REMOVABLE PROSTHODONTICS

SECTION EDITORS
LOUIS BLATTERFEIN S. HOWARD PAYNE

A contemporary review of the factors involved in

complete dentures. Part III: Support
T. E. Jacobson, D.D.S.,* and A. J. Krol, D.D.S.**
University of California, School of Dentistry, San Francisco, Calif., and Veterans Administration Medical Center.
San Francisco, Calif.

C omplete denture support is the resistance to verti-

cal movement of the denture base toward the ridge. It
tively loaded during function, (3) those tissues most
capable of resisting vertical displacement are allowed to
counteracts those forces directed toward the ridge at make firm contact with the denture base during
right angles to the occlusal surfaces. Support involves a function, and (4) compensation is made for the varying
consideration of the relationship between the intaglio of tissue resiliency to provide for uniform denture base
the denture base and the underlying tissue surface movement under function and maintain a harmonious
under varying degrees and types of function. This occlusal relationship.
relationship must be developed so as to maintain the Most prosthodontic texts agree that maximal border
established occlusal relations and to promote optimal extension is essential in providing denture support.
function with a minimum of tissueward movement and Many techniques documented in the literature describe
base settling. border molding procedures designed to determine the
location of the denture border and its relationship to
TYPES OF SUPPORT the peripheral tissues, thereby gaining optimal exten-
Support may be considered from two points of view. sion.“” Most require that the denture be extended to
First, the maxillary and mandibular dentures should make positive contact with the soft, yielding peripheral
conform to the underlying tissues so that the occlusal tissues as limited by muscle function and bony or
surfaces can correctly oppose one another at the time of tendinous anatomic structures. The basic “snowshoe
insertion. Bilateral simultaneous contact should exist principle” of maximal extension is that given a con-
both at initial closure and under functional loading. stant occlusal force, a broader denture-bearing area
Second, the denture bases should maintain this rela- decreases the stress per unit area under the denture
tionship for a period of time. This property indicates base, decreases tissue displacement, and reduces den-
the need for consideration of denture support in terms ture-base movement.
of longevity. Without long-term support complete
denture retention and stability also become compro- NATURE OF SUPPORTING TISSUES
mised. Having determined the outline form of the total
Initial denture support is achieved by using impres- denture-bearing area, one must study the nature of the
sion procedures that provide optimal extension and supporting tissues contained within the borders. Sever-
functional loading of the supporting tissues, which vary al factors govern the selection of those tissues best
in their resiliency. Long-term support is obtained by suited to provide support. Ideally, the soft tissues
directing the forces of occlusal loading toward those should be firmly bound to underlying cortical bone,
tissues most resistant to remodeling and resorptive contain a resilient layer of submucosa, and be covered
changes. by keratinized mucosa. The underlying bone should be
Effective support is realized when (1) the denture is resistant to pressure-induced remodeling. These char-
extended to cover a maximal surface area without acteristics minimize base movement, decrease soft tis-
impinging on movable or friable tissues, (2) those sue trauma, and reduce long-term resorptive changes.
tissues most capable of resisting resorption are selec-
SOFT TISSUES
Supporting soft tissues must be capable of with-
*Assistant Clinical Professor, Removable Prosthodontics standing the pressures induced through normal func-
**Chief of Dental Services, Removable Prosthodontics. tion of the prosthesis. The presence of keratinized,

