Anatomical Landmarks of maxilla and mandible

Anatomical landmarks

What is landmark? It is an object which is significant and important The role of making denture is to replace function and appearance and create a restoration which is in harmony with the oral enviroment, the knowledge of landmarks of the maxilla and the mandible help us to achieve this role

Landmarks of the maxilla

Labial frenum Incisive papilla Labial sulcus Buccal frenum Buccal sulcus Rugea area Palatine raphe Maxillary tuberosity Hamular notch Fovea palatine Vibrating line

Landmarks of the mandible

Labial frenum Labial sulcus Buccal frenum Buccal sulcus (vestibule) Lingual frenum Mylohyoid ridge Retromolar pad area

Anatomical landmarks

Sulci: the alveolar ridges are defined labially and buccally by a trough of soft tissues called the sulcus. The sulcus is formed by the reflection of mucosa overlying the ridges into the lips and cheeks The lower alveolar ridge also posses lingual sulculs formed by the reflection of mucosa into the tissues of the floor of the mouth

Within the sulcus are seen frenal attachments which are fibrous bands of mucous membrane Each the upper and the lower jaw have labial frenum in the midline area, also each jaw has two buccal frenam on the premolar area The lower jaw has lingual frenum on the midline of the lingual sulcus and is attached to the underside of the tongue

The palate: the palate in the upper jaw consists of the hard palate anteriorly and the soft palate posteriorly

Retromolar pad area:the mandibular alveolar ridge terminates distally in an elevated pad of soft tissues called the retromolar pad

The tissue covering approximately the anterior third of the retromolar pad is fixed, beyond this the tissue moves during functional movements of the mouth, due to the presence of muscle tissue

some of anatomical landmarks are considered limiting, this means that they guides us to have optimum extension of the complete denture, therefore to engage maximum surface area without interupting muscles activity. If the denture impinge on these landmarks, this will lead to dislodgment of the denture or soreness upon those areas while failure to cover the areas up to the limiting structure will cause decreased retention, stability and support.

Limiting landmarks in maxilla

1. Labial frenum: the complete denture is limited from the anterior part by the labial frenum, thus the complete denture must be grooved anteriorly to produce labial notch, this notch must be deep enough not to cause interference to the labial frenum but it should also be closley adapted around the frenum to provide peripheral seal 2.Labial sulcus (vestibule): it runs from the labial frenum till the buccal frenum at both sides

Labial frenum,sulcus and buccal frenum

3.Buccal frenum: It needs greater clearance on buccal flange of the denture (the groove should be shallower and wider) than the labial frenum. 4.The buccal sulcus: extends from the buccal frenum to the hamular notch area 5.Hamular notch-It is depression situated posterior to the maxillary tuberosity, the hamular notch limits the extension of denture base posteriorly and the denture base should not extend beyond this notch, otherwise it will cause truama to the overlying mucosa(pressure being on the pterygoid hamulus and interference with the pterygomandibular raphae

Buccal frenum Buccal sulcus

Hamular notch

6.TheVibrating line-An imaginary line drawn across the palate that marks the beginning of the movement of soft palate when the patient says ah extending from one hamular notch to the other hamular notch;lying usually 2mm in front of fovea palatinae. The vibrating line defines the posterior extention of the fully extended maxillary denture base

Vibrating line

Vibrating line

Limiting landmarks in the mandible

1.Labial frenum: the most anterior part of the denture base is grooved by the labial , frenum 2.Labial vestibule -Runs from the labial frenum to the buccal frenum on each side. Mentalis muscle is quite active in this region 3.Buccal frenum 4.Buccal vestibule- Extends posteriorly from the buccal frenum to outside back corner of the retromolar pad

Buccal sulcus

Labial sulcus labial frenum

Buccal frenum

5.Lingual frenum 6.lingual sulcus Distally the lower denture base covers the anterior third of the 7.retromolar pad area only as buccinator fibres are inserted into the posterior two thirds and therefore moves when buccinator activity occurs

Retromolar pad area

Mylohyoid groove Mylohyoid line Lingual sulcus Lingual frenum

There are also some muscles that sourround and influence the extension and periphery of the complete denture For example in addition to the labial and buccle frenum, the sulcus, the hamular notch and the vibrating line, the upper complete denture is limited by the fibers of the incisivuse labii superiors in the lateral incisors region These fibers are attached to the orbicularis muscle and limits the extension of complete denture

Also in the canine region , there is the orgin of the levator angulii oris that is also inserted in the orbicularis muscle The levator angulii oris limits denture periphery in the canine region The zygomatic process limits the periphery of the denture base The buccinator muscle also limits the preriphery of the denture base in the molar region

Maxillary denture base periphery (the muscles that influence the extension of upper denture base)

Manibular denture perihery

In addition to the labial, buccle lingual frenum and the sulcus, the periphery of the lower complete denture is influnced by number of muscles Lateral to the labial frenum, the periphery of the lower complete denture is enhanced by the mentalis muscle that descends to their insertion to the skin of the chin. Further the periphery is enhanced by the muscles of incisivuse labii inferiors muscle

More distally it is influenced by the depressor labii inferiors, the depressor angulii oris muscle and the tissues overlying the buccinator muscle

Mandibular denture base periphery (the muscles that influence the extension of lower denture base)