Anatomy of edentulous maxilla and mandible

First of all I want to tell you that this lecture is very interesting lecture and as DR said it is very important to understand this lecture very well . only study it well .


Denture- bearing Area ( DBA) : We will discuss the anatomy of supporting areas of complete denture


In the maxilla we call denture –bearing area Denture foundation but in the mandible we call it Denture Basal Seat .

- In any denture we have two types of area :

Stress bearing areas or supporting areas (provide support to denture ) Peripheral or limiting areas (determine the periphery of the denture )


- Maxillary denture foundation :

It is made up of bone of hard palate and RAR (residual alveolar ridge) covered by mucus membrane .


2. The denture base must extend as far as possible without interfering with health and function of tissues so extension of the denture is limited by tissues.

For example if we over-extended the denture labially we interfere with orbicularis oris muscle.

The denture base rests on mucus membrane which acts as a cushion between the base and supporting bone ( this info from the book ).

- Anatomy of supporting structures:


Mucus membrane : it is composed of mucosa and submucosa .


Mucosa : it is stratified sqamous epithelium often keratinized underlying layer of thin connective tissue ( lamina propria) joining with submucosa.

2.Submucosa: - connective tissue varies from dense to loose areolar tissue and varies in thickness .



may contain glands , fat , mucle fibers.

- It transmit blood and nerve supply to the mucosa. - It attached to bone by periosteum

- Very important notes :

The support of complete denture relies on two things :

- type of bone of denture-bearing area. - the thikness and consistency of submucosa :


if submucosa is firmly attached to bone so it can withstand the pressure of denture -------good for support if submucosa is thin and loosely attached to bone so soft tissue will non-resilent , and mucus membrane will be easily traumazied ----- poor support.


2. soft tissue is very important for support of complete denture . so the arragment finally is : mucosa----- lamina propria ----- submucosa---periosteum ----- bone

It covers with soft tissues varying in thickness.Hard palate : 1. - Median sagittal suture : 1. It is the junction between two maxillae. 2. It is formed by the palatine processes of the two maxillae and palatine bone .4 . 2. We consider it relief area because soft tissue that cover it is thin although madian sagittal suture is on the palate but we consider it as Relief area . .

.Anterior palate (rauge ) : It is mainly composed of fat tissues so this increase the displace ability . The submucosa of posterior palate is mainly contain minor salivary glands. . Relief area : it means that fitting surface of denture or the base of the denture doesn’t have intimate contact with this area so we provide a little space for relief .Residual alveolar ridge (RAR) : .Posterior palate : We cosider it primary stress-bearing area ( it means it provides the main support to complete denture during function )for two reasons: 1. 2. The submucosa of soft tissue is firmly attached to bone . Soft tissue is more displaceable 3. . We consider it as secondry stress bearing area for two reasons 1. Posteriotr palate is perpendicular to vertical forces and it is resistant to resorption.5 3. Rugae is inclined so inclinations of this rugae are not perpendicular to vertical forces.

2.6 1. The rate of resorption in the mandible is 3-4 times higher than in the maxilla and this is the reason why in most cases we suffer from supporting problems in maxillary arch . 5. 3. The rate of resorption : it continues forever from time of extraction until patients death (allah yrhamo ) 4. Shape and size change after tooth extraction due to resorption if the patient wear denture or not . Direction of resorption in maxilla it happens upward . Most of resorption happen in the first three months of extraction after that the rate of resorption declined but it continues of significant amount until first year after that resorption happens with lesser rate . The resorption is a physiological not pathological process . backward . inward because there is a palate which is resistant to resorption so most of resorption happened facially so . 6.

lack of cortical bone so we will have spaces in the bone we call this type of bone cancellous bone (trabecular. .the vertical height shorten the net result of that resorption is : 1. spongy ) soft tissue is firmly attached to bone and it is perpendicular to vertical forces but we consider crest of RAR secondary stress.7 .the lateral wall of the ridge goes inward . smaller maxilla 2. 7. slopes of RAR provide little support because they aren’t perpendicular to vertical forces (inclination ) and we have what we call it mucogingival folds ( junction between keratinized and non-keratinized mucosa ) 8.bearing area because the lack of cortical bones .the labial wall of the ridge goes backward .

8 The arrow indicate to Muco-buccal fold or - Note: sometimes in tuberosity area we can find cortical bones this is why in some textbooks they consider tuberosity as primary stress. . stability . retention. The first picture on the left : This is the most favourable types of palate(horizontal palate) because it provides good support. We can see well-developed ridges .bearing area.Types of RAR and palate : Please refer to the pic on the slides from left to right i will explain the pictures. . 1.

