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Intraoral Anatomical Landmarks

Prosthodontic Importance of Intraoral Anatomical Landmarks

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Intraoral Anatomical Landmarks

  1. 1. INTRAORAL ANATOMICAL LANDMARKS OF PROSTHODONTIC IMPORTANCE By Dr. Mohammed M. Fouad Prof. of Removable Prosthodontics Faculty of Dentistry Mansoura University
  2. 2. Prof Dr Mohammed M Fouad 2 Objectives: • To give Knowledge's about the intraoral anatomical landmarks (denture bearing areas, and denture boundaries) of prosthodontic importance to fabricate a complete denture that has maximum retention, stability and support with preservation of these underlying and surrounding structures. 23/10/2017
  3. 3. Prof Dr Mohammed M Fouad 323/10/2017
  4. 4. Prof Dr Mohammed M Fouad 4 Intraoral Anatomical Landmarks of prosthetic importance 23/10/2017
  5. 5. Intraoral Maxillary Anatomical landmarks 1. LIMITING STRUCTURES. 2. SUPPORTING STRUCTURES. 3. RELIEF AREAS. 23/10/2017 Prof Dr Mohammed M Fouad 5
  6. 6. Prof Dr Mohammed M Fouad 6 Intraoral Maxillary Anatomical landmarks 1. LIMITING STRUCTURES:  The labial frenum.  The labial vestibule.  The buccal frenum.  The buccal vestibule.  The hamular notch  Soft palate, Vibrating lines and Posterior palatal seal area: 2. SUPPORTING STRUCTURES :  The residual alveolar ridge.  Maxillary tuberosity.  Hard palate (Palatine vault).  Rugae area. 3. RELIEF AREAS:  The incisive papilla.  Median palatine raphe (suture).  Torus palatinus.  The fovea palatina 3. 23/10/2017
  7. 7. Prof Dr Mohammed M Fouad 7 Border structures that limits the periphery of the maxillary denture • The labial frenum • Labial vestibule • Buccal frenum • Buccal vestibule • Hamular notch • Vibrating line of the soft palate 23/10/2017
  8. 8. THE LABIAL FRENUM AND LABIAL VESTIBULE • The labial frenum: • Fold of mucous membrane, no muscle and no action of its own. • A “V” shaped notch should be recorded during impression making and a labial notch in the labial flange of the denture must be just wide and deep enough to accommodate the labial frenum. • The labial vestibule: • It is divided left and right by the labial frenum • Orbicularis oris is the main muscle which forms the outer surface of the labial vestibule . It has only an indirect effect on the labial vestibule because its fibers run in horizontal direction. Prof Dr Mohammed M Fouad 823/10/2017
  9. 9. THE BUCCAL FRENUM AND BUCCAL VESTIBULE • Buccal frenum: • Dividing line between the labial and buccal vestibule. May be single or double. • Levetor anguli oris muscle attaches beneath the frenum. • Orbicularis muscle pulls the frenum forward, and buccinator muscle pulls it backward. • Require more clearence for its action • Buccal vestibule: • Extend from buccal frenum to hamular notch • Bounded laterally by the cheeks and medially by the ridge. • Size of the vestibule varies with the contraction of buccinator muscle, position of the mandible, and amount of bone lost from maxilla. • Adequate depth/width should be recorded • Prof Dr Mohammed M Fouad 923/10/2017
  10. 10. The hamular notch. • Distal limit of the buccal vestibule. • Situated between the tubrosity and hamulus of the medial pterygoid bone. • Aids in achieving posterior palatal seal. Prof Dr Mohammed M Fouad 1023/10/2017
  11. 11. Soft palate, Vibrating lines and Posterior palatal seal area: • Imaginary line across the posterior part of the palate making the division between the movable and immovable tissues of the soft palate which can be identified when the movable tissues are moving Prof Dr Mohammed M Fouad 1123/10/2017
  12. 12. Prof Dr Mohammed M Fouad 12 Residual alveolar ridge Description Significance - The portion of the alveolar process and it's soft tissue covering that remains after extraction. (Arch/Ridge) - Covered by a dense connective tissue fibers so, it is considered as a secondary stress bearing area (resorbed with time). 23/10/2017
  13. 13. Prof Dr Mohammed M Fouad 1323/10/2017
