INTRO TO PROSTHODONTICS ANATOMY OF EDENTULOUS

PROSTHODONTICS
MAXILLA & MANDIBLE
- Branch of dental art and science pertaining to the
restoration and maintenance of oral function by CLASSIFICATION OF MUCOSA
the replacement of missing teeth and associated 1. MASTICATORY MUCOSA – well-defined
structures by artificial devices stratified squamous keratinized layer on its outermost
surface subject to changes in thickness
PROSTHESIS – appliance (bridge, crown, denture) - Found on stress-bearing areas
- Covers the following:
BRANCHES OF PROSTHODONTICS 1. Crest of residual ridge (inc. maxillary tuberosity)
2. Attached gingiva on slopes of the residual ridge
3. Hard palate and palatine rugae
PROSTHODONTICS 2. LINING MUCOSA – stratified squamous non-
keratinized
Removable Fixed Partial Maxillofacial Implant - Covers the following:
Prosthodontics Prosthodontics Prosthodontics Prosthodontics
1. Mucous membrane of the lips, cheeks
2. Vestibular spaces – between the lips, cheeks and
Removable Partial
Denture
Complete Denture the residual alveolar ridge
Prosthodontics
Prosthodontics 3. Alveolo-lingual sulcus – between the tongue and
COMPLETE DENTURE PROSTHESIS residual alveolar ridge
1. CONVENTIONAL – for completely edentulous 4. Soft palate (posterior to vibrating line)
patients 5. Ventral Surface of the tongue
2. IMMEDIATE – patients about to lose their teeth 6. Free gingiva on the slopes of the residual ridge
o Badly carious; beyond restoration 3. SPECIALIZED MUCOSA – keratinized mucosa
3. OVERDENTURE – not completely edentulous seen on the dorsal surface of the tongue
o Implant patients
o No bone resorption. Roots are preserved. CONSISTENCIES OF MUCOSA
1. RESILIENT
OBJECTIVES AND AIMS ü Most ideal type for complete denture.
1. Restore function ü Returns to its original form when distorted
2. Restore phonetics after pressure is applied
3. Provide esthetics 2. NON-RESILIENT (Unyielding)
4. Provide comfort ü very thin mucosa and submucosa
ü Tightly attaches to the ridges.
YMATO FACTOR – Relationship of dentist, patient, and 3. FLABBY
technician. ü More then 3-5mm ridge and wiggly.
- Dentist interacts with both technician and patient. ü Thin mucosa, thick submucosa
- Technician only applies mechanical principles but ü Not a good candidate for CD
cannot analyze biological considerations ü Cannot take an impression of the
anatomical ridge form
PSYCHOLOGICAL CLASSIFICATION OPEN WINDOW IMPRESSION TECHNIQUE – tray
used is perforated. Therefore less pressure to capture the
OF PATIENTS (Dr. House) anatomical ridge form
1. Philosophic
- Accepts dentist's judgement and instructions, best
prognosis. B. HARD & SOFT TISSUE LANDMARKS
2. Exacting/Critical OF THE MAXILLA AND MANDIBLE
- Methodical and demanding, asks a lot of
questions, good prognosis. MAXILLARY ARCH
3. Hysterical/Skeptical 1. Residual Alveolar Ridge
- Emotionally unfit, never happy, worst prognosis. o Resorption of
4. Indifferent the maxillae
- Doesn't care about dental treatment and gives up
easily.
2. Incisive Papilla * Retract check, forward, back and down to capture correct
- Originally found lingually in between the relief area of buccal frenum.
2 maxillary central incisors. * Tray should be extended up to the vestibule.
- Most stable landmark for the midline Overextended = roundness of vestibule not captured
(incisive foramen and nasopalatine nerve Too short = no vestibule
blocking)
- Guide for bone resorption 6. Vestibule
(Moves anteriorly as bone resorbs) - pocket formed by the soft tissue of the
lips/cheeks and the gingiva

3. Maxillary Tuberosity
- Most posterior, bulbous part of the 7. Palatine Fovea
residual alveolar ridge at the 3rd molar - 2 small openings located 2mm posterior to
area. the vibrating line
- Secondary stress-bearing area. - Functions to lubricate mouth via
coalescence of ducts of salivary glands
- Should not be part of the denture or else:
o Can cause gag reflex
o Dislodgement. Lack of saliva
lessens retention of the denture.
- Can be used as a guide for the midline