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COMPLETE DENTURE SUPPORT

firmly bound mucosa permits the tissues to better resist

stress. Keratin is a scleroprotein present in the stratum
corneum and is the end product of epithelial degenera-
tion, which protects the vital underlying epithelial
layers.12 Generally, nonkeratinized alveolar mucosa is
not well adapted to tolerate the functionally generated
stresses of a denture base. Excessive trauma to the
mucosa beneath a denture base can lead to abnormal
tissue changes such as the development of parakeratin,
localized hyperkeratosis, and epithelial ulceration or
necrosis.
The presence of a layer of resilient submucosa
permits moderate compressibility without mechanical
impingement of the mucosa between the denture base
and underlying bone. The fatty and glandular submu-
cosa acts as a “hydraulic cushion” similar to the palm
of the hand as described by Orban.” Some parts of the
masticatory mucosa are without a distinct submucous
layer, yet dense connective tissue of the lamina propria Fig. 1. A and B, Both of these patients had worn
firmly binds the mucosa to underlying periosteum. complete dentures for over 30 years. Difference in
Although not as effective in providing resiliency, this resorption of mandibles may indicate individual vari-
ations in bone index.
connective tissue layer serves as a protective base for
the mucosa. The connective tissue bands firmly bind
the masticatory mucosal covering of the edentulous not completely understood. The potential for resorption
ridges. Those regions, which possessa thin and/or less of the residual ridges varies between patients (Fig. 1).
keratinized mucosa over bone without an intervening There seem to be some characteristics within the
layer of submucosa, should be relieved or recorded biologic makeup of the individual that determine the
without displacement. This eliminates impingement of relative resistance of bone to resorption. This intrinsic
soft tissues between the denture base and bony founda- bone factor is described by Glickman,‘” Krol,” and
tion during occlusal loading, thereby minimizing soft others20and is unique to each individual. At the present
tissue trauma and reducing pressure-induced bony time, bone factor can be determined only by studying
remodeling. the previous response of the patient’s bone to stress.
Such stress may be in the form of extractions, surgical
HARD TISSUES trauma, or forces generated by a functionfng prosthesis.
Another requirement of ideal support is the presence Usually, radiographic observation of previous denture-
of tissues that are relatively resistant to remodeling and induced bone loss provides the only indication of the
resorptive changes. The problems associated with ridge patient’s intrinsic bone factor.
resorption have been studied extensively by TallgrerP Although all bone responds to forces by remodeling
and others.‘,‘5.‘7 The rate and amount of bone loss and as described by Wolff s law, it is interesting to note that
remodeling that occur in the anterior maxillae and the supporting alveolar bone may differ m its response
mandible are of serious concern in prosthodontics. to stress as compared to basal residual ridge bone. The
Although overdentures can greatly reduce such bone response of bone to stress varies according to anatomic
loss, consideration must be given to the maintenance of location. Thus, bone factor appears to he related to
alveolar ridge height in the conventional complete local anatomic and physiologic variations within and
denture patient. Minimizing the pressures in those between individuals (Fig. 2).
regions most susceptible and directing the forces The generally accepted pressure-tension concept
toward those regions relatively resistant to resorption appears to play an important role in the destruction or
can help to maintain healthy residual ridges. preservation of the bone of the residual ridges. This
concept holds that pressure stimulates resorption
BONE FACTOR whereas tension maintains the integrity or actually
Much remains to be researched in the field of bone causes deposition of bone. Tension placed on bone,
physiology. The response of bone to external forces is such as that observed in the area of musclr attachment,

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 JACOBSON AND KROL

Retromolor pod with glands 1

Fig. 2. This patient wore a mandibular overdenture

several years. Note that marked resorption is limited
to regions of basal bone and that alveolar bone
remains at a favorable height adjacent to remaining
teeth.