  14. 14. Prof Dr Mohammed M Fouad 1423/10/2017
  15. 15. Prof Dr Mohammed M Fouad 15 Maxillary tuberosity Description Significance -Bony prominence located posterior to the maxillary 3rd molar. - Aid in support, retention and stability maxillary complete denture. - When it is large: 1- Relieved. 2- Modify the path of insertion. 3- Surgical removal. 23/10/2017
  16. 16. Prof Dr Mohammed M Fouad 16 Hard palate and Palatine vault Description Significance •Formed anteriorly by the hard palate and posteriorly by the soft palate. •The palatal surface of the alveolar arch forms the lateral and anterior boundaries of the vault. -The palatal vault may be high and V shaped, or shallow and flat. -The U shaped hard palate is more desirable for denture stability -The horizontal portion of the hard palate is considered the primary stress-bearing area for the upper denture. 23/10/2017
  17. 17. Prof Dr Mohammed M Fouad 17 Incisive papilla Description Significance - Pear-shaped elevation present in the midline behind the 2 centrals. - After extraction of teeth it migrates to the crest of the ridge. - It should be relieved to avoid the burning sensation of the palate. 23/10/2017
  18. 18. Prof Dr Mohammed M Fouad 18 Palatine rugae Description Significance - It is irregular elevations radiates from the midline of the anterior part of the palate. - 2ry stress bearing area. - Prevent forward movement of the denture. - If it is sensitive or prominent it should be relived. 23/10/2017
  19. 19. Prof Dr Mohammed M Fouad 19 Median palatine raphe Description Significance -The mucoperiostium that covers the median palatine suture. - When it is prominent it should be relieved. - Lack of relief cause: 1- rocking of the denture due to bone resorption. 2- Tissue ulceration. 3- Midline denture fracture. 23/10/2017
  20. 20. Prof Dr Mohammed M Fouad 20 Torus palatinus Description Significance - Bony prominence present at both sides of the midline of the palate. - It should be: 1- Relieved. 2- Surgical removal. 23/10/2017
  21. 21. Fovea palatinae Description Significance - Two openings of minor salivary glands present in both sides of the midline posterior to junction of hard and soft palate. - It determines the posterior extension of the upper complete denture to be 2mm posterior to it. Prof Dr Mohammed M Fouad 2123/10/2017
  22. 22. Prof Dr Mohammed M Fouad 22 Interpreting anatomic maxillary landmarks (Impression) 23/10/2017
  23. 23. Intraoral mandibular anatomical landmarks 1. LIMITING STRUCTURES. 2. SUPPORTING STRUCTURES. 3. RELIEF AREAS. Prof Dr Mohammed M Fouad 2323/10/2017
  24. 24. Prof Dr Mohammed M Fouad 24 Intraoral mandibular landmarks 1. LIMITING STRUCTURES:  Labial frenum  Labial vestibule  Buccal frenum  Buccal vestibule  Retromolar bade  Lingual frenum  Lingual pouch (Retromylohyoid Space)  Sublingual fold (Crescent area ) 2. SUPPORTING STRUCTURES :  Residual alveolar ridge  External oblique ridge  Buccal shelf area 3. RELIEF AREAS:  Mental foramen  Torus mandibularis  Internal oblique ridge (mylohyoid ridge)  Genial tubercles 23/10/2017
  25. 25. Prof Dr Mohammed M Fouad 25 Border structures that limits the periphery of the mandibular denture • Labial frenum Labial vestibule • Buccal frenum • Buccal vestibule • Masseter muscle influencing area • Retromolar pad • Lingual border anatomy  Palatoglossal arch  LInguaI pouch  Sublingual salivary gland area  Lingual frenum 23/10/2017
  26. 26. Prof Dr Mohammed M Fouad 26  The labial frenum  The buccal frenum  The lingual frenum  The labial vestibule  The buccal vestibule  The lingual pouch  The sublingual fold (Crescent area ) 23/10/2017
  27. 27. Prof Dr Mohammed M Fouad 27 Retromolar pad: • A pear-shaped bulge of mucous membrane at the posterior end of the mandibular residual alveolar ridge. It is a pad of loose, areolar tissue that contains retromolar mucous glands. • Because of its spongy nature it acts as a cushion or shock absorbent. It also provides a posterior seal for the mandibular denture. 23/10/2017
