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THE NEUTRAL ZONE

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REVIEW
THE NEUTRAL ZONE
Gibi Babu Philip1, Vivek Thomas2, Anand Rajapur3, Arun Gupta4, Jeetendra5
1
Post Graduate Student, 2Prof. and Head, 3,4Reader, 5Senior Lecturer
Dept. of Prosthodontics, Vyas Dental College and Hospital, Jodhpur
Corresponding Author: Dr. Gibi Babu Philip, Email : drgibi.philip@gmail.com
ABSTRACT
The soft tissues that forms the boundaries of the
denture space exert forces which influences the
stability of the dentures. The neutral zone is an area
in the edentulous mouth where the teeth can be
positioned so that the forces exerted by muscles of
tongue and the cheek will tend to stabilize the
denture rather than unseat it.
Key Words: Neutral Zone, Forces, Muscles
INTRODUCTION
Worldwide life expectancy is found to be 67.2 years
from 2005 through 2010.1 It is estimated that 7% -
69% of adult population are completely
edentulous.2
The role of a dentist is in helping the patients to keep
their teeth in healthy condition throughout their life.
If the teeth are lost despite of all the efforts to save
them, then a restoration should be made such that
they function efficiently and comfortably in
harmony with the muscles of the stomatognathic
system.
The neutral-zone approach in complete denture
fabrication was contributed by Wilford Fish3 and
Russell Tench.4 Many others,4-11 including Perry12
have helped to advance and develop both the
theoretical basis and practical procedures. The term
neutral zone concept was coined by Beresin and
Schiesser in 1976.13
When the natural teeth have been lost, there exists a
void within the oral cavity called the potential
denture space. NEUTRAL ZONE: also known as
stable zone, Dead space, and Zone of minimal
conflict14 is defined as According to GPT 8 "The
Dental Impact Vol. 5, Issue 2, Dec. 2013
ISSN 2249-5436
potential space between lips & cheeks one side &
tongue on the other side. That area or position where
the forces between tongue & cheeks or lips are
equal".29
The neutral zone is that area in the potential denture
space where the forces of the tongue pressing
outward are neutralized by forces of the cheeks and
lips pressing inward. These forces are developed
through muscular contraction during the various
functions of chewing, speaking, and swallowing.
The technique for recording is referred as the
anthropoidal pouch technique according to Jagger
D,15 denture from impression technique according to
McCord JF,16 piezograph technique according to
Mersel A17 and border moulding technique.14
Muscles and the neutral zone
The dental arch is influenced by the muscle forces
exerted on the teeth by the tongue, lips, and cheeks.
The outer limits of the neutral zone are determined
by the perioral musculature. The main determinant
of length, strength and position of the perioral
musculature is the buccinator muscle. The
buccinator is a thin, flat muscle composed of three
bands. The combined width of the three bands
covers the entire outer surface of the dento alveolar
structures, that is the teeth, alveolar process and
gingival tissues.
The muscles of the lips include orbicularis oris,
canine muscle, risorious, mentalis etc. Orbicularis
oris forms a great extent of the lips. It plays a major
role in chewing, smiling and swallowing, it exerts
force against the teeth and denture flanges, which is
counteracted by the tongue.
Canine muscle pulls the lower lip up and helps to
pull the lips forward during swallowing and
sucking, thus exerting forces on the teeth and labial
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 denture flange. The risorius muscle retracts the
corner of the mouth. The mentalis muscle turns the
lower lip outward and makes the lower labial
vestibule shallow during contraction. The triangular
muscle contracts during sucking to exert pressure on
the teeth and the denture flanges.
The tongue is composed of intrinsic muscles that lie
within the tongue and extrinsic muscles that insert
into the tongue. The function of the extrinsic
muscles the styloglossus, palatoglossus,
hyoglossus, and genioglossus is to move the tongue
into various positions. The tongue is capable of
many shapes and positions during speech,
mastication, and swallowing and during all these
functions remains in constant contact with the
lingual surface of the teeth, the lingual flange of the
lower denture and the palatal surface of the upper
denture. Because of this contact, the tongue is a
dominant factor in establishing the neutral zone and
therefore in the stability of the lower denture.
After the teeth have been lost, muscle function
greatly influence any complete dentures that are
placed in the mouth. It is therefore, extremely
important that the teeth be placed in the mouth
within the arch form that falls within the area that is
compatible with muscular forces.
DENTURE SURFACES
The dentist generally is only concerned with
transmitting the vertical forces through the occlusal
surfaces of the teeth and which is later neutralized
by the ridges. Horizontal forces exerted on the
external surfaces of the dentures are usually
ignored. Fish3 has described that denture has three
surfaces, with each surface playing an independent
and important role in stability and comfort of the
denture. The two surfaces are the impression and the
occlusal surfaces of the denture. The third surface as
termed by Fish, ''the polished surface'' which is the
rest of the denture that is not part of the other two
surfaces. The polished surface of the denture is in
contact with the cheeks, lips, and tongue.
