Biological Considerations in Mandibular Impression
Biological Considerations in Mandibular Impression
Biological Considerations in Mandibular Impression
CONSIDERATIONS IN
MANDIBULAR
IMPRESSION.
CHRISTEENA JOSEPH
FIRST YR PG
Dept.of prosthodontics
CONTENTS
Introduction
Definition
Supporting structures
1. Bone
2.Mucous membrane
Anatomy of limiting structures in
mandibular region
Anatomy of supporting structures
in mandibular region
Anatomy of relief structures in
mandibular region
Muscle attachments
summary
Conclusion
INTRODUCTION
The fundamental principles involved in
the support of mandibular and maxillary
dentures are the same .
The denture bases must be extented to
cover the maximum area possible
without interfering with the health or
function of the tissues ,whose support
is from bone.
The prosthodontist must have a
complete understanding of macroscopic
and microscopic anatomy of edentulous
mouth of patient.
ANATOMICAL
LANDMARK
“ a recognizable anatomic structure
used as a point of reference.”
GPT-8
In both maxilla and mandible anatomic
landmarks has been divided in-
-supporting structures
-peripheral or limiting structure
formation exceeds the rate of bone resorption. In the adult, the two
processes are more nearly balanced.
In the aged or in any person with local or systemic disease, the rate of
bone resorption exceeds that of formation.
This is only one of the many reasons some dentures appear to be
physiologically tolerated over a period of time and then seem to fail.
syllabus of complete dentures-charles m. heartwell
DIRECTION OF RIDGE
RESORPTION
The maxilla resorb upward and and inward to
become progressively smaller because of the
inclination of the teeth and the alveolar process.
The opposite is true for the mandible ,which inclines
outward and progressively wider.
mastering the art of complete denture-halperin ,graser,rogoff
BLOOD SUPPLY
The blood supply to bone of maxillae and mandible is derived
principally from medullary and periosteal vessels that form plexuses .
When teeth are present, intra-osseous vessels supply pulpal, periodontal
and alveolar branches.
These various vessels anastomose with periosteal, gingival and other
vessels supplying the surrounding soft tissues. However, in edentulous
patient, the pulpal, periodontal and depending on extent of alveolar bone
resorption the alveolar branches are lost.
syllabus of complete denture-charles m.heartwell .jr
The blood to the mandible comes from branches facial, buccal
Mylohyoid ridge
Mental formen
Genial tubercles
Torus mandibularis
- covered by keratinized
layer and firmly attached to
the periosteum
- cancellous in nature, does
not have a good cortical plate
covering it
Significance
-hence it is a secondary
relief area, usually relieved
during impression.
boucher's prosthodontic
SLOPES OF RESIDUAL
ALVEOLAR RIDGE
- has thin plate of cortical bone
Significance
- because walls are steep and at an angle to
occlusal forces, it is not suited for primary
stress bearing, hence it is secondary stress
bearing.
syllabus of complete denture-charles m.
heartwell
BUCCAL SHELF
AREA
Buccal shelf area
- bounded by
anteriorly – buccal frenum
posteriorly – retromolar pad
medially – crest of alveolar ridge
laterally – external oblique ridge
Inferior part of buccinator is attached in
the buccal shelf area, but does not
interfere with the denture because the
fibers runs anteroposteriorly.
Significance
buccal shelf area may be very
wide and is at right angles to the
vertical occlusal forces. For this
reason it offers excellent
resistance to such forces.
hence considered as primary
stress bearing area.
syllabus of complete denture
charles m. heartwell.
RELIEF AREAS OF
MANDIBLE
MYLOHYOID
RIDGE
bony ridge found on lingual side of the
mandible
- mylohyoid muscle is attached to this ridge
- soft tissue usually hides the sharpness of
the ridge, which can be found by palpation
- anteriorly the muscle attaches close to the
inferior border of the mandible and posteriorly
it may flush with superior surface of residual
ridge.
boucher's prosthodontic treatment for
edentulous patients
significance
- level, inclination and prominence vary widely
between patients
- thin, sharp mylohyoid ridge can result in soft
tissue irritation when denture is placed over it.
