4th year Lect.

Prosthodontics
Anatomy and physiology as related to dental prosthesis
In order to construct a prosthesis a dentist require an understanding and a
thorough knowledge of the anatomy and physiology of the supporting
structures to assure successful results.

Osteology
The osseous structures not only support the denture but have a direct
relation on the impression making procedure, position of teeth and the
contours of the finished denture.
It is quite essential to have knowledge of the tissues that support the
maxillary and the mandibular dentures. These tissues also help the dentures
in obtaining their retention and stability. There are certain tissue areas or
regions in the maxillary and mandibular edentulous foundations, which are
better suited to bear the stresses due to mastication, and are called as stress
bearing areas. While there are other tissue areas which are not quite suited
to take up these stresses, either due to their anatomy or due to the structures
that lie beneath them and are called stress relief areas. The structures which
limit the extension of the maxillary and mandibular complete dentures are
called border-limiting areas.

The mucous membrane that lines the oral cavity varies in character in
different zones and denture border depends on the function of the different
zones. The sub-mucosa, which is a connective tissue, attaches the mucosa
to the underlying structures. The submucosa varies in composition
depending on whether the mucosa is firmly or loosely attached to the bony
structure and whether there is muscle tissue between itself and the
underlying bone. The blood vessels present in the submucosa supply blood
to the edentulous foundation and the nerves innervate it.
Factors that influence the form and size of the supporting
bone include the following:
1. The original size and arch form before extractions.
2. The severity of periodontal disease.
3. Amount of alveoloplasty at the time of tooth extraction.
4. Forces developed by the surrounding musculature.
5. Forces accruing from the wearing of dental prostheses.
6. The relative length of time different parts of the jaws have been
edentulous.
7. Unknown genetic predisposition to bone resorption.
1
 ‫ﻣﺘﺮﺟﻢ ﻣﻦ ﺍﻹﻧﺠﻠﻴﺰﻳﺔ ﺇﻟﻰ ﺍﻟﻌﺮﺑﻴﺔ ‪www.onlinedoctranslator.com -‬‬

‫ﺍﻟﺘﺮﻛﻴﺒﺎﺕ‬ ‫‪4‬ﺍﻟﻌﺎﺷﺮﺍﻟﻌﺎﻡ ‪.Lect‬‬

‫ﻋﻠﻢﺍﻟﺘﺸﺮﻳﺢ ﻭﻭﻇﺎﺉﻒ ﺍﻷﻋﻀﺎء ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ ﺑﺎﻷﻃﺮﺍﻑ ﺍﻟﺼﻨﺎﻋﻴﺔ ﺍﻟﺴﻨﻴﺔ‬

‫ﻣﻦﺃﺟﻞ ﺑﻨﺎء ﻃﺮﻑ ﺍﺻﻄﻨﺎﻋﻲ ‪ ،‬ﻳﺤﺘﺎﺝ ﻃﺒﻴﺐ ﺍﻷﺳﻨﺎﻥ ﺇﻟﻰ ﻓﻬﻢ ﻭﻣﻌﺮﻓﺔ ﺷﺎﻣﻠﺔ‬
‫ﺑﺘﺸﺮﻳﺢﻭﻭﻇﺎﺉﻒ ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﺪﺍﻋﻤﺔ ﻟﻀﻤﺎﻥ ﻧﺘﺎﺉﺞ ﻧﺎﺟﺤﺔ‪.‬‬

‫ﻋﻠﻢﺍﻟﻌﻈﺎﻡ‬
‫ﻻﺗﺪﻋﻢ ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﻌﻈﻤﻴﺔ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﻓﺤﺴﺐ ‪ ،‬ﺑﻞ ﻟﻬﺎ ﻋﻼﻗﺔ ﻣﺒﺎﺷﺮﺓ ﺑﻌﻤﻠﻴﺔ‬
‫ﺗﻜﻮﻳﻦﺍﻻﻧﻄﺒﺎﻉ ‪ ،‬ﻭﻣﻮﺿﻊ ﺍﻷﺳﻨﺎﻥ ﻭﺧﻄﻮﻁ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻨﻬﺎﺉﻴﺔ‪.‬‬

‫ﻣﻦﺍﻟﻀﺮﻭﺭﻱ ﺟﺪﺍً ﻣﻌﺮﻓﺔ ﺍﻷﻧﺴﺠﺔ ﺍﻟﺘﻲ ﺗﺪﻋﻢ ﺃﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻔﻜﻴﺔ ﻭﺍﻟﻔﻜﻴﺔ‪ .‬ﺗﺴﺎﻋﺪ‬
‫ﻫﺬﻩﺍﻷﻧﺴﺠﺔ ﺃﻳﻀﺎً ﺃﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﻓﻲ ﺍﻻﺣﺘﻔﺎﻅ ﺑﻬﺎ ﻭﺍﺳﺘﻘﺮﺍﺭﻫﺎ‪ .‬ﻫﻨﺎﻙ ﻣﻨﺎﻃﻖ ﺃﻭ‬
‫ﻣﻨﺎﻃﻖﻧﺴﻴﺠﻴﺔ ﻣﻌﻴﻨﺔ ﻓﻲ ﺃﺳﺎﺳﺎﺕ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﻭﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ‪ ،‬ﻭﺍﻟﺘﻲ ﻫﻲ ﺃﻛﺜﺮ‬
‫ﻣﻼءﻣﺔﻟﺘﺤﻤﻞ ﺍﻟﻀﻐﻮﻁ ﺍﻟﻨﺎﺗﺠﺔ ﻋﻦ ﺍﻟﻤﻀﻎ ‪ ،‬ﻭﺗﺴﻤﻰ ﺑﺎﺳﻢﻣﻨﺎﻃﻖ ﺗﺤﻤﻞ ﺍﻟﻀﻐﻂ‪.‬‬
‫ﻓﻲﺣﻴﻦ ﺃﻥ ﻫﻨﺎﻙ ﻣﻨﺎﻃﻖ ﻧﺴﻴﺠﻴﺔ ﺃﺧﺮﻯ ﻏﻴﺮ ﻣﻨﺎﺳﺒﺔ ﺗﻤﺎﻣﺎً ﻟﺘﺤﻤﻞ ﻫﺬﻩ ﺍﻟﻀﻐﻮﻁ ‪،‬‬
‫ﺇﻣﺎﺑﺴﺒﺐ ﺗﺸﺮﻳﺤﻬﺎ ﺃﻭ ﺑﺴﺒﺐ ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﺘﻲ ﺗﻘﻊ ﺗﺤﺘﻬﺎ ﻭﺗﺴﻤﻰﻣﻨﺎﻃﻖ ﺗﺨﻔﻴﻒ‬
‫ﺍﻟﺘﻮﺗﺮ‪ .‬ﺗﺴﻤﻰ ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﺘﻲ ﺗﺤﺪ ﻣﻦ ﺍﻣﺘﺪﺍﺩ ﺃﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻜﺎﻣﻠﺔ ﻟﻠﻔﻚ ﺍﻟﻌﻠﻮﻱ‬
‫ﻭﺍﻟﻔﻚﺍﻟﺴﻔﻠﻲﺍﻟﻤﻨﺎﻃﻖ ﺍﻟﺤﺪﻭﺩﻳﺔ‪.‬‬

‫ﻳﺨﺘﻠﻒﺍﻟﻐﺸﺎء ﺍﻟﻤﺨﺎﻃﻲ ﺍﻟﺬﻱ ﻳﺒﻄﻦ ﺗﺠﻮﻳﻒ ﺍﻟﻔﻢ ﻓﻲ ﻃﺒﻴﻌﺘﻪ ﻓﻲ ﻣﻨﺎﻃﻖ ﻣﺨﺘﻠﻔﺔ‬

‫ﻭﺗﻌﺘﻤﺪﺣﺪﻭﺩ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﻋﻠﻰ ﻭﻇﻴﻔﺔ ﺍﻟﻤﻨﺎﻃﻖ ﺍﻟﻤﺨﺘﻠﻔﺔ‪ .‬ﺍﻟﻐﺸﺎء ﺍﻟﻤﺨﺎﻃﻲ‬
‫ﺍﻟﻔﺮﻋﻲ ‪،‬ﻭﻫﻮ ﻧﺴﻴﺞ ﺿﺎﻡ ‪ ،‬ﻳﺮﺑﻂ ﺍﻟﻐﺸﺎء ﺍﻟﻤﺨﺎﻃﻲ ﺑﺎﻟﻬﻴﺎﻛﻞ ﺍﻷﺳﺎﺳﻴﺔ‪ .‬ﻳﺨﺘﻠﻒ‬
‫ﺗﻜﻮﻳﻦﺍﻟﻄﺒﻘﺔ ﺗﺤﺖ ﺍﻟﻤﺨﺎﻃﻴﺔ ﺍﻋﺘﻤﺎﺩﺍً ﻋﻠﻰ ﻣﺎ ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﻐﺸﺎء ﺍﻟﻤﺨﺎﻃﻲ ﻣﺮﺗﺒﻄﺎً‬
‫ﺑﻘﻮﺓﺃﻭ ﻓﻀﻔﺎﺿﺔ ﺑﺎﻟﻬﻴﻜﻞ ﺍﻟﻌﻈﻤﻲ ﻭﻣﺎ ﺇﺫﺍ ﻛﺎﻥ ﻫﻨﺎﻙ ﻧﺴﻴﺞ ﻋﻀﻠﻲ ﺑﻴﻨﻪ ﻭﺑﻴﻦ‬
‫ﺍﻟﻌﻈﻢﺍﻷﺳﺎﺳﻲ‪ .‬ﺗﻤﺪ ﺍﻷﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﻤﻮﺟﻮﺩﺓ ﻓﻲ ﺍﻟﻄﺒﻘﺔ ﺗﺤﺖ ﺍﻟﻤﺨﺎﻃﻴﺔ ﺑﺎﻟﺪﻡ‬
‫ﺇﻟﻰﺍﻷﺳﺎﺱ ﺍﻟﻼ ﺃﺳﻨﺎﻥ ﻭﺍﻷﻋﺼﺎﺏ ﺗﻌﺼﺒﻬﺎ‪.‬‬

‫ﺗﺸﻤﻞﺍﻟﻌﻮﺍﻣﻞ ﺍﻟﺘﻲ ﺗﺆﺛﺮ ﻋﻠﻰ ﺷﻜﻞ ﻭﺣﺠﻢ ﺍﻟﻌﻈﻢ ﺍﻟﺪﺍﻋﻢ ﻣﺎ ﻳﻠﻲ‪:‬‬

‫‪.1‬ﺍﻟﺤﺠﻢ ﺍﻷﺻﻠﻲ ﻭﺷﻜﻞ ﺍﻟﻘﻮﺱ ﻗﺒﻞ ﺍﻻﺳﺘﺨﺮﺍﺝ‪.‬‬

‫‪.2‬ﺷﺪﺓ ﻣﺮﺽ ﺍﻟﻠﺜﺔ‪.‬‬
‫‪.3‬ﻛﻤﻴﺔ ﺭﺃﺏ ﺍﻟﺤﻮﻳﺼﻼﺕ ﺍﻟﻬﻮﺍﺉﻴﺔ ﻭﻗﺖ ﻗﻠﻊ ﺍﻟﺴﻦ‪.‬‬
‫‪.4‬ﺍﻟﻘﻮﻯ ﺍﻟﺘﻲ ﻳﻄﻮﺭﻫﺎ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﻀﻠﻲ ﺍﻟﻤﺤﻴﻂ‪.‬‬
‫‪.5‬ﺍﻟﻘﻮﻯ ﺍﻟﻨﺎﺷﺉﺔ ﻋﻦ ﻟﺒﺲ ﺍﻷﺳﻨﺎﻥ ﺍﻻﺻﻄﻨﺎﻋﻴﺔ‪.‬‬
‫‪.6‬ﺍﻟﻄﻮﻝ ﺍﻟﻨﺴﺒﻲ ﻟﻠﻮﻗﺖ ﻛﺎﻧﺖ ﺍﻷﺟﺰﺍء ﺍﻟﻤﺨﺘﻠﻔﺔ ﻣﻦ ﺍﻟﻔﻜﻴﻦ ﻣﺘﻘﻄﻌﺔ‪.‬‬

‫‪.7‬ﺍﺳﺘﻌﺪﺍﺩ ﻭﺭﺍﺛﻲ ﻏﻴﺮ ﻣﻌﺮﻭﻑ ﻻﺭﺗﺸﺎﻑ ﺍﻟﻌﻈﺎﻡ‪.‬‬

‫‪1‬‬
STRUCTURES RELATED TO THE MAXILLARY AND
MANDIBULAR DENTURE EDENTULOUS FOUNDATION
These structures can be divided into two categories:
1. Supporting structures: These are the structures that support the denture
2. Border limiting structures: These are the structures that limit the border
extent of the denture (maxillary and mandibular denture).

