ANATOMIC

LANDMARKS
By Syeda Faryal
Demonstrator Dental Technology
IPMS-KMU
Introduction

■ The anatomy of the edentulous ridge in the maxilla and mandible is very
important for the design of a CD
■ The consistency of the mucosa and the architecture of the underlying bone is
different in various parts of the edentulous ridge
■ Some parts of the ridge are capable of withstanding more force than other
areas
■ A thorough knowledge of these landmarks is essential even prior to impression
making
Mucous Membrane

■ The entire oral cavity is lined by the oral mucosa

• The oral mucosa has two layers namely the mucosa and a submucosa
• The mucosa has a keratinized, stratified squamous epithelium
• The mucosa covering the hard palate and the crest of the residual ridge including
the residual attached gingiva is called the Masticatory mucosa
Conti…

■ The submucosa varies in thickness and consistency and it is responsible for

supporting the denture
■ When it is thin, it easily gets traumatized. When it is loosely attached, inflamed
or edematous, it gets easily displaced
■ In denture wearers, the keratinization is reduced and the stratum corneum of
epithelium is thinner
Conti…

■ This reduces the resistance of epithelium to trauma. Removing the dentures

for 6-8 hours everyday can provide rest to the soft tissues

■ Toothbrush physiotherapy over the soft tissues can stimulate keratinization of

the epithelium
ANATOMICAL LANDMARKS IN THE
MAXILLA
The anatomical landmarks in the maxilla are:
■ Limiting Structures
 Labial frenum
 Labial vestibule
 Buccal frenum
 Buccal vestibule
 Hamular notch
 Posterior palatal seal area.
Conti…

■ Supporting Structures
 Primary stress-bearing areas:
 Hard palate (Jacobson and Krol)
 The postero-lateral slopes of the residual alveolar ridge
 Secondary stress-bearing areas:
 Rugae
 Maxillary tuberosity, alveolar tubercle
Conti…

■ Relief Areas:
 Incisive papilla
 Cuspid eminence
 Mid-palatine raphe
 Fovea palatina


Limiting Structures

■ They determine and confine the extent of the denture
Labial Frenum:
 It is a fibrous band covered by mucous membrane that extends from the labial
aspect of the residual ridge to the lip
 It has no muscle fibers
 It is a passive frenum
 A V-shaped notch should be recorded during impression making to
accommodate the labial frenum
 The labial notch of the denture should be narrow but deep enough to avoid
interference
Labial Vestibule

■ It is defined as, “That portion of the oral cavity which is bounded on one side by
the teeth, gingiva, and alveolar ridge (in the edentulous mouth the residual ridge)
and on the other side by the lips and cheeks”
■ It runs from the buccal frenum on one side to the other, on the labial side of the
ridge
■ It is divided into two compartments by a labial frenum namely the right and left
■ The vestibule is covered by the lining mucosa
■ The labial and buccal borders of the denture are not important for a border seal
because the lips and cheeks create a facial seal
Buccal Frenum

■ The buccal frenum separates the labial and buccal vestibule

■ It has attachments of the following muscles,
■ Levator anguli Oris: Attaches beneath the frenum
■ Orbicularis oris: Pulls the frenum in a forward direction
■ Buccinators: Pulls the frenum in the backward direction
Buccal Vestibule

■ It extends from the buccal frenum anteriorly to the Hamular notch posteriorly
■ The size of the buccal vestibule varies with the
 Contraction of buccinators
 Position of the mandible
 Amount of bone loss in the maxilla
Hamular Notch

■ The Hamular notch is a depression situated between the maxillary tuberosity

and the Hamulus of medial pterygoid plate
■ It is soft area of loose areolar tissue. The tissues in this region can be safely
displaced to achieve the posterior palatal seal
■ The distolateral border of the denture base rests in the Hamular notch. The
denture border should extend till the Hamular notch
■ If the border is located anteriorly near the maxillary tuberosity, the denture will
not have any retentive properties because the border seal is absent when
placed over nonresilient tissues
Posterior Palatal Seal Area (Post dam)

■ It is defined as “ The soft tissues at or along the junction of the hard and soft
palates on which pressure within the physiological limits of the tissues can be
applied by a denture to aid in the retention of the denture.”
■ This is the area of the soft palate that contacts the posterior surfaces of the
denture base. It prevents air entry between the denture base and soft palate. It
is the area between the anterior and posterior vibrating lines
Function of Posterior Palatal seal

