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Mandibular Anatomical Landmarks

Mandibular Anatomical Landmarks

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Published by Kishor Chindam

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Published by: Kishor Chindam on Feb 17, 2012
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MANDIBULAR ANATOMICAL LANDMARKS

LIMITING STRUCTURES
 THESE ARE THE STRUCTURES, WHICH SURROUND THE DENTURE.  THESE STRUCTURES DETERMINE AND CONFINE THE EXTENT OF THE DENTURE.  THE STRUCTURES INCLUDES: 1) LABIAL FRENUM 2) LABIAL VESTIBULE 3) BUCCAL FRENUM 4) BUCCAL VESTIBULE 5) RETROMOLAR PAD 6) DISTAL EXTENSION 7) LINGUAL FRENUM 8) ALVEOLOLINGUAL SULCUS 9) RETROMYLOHYOID FOSSA
10) MYLOHYOID MUSCLE 11) SUBLINGUAL GLAND REGION

    IMPRESSION MAKING: TO RECORD THE LABIAL FRENUM. WHILE MAKING IMPRESSION. IT IS QUITE SENSITIVE & ACTIVE. DOWNWARD AND INWARD MOVEMENTS OF THE LOWER LIPS. SIGNIFICANCE: DENTURE MUST BE FITTED CAREFULLY AROUND THE LABIAL FRENUM i.e. IT SHOULD BE RELIEVED TO MAINTAIN PERIPHERAL SEAL WITHOUT CAUSING DISPLACEMENT OF THE DENTURE & HENCE WITHOUT CAUSING SORENESS.LABIAL FRENUM  IT IS A FOLD OF FIBROUS CONNECTIVE TISSUE THAT EXTENDS FROM LABIAL ASPECT OF RESIDUAL ALVEOLAR RIDGE TO THE LIP. . THEREFORE. LIFT AND MAKE OUTWARD. IT IS INFLUENCED BY ORBICULARIS ORIS & INCISIVUS MUSCLES.

o IT IS USUALLY WIDE IN CLOSED MOUTH BUT IT BECOMES NARROW ON OPENING THE MOUTH.LABIAL VESTIBULE  IT IS DEFINED AS “THAT PORTION OF THE ORAL CAVITY WHICH IS BOUNDED ON ONE SIDE BY THE TEETH.     IMPRESSION MAKING: TO RECORD THE LABIAL VESTIBULE. WHILE MAKING IMPRESSION. THIS WOULD DISPLACE THE DENTURE IF THE LABIAL FLANGE IS UNNECESSARILY THICK. WHICH IS NON-KERATINIZED. HENCE THE LENGTH & THICKNESS OF THE LABIAL FLANGE IS CRUCIAL IN INFLUENCING THE LIP SUPPORT & RETENTION. LIFT AND MAKE OUTWARD. BECAUSE THE ORBICULARIS ORIS MUSCLE & MENTALIS BECOMES STRETCHED. SIGNIFICANCE: o IT IS A PART OF VALVE SEAL AREA. DOWNWARD AND INWARD MOVEMENTS OF THE LOWER LIPS. & THE SUBMUCOSA HAS LOOSELY ARRANGED CONNECTIVE TISSUE FIBERS MIXED WITH ELASTIC & MUSCLE FIBERS. GINGIVA & ALVEOLAR OR RESIDUAL RIDGE AND ON OTHER SIDE BY THE LIPS”. . IT EXTENDS FROM LABIAL FRENUM TO BUCCAL FRENUM MUCOUS MEMBRANE HAS THIN EPITHELIUM.