Osteology of the oral cavity: the maxilla:

The maxillary denture is supported by two pairs of bone the maxillae and
the palatine bones whereas the mandibular denture is supported by one
bone the mandible. There are two maxillae each consisting of a central
body and four processes: alveolar, frontal, zygomatic and palatine. Some
area of the body and two of the processes are involved in the support of the
maxillary denture.

Supporting Structures in the Maxillary Edentulous Foundation

1. Zygomatico-alveolar crest (malar process).
2. Alveolar process
3. The palatine bone
4. Palatine process of the maxilla
5. The incisive fossa
6. The pterygoid hamulus
7. Maxillary tuberosity
8. The greater palatine foramen
9. Cuspid eminence.

2
 ‫ﺍﻟﻬﻴﺎﻛﻞﺍﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻷﺳﻨﺎﻥ ﺍﻟﻔﻜﻴﺔ ﻭﺍﻟﻔﻜﻴﺔ‬

‫ﻳﻤﻜﻦﺗﻘﺴﻴﻢ ﻫﺬﻩ ﺍﻟﻬﻴﺎﻛﻞ ﺇﻟﻰ ﻓﺉﺘﻴﻦ‪:‬‬

‫‪.1‬ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﺪﺍﻋﻤﺔ‪ :‬ﻫﺬﻩ ﻫﻲ ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﺘﻲ ﺗﺪﻋﻢ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ‬
‫‪.2‬ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﺘﻲ ﺗﺤﺪ ﻣﻦ ﺍﻟﺤﺪﻭﺩ‪ :‬ﻫﺬﻩ ﻫﻲ ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﺘﻲ ﺗﺤﺪ ﻣﻦ ﺍﻻﻣﺘﺪﺍﺩ ﺍﻟﺤﺪﻭﺩﻱ‬
‫ﻟﻄﻘﻢﺍﻷﺳﻨﺎﻥ )ﻃﻘﻢ ﺃﺳﻨﺎﻥ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﻭﺍﻟﺴﻔﻠﻲ(‪.‬‬

‫ﻋﻈﺎﻡﺗﺠﻮﻳﻒ ﺍﻟﻔﻢ‪ :‬ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ‪:‬‬

‫ﻳﺘﻢﺩﻋﻢ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻔﻜﻲ ﺑﻮﺍﺳﻄﺔ ﺯﻭﺟﻴﻦ ﻣﻦ ﻋﻈﺎﻡ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﻭﻋﻈﺎﻡ ﺍﻟﺤﻨﻚ‬
‫ﺑﻴﻨﻤﺎﻳﺘﻢ ﺩﻋﻢ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ﺑﻮﺍﺳﻄﺔ ﻋﻈﻢ ﻭﺍﺣﺪ ﻫﻮ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ‪.‬‬
‫ﻫﻨﺎﻙﻧﻮﻋﺎﻥ ﻣﻦ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﻳﺘﻜﻮﻥ ﻛﻞ ﻣﻨﻬﻤﺎ ﻣﻦ ﺟﺴﻢ ﻣﺮﻛﺰﻱ ﻭﺃﺭﺑﻊ ﻋﻤﻠﻴﺎﺕ‪:‬‬
‫ﺳﻨﺨﻴﺔ ‪،‬ﻭﺟﺒﻬﺔ ‪ ،‬ﻭﻭﺟﻨﻴﺔ ‪ ،‬ﻭﺣﻨﻔﻴﺔ‪ .‬ﺗﺸﺎﺭﻙ ﺑﻌﺾ ﻣﻨﺎﻃﻖ ﺍﻟﺠﺴﻢ ﻭﺍﺛﻨﺘﺎﻥ ﻣﻦ‬
‫ﺍﻟﻌﻤﻠﻴﺎﺕﻓﻲ ﺩﻋﻢ ﺃﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻔﻜﻴﺔ‪.‬‬

‫ﺍﻟﻬﻴﺎﻛﻞﺍﻟﺪﺍﻋﻤﺔ ﻓﻲ ﻣﺆﺳﺴﺔ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﺍﻟﻔﻜﻲ‬

‫‪.1‬ﻗﻤﺔ ‪) Zygomatico-alveolar‬ﻋﻤﻠﻴﺔ ﺍﻟﻤﻼﺭ(‪.‬‬
‫‪.2‬ﻋﻤﻠﻴﺔ ﺍﻟﺴﻨﺨﻴﺔ‬
‫‪.3‬ﻋﻈﻢ ﺍﻟﺤﻨﻚ‬
‫‪.4‬ﻋﻤﻠﻴﺔ ﺣﻨﻜﻴﺔ ﻣﻦ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ‬
‫‪.5‬ﺍﻟﺤﻔﺮﺓ ﺍﻟﻘﺎﻃﻌﺔ‬
‫‪.6‬ﺍﻟﺤﺎﻣﻞ ﺍﻟﺠﻨﺎﺣﻲ‬
‫‪.7‬ﺍﻟﺤﺪﺑﺔ ﺍﻟﻌﻠﻮﻳﺔ‬
‫‪.8‬ﺍﻟﺜﻘﺒﺔ ﺍﻟﺤﻨﻜﻴﺔ ﺍﻟﻜﺒﺮﻯ‬
‫‪.9‬ﺳﻤﺎﺣﺔ ﺃﻧﺒﻮﺑﺔ‪.‬‬

‫‪2‬‬
Zygomatico-alveolar crest (malar process):
This is located opposite the 1st molar region some denture require relief
over this area to prevent soreness and aid in retention especially in sever
resorbed ridge.

Alveolar process:
It arises from the lower surface of the maxilla. It consists of two parallel
plates of cortical bone which unite behind the last molar to form the
tuberosity. The part of the alveolar process that remain after loss of teeth
is called the residual alveolar ridge. The maxillary ridge act as a secondary
stress bearing area. The slopes of the ridges do help in the stability of the
denture during function. Hence, some of the stress does get transmitted
through the slopes.

The palatine processes of maxillary bone:

They arises as horizontal plates from the body of the maxilla. The two
plates unite in the mid line forming the mid palatine suture. Sometime
overgrowth of bone seen in this area called torus palatinus. The hard palate
resist resorption (primary stress bearing area).
The area of sutural joint (mid palatal raphe) is covered by firmly adherent
mucous membrane to the underlying bone with little submucosal tissue.
There is, therefore, no resiliency in this region and stress cannot be applied

3
 ‫ﻗﻤﺔ‪) Zygomatico-alveolar‬ﻋﻤﻠﻴﺔ ﺍﻟﻤﻼﺭ(‪:‬‬
‫ﻳﻘﻊﻫﺬﺍ ﻣﻘﺎﺑﻞ ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﻤﻮﻟﻴﺔ ﺍﻷﻭﻟﻰ ‪ ،‬ﺑﻌﺾ ﺃﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺗﺘﻄﻠﺐ ﺭﺍﺣﺔ ﻓﻮﻕ‬
‫ﻫﺬﻩﺍﻟﻤﻨﻄﻘﺔ ﻟﻤﻨﻊ ﺍﻷﻟﻢ ﻭﺍﻟﻤﺴﺎﻋﺪﺓ ﻓﻲ ﺍﻻﺣﺘﻔﺎﻅ ﺧﺎﺻﺔ ﻓﻲ ﺍﻟﺘﻼﻝ ﺷﺪﻳﺪﺓ‬
‫ﺍﻻﻣﺘﺼﺎﺹ‪.‬‬

‫ﻋﻤﻠﻴﺔﺍﻟﺴﻨﺨﻴﺔ‪:‬‬
‫ﻳﻨﺸﺄﻣﻦ ﺍﻟﺴﻄﺢ ﺍﻟﺴﻔﻠﻲ ﻟﻠﻔﻚ ﺍﻟﻌﻠﻮﻱ‪ .‬ﻳﺘﻜﻮﻥ ﻣﻦ ﺻﻔﻴﺤﺘﻴﻦ ﻣﺘﻮﺍﺯﻳﺘﻴﻦ ﻣﻦ‬
‫ﺍﻟﻌﻈﻢﺍﻟﻘﺸﺮﻱ ﺗﺘﺤﺪﺍﻥ ﺧﻠﻒ ﺍﻟﻀﺮﺱ ﺍﻷﺧﻴﺮ ﻟﺘﺸﻜﻴﻞ ﺍﻟﺤﺪﺑﺔ‪ .‬ﻳﺴﻤﻰ ﺍﻟﺠﺰء ﻣﻦ‬
‫ﺍﻟﻌﻤﻠﻴﺔﺍﻟﺴﻨﺨﻴﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ ﺑﻌﺪ ﻓﻘﺪﺍﻥ ﺍﻷﺳﻨﺎﻥ ﺑﺎﻟﺤﺎﻓﺔ ﺍﻟﺴﻨﺨﻴﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ‪ .‬ﺗﻌﻤﻞ‬
‫ﺍﻟﺤﺎﻓﺔﺍﻟﻌﻠﻮﻳﺔ ﻛﻤﻨﻄﻘﺔ ﺗﺤﻤﻞ ﺿﻐﻂ ﺛﺎﻧﻮﻱ‪.‬ﺗﺴﺎﻋﺪ ﻣﻨﺤﺪﺭﺍﺕ ﺍﻟﺤﻮﺍﻑ ﻓﻲ ﺍﺳﺘﻘﺮﺍﺭ‬
‫ﻃﻘﻢﺍﻷﺳﻨﺎﻥ ﺃﺛﻨﺎء ﺍﻟﻮﻇﻴﻔﺔ‪ .‬ﻭﻣﻦ ﺛﻢ ‪ ،‬ﻳﻨﺘﻘﻞ ﺑﻌﺾ ﺍﻟﻀﻐﻂ ﻋﺒﺮ ﺍﻟﻤﻨﺤﺪﺭﺍﺕ‪.‬‬

