CHAPTER

Anatomy of the
Edentulous Ridges
Dr. Mohamed Sbarawy

25
26 Textbook of Complete Dentures

Altiiough a thorough knowledge of all anatomical landmarks of the edentulous mouth is

indispensable tor the .successliil treatment of dental patients, certain structures are espe-
cially important wben fabricating complete denture.s. These structures, which affect tlie
fabrication of complete dentures, and the structures that underlie those important land-
marks will be discussed in this chapter.
Accurate impressions of the maxillaiy and mandibular arches should reproduce
the landmarks that do not cbange their position with function (Ex: alveolar ridges and
hard palate) and the landmarks that change their shape v\ith function (Ex: freniila,
vibrating line between soft and hard palate).
Identifying the anatomical landmarks in casts of the maxillary and mandibular
arches and comparing them lo the same structures in a patient's mouth should help to
provide the clinician with the confidence that the impression procedure accurately
reproduced the area to be covered with tiie denture.

E Extraoral Features

The following extraoral anatomical features should be noted when the patient has
his/her mouth closed (mandible in resting position) and his/her top and bottom lips
lightly touching: phíltrum. labial tubercle, vermillion borders, nasolabial groove, and
labiomental groove (Eigure 3-1). The philtrum is a midline shallow depression of the
upper Up, which starts at the labial tubercle and ends at the nose. The labial tubercle is
a little swelling in the midportion of the vermillion border of the upper lip. Tbe lip is
covered by the skin at its facial surface and the mucous membrane at its inner surface.
The transitional area between the skin and the mucous membrane of the upper and
lower lips is a pink or red zone of thinner epithelium, which is called the vermillion
border. The nasolabial groove is a fuiTow of variable depth that extends from the wing
(ala) of the nose to end at some distance from the comer of the mouth. The labiomen-

Fjgure 3-1 Note the Philtrum (P), Nasolabial groove (NL),

Labial tubercle (T), Vermillion border (VB) and Labiomental
groove (LM).
 Anatomy of the Edentulous Ridges 27

tal groove is a sharp or deep groove that lies between the lower lip and the chin.
Obliteration or filling of one of the above-mentioned normal grooves can occur from a
swelling caused by trauma, infection, cyst, or neoplastic growth.

Structures of the Facial Vestibules

The maxillar)' and mandibular dental arches separate the oral cavity into a facial
vestibule and an oral ca\it\' proper. With the patient in centric occlusion, the space that
is bound by the lips and cheeks facially and the teeth and gingiva internally is called the
labiobuccal, or facial, vestibule. The depth of the facia! vestibule and fornices change
wit!) the way the cheek and lips aje manipulated during impression making. Horizontal
pull or functional movements of the lips and cheek should moid the soft impression
materials and reproduce the position of the fornices.
The following facial vestibular anatomical landmarks should be idendfied on
botli arches: fomix of the vestibule; free gingiva; attached gingiva; unattached gingiva
(alveolar mucosa); interdental papilla; median labial frenums; buccal frenums; and
canine eminences.
The fomix of the vestibule is the site where the mucous membrane lining of the lips
and cheeks reflects and joins the unattached gingiva, or alveolar mucosa. Some people
call the fornix the mucobuccal fold—a term tliat is inaccurate. The depth of the vestibule
in the upper and lower Jaws is determined by tlie site of the fornix, which in turn is deter-
mined by the muscle attachments to the bony Jaws. The muscle that limits the buccal
vestibule in the upper and lower jaws is the buccinator- The muscle takes origin from the
base ofthe alveolar process, at the upper first, second, and diird tnolars and the external
oblique ridge opposite the lower molars. It also takes origin from the pterj'goid hamulus
and the pter>gomandibular raphé. The latter joins the buccinator with the superior
constrictor muscle of the pharynx. The fibers of the buccinator have to cross the retro-
molar triangle (deep to retromolar pad) to join the pterygomandibular raphé medial to
the medial pteiygoid muscle.
The upper fornix is not supported by strong muscles but has small muscles oppo-
site the region of lateral incisor called incisi\Tis muscle. In addition to the latter, oblique
fibers of nasalis muscle fix the ala of the nose to underlying bone and septal muscle,
which attaches to the septum of the nose. These little muscles do not form a barrier to
the subcutaneous tissue of the face. If, while taking an upper impression, the lips are
pulled vertically instead of horizontally the action will artificially increase the depUi of
the vestibule, and the flange of the denture will extend into tlie subcutaneous space,
causing irritation of the mucosa and alteration of the facial appearance.
Following extraction oí teeth, the bone supporting the roots (alveolar process)
undej^oes résorption and therefore the depth of the vestibule become shallower.
Surgical creation ofa new fornix that would permit increase in the depth ofthe vestibitle
may be required before denture construction.
The free gingiva is the part ofthe gingiva that extends from the gingival margin to
the attached gingiva (approximately tlie level of the gingival sulcus). The attached
gingiva is the part of the gingi\a that is held fii miy to the underhing bone and cemen-
tum (hard tissue that covers the root ofthe tooth). The unattached gingiva is tlie part of
the gingiva that is loosely attached to the underlying bone. It is continuous witli the alve-
olar mucosa. The interdental papilla is the part of the gingiva located in the interdental
28 Textbook of Complete Dentures