. The last one : We can see developed ridges but we have undercuts . The one on the right : v-shaped palate it is good for stability (can resist displacement during function ) but adhesion and cohesion are reduced so (good stability . if we have undercuts we have the following : If undercuts are mild ---. The second one in the left corner : We can see resorped ridges and more displacable soft tissue Poor retention because reduced surface area Poor stability because no resistant to retentional forces Poor support because most of the bones are lost 4. reduced retention) 3.9 2.good for retention If undercuts are moderate to severe specially if bilateral ----not good for retention either we need to do relief of the denture or surgical reduction of the ridges to avoid trauma and loss of peripheral retention.

10 . Indicator of amount of resorption If incisive papilla is closed to the crest of the ridge this indicate that significant amount of resorption happened If incisive papilla is still higher than crest of RAR this indicate that the ridges are still good (little resorption) 3. 2. Supportive area . It covers incisive foramen or canal . It is helpful in setting of teeth The arrow indicate to : Incisive papilla Not incisive foramen why??? Because foamen in the bone only - Maxillary tuberosity (area posterior to third molar) : 1.Incisive papilla : 1. It is considered as relief area 4.

Sharp spiny processes (it happens because of the resorption of the bone and we should relief the denture beneath it ) 2. and the soft tissue that cover it is thin so we consider it as relief area. . Torus palatinus : it just bony enlargement . This is picture of torus palatinus be careful this is not osteosarcoma this is just benign bony growth or enlargement It is not uncommon that’s mean it is common ( less than common) If it is too big like this picture we prefer surgical reduction not necessarily completetly removal .Labial sulcus or vestibule : From one buccal frenum to the other . May hang down and need surgical removal 3. .Other relief areas: 1. Could be fibrous or bony enlargement .11 2.Anatomy of peripheral structures : 1.

2.Buccal frenum should have wide notch than on denture than labial frenum because of more movements . As we know from anatomy we know what modiouls means Modiouls : it is the junction between the fibers of orbicularis oris muscle and buccinator muscle . Labial frenum : fold of mucous membrane with no muscular attachment . because of this we need relief in the denture flange we call it labila notch and this notch shouldn’t be wide from latral side to the other because we don’t have muscular attachment in this region and for our luck as dentists (hahah) orbicularis oris muscle it’s fibers are run horizontal so whe this muscle contracts it doesn’t dislodge the denture.12 The labial vestibule divided to right and left labial vestibule by the labial frenum .Buccal frenum moves : .Divides labial and buccal vistibues - It could be single or double folds ( note that labial frenum is always single fold) .Buccal frenum : . 3.

Usually this vestibule has the longest and highest space in the upper complete denture. - Distal to it there is root of zygoma (soft tissue that cover it is thin so we need relief the denture ) how??? During border molding we ask the patient to open widely and move from side to side because if buccal flange of denture was thick . dislodgment of . 4. opening will be limited .From buccal frenum to hamular notch .It’s size varies depend on : 1. Coronoid process of mandible . Masseter contraction 4. Up and down by levator anguli muscle 2. Anteriorly by orbicularis oris muscle - If we don’t provide sufficient room or space for this range of movement in the buccal frenum we will end up with frenum ulceration . Amount of resorption 2. trauma could happen .Buccal sulcus or vestibule : . Buccinator contraction 3. Posteriorly by buccinators muscle 3.13 1.

It is 2mm away from fovea palatinae - Fovea palatinae : small identations in the anterior part of the soft palate formed by coalescence of gland ducts( arrow in pic) . It composed of thick submucosa so it is compressible and this help in achieve posterior palatal seal (peripheral seal of upper complete denture) 3.It is an imaginary line from one hamular notch to the other .Hamular notch : 1. 6.14 denture could also happen because of the thickness of the flange . 5. It is the area between tuberosity and hamulus of medial pterygoid plate . 2. The posterior extension of upper complete denture is hamular notch.The vibrating line (ah line ): .

Please look at these pictures they are useful .15 - Denture extends to vibrating line or 1-2 mm posterior to it and extends into hamular notch 7. . - If denture manily lower is over-extended posteriorly trauma to the raphe could happen . .It is very important in ID block. Perygomandibular raphe: - It extends from hamulus to the top of disto-medial corner of retromolar pad area in the mandible ( buccinator musle when it turns medially behind retro-molar pad area it will merge with superior constrictor muscle of the pharynx in this raphe .