Fig. 4. Notice anatomic demarcation between struc-

tures that ultimately form pear-shaped pad and retro-
Fig. 3. Edentulous mandible demonstrates that even molar pad of edentulous mandibular ridges. Glandular
following severe resorption, the genial tubercles retromolar pad is posterior to pear-shaped pad, which
remain relatively unchanged. is formed by scar tissue of extraction site of mandibu-
lar third molar fusing with retromolar papilla. (From
Sicher, H., and DuBrul, E. L.: Oral Anatomy, ed 6. St.
Louis, 1975, The C. V. Mosby Co.)
tends to preserve the quality of the bone and sometimes
results in bone deposition. There is no physiologic
mechanism whereby a complete denture can transmit bone through a variable zone of connective tissue and
tension to bone; therefore, most forces applied beneath submucosa with associated muscle attachments that
dentures result in pressure and subsequent resorptive provides the ideal denture-bearing tissue.
changes. One of the objectives of the prosthodontist is to
minimize and control the rate of these changes. ANATOMIC CONSIDERATIONS OF
Cortical bone is more resistant to resorption than DENTURE-BEARING AREA
cancellous or medullary bone. Use of cortical bone in As Edwards and Boucher” noted: “Since the success
support of complete dentures permits the prosthesis to of complete dentures depends largely on the relation of
maintain its recorded relationship to the edentulous the dentures to anatomic structures which support and
ridge over a longer period of time. Regions of muscle limit them, familiarity with the location and character
fiber and tendinous attachments to cortical plate of these structures is essential.” Based on clinical and
through Sharpey’s fibers ensure tension on bone. This histologic impressions, the dentist can categorize the
tension minimizes the resorptive changes that would denture-bearing tissues into primary and secondary
otherwise be the normal response of bone to pressure. support and recognize tissues that require relief to
A classic example of muscle attachment enhancing the minimize pressure.
resistance to remodeling is often seen in severely
atrophied mandibular edentulous ridges. These mandi- MANDIBULAR ANATOMIC
bles exhibit prominent mylohyoid ridges, genial tuber- CONSIDERATIONS
cles, and mental protuberances (Fig. 3). Such regions The primary stress-bearing regions on the mandible
remain remarkably unchanged as a result of associated must include the pear-shaped pad and the buccal shelf.
muscle attachments. It is, therefore, a keratinized The pear-shaped pad is the most distal extent of the
masticatory mucosa firmly bound to underlying cortical keratinized masticatory mucosa of the mandibular

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COMPLETE DENTURE SUPPORT

ridge and is formed by the scarring pattern of the

extracted third molar and its retromolar papilla (Fig.
4). The term was first coined by Craddock*’ to differ-
entiate it from the more distal retromolar pad, which is
composed of alveolar mucosa overlying glandular and
loose alveolar connective tissue. Clinicians must recog-
nize the differences between the pear-shaped pad and
the retromolar pad based on anatomic location and
histologic composition. Frequently, the entire area of
the distal ridge crest is referred to as retromoloar pad.
This leads to confusion in determining the mandibular
denture extension.
The retromolar pad is not a favorable denture-
bearing area. The junction of the pear-shaped and
retromolar pad demarcates the distal border of a
properly extended mandibular complete denture.
The pear-shaped pad area is associated with muscle
and/or tendinous attachments of the buccinator, supe-
rior constrictor, and temporal muscles. The deep and
superficial tendons of the temporal muscles insert
medially and laterally in the mandible at the posterior
border of the pear-shaped pad. Such muscle attach-
ments and the overlying, firmly bound masticatory
mucosa provide a stress-bearing region that is relatively
resistant to resorptive changes. If the mandibular
denture is short of this region, there will be more rapid
resorption of the distal alveolar ridge and a resulting
Fig. 5. A, Underextension of mandibular partial den-
settling of the denture base posteriorly (Fig. 5). ture short of pear-shaped pad contributed to marked
Many authors recognize the importance of the resorption of residual ridge area, which was covered
buccal shelf as a primary support area for the mandib- by denture. B, Lack of adequate support contributed to
ular denture.* R.9.I” 12~22It is usually covered by mucosa settling of extension base secondary to resorption.
with an intervening submucous layer containing glan-
dular connective tissue and buccinator muscle fibers. changes occurring more rapidly than in the areas of
The buccinator muscle is attached inferiorly along the primary support.
buccal shelf between the ridge crest and the external The remaining anatomic regions of the mandible are
oblique ridge.” The muscle fibers run along the shelf not usually essential in providing denture support. The
in a longitudinal anteroposterior direction, permitting less keratinized alveolar mucosa of the lingual and
the denture base to rest directly on a portion of the anterior labial ridge slopes lies directly over basal bone
buccinator muscle without displacement. This buccina- and does not tolierate pressure well. In fact, the lingual
tor muscle attachment extends posteriorly to include tissue over the mylohyoid ridge often requires relief to
the pear-shaped pad area. Again, owing to the nature reduce impingement of the mucosa. The denture bor-
of the overlying soft tissues and the presence of muscle der is extended into the movable soft tissue to effect
attachments, these regions provide primary support for border seal and not to promote support. In markedly
the mandibular denture base. resorbed mandibles, the genial tubercles provide a bony
The role of the mandibular residual ridge crest in foundation resistant to resorption due to the genioglos-
support depends on the nature of the ridge and the bone sus muscle attachments, but the friabie overlying
factor of the individual patient. Patients exhibiting mucosa usually obviates its use as a primary stress-
broad, square, well-developed residual ridges covered bearing area capable of resisting vertical forces. The
by firmly bound masticatory mucosa plus a favorable mandibular anatomic regions and their relative contri-
intrinsic bone factor may rely on the ridges for support. bution to denture support are outlined in Fig. 6 and are
Generally, the ridge crests are reserved as secondary based on the average healthy edentulous mandible.
support areas. The lack of muscle attachments and Individual variations may dictate changes from the
presence of cancellous bone usually result in resorptive normally desired relationship of denture hase to under-

