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ROLE OF MUSCULATURE OF TONGUE AND FLOOR OF THE MOUTH IN

COMPLETE DENTURE TREATMENT

Anatomy in Physiology of tongue:


This muscular organ situated partly in the mouth and partly in the pharynx. By its
constituent muscles tongue is attached to the mandible, the styloid process, and the hyoid bone
and to the pharynx.

1. Parts: It possess a tip, root, curved dorsum and an inferior surface

2. Development:
a. Epithelium: Anterior 2/3rd from the fusion of the lateral lingual swellings and
tuberculum impar i.e., from the first branchial arch
Posterior 1/3rd from the cranial half of the hypobranchial eminence. i.e., from the
third branchial arch
Posteromost part: From the fourth arch
b. Muscles of tongue develop from the occtpttal myotomes
c. Connective Tissue: develops from local mesenchyme

3. Muscles of Tongue:
The middle fibrous septum divides the tongue into right & left halves. Each half
contains 4 extrinsic & 4 intrinsic muscles. The intrinsic muscles are completely
within the tongue, their activities alter the form of the tongue.
Inferior Longitudinal:
Is a narrow band of muscle situated on the undersurface of the tongue. Between
the genioglossus and hyglossus. It extends from the root to the apex of the tongue.
Some of its fibers being connected to the body of the hyoid bone.
Action: Shortens the tongue and makes its dorsum convex.

Superior Longitudinal:
Origin: From sub mucous fibrous layer close to the epiglottis and from the median
fibrous septum
Insertion: The fibers runs towards the edges of the tongue & some fibers inserted
to the mucous membrane.
Action: The muscle shortens the tongue and makes its dorsum concave

Transverse Muscle:
This muscle extends from the median fibrous septum to the margins
Action: Makes the tongue narrow and elongated.

Vertical muscle:
Found at the borders of the tongue
Action: Makes the tongue broad & flattened.

Extrinsic Muscles:
Extrinsic muscles have their origin outside the tongue but their course terminates
within it. Contraction of these muscles maintains a certain position of the tongue
or shifts the tongue to other positions.
Extrinsic muscles connects the tongue
To the mandible (Genioglossus)
To the Hyoid bone (Hyoglossus)
The Styloid (Styloglossus)
The Palate (Palatoglossus)

Genioglossus:
Origin: From genial tubercle on the inner surface of the mandible at its lower
border in the midline
Insertion: Anterior fibrous inserted into the tip of the tongue and most of the
posterior fibers inserted to the base of the tongue
Action: Acts as protractor and depressor of the tongue.

Styloglossus:
Origin: From the anterior surface of the styloid process and enters the near the
tongue
Action: Move the tongue backward & upward
Hyglossus:
Origin: From the whole length of the greater corner and the front of the lateral
part of the body of the hyoid bone.
Insertion: The fibers runs upward to be inserted in to the side of the tongue
between Styloglossus and inferior longitudinal muscles of the tongue
Action: Depress the tongue.

Palatoglossus:
Arises from the oral surface of the palatine aponeurosis, descends in the
palatoglossal arch to the tongue. At the junction of its oral and pharyngeal parts
Action: draws the tongue and soft palate together.

4. Arterial supply:
Tongue is chiefly supplied by the lingual artery, a branch of external carotid artery. The
root of the tongue is supplied by the tonsillar and ascending pharyngeal arteries

5. Venous drainage:
The deep lingual vein is the largest and principle vein

6. Lymphtic drainage
- The tip of the tongue drains bilaterally to the submental nodes
- The right and left halves of the remaining part of the anterior 2/3 of the
tongue drain unilaterally to Submandibular nodes
- The posterior 1/3 drains bilaterally to the jugu loomohyoid nodes

7. Nerve Supply:
Motor nerve supply: all intrinsic and extrinsic muscles except the
palatoglossus are supplied by the hypoglossus nerve. The
palatoglossus muscles supplied by the cranial dart of the accessory,
nerve through the pharyngeal dlexus
Sensory nerve supply: the lingual nerve is the nerve of the general
sensation and chorda tympani nerve is the nerve of taste sensation
for anterior 2/3 of the tongue
Glosspharyngeal nerve is the nerve for both general sensation and
taste sensation for posterior 1/3 of the tongue
The posterior most part supplied by the vagus nerve, through the
internal laryngeal nerve