Surgical correction may be required
- height of the lingual flange is determined by
the mylohyoid ridge.
boucher's prosthodontic treatment of
edentulous patients
MENTAL FORAMEN
AREA
This is of concern when the
ridge is extremely resorbed
Foramen is found near or on
the ridge crest in premolar
region
significance
In such cases it should be
relieved
Pressure on mental nerve can
cause numbness of the lip.
Syllabus of complete denture -
charles m. heartwell.
TORUS
MANDIBULARIS
rounded prominences found in some
individuals
located in the region of premolars,
midway between soft tissues of the floor
of the mouth and crest of the ridge
significance
-covered by a thin layer of mucous
membrane which may be irritated by the
denture, it should be relieved when
present.
Boucher's Prosthetic treatment of
-large tori should be
surgically removed if they
interfere with denture seal
GENIAL TUBERCLE
These are pair of bony
tubercles found anteriorly on
the lingual side of the mandible.
Due to resorbtion ,it may
become increasingly prominent
making denture usage difficult
Superiorly ,it is attached with
genioglossus muscle and there
inferior tubercle gives
attachment to the geniohyoid
muscle.
Boucher's prosthetic treatment
for edentulous patients.
MANDIBULAR LIMITING
STRUCTURES
LABIAL FRENUM
contains a band of
fibrous connective
tissue that helps to
attach the orbicularis
muscle
the frenum is quite
sensitive and active
the denture must be
fitted carefully to
maintain seal without
causing soreness
LABIAL VESTIBULE
extends from labial frenum to the
buccal frenum
length and thickness of the labial
flange vary with amount of tissue that
has been lost
There is muscle extending from the
residual ridge to the lip, the two
depressor anguli oris, so the labial
flange can be extended in length and
thickness to provide support to the lip.
The mucous membrane lining the labial
vestibule is relatively thin and is classified as
lining mucosa
When the patient’s mouth opens wide, the
orbicularis oris muscle becomes stretched,
narrowing the sulcus.
This would displace the mandibular denture
if the flange is unnecessarily thick. hence,
impressions will always be narrowest in the
anterior labial region
The extent of
denture flange in this
region often is limited
because of the
muscles that are
inserted close to the
crest of ridge.
The
mentalis muscle is
particularly active in
this region.
Boucher's prosthetic treatment for edentulous patients.
Significance
It accomdates the labial flange of the
dentures
It forms a part of peripheral seal areaa
of lingual flange.
Pouch shaped retromylohyoid space is lined completely
with loosely attached mucosa.
There are no supporting structures here since the medial
surface of mandibular body slope obliquely outward from
mylohyoid ridge to mandibular border forming
Distal to mylohyoid
muscle the space dips
toward and outward to
permit formation of
retromylohyoid
eminence of mandibular
denture.
GPT-8
Is a triangular soft pad of
tissue at distal end of lower
ridge
Must be covered by the
denture to perfect the border
seal in this prosthetic
Boucher's region treatment for edentulous patients
Its mucosa is composed of a thin, nonkeratinized
epithelium, and in addition to loose alveolar tissue.
its submucosa contains;
glandular tissue,
fibers of the buccinator and superior constrictor
muscles,
the pterygomandibular raphe, and
terminal part of the tendon of the temporalis muscle.
Mental spines
They are situated on lingual aspect of
mandibular body in midline slightly above the body.
syllabus of complete denture- charles m. heartwell
These bony elevations are often divided
into a superior and an inferior section
and sometimes into right and left
prominences. When loss of RR is
extensive these spines are more superior
position than crest of existing ridge,
requiring surgically intervention
Origin:
Frontal surface of the mandible
between alveolar jugum of lateral
incisor and canine eminence.
Extends inferiorly,anteriorly, and
medially to fuse in midline with
corresponding muscle fibers from
the opposite side.
Sublingual fossa
-during swallowing the mylohyoid
raises with
article on the nature
dynamic tongue and
of lower brings
dentures the floor
JPD-1965,15 (3)-n
.brill,dr.odont,g tryde LDS, R.cantor.DDS
- frequently this muscle is shows signs of
flabbiness and it is possible to extend the lingual
flange of denture for additional retention
Retromylohyoid fossa
-Is below and behind the retromolar pad
-This space provides an excellent place for
extending the denture for positive retention especially
when extensions into sublingual crescent and
sublingual fossa cannot be made.