Applied anatomy:Mandiblular

denture bearing area

Convenor and guide

Prof Dr.Suraj R.B.Mathema
Dept of Prosthodontics &
Maxillofacial Prosthetics
Peoples Dental College &
Hospital

Dr.S.N.Thakur
1st year PG Resident
Department of
Prosthodontics &
Maxillofacial
Prosthetics
1

contents

Introduction
Development of mandible
Ossification of mandible
skeletal landmarks of mandible
Soft tissue attachment of mandible
Sequele of loss of teeth
Anatomy of mandibular denture bearing area
Anatomy of limiting structure and its significance
Anatomy of supporting structures and its significance
Anatomy of relieving structure and its significance
conclusion
Reference
2

Introduction
Largest and strongest bone of the face
with horse shoe shaped body which
lodges the teeth and a pair of rami
which projects upwards from the
posterior end of the body and provide
attachment to the muscle.

Development of
mandible

The mandible develops

intramembranously and its
subsequent growth is related to the
appearance of secondary cartilages
(the condylar cartilage being the
most important)

Meckels cartilage belonging to 1st brachial

arch appears at about the sixth week of
intra-uterine life.
Form the cartilaginous bar
proximal ends are connected with the ear capsules and forms the
malleus and incus
& the distal extremities are joined to one another at the
symphysis by mesodermal tissue.
They run forward immediately below the condyles and then,
bending downward, lie in a groove near the lower border of the
bone
in front of the canine tooth they incline upward to the symphysis

Ossification of
mandible

as a wedgeshaped nucleus
takes place in the membrane covering the outer surface of
ventral
end of
inthe
the
condyloid
Meckels cartilage
process and
extending
each half of the bone is formed from a single center which
appears, near
the
downward
through
mental foramen, about the sixth week of fetal life
the ramus;
By the tenth week, the portion of Meckels cartilage which
lies below
andalong
a small
strip
behind the incisor teeth is surrounded and invaded by the membrane bone

the anterior
border of the
later,accessory nuclei of cartilage make their appearance,
coronoid
process;

are invaded by the surrounding membrane bone and undergo

absorption.
smaller
nuclei

in
the front part of
both alveolar
The inner alveolar border is formed by an ingrowth from the main mass of the
walls and along
bone
the front of the
lower border of the
7
bone

 skeletal landmarks of
mandible

External surface

Incisive
fossa

Medial surface of mandible

Mandibular foramen
Mylohyoid ridge

Genial tubercles

10

Muscle attachment of
mandible

11

Outer surface of mandible

Masseter muscle
Buccinator
Temporalis
Mentalis
Depressor anguli oris
Depressor labi inferioris
Platysma
12

Inner surface of mandible

Medial pterygoid
Lateral pterygoid
Temporalis
Superior constrictor
Mylohyoid muscle
Genioglossus
Geniohyoid
Anterior belly of digastric
13

Sequele of loss of teeth

14

As resorption continues,
The width of inferior border of mandible
from side to side is greater than width of
totalmandible
width in
ofalveolar
bony process
foundation
from side to
mandibular basal side
seat becomes

The
and
greater in molar region

15

16

Anatomy of mandiblular denture

bearing area

17

Labial frenum
Labial vestibule.
Buccal frenum.
Buccal vestibule.
Retromolar pads.
Pterygomandibular
raphe
Lingual frenum.
Alveololingual
sulcus.

Buccal shelf
area
(Primary stress
bearing area)
Residual
alveolar
ridge(secondar
y stress
bearing area)

Crest of the
residual alveolar
ridge.
Mental foramen.
Genial tubercles
Torus
mandibularis.
18

Stress bearing areas in the mandible

19

Limiting structures
Mandibular dentures should be extended as far as
possible within limits of health and function of the
tissues and structures that support and surround them.
Labial frenum
Labial vestibule.
Buccal frenum.
Buccal vestibule.
Retromolar pads.
Alveololingual
sulcus.
Lingual frenum.
20

Labial Frenum
Contains band of fibrous connective tissue
that helps to attach the orbicularis oris
muscle.

Labial frenum

21

Histology
Thin non keratinized epithelium
Submucosa consist of loosly
arranged connective tissue fibres
mixed with elastic fibres

22

significance
The frenum is quite sensitive and active and
must be carefully fitted to maintain a seal
without causing soreness

The activity of this area tend to be

vertical so the labial notch in this area
narrow
23

Method of recording
impression
During the
impression procedure,the
lip has to be reflected
outward,upward and inward.