Residual alveolar ridge 7.16 - This picture sammarizes every things: 1.Labial vestibule 3.Maxillary tuberosity 8.Coronoid bulge 6. - Anatomy of supporting structures : Mandibular DBA ( denture-bearing area) = 14 cm square Maxillary DBA =24 cm square .Hamular notch Oh 25eeeran 5alsna anatomy of maxilla we will move to anatomy of mandible (eshrabo fnjan 2hweh w rja3o 3la tafree3’) .Labial frenum 2.Buccal frenum 4.Buccal vestibule 5.

it contains cancellous bone so we consider it secondary stress –bearing area . Rate of resorption : it is 4 times faster than maxilla and as we know most of resorption happened after 3 months of extraction so we ask the patient to visit us after 3 months to be sure that we don’t need to do relining to the denture .better retention ). Shape and size change after teeth extraction due to resorption 2. - Crest of RAR : keratinized mucosa and variable submucosa attachment it could be firm or loose .17 We notice that mandibular DBA is about half surface area of maxillary arch so this is why maxillary dentures are more successful than more mandibular dentures ( increase surface area -----. - Direction : In the mandible the alveolar ridge and the base are not on the same level so after extraction the resorption takes place in the alveolar bone not the base . . - RAR: 1. 3.

In the molar region : you don’t have resorption from labial wall resorption from lingual wall ----.smaller maxilla ( class III ) prognathic .goes labially But the crest of RAR stays static (in the same place ) . .labial wall of ridge resorption happened backward - Lingual wall of ridge it goes forward Net result is RAR becomes more forward In premolar area : labial wall ---.goes lingually - Lingual wall --.labially the net result : larger mandible .18 In anterior area : there is no palate to resist resorption as maxilla so ---.

- We know that after resorption we will end with sharp spines .19 In this pic we can see resorption that take place anteriorly In this picture we see resorption that take place posteriorly In this picture we can see the progressive resorption of maxillary and mandibular ridges makes the maxilla narrower and mandible wider. A and B represent the centers of the ridges notice that distance become greater as maxilla and mandible resorb. Sometimes when the resorption is of significant amount the lingual fold ( soft tissue of .

crest of RAR Laterally ----.The anatom of supporting structures : 1.buccal frenum Posteriorly---.Buccinators muscle fibers are horizontal so it doesn’t dislodge the denture. so when it becomes higher than the ridges it self it complicate the construction of lower complete denture . Retro-molar fossa : it is the space between the external and internal oblique ridges.retromolar pad - The mucus membrane is loosely attached and less keratinized but because there are high amount of cortical bone and perpendicular to vertical forces we consider it primary stress –bearing area . Note very important : - In lower complete denture : . - .external oblique ridge Anteriorly ---. Buccal shelf (buccal flange area ): .Boundaries : Medially ----.20 floor of the mouth and submandibular gland duct underneath it ) .

Mylohyoid ridge : .bearing area is crest of RAR Left picture : the arrow indicate buccal shelf area Right picture : the dotted area is the buccal shelf area that extend from buccal frenum (A) to retromolar pad area (B) and from external oblique ridge to the crest of the residual alveolar ridge (C) 2.21 The primary stress –bearing area is buccal shelf area but The secondary stress.Obligue .It is close to inferior border of the mandible anteriorly .

In the picture : A.22 .Indicator of the amount of resorption if it is very close to the crest of RAR this indication of severe resorption.Canine region B.It is close to superior border of mandible posteriorly - The mucus membrane over a sharp mylohyoid ridge will be easily traumatized by denture base .Mental foramen : .so we need to do relief to the denture base.Premolar region C. 3.The mental nerve and blood vessels could be compressed by denture base unless relief is provided .Third molar In anterior area we see that mylohyoid muscle is close to the base of the mandible but in . .First molar D.

Genial tubercules : - With resorption it become prominent so we need t do relief . - It covers with thin layer of mucus membrane so we need to do surgical removal of these tori because trauma could happen to the mucosa and peripheral seal affected also . 5. This is a picture of torus mandibularis as we said if too large like this we should do surgical removal .Anatomy of limiting strctures : 1.It is bony prominence .It found bilaterally and lingually near the first and second premolars.Labial vestibule : .23 - In some patients with severe resorption mylohyoid muscle becomes sometimes above the crest of the ridge 4.Torus mandibularis : .