Figure 3-2 Facial vestibule showing: Fornix (*), upper

median labial frenum and lower median labial frenum (F),
buccal frenum (BF), alveolar mucosa (AM), interdental
papillae ÍIP) and marginal gingiva (MG).

space. In some patients, the marginal, or free, gingiva is demarcated from the attached
gingiva by the presence of a gingival groove (Figure 3-2).
The vipper medial labial frenum, or frenulum, is a fold of mucous membrane that
overlies dense connective tissue (Figures 3-2 and 3-4). It does not contain muscle fibei-s,
in contrast to die buccal írenula. It anchors the upper lip to the gingiva. The frenum
varies in size among individuals but it is usually more developed than other frenula found
in the vestibule. When it is ahnonnally large, it extends to the interdental papilla between
the two central incisors. An enlarged upper median labial frenum is frequently found in
association with a diastema (large space between the two central incisors). In many eden-
tulous patients, resoiption of Lhe alveolar bone brings tlie crest of the alveolar ridge
closer to the frenum. Therefore, a normal frenum may need surreal excision before

Figure 3-3 Buccal Vestibule. Note the prominent buccal

frenums.
 Anatomy of the Edentulous Ridges 29

Figure 3-4 The upper medial labial frenum, or frenulum,

is a fold of mucous membrane that overlies dense connec-
tive tissue.

successftiï denture construction can be initiated. In all cases, the denmres should be
relieved away from the frenula, to avoid iiTitation of these folds and to prevent future
instability of the dentures. The upper buccal frenum is a mucotis membrane fold that
overlies dense flbrous connective tissue and fibers of tiie caninus, or the levator anguli
oris muscle (elevator ofthe angle ofthe mouth). The latter is one ofthe muscles of facial
expression. The lower median labial frenum is morphologically similar to the upper
median labial frenum but commonly less developed. The lower buccal labial frenum is
also morphologically similar to Uie upper bticcal labial frenum but again less developed.
It contains muscle fibers from the depressor anguli oris, or triangularis (another muscle
of facial expression) (Figure 3-3).
The canine eminence is a bony prominence in both the nieixilla and mandible that
denotes the roots of the canine teeth. The eminences of the upper jaw raise the upper
lip; its loss leads to the sagging of the lip associated with aging.

Alveolar (Residuai) Ridges

The roots of tlie teeth are supported by the alveolar process of the maxilla and the
mandible. Following full mouth extractions, the alveolar ridges undergo significant
boney changes, with the largest changes seen on the mandibular arch. Studies indicate
that the mandibular ridge resorps approximately four times as much as the niaxillar\'
arch. The direction of mandibular résorption is downward and outward, while maxillary
resolution is upward and inward. The results of this resorptive pattern often force a cross-
bite ofthe posterior dentures in order to maintain the dentures over the residual ridges
(Figures 3-5, 3-6).
The maxillarv" uiberosity is the most posterior part of tlie alveolar ridge; it lies distal
to the position of the last molar. It is a bulbous mass of mucous membrane that overlies
a bony tuberosity. The maxillary tuberosit)' is important from a denture standpoint
30 Textbook of Complete Dentures

Figure 3 5 Mandibular alveolar ridge showing: crest of

the ridge (*) and the retromolar pad areas (RP).

because it is considered a primary stress-bearing area and because surgery must be

considered wben die tuberosity is extremely large and compromises the clearance neces-
sary for opposing dentures. The most distal structure in the mandibular residual ridge is
the retromolar pad.

• Maxillary Arch

The anatomical landmarks of the maxillary arch, which may affect denture fabrication,
include the incisive papilla, palatine rugae, torus palatinus. mid-palatine raphe. xnaila.

Figure 3-6 Maxillary arch showing: incisive papilla (IP),

nnaxitlary tuberosity (MT) and the hamular notch (HM).
 Anatomy of the Edentulous Ridges 31

