not extreme,
contracted or elevated positions.
The average mylohyoid border is 4-6 mm beyond the mylohyoid
ridge in fair to good ridge it is about 2-3 mm . If the ridge is flat it
is often advantageous to make mylohyoid border thicker (4-5mm
or more).
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 Distolingual vestibule:
The lateral throat form is bounded anteriorly by mylohyoid
muscle, laterally by pear shaped pad, posterolaterally by superior
constrictor, posteromedially by palatoglossus and medially by
tongue.
The so called “s” curve of the lingual flange of the mandibular
denture results from stronger intrinsic and extrinsic tongue
muscles, which usually place the retromylohyoid borders more
laterally and towards the retromylohyoid fossa, as the oppose
weaker superior constrictor muscle.

The posterior limit of the mandibular denture is determined

mainly by the palatoglossus muscle and somewhat by weaker
superior constrictor muscle this is area is called posterior/
retromylohyoid curtain.

Neil described this area and noted that the denture could have
three possible lengths, depending on the tonicity, activity, and
anatomic attachments of the adjacent structures-
Class III lateral throat form has minimum length and thickness.
The border usually ends 2-3 mm below the mylohyoid ridge or
sometimes just at the ridge.

Class I throat form: The horizontal border is usually 2-3 mm

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

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