From buccal frenum to retromolar pad. - Posteriorly the buccal vestibule must converge to avoid displacement by the contraction of masseter muscle ( anterior fibers of this muscle run outside and behind the buccinators muscle ) so we need to do relief . 2.The extent of buccal vestibule is influenced by the buccinator muscle .Length and thickness of labial flange vary - Labial frenum : it contains band of fibrous connective tissue that helps attach the orbicularis oris muscle so labilal frenum is quiet sensitive and active . - Distal extension : .Buccal vestibule : . .24 - From labial frenum to buccal frenum . - The buccal flange may extend to the external oblique ridge up onto it or over it depending on the location of muco-buccal fold and sharpness of external oblique ridge.

Retromolar fossa : it is the area between external and internal oblique ridges If the impression is overextend it can cause soreness and displacement of denture because pterygomandibular raphe during movement it will dislodge the denture anteriorly 2.It is pear shaped soft tissue pad located at distal end of RAR . The arrow indicate to retromolar pad area and pterygomandibular raphe.Submucosa contain glandular tissue and muscle fibers (pterygomandibular raphe and tendon of temporalis ) .It contains thin non-keratinized mucosa .Retromolar pad : . - Notice when buccal shelf turns to cover retromolar pad area (in that area we have only buccinators muscle) behind buccinators there is masseter muscle so when the .25 1.The denture should cover ½ to 2/3 over the retromolar pad .

Lingual border : - The lingual tissues under the tounge are less resistance than labial and buccal and ar easily distorted. It forms the floor of the mouth 2. Retromylohyoid fossa : .26 patient bites masseter muscle contracts and become wider . The ridge more prominent posteriorly so denture flange must parallel to mylohyoid muscle to avoid sorness (pain) . so in some patient we need to do relief to flange of denture and we do this during border molding we press on tray and ask the patient to bite aganist our fingers so masseter muscle contarcts and we call this ( masseteric notch ) .In other patient we have tense mentalis muscle so we can’t provide thick flange in this area it will dislodge so the flange of denture should extend to muco-buccal fold and some fibers of buccinators muscle will be under the denture. 3. - Mylohyoid muscle : 1. peripheral seal and tounge rests on the flange 4. it pushes buccinators muscle . It originates from mylohyoid ridge and inserted to hyoid bone 3.

Posteriomedially : palatoglossus muscle .Retromylohyoid curtain boundaries: .Inferior wall : overlies submandibular gland - Medial pterygoid muscle can cause bulge in the wall of the curtain as masseter dose with buccinators .27 - It located posterior to mylohyoid muscle and it is bounded with Retromylohyoid curtain - The denture must extend to this fossa ( S-curve configuration ) 5.Posteriolaterally : superior constrictor .

Finally i advice you to refer to my tafree3’on mytoothy because there are alot of pictures . If pic is not clear please refer to the book page 242 figure 14- .28 In this picture sorry the letters are inverted B : buccinator muscle M: masseter muscle MP: medial ptyregoid PR: pterygomandibular raphe RM: ramus of the mandible SC: superior constrictor muscle RMC : posteriolateral portion of retromylohyoid curtain formed by the mucus membrane covering SC.The following picture may help you in understanding : .

nur ----always well ) . haneen mind (sho mshan sho jab l jab 2affa 3leke hek bde eyake ) . my partener in labs (nor t3ani love your smile . - Special thanks to pharmacist 3yoosh (ra7 3leke el. haneen mohsen (welcome back nawarteena wallah ) . ( 2thorah . 7anan kateeb (thanks for everything) - My lovely friend ( Maram jaradat ) love you .film hah ) .Big thank to our CR Bader Ali ( allah y3teek al3afyeh) - Deena (5arej altagteyeh) . love you ) - To my lovely niece muna ( your album ‘manosh in Jordan’ is ready i am waiting you to grow uo to see it ) And to my lovely nephew (mahmood (‫ )حوكه‬allah y3enek hal fatrah btale3 asnan hahha ) - . aya (allh y5alsek mn lsanek haha) .29 .Big greeting to my lovely dad ( miss you too much ) - This lecture is dedicated to my mother ( mam . allah y3enek 3lye ) .ground me for the day of judgment .

Hold every person Close to your Heart because you might wake up one day and realise that you have lost a diamond while you were too busy collecting stones. your collegue : Abeer Talal al-hamarneh .30 - Finally i wish that i explain lecture in understanding way .Wish you all the best in the your third year in dentistry here in just ." Remember this . This words make me stronger when i read it : Never take some one for granted . always in life .

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