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 JACOBSON AND KROL

Fig. 6. Relative importance of various anatomic

regions of mandible in providing denture support.
Primary support areas must include buccal shelf and
pear-shaped pad (2 “). Ridge crest and area of genial
tubercles may be treated as secondary support areas Fig. 7. Skin has been grafted over area of genial
(2”). Lingual and labial ridge inclines are either tubercles. Such treatment allows use of genial tuber-
relieved 07) or noncontributing (N/C). cles for primary support.

lying tissues. For example, the presence of pendulous, The cortical bone of the hard palate, composed of the
redundant, fibrous connective tissues over the mandib- palatine processes of the maxillae and the horizontal
ular ridge crest would preclude its use even for processesof the palatine bones, has been shown to resist
secondary support. resorptive changes in longitudinal studies of conven-
Patients who have undergone vestibuloplasty proce- tional complete denture patients. Clinical observations
dures with split-thickness skin grafts have favorable of patients wearing “roofless” maxillary dentures sub-
keratinized tissue overlying regions of muscle attach- stantiate the significance of incorporating the hard
ments such as the genial tubercles (Fig. 7). Those palate into denture support. Such dentures are often
genial tubercles covered by a skin graft would be associated with severe alveolar ridge resorption because
considered. as primary support regions. The regions the hard palate was not included in the support-
that will contribute to the complete denture support ing area.
should govern the selection of impression procedures. An explanation for the resistance of the bony hard
palate to resorption based on the pressure-tension
MAXILLARY ANATOMIC phenomenon has not been described. The functioning
CONSIDERATIONS tensor veli and levator palatini muscles of the soft
In the maxillae the horizontal portion of the hard palate may provide the sources of tension that counter-
palate lateral to the midline raphe should provide act the pressure resorption normally expected beneath
primary support for complete dentures. Van Scatter a denture base. In any event, the horizontal hard palate
and Boucher” describe the histology of the palate in resists resorption and is covered by keratinized mucosa
detail. Keratinized masticator-y mucosa overlies a dis- and resilient submucosa. These properties dictate its
tinct submucous layer everywhere but at the midline essential function as a primary denture-support area.
suture. The submucosa contains fatty tissue anterolat- The crest of the maxillary edentulous ridge is also
erally and glandular tissue posterolaterally. This resil- important in complete denture support. The soft tissue
ient layer acts as a cushion for the functional stresses is often thick, keratinized, and firmly bound to the
transmitted to the mucosa. Dense bands of connective periosteum and underlying bone. A layer of dense
tissue traverse the submucosa, firmly binding the fibrous connective tissue intervenes between the muco-
lamina propria of the epithelium to the underlying sa and bone and acts as a resilient liner for the mucosa.
periosteum. Over the midline raphe the mucosa is Despite this favorable soft tissue covering, the underly-
unyielding, has little or no submucosa, and must be ing cancellous bone is subject to resorptive changes,
relieved to avoid tissue impingement between the depending on the intrinsic bone factor of the patient.
denture base and bone.12However, the relief should be Clinical research has shown that the maxillary
minimal to permit light contact of this tissue with the alveolar ridges undergo remodeling changes when
denture base under masticatory loading. subject to the functional stresses transmitted by a

