BIOLOGIC CONSIDERATIONS

FOR MANDIBULAR
IMPRESSIONS

Presented by – Guided by –
Shivangi Bhatnagar Dr. Pankaj Dutta
Dr. Suprabha Rathi
 • Introduction
• Anatomical landmarks
• Bone of the basal seat
• Sequelae of teeth loss
CONTENTS • Macroscopic anatomy of Supporting
structures
• Macroscopic anatomy of limiting structures
• Retromylohyoid curtain
• Relief areas
• Microscopic anatomy of supporting
structures
• Microscopic anatomy of limiting structures.
 INTRODUCTION :

• The basal seat of the mandible is considerably different in size and form from the basal seat of
the maxilla.
• The nature of the supporting bone on the crest of the residual ridge usually differs between the
two jaws.
• The clinical incorporation of the “biologic principles of supporting and limiting structures will
enable the dentist to unravel what is sometimes called the “MYSTERY OF THE LOWER
DENTURE”.
• The denture bases must extend as far as possible without interefering in health or function of the
tissue, whose support is derived from bone.
• The support for a mandibular denture comes from the body of the mandible.
Total area of support for mandible Total area of support for maxilla is
is 14 cm2 24 cm2

This means that mandible is less capable of resisting occlusal forces than
the maxilla so extra care must be taken.
 ANATOMIC LANDMARKS

• “A recognizable anatomic structure used as a point of reference”

(GPT 8)

• In both maxilla and mandible anatomic landmarks have been divided into-
• 1.supporting structures
• 2.peripheral or limiting structures
• The consistency of the mucosa and the structure of the underlying bone is different in various
parts of edentulous ridge.
 ANATOMICAL LANDMARKS CAN BE
STUDIED UNDER :
• Supporting structures
• Limiting structures
• Relief areas
 STRUCTURES THAT WE WILL BE SEEING
INTO DETAIL ULTIMATELY DEPEND ON
WHAT ??

•Bone of the
basal seat
BONE OF THE BASAL SEAT Click icon to add picture
It varies considerably in patients.
In addition , important variations in the basl seat of a
mandibular denture include :
a) Stages of change in the mandible
b) mylohyoid ridge
c) mental foramen area resorption
d) Insufficient space between the mandible and the
tuberosity
e) Low mandibular ridges
f) Direction of ridge resorption
g) Torus mandibularis
STAGES OF CHANGE IN THE
MANDIBLE Click icon to add picture
Figure portrays the mandible at various stages of
development .
As the alveolar process is progressively lost , the
attaching structures converge and thus the supporting
surface of the denture becomes more and more limited.
 Click icon to add picture
MYLOHYOID RIDGE
Soft tissue usually hides the sharpness of the mylohyoid
ridge , which can be found by palpation.
Its shape and inclination varies greatly.
Note the various level of attachment of the mylohyoid muscle
as it extends posteriorly along the ridge from symphysis
mandibulae.
ANTERIORLY : close to the inferior border of mandible
PSTERIORLY : it may flush with the superior surface of
residual ridge.
 MENTAL FORAMEN AREA
RESORPTION
Click icon to add picture

Severe resorption results in compression of mandibular nerves

and blood vessels if relief is not provided in the denture base.
Pressure on the mental nerve can cause numbness of the lower
lip.
 INSUFFICIENT SPACE
Click icon to add picture
BETWEEN THE MANDIBLE
AND THE TUBEROSITY

Maxillary sinus enlarges throughout life if not restricted by

natural dentition or denture , thus moving the tuberosity
downwards.
Early loss of posterior teeth destroys the necessary
counterbalance against the muscle pull at the angle of the
mandible.
Such “straightening” of the mandible reduces the
maxillomandibular space in the posterior region that can lead
to denture failure.
 Click icon to add picture
LOW MANDIBULAR RIDGES

Frequently mandibular supporting area is depressed rather

than elevated because of difference in nature of resorption of
cortical and cancellous bone.

Lingually , d/t resorption the bone has shrunken down to the

level of the attachments of the structures in the floor of the
mandible.
This makes ADAPTATION OF LINGUAL FLANGE difficult.
 DIRECTION OF RIDGE
RESORPTION Click icon to add picture

Resorption of maxilla : upward and inward & becomes

progressively smaller .
It is d/t the direction and inclination of the roots of the teeth
and the alveolar process.