Labial notch

24

Labial vestibule:
Runs from labial frenum to buccal
frenum on both right and left side

25

Histology
The epithelium -thin and non
keratinized
submucosa -loosly arranged
connective tissue fibres mixed with
elastic fibres and muscle fibres

26

Significance
Mandibular labial vestibule region
has limited extension because the
fibres of orbicularis oris and
mentalis runs close to the crest of
the ridge

27

Significance contd.

As the fibres of orbicularis oris runs runs

horizontally, impression border in this
region should not be overextended .
because

28

Significance contd.
The mentalis
muscle originates from
mental tubercle with its muscle fibres
placed vertically and inserts into lower
lip(orbicularis oris).
When
the
lip
is
pulled
too
much
during
border
molding, the vestibule
becomes shallow as
the mentalis muscle
attachment is higher
then the base of labial
29

Method of recording
impression

For recording the depth of vestibule,

the patient is instructed to close
mouth slightly with lips relaxed and
then the lip is pulled lightly outwards

LABIAL FLANGE
30

BUCCAL FRENUM
Usually in the area of 1st pre molar.
may be single band or two or more bands

Buccinator-backward direction
depressor anguli oris-attached
beneath the frenum
Orbicularis oris-forward
direction
31

Significance
Oral activities in this area are
horizontal as well as vertical so wider
clerance is needed .
The contour of the denture is little
narower due to the activity of
depressor anguli oris.

32

Method of recording buccal frenum

The cheek is lifted
outward,
Upward
Inward

Then forward and backward

33

Buccal vestibule:
It 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

34

The extent of buccal vestibule

is influenced by

Buccinator muscle, which extends from

modiolus anteriorly to pterygomandibular
raphe posteriorly and has its lower fibres
attached to buccal shelf area and external
oblique ridge
orbicularis
oris,
buccinator,
levator anguli oris,
depressor anguli oris
zygomaticus major&minor,
risorius
,platysma.
36

Buccal shelf area:

Primary stress bearing area of
mandible

37

Significance
Buccal shelf area is covered with dense
cortical bone and is also a wide area lying
perpendicular to the direction of occlusal
force.
The denture should completely cover the
buccal shelf area despite of the fact that it
will rest directly on fibres of buccinator muscle

38

Outside the buccal shelf area, a bony ridge

runs anteroposteriorly which is called external
oblique ridge(used as a landmark for denture
border)

an anatomic guide for the lateral

termination of the buccal flange of
the mandibular denture.
39

40

Method of recording buccal

vestibule
The buccal vestibule is moulded
when the cheek is moved
Outward
Upward
inward

Buccal
flange

41

Effect of masseter muscle on the

distobuccal border
The distobuccal border , at the end of
buccal vestibule must converge
rapidly to avoid displacement by the
contracting masseter muscle whose
anterior fibres runs outside and
behind the buccinator muscle in this
region.

42

43

 Moderate activity will create a straight line

Active muscle will create concavity
An inactive muscle will create convexity

44

Method of recording impression

The patient is asked to exert a closing
force when the dentist exerts a downward
pressure on the tray

45

Retromolar pad
It is a triangular soft pad of tissue at the
distal end of lower denture bearing area.

46

It is consist of

Mucosa
thin non keratinized epithelium

Submucosa

BUCCINATOR
PTERYGOMANDIBULAR
RAPHE SUPERIOR
CONSTRICTOR
TENDON
OF
TEMPORALIS
47

Significance
The retromolar pad consist of fibrous
connective tissue in its anterior half and
soft tissue containing molar glands in its
posterior half

It provides the peripheral seal for the denture.

48

Height of occlusal plane

49

Therefore, summarizing the outline

of denture base in distal area
2/3rd from
anterior
border of
retromolar
pad

4-6 mm
below the
mylohyoid
ridge

1 mm
beyond
external
oblique
ridgs

50

LINGUAL
Lingual
frenum
BORDER
Alveololingual sulcus
Sublingual gland area

51

Lingual frenum:
It is the anterior attachment of tongue.
And is extermenly active and often wide

52

Significance
The denture should be completely
functionally trimmed so that
movement of lingual frenum will not
displace the denture or create
soreness here.
Tongue tie

53

Method of recording impression

After the tray is placed in the patients

mouth,

the patient is instructed to protrude

tongue

This creates functional movement of anterior

part of floor of mouth
including lingual
frenum and slope of lingual flange in molar
region and determines length of lingual flange

Push the tongue forcefully against the

front of the palate

This causes base of the tongue to flare out

and record the thickness of anterior part of
lingual flange
54

Alveololingual sulcus

Space between the residual ridge and tongue extends posteriorly from the retromylohyoid curtain to
the lingual frenum .