BUCCAL FRENUM  IT IS ALSO THE SIMILAR FOLD AS THE LABIAL FRENUM PRESENT BUCALLY AND GIVES ATTACHMENT TO THE BUCCINATOR & IT OVERLIES THE DEPRESSOR ANGULI ORIS MUSCLE. DOWNWARD AND INWARD MOVEMENTS OF THE CHEEK. SIGNIFICANCE: IT SHOULD BE RELIEVED CAREFULLY TO MAINTAIN PERIPHERAL SEAL WITHOUT CAUSING DISPLACEMENT OF THE DENTURE & HENCE WITHOUT CAUSING SORENESS. . WHILE MAKING IMPRESSION. MAKE OUTWARD. IT IS CONNECTED TO THE MAXILLARY BUCCAL FRENUM AS A CONTINOUS BAND THROUGH THE MODIOLUS AT THE CORNER OF THE MOUTH.    IMPRESSION MAKING: TO RECORD THE BUCCAL FRENUM.

. DENTURE COVERS COMPLETELY THE BUCCAL SHELF AREA WITH LESS DISPLACEMENT OF BUCCINATOR MUSCLE FIBERS. o HENCE. THUS IT IS POSSIBLE TO STRETCH & DISPLACE THESE TISSUES & SO INCREASE THE AREA AVAILABLE FOR SUPPORT & STABILITY.e. SIGNIFICANCE: o IT ACTS AS A VALVE SEAL AREA.BUCCAL VESTIBULE  IT IS DEFINED AS “THAT PORTION OF THE ORAL CAVITY WHICH IS BOUNDED ON ONE SIDE BY THE TEETH. IT EXTENDS FROM THE BUCCAL FRENUM TO THE OUTSIDE BACK CORNER OF THE RETROMOLAR PAD. MAKE OUTWARD. IT MAY EXTEND UPTO EXTERNAL OBLIQUE RIDGE OR EVEN OVER IT. WHILE MAKING IMPRESSION. o LOCATION OF MUCOSAL FOLD OF BUCCAL VESTIBULE DETERMINES THE EXTENSION OF BUCCAL FLANGE i.     IMPRESSION MAKING: TO RECORD THE BUCCAL VESTIBULE. GINGIVA & ALVEOLAR OR RESIDUAL RIDGE AND ON OTHER SIDE BY THE BUCCINATOR MUSCLE”. MUCOUS MEMBRANE IS SAME AS THAT ON LABIAL VESTIBULE. DOWNWARD AND INWARD MOVEMENTS OF THE CHEEK.

OBLIQUE RIDGE IS A VALUABLE LANDMARK TO JUDGE AMOUNT OF RESISTANCE OR LACK OF RESISTANSE OF THE BORDER TISSUES OF THIS REGION.  MASSETRIC NOTCH   IT IS CLOSELY RELATED TO THE POSTERIOR BORDER OF BUCCAL VESTIBULE. IT DOES NOT GOVERN THE EXTENSION OF THE BUCCAL FLANGE. EXTERNAL OBLIQUE RIDGE   PRESENT ON THE OUTER SURFACE OF THE MANDIBLE. CONTRACTION OF MASSETER PUSHES THE SPACE INWARD AGAINST BUCCINATOR PRODUCING A BULGE IN THE MOUTH. . o MASSETRIC NOTCH.STRUCTURES CLOSELY RELATED TO BUCCAL VESTIBULE INCLUDE: o EXTERNAL OBLIQUE RIDGE. SIGNIFICANCE: PALPATATION OF EXT. WHICH IS REPRODUCED AS A NOTCH IN THE DENTURE FLANGE CALLED AS MASSETRIC NOTCH. ASK THE PATIENT TO CLOSE THE JAW AGAINST THE RESISTANCE GIVEN BY OPERATOR IN THE REGION OF MANDIBULAR MOLAR. SIGNIFICANCE: IT IS REPRODUCED AS A NOTCH IN THE DISTAL BORDER OF THE DENTURE CALLED AS MASSETRIC NOTCH.   IMPRESSION MAKING: WHILE TAKING IMPRESSION. WHICH DEPENDS ON THE LOCATION OF THE BUCCAL VESTIBULE.