4. Hamular Notch or Pterygomaxillary

POST-DAM constitutes
hamular notch to the
vibrating line
5. Frenae – fold of tissue that restricts movement - For retention
- Relief area (cannot bear stress/pressure) ** Posterior Palatal Seal Area (PPSA)
a. Labial Frenum – moves vertically - Hamular notch + vibrating line
b. Buccal Frenum – movement is horizontal - Denture base should be extended up to this area
- Orbicularis Oris (buccal frenum forward) - Provides peripheral seal
- Buccinator (buccal frenum back) 9. Rugae
- Levator anguli oris (buccal frenum up) - Irregular folds of tissue on the hard palate
- Not perpendicular to masticatory forces
therefore a secondary stress bearing area
 10. Median Palatine Suture MANDIBULAR ARCH
- Made up of compact bone 1. Retromolarpad
- Covered with a very thin layer mucosa - Most distal part of the residual ridge
like a non-resilient mucosa - Oblong, triangular or pear-shaped
- Considered as a relief area - Primary stress bearing area
o Mucosa is thin, non-keratinized
o Submucosa – made up of
glandular tissue, fibers of
buccinator, superior constrictor,
PMR (pterygomandibular raphe)
and temporal part of the tendon of
the temporalis muscle
- Denture base can be extended 2/3 of the
11. Coronoid Bulge retromolar pad if the patient cannot
- Found at the coronomaxillary/tuberosity tolerate it being extended in the whole part
sulcus area (deepest part of the maxillary of the retromolar pad
buccal vestibule) - 2/3 of the retromolar pad height = occlusal
- Caused by the coronoid process which surface of mandibular molars
moves forward when mouth is opened.
- Therefore, coronomaxillary sulcus
becomes more shallow
- In denture making, phlanges should not
completely invade tuberosity sulcus.

2. Buccal Shelf
- Anteriorly: buccal frenum
Posteriorly: masseteric notch
Laterally: external oblique ridge
Medially: crest of the residual ridge
12. Torus Palatinus - Primary stress bearing area
- Affects retention and support of denture
- Usually removed via surgery
- Wax cannot be used in relieving the area.
Just use tin foil or stones

3. Residual Ridge
- The slope is a primary stress-bearing area
- The crest is composed of spongy bone and
cannot accommodate the occlusal forces

BORDERS OF DENTURE
MAXILLA MANDIBLE
ANT. Labial vestibule (mucolabial fold)
Buccal vestibule
LAT. Buccal shelf
(mucobuccal fold)
Retromolar pad
Hamular notch
POST. Pterygomandibular
Vibrating line 4. Frenae
raphe
Alveolo-lingual sulcus a. Labial
Median palatine b. Buccal
MED. Retromylohyoid
raphe c. Lingual
curtain
5. Alveololingual Sulcus 10. Lingual/Genial Tubercle
- space located between the tongue and the - 4 mental spines
residual ridge - May become too prominent due to
alveolar ridge resorption.
- Can be used as a support if there is no
residual ridge
- Outline can be extended up to this area if
the patient can tolerate
11. Submandibular caruncle
- Opening of the submandibular duct
(Wharton’s duct)

a. Retromylohyoid area
o Deepest part of the vestibule
o Posterior segment and the deepest
part; found below and posterior to
the mylohyoid ridge
o Provides retention and stability
** Insert mouth mirror between the tongue and the
residual ridge, and ask patient to protrude tongue. 12. Torus Mandibularis
- If mouth mirror moves, shallow sulcus. - Common in men
b. Mylohyoid space - Not used for support
o Middle compartment where the - Surgical removal should be done
mylohyoid ridge is found
c. Premylohyoid / Sublingual Crescent
o Crescent shape area on the
anterior part of the alveolo-
lingual sulcus formed by the
lingual wall of the mandible and
the adjacent sublingual fold.
o It runs from canine-to-canine
6. Masseteric notch
- A relief area at the lateral part of the
retromolar pad.
- When the masseter muscle activates it can
lift the denture thus dislodging it
7. Vestibule
- space between lips/cheeks and the
residual alveolar ridge
8. Retromylohyoid curtain
- Curtain-like tissue found behind the
retromylohyoid space
- Sometimes denture base can be extended
up to this area as long as the patient can
tolerate
9. Pterygomandibular raphe
- Part of the oral cavity that connects the
maxilla and the mandible
** If denture base is extended up to this area once
the patient opens the mouth PMR will move
forward thus dislodging the denture
 MAXILLA MANDIBLE
Incisive Papilla
- Needs to be relived because it Crest of the Residual Alveolar Ridge
houses the nasopalatine nerve
Median Palatine Raphe
RELIEF AREAS - Covered by a thin layer of mucous Labial, Buccal, Lingual Frenae
- Must not be membrane
covered by any part Labial and Buccal Frenae Masseteric Notch
of the denture base. Cuspid eminence
- Will result in - After canine extraction, prominent
Mental Foramen
insufficient bony socket may be left
retention, or support underneath
or easy Extensive undercut
Bony Spicules
dislodgement - Cannot recontour the bone
Sharp bones
- When surgical procedures cannot Torus Mandibularis
be done
Torus Palatinus
PRIMARY
STRESS- Hard Palate Buccal Shelf
BEARING AREAS
- Receives
perpendicular forces
of mastication
- Must be covered Crest of Residual Alveolar Ridge Slope of Residual Alveolar Ridge
by denture for even
distribution of load

SECONDARY
STRESS Rugae Retromolar Pad
BEARING AREAS
- Do not receive
perpendicular forces
Slope of Residual Alveolar Ridge
of mastication