Resorption of mandible : resorption is outwards leading to

progressive widening.
That leads to “PSUEDOPROGNATHISM”
 TORUS MANDIBULARIS Click icon to add picture

It is the bony prominence usually found near the first and

second premolars , midway between the soft tissues of the
floor of the mouth and the crest of the alveolar process.
It varies in size from a peanut to hazelnut.

It is covered by extremely thin layer of mucous membrane

and so it may be irritated by even slight movements of the
denture base.
Hence , should be surgically removed if can’t be relieved
 WHAT HAPPENS
WHEN ALL TEETH
ARE LOST??
 SEQUELAE OF TOOTH LOSS
• When the teeth are removed from the mandible , the alveolar tooth sockets tends to fill with new
bone but the bone of alveolar mucosa start resorbing.
• This means that the bony foundation for a mandibular denture becomes shorter vertically &
narrower buccolingually.
• The bony crest of the residual ridge becomes narrower and sharper.
• The total width of the bony foundation becomes greater in molar region as resorption continues.
the reason is that the width of the inferior border of the mandible from side to side is greater
than the width at the alveolar process from side to side.
• The shrinkage of the alveolar process in the anterior region moves the residual bony ridge
lingually at first as resorption continues this foundation moves progressively further forward.
 With resorption of alveolar process occlusal contours of Click icon to add picture
residual ridges often develop that make them curved from a
low level anteriorly to a high level posteriorly.
These conditions cause severe problems in stability.
SUPPORTING STRUCTURES
• Residual alveolar ridge
• Buccal shelf area
 SUPPORTING STRUCTURES
• “Those areas of maxillary and mandibular edentulous ridges that are considered best suited to
carry the forces of mastication when dentures are in function”
(GPT-8)

• Dentures transfer occlusal load to these so called supporting structures.

• The ultimate support for a denture is provided by underlying bone which is covered by mucous
membrane. Support is provided for mandibular denture by mandible.
 MACROSCOPIC ANATOMY OF THE
SUPPORTING STRUCTURES

• Support of lower denture is provided by the mandible and the soft tissues overlying it.
• Some parts of the mandible are more favourable for this function than others and pressure must
be applied to the bone through soft tissues according to the ability of the tissues and different
parts of the bone to resist occlusal stresses.
 CREST OF RESIDUAL Click icon to add picture
RIDGES

It is mainly covered by fibrous connective

tissue but in many mouths it may be
cancellous and without a good cortical bone
plate covering it.
Fibrous connective tissue : favourable for
denture.
Cancellous bone : unfavourable condition.
 BUCCAL FLANGE AREA Click icon to add picture
AND THE BUCCAL SHELF

It is the area between the mandibular buccal frenum and

the anterior edge of the masseter is k/a buccal shelf or
buccal flange.
Boundaries : MEDIALLY : crest of residual ridge
ANTERIORLY : buccal frenum
LATERALLY : external oblique line
DISTALLY : retromolar pad
CINICAL RELEVANCE :It may be very wide and is at
right angles to vertical occlusal forces and hence offers
excellent resistance to these forces.
 Click icon to add picture
The inferior part of the buccinator is attached in the
BUCCAL SHELF of the mandible and thus the contraction
of this muscle do not lifts the lower denture.
The buccal shelf is the PRINCIPAL BEARING SURFACE of
mandibular denture and takes the load off the sharp narrow
crest of residual alveolar ridge.

The accuracy of the diagnosis and the skill with which the
impressions are made will determine the effectiveness of the
distribution of pressure to selected parts.
 LIMITING STRUCTURES
• The functional anatomy of mouth determines the extent of the basal surface of denture.
• The denture base should include the maximum surface possible within the limits of the health
and function of the tissues it covers and contacts i.e. it should cover all the available basal seat
tissues without interfering in action of any of the structures that contact or surround it.
 LIMITING STRUCTURES

• Labial frenum
• Labial vestibule
• Buccal frenum
• Buccal vestibule
• Lingual frenum
• Lingual flange
• Alveololingual sulcus
• Retromolar pads
• Residual alveolar ridge
 MACROSCOPIC ANATOMY OF LIMITING
STRUCTURES OF MANDIBLE

• Mandibular dentures should extend as far as possible within the health and function of the tissues
and structures that surround and support them.
• But it becomes difficult to apply in mandibular denture because structures on lingual side of the
mandible are difficult to control than those on buccal and labial surface
• The problem is the greater range of their movement and the speed of their actions.
 LABIAL FRENUM Click icon to add picture
• It is a fibrous band similar to that found in maxilla.
• The muscles INCISIVUS & ORBICULARIS INFLUENCE this
frenum.
• Unlike maxillary labial frenum , it is ACTIVE and sensitive due to
attachment of orbicularis oris muscle.
• The part of the denture that extends between labial and buccal
frenum is k/a “mandibular labial flange”.
• CLINICAL RELEVANCE : On opening wide , the sulcus gets
narrowed and hence impression will be narrowest in the anterior
labial region.
 Click icon to add picture
LABIAL VESTIBULE