fovea palatini, hamuîar notches, posterior palatal seal area, and vibrating line (Figure 3-6
through 3-8).
The incisive papilla is a small tubercle located on the palatal side between the two
cenli"al incisors. It overlies the incisive foramen, through which the incisive nerve and
blood vessels exit. Because of the sensitivitj of this structure, care must be taken when
inserting the maxillary denture to relieve almost all pressure in this area. The incisai
papilla is a good landmark wben contouring occlusion rims and positioning the dentures
because studies indicate that tbe facial surfaces of the natural central incisors, when
present, were approximately &-10 mm anterior to the middle of the incisai papilla, and
tlie tips of the canines were approximately in line with the middle of the incisai papilla
(Figure 3-7).
The palatine rugae (Figure 3-7) are irregular mucous membranes that extend bilat-
erally from the midline of the hard palate in relation to the upper six anterior and some-
times bicuspid teeth. Many years ago it was felt dial these süuctures could potentially play
a large role is speech and in helping the patient position the tongue. Dentures were fabri-
cated with artificial rugae in an attempt to aid patients in these areas, however current
studies do not indicate that tlie rugae play a significant role in speech or tongue position-
ing, and they are no longer considered important when fabricating maxillarv' dentures.
Wien present, tbe torus palatinus (Eigiue 3-7) is a bonv prominence of variable size
and shape, which is located in the middle of the hard palate. Because the tissue overlying
a palatal torus is usually very thin, and the torus is very rigid, any pressure caused by a
maxillarv' denture during chewing and swallowing v\ill often u-aumatize ihe tissue and lead
to irritation and ulcération. Care must be taken during insertion to relieve any pressure
to the torus caused by the denture. Additionally, an enlarged torus palatinus could act as
a fulcaim that can lead to Ínstabilit\ of a denture. Generally, any tonis thai has lateral
undercuts or extends to the vibrating line should be considered for surgical removal.
The midpalatine raphé (Eigure 3-8, A) is a line in the middle of the mucosa of the
hard palate that overlies the mid-palatine bony suture. The tissue in this area is very thin,
and any pressure from a denture will not be tolerated in most patients. Care must be
taken when inserting the denture to provide necessary relief.
The uvaila is a tongue-like projection extending from the distal extent of the soft
palate. The uvula is muscular. Its exact function is unknown, however it helps in sealing

Figure 3-7 Note the palatine rugae (PR), incisive papilla

(IP) and the torus palatines (T).
32 Textbook of Complete Dentures

Figure 3-8 The midpalatine raphé (A) is a line ¡n the

middle ofthe mucosa ofthe hard palate, which overlies
the midpalatine bony suture.The fovea palatini (B) are two
depressions that lie bilateral to the midline of the palate,
at the approximate junction between the soft and hard
palate, and denote the sites of opening of ducts of small
mucous glands of the palate.

the oral cavitj' from the nasal cavity during swallowing. Until recently, removing the uvula
and part of the soft palate (uvulopalatopharyngoplasty, UPPP) in an attempt to reheve
the symptoms of snoring and obsu uciive sleep apnea has been popular in the medical
community. This procedure has lost favor, however, because of tiie reasonably low success
rate, a certain amount of morbidity associated with the procedure, and the resultant diffi-
culty in speech and swallowing in some patients. It is not involved in ttie constn.iction of
complete dentures.
The fovea palatini (Figure 3-8, B) are two depressions that lie bilateral to the
midline of the palate, at the approximate junction between the soft and hard palate.
They denote the sites of opening of ducts of small mucous glands of the palate. They are
often useful in the identification of the vibrating line because they generally occur within
2 mm of the vibrating line.
The hamular process, or hamulus, is a bony projection of the medial plate of the
pterygoid bone and is located distal to the maxillary tuberosity. Lying between the maxil-
lar)- tuberosity and the hamulus is a groove called the hamular notch (Figure 3-9). This
notch is a key clinical landmark in maxillar) denture construction because the maxjmitm
posterior extent of tlie denture is the vibrating line that runs bilaterally through tlie
hamular notches. The hamulus can be palpated clinically and it can be a possible site of
irritation in denture wearing patients, if the denture touches diis process. The tendon of
the tensor velli palatini muscle runs across the hamulus to reach the soft palate. Under
the tendon is a small bursa (membrane between the moving tendon and the hamulus).
Inilammation and pain can result from mechanical irritation by imstable dentures.
Although not a truly anatomical feature, tlie vibrating line is ver>' important to
locate for proper construction of tlie maxillarv complete denture (Figure 3-10).
•Although not precisely true, tlie vibrating line can be considered as thejimction between
the hard and soft palates and is important because it is the maximum posterior limit to
the maxillarv denture. This line runs from about 2 mm buccal to the center ofthe hamu-
 Anatomy of the Edentulous Ridges 33

Figure 3-9 Lying between the maxillary tuberosity and

the hamulus is a groove called the hamular notch.This
notch is a key clinical landmark in maxillary denture
construction because the maximum posterior extent of the
denture is the vibrating line, which runs bilaterally through
the hamular notches.

lar notch on one side ofthe arch, follows the junction ofthe hard and soft palates across
the palate, and ends about 2 mm buccal to the center of the opposite hamular notch.
Additionally the vibrating line is the distal extent of the posterior palatal seal area
(Figure .3-11). The posterior palatal seal area is verv' important in maxillar> complete
denture fabrication and must be identified and evaluated. It is the area of compressible
tissue located anterioi" to the vibrating line and lateral to the midline in the posterior
third of the hard palate. The distal extent of this area is tlie vibrating line, while the

Figure 3-10 The vibrating line is a very important feature

to be located in the construction of the maxillary complete
denture. It can be considered as the junction between the
hard and soft palates and is important because it is the
maximum posterior limit to the maxillary denture.
34 Textbook of Complete Dentures

Figure 3-11 The posterior palatal seal area is very impor-

tant in maxillary complete denture fabrication and must be
identified and evaluated