INFLUENCE OF FORCES ON DENTURE
SURFACES
When there is excess bone resorption, the denture
base area is smaller and so is the impression surface
due to which the stability and retention of the
Dental Impact Vol. 5, Issue 2, Dec. 2013
denture base is compromised. As the area of the
impression surface decreases and the polished
surface area increases, the position of the teeth
becomes more critical. In other words, we can say
that when more of the alveolar ridge is lost, denture
stability and retention are more dependent on
correct position of the teeth and contour of the
external surfaces of the dentures.
The forces exerted on the external surfaces of the
teeth and the polished surfaces are usually
horizontal. When the occlusal surfaces of the teeth
are not in occlusion, the stability of the denture is
due to the fit of the impression surface and amount
of forces transmitted through the polished surfaces.
In order to construct a dentures which function
properly in chewing, swallowing, speaking etc, we
must develop proper tooth position and also the fit
and contour of the polished surfaces . The influence
of the lip on stability of the denture becomes critical
as ridge resorption increases. Lammie7 stated that as
the alveolar ridge resorbs, the ridge falls below the
origin of mentalis muscle. Due to which, the muscle
attachment folds over the mandibular ridge and
thereby rests on the superior surface of the ridge
crest.
This results in neutral zone being pushed
posteriorly, because of this the lower anterior teeth
has to be shifted further lingually than the original
position of the natural teeth. Thus if the teeth and
flanges are not properly positioned and contoured,
the force of the muscles from the lower lip may
constantly unseat the lower denture.
REVERSED SEQUENCE IN DENTURE
CONSTRUCTION
The normal sequence for complete denture
fabrication is to make a primary impressions,
construct special trays, make secondary
impressions, and then fabrication of stable denture
base. Occlusion rims are fabricated on the denture
base to establish the vertical dimension and centric
relation.
When using the neutral zone technique, the
procedure is reversed. After individual trays are
constructed, they are adjusted such that they remain
stable in mouth during opening, swallowing, and
speaking. After which, occlusion rims are fabricated
with modelling compound. These rims are molded
106
 by muscle action to locate the patient's neutral zone
followed by a tentative vertical dimension and
centric relation. Then a final impressions is made
with a closed-mouth procedure. And finally an
accurate occlusal vertical dimension and centric
relation is determined.
TECHNIQUES
The most commonly used technique for recording
the neutral zone are swallowing18 and phonetics.19
Besides these, various other techniques can also be
used such as sipping water, licking, smiling, pursing
the lips, sucking, protruding the tongue, opening
and closing of mouth and whistling etc.14
Makzoume20 in a study compared between phonetics
and tissue conditioner with swallowing and
modelling compound in recording neutral zone.
And concluded that the phonetic neutral zone
appears to be narrower posteriorly, limiting the
position of premolar and molar.
Lott and Levin,21 stated that patients should be
asked to read an interesting topic aloud and rapidly.
This will make the muscles to strain and increase
salivary secretion. This will result in more
swallowing action, thus enabling patients to make
more natural movements of the muscles.
MATERIALS
Tench et al 22 used modelling impression compound
for the first time to record neutral zone. Although
this is widely followed, other materials such as
tissue conditioner, wax, zinc oxide eugenol
impression material, chair side relining material and
acrylic resin are also used for this technique.14
MAXILLOFACIAL PROSTHETICS AND
IMPLANTS
It is difficult to record neutral zone when the patient
is not able to perform proper functional movements
of the cheek, tongue, or lips. Even implant retained
or supported overdenture requires a polished
surface which can prevent harmful forces from
acting on the implant. Suzuki et al stated that neutral
zone concept can be used for preparing diagnostic
and surgical templates which facilitates proper
placement of implants for complete dentures.23
Dental Impact Vol. 5, Issue 2, Dec. 2013
According to Kokubo et al the neutral zone
technique can be used for patients undergoing
undergoing mandibular surgical reconstruction,24
s e g m e n t a l m a n d i b u l e c t o m y, 2 5 m a rg i n a l
mandibulectomy, maxillectomy, 2 7 partial
glossectomy and mandibular continuity defects.28
CONCLUSION
The neutral-zone is based upon the concept that
there exists a specific area in the denture space
where forces generated by the tongue are
neutralized by the forces generated by the lips and
cheeks and where the function of the musculature
will not unseat the denture.
Tooth position and flange contour play an important
role on denture stability. We should not insist that
teeth have to be placed over buccal, lingual or crest
of the ridge. Teeth should be placed as according to
the musculature. The two main objectives of
positioning artificial teeth in the neutral zone are
1) The teeth will not interfere with the normal
muscle function.
2)The forces exerted by the tongue and cheek
muscles against the dentures are more favorable for
stability and retention.
REFERENCES
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2. Peterson PE, Bourgeois D. The global burden of oral diseases
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3. Fish EW. Principles of full denture prosthesis. 7th ed.
London: Staples Press, Ltd; 1948.
4. Tench RW. Personal communication, 1952.
5. Brill N, Tryde G, Cantor R. The dynamic nature of the lower
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How to cite this article: Philip GB, Thomas V, Rajapur A,
Gupta A, Jeetendra. The neutral zone. Dent Impact
2013;5:105-8.
Source of support: Nil Conflict of interest: None declared
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