ANATOMY AND PHYSIOLOGY OF THE FLOOR OF THE MOUTH


Floor of the mouth is formed by the right and left mylohyoid muscles and the Geniohyoid
muscle
a) Mylohyoid Muscles:
Origin: Arises from the whole length of the mylohyoid line, extending from about
1 cm back of the distal end of the mylohyoid ridge to the lingual anterior portion of
the mandible at the symphysis
Insertion: Medially the fibers joins those from the opposite side, and posteriorly they
continue to the hyoid bone.
Action: The contraction of this muscle flattens out the angle between its two halves.
The hyoid and the raphe are drawn upwards, elevating the floor of the mouth
The muscle supplied by the mylohyoid nerve and vessels
b) Geniohyoid Muscles:
This is a short and narrow muscle, which lies above the medial part of the mylohyoid
Origin:Arises from the genial tubercle of the mandible. The fibers runs downwards
and backwards to be inserted into the anterior surface of the body of the hyoid bone.
Action: Elevates the hyoid bone. May depress the mandible when the hyoid bone is
fixed.
The muscle supplied by the first cervicle nerve through hypoglossal nerve.

c) Alvelolingual sulcus:
The space between the residual ridge and the tongue is the alveolingual sulcus. This is
the part, which is available for the lingual flange of the denture, extends from the
lingual frenum to the retromylohyoid curtain
The Alveololingual sulcus is described in 3 regions
The anterior region
The middle region
The posterior region

- Anterior region (Premylohyoid region)


Extends from the lingual frenum to where the mylohyoid ridges curves
down below the level of the sulcus. This is the region at which a
depression can be palpated and a corresponding prominence can be seen
on impression. This is called premylohyoid eminence. The
premylohyoid fossa results from the concavity of the mylohyoid ridge
- Middle region (Post-mylohyoid Region)
This part of the alveolingual sulcus extends from the premyloid fossa to
the distal end of the mylohyoid ridge. Curving medially from the body
of the mandible. The curvature is caused by the prominence in the
mylohyoid ridge
In the premolar region above the mylohyoid ridge the sublingual gland
rests.

When the floor of the mouth is raised, this gland comes quite close to the
crest of the ridge and reduces the verticle space available for the flange
extension in the anterior part of the mouth
- A concave area in the mandible inferior and distal to the mylohyoid
ridge is the Submandibular fossa. It has a little significance in
impression making except that it is necessary to be aware of its
configuration.
- Posterior Region (Retromylohyoid Region)
This part of the Alveololingual sulcus is the retromylohyoid space or
fossa. Also referred to as the lateral throat form. Ridge to the
retromylohyoid curtain
Being bounded on the lingual by the anterior tonsillar pillar (distal end
of the retromylohyoid curtain and superior constrictor) and on the buccal
by the mylohyoid muscle, mandibular ramus and retromolar pad. The
superior support for the retromylohyoid curtain is provided by part of the
superior pharyngeal constrictor the action of this muscle and of the
tongue determines the posterior extent of the lingual flange
Relationship of the medial pterygoid to the superior constrictor,
contraction of medial pterygoid, which lies posterior to the superior
constrictor causes the retromylohyoid curtain, to move anteriorly, thus
limiting the space in the retromylohyoid fossa for Retromylohyoid
eminence at the posterior end of the lingual flange

Neil described this important area and noted that the denture could have three possible
lengths, depending on the tonicity, activity and anatomic attachments of the adjacent structures.
Classification:

Class I: Throat form: Indicates that the anatomical structures will accommodate a fairly long and
wide flange. The thickness varies greatly the horizontal border is usually 2-3mm thick, but a
thicker border of 4-5mm should be used for better seal if the border is flat.
Class II: Throat form: is about half as long and narrow as the class I and about twice as long as a
class III.