‫ﺍﻟﻌﻤﻠﻴﺎﺕﺍﻟﺤﻨﻜﻴﺔ ﻟﻌﻈﻢ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ‪:‬‬

‫ﺗﻨﺸﺄﻋﻠﻰ ﺷﻜﻞ ﺻﻔﺎﺉﺢ ﺃﻓﻘﻴﺔ ﻣﻦ ﺟﺴﻢ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ‪ .‬ﺗﺘﺤﺪ ﺍﻟﻠﻮﺣﺎﻥ ﻓﻲ ﺍﻟﺨﻂ‬
‫ﺍﻷﻭﺳﻂﻟﺘﺸﻜﻴﻞ ﺧﻴﺎﻃﺔ ﻣﻨﺘﺼﻒ ﺍﻟﺤﻨﻚ‪ .‬ﻓﻲ ﻭﻗﺖ ﻣﺎ ﻳﻈﻬﺮ ﻓﺮﻁ ﻧﻤﻮ ﺍﻟﻌﻈﺎﻡ ﻓﻲ‬
‫ﻫﺬﻩﺍﻟﻤﻨﻄﻘﺔ ﻳﺴﻤﻰ ‪ .torus palatinus‬ﻣﻘﺎﻭﻣﺔ ﺍﺭﺗﺸﺎﻑ ﺍﻟﺤﻨﻚ ﺍﻟﺼﻠﺐ )ﻣﻨﻄﻘﺔ‬
‫ﺗﺤﻤﻞﺍﻟﻀﻐﻂ ﺍﻷﻭﻟﻲ(‪.‬‬
‫ﻣﻨﻄﻘﺔﺍﻟﻤﻔﺼﻞ ﺍﻟﺨﻴﻄﻲ )ﺍﻟﺮﻓﺎء ﺍﻟﺤﻨﻜﻲ ﺍﻷﻭﺳﻂ( ﻣﻐﻄﺎﺓ ﺑﻐﺸﺎء ﻣﺨﺎﻃﻲ ﻣﻠﺘﺼﻖ‬
‫ﺑﻘﻮﺓﺑﺎﻟﻌﻈﻢ ﺍﻷﺳﺎﺳﻲ ﻣﻊ ﺍﻟﻘﻠﻴﻞ ﻣﻦ ﺍﻷﻧﺴﺠﺔ ﺗﺤﺖ ﺍﻟﻤﺨﺎﻃﻴﺔ‪ .‬ﻟﺬﻟﻚ ‪ ،‬ﻻ ﺗﻮﺟﺪ‬
‫ﻣﺮﻭﻧﺔﻓﻲ ﻫﺬﻩ ﺍﻟﻤﻨﻄﻘﺔ ﻭﻻ ﻳﻤﻜﻦ ﺗﻄﺒﻴﻖ ﺍﻟﻀﻐﻂ‬

‫‪3‬‬
in this region. This is a stress relief area in the maxillary edentulous
foundation.
Clinical consideration:
During final impression procedure the mid palatal raphae is relieved in
order to create equilibrium between the resilient and non-resilient tissue
supports.
The palatine bone:
The horizontal plate of palatine bone
unite with the posterior rough border of
the horizontal palatal process of
maxillae. The posterior border of palatine
bone unite at midline forming the
posterior nasal spine. The soft palate is
attached to this posterior border. The
posterior palatal seal (PPS) is placed at
the junction between immovable and movable parts of the soft palate.
Posterior palatal seal area: The soft tissue area limited posteriorly by the
distal demarcation of the movable and non-movable tissues of the soft
palate and anteriorly by the junction of the hard and soft palates on which
pressure, within physiologic limits, can be placed; this seal can be applied
by a removable complete denture to aid in its retention.
Vibrating line:
An imaginary line across the posterior part of the soft palate marking the
division between the movable and immovable tissues; this line can be
identified when the movable tissues are functioning.
Incisive foramen:
The incisive foramen is located in the palate on the median line posterior
to the maxillary central incisor. In edentulous mouth it comes nearer to the
crest of the ridge as resorption progress. Failure to relieve this area may
result in irritation and burning sensation at the anterior part of the palate.

Incisive Papilla
It is a pad of fibrous connective tissue anteriorly overlying the incisive
foramen. The submucosa in this region contains the nasopalatine nerves
and vessels.

4
 ‫ﻓﻲﻫﺬﻩ ﺍﻟﻤﻨﻄﻘﺔ‪ .‬ﻫﺬﻩ ﻣﻨﻄﻘﺔ ﺗﺨﻔﻒ ﺍﻟﻀﻐﻂ ﻓﻲ ﺍﻷﺳﺎﺱ ﺍﻟﻔﻜﻲ ﺍﻟﻔﻜﻲ‪.‬‬

‫ﺍﻻﻋﺘﺒﺎﺭﺍﺕﺍﻟﺴﺮﻳﺮﻳﺔ‪:‬‬
‫ﺃﺛﻨﺎءﺇﺟﺮﺍء ﺍﻻﻧﻄﺒﺎﻉ ﺍﻟﻨﻬﺎﺉﻲ ‪ ،‬ﻳﺘﻢ ﺗﺨﻔﻴﻒ ﺭﻓﺎﻫﻴﺔ ﻣﻨﺘﺼﻒ ﺍﻟﺤﻨﻚ ﻣﻦ ﺃﺟﻞ ﺧﻠﻖ‬
‫ﺗﻮﺍﺯﻥﺑﻴﻦ ﺩﻋﺎﻣﺎﺕ ﺍﻷﻧﺴﺠﺔ ﺍﻟﻤﺮﻧﺔ ﻭﻏﻴﺮ ﺍﻟﻤﺮﻧﺔ‪.‬‬

‫ﻋﻈﻢﺍﻟﺤﻨﻚ‪:‬‬
‫ﺗﺘﺤﺪﺍﻟﺼﻔﻴﺤﺔ ﺍﻷﻓﻘﻴﺔ ﻟﻌﻈﻢ ﺍﻟﺤﻨﻚ ﻣﻊ ﺍﻟﺤﺪ‬
‫ﺍﻟﺨﻠﻔﻲﺍﻟﺨﺸﺒﻲ ﻟﻌﻤﻠﻴﺔ ﺍﻟﺤﻨﻚ ﺍﻷﻓﻘﻴﺔ‬
‫ﻟﻠﻔﻜﻴﻦ‪.‬ﺗﺘﺤﺪ ﺍﻟﺤﺪﻭﺩ ﺍﻟﺨﻠﻔﻴﺔ ﻟﻌﻈﻢ ﺍﻟﺤﻨﻚ‬
‫ﻋﻨﺪﺧﻂ ﺍﻟﻮﺳﻂ ﻟﺘﺸﻜﻞ ﺍﻟﻌﻤﻮﺩ ﺍﻟﻔﻘﺮﻱ ﺍﻷﻧﻔﻲ‬
‫ﺍﻟﺨﻠﻔﻲ‪.‬ﺍﻟﺤﻨﻚ ﺍﻟﺮﺧﻮ ﻣﺘﺼﻞ ﺑﻬﺬﺍ ﺍﻟﺤﺪ‬
‫ﺍﻟﺨﻠﻔﻲ‪.‬ﻳﺘﻢ ﻭﺿﻊ ﺧﺘﻢ ﺍﻟﺤﻨﻚ ﺍﻟﺨﻠﻔﻲ )‪(PPS‬‬
‫ﻓﻲ‬

‫ﺍﻟﺘﻘﺎﻃﻊﺑﻴﻦ ﺍﻷﺟﺰﺍء ﺍﻟﺜﺎﺑﺘﺔ ﻭﺍﻟﻤﺘﺤﺮﻛﺔ ﻣﻦ ﺍﻟﺤﻨﻚ ﺍﻟﺮﺧﻮ‪.‬‬

‫ﻣﻨﻄﻘﺔﺧﺘﻢ ﺍﻟﺤﻨﻚ ﺍﻟﺨﻠﻔﻲ‪ :‬ﻣﻨﻄﻘﺔ ﺍﻷﻧﺴﺠﺔ ﺍﻟﺮﺧﻮﺓ ﻣﺤﺪﻭﺩﺓ ﺧﻠﻔﻴﺎً ﺑﺎﻟﺘﺮﺳﻴﻢ‬
‫ﺍﻟﺒﻌﻴﺪﻟﻸﻧﺴﺠﺔ ﺍﻟﻤﻨﻘﻮﻟﺔ ﻭﻏﻴﺮ ﺍﻟﻤﻨﻘﻮﻟﺔ ﻟﻠﺤﻨﻚ ﺍﻟﺮﺧﻮ ﻭﺍﻷﻣﺎﻡ ﻣﻦ ﺧﻼﻝ ﺗﻘﺎﻃﻊ ﺍﻟﺤﻨﻚ‬
‫ﺍﻟﺼﻠﺐﻭﺍﻟﻠﻴﻦ ﺣﻴﺚ ﻳﻤﻜﻦ ﻭﺿﻊ ﺍﻟﻀﻐﻂ ‪ ،‬ﺿﻤﻦ ﺍﻟﺤﺪﻭﺩ ﺍﻟﻔﺴﻴﻮﻟﻮﺟﻴﺔ ؛ ﻳﻤﻜﻦ‬
‫ﺗﻄﺒﻴﻖﻫﺬﺍ ﺍﻟﺨﺘﻢ ﺑﻮﺍﺳﻄﺔ ﻃﻘﻢ ﺃﺳﻨﺎﻥ ﻛﺎﻣﻞ ﻗﺎﺑﻞ ﻟﻺﺯﺍﻟﺔ ﻟﻠﻤﺴﺎﻋﺪﺓ ﻓﻲ ﺍﻻﺣﺘﻔﺎﻅ ﺑﻪ‪.‬‬

‫ﺧﻂﺍﻻﻫﺘﺰﺍﺯ‪:‬‬
‫ﺧﻂﻭﻫﻤﻲ ﻋﺒﺮ ﺍﻟﺠﺰء ﺍﻟﺨﻠﻔﻲ ﻣﻦ ﺍﻟﺤﻨﻚ ﺍﻟﺮﺧﻮ ﻳﺸﻴﺮ ﺇﻟﻰ ﺍﻻﻧﻘﺴﺎﻡ ﺑﻴﻦ ﺍﻷﻧﺴﺠﺔ‬
‫ﺍﻟﻤﻨﻘﻮﻟﺔﻭﻏﻴﺮ ﺍﻟﻤﻨﻘﻮﻟﺔ ؛ ﻳﻤﻜﻦ ﺗﺤﺪﻳﺪ ﻫﺬﺍ ﺍﻟﺨﻂ ﻋﻨﺪﻣﺎ ﺗﻌﻤﻞ ﺍﻷﻧﺴﺠﺔ ﺍﻟﻤﺘﺤﺮﻛﺔ‪.‬‬

‫ﺍﻟﺜﻘﺒﺔﺍﻟﻘﺎﻃﻌﺔ‪:‬‬
‫ﺗﻘﻊﺍﻟﺜﻘﺒﺔ ﺍﻟﻘﺎﻃﻌﺔ ﻓﻲ ﺍﻟﺤﻨﻚ ﻋﻠﻰ ﺍﻟﺨﻂ ﺍﻷﻭﺳﻂ ﺍﻟﺨﻠﻔﻲ ﻟﻠﻘﺎﻃﻊ ﺍﻟﻤﺮﻛﺰﻱ ﺍﻟﻌﻠﻮﻱ‪.‬‬
‫ﻓﻲﺍﻟﻔﻢ ﺍﻟﻼﻣﻊ ‪ ،‬ﻳﻘﺘﺮﺏ ﻣﻦ ﻗﻤﺔ ﺍﻟﺘﻼﻝ ﻣﻊ ﺗﻘﺪﻡ ﺍﻻﻣﺘﺼﺎﺹ‪ .‬ﻗﺪ ﻳﺆﺩﻱ ﻋﺪﻡ‬
‫ﺗﺨﻔﻴﻒﻫﺬﻩ ﺍﻟﻤﻨﻄﻘﺔ ﺇﻟﻰ ﺗﻬﻴﺞ ﻭﺣﺮﻗﺎﻥ ﻓﻲ ﺍﻟﺠﺰء ﺍﻷﻣﺎﻣﻲ ﻣﻦ ﺍﻟﺤﻨﻚ‪.‬‬

