Applied Anatomy : Maxillary Denture Bearing Area

Convener & Guide Dr Suraj R.B Mathema Professor Dept. of Prosthodontics & Maxillofacial Prosthetics

Dr. Rinu Sharma 1st year P.G Resident Dept of Prosthodontics & Maxillofacial Prosthetics

Content
Definition Importance of maxillary denture bearing area Denture Foundation area : micro anatomy Supporting structures Limiting structures Relief areas Conclusion Reference
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Definition
Denture bearing area/ Denture foundation area :
The surfaces of the oral structures available to support a denture. - GPT

Importance of maxillary denture bearing area

Helps to determine : The selective placement of forces by the denture bases upon the supporting tissues The form of the denture borders in harmony with the normal function of the limiting structures that surround them

Denture Foundation area of maxilla

1. Bone : hard palate residual ridge

2. Mucous membrane: mucosa submucosa

Histologic diagram of maxillary denture bearing area Bone

Sub mucosa

Mucosa
The soft tissues act as cushion between(bone & denture base) & also helps to increase the surface area of the basal seat 6

Bone
Hard palate :
Two maxilla and the palatine bone. Palatine process of maxilla joined in midline forming median palatal suture.

Residual alveolar ridge :

Alveolar process forms - as primary & permanent teeth develop & erupt . Bony process that remains after teeth has been lost including mucous membrane that covers the bone.

Mucous membrane
Mucosa : stratified squamous epithelium which is often keratinized Lamina propria

Depending on the location

Oral mucosa

Masticatory mucosa

Lining mucosa

Specialized mucosa

covers dorsal surface of crest of residual covering of lips & cheeks, ridge & hard vestibular spaces,soft palate, tongue & includes palate alveolingual sulcus, ventral specialized papillae on surface of tongue, slopes of upper surface of tongue. residual ridge 10

Sub mucosa
Formed by loose or areolar connective tissue Varies considerably in width & thickness according to location Contains glandular , fat & muscle cells . Helps in blood & nerve supply to mucosa Attached to bone through periosteum

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Applied aspect
Thickness & consistency of sub mucosa is responsible for the support of dentures Thin sub mucosal layer small movements will tend to break retentive seal If loosely attached to periosteum or inflammed / edematous support & stability of dentures adversely affected
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Anatomic structures
Limiting structures Supporting structures Relief areas

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Limiting structures
Those structures which limit the extent of denture base . The denture base should include maximum surface possible within the health & function of tissues.

Labial frenum Labial vestibule Buccal frenum Buccal vestibule Hamular notch Vibrating line
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Labial frenum
Single band of fibrous connective tissue Superiorly fan shaped , converges to the labial side of ridge No muscle of its own

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 When activated it creates labial notch in the labial flange of denture base.

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 During border molding lip should be elevated and extended outward, downward and inward

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 Overzealous lateral movement can cause labial notch that is too wide. Can cause loss of seal especially when patient has short and active lip.

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A - correct contour B incorrect contour.

C - area should have been covered.

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Labial vestibule
Extends between right and left buccal frenums

Labial frenum divides it into right and left labial vestibule

Orbicularis oris : main muscle of lip. Fibres horizontal, anastomose with fibres of buccinator. - tone depends on support from labial flange

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Applied aspects
The impression on the area of labial vestibule should
Be in accordance to the amount of bone loss from the labial side (thicker flange obliterates philtrum)

labial flange must have sufficient height to reach the reflecting mucous membrane (inappropriate height causes loss of seal)

No interference with the action of lip function

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Microscopic anatomy of vestibule

Relatively thin epithelium, non keratinized Thick sub mucosa contains large amount of loose areolar tissue & elastic fibers. thus easily movable tissue Hence, chances of over extension.
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Buccal frenum
Single or double folds of mucous membrane. Broad and fan shaped.

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Moves with muscles during speech and mastication: 1. Levator anguli oris - attaches beneath frenum effects its position 2. Orbicularis oris - pulls it forward 3. Buccinator - pulls it backward
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Applied aspect
The buccal notch in the denture should be broad enough to allow movement of frenum Depth and width should be properly recorded during border molding Resembles v shape

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Border molding
Cheek elevated and pulled outward, downward & inward Also moved backward & forward

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Buccal vestibule
Extends from buccal frenum to hamular notch Influenced by buccinator muscle, modiolus and distally by coronoid process i. ii. iii. Size depends on Contraction of buccinator Position of mandible Amount of bone loss from maxilla
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Applied aspects
When ridges are flat, zygomatic or malar process usually requires relief to prevent soreness

During impression making if buccal space width is recorded narrower ; then the action of buccinator will displace the denture. Whereas if appropriate width it aids in retention of the denture

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Border molding of buccal vestibule

Cheek extended outward, downward & inward Patient also asked to open mouth wide & move mandible from side to side

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Hamular notch
Displaceable area about 2mm wide between tuberosity of maxilla and the hamulus of the pterygoid plate
Microscopically, Submucosa is thick & made up of loose areolar tissue

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Applied aspect
Used as a boundary of the posterior border of the denture Overextension will cause extreme discomfort due to interference with ascending ramus of mandible Additional pressure by the denture can be placed on this area because histological nature allows it to be displaced without trauma.
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Clinically,
This area can be accomplished by using a mouth mirror, so that the area drops into definite depression

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Vibrating Line
It is an imaginary line across the posterior part of the palate marking the division between the movable and immovable tissues of the soft palate (GPT8) It extends from one hamular notch to the other , with midline usually 2 mm infront of the fovea palatinae
Always on the soft palate

2 mm

Fovea palatinae

microscopically
Submucosa contains glandular tissue but it does not directly rest on bone , Thus the tissues for few millimeters can be repositioned during impression to improve posterior palatal seal.