SUBMUCOSA CONTAINS GLANDULAR TISSUE AND SOME FIBERS OF THE TEMPORALIS TENDON (POSTERIORLY). EXTRA PRESSURE ON THE PAD IS AVOIDED WHILE TAKING IMPRESSION & HENCE THE DENTURE CAN BE EXTENDED ONLY UPTO 1/2 OR 2/3rd OF THE PAD.   . o DUE TO THE ACTION OF ALL THE MUSCLE FIBERS. IT IS COVERED BY THIN NON-KERATINIZED EPITHELIUM. BUCCINATOR (LATERALLY) AND SUPERIOR CONSTRICTOR MUSCLE & THE PTERYGOMANDIBULAR RAPHE (MEDIALLY). SIGNIFICANCE: o ACTS AS A VAVLE SEAL AREA.RETROMOLAR PAD  IT IS A TRIANGULAR PAD OF SOFT TISSUE AT THE DISTAL END OF THE LOWER RIDGE.

THE BUCCINATOR & ADJACENT TISSUES WILL BE COMPRESSED BETWEEN THE HARD DENTURE & THE SHARP OBLIQUE RIDGES. THIS LIMITS THE FUNCTIONS OF THE BUCCINATOR MUSCLE. .  SIGNIFICANCE: DISTAL BORDER SHOULD BE LIMITED BECAUSE IF THE DENTURE EXTEND ON TO THE RAMUS. o CONTINUATION OF INTERNAL & EXTERNAL OBLIQUE RIDGE TO FORM RETROMOLAR FOSSA.DISTAL EXTENSION  IT IS THE DISTAL BORDER OF THE MANDIBULAR DENTURE & IT IS LIMITED BY: o RAMUS OF MANDIBLE o BUCCINATOR MUSCLE FIBERS THAT CROSS FROM BUCCAL TO LINGUAL SIDE AS THEY ATTACH TO PTERYGOMANDIBULAR RAPHE & SUPERIOR CONSTRICTOR MUSCLE.

.  IMPRESSION MAKING: TO RECORD THE LINGUAL FRENUM. ASK THE PATIENT TO PROTRUDE THE TONGUE. IT IS ACTIVE & EXTREMELY RESISTANT.   o A HIGH LINGUAL FRENUM IS CALLED AS TONGUE TIE AND IT SHOULD BE CORRECTED IF IT AFFECTS THE STABILITY OF THE DENTURE. IT IS ALSO A FOLD OF FIBROUS CONNECTIVE TISSUE THAT IS ATTACHED TO THE ALVEOLAR RIDGE ANTERIORLY & TO THE VENTRAL PART OF TONGUE POSTERIORLY.LINGUAL FRENUM  LIKE LABIAL FRENUM. SIGNIFICANCE: o IT SHOULD BE RELIEVED CAREFULLY WITHOUT WHICH IT MAY LEAD TO SORENESS & DISLODGEMENT OF THE DENTURE.

 . IT HAS THREE REGIONS: ANTERIOR.ALVEOLOLINGUAL SULCUS     IT IS THE SPACE BETWEEN RESIDUAL ALVEOLAR RIDGE & THE TONGUE. MIDDLE & POSTERIOR ANTERIOR REGION EXTENDS FROM LINGUAL FRENUM TO THE PREMYLOHYOID FOSSA (INCISOR TO PREMOLAR). IT EXTENDS FROM THE LINGUAL FRENUM TO THE RETROMYLOHYOID CURTAIN. MIDDLE REGION EXTENDS FROM THE PREMYLOHYOID FOSSA TO THE DISTAL END OF THE MYLOHYOID RIDGE (PREMOLAR TO MOLAR).