Class III: Throat Form: Has minimal length and thickness. The border usually ends 2-3mm
below the mylohyoid ridge or sometimes just at the ridge. The thickness should be no more than
approximate 2mm or it may even end in a knife-edge if the border terminates at the mylohyoid
ridge.
The Role of these Muscles During Impression Procedure
A preliminary impression is made with the operators material of choice
A plaster cast is obtained
On this cast a design of the desired peripheral outline is made which should be slightly
shorter than the desired completed denture outline.
The resin tray is made. The tray thickness should be 2mm fro ease of handling.
The tray should be checked in patients mouth
The resin tray inserted into the mouth and stabilized by placing two index fingers in
premolar region. The patient is asked to bring the tongue straight out. If the tray rises
vigorously from the posterior region. The distolingual flange in the retromylohyoid space
is shortened to where a minimal displacement of the tray occurs during protrusive tongue
action.
The left lingual border of the tray below the molar and premolar area is checked, by
having the patient bring the tongue tip in contact with the right buccal mucosa and noting
the degree displacement of the left segment of the tray in the first molar area.
The opposite side is checked in the same manner
After necessary correction the tray usually presents a shortened border in the first molar
region, blending into a longer section of flange in the retromylohyoid space because of
the resorption and muscle pattern the border configurations are not necessarily
symmetrical.
BORDER MOLDING THE LINGUAL FLANGE

The lingual flanges are border molded in 5 steps. Low fusing impression
compound is used.
I Step: With the tray in the mouth the length and thickness of the flange in the anterior region are
observed, relative to the available space, in the Alveololingual sulcus, as limited by the lingual
frenum, sublingual folds & submaxillary coruncles if space can be seen between the lingual
border of the tray and these limiting structures with the tongue slightly raised, more impression
material is added in this region. If the tongue encroaches on the limiting structures the lingual
border is molded. When the tray appears to fill the available space the impression compound is
added between the premylohyoid eminences and softened, tempered and the tray is placed in the
mouth, patient is instructed to protrude the tongue, this movement creates functional activity of
the anterior part of the floor of the mouth, including the lingual frenum and determines the length
of the lingual flange of the tray in this region. Both premylohyoid eminences are usually visible
after this procedure.

II Step: The impression compound is added in the anterior region i.e., from premolar to premolar.
The material softened, tempered and the tray is placed in the patients mouth and the patient is
asked to push the tongue forcefully against the front part of the palate. This action causes the
base of the tongue to spread out and develops the thickness of the anterior part of the lingual
flange

III Step: The impression compound is added to the lingual borders in the molar regions on both
sides of the tray between the premylohyoid and postmylohyoid eminences the compound is
heated and tempered, and then the tray is placed, in patients mouth. Patient asked to protrude the
tongue and to move the tongue from side to side. This develops the slope of the lingual flange in
the molar region to allow for the action of mylohyoid muscle
The lingual flange shorter anteriorly than posteriorly at the premylohyoid fossa in the canine
premolar regions. The flange becomes longer and extends below the level of the mylohyoid
line. It must slope towards the tongue more or less parallel to the direction of the fibers of the
mylohyoid muscle in the molar region.
If the flange slope towards the tongue and extends below the mylohyoid ridge. The tongue
can rest n top of the flange and aid in stabilizing the mandibular denture. Id addition the slope
of the lingual flange in the molar region provides space for the floor of the mouth to be raised
during function, without dislodging the mandibular denture. The seal of the mandibular
denture is maintained during the movements of floor of the mouth because the lingual flange
remains in contact Alveololingual sulcus.

IV Step: The compound on the border of the flange on both sides in molar region is heated to
a depth of 1-2mm. The tray is placed in the mouth and the patient instructed to protrude the
tongue. The action of the mylohyoid muscle, which rises the floor of the mouth during this
movement, determines the length of the flange in the molar region.

V Step: Impression compound on the distal end of the flange is heated and the tray is placed
in the mouth, the patient is instructed to protrude the tongue to activate the superior
constrictor (which support the retromylohyoid curtain). The contraction o the medial
pterygoid muscle, acting posteriorly on the retromylohyoid curtain, can limit the space
available for the border of the impression in the retromylohyoid fossa.