• It occupies a potential space bounded by the labial

aspect of the residual alveolar ridge , the mucolabial
fold and the orbicularis oris muscle.
• CLINICAL RELEVANCE : the length and thickness
of the labial flange of the denture occupying this
space is crucial in influencing lip support and
retention.
 BUCCAL FRENUM Click icon to add picture
• It connects as a continuous band through the
modiolus at the corner of the mouth to the buccal
frenum in the maxilla.
• It overlies the DEPRESSOR ANGULI ORIS.
• These fibrous and muscular tissues pull actively
across the denture borders, polished surface and the
teeth.
• CLINICAL RELEVANCE : denture must extend
less / be relieved in this region and impression must
be functionally trimmed to have maximum seat.
 BUCCAL VESTIBULE
• It extends from buccal frenum posteriorly to the Click icon to add picture
outside back corner of the retromolar pad and from
the crest of the residual alveolar ridge to the cheek.
• Bunded by residual alveolar ridge on one side and
buccinator on other side.
• Space is influenced by ACTION OF MASSETER .
• CLINICAL RELEVANCE ::When masseter
contracts: it pushes inward against the buccinator ,
producing a bulge in the mouth. It is produced as a
notch in the denture flange k/a MASSETRIC
NOTCH.
 MASSETER MUSCLE REGION Click icon to add picture

The distobuccal borders or mandibular denture must converge

rapidly to avoid displacement because of contracting pressure
of masseter muscle whose anterior fibres pass outside
buccinator in these region.
When masseter contracts , it alters the size of distobuccal
end of the lower buccal vestibule.
It pushes inward against the buccinator muscle and suctorial
pad of the cheek.
 LINGUAL FRENUM Click icon to add picture
The height and width of the frenum varies considerably.
Relief should be provided in the anterior portion of the lingual
flange.

This anterior portion of lingual flange is k/a SUB-LINGUAL

CREST AREA.
CLINICAL RELEVANCE :
A high lingual frenum is k/a tongue tie should be corrected if
it affects the stability of the denture.
 LINGUAL FLANGE
Click icon to add picture
• The lingual flange f the denture occupies the
alveolingual sulcus.
• The distal extent of the lingual flange is partly
limited by the glossopalatine arch (glossopalatine
muscle+lingual extension of superior constrictor).
• CLINICAL RELEVANCE :
This extension maintains peripheral contacts and avoids
the disturbing action of the lateral borders of the tongue
upon the inferior termination of the lingual flange of the
denture.
 RETROMOLAR REGION AND
PAD Click icon to add picture
• The distal end of mandibular denture is bounded by the
anterior border of the ramus.
• Thus the denture includes the retromolar pad posteriorly.
• SICHER described it as triangular soft elevation of mucosa
that lies distal to the third molar.
• CLINICAL RELEVANCE :
• The retromolar pad must be covered(one half to two third)
by the denture to perfect the border seal in this region.
• The muscles attached to the region prevent the placement
of extra pressure during impression making.
 Click icon to add picture

Retromolar pad contains :

 glandular tissue
 Some fibres of temporalis tendon posteriorly
 Buccinator fibres which enter it from buccal
side(laterally)
 Fibres of superior pharyngeal constrictor
 Pterygomandibular raphe which enters from sup-post
inside corner(medially)
 Click icon to add picture
ALVEOLINGUAL SULCUS
It is the space between the residual ridge and the tongue.
It extends posteriorly from the lingual frenum to the
retromylohyoid curtain.
Part of it is available for the lingual flange of the denture.

It can be considered in three regions :

 The anterior region
 The middle region
 The posterior region
 THE ANTERIOR REGION

It extends from the lingual frenum to where the

mylohyoid ridge curves down below the level of the
sulcus / premylohyoid fossa.
The lingual border of the anterior region should extent
down to make definite contact with the mucous
membrane with the floor of the mouth when the tip of
the tongue touches the upper incisors.
 THE MIDDLE REGION

• This part extends from the premylohyoid fossa to the distal end of the mylohyoid
ridge , curving medially from the body of the mandible.
• The curvature is d/t the prominence of mylohyoid ridge.
• CLINICAL RELEVANCE :

This part of the lingual flange of the tray should be shaped inward , towards the
tongue . So , that
 The tongue rest over the flange stabilizing the denture.
 Provides space for raising the floor of the mouth without displacing the denture.
 The peripheral seal is maintained during function.
THE POSTERIOR REGION Click icon to add picture

This part is the retromylohyoid space or the fossa.