o IN MIDDLE REGION. o IN ANTERIOR REGION.  POSTERIOR REGION IS FORMED BY RETROMYLOHYOID FOSSA. SIGNIFICANCE: o ACTS AS A VAVLE SEAL AREA. o MIDDLE REGION: ASK THE PATIENT TO PROTRUDE THE TONGUE (DETERMINES THE HEIGHT OF THE LINGUAL FLANGE) AND THEN TO BRING THE TONGUE IN CONTACT WITH THE CONTRALATERAL CHEEK. . IT IS SHALLOW DUE TO PROMINENCE OF MYLOHYOID RIDGE & ACTION OF THE MYLOHYOID MUSCLE. THE FLANGE WILL BE SHORTER & SHOULD TOUCH THE MUCOSA OF THE FLOOR OF THE MOUTH WHEN TIP OF TONGUE TOUCHES THE UPPER INCISORS.  IMPRESSION MAKING: o ANTERIOR REGION: ASK THE PATIENT TO PROTRUDE THE TONGUE (DETERMINES THE HEIGHT OF THE ANTERIOR LINGUAL FLANGE) AND THEN TO PUSH THE TONGUE FORCEFULLY AGAINST THE FRONT PART OF THE PALATE (TO DEVELOP THE THICKNESS OF THE FLANGE).

RETROMYLOHYOID FOSSA  IT IS THE TRIANGULAR DEPRESSION PRESENT POSTERIOR TO THE MYLOHYOID MUSCLE. o PATIENT IS THEN ASKED TO CLOSE THE JAW AGAINST THE RESISTANCE FROM THE OPERATOR TO LIMIT THE DISTAL DORDER THE REGION. SIGNIFICANCE: ACTS AS A VAVLE SEAL AREA. IT IS BOUNDED BY RETROMYLOHYOID CURTAIN. IT FORMS THE TYPICAL S-CURVE OF THE LINGUAL FLANGE IN ITS POSTERIOR REGION. POSTERO-LATERALLY. THIS IS ALSO CALLED AS LATERAL THROAT FORM. IT IS RELATED TO SUPERIOR CONSTRICTOR MUSCLE & POSTEROMEDIALLY. TO THE PALATOGLOSSAL MUSCLE & LATERAL SURFACE OF THE TONGUE & INFERIORLY IT IS RELATED TO THE SUBMANDIBULAR FOSSA & GLAND. .      IMPRESSION MAKING: o ASK THE PATIENT TO OPEN THE MOUTH AND PROTRUDE THE TONGUE AND THEN THE TIP OF TONGUE IS PLACED ON THE FRONT PART OF THE UPPER RIDGE (THIS MAKES DENTURE BORDER EXTEND POSTERIORLY TO CONTACT FOSSA WHILE IMPRESSION MAKING).

o FOR THE DENTURE TO BE SUCCESSFUL.   . SIGNIFICANCE: o IF THE LINGUAL FLANGE EXTENDS UNDER THE MYLOHYOID RIDGE. IT ARISES FROM THE WHOLE LENGTH OF THE MYLOHYOID RIDGE & JOIN THE FIBRES OF MYLOHYOID MUSCLE OF THE OPPOSITE SIDE & POSTERIORLY INSERTED ON TO THE HYOID BASE.MYLOHYOID MUSCLE  MYLOHYOID MUSCLE FORMS AN IMPORTANT LANDMARK IN THE MANDIBULAR PROSTHESIS BECAUSE IT FORMS THE FLOOR OF THE MOUTH. CONTRACTION OF MYLOHYOID RAISES THE FLOOR OF MOUTH & HENCE PROTRUDES THE TONGUE WHICH DISPLACES THE DENTURE CAUSING SORENESS. THE FLANGE MUST BE MADE PARELLELTO THE MYLOHYOID MUSCLE AFTER WHEN IT IS CONTRACTED.

IT CAN BE PUSHED DOWN & LATERALLY OUT OF THE POSITION BY RESISTANT IMPRESSION MATERIAL.   ***** .SUBLINGUAL GLAND REGION   IT IS PRESENT ABOVE THE MYLOHYOID MUSCLE IN THE PREMOLAR REGION. THIS CAUSES THE GLAND TO COME QUITE CLOSE TO THE CREST OF THE RIDGE. CONTRACTION OF MYLOHYOID RAISES THE FLOOR OF MOUTH. THIS REDUCES THE VERTICAL SHAPE AVAILABLE FOR THE EXTENSION OF THE FLANGE IN THE ANTERIOR PART OF THE MOUTH.

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