TONGUE POSITION:
The position of the tongue has great importance when the height of the occlusal surface is
selected for a complete mandibular denture. The tongue cannot be expected to handle food
efficiency when the occlusal plane is moved away from the margins of the tongue, and
certainly not if the plane is placed too high and combined with a narrow dental arch such as
tooth position, accentuated by lingually overchanging cusps, permits the tongue easily to lift
the mandibular denture away from its foundation as the mouth is closed and the tongue seeks
its usual position in contact with the palate.

Proper height of occlusal plane Too high occlusal plane


The tongue passively follows the mandible during movement because of the direct
attachment of the genioglossus muscle to the mandible and by the indirect attachment of the
tongue to the mandible by means of the mylohyoid muscles. Therefore the contact between
the teeth and the margins of the tongue is not broken when the mouth is opened, whereas, the
dorsum of the tongue breaks away from the hard palate and drops until it lies slightly curved
above the occlusal plane from this the tongue manipulates the food and keeps it positioned
between the teeth until satisfactory communication takes place.

Tongue Position:
Tongue position is important to the prognosis of the mandibular denture

Wrights classification of tongue position.:


Class I: The tongue lies in the floor of the mouth with the tip forward and slightly below the
incisal edges of the mandibular anterior teeth.

Class II: The tongue flattened and broad ended but tip is in a normal position.

Class III: The tongue retracted and the depressed in the floor of the mouth with tip curled
upward, downward or assimilated to the body of the tongue.
The most common complaint of complete denture patients concerns the loose mandibular
denture patient should be educated with all mandibular dentures.
1. Although the area of the mandibular denture basal seat is approximately 1/3 of the
maxillary denture both are subjected to same occlusal loads & thrusts.
2. The mandibular denture is surrounded lingually as well as buccally by muscles all of
which have potential for denture base disruption.
3. Last and important the mandibular denture depends on proper tongue position to maintain
adequate peripheral seal and stability
In order to determine whether the patient has a normal tongue position or an abnormal
retracted tongue position, ask the patient to open just wide enough to accept food the
dentist should see only the dorsal surface of the tongue and it should be in an intimate
contact with the lingual surface of the denture. The mandibular denture should be stable
and able to resist gentle push on the mandibular incisors. This will demonstrate and
reinforce the importance of tongue position to the patient.
If on the other hand, the dentist sees the occlusal surfaces of the teeth, lingual
surface of the denture and anterior floor of the mouth the tongue is in a retracted position
the denture will be unstable have no retention and will be easily dislodged or a gentle
push on the mandibular incisors. The patient will complain the denture is loose and
floots.
The diagnosis of a retracted tongue position is uncomplicated but the treatment can be
difficult.
1. Make the patient aware of the importance of tongue position.
2. Demonstrate the proper tongue position and subsequent increase in denture
stability & retention while the patient looks in a mirror
The patient must practice opening and closing while the tongue assumes a
normal position. Once practiced, the enhancement of mandibular denture
stability should be enough to reinforce the normal tongue position.

The Role Of Musculature Of Tongue And The Floor Of The Mouth In Stabilizing The
Mandibular Denture Along With The Muscles Of Cheeks And Lips
The musculature of the denture space is divided in 2 groups
Those muscles which primarily dislodge denture during activity and
Those muscles that fix the denture by muscular pressure on the polished surface
of the denture.
These muscles divided according to their location on the vestibular or lingual side of the
denture and to their dislodging and fixing actions
Dislocation muscles Fixing Muscles
Vestibular: Buccinator
Masseter Orbicularis Oris
Mentalis
Incisivus labii
Inferioris

Lingual:
Internal pterygoid Genioglossus
Palato glossus Longitudinal
Styloglossus Verticle
Mylohoideus Transverse

The mechanism by which the stabilization of mandibular denture is achieved by the action of
musculature is divided as
Active Muscular Fixation &
Passive Muscular Fixation

Active Muscular Fixation:


The principle of active muscular fixation is demonstration by antagonistic muscle groups
pressure exerted by the thumb presents the function of the tongue, and the opposing pressure by
the index finger represents the function of buccinator muscle

Active muscular fixation of a lower denture is demonstrate by opposing forces exerted by the
right & left buccinator muscles as represented by the finger holding the denture.