55

This can be considered in three regions

Anterior lingual sulcus also known as sub lingual crescent area or sublingual fold
Middle lingual sulcus also called the mylohyoid area
Distolingual sulcus also called as lateral throat form or retromylohyoid fossa

56

Anterior lingual sulcus

From lingual frenum to premylohyoid
eminence.

57

Significance
It is mainly influenced by
Genioglossus muscle
Lingual frenum
Anterior portion of sublingual gland

58

Genioglossus muscle
Originated from genial tubercles

genioglossus
geniohyoid

Main action of this muscle is to raise and

protrude the tongue
59

 Sometimes the lower ridge is highly

resorbed and the genial tubercle are
higher on the crest of the ridge resulting
in little or no vestibular space. In such
cases surgical sulcus deepening
procedure may be required
If surgery is not possible, it is best to try
to cover the genial tubercles because it is
not possible to have peripheral seal when
the denture border ends in hard tissue
60

 The width of the border is usually

2mm but may be narrower or wider
depending upon activity and tonicity
of genioglossus muscles and the
overlying lingual frenum

61

Method of recording impression

The lingual border of mpression in this
region should extend down to make
contact with the mucous membrane of
floor of the mouth when the tip of the
tongue touches upper incisors
The lingual flange will be shorter anteriorly
than posteriorly

62

Middle region of alveololingual sulcus

Extends from premylohyoid fossa to

distal end of mylohyoid ridge curveing
medially from the body of the
63
mandible.

This area is mainly affected by

mylohyoid muscle and to some
extent by posterior part of sublingual
gland

64

Mylohyoid muscle
It is the largest muscle in the floor of mouth
and principle function occurs during
swallowing
Origin:
Insertion:

65

Mylohyoi
d muscle

Diagram showing relationship of mylohyoid muscle

in various regions.
A` Cross section in canine region
B` Cross section in premolar region
C` Cross section in molar region
D` Cross section in 3rd molar region.
D Showing mylohyoid ridge approaching66the level of
crest of residual alveolar ridge

67

 This slope also

provides space for
the floor of the
mouth to be raised
during
function
without displacing
Peripheral seal also will bethe
maintained
lingual
lower denture
flange will be in contact with mucolingual fold
in the lingual sulcus
68

Cross section of mandible in the region of 3rd

molar. It is possible to place buccal flange on
buccinator muscle and lingual flange on
mylohyoid muscle

A. Tongue
B. Space into which
lingual flange of
denture is placed
under tongue away
from bony contour of
mandible
C. Epithelium
D. Mylohyoid muscle
E. Buccinator muscle
69
F. Mandibular canal

 The average mylohyoid border is around 46mm below mylohyoid ridge

Some patients have lower floor of mouth
and require longer flange to obtain
peripheral seal.
In fair to good ridge, the border width
should be about 2-3mm
If the ridge is flat, it is advantageous to
make thick mylohyoid border
70

Method of recording
impression

Patient is asked to protrude the

tongue
Activates mylohyoid
muscle(which raises floor of
mouth)
Determines length and slope of
lingual flange in molar area

71

Distolingual sulcus

an anatomic area in the alveololingual sulcus just

lingual to the retromolar pad and extends from
end of mylohyoid ridge to the retromylohyoid
72
curtain

Also known as lateral throat form

Boundaries
Anteriorly- mylohyoid
muscle
Laterally- pear shaped
pad
Posterolaterally-superior
constrictor muscle
Posteromediallypalatoglossus muscle
Medially- tongue
73

The denture border should be extended

posteriorly to contact the retromylohyoid
curtain when the tip of the tongue is
placed against the front part of the upper
residual ridge.

74

Neils classification of Lateral throat

form
The denture could have three
possible lengths, depending on the
tonicity, activity, and anatomic
attachments
of
the
adjacent
structures-

76

76

Examination of lateral throat form

77

Method of recording
impression
The extension of denture border can be
detremined by examining the tightness of
the fossa with a mouth mirror when the
patient is instructed to make moderate
tongue movements like touching the
maxillary anterior ridge with the tip of the
tongue

78

 Patient is asked to protrude the tongue

Activates
superior
constrictor
muscle

The patient is asked to close the mouth

as dentist applies downward force

Records effects of
contraction of medial
pterygoid muscle on
retromylohyoid curtain

Patient is asked to open mouth wide

A notch will be formed

at posteromedial
border of retromolar
pad indicating
encroachment of tray
on pterygomandibular
79
raphe

During border moulding, the border of the

impression is pushed into the retromylohyoid
fossa by strong intrinsic and extrinsic muscle of
tongue resulting in so called S shaped curve
as viewed from impression surface.

