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Coronomaxillary space and its significance in complete denture retention-

Case reports

Article  in  General dentistry · July 2012

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Naveen Y g Jitendra Patel

Subbaiah institute of dental sciences Indian Institute of Technology (Banaras Hindu University) Varanasi
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Rajesh Sethu Paranjay prajapati

Sumandeep Vidyapeeth University Sumandeep Vidyapeeth University
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 Complete Dentures

Coronomaxillary space and its significance in

complete denture retention—Case reports
Y.G. Naveen, BDS, MDS   n  J.R. Patel, BDS, MDS   n  Rajesh Sethuraman, BDS, MDS, DNB   n  Paranjay Prajapati, BDS, MDS

The coronomaxillary space defines the distal-most extension of
the maxillary denture border, and it usually is tightened during
mouth opening. It has been reported that its adequate filling
or overfilling is helpful in prosthesis retention. Two types of
individual anatomical variations can affect the size of this space:
vertical or lateral. With vertical variations, the space increases or
does not vary when the mouth is opened; therefore, the prosthesis
border must be thicker to obtain adequate retention. With lateral
variations, the coronomaxillary space is reduced when the mouth
is opened; therefore, the prosthesis border must be thin. The case
reports presented here show how complete denture retention can
be augmented by the careful recording of the coronomaxillary
space dimensions.
Received: August 9, 2011
Final revisions: October 25, 2011
Accepted: November 8, 2011

A
positive continuous periph- the zygomatic process. Its posterior region.1 For individuals with flared
eral (border) seal is one of boundary is the pterygomaxillary or coronoid processes, the space
the factors that influences the hamular notch. Its inferior boundary can widen or remain constant on
retention of complete dentures.1 is the crest of the residual ridge.6 opening (Fig. 1). In such cases,
Compared to mandibular dentures, The size of this space is primar- denture borders might require wid-
maxillary dentures do not often ily influenced by the action of ening in contour to achieve reten-
pose a significant problem to reten- the coronoid process. Swenson & tion. For individuals with straight
tion.2 However, in most conditions, Stout reported that the full extent coronoid processes, this space
the retention can be achieved by the of the space is obscured by the narrows upon opening (Fig. 2).2 In
accurate record and extension in the coronoid process when the mouth is such cases,the denture border at the
distobuccal vestibular space.3 Many completely open, and that the oral corono-maxillary area might need
maxillary impression techniques examination in this region should to be thinned to maintain reten-
have been described, but relatively be completed with the mouth par- tion function.8 This article reports
few have emphasized the impor- tially closed.7 There are two exten- a case of both anatomical types as
tance of recording the maxillary sion types of the coronomaxillary described above.
distobuccal vestibular space.4,5
Many terms have been used to
identify this area: buccal space or
vestibule, buccal pocket, tuberosity
sulcus, distobuccal angle of the
buccal vestibule, buccal sulcus, buccal
pouch, buccal mucous membrane
reflection region, or the post-malar
area and coronomaxillary space.6
A brief review of the literature indi-
cates that the most accepted term for
the distobuccal sulcus region is the
coronomaxillary space. It is defined
as the anatomic region that lies
medial to the coronoid process and
lateral to the maxillary tuberosity. It Fig. 1. Wide coronomaxillary space due to a Fig. 2. Narrow coronomaxillary space due to a
is bounded anteriorly by the base of flared coronoid process. straight coronoid process.