310 MARCH 1983 VOLUME 49 NUMBER 3

COMPLETE DENTURE SUPPORT

Fig. 9. Various anatomic regions of maxillae in pro-

viding support. Primary support areas (1 “J should
include horizontal antero- and posterolateral hard
palate. Ridge crest should function at best as a second-
ary support a:rea (2”). Midline suture normally
requires slight relief fR) while denture border is
noncontributing (N/O.

little resistance to vertical base movement. As in the

mandible, the peripheral tissues should be contacted
to obtain a seal but are not essential to support
(Fig. 9).

RELIEF REGIONS
Relief regions fall into three categories. First, tissues
Fig. 8. A and B, Resorption of anterior maxillary that are susceptible to resorption should not be sub-
ridge caused by functioning of natural mandibular jected to functional pressures. These would include
anterior teeth against a maxillary complete denture some maxillary and most mandibular ridge crests.
with inadequate posterior occlusion. Second are those regions that have a thin mucosa
directly over hard cortical bone. These include the
tissue-borne prosthesis.‘“.‘“,2’ Rapid resorption involv- palatal midline raphe, tori and exostoses, and the
ing the anterior maxillary ridge beneath a complete lingual surface of the mandible, especially the mylo-
denture opposed by mandibular anterior natural denti- hyoid ridge. A third category involves these regions of
tion is frequently seen. Resorption is usually more mucosa overlyirng neurovascular bundles such as the
rapid when the lower anterior teeth are permitted to incisive papilla and, in some cases,the mental foramen.
contact the maxillary denture without simultaneous These should be recorded at rest or relieved according
posterior contact either in centric relation or during to the techniques used. Sore spots and long adjustment
excursive movements. The appearance of loose, redun- periods will result if these considerations are not
dant tissue anteriorly together with fibrous, pendulous followed during the fabrication of complete dentures.
tuberosities posteriorly is referred to as the “combina- Impression techniques, materials, and associated pro-
tion syndrome” by KellyI (Fig. 8). These and other cedures should be selected to effect that relationship of
associated changes result from excessive forces trans- denture base to the underlying tissues that will promote
mitted to the anterior maxillae. Such forces must be effective and physiologic support for Ihe complete
controlled and minimized by proper design and tech- denture. No single cookbook formula can provide this
nique. Given proper attention, the maxillary ridge relationship for every patient. Variations in the indi-
crest can remain relatively resistant to resorption and vidual anatomic and physiologic requirements of each
should be considered as a primary or, at the very least, patient will dictate certain alterations in technique.
as a secondary supporting area.
The remaining facial slopes of the maxillary residual PRACTICAL CONSIDERATIONS
ridges are not essential in the denture support. The One generally accepted principle of impression pro-
nonkeratinized alveolar mucosa cannot tolerate func- cedures is that the maximal allowable denture-bearing
tional stresses, and the inclined surface would provide surface area should be incorporated. Many authors