  28. 28. Prof Dr Mohammed M Fouad 28 Residual Alveolar ridge • The part of the alveolar process and its soft tissue covering that remains after extraction of teeth. • It is formed of cancellous bone, thus it is unsuitable as a primary stress bearing area for mandibular denture. 23/10/2017
  29. 29. Prof Dr Mohammed M Fouad 29 External oblique ridge: • A ridge of dense bone extending from just above the mental foramen superiorly and distally, and then becomes continuous with the anterior border of the ramus of the mandible. • The lower denture should cover but not extend beyond this ridge to avoid denture displacement by the powerful musculature in this area. 23/10/2017
  30. 30. Prof Dr Mohammed M Fouad 30 Buccal shelf area: • It is bounded externally by the external oblique ridge and internally by the slope of the residual ridge. • Its bone is very dense and forces of occlusion can be directed more nearly at right angles to it, so, it is considered as a primary stress bearing area and should be covered by the lower denture to provide support. 23/10/2017
  31. 31. Prof Dr Mohammed M Fouad 31 Mental foramen: • On the buccal surface of the mandible between the roots of the first and second premolar. • The mental nerves and vessels pass through it. • In cases of sever ridge resorption, it is usually located near or on the crest of the ridge. In such cases, relief of the denture is necessary to avoid pain and numbness of the lower lip. 23/10/2017
  32. 32. Prof Dr Mohammed M Fouad 32 Internal oblique ridge (mylohyoid ridge) • A ridge that extends near the inferior border of the mandible in the incisal region, and then it becomes progressively higher posteriorly till terminates just distal to a slight prominence (the lingual tuberosity). It gives attachment to the mylohyoid muscle that forms the floor of the mouth. • It should be included in the denture bearing area. In cases of excessive bone resorption, the mylohyoid ridge comes to lie close to the crest of the residual ridge. When it is sharp and prominent, it should be reduced surgically or otherwise relieved. 23/10/2017
  33. 33. Prof Dr Mohammed M Fouad 33 Torus mandibularis : • A unilateral or bilateral bony projection sometimes found on the inner surface of the premolar region in the mandible. Covered by a thin mucous membrane. • Relief of the lower denture in this area is necessary. When it is large, and interferes with the seating of denture, it should be surgically removed. 23/10/2017
  34. 34. Prof Dr Mohammed M Fouad 34 Genial tubercles: • Two small prominences on the inner surface of the mandible, one on each side of the symphesis. The genio- glossi muscles are attached to their upper surface and the geniohyoid to their lower surfaces. • In extreme alveolar bone resorption; they may be located on the crest of the ridge. In such cases relief of the lower denture must be made opposite to their position. 23/10/2017
  35. 35. Prof Dr Mohammed M Fouad 35 Interpreting anatomic mandibular landmarks (Impression) 23/10/2017
  36. 36. Conclusion: Thus, a sound knowledge of the anatomical landmarks of the edentulous jaw is a prerequisite if one has to achieve the objective of fabricating a complete denture that has maximum retention, stability and support with preservation of underlying structures with minimum post insertion problems. 23/10/2017 Prof Dr Mohammed M Fouad 36
  37. 37. Prof Dr Mohammed M Fouad 37 Questions: • Discuss the Prosthodontic importance of: 1. Buccal shelf area 2. Fovea palatinae 3. Incisive papilla 4. Palatine vault • Discuss border structures that limits the periphery of the maxillary denture. • Discuss border structures that limits the periphery of the mandibular denture. 23/10/2017
  38. 38. References: • Boucher's Prosthodontics • Essential of complete denture prosthesis by Sheldon Winkler • Clinical dental prosthetics by h r b fenn 23/10/2017 Prof Dr Mohammed M Fouad 38
  39. 39. Prof Dr Mohammed M Fouad 39 Thank you 23/10/2017

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