Anatomy and histology of the denture bearing area

Dr. Aylin BAYSAN The University of Birmingham School of Dentistry

Anatomy of the edentulous area

In the mouth, complete or partial dentures are surrounded by muscles. Muscles tend to distabilise the denture if they are encroached upon during contraction.

Anatomy of the edentulous area

Other structures should also be identified to establish their precise relation to denture base. These are as follows:

Upper and Lower jaw

Ligaments Frenulum Glandular tissues

Lower jaw

Labial frenulum
It is a fold of fibrous tissue in the midline between lip and alveolus.

Orbicularis oris
Orbicularis oris forms a muscular circle within the lips. It is inserted near the midline into labial aspect of the maxilla and mandible.

Modiolus
This muscular knot is at the angles of the mouth where the dilator muscles: - Levator anguli oris - Zygomaticus major and minor - Depressor anguli oris Modiolus is lateral to the lower premolars so it will displace a lower denture if those teeth are set too far BUCCALLY.

Mentalis muscle
This muscle arises from the symphysis menti and is inserted downward into skin of the chin. It elevates the lower lip and may lift up the lower denture.

Muscles of facial expression which form modiolus

Mental nerve
This nerve emerges from the mental foramen near the apices of the lower premolars. In patients with extreme alveolar resorption, the nerve may lie on or near the crest of the alveolar ridge. Pain or paraesthesia may be experienced if the nerve is trapped by a denture base, usually by the fitting surface.

Buccinator muscle
It arises from both jaws opposite the molar alveolar area and posteriorly from the pterygomandibular raph. As the buccinator fibres run almost parallel to the denture border, they can slightly be displaced for additional retention. In this respect, it is the UNIQUE and ONLY muscle that can be used this way.

Massater muscle
This muscle is the MOST powerful of the muscles which close the MANDIBLE. The lower denture periphery related to it should be shaped according to its structure so that displacement of the denture can be avoided when the muscle contracts.

Denture bearing area

Anterior fibres of temporalis

These fibres are sometimes attached low down on the anterior border of the ramus as far as the attachment of the buccinator in the retromolar fossa. The contraction of these fibres may sometimes displace a lower denture.

Retromolar pad
Retromolar pad lies distal to the lower third molar and is composed of fibrous tissue and mucous glands.

Mylohyoid muscle
It is a thin sheet of muscle and forms the floor of the mouth. Its linear origin from the mylohyoid line of the mandible continues posteriorly to the level of the third molar.

Superior constrictor muscle

This muscle originates from the pterygomandibular raph with a small extension continuing on the lingual surface of the mandible to the posterior end of the mylohyoid line.

Sublingual salivary gland

This gland rests on the mylohyoid muscle medial to the mandible. It is usually adjacent to the lower canine region. Its indentation is often seen on lower impressions

Genioglossus muscle and genial tubercle

The genioglossus arises from the superior genial tubercles on the lingual surface of the mandible. When the tongue is protruded, this muscle may lift the lower denture. When the edentulous mandible is severely resorbed, the superior genial tubercle may project above the level of the alveolar ridge and the mucosa may become traumatised by a lower denture.

Muscles limiting the extension of a lower denture

Anterior labial flange

Orbicularis oris as far as the first premolar region.

Buccally
Buccinator muscle

Retromolar pad
Buccinator and its insertion pterygomandibular raph. into the

Muscles limiting the extension of a lower denture Lingually

The posterior extension is limited by fibers from the superior constrictor muscle. Fibres from the palatoglossus also form a posterior limit. The depth of the lingual flange is governed by the mylohyoid.

Upper jaw

Coronoid process
Coronoid process lies lateral to the maxillary tuberosity. It may sometimes impinge on the buccal flange of a denture and cause pain or instability.

Hamular notch
This notch is the junction of the maxillary tuberosity and hamular process. The periphery of a correctly extended denture should extend through these notches via the area of the fovea palatinae.

Fovea palatinae
These are a pair of mucous gland duct orifices near the midline at the junction of the hard and soft palate. These landmarks provide a guide to the position of the posterior palatal border of a denture.

Muscles limiting the extension of a upper denture

Anterior labial flange

Anterior labial flange is limited by the orbicularis oris as far as the first premolar region.

Incisive papilla
Incisive papilla is a mass of fibrous tissue about 1 cm behind the upper incisors. Its position in the edentulous mouth indicates where the incisors and canines should be set.

Buccally
From the second premolar region posteriorly, the buccal flange is limited by the buccinator.

Facial curtain
The orbicularis oris and buccinator muscles are draped around the mouth to form a curtain, which is supported by teeth and alveoli. In edentulous patients, this curtain collapses to give the characteristic toothless look.

Collapse of elevator and depressor muscles and modiolus following loss of teeth

Maxilla and mandible

There is difference in resorption pattern for maxilla and mandible. This leads to the appearance of prognatism and gross positional discrepancies between opposing residual ridges.

Edentulous face

Muscles attachment changes with progressive bone loss

Oral mucous membrane

Oral cavity
Stratified squamous type and shows differences in degree of development, which correlates with the functions of a particular area. Apart from systemic that affect the integrity of the oral mucous membrane, it should be noted that there are age changes that are frequently seen in the elderly edentulous patient including tendency to dryness and general atrophy of the mucous membrane.

The varying thickness of the mucosa covering the oral cavity

Oral mucosa

Tongue
The tongue is highly mobile muscular organ that needs careful attention during the construction of complete dentures. In coordination with lips, cheek, palate and pharynx, the tongue functions in speech, mastication and swallowing.

Tongue
The tongue is in intimate contact with a complete lower denture and its position in relation to an edentulous ridge varies widely. This relationship must be considered very carefully in each particular patient.

Salivary glands
Saliva is derived from the major and minor salivary glands. The major salivary glands consist of three pairs of glands:

Submandibular Gland
Extension of the lingual flange of a denture in this region can lead to obstruction of the submandibular gland. Patients may complain of developing swellings under the jaws when eating.

Parotid Gland Submandibular Gland Sublingual Gland

The outline of the lingual flange of the lower denture in relation to submandibular gland