80

Sublingual gland region

The sublingual gland lies above the
mylohyoid muscle and is raised when
mylohyoid muscle contracts during
swallowing reducing the vertical
space available for extension of
flange in the anterior part of mouth.

81

82

The sublingual gland serves as

cushion, so it neither lifts the denture
nor causes the mucosa to be
traumatized by the denture

83

Applied anatomy of
tongue

84

In the normal position, the tongue

appears relaxed and completely fills
lower arch with its apex lightly
contacting the lingual surface of
lower teeth.
This is most
favourable position
for maintaining
the lingual border
seal, which will
enhance the
retention of the
denture
85

 The retruded position found in 25%

of general population, allows an
easier ingress of food and air under
the lingual borders and subsequent
loss of peripheral seal.
This tongue position is usually
accompanied by higher floor of
mouth due to more tension in all
associated lingual muscles

86

Some authors have used the following

procedure for retruded tongue position
and has proven successful in many
patients
A small training groove of 10mm long,

2mm wide and 2mm deep is made just

below the anterior central incisor.
The patient is instructed to place the
tongue on the groove all the times
except when eating and speaking
Most patients' learn to keep the tongue
on this correct position in a few weeks.
Afterwards, the groove can be filled with
auto polymerizing acrylic resins
87

Supporting structures
Residual alveolar
ridge
Buccal shelf area

88

 RESIDUAL ALVEOLAR RIDGE

Covered with fibrous connective
tissue and hence is capable of
resisting externally applied forceunderlying
bone is
cancellous
usually without
good cortical
plate covering
it

High rate of resorption when

excessive pressure is applied to this
area.
relief is required

89

Microscopic feature of lower

residual ridge
mucosa

submucosa

Spongy bone
90

BUCCAL SHELF AREA

area between mandibular buccal
frenum and anterior edge of masseter
muscle

It is bounded

laterally - external oblique line

medially or internally -slope of residual
ridge
anteriorly - buccal frenum

posteriorly - retro molar pad

91

Significance of buccal shelf area

The buccal shelf may be very wide and is
at right angles to vertical occlusal forces
Formed by smooth compact bone
Disposition is in horizontal pattern
The inferior part of buccinator is attached
to buccal shelf of mandible and thus
contraction of muscles does lift the lower
denture.

92

 The buccal shelf is the primary stress

bearing area.
The bone of buccal shelf is very
dense because the resultant forces of
elevator muscles are directed to this
area and trabeculation is arranged
perpendicular to occlusal forces.

93

Histologic drawing of Buccal shelf

area.
The bone of the buccal
shelf may is covered by a
layer of compact bone
composed of haversian
systems.
Fibers of buccinator run
horizontally in submucosa
immediately overlying the
bone.
The mucous membrane is
more loosely attached and
less keratinized.
It contains thick submucos
layer.
94

Relief areas
The relief areas have following
features
have fragile structures within
covered by thin mucosa
bcan be easily traumatized.
95

MYLOHYOID RIDGE
Mylohyoid ridge running along
the lingual surface of the
mandible anteriorly lies close to
the inferior border of the
mandible while posteriorly it lies
close to the ridge.

Thin mucosa over the mylohyoid

96

Mental foramen
The anterior exit of mandibular
canal and inferior alveolar nerve.

97

 In cases of severe residual ridge

resorption, the foramen occupies a
more superior position and the denture
base must be relieved to prevent nerve
compression and pain.

Pressure on the mental nerve can

cause numbness of the lower lip.

98

Torus Mandibularis:
It is the bony prominence usually found in the
region of premolars.

Covered by extremely
thin layer of mucous
membrane and so may
be irritated by slight
movement of denture
base.

It should be removed
surgically if relief cannot
be provided.

99

Genial tubercles:

These are a pair 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.
100

Conclusion
Mandible is in the process of
constant change throughout our
lifetime. Sound knowledge of its
structure, pathologies and
abnormalities associated aids not
only in proper diagnosis and
treatment planning of any disease
or abnormality associated with it,
but also to execute the required
treatment in a better manner.
101

Refrences
BOUCHERS prosthodontic treatment for edentulous
patients: 9th edition.
Clinical dental prosthetics.
HRB FENN, KP LIDDELOW, AP GIMSON
Essentials of complete denture prosthodontics
SHELDON WINKLER
2ND EDITION
Principles & practices of complete dentures by iawa
hayakwa
Impression for complete dentures Bernard Levin
Comparative evaluation of the lateral throat form and the
border
extension of mandibular complete denture in the
distolingual
region among the south coastal karnataka population: an in
vivo study by parajuli PK1, shetty TB2, shenoy VK3,
rodrigues SJ4
Impression for complete dentures: Bernard Levin
102

THANK YOU
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