Passive Muscular Fixation:

A frontal section through the polished surfaces indicates their correct inclination. Note that by
extending the primary supporting surface horizontally, the lingual and buccal polished surfaces
can be wedged below the cheeks and tongue.
The mandibular denture wedged into space below the tongue and the lower lip & cheeks.

Altered Anatomy and physiology:


The tongue, which often presents abnormalities of size form, functions and position,
should be examined.
A small narrow tongue contributes to ease of impression making but jeopardizes the
lingual seal for mandibular denture.
A broad, thick tongue always in the way during impression making provides an excellent
seal for the denture.
An extremely large tongue (Macroglossia) passes additional problems during impression
making and impairs denture stability
Ankyloglossia: Complete ankyglossia occurs as a result of fusion between the tongue
and floor of the mouth. Partial Ankyloglossia or tongue tie is a much more frequent
condition and is usually a result of a short lingual frenum or one which is attached too
near the tip of the tongue because of the restricted movement of the tongue, patient with
this defect exhibit speech difficulties and in the impression procedure.
Loss of taste sensation: Elderly patients complain of this more than younger edentulous
patient, probably because their taste buds began to atrophy at about the same time that
dentures were first worn. The patient on the tongue and are not covered by the denture.
Floor of the mouth presets variations in resiliency and position relative to the ridge crest.
This is true also in each individual relationship. If the floor of the mouth is near the ridge
crest, stability and retention of the denture will be impaired. Minimal changes in form
and elevation are desirable. When these changes occur with a force of great magnitude,
denture displacement is likely
Anteriorly a well developed sublingual fold and resilient sublingual space are favorable.
The superior spine of the geniotubercle may be prominent, distinguishing the resiliency
of the sublingual fold space, occasionally it is more prominent than the residual ridge and
is sharp or curved with very thin mucosa
Hypertrophy of the sublingual glands forces the floor of the mouth superiorly, lessening
the chance of success and is detected by palpation, surgical removal of a portion of these
glands is feasible and enhances the prognosis
The floor of the mouth in the mylohyoid area may protrude superiorly and spill over the
residual ridge, eliminating the Alveololingual sulcus, which results in no space for lingual
flange. Occasionally these tissues offer marked resistance seriously hampering the
development of an adequate lingual flange attempts to do so will cause severe denture
displacement or injury to the floor of the mouth. Surgical release of mylohyoid muscle at
its origin and attachment at a lower level will enhance the success of mandibular denture.

IN SUMMATION

1. Importance of neuromotor unit of tongue in speech and taste and swallowing is


paramount interest besides parafunction.
2. The significance of function of this organ lies only in the state of the health and
thus becomes a major handicap in partial or complete glossectomy affecting the
all the functions.
3. Musculature of the floor of the mouth also plays significant role in holding the
mandibular denture more secured through its training
4. Importance of musculature of floor of the mouth becomes evident in case
hemimandibular surgical resection.
CONCLUSION
The complete denture considered as mechanical device since they function
in he oral cavity they should be fashioned according to the surrounding
neuromuscular structures.
All the functions of the oral cavity Ex. swallowing, smiling, speech
mastication etc. are due to the synergistic action of the lips, cheeks tongue
& floor of the mouth.
Failure to recognize the cardinal importance of the position of the teeth, &
tongue position results in unstable and unsatisfactory complete denture.
Even though they are skillfully designed and expertly constructed.
So normal coordination of the complete denture with the surrounding
neuromuscular structure is foundation for the successful and stable
complete denture treatment

LIST OF REFERENCES

1. Buchers Prosthodontic Treatment for Edentulous Patient Ninth Edition

2. Complete Denture Prosthodontics : John J. Sharry (3rd Edition)

3. Essentials of Complete Denture Prosthodontics : Sheldon Winkler (2nd Edition)

4. Impression for Complete Denture : Bernard Levin

5. J. Pros. Dent. May-June 1963, Vol.15

6. Grays Anatomy 31st Edition

7. Text Book of Oral Pathology : Shafers (4th Edition)