‫ﺍﻟﺤﻠﻴﻤﺔﺍﻟﻘﺎﻃﻌﺔ‬
‫ﻭﻫﻲﻋﺒﺎﺭﺓ ﻋﻦ ﻭﺳﺎﺩﺓ ﻣﻦ ﺍﻟﻨﺴﻴﺞ ﺍﻟﻀﺎﻡ ﺍﻟﻠﻴﻔﻲ ﺗﻌﻠﻮ ﻣﻦ ﺍﻷﻣﺎﻡ ﺍﻟﺜﻘﺒﺔ ﺍﻟﻘﺎﻃﻌﺔ‪.‬‬
‫ﺗﺤﺘﻮﻱﺍﻟﻄﺒﻘﺔ ﺗﺤﺖ ﺍﻟﻤﺨﺎﻃﻴﺔ ﻓﻲ ﻫﺬﻩ ﺍﻟﻤﻨﻄﻘﺔ ﻋﻠﻰ ﺍﻷﻋﺼﺎﺏ ﻭﺍﻷﻭﻋﻴﺔ ﺍﻷﻧﻔﻴﺔ‪.‬‬

‫‪4‬‬
Significance
• A stable landmark is related to the incisive foramen through which the
neurovascular bundle emerge and lies on the surface of the bone.
• It is a biometric guide giving information about location of maxillary
canines (a perpendicular line drawn posterior to the center of the incisive
papilla to sagittal plane passes through the canines).
• It is a biometric guide giving information on positional relation of central
incisors, which are about 8-10 mm anterior to the incisive papilla.
Clinical consideration:
During the impression procedure, care should be taken not to compress the
papilla. This is one of the relief areas of the maxillary edentulous
foundation. Hence the incisive papilla should be relieved.
Anterior (greater) palatine foramen:
This is located medial to the third molar at the junction of the ridge and
horizontal plates of palatine bone .Rarely would a relief be required in the
denture base over this area since the nerve and blood vessels are retained
in a groove and covered by thick soft tissue.
Maxillary tuberosity:
It is that part of the residual ridge that extend distally from the area of the
2nd molar to the hamular notch. The tuberosities often are covered with
dense fibrous connective tissues with minimal compressibility. In this
situation, considerable support is offered to the denture. Sometimes cause
problem in maxillary denture construction such as:
1. Enlargement of the tuberosity with the presence of bilateral
undercuts negatively affect the insertion and removal of denture.
2. The presence of pendulous tuberosities cause a reduction in the
interarch distance in the posterior region against the retro molar pad.
3. To prevent oro-antral fistula, it is important to have an occlusal
radiograph before surgical resection of the tuberosity.
4. In case of severe undercuts at the tuberosity region, the undercut on
the preferential chewing side should be reduced.
5. The last posterior tooth should not be placed on the tuberosity.

5
 ‫ﺍﻟﺪﻻﻟﺔ‬
‫• ﻳﺮﺗﺒﻂ ﺍﻟﻤﻌﻠﻢ ﺍﻟﻤﺴﺘﻘﺮ ﺑﺎﻟﺜﻘﺒﺔ ﺍﻟﻘﺎﻃﻌﺔ ﺍﻟﺘﻲ ﻣﻦ ﺧﻼﻟﻬﺎ ﺗﻈﻬﺮ ﺍﻟﺤﺰﻣﺔ ﺍﻟﻮﻋﺎﺉﻴﺔ‬
‫ﺍﻟﻌﺼﺒﻴﺔﻭﺗﻘﻊ ﻋﻠﻰ ﺳﻄﺢ ﺍﻟﻌﻈﻢ‪.‬‬
‫• ﻫﻮ ﺩﻟﻴﻞ ﺑﻴﻮﻣﺘﺮﻱ ﻳﻌﻄﻲ ﻣﻌﻠﻮﻣﺎﺕ ﺣﻮﻝ ﻣﻮﻗﻊ ﺍﻷﻧﻴﺎﺏ ﺍﻟﻌﻠﻮﻳﺔ )ﺧﻂ ﻋﻤﻮﺩﻱ‬
‫ﻣﺮﺳﻮﻡﺧﻠﻒ ﻣﺮﻛﺰ ﺍﻟﺤﻠﻴﻤﺔ ﺍﻟﻘﺎﻃﻌﺔ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﺴﻬﻤﻲ ﻳﻤﺮ ﻋﺒﺮ ﺍﻷﻧﻴﺎﺏ(‪.‬‬

‫• ﻫﻮ ﺩﻟﻴﻞ ﺑﻴﻮﻣﺘﺮﻱ ﻳﻌﻄﻲ ﻣﻌﻠﻮﻣﺎﺕ ﻋﻦ ﺍﻟﻌﻼﻗﺔ ﺍﻟﻤﻮﺿﻌﻴﺔ ﻟﻠﻘﻮﺍﻃﻊ ﺍﻟﻤﺮﻛﺰﻳﺔ ‪،‬‬

‫ﻭﺍﻟﺘﻲﺗﻜﻮﻥ ﺣﻮﺍﻟﻲ ‪ 10-8‬ﻣﻢ ﺃﻣﺎﻡ ﺍﻟﺤﻠﻴﻤﺔ ﺍﻟﻘﺎﻃﻌﺔ‪.‬‬
‫ﺍﻻﻋﺘﺒﺎﺭﺍﺕﺍﻟﺴﺮﻳﺮﻳﺔ‪:‬‬
‫ﺃﺛﻨﺎءﺇﺟﺮﺍء ﺍﻻﻧﻄﺒﺎﻉ ‪ ،‬ﻳﺠﺐ ﺍﻟﺤﺮﺹ ﻋﻠﻰ ﻋﺪﻡ ﺿﻐﻂ ﺍﻟﺤﻠﻴﻤﺔ‪ .‬ﻫﺬﺍ ﻫﻮ ﻭﺍﺣﺪ ﻣﻦ‬
‫ﻣﻨﺎﻃﻖﺍﻹﻏﺎﺛﺔﻣﻦ ﺍﻷﺳﺎﺱ ﺍﻟﻔﻜﻲ ﺍﻟﻌﻠﻮﻱ‪ .‬ﻭﻣﻦ ﺛﻢ ﻳﻨﺒﻐﻲ ﺗﺨﻔﻴﻒ ﺍﻟﺤﻠﻴﻤﺔ ﺍﻟﻘﺎﻃﻌﺔ‪.‬‬

‫ﺍﻟﺜﻘﺒﺔﺍﻟﺤﻨﻜﻴﺔ ﺍﻷﻣﺎﻣﻴﺔ )ﺍﻷﻛﺒﺮ(‪:‬‬

‫ﻳﻘﻊﻫﺬﺍ ﻓﻲ ﻭﺳﻂ ﺍﻟﻀﺮﺱ ﺍﻟﺜﺎﻟﺚ ﻋﻨﺪ ﺗﻘﺎﻃﻊ ﺍﻟﺘﻼﻝ ﻭﺍﻟﺼﻔﺎﺉﺢ ﺍﻷﻓﻘﻴﺔ ﻟﻌﻈﻢ‬
‫ﺍﻟﺤﻨﻚ‪.‬ﻭﻧﺎﺩﺭﺍً ﻣﺎ ﺗﻜﻮﻥ ﻫﻨﺎﻙ ﺣﺎﺟﺔ ﺇﻟﻰ ﺭﺍﺣﺔ ﻓﻲ ﻗﺎﻋﺪﺓ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﻓﻮﻕ ﻫﺬﻩ‬
‫ﺍﻟﻤﻨﻄﻘﺔﺣﻴﺚ ﻳﺘﻢ ﺍﻻﺣﺘﻔﺎﻅ ﺑﺎﻟﻌﺼﺐ ﻭﺍﻷﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻓﻲ ﺃﺧﺪﻭﺩ ﻭﻣﻐﻄﺎﺓ ﺑﻄﺒﻘﺔ‬
‫ﺳﻤﻴﻜﺔﻧﺎﻋﻤﺔ ﺍﻻﻧﺴﺠﺔ‪.‬‬
‫ﺍﻟﺤﺪﺑﺔﺍﻟﻌﻠﻮﻳﺔ‪:‬‬
‫ﺇﻧﻪﺫﻟﻚ ﺍﻟﺠﺰء ﻣﻦ ﺍﻟﺤﺎﻓﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ ﺍﻟﺬﻱ ﻳﻤﺘﺪ ﺑﻌﻴﺪﺍً ﻋﻦ ﻣﻨﻄﻘﺔ ‪2‬ﺍﺧﺘﺼﺎﺭ ﺍﻟﺜﺎﻧﻲﺍﻟﻀﺮﺱ‬
‫ﺇﻟﻰﺍﻟﺸﻖ ﺍﻟﻔﺨﺬﻱ‪ .‬ﺍﻝﺍﻟﺤﺪﺑﺔﻏﺎﻟﺒﺎً ﻣﺎ ﺗﻜﻮﻥ ﻣﻐﻄﺎﺓ ﺑﺄﻧﺴﺠﺔ ﺿﺎﻣﺔ ﻟﻴﻔﻴﺔ ﻛﺜﻴﻔﺔ ﺑﺄﻗﻞ‬
‫ﻗﺪﺭﻣﻦ ﺍﻻﻧﻀﻐﺎﻁ‪ .‬ﻓﻲ ﻫﺬﻩ ﺍﻟﺤﺎﻟﺔ ‪ ،‬ﻳﺘﻢ ﺗﻘﺪﻳﻢ ﺩﻋﻢ ﻛﺒﻴﺮ ﻟﻄﻘﻢ ﺍﻷﺳﻨﺎﻥ‪ .‬ﻳﺴﺒﺐ‬
‫ﺃﺣﻴﺎﻧﺎًﻣﺸﻜﻠﺔ ﻓﻲ ﺑﻨﺎء ﺃﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻔﻜﻴﺔ ﻣﺜﻞ‪:‬‬

‫‪.1‬ﺗﻀﺨﻢ ﺍﻟﺤﺪﺑﺔ ﻣﻊ ﻭﺟﻮﺩ ﺗﻘﻄﻴﻌﺎﺕ ﺛﻨﺎﺉﻴﺔ ﺗﺆﺛﺮ ﺳﻠﺒﺎً ﻋﻠﻰ ﺇﺩﺧﺎﻝ ﻭﺇﺯﺍﻟﺔ‬
‫ﻃﻘﻢﺍﻷﺳﻨﺎﻥ‪.‬‬
‫‪.2‬ﻳﺆﺩﻱ ﻭﺟﻮﺩ ﺣﺪﺑﺔ ﻣﺘﺪﻟﻴﺔ ﺇﻟﻰ ﺗﻘﻠﻴﻞ ﺍﻟﻤﺴﺎﻓﺔ ﺑﻴﻦ ﺍﻟﻘﻮﺳﻴﻦ ﻓﻲ ﺍﻟﻤﻨﻄﻘﺔ‬
‫ﺍﻟﺨﻠﻔﻴﺔﻣﻘﺎﺑﻞ ﻭﺳﺎﺩﺓ ﺍﻟﻀﺮﺱ ﺍﻟﺮﺟﻌﻴﺔ‪.‬‬
‫‪.3‬ﻟﻠﻮﻗﺎﻳﺔ ﻣﻦ ﺍﻟﻨﺎﺳﻮﺭ ﺍﻟﻔﻤﻮﻱ ﺍﻟﻐﺎﺭﻱ ‪ ،‬ﻣﻦ ﺍﻟﻤﻬﻢ ﺍﻟﺤﺼﻮﻝ ﻋﻠﻰ ﺻﻮﺭﺓ‬
‫ﺷﻌﺎﻋﻴﺔﻟﻺﻃﺒﺎﻕ ﻗﺒﻞ ﺍﻻﺳﺘﺉﺼﺎﻝ ﺍﻟﺠﺮﺍﺣﻲ ﻟﻠﺤﺪﺑﺔ‪.‬‬
‫‪.4‬ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﺠﺮﻭﺡ ﺍﻟﺸﺪﻳﺪﺓ ﻓﻲ ﻣﻨﻄﻘﺔ ﺍﻟﺤﺪﺑﺔ ‪ ،‬ﻳﺠﺐ ﺗﻘﻠﻴﻞ ﺍﻟﺘﻘﻮﻳﺾ ﻋﻠﻰ‬
‫ﺟﺎﻧﺐﺍﻟﻤﻀﻎ ﺍﻟﺘﻔﻀﻴﻠﻲ‪.‬‬
‫‪.5‬ﻻ ﻳﺠﺐ ﻭﺿﻊ ﺍﻟﺴﻦ ﺍﻟﺨﻠﻔﻲ ﺍﻷﺧﻴﺮ ﻋﻠﻰ ﺍﻟﺤﺪﺑﺔ‪.‬‬

