BIOLOGICAL CONSIDERATION IN
MANDIBULAR IMPRESSION
PROCEDURES
BY SARAVANAN .T.T
1ST YEAR PG
INTRODUCTION
Complete denture impression procedures are
perhaps one phase on which much has been
spoken about. The literature on the subject shows
a persistent disagreement ever since 1850.
Much of this confusion results from the fact that
many impression procedures have been developed
on empirical basis.
Many have used the available knowledge of
functional and histological anatomy for the
development of their procedures, but the variation in
these techniques indicate a wide difference in
interpretation of the foundation of dentures.
Whatever the method used it is generally agreed that
good impressions are basic for the construction of a
good denture.
DEFINITIONS
IMPRESSION
A negative likeness or copy in reverse of the surface of
an object .
– gpt 8
An impression can also be defined as an imprint of the
teeth and adjacent structures for use in dentistry. - gpt 4
COMPLETE DENTURE IMPRESSION
A complete denture impression is a negative registration of the entire
denture bearing, stabilizing and border seal areas present in the
edentulous mouth
PRELIMINARY IMPRESSION
A preliminary impression is an impression made for the purpose of
diagnosis or for the construction of a tray
MUCOUS MEMBRANE
MUCOUS MEMBRANE
The bones of the upper and lower edentulous jaws are
covered with soft tissue, and the oral cavity is lined with
soft tissue known as mucous membrane.
The denture bases rest on the mucous membrane, which
serves as a cushion between the bases and the supporting
bone.
The mucous membrane is composed of two layers
Mucosa
Submucosa
The mucosa is formed by the stratified squamous
epithelium and a subjacent layer of connective
tissue known as the lamina propria.
• The submucosa is formed by connective tissue.
It may contain glandular , fat , or muscle cells and
transmits the blood and nerve supply to mucosa.
• The thickness and consistency of submucosa are
largely responsible for the support that the soft tissue
affords the denture, since in most instances the
submucosa makes up the bulk of the mucous
membrane.
• In a healthy mouth the submucosa is firmly attached
to the periosteum of the underlying bone of the
residual ridge and will usually successfully withstand
the pressure of the denture.
HISTOLOGY OF THE MUCOUS MEMBRANE
COVERING CREST OF THE RESIDUAL RIDGE
BONE
PERIOSTEUM
SUBMUCOSA
MUCOSA
The oral mucosa is
●
divided in three
catogories depending
CLASSIFICAT
on its location in the
ION OF ORAL
mouth
MUCOSA: ●
Masticatory mucosa
●
Lining mucosa
●
Specialized mucosa
The masticatory mucosa covers the
crest of the ridge
the residual attached gingiva firmly adherent to the
supporting bone
hard palate.
It is characterized by a well defined keratinized layer on its
outermost surface subject to changes in thickness.
The specialized mucosa covers the dorsal surface of the
tongue. This mucosal covering is keratinized.
The lining mucosa is generally devoid of the
keratinized layer. It is found to cover the :
mucous membrane of lips, cheek
vestibular spaces
alveolingual sulcus
soft palate
ventral surface of the tongue and,
the unattached gingiva found on slopes of residual
ridge.
BIOLOGICAL CONSIDERATIONS
The considerations for the mandibular impressions are
generally similar to that for those of maxillary
impressions and yet there are many differences owing
to the following facts:
The basal seat of mandible is different in size and
form from the maxillary counterpart.
The submucosa in some parts of mandibular basal
seat contains anatomic structures different from
those in the upper jaw.
The nature of the supporting bone on the crest of
residual ridge usually differs between the two
jaws.
The presence of the tongue complicates the
impression procedures for the lower denture.
The available area of support from an edentulous
mandible is 14 cm2 while the same for the
edentulous maxilla is 24cm2 .
The supporting and the peripheral sealing areas
will be in contact with the dentures fitting or
impression areas. The support for the mandibular
denture is derived from the body of mandible.
The landmarks can be broadly grouped into:
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.
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 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.
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.
Sears has 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 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).
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 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.
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.
BASIC REQUIREMENTS FOR IMPRESSION MAKING
Knowledge of Basic anatomy
Knowledge of basic reliable technique
Knowledge and understanding of impression
materials
Skill
Patient management
OBJECTIVES OF IMPRESSION
MAKING
1) RETENTION
2) STABILITY
3) SUPPORT
4) ESTHETICS
5) PRESERVATION OF REMAINING
STRUCTURES
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THANK YOU