It extends from end of the mylohyoid ridge to the
retromylohyoid curtain.

Boundaries ; on lingual side : anterior tonsillar pillar

On buccal side : mylohyoid muscle . Mandibular ramus and
the retromolar pad.
Superior support : sup pharyngeal constrictor.
The action of muscles and the tongue determine the posterior
extend of lingual flange.
 RETROMYLOHYOID FOSSA
• It belongs to the posterior part of alveololingual sulcus.
• It lies posterior to the mylohyoid muscle.
• This fossa is bounded :
• Anteriorly : retro – mylohyoid curtain
• Posterolaterally : superior constrictor of the pharynx
• Posteromedially : platoglossus and lateral surface of the tongue
• Inferiorly : sub mandibular gland.
 RETROMYLOHYOID CURTAIN

• It forms the distal end of the alveololingual sulcus

• It is curtain formed by the mucous membrane in the oral cavity.
• It bounds the retromylohyoid fossa.
• it plays a very important role in success or failure of complete denture.
• It is rounded in shape and should be mimicked in the secondary impression tray as
well.
• LOCATION OF RETROMYLOHYOID CURTAIN :
• It is situated between the anterior pillar of fauces and
the pterygomandibular fold.
• The muscles which form retromylohyoid curtain are :
 Posterio laterally : superior constrictor muscle
 Posterio medially : platoglossus muscle and lateral
surface of tongue
 Inferiorly : mylohyoid muscle and submandibular
gland
• CLINICAL RELEVANCE OF RETROMYLOHYOID CURTAIN :

• It is a limiting structure in forming the lingual flange of mandibular denture

• It is pulled forward when the tongue is protruded out making it an important landmark to be
considered.
• The action of the medial pterygoid muscle helps in deciding the posterior border of the
denture near the retromylohyoid fossa.
• The posterior border of the denture should touch the retromylohyoid curtain when the tip of
the tongue is placed against the central part of the residual alveolar ridge.
 RELIEF AREAS

• Mylohyoid ridge
• Mental foramen
• Genial tubercles
• Torus mandibularis
 MYLOHYOID RIDGE

• It runs along the lingual surface of the mandible..

• Anteriorly it lies close to the inferior border of
mandible while posteriorly , it lies flush with the
residual ridge.
• The thin mucosa over the mylohyoid ridge may get
traumatized and should be relieved.
• The area under this area is an undercut.
 MENTAL FORAMEN

• It lies between first and second premolar region.

• Due to ridge resorption , it may lie close to the ridge.
• It should be relieved in such a case as pressure over it
produces paraesthesia.
 GENIAL TUBERCLES

• These are a part of bony tubercles found anteriorly on

the lingual side of the body of the mandible.
• Due to resorption , it may become increasingly
prominent making denture usage difficult.
 TORUS MANDIBULARIS

• It is an abnormal bony prominence found

bilaterally on the lingual side , near the
premolar region.
• It is covered by thin mucosa.
• It has to be relieved or surgically removed as
decided by its size and extent.
 MICROSCOPIC ANATOMY OF SUPPORTING
TISSUES
• CREST OF THE RESIDUAL RIDGE :
• It is covered by a keratinized layer and is firmly attached by its submucosa to the periosteum of
the mandible.
• However the attachment of the bone varies considerably.
• When the soft tissues are mobile they must be carefully registered.
• As the underlying bone is cancellous so is not favourable as the primary stress bearing area
 BUCCAL SHELF :
The mucous membrane covering the buccal shelf is
loosely attached and less keratinized with thicker
submucosal layer.
Fibres of buccinator can be seen running horizontally in
the submucosa.
The mucous membrane overlying the buccal shelf is
suitable to provide primary support for the lower
denture d/t nature of the bone(compact bone) and the
horizontal supporting surface.
MICROSCOPIC ANATOMY OF
LIMITING STRUCTURES

The epithelium is thin and non keratnized and

submucosa is formed by loosely arranged C/T fibres
mixed with elastic fibres.
Thus the mucous membrane is freely movable which
allows necessary movements of the lips , cheeks and the
tongue.