■ Aids in retention by maintaining constant contact with the soft palate during
functional movements like speech, mastication and deglutition

■ Reduces the tendency for gag reflex as it prevents the formation of the gap
between the denture base and the soft palate during functional movements
Supporting Structures

■ These areas are the load-bearing areas. They show minimal ridge resorption
even under constant load
■ The denture should be designed such that most of the load is concentrated on
these areas
■ The posterolateral slope of the hard plate is the primary stress-bearing area
■ The Rugae area is the secondary stress-bearing area
Hard Palate

■ The anterior region of the palate is formed by the palatine shelves of the
maxillary bone, which meet at the center to form the median suture
■ The horizontal plate of the palatine bone forms the posterior part of the palate
■ The submucosa in the mid-palatine suture is extremely thin. Hence, relief
should be provided in the part of the denture covering the suture
Conti…

■ The horizontal portion of the hard palate lateral to the midline acts as the
primary support area
■ The Rugae area acts as a secondary support area
■ The incisive papillae, nasopalatine canal and the Midpalatine raphe must be
relieved
Residual Ridge

■ It is defined as “The portion of the alveolar ridge and its soft tissue covering
which remains following the removal of teeth.”
■ It resorbs rapidly following extraction and continues throughout life in a reduced
rate
■ The submucosa over the ridge has adequate resiliency to support the denture.
The crest of the ridge may act as a secondary stress-bearing area
■ Loosely attached tissues along the slopes of the ridge cannot withstand the
forces of mastication
■ The posterolateral portion of the residual ridge is a primary stress-bearing area
Rugae

■ These are mucosal folds located in the anterior region of the palatal mucosa
■ They act as a secondary support area
■ The folds of the mucosa play an important role in speech
■ Metal denture bases reproduce this contour making it very comfortable for the
patient
Maxillary Tuberosity

■ It is a bulbous extension of the residual ridge in the second and third molar
region
■ The posterior part of the ridge and the tuberosity areas are considered as one
of the most important areas of support because they are least likely to resorb
■ A rough prominence formed behind the position of the last tooth is called the
Alveolar tubercle
Relief Areas

■ These areas resorb under constant load or contain fragile structures within. The
denture should be designed such that the masticatory load is not concentrated
over these areas
■ Incisive Papilla:
■ It is a midline structure situated behind the central incisors
■ It is the exit point of the nasopalatine nerves and vessels
■ It should be relieved if not, the denture will compress the vessels or nerves and
lead to necrosis of the distributing areas and paresthesia of anterior palate
Conti…

■ Mid-Palatine Raphe:
■ This is the median suture area covered by a thin submucosa. It should be
relieved during denture fabrication. This area is the most sensitive part of the
palate to pressure
■ Fovea Palatine:
■ The fovea is formed by coalescence of the ducts of several mucous glands. This
acts as an arbitrary guide to locate the posterior border of the denture
■ The position of the fovea palatine also influences the position of the posterior
border of the denture
■ The denture can extend 1-2 mm beyond the fovea palatine. The secretion of
the fovea spreads as a thin film on the denture thereby aiding in retention
Cuspid Eminence

■ It is a bony elevation on the residual alveolar ridge formed after extraction of

the canine. It is located between the canine and first premolar region
ANATOMICAL LANDMARKS IN THE
MANDIBLE
 Limiting Structures
■ Labial frenum
■ Labial vestibule
■ Buccal frenum
■ Buccal vestibule
■ Lingual frenum
■ Alveololingual sulcus
■ Retro molar pads
■ Pterygomandibular raphe
Conti…

 Supporting Structures
■ Buccal shelf area
■ Residual alveolar ridge
 Relief Areas
■ Crest of the residual alveolar ridge
■ Mental foramen
■ Genial tubercles
■ Torus mandibularis
Limiting Structures

■ Labial Frenum:
■ It is a fibrous band similar to that found in the maxilla. The muscles, incisive and
orbicularis oris influence this frenum
■ Unlike the maxillary labial frenum, it is active. The mandibular labial frenum
receives attachment from the orbicularis oris muscle. Hence, it is quite
sensitive and active
■ On opening wide, the sulcus gets narrowed. Hence, the impression will be the
narrowest in the anterior labial region
Conti…

 Labial Vestibule:
■ This is the space between the residual alveolar ridge and the lips
■ The length and thickness of the labial flange of the denture occupying this
space is crucial in influencing lip support and retention
 Buccal Frenum:
■ It overlies the depressor anguli oris. The fibers of the buccinators are attached
to the frenum
■ It should be relieved to prevent displacement of the denture during function
Buccal Vestibule