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Function
Improves border seal, Prevents food impaction beneath the denture, improves retention

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Clinical consideration
Posterior border of denture should extend at least to Vibrating line. It should end 1-2 mm posterior to vibrating line.

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Supporting structures
Support is the resistance to displacement towards basal tissue or underlying structures Primary stress bearing area :
the horizontal portion of hard palate lateral to midline

Secondary stress bearing area

Rugae area residual alveolar ridge

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Hard palate
Microscopically,
Soft tissues covering hard palate is keratinized through out with varying depth. Thus, it is important to employ an impression technique that equalizes the pressure distribution

Antero laterally sub mucosa contains adipose tissue and postero laterally it contains glandular tissue.
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 Applied aspect : these tissues should be recorded in resting condition because when they are displaced in final impression, they tend to return to normal form within denture base creating soreness in patients mouth

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According to shape
Flat palate resists vertical displacement but easily displaced by lateral / torquing force
Flat palate

Rounded / U-shaped palate best resistance to both forces V-shaped palate any vertical or torquing force tend to break the seal ( associated with class III throat form ) difficult to place adequate posterior palatal seal.
rRounded

V - shaped
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Rugae
Raised area of dense connective tissue radiating from midline to anterior one third of palate Resists the forward movement of denture

Palate is set at an angle to the occlusal plane

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Residual alveolar ridge

Mucous membrane covering crest of residual ridge is firmly attached to periosteum & is thickly keratinized
Submucosa is devoid of fat or glandular cells but characterized by presence of collagenous fibers contiguous with lamina propria
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Contd..
outer surface of bone is compact and made up of haversian systems Mucous membrane towards slope of the ridge are more loosely attached & has none / slightly keratinized epithelium

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Contd..
Crest of residual ridge is subjected to resorption which limits its potential for support (unlike palate which is resistant to resorption)

Maximum resorption in the 1st yr and subsequently decreases in intensity but continues throughout

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Maxillary tuberosity
These are the distal aspect of posterior ridges

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Applied aspect
In case of over eruption of maxillary posteriors, they bring the maxillary process along with them Thus enlarged tuberosity can interfere with mandibular denture & also with coronoid process during opening, lateral jaw movements

This may require surgical reduction of the tuberosities.

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Relief areas
Incisive papilla Mid-palatine raphe Cuspid eminence Fovea palatini

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Incisive papilla
Pad of fibrous connective tissue overlying bony exit of nasopalatine blood vessels & nerves Should be relieved because denture pressure on papilla can cause paresthesia, pain & burning sensation
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Applied aspects
1. It can indicate rate of resorption. Excessive bony resorption makes the papilla lie on the crest of ridge

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2. Rough guide in locating antero-posterior positioning of central incisors

8-10mm

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 Helps in determining vertical dimension of occlusion Incisive papilla to maxillary incisal edge= 6mm Overlap of upper & lower incisors= 2mm So, incisive papilla to mandibular incisors = 4mm.

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Cuspid eminence
Bony elevation on the residual alveolar ridge formed after extraction of the canine Located between the canine and the first premolar

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Mid palatal raphae

Extends from incisive papilla to distal end of the hard palate Palatine processes of maxillae are joined here.
Submucosa: extremely thin (mucosal layer practically in contact with underlying bone) nonresilient- should be relieved

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Clinical consideration
If this area is not relieved:
i. Tissue irritation ii. Rocking of the denture due to resorption

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Fovea palatini
Bilateral indentations near the midline of palate Formed by coalescence of several mucous gland ducts Usually it lies posterior to junction of hard and soft palate But not considered as a stable landmark
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Clinical consideration
Denture should extend 1-2 mm posterior to it In patients with thick saliva, the fovea palatine should be left uncovered or else thick saliva flowing between the tissue and the denture can increase the hydrostatic pressure and displace the denture

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Conclusion
The clinical procedures used in making impression are directly related to gross anatomic structures of oral cavity & their function.

For the ultimate success of denture, along with the fabrication of a functional , anatomic and aesthetic prosthesis , the preservation of the residual ridges & comfort of the patient with the prosthesis should be given prime importance.
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References
Prosthodontics treatment for edentulous patients-Zarb Bolender, 12th edition Principles and practices of complete dentures-Iwao Hayakawa

Textbook of Complete Denture-Arthur O. Rahn,Charles M. Heartwell Jr.,5th edition

Complete denture manual-Robert W. Loney,2009 Oral surgery-Fragiskos D. Fragiskos,2007 Investigation of Vertical Distance between Incisive Papilla and Incisal Edge of Maxillary Central Incisors-M. Ustun Guldag,a Fatih Sentut,b and U. Sebnem Buyukkaplan;Eur J Dent. 2008 July; 2: 161166.

THANK YOU
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