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 JACOBSON AND KROL

recognize the need to record the different anatomic tion, the dentist must weigh the advantages and disad-
regions under varying degrees of pressure, depending vantages in each situation.
on the nature of the tissues.‘*6~8~22~ 24-26The rationale A technique that incorporates ideas from both the
behind these techniques is that certain tissues require pressure-free and selective-pressure procedures usually
slight placement while others must be recorded at rest can provide a desirable impression and contribute to
or relieved. On the other hand, proponents of the the longevity of the final prosthesis. According to their
mucostatic theory recommend the recording of all delegated role in support, certain tissues should be
tissues at rest without distortion.27 recorded at or near rest while others should be subject
A truly mucostatic or pressure-free impression is to mild tissue displacement. Craddockz9 has noted that
virtually impossible to achieve. The fluid impression an “automatic relief” over hard-to-displace tissues can
material contained in a rigid tray inevitably causes be obtained through the use of more viscous impression
some tissue compression. Even if it were possible to material. A study by Frank was conducted to determine
obtain a pressure-free impression of the tissues at rest, the effect of tray modifications and selection of impres-
the mucostatic theory is based on the belief that oral sion materials on pressures exerted on the denture-
tissues of the denture-bearing area behave as a confined supporting tissues during maxillary edentulous
fluid following Pascal’s laws of hydrostatics. These impression procedures. The study concluded that (1)
laws state that pressure exerted on a confined fluid will differences in pressure were correlated to the use of
transmit evenly throughout the fluid. Unfortunately, different impression materials (irreversible hydrocol-
the fluid in oral tissues is not confined. The tissue loid exhibited the highest pressures followed by thiokol
fluids can move through the interstitial spaces in rubber and metallix oxide-eugenol pastes); (2) more
response to stresses placed on them. They also vary in pressures were measured at the crest of the ridge than
their ability to tolerate or transmit pressures according on the palate when no relief was used; and (3)
to their anatomic location and histologic makeup. For generally, use of either escape vents or relief was
these reasons, it would seem that the most desirable equally effective in decreasing pressures and in equal-
impression techniques would attempt to provide mild izing the amount of pressure exerted on the ridge crest
displacement of the more resilient tissues, which are and the palatal areas.3o Therefore, the selection of
capable of providing denture support and resisting impression material and use of relief holes, wax
resorption. spacers, and localized tray relief are several methods
Ideally, the tissues beneath the denture base should that can control and direct pressure recorded in the
be recorded in the shape and contour that they assume impression.
under a loading force. In this way the more resilient
tissues would be more displaced than those tissues that SUMMARY
are unyielding, such as the maxillary midline raphe. Dentists must base their technique on an under-
Such an impression would provide an equalized distri- standing of the biologic aspects of the relationship
bution of pressure to the supporting tissues during between the denture base and supporting tissues.
function and avoid an unstable denture base rocking on Those tissues must be able to tolerate functional
a fulcrum point of unyielding tissue, such as the stresses without promoting patient discomfort and
midline suture. The concept of equalized pressure should be recorded in such a manner that these areas
distributed over the supporting areas will minimize provide complete denture support. Anatomic regions
localized stress concentration, which otherwise leads to that satisfy the requirements for providing primary
pressure-induced resorption, mucosal irritation, and support should make positive contact with the denture
base instability. As Swensor? stated: “Tissue place- base under functional loading. Those that are less
ment for equalization of pressure in order to resist resistant to long-term changes or are unable to tolerate
occlusal stress over the entire bearing area is desir- stress should be relieved of excessive contact with the
able. . . .” denture base. Selection of those regions that should
Selective pressure impressions have some disadvan- provide primary and secondary support depends on the
tages and limitations. A denture base that records the anatomic variations unique to each patient.
functional contours of the bearing area displaces the REFERENCES
more resilient tissues. At rest the denture base may
1. Friedman, S.: Edentulous impression procedures for maximum
rebound and pull away from the underlying tissues. retention and stability. J PROSTHET DENT 214, 1957.
Because no single technique can provide an equitable 2. Preiskel, H. W.: The posterior lingual extension of complete
distribution of pressures both at rest and under func- lower dentures. J PROSTHET DENT 19:452, 1968.