‫‪5‬‬
 Hamular notch:
It is a narrow cleft of loose connective tissue, which is approximately 2
mm in extent antero-posteriorly. This structure is bounded by the
maxillary tuberosity anteriorly and the pterygoid hamulus posteriorly
and marks the postero-lateral limit of the upper denture. The submucosa
in this region is thick and made up of loose areolar tissue. A seal can be
obtained by utilizing this area as it can be displaced to a certain extent
without trauma.
Significance
1. Constitutes the lateral boundary of the posterior palatal seal area in
the maxillary foundation.
2. The pterygomandibular raphe attaches to the hamulus.
Clinical considerations: The denture should not extend beyond the
hamular notch, failure of which will result in:
1. Restricted pterygomandibular raphe movement.
2. When mouth is wide open, the denture dislodges.
3. Pterygomandibular raphe may be sandwiched below the denture.

Cuspid eminence:
It is a bony elevation on the residual ridge formed after extraction of the
canine located over the canine root and serve as a guide for positioning
of artificial canine.

The limiting structures of the upper denture can be divided

into three areas: (1) the labial vestibule, which runs from one buccal
frenum to the other on the labial side of the ridge; (2) the right and left
buccal vestibules, which extend from the buccal frenum to the hamular

6
 ‫ﺍﻟﺸﻖﺍﻟﺤﺎﻣﻞ‪:‬‬
‫ﺇﻧﻪﺷﻖ ﺿﻴﻖ ﻣﻦ ﺍﻟﻨﺴﻴﺞ ﺍﻟﻀﺎﻡ ﺍﻟﺮﺧﻮ ‪ ،‬ﻭﺍﻟﺬﻱ ﻳﺒﻠﻎ ﻃﻮﻟﻪ ﺣﻮﺍﻟﻲ ‪ 2‬ﻣﻢ ﻣﻦ‬
‫ﺍﻟﺨﻠﻒ‪.‬ﻳﺤﺪ ﻫﺬﺍ ﺍﻟﻬﻴﻜﻞ ﻣﻦ ﺣﺪﺑﺔ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﻣﻦ ﺍﻷﻣﺎﻡ ﻭﺍﻟﺤﻤﻞ ﺍﻟﺠﻨﺎﺣﻲ‬
‫ﻟﻠﺨﻠﻒﻭﻳﻤﺜﻞ ﺍﻟﺤﺪ ﺍﻟﺨﻠﻔﻲ ﺍﻟﺠﺎﻧﺒﻲ ﻟﻄﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻌﻠﻮﻱ‪ .‬ﺗﻜﻮﻥ ﺍﻟﻄﺒﻘﺔ ﺗﺤﺖ‬
‫ﺍﻟﻤﺨﺎﻃﻴﺔﻓﻲ ﻫﺬﻩ ﺍﻟﻤﻨﻄﻘﺔ ﺳﻤﻴﻜﺔ ﻭﺗﺘﻜﻮﻥ ﻣﻦ ﻧﺴﻴﺞ ﺣﻠﻘﻲ ﺭﺧﻮ‪ .‬ﻳﻤﻜﻦ‬
‫ﺍﻟﺤﺼﻮﻝﻋﻠﻰ ﺍﻟﺨﺘﻢ ﻣﻦ ﺧﻼﻝ ﺍﺳﺘﺨﺪﺍﻡ ﻫﺬﻩ ﺍﻟﻤﻨﻄﻘﺔ ﺣﻴﺚ ﻳﻤﻜﻦ ﺇﺯﺍﺣﺘﻬﺎ ﺇﻟﻰ‬
‫ﺣﺪﻣﻌﻴﻦ ﺩﻭﻥ ﺍﻟﺘﻌﺮﺽ ﻟﺼﺪﻣﺔ‪.‬‬

‫ﺍﻟﺪﻻﻟﺔ‬
‫‪.1‬ﻳﺸﻜﻞ ﺍﻟﺤﺪ ﺍﻟﺠﺎﻧﺒﻲ ﻟﻤﻨﻄﻘﺔ ﺍﻟﺴﺪﺍﺩ ﺍﻟﺤﻨﻜﻲ ﺍﻟﺨﻠﻔﻲ ﻓﻲ ﺍﻷﺳﺎﺱ ﺍﻟﻔﻜﻲ‪.‬‬

‫‪.2‬ﺗﻌﻠﻖ ﺍﻟﺮﻓﺔ ﺍﻟﻈﻔﺮﺓ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ﺑﺎﻟﺤﻤﺔ‪.‬‬

‫ﺍﻻﻋﺘﺒﺎﺭﺍﺕﺍﻟﺴﺮﻳﺮﻳﺔ‪:‬ﻻ ﻳﻨﺒﻐﻲ ﺃﻥ ﻳﻤﺘﺪ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺇﻟﻰ ﻣﺎ ﺑﻌﺪ ﺍﻟﺸﻖ‬
‫ﺍﻟﺴﻔﻠﻲ ‪،‬ﻭﺍﻟﺬﻱ ﺳﻴﺆﺩﻱ ﻓﺸﻠﻬﺎ ﺇﻟﻰ‪:‬‬
‫‪.1‬ﺍﻟﺤﺮﻛﺔ ﺍﻟﻤﻘﻴﺪﺓ ﻟﻠﺮﺍﻓﻌﺔ ﻓﻲ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ‪.‬‬
‫‪.2‬ﻋﻨﺪﻣﺎ ﻳﻜﻮﻥ ﺍﻟﻔﻢ ﻣﻔﺘﻮﺣﺎً ﻋﻠﻰ ﻣﺼﺮﺍﻋﻴﻪ ‪ ،‬ﻳﺨﻠﻊ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ‪.‬‬
‫‪.3‬ﻗﺪ ﺗﻜﻮﻥ ﺍﻟﺮﻓﺔ ﺍﻟﻔﻜﻴﺔ ﻟﻠﻔﻚ ﺍﻟﺴﻔﻠﻲ ﻣﺤﺼﻮﺭﺓ ﺃﺳﻔﻞ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ‪.‬‬

‫ﺳﻤﺎﺣﺔﺃﻧﺒﻮﺑﺔ‪:‬‬
‫ﺇﻧﻪﺍﺭﺗﻔﺎﻉ ﻋﻈﻤﻲ ﻋﻠﻰ ﺍﻟﺘﻼﻝ ﺍﻟﻤﺘﺒﻘﻴﺔ ﺍﻟﺘﻲ ﺗﺸﻜﻠﺖ ﺑﻌﺪ ﺍﺳﺘﺨﺮﺍﺝ ﺍﻟﻜﻼﺏ‬
‫ﺍﻟﻤﻮﺟﻮﺩﺓﻓﻮﻕ ﺟﺬﺭ ﺍﻟﻜﻼﺏ ﻭﺗﻌﻤﻞ ﻛﺪﻟﻴﻞ ﻟﺘﺤﺪﻳﺪ ﻣﻮﺿﻊ ﺍﻟﻜﻼﺏ ﺍﻻﺻﻄﻨﺎﻋﻴﺔ‪.‬‬

‫ﻳﻤﻜﻦﺗﻘﺴﻴﻢ ﺍﻟﻬﻴﺎﻛﻞ ﺍﻟﻤﺤﺪﺩﺓ ﻟﻄﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻌﻠﻮﻱ ﺇﻟﻰ ﺛﻼﺙ ﻣﻨﺎﻃﻖ‪) :‬‬
‫‪ (1‬ﺍﻟﺪﻫﻠﻴﺰ ﺍﻟﺸﻔﻮﻱ ‪ ،‬ﻭﺍﻟﺬﻱ ﻳﻤﺘﺪ ﻣﻦ ﻟﺠﺎﻡ ﺷﺪﻕ ﺇﻟﻰ ﺍﻵﺧﺮ ﻋﻠﻰ ﺍﻟﺠﺎﻧﺐ‬
‫ﺍﻟﺸﻔﻮﻱﻣﻦ ﺍﻟﺤﺎﻓﺔ ؛ )‪ (2‬ﺍﻟﺪﻫﻠﻴﺰ ﺍﻟﺸﺪﻕ ﺍﻷﻳﻤﻦ ﻭﺍﻷﻳﺴﺮ ‪ ،‬ﻭﺍﻟﺘﻲ ﺗﻤﺘﺪ ﻣﻦ‬
‫ﺍﻟﻠﺠﺎﻡﺍﻟﺸﺪﻕ ﺇﻟﻰ ﺍﻟﻌﻀﺪ‬

‫‪6‬‬
 notch; and (3) the vibrating line, which extends from one hamular notch
to the other across the palate.

Osseous structures associated with the mandibular denture:

1. Coronoid process.
2. Residual alveolar ridge.
3. Buccal shelf area.
4. Mental foramen.
5. Mylohyoid ridge.
6. Genial tubercles.
7. Torus mandibularis.
8. External oblique ridge.

The mandible is the movable member of the stomatognathic system. It

consist of:
A. The body of the mandible.
B. The rami: Each ramus terminate at its upper extremity into two
processes, posteriorly the condyloid and anteriorly the coronoid process.

Coronoid process: It is the anterior process and continuous with the

anterior border of the ramus. If the distobuccal flange of maxillary denture
is too thick it will cause discomfort and dislodgment of upper denture when
the mandible is protruded and move from side to side. Trimming of the
flange will solve the problem.

Residual alveolar ridge:

It is that part which remain after loss of teeth. The bone underlying the crest
of RR is cancellous which makes it unfavorable for resisting applied forces
from a denture.

Buccal shelf area: The buccal shelf is the area between the mandibular
buccal frenum and the anterior edge of the masseter muscle. Medially it is
bound by the crest of the ridge and laterally by the boney external oblique
ridge and distally by the retromolar pad. The buccinators muscle fibers
attach horizontally along the boney oblique ridge. As resorption of the
ridge occurs, the buccal shelf does not resorb because of its muscle
attachments on the posterior and lateral borders. The alveolar ridge of the

7
 ‫ﺍﻟﺸﻖ‪.‬ﻭ )‪ (3‬ﺍﻟﺨﻂ ﺍﻟﻤﻬﺘﺰ ﺍﻟﺬﻱ ﻳﻤﺘﺪ ﻣﻦ ﺷﻖ ﻋﻈﻤﻲ ﺇﻟﻰ ﺁﺧﺮ ﻋﺒﺮ ﺍﻟﺤﻨﻚ‪.‬‬

‫ﺍﻟﻬﻴﺎﻛﻞﺍﻟﻌﻈﻤﻴﺔ ﺍﻟﻤﺮﺗﺒﻄﺔ ﺑﺄﺳﻨﺎﻥ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ‪:‬‬

‫‪.1‬ﻋﻤﻠﻴﺔ ﻛﻮﺭﻭﻧﻮﻳﺪ‪.‬‬
‫‪.2‬ﺍﻟﺘﻼﻝ ﺍﻟﺴﻨﺨﻴﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ‪.‬‬
‫‪.3‬ﻣﻨﻄﻘﺔ ﺍﻟﺠﺮﻑ ﺍﻟﺸﺪﻕ‪.‬‬
‫‪.4‬ﺍﻟﺜﻘﺒﺔ ﺍﻟﻌﻘﻠﻴﺔ‪.‬‬
‫‪.5‬ﻗﻤﺔ ﻣﻴﻠﻮﻫﻮﻳﺪ‪.‬‬
‫‪.6‬ﺍﻟﺪﺭﻧﺎﺕ ﺍﻟﻠﻄﻴﻔﺔ‪.‬‬
‫‪.7‬ﺣﻠﻖ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ‪.‬‬
‫‪.8‬ﺍﻟﺤﺎﻓﺔ ﺍﻟﺨﺎﺭﺟﻴﺔ ﺍﻟﻤﺎﺉﻠﺔ‪.‬‬

‫ﺍﻟﻔﻚﺍﻟﺴﻔﻠﻲ ﻫﻮ ﺍﻟﻌﻀﻮ ﺍﻟﻤﺘﺤﺮﻙ ﻓﻲ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻔﻤﻲ‪ .‬ﺍﻧﻪ ﻳﺘﻜﻮﻥ ﻣﻦ‪:‬‬

‫ﺃ‪.‬ﺟﺴﻢ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ‪.‬‬

‫ﺏ‪.‬ﺍﻟﺮﺍﻣﻲ‪ :‬ﻳﻨﺘﻬﻲ ﻛﻞ ﻓﺮﻉ ﻋﻨﺪ ﺍﻟﻄﺮﻑ ﺍﻟﻌﻠﻮﻱ ﻟﻌﻤﻠﻴﺘﻴﻦ ‪ ،‬ﺍﻟﻠﻘﻤﻴﺔ ﺍﻟﺨﻠﻔﻴﺔ‬
‫ﻭﺍﻷﻣﺎﻣﻴﺔﺍﻟﻨﺘﻮء ﺍﻹﻛﻠﻴﻠﻲ‪.‬‬

‫ﻋﻤﻠﻴﺔﺍﻹﻛﻠﻴﻼﻧﻴﺔ‪:‬ﺇﻧﻬﺎ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻷﻣﺎﻣﻴﺔ ﻭﺍﻟﻤﺴﺘﻤﺮﺓ ﻣﻊ ﺍﻟﺤﺪ ﺍﻷﻣﺎﻣﻲ ﻟﻠﻜﻌﺐ‪ .‬ﺇﺫﺍ‬

‫ﻛﺎﻧﺖﺍﻟﺤﺎﻓﺔ ﺍﻟﺒﻌﻴﺪﺓ ﻣﻦ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻔﻜﻴﺔ ﺳﻤﻴﻜﺔ ﻟﻠﻐﺎﻳﺔ ‪ ،‬ﻓﺴﻮﻑ ﻳﺘﺴﺒﺐ ﺫﻟﻚ‬
‫ﻓﻲﻋﺪﻡ ﺍﻟﺮﺍﺣﺔ ﻭﺇﺯﺍﺣﺔ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻌﻠﻮﻱ ﻋﻨﺪﻣﺎ ﻳﻜﻮﻥ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ﺑﺎﺭﺯﺍً‬
‫ﻭﻳﺘﺤﺮﻙﻣﻦ ﺟﺎﻧﺐ ﺇﻟﻰ ﺁﺧﺮ‪ .‬ﺳﻴﺆﺩﻱ ﺗﻘﻠﻴﻢ ﺍﻟﺤﺎﻓﺔ ﺇﻟﻰ ﺣﻞ ﺍﻟﻤﺸﻜﻠﺔ‪.‬‬

‫ﺍﻟﺤﺎﻓﺔﺍﻟﺴﻨﺨﻴﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ‪:‬‬
‫ﺇﻧﻪﺫﻟﻚ ﺍﻟﺠﺰء ﺍﻟﺬﻱ ﻳﺒﻘﻰ ﺑﻌﺪ ﻓﻘﺪﺍﻥ ﺍﻷﺳﻨﺎﻥ‪ .‬ﺍﻟﻌﻈﻢ ﺍﻟﻜﺎﻣﻦ ﻭﺭﺍء ﻗﻤﺔ ‪ RR‬ﻫﻮ‬
‫ﺇﺳﻔﻨﺠﻲﻣﻤﺎ ﻳﺠﻌﻠﻪ ﻏﻴﺮ ﻣﻨﺎﺳﺐ ﻟﻤﻘﺎﻭﻣﺔ ﺍﻟﻘﻮﻯ ﺍﻟﻤﻄﺒﻘﺔ ﻣﻦ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ‪.‬‬

‫ﻣﻨﻄﻘﺔﺍﻟﺠﺮﻑ ﺍﻟﺸﺪﻕ‪ :‬ﺍﻝﺍﻟﺠﺮﻑ ﺍﻟﺸﺪﻕﻫﻲ ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﻮﺍﻗﻌﺔ ﺑﻴﻦ ﻟﺠﺎﻡ ﺍﻟﻔﻚ‬

‫ﺍﻟﺴﻔﻠﻲﻭﺍﻟﺤﺎﻓﺔ ﺍﻷﻣﺎﻣﻴﺔ ﻟﻠﻌﻀﻠﺔ ﺍﻟﻤﺎﺿﻐﺔ‪ .‬ﻣﻦ ﺍﻟﻨﺎﺣﻴﺔ ﺍﻟﻮﺳﻄﻰ ‪ ،‬ﻳﺘﻢ ﺭﺑﻄﻪ ﺑﻘﻤﺔ‬
‫ﺍﻟﺘﻼﻝﻭﺟﺎﻧﺒﺎً ﺑﻮﺍﺳﻄﺔ ﺍﻟﺤﺎﻓﺔ ﺍﻟﺨﺎﺭﺟﻴﺔ ﺍﻟﻤﺎﺉﻠﺔ ﻟﻠﻌﻈﻢ ﻭﺑﻌﻴﺪﺍً ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺳﺎﺩﺓ‬
‫ﺍﻟﺨﻠﻔﻴﺔ‪.‬ﺗﻠﺘﺼﻖ ﺍﻷﻟﻴﺎﻑ ﺍﻟﻌﻀﻠﻴﺔ ﺍﻟﻘﺎﺗﻠﺔ ﺑﺸﻜﻞ ﺃﻓﻘﻲ ﻋﻠﻰ ﻃﻮﻝ ﺍﻟﺤﺎﻓﺔ ﺍﻟﻤﺎﺉﻠﺔ‬
‫ﻟﻠﻌﻈﻢ‪.‬ﻋﻨﺪ ﺣﺪﻭﺙ ﺍﺭﺗﺸﺎﻑ ﻟﻠﺤﻴﺪ ‪ ،‬ﻻ ﻳﻌﻮﺩ ﺍﻟﺠﺮﻑ ﺍﻟﺸﺪﻗﻲ ﺇﻟﻰ ﺍﻻﻣﺘﺼﺎﺹ‬
‫ﺑﺴﺒﺐﺍﺭﺗﺒﺎﻃﺎﺗﻪ ﺍﻟﻌﻀﻠﻴﺔ ﻋﻠﻰ ﺍﻟﺤﺪﻭﺩ ﺍﻟﺨﻠﻔﻴﺔ ﻭﺍﻟﺠﺎﻧﺒﻴﺔ‪ .‬ﺍﻟﺤﺎﻓﺔ ﺍﻟﺴﻨﺨﻴﺔ ﻣﻦ‬

‫‪7‬‬
mandible is significantly medial to the inferior border of the mandible;
therefore, as the ridge resorbs, the denture-bearing surface becomes flatter
and widens towards the buccal shelf. The shelf is dense cortical bone and
lies at right angles to vertical occlusal forces, and is therefore a primary
stress-bearing area for the denture.

Mental foramen:
It is located on the lateral surface of the mandible between 1 st and 2nd
premolar half way between the lower border and alveolar crest. The mental
nerve exits the mental foramen below the alveolar ridge, but with continued
resorption of the ridge, the mental foramen can become positioned at the
crest of the ridge and be compressed by the denture. This causes pain or
even altered sensation in the lip (numbness in the lower lip).

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.

8
 ‫ﺍﻟﻔﻚﺍﻟﺴﻔﻠﻲ ﻫﻮ ﻭﺳﻄﻲ ﺑﺸﻜﻞ ﻛﺒﻴﺮ ﺇﻟﻰ ﺍﻟﺤﺪ ﺍﻟﺴﻔﻠﻲ ﻣﻦ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ؛ ﻟﺬﻟﻚ ‪،‬‬
‫ﻣﻊﺍﺭﺗﺸﺎﻑ ﺍﻟﺤﺎﻓﺔ ‪ ،‬ﻳﺼﺒﺢ ﺍﻟﺴﻄﺢ ﺍﻟﺤﺎﻣﻞ ﻷﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺃﻛﺜﺮ ﺍﻧﺒﺴﺎﻃﺎً ﻭﻳﺘﺴﻊ ﻧﺤﻮ‬
‫ﺍﻟﺮﻑﺍﻟﺸﺪﻗﻲ‪ .‬ﺍﻟﺠﺮﻑ ﻋﺒﺎﺭﺓ ﻋﻦ ﻋﻈﻢ ﻗﺸﺮﻱ ﻛﺜﻴﻒ ﻭﻳﻘﻊ ﻓﻲ ﺍﻟﺰﻭﺍﻳﺎ ﺍﻟﻴﻤﻨﻰ ﻟﻘﻮﻯ‬
‫ﺍﻹﻃﺒﺎﻕﺍﻟﺮﺃﺳﻴﺔ ‪ ،‬ﻭﺑﺎﻟﺘﺎﻟﻲ ﻓﻬﻮ ﻣﻨﻄﻘﺔ ﺗﺤﻤﻞ ﺿﻐﻄﺎً ﺃﺳﺎﺳﻴﺎً ﻟﻄﻘﻢ ﺍﻷﺳﻨﺎﻥ‪.‬‬

‫ﺍﻟﺜﻘﺒﺔﺍﻟﻌﻘﻠﻴﺔ‪:‬‬
‫ﻳﻘﻊﻋﻠﻰ ﺍﻟﺴﻄﺢ ﺍﻟﺠﺎﻧﺒﻲ ﻟﻠﻔﻚ ﺍﻟﺴﻔﻠﻲ ﺑﻴﻦ ‪1‬ﺷﺎﺭﻉﻭ ‪2‬ﺍﺧﺘﺼﺎﺭ ﺍﻟﺜﺎﻧﻲ‬

‫ﺍﻟﻀﺎﺣﻚﻓﻲ ﻣﻨﺘﺼﻒ ﺍﻟﻄﺮﻳﻖ ﺑﻴﻦ ﺍﻟﺤﺪ ﺍﻟﺴﻔﻠﻲ ﻭﺍﻟﻘﻤﺔ ﺍﻟﺴﻨﺨﻴﺔ‪ .‬ﺍﻝﺍﻟﻌﺼﺐ‬

‫ﺍﻟﻌﻘﻠﻲﻳﺨﺮﺝ ﻣﻦﺍﻟﺜﻘﺒﺔ ﺍﻟﻌﻘﻠﻴﺔﺃﺳﻔﻞ ﺍﻟﺤﺎﻓﺔ ﺍﻟﺴﻨﺨﻴﺔ ‪ ،‬ﻭﻟﻜﻦ ﻣﻊ ﺍﺳﺘﻤﺮﺍﺭ ﺍﺭﺗﺸﺎﻑ‬
‫ﺍﻟﺤﺎﻓﺔ ‪،‬ﻳﻤﻜﻦ ﺃﻥ ﺗﺼﺒﺢ ﺍﻟﺜﻘﺒﺔ ﺍﻟﺬﻗﻨﻴﺔ ﻓﻲ ﻗﻤﺔ ﺍﻟﺤﺎﻓﺔ ﻭﻳﺘﻢ ﺿﻐﻄﻬﺎ ﺑﻮﺍﺳﻄﺔ ﻃﻘﻢ‬
‫ﺍﻷﺳﻨﺎﻥ‪.‬ﻫﺬﺍ ﻳﺴﺒﺐ ﺍﻷﻟﻢ ﺃﻭ ﺣﺘﻰ ﺍﻹﺣﺴﺎﺱ ﺍﻟﻤﺘﻐﻴﺮ ﻓﻲ ﺍﻟﺸﻔﺔ )ﺧﺪﺭ ﻓﻲ ﺍﻟﺸﻔﺔ‬
‫ﺍﻟﺴﻔﻠﻴﺔ(‪.‬‬

‫ﺭﻳﺪﺝﻣﻴﻠﻮﻫﻮﻳﺪ‪:‬‬
‫ﻳﻤﺘﺪﻋﻠﻰ ﻃﻮﻝ ﺍﻟﺴﻄﺢ ﺍﻟﻠﻐﻮﻱ ﻟﻠﻔﻚ ﺍﻟﺴﻔﻠﻲ‪ .‬ﺗﻘﻊ ﺍﻟﺤﺎﻓﺔ ﺍﻷﻣﺎﻣﻴﺔ ﺑﺎﻟﻘﺮﺏ ﻣﻦ ﺍﻟﺤﺪ‬
‫ﺍﻟﺴﻔﻠﻲﻟﻠﻔﻚ ﺍﻟﺴﻔﻠﻲ ﺑﻴﻨﻤﺎ ﺗﻘﻊ ﻓﻲ ﺍﻟﺨﻠﻒ ﻣﻊ ﺍﻟﺤﺎﻓﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ‪ .‬ﺭﻗﻴﻘﺔ‬

‫ﻗﺪﻳﺼﺎﺏ ﺍﻟﻐﺸﺎء ﺍﻟﻤﺨﺎﻃﻲ ﻓﻮﻕ‬

‫ﺍﻟﺤﺎﻓﺔﺍﻟﻨﺨﺎﻋﻴﺔ ﺍﻟﻼﻣﻴﺔ ﺑﺼﺪﻣﺔ‬
‫ﻭﻳﺠﺐﺍﻟﺘﺨﻠﺺ ﻣﻨﻬﺎ‪ .‬ﺍﻟﻤﻨﻄﻘﺔ‬
‫ﺍﻟﻮﺍﻗﻌﺔﺗﺤﺖ ﻫﺬﺍ ﺍﻟﺘﻼﻝ ﺗﻘﻮﺽ‪.‬‬

‫‪8‬‬
Genial tubercles:
Also called mental spines, 2- 4 in number situated on the lingual surface of
the body of mandible in the mid line. They represents the muscle
attachment of the genioglossus and geniohyoid muscle .it is usually seen
below the crest of the ridge.
Significance
• In a severely resorbed ridge, it is seen above the residual alveolar ridge
and hence, it should be relieved.
• The mucosa covering the genial tubercle is thin and tightly adherent to
the underlying bone.
Clinical consideration:
It should be relieved with a spacer, failure of which leads to ulceration.

Mandibular tori
Mandibular tori are lingual bilateral or unilateral prominences of cortical
bone in the premolar area. But they may extend posteriorly to the molar
area. Small tori may only require relief in the denture. Large tori require
removal before a denture can be fabricated.

External oblique ridge:

It is a ridge of dense bone extended from just above the mental foramen
superiorly and distally to be continuous with the anterior border of the
ramus. In most individuals it is the anatomic guide for lateral end of the
buccal flange of lower denture.

Retromolar pad:
The retromolar pad is a triangular pad of tissue at the distal end of the
residual ridge. The anterior portion of the triangle is keratinized tissue of
the remnant gingiva of the third molar called the pear-shaped pad. The
posterior aspect of the triangle is composed of thin, non-keratinized
epithelium; loose connective tissue; glandular tissue; fibers of the
temporalis tendon and of the buccinators and superior constrictor muscles;
and the pterygomandibular raphe. The underlying bone is dense cortical
bone because of the muscle attachments and is resistant to resorption. The
denture should cover the retromolar pad because of the support and absence
of long-term cortical bone resorption.

9
 ‫ﺍﻟﺪﺭﻧﺎﺕﺍﻟﻠﻄﻴﻔﺔ‪:‬‬
‫ﺗﺴﻤﻰﺃﻳﻀﺎً ﺍﻟﻌﻤﻮﺩ ﺍﻟﻔﻘﺮﻱ ﺍﻟﻌﻘﻠﻲ ‪ ،‬ﻭﺗﺘﻜﻮﻥ ﻣﻦ ‪ 2‬ﺇﻟﻰ ‪ 4‬ﻓﻲ ﺍﻟﻌﺪﺩ ﻭﺗﻘﻊ ﻋﻠﻰ‬
‫ﺍﻟﺴﻄﺢﺍﻟﻠﺴﺎﻧﻲ ﻟﺠﺴﻢ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ﻓﻲ ﺍﻟﻤﻨﺘﺼﻒﺷﻤﺎﻝ ﺷﺮﻕﺇﻧﻬﺎ ﺗﻤﺜﻞ ﺍﻻﺭﺗﺒﺎﻁ‬
‫ﺍﻟﻌﻀﻠﻲﻟﻠﻌﻀﻠﺔ ﺍﻟﺬﻛﺮﻳﺔ ﻭﺍﻟﻌﻀﻠﺔ ﺍﻟﻼﻣﻴﺔ ﺍﻟﺠﻴﻨﻴﺔ ‪ ،‬ﻭﻋﺎﺩﺓ ﻣﺎ ﺗﺮُﻯ ﺃﺳﻔﻞ ﻗﻤﺔ ﺍﻟﺘﻼﻝ‪.‬‬

‫ﺍﻟﺪﻻﻟﺔ‬
‫• ﻓﻲ ﺍﻟﺘﻼﻝ ﺷﺪﻳﺪﺓ ﺍﻻﻣﺘﺼﺎﺹ ‪ ،‬ﻳﻤﻜﻦ ﺭﺅﻳﺘﻬﺎ ﻓﻮﻕ ﺍﻟﺤﺎﻓﺔ ﺍﻟﺴﻨﺨﻴﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ ‪،‬‬
‫ﻭﺑﺎﻟﺘﺎﻟﻲ ‪،‬ﻳﺠﺐ ﺇﺯﺍﻟﺘﻬﺎ‪.‬‬
‫• ﺍﻟﻐﺸﺎء ﺍﻟﻤﺨﺎﻃﻲ ﺍﻟﺬﻱ ﻳﻐﻄﻲ ﺍﻟﺤﺪﻳﺒﺔ ﺍﻷﻧﺜﻮﻳﺔ ﺭﻗﻴﻖ ﻭﻣﻠﺘﺼﻖ ﺑﺈﺣﻜﺎﻡ ﺑﺎﻟﻌﻈﻢ‬
‫ﺍﻷﺳﺎﺳﻲ‪.‬‬
‫ﺍﻻﻋﺘﺒﺎﺭﺍﺕﺍﻟﺴﺮﻳﺮﻳﺔ‪:‬‬
‫ﻳﺠﺐﺗﺨﻔﻴﻔﻪ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻤﺒﺎﻋﺪﺓ ﺍﻟﺘﻲ ﻳﺆﺩﻱ ﻓﺸﻠﻬﺎ ﺇﻟﻰ ﺍﻟﺘﻘﺮﺡ‪.‬‬

‫ﺗﻮﺭﻱﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ‬
‫ﺗﻮﺭﻱﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ﻫﻲ ﺑﺮﻭﺯﺍﺕ ﺛﻨﺎﺉﻴﺔ ﻟﻐﻮﻳﺔ ﺃﻭ ﺃﺣﺎﺩﻳﺔ ﺍﻟﺠﺎﻧﺐ ﻟﻠﻌﻈﻢ ﺍﻟﻘﺸﺮﻱ ﻓﻲ‬
‫ﻣﻨﻄﻘﺔﺍﻟﻀﻮﺍﺣﻚ‪ .‬ﻟﻜﻨﻬﺎ ﻗﺪ ﺗﻤﺘﺪ ﺇﻟﻰ ﺍﻟﺨﻠﻒ ﺇﻟﻰ ﻣﻨﻄﻘﺔ ﺍﻟﻀﺮﺱ‪ .‬ﻗﺪ ﻳﺤﺘﺎﺝ ﺍﻟﺘﻮﺭﻱ‬
‫ﺍﻟﺼﻐﻴﺮﻓﻘﻂ ﺇﻟﻰ ﺍﻟﺮﺍﺣﺔ ﻓﻲ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ‪ .‬ﻳﺘﻄﻠﺐ ﺍﻟﺘﻮﺭﻱ ﺍﻟﻜﺒﻴﺮ ﺇﺯﺍﻟﺘﻪ ﻗﺒﻞ ﺗﺼﻨﻴﻊ‬
‫ﻃﻘﻢﺃﺳﻨﺎﻥ‪.‬‬

‫ﺍﻟﺤﺎﻓﺔﺍﻟﻤﺎﺉﻠﺔ ﺍﻟﺨﺎﺭﺟﻴﺔ‪:‬‬
‫ﺇﻧﻪﻧﺘﻮء ﻣﻦ ﻋﻈﻢ ﻛﺜﻴﻒ ﻳﻤﺘﺪ ﻣﻦ ﺃﻋﻠﻰ ﺍﻟﺜﻘﺒﺔ ﺍﻟﺬﻗﻨﻴﺔ ﻣﺒﺎﺷﺮﺓ ﺑﺸﻜﻞ ﻣﺘﻔﻮﻕ ﻭﺑﻌﻴﺪﺍً‬
‫ﻟﻴﻜﻮﻥﻣﺴﺘﻤﺮﺍً ﻣﻊ ﺍﻟﺤﺪ ﺍﻷﻣﺎﻣﻲ ﻟﻠﻜﻌﺐ‪ .‬ﻓﻲ ﻣﻌﻈﻢ ﺍﻷﻓﺮﺍﺩ ‪ ،‬ﻳﻜﻮﻥ ﻫﺬﺍ ﻫﻮ ﺍﻟﺪﻟﻴﻞ‬
‫ﺍﻟﺘﺸﺮﻳﺤﻲﻟﻠﻨﻬﺎﻳﺔ ﺍﻟﺠﺎﻧﺒﻴﺔ ﻟﻠﺤﺎﻓﺔ ﺍﻟﺸﺪﻗﻴﺔ ﻷﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﺍﻟﺴﻔﻠﻴﺔ‪.‬‬

‫ﻭﺳﺎﺩﺓﺭﻳﺘﺮﻭﻣﻮﻻﺭ‪:‬‬
‫ﺍﻟﻮﺳﺎﺩﺓﺍﻟﺨﻠﻔﻴﺔ ﻫﻲ ﻭﺳﺎﺩﺓ ﻣﺜﻠﺜﺔ ﻣﻦ ﺍﻷﻧﺴﺠﺔ ﻓﻲ ﺍﻟﻨﻬﺎﻳﺔ ﺍﻟﺒﻌﻴﺪﺓ ﻟﻠﺤﺎﻓﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ‪.‬‬
‫ﺍﻟﺠﺰءﺍﻷﻣﺎﻣﻲ ﻣﻦ ﺍﻟﻤﺜﻠﺚ ﻫﻮ ﻧﺴﻴﺞ ﻛﻴﺮﺍﺗﻴﻨﻲ ﻣﻦ ﺍﻟﻠﺜﺔ ﺍﻟﻤﺘﺒﻘﻴﺔ ﻣﻦ ﺍﻟﻀﺮﺱ‬
‫ﺍﻟﺜﺎﻟﺚﻳﺴﻤﻰ ﺍﻟﻀﻤﺎﺩﺓ ﻋﻠﻰ ﺷﻜﻞ ﻛﻤﺜﺮﻯ‪ .‬ﻳﺘﻜﻮﻥ ﺍﻟﺠﺎﻧﺐ ﺍﻟﺨﻠﻔﻲ ﻟﻠﻤﺜﻠﺚ ﻣﻦ‬
‫ﻇﻬﺎﺭﺓﺭﻗﻴﻘﺔ ﻏﻴﺮ ﻣﺘﻘﺮﻧﺔ ؛ ﺍﻟﻨﺴﻴﺞ ﺍﻟﻀﺎﻡ ﻓﻀﻔﺎﺿﺔ؛ ﺍﻷﻧﺴﺠﺔ ﺍﻟﻐﺪﻳﺔ؛ ﺃﻟﻴﺎﻑ ﺍﻟﻮﺗﺮ‬
‫ﺍﻟﺼﺪﻏﻲﻭﺍﻟﻌﻀﻼﺕ ﺍﻟﻤﻀﻴﻘﺔ ﺍﻟﻌﻠﻮﻳﺔ ؛ ﻭﺭﺍﻓﻌﺔ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ‪ .‬ﺍﻟﻌﻈﻢ ﺍﻟﻜﺎﻣﻦ ﻫﻮ‬
‫ﻋﻈﻢﻗﺸﺮﻱ ﻛﺜﻴﻒ ﺑﺴﺒﺐ ﺍﺭﺗﺒﺎﻃﺎﺕ ﺍﻟﻌﻀﻼﺕ ﻭﻣﻘﺎﻭﻡ ﻟﻼﺭﺗﺸﺎﻑ‪ .‬ﻳﺠﺐ ﺃﻥ ﻳﻐﻄﻲ‬
‫ﻃﻘﻢﺍﻷﺳﻨﺎﻥ ﺍﻟﻮﺳﺎﺩﺓ ﺍﻟﺨﻠﻔﻴﺔ ﺑﺴﺒﺐ ﺩﻋﻢ ﻭﻏﻴﺎﺏ ﺍﺭﺗﺸﺎﻑ ﺍﻟﻌﻈﻢ ﺍﻟﻘﺸﺮﻱ ﻋﻠﻰ‬
‫ﺍﻟﻤﺪﻯﺍﻟﻄﻮﻳﻞ‪.‬‬

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Maxillary and Mandibular Stress-Bearing Areas
Maxillary
1° firm tuberosities
1° hard palate on either side of palatal raphe
2° alveolar ridge
2° rugae
Mandibular
1° buccal shelves
1° retromolar pads
2° alveolar ridge
Areas Requiring Relief in Final Impression
2° stress-bearing areas
Palatal torus
Median palatal raphe
Mandibular tori
Retromylohyoid ridge
Undercuts or sharp boney prominence on ridges.
The pattern of bone resorption:
The maxilla resorb upward and inward to become progressively smaller
(centripetal). While the mandible resorb downward and outward to become
gradually wider (centrifugal). This progressive change of the mandible and
maxillae makes many edentulous patients appear to be prognathic.

Thinking Notes/ The mean denture bearing area for edentulous maxillae
are 23cm2 while for mandible 12cm2 in contrast with 45cm2 area of PDL
in each dental arch.
The masticatory loads recorded for the natural teeth are about 20 Kg while
maximum forces of 6 Kg during chewing have been recorded with
complete denture. In fact, maximal bite forces appear to be five to six times
less for complete denture wearer than person with natural teeth.

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 ‫ﻣﻨﺎﻃﻖﺗﺤﻤﻞ ﺍﻹﺟﻬﺎﺩ ﻓﻲ ﺍﻟﻔﻜﻴﻦ ﺍﻟﻌﻠﻮﻱ ﻭﺍﻟﺴﻔﻠﻲ‬
‫ﺍﻟﻔﻚﺍﻟﻌﻠﻮﻱ‬
‫‪1‬ﺩﺭﺟﺔ ﺣﺪﺑﺔ ﺛﺎﺑﺘﺔ‬
‫‪1‬ﺩﺭﺟﺔ ﻣﻦ ﺍﻟﺤﻨﻚ ﺍﻟﺼﻠﺐ ﻋﻠﻰ ﺟﺎﻧﺒﻲ ﺍﻟﺤﺎﻓﺔ ﺍﻟﺤﻨﻜﻴﺔ ‪° 2‬‬
‫ﺍﻟﺤﺎﻓﺔﺍﻟﺴﻨﺨﻴﺔ‬
‫‪ °2‬ﺭﺟﺎء‬
‫ﺍﻟﻔﻚﺍﻟﺴﻔﻠﻲ‬
‫‪1‬ﺩﺭﺟﺔ ﺍﻟﺮﻓﻮﻑ ﺍﻟﺸﺪﻕ‬
‫‪ °1‬ﻣﻨﺼﺎﺕ ﺧﻠﻔﻴﺔّ‬
‫‪ °2‬ﺍﻟﺤﺎﻓﺔ ﺍﻟﺴﻨﺨﻴﺔ‬
‫ﺍﻟﻤﻨﺎﻃﻖﺍﻟﺘﻲ ﺗﺘﻄﻠﺐ ﺍﻟﺘﺨﻔﻴﻒ ﻓﻲ ﺍﻻﻧﻄﺒﺎﻉ ﺍﻟﻨﻬﺎﺉﻲ‬
‫‪ °2‬ﻣﻨﺎﻃﻖ ﺗﺤﻤﻞ ﺍﻹﺟﻬﺎﺩ ﺣﻠﻖ ﺍﻟﺤﻨﻚ‬

‫ﺍﻟﺮﻓﺎءﺍﻟﺤﻨﻜﻲ ﺍﻟﻤﺘﻮﺳﻂ‬
‫ﺗﻮﺭﻱﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ‬
‫ﺣﺎﻓﺔ‪Retromylohyoid‬‬
‫ﺗﻘﻮﻳﻀﺎﺕﺃﻭ ﺑﺮﻭﺯ ﻋﻈﻤﻲ ﺣﺎﺩ ﻋﻠﻰ ﺍﻟﺘﻼﻝ‪ .‬ﻧﻤﻂ‬
‫ﺍﺭﺗﺸﺎﻑﺍﻟﻌﻈﻢ‪:‬‬
‫ﺗﻤﺘﺺﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﻟﻸﻋﻠﻰ ﻭﻟﻠﺪﺍﺧﻞ ﻟﺘﺼﺒﺢ ﺗﺪﺭﻳﺠﻴﺎً ﺃﺻﻐﺮ )ﺟﺎﺫﺑﺔ(‪ .‬ﺑﻴﻨﻤﺎ ﻳﻤﺘﺺ‬
‫ﺍﻟﻔﻚﺍﻟﺴﻔﻠﻲ ﻟﻸﺳﻔﻞ ﻭﻟﻠﺨﺎﺭﺝ ﻟﻴﺼﺒﺢ ﺃﻭﺳﻊ ﺗﺪﺭﻳﺠﻴﺎً )ﻃﺎﺭﺩ ﻣﺮﻛﺰﻱ(‪ .‬ﻫﺬﺍ ﺍﻟﺘﻐﻴﻴﺮ‬
‫ﺍﻟﺘﺪﺭﻳﺠﻲﻓﻲ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ﻭﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﻳﺠﻌﻞ ﺍﻟﻌﺪﻳﺪ ﻣﻦ ﺍﻟﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ‬
‫ﻣﻦﻋﺪﻡ ﺍﻟﻘﺪﺭﺓ ﻋﻠﻰ ﺍﻷﺳﻨﺎﻥ ﻳﺒﺪﻭ ﺃﻧﻬﻢ ﻳﻨﺬﺭﻭﻥ‪.‬‬

‫ﻣﻼﺣﻈﺎﺕﺍﻟﺘﻔﻜﻴﺮ ‪/‬ﻣﺘﻮﺳﻂ ﻣﺴﺎﺣﺔ ﺗﺤﻤﻞ ﻃﻘﻢ ﺍﻷﺳﻨﺎﻥ ﻟﻠﻔﻜﻴﻦ ﺍﻟﻼﻣﻌﻴﻦ ﻫﻲ‬

‫‪23‬ﺳﻢ‪2‬ﺑﻴﻨﻤﺎ ﻟﻠﻔﻚ ﺍﻟﺴﻔﻠﻲ ‪ 12‬ﺳﻢ‪2‬ﻋﻠﻰ ﺍﻟﻨﻘﻴﺾ ﻣﻦ ‪ 45‬ﺳﻢ‪2‬ﻣﻨﻄﻘﺔ ‪ PDL‬ﻓﻲ ﻛﻞ‬
‫ﻗﻮﺱﺃﺳﻨﺎﻥ‪.‬‬
‫ﺗﺒﻠﻎﺃﺣﻤﺎﻝ ﺍﻟﻤﻀﻎ ﺍﻟﻤﺴﺠﻠﺔ ﻟﻸﺳﻨﺎﻥ ﺍﻟﻄﺒﻴﻌﻴﺔ ﺣﻮﺍﻟﻲ ‪ 20‬ﻛﺠﻢ ﺑﻴﻨﻤﺎ ﺗﻢ ﺗﺴﺠﻴﻞ‬
‫ﺍﻟﻘﻮﻯﺍﻟﻘﺼﻮﻯ ﺍﻟﺒﺎﻟﻐﺔ ‪ 6‬ﻛﺠﻢ ﺃﺛﻨﺎء ﺍﻟﻤﻀﻎ ﺑﺎﺳﺘﺨﺪﺍﻡ ﻃﻘﻢ ﺃﺳﻨﺎﻥ ﻛﺎﻣﻞ‪ .‬ﻓﻲ‬
‫ﺍﻟﻮﺍﻗﻊ ‪،‬ﺗﺒﺪﻭ ﻗﻮﻯ ﺍﻟﻌﻀﺔ ﺍﻟﻘﺼﻮﻯ ﺃﻗﻞ ﺑﺨﻤﺲ ﺇﻟﻰ ﺳﺖ ﻣﺮﺍﺕ ﻟﻤﻦ ﻳﺮﺗﺪﻱ ﻃﻘﻢ‬
‫ﺃﺳﻨﺎﻥﻛﺎﻣﻞ ﻣﻦ ﺍﻟﺸﺨﺺ ﺍﻟﺬﻱ ﻟﺪﻳﻪ ﺃﺳﻨﺎﻥ ﻃﺒﻴﻌﻴﺔ‪.‬‬

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