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Complete Dentures  Coronomaxillary space and its significance in complete denture retention
Fig. 3. Intraoral view of the coronomaxillary
space that remains the same when the jaw is
opened.
Fig. 5. Postinsertion intraoral view showing
complete filling of the coronomaxillary space.
Case reports
Case report No. 1
A 58-year-old man reported to the
Department of Prosthodontics at
K.M. Shah Dental College with
the chief complaint of looseness in
his maxillary denture. His history
revealed the same problem with his
previous two dentures. Upon intraoral
examination, it was evident that the
ridges were fair and the oral mucosa
was firm and resilient. However, the
sulcus was wider at the coronomaxil-
lary area and the space remained
the same size when the mouth was
opened and closed (Fig. 3). The exist-
ing denture extensions were checked
in the patient’s mouth and it was
e264 July/August 2012 General Dentistry
Fig. 4. Wide and thick distobuccal denture flange.
discovered that the distobuccal flange
area was fully extended to the depth
of the sulcus, but the borders were
thin and did not fill the coronomaxil-
lary space sufficiently. This led to loss
of the peripheral seal and, in turn,
to a loss of retention. It was decided
to reconstruct a new denture with
proper extension.
Conventional procedures for
complete denture construction were
followed. Emphasis was placed on
recording the full extension of the
sulcus, in both width and depth, in
the coronomaxillary area by having
the patient open his mouth halfway
and not protrude the mandible
or move it laterally during border
molding and final impression
procedures. A gentle molding of the
region was conducted by pulling
the cheek out, down, and in.
The new denture had a thicker
and wider denture border in the
coronomaxillary area (Fig. 4).
During intraoral examination at the
insertion appointment, the authors
noted that the coronomaxillary
space area was filled sufficiently and
this, in turn, sufficiently improved
retention (Fig. 5). There was no
hindrance to the lateral/protrusive
mandible movement.
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Case report No. 2
A 72-year-old man reported to the
Department of Prosthodontics
with the chief complaint of loose-
ness of his maxillary denture.
Upon intraoral examination, it was
evident that the patient’s ridges
were fair in height and width, with
firm and resilient oral mucosa.
However, the depth of the sulcus
in the coronomaxillary area was
greater and the space was narrowed
when the mouth was opened
(Fig. 6). When the old denture
extensions were checked in the
patient’s mouth, it was discovered
that the distobuccal flange area
extended fully into the depth of
the sulcus, but the flange thickness
was greater, causing displacement
of the denture. Therefore, the
treatment plan was to construct a
new denture with the proper flange
thickness in this region.
Conventional procedures for
complete denture construction were
followed. Emphasis was placed on
recording the full extension of the
sulcus, in both width and depth,
in the coronomaxillary area. The
patient was asked to perform right
and left jaw movements to record
the width, and to open and close his
Fig. 6. Intraoral view of the coronomaxillary
space that becomes narrower when the jaw is
opened.
Fig. 9. Type 1 wide coronomaxillary space (left) and type 2 narrow coronomaxillary space (right).
mouth to record the depth, both in
the primary and secondary impres-
sion procedures.
The new denture was constructed
with a thinner, longer denture
border at the coronomaxillary area
(Fig. 7). After insertion, intraoral
examination revealed that not only
was the coronomaxillary space suf-
ficiently filled, the flange thickness
was adequately contoured. The new
denture did not interfere with the
movement of the coronoid process of
the mandible and this, in turn, suf-
ficiently improved retention (Fig. 8).
Discussion
Though the border seal extension,
surface detail, and area coverage
Fig. 7. Long, thin distobuccal denture flange.
can be judged to be adequate
elsewhere, denture retention can
be difficult to achieve if the seal is
incomplete in the coronomaxillary
region. Most patients exhibit vari-
able success in denture retention;
therefore, special attention in this
region is necessary. Any overexten-
sion (vertical and/or horizontal) in
this area will cause retention loss.9
The clinical examination at the
first appointment often fails to
include a detailed examination of
the coronomaxillary space. However,
each patient needs an individual
evaluation to assess variations in the
size of the coronomaxillary space
when the mouth is opened. The
coronomaxillary denture flange
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Fig. 8. Postinsertion intraoral view showing
complete filling of the coronomaxillary space.
Fig. 10. Depth measured using a mouth mirror.
should be contoured to ensure that
the prosthesis is created with maxi-
mum retentive qualities. As described
earlier, there are two extension types:
flared and straight coronoid processes
(Fig. 9). The use of a mouth mirror
provides adequate information about
the height, but little information
about the width (Fig. 10). For this
reason, a diagnostic technique—a
space impression tool—has been
proposed to clinically delineate the
type of space present and to help
visualize dimensions. This technique
consists of the use of a modified
tongue blade (Fig. 11) that, in con-
junction with low-fusing impression
compound recorded in semi-open
(Fig. 12 and 13) and functional
General Dentistry July/August 2012 e265
Complete Dentures  Coronomaxillary space and its significance in complete denture retention
Fig. 11. Modified tongue blade (space impres-
sion tool) tried in the patient’s mouth.
opening (Fig. 14 and 15), can help
to diagnose the type of space. Doing
so can provide clinical assistance in
impression reading and ensuring
retention of the denture.
In addition to using the space
impression tool to evaluate the width
of the coronomaxillary space during
opening and closing of the mouth, it
is useful to consider a frontal view of
the ramus. In the first case report, the
coronoid process appeared to flare
laterally at its height. With a stronger
temporal muscle insertion, this flare
can be increased. If a lateral flare of
the coronoid process is observed in
the patient during mouth opening,
the space often remains the same or
becomes wider.10
If the coronomaxillary space
broadens or maintains its size when
the mouth is opened, the functional
filling of this space with the denture
flange becomes important.7 If the
space is not completely filled, or
even slightly overfilled, maximum
retention can be lost.1 In the first
case report, close examination of the
coronomaxillary flange of the prior
denture revealed that this region had
thinned during laboratory finish-
ing procedures. In such cases, it is
advisable not to have the patient
open the mouth wide, to protrude,
e266 July/August 2012 General Dentistry
Fig. 12. Type 1 Fig. 13. Type 2
coronomaxillary coronomaxillary
space width space width
recorded in a recorded in a
semi-open state. semi-open state.
or to move laterally during border
molding or impression procedures.11
A gentle molding of the region by
pulling the cheek out, down, and in
will yield more successful results.12
Re-establishing the correct widened
contour denture improved the
retention for that patient.
The coronoid process can be
relatively straight or vertical in some
individuals, as it was in the second
case report. For these patients,
opening the mandible can result in
narrowing of the space.7,10,13 If the
space narrows when the mouth is
opened, any horizontal extension
into the space would result in den-
ture base contact and loss of reten-
tion. Border molding procedures in
this region should include opening
and closing together with protrusion
and lateral movements of the jaw.
Summary
The case reports presented here viv-
idly illustrate the method by which
complete denture retention can be
augmented by the careful recording
of the dimensions of the coro-
nomaxillary space. The coronoid
contour thus obtained should fill
the entire space available in the
distobuccal vestibule. This space can
be evaluated by an accurate intraoral
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Fig. 14. Type 1 Fig. 15. Type 2
coronomaxillary coronomaxillary
space width space width
recorded in recorded in
functional opening. functional opening.
examination in a semi-open position
and an extraoral examination of the
ramus in frontal view. The corono-
maxillary space, if used properly, can
provide another potential source of
retention in complete dentures.
Author information
Drs. Naveen and Sethuraman are
assistant professors, Department of
Prosthodontics, K.M. Shah Dental
College, Sumandeep Vidyapeeth,
Vadodara, Gujarat, India, where Dr.
Prajapati is a senior lecturer and Dr.
Patel is professor dean, professor,
and department head.
References
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General Dentistry. © Copyright 2012 by the
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