312 MARCH 1983 VOLUME 49 NUMBER 3

COMPLETE DENTURE SUPPORT

Tllron. G. E.: The denture periphery. J PROSTHET DENT 18. Glickman, I.: Clinical Periodonrology, ed ,: Philadelphia.
2:x0, 1952. 1972. W. B. Saunders Co., pp 432-439.
Tuckfield, W. ,J.: The problem of the mandibular denture. 19. Krol. Iz. .J: Removable Partial Denture I)e~qrr. An Outline
J Dent 3:R. 1953. Syllabus. San Francisco. 1976, c:niversitv o! the Pacilic, pp
M,tison. M’. (:. Denture outline form. J Am Dent Assor IS-16
593938, 1059 20. Henderson, I:,., and Stcffel, V. L,.: McCracken‘s Remrwahle
Fisher. R. D.: Six fundamental rules for making full denture Partial Prosthmodontics.ed 4. Sr. Louis. 19’73. ‘l‘hr (Z. \ Moshy
impressions. J PROSTHE? DENT 1:135, 1951. (:a.. pp 166-169.
Roberts, A. I,: Principles of full denture impression making 21. Craddock, F. W.: Prosthetic Dentistry. wl ? it. l,ou~, 1951~
and their application in practice. J PROSTHET DENT 1:213, The (1. V. Moshy Co., pp 212-213.
1051. 22. Boucher, C. 0: Complete denture unpressionh hased upon Ihe
8. Bcwcher, ( 0.: A critical analysis of midcentury impression anatomy of the mouth. J Am Dent Assoc 31: i 174, 1044.
rwhniqurs l’or full dentures. J PROSTHET DENT 1:472, 1951. 23. Alwood. I). .\ : A cephalometrir study 01’ ihe clinical rest
9. Bereft. S. G.. nnd Haines. R. W.: Structure of the mouth in posItion of the mandible. Part II. The variability in the rate of
the mandibular molar region and its relation to the denture. bone loss l’ollowing the removal of oc-clusai I cbnlncts. J PKOS
J PROSTHET DENT 12:835, 1962. ‘I ttt.7’ DENT 7:544. 1957.
10. Nwards. L. F., and Boucher, C. 0.: Anatomy of the mouth in 24. Carlilr. E. F. Functional adaptation of IOYYI. denture bases.
relation to complete dentures. J Am Dent Assoc 29:331, ,J PROSTHET DENT 1:662. 1951.
1042. 25. (Campbell, R. L.. Relief chambrrs in (omplete dentures.
11. Barone. J. V.: Physiologic complete denture impressions. J PROSTHET DCN.I. 11:230. 1961.
J PROSTHE~ DENT 13:800, 1963. 26. DeVan. kl. M.: Basic principles in imlwwon making.
12. Van Scottrr. D. E., and Boucher, L. J.: The nature of J PROSWET DENT 2:26, 1952.
supporting tissues for complete dentures. J PROSTHET DENT 27. Page. H. L.: Mucostatics-A Principlr, Not :L Technique.
153285, 1965. (Chicago. 194ti, published hv Ihe author.
13. Orban, B.: Oral Histology and Embryology, ed 3. St. Lows. 28. Swenson, bl. (;.. Complete Dentures, rd 2 St. Louis, 1947,
1’153, The C. V. Mosby <:o. ‘i‘he (1. V. hfoshy Co., pp 13-87, 331-359.
14. Tallgren, A.: The continuing reduction of the residual alveolar 29. Craddock, F. W.: Prosthetic Dentistry--1\ Clinital Outline. ed
ridges in cx)mplele denture wearers: A mixed-longitudinal 3. London, 1956, Hwry Klimpton, pp 00-91 91. 217
study covrrjng 25 years. J PROWHET DENT 27:120, 1972. 30. Frank, R. P: Analysis of pressurr produced during maxillary
IS. .\twood. D A.: Some clinical factors related to rate of edenrulous impression procedures. ,J PK~XI it r Dcx,~ 22:400,
rcwrp~ion of residual ridges. J PROSTHET DENT 12:441, 1969
1002.
16 (kukson. (G. E.. and Pcrssin. G.: Morphologic changes of the
mandible after extractwn and wearing of dentures. Odont Revy
l&27, 196’.
17. Kelly, E.. (:hanges caused by a mandibular removable partial
dcnturr opposing a maxillary complete denture. J PROSTHET
DEN-~ 27:l-N). 1972.

THE JOURNAL OF PROSTHETIC DENTISTRY 313