■ It extends posteriorly from the buccal frenum till the retro molar region. It is
bound by the residual alveolar ridge on one side and buccinators on the other
side
■ This space is influenced by the action of masseter. When the masseter
contracts, it pushes inward against the buccinators, producing a bulge into the
mouth
■ This bulge can be recorded only when the masseter contracts. It is reproduced
as a notch in the denture flange called the masseteric notch
Lingual Frenum

■ The height and width of the frenum varies considerably

■ Relief should be provided in the anterior portion of the lingual flange
■ This anterior portion of the lingual flange is called sub-lingual crescent area. A
high-lingual frenum is called a Tongue Tie
■ It should be corrected if it affects the stability of the denture
Alveololingual Sulcus

■ It extends from the lingual frenum to the retro mylohyoid curtain. It is

considered in three regions namely:
■ Anterior region It extends from the lingual frenum to the Premylohyoid fossa,
where the mylohyoid curves below the sulcus
■ Middle region It extends from the pre-mylohyoid fossa to the distal end of the
mylohyoid ridge. This region is shallower than other parts of the sulcus
■ Posterior region The retro-mylohyoid fossa is present here. The denture flange
in this region should turn laterally towards the ramus of the mandible to fill up
the fossa and complete the typical S-form of the lingual flange of the lower
denture
Retro-mylohyoid Fossa

■ It belongs to the posterior part of the alveololingual sulcus. It lies posterior to

the mylohyoid Muscle
■ This fossa is bounded:
 Anteriorly by the retro-mylohyoid curtain
 Posterolaterally by the superior constrictor of the pharynx
 Posteromedially by the palatoglossus and lateral surface of the tongue
 Inferiorly by the sub-mandibular gland
Retro molar Pad

■ The retro molar pad is an important structure, which forms the posterior seal of
the mandibular denture
■ It is a non-keratinized pad of tissue seen as a posterior continuation of the pear
-shaped pad
■ These muscles limit the denture extent and prevent the placement of extra
pressure during impression making
■ The denture base should extend only one half to two third over the retro molar
pad
Pterygomandibular Raphe

■ Pterygomandibular raphe arises from the Hamular process of the medial

pterygoid plate and gets attached to the mylohyoid ridge
■ A raphe is tendinous insertion of two muscles. In this case the superior
constrictor is inserted posteromedially and the buccinators is inserted antero
laterally
Supporting Structures

■ It is very prominent in some patients where a notch-like relief may be required

on the denture
■ The mandibular denture poses a great technical challenge. The support for a
mandibular denture comes from the body of the mandible
■ The available denture-bearing area for an edentulous mandible is 14 cm2 but
for maxilla it is 24 cm2
Buccal Shelf Area

■ It is the area between the buccal frenum and anterior border of the masseter
■ Its boundaries are:
 Medially the crest of the ridge
 Distally the retro-molar pad
 Laterally the external oblique ridge
■ The width of the buccal shelf area increases as alveolar resorption continues
■ It has a thick submucosa overlying a cortical plate. As it lies at right angles to
the occlusal forces, it serves as a primary stress-bearing area.
Residual Alveolar Ridge

■ The edentulous mandible may become flat with a concave denture-bearing

surface
■ In such cases the attaching structures on the lingual side of ridge attach over
the ridge
Relief Areas

 Mylohyoid Ridge:
■ It runs along the lingual surface of the mandible
■ Anteriorly the ridge lies close to the inferior border of mandible while posteriorly,
it lies flush with the residual ridge
■ The thin mucosa over the mylohyoid ridge may get traumatized and should be
relieved
■ The area under this ridge is an undercut
Conti…

 Mental Foramen:
■ It lies between the first and second premolar region
■ Due to ridge resorption, it may lie close to the ridge
■ It should be relieved in these cases as pressure over the nerve produces
paresthesia
 Genial Tubercles:
■ These are a pair of bony tubercles found anteriorly on the lingual side of the
body of the mandible. Due to resorption, it may become increasingly prominent
making denture usage difficult.
Conti…

 Torus Mandibularis:
■ It is an abnormal bony prominence found bilaterally on the lingual side, near the
premolar region
■ It is covered by a thin mucosa
■ It has to be relieved or surgically removed as decided by its size and extent
Reference Book

■ Textbook of Prosthodontics by Deepak Nallaswamy

■ Chapter No 5 Primary Impressions in Complete Denture

THANK
YOU