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Presentd by Dr. Sneha Deepthi. G I st yr. pg student Dept. of prosthodontics and crown & bridge Sibar institute of dental sciences Guntur .
Content
Introduction Anatomy of Mandible Muscle attachments of Mandible that influence Complete Denture fabrication Anatomy of supporting structures
Residual Ridges Buccal Shelf area
Anatomy
Movable member of stomotognathic system Horse Shoe shaped Consists - Alveolar process
Ramus on each side Condylar process Caronoid process
Coronoid process
Anterior border continues into anterior border of ramus Dislodgement of the maxillary denture on protrusive & lateral movements of mandible in thick distobuccal flange of maxillary denture
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Anatomy
External Oblique line
Lateral termination of buccal flange of mandibular dentures
Anatomy
Mental Foramen
Extensive loss of RR occupies superior position of RR relief in denture bone pressure of mental nerve causes numbness of lower lip
Mylohyoid line
Irregular, rough, bony crest extending from 3rd molar region to lower border of mandible in the region of chin Lingual flange of mandibular denture should extend inferior to, but not lateral to the mylohyoid line Sharp, prominent act as stress bearing area or fulcrum point surgical intervention
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Anatomy
Lingual tuberosity
Bony prominense on distal end of mylohyoid line Excessively prominent under cut surgically removed or rounded
Mental spines
Sharp interfere with denture retention & function Genioglossus muscle Interfere n extensive RRR Muscle attached to geniohyoid muscle below
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Anatomy
Muscle attachments to mandible & their influence on mandibular denture
The origins of several of the muscles of facial expression are near enough to the denture bearing areas. Their action must be considered as definitely influencing the denture borders. Their influence is in proportion to the contour & quality of RR present in vertical direction. Higher the RR less influence.
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Anatomy
Buccinator Muscle
Origin horse shoe shaped line along the outersurfaces of the maxillary & mandibular alveolar process in area of 1st molar region. Pterygomandibular ligament Lower Jaw
Part of denture bearing area Severely resorbed ridges Covers the bony support
Acts paralell to occlusal plane no dislodgement of denture Present perpendicular to masseter muscle Action of masseter muscle medial movement of buccinator muscle dislodging force Recorded as massetric groove in denture bases
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Anatomy
Mylohyoid muscle Origin Mylohyoid line Insertion Posterior fibres hyoid bone (body) Median fibrous raphae from symplysis to hyoid bone Action Elevates hyoid bone, tongue & floor of the mouth during swallowing Denture flange extended below but not under mylohyoid line Inferior border of denture in compatable position with tongue Extensive bone loss surgically detached & reattached more inferiorly on the body of mandible without apparent impairment of function
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Anatomy
Geniohyoid muscles
Origin inferior mental spine No problem unless extensive resorbtion of RR Surgically reattached inferiorly on the mandible
Tongue
The denture flanges are contoured to allow the tongue to have its normal wide range of functional movements The muscular activity of tongue
Intrinsic muscles Extrinsic muscles
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Anatomy
Genioglossus
Origin superior mental spine
Palatoglossus muscle
Palatoglossus arch follows the movements of tongue Protrusion or lateral movement of tongue forward movement of the arch Posterolingual extent of lower denture is extended backwards so that it prevents this forward movement of the arch Most forward position of the arch determines the posterolingual edge of the lower denture
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Anatomy
Tongue Tongue acts in the following way in retaining & stabilising the complete dentures
The dorsum is pressed against the back of the upper denture to prevent it dropping when incising The tip is pressed forwards & downwards against the anterior lingual surface of lower denture when the lower lip tends to force the denture backwards The lateral borders of the tongue rest on the occlusal surfaces of lower denture when opening the mouth
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Classification of mandibular anterior residual ridge (Atwood DA) Order I preextraction Order II- postextraction Order III high well rounded Order IV knife edge Order V low well rounded Order VI depressed
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Buccinator muscle fibres present beneath the buccal flange Antero-posteriorly parellel to bone Contraction does not dislodge the denture Bone in this area is very dense & the trabeculation is arranged almost at right angles to the path of closure
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Forces of occlusion are applied nearly at right angles Buccal shelf is the area of bone between the extension sites of molars & the external oblique line Intact cortical plate & tends not to resorb due to stimulation of attachment of buccinator Flat ridges buccinator center of ridge Flaccid & inactive - covered by denture Buccal shelf is a platform of bone buccal to the position of molar teeth
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Anatomically, the buccal shelf is defined as that part of the basal seat that is located posterior to the buccal frenum and extends from crest of the lower residual ridge to the external oblique ridge Mucous membrane covering
Loosely attached, less keratinized Thick submucosa certain buccinator muscle fibers Histologiclly may not be suitable for support but compact bone with Haversion system and the horizantal supporting surface provided by buccal shelf suitable for support Final Impression tray direct contact tissue slightly displaced
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Active muscle ramus perpendicular & zygomatic arch medial muslce pull directly on distobuccal border concave border Inactive muscle - convex border Recorded by applying downward pressure at the premolar region when the patient closes the mouth or elevates the mandible Under extension may result in loss of support and resistance to displacement.
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The desirable distal extension is slightly to the lingual of these bony prominences & includes the pear-shaped retromolar pad
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Denture border should extend posteriorly to contact retromylohyoid curtain when the tip of the tongue is placed against the front part of the upper residual ridge Protrusion causes retromylohyoid curtain to move forward
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Lingual frenum
It is a fibrous band of tissuethat overlies the center of genioglossus muscle.
Anterior attachment of tongue Functional trimming of denture border to provide most of lingual frenum without displacing the denture. Careful clearance is needed
inadequate clearance may result in pain or displacement of denture. over clearance may result in loss of seal and loose denture.
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Extent lingual frenum to premylohyoid fossa Impression should extend down to make definite contact with mucous membrane of floor of the mouth when the tip of the tongue touches the upper anterior residual ridge The width of the border is usually about 2 mm varies depending on activity & tonicity of genioglossus muscle & lingual frenum
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The sulcus curves medially from body of mandible caused by prominence of mylohyoid ridge. Influenced by mylohyoid muscle Nagel & Sears have shown that, at the maximum contraction, the fibres are still in downward & forward direction so that the denture can be extended below the muscle attachment of mylohyoid ridge The length & width of mylohyoid flange is determined by the membranous attachment of tongue to mylohyoid ridge & width of hyoglossus muscle Average mylohyoid border is 4-6 mm below the mylohyoid ridge. Width of 2-3 mm
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Extent
End of mylohyoid ridge to retromylohyoid curtain
Neil described this area & noted that denture could have 3 possible lengths depending on tonicity, activity and anatomic attachments of adjacent structures
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Class I deep accommodate fairly long & wide flange Class II moderate half as long & narrow as class I and about twice as long as class III Mostly class I & II are seen Class III shallow . This form is rarely seen.
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Histology of Limiting Structures Epithelium thin, non keratinized Submucosa loosely arranged CT fibres mixed with elastic fibres Mucous membrane of alveolingual sulcus is freely movable for necessary movement of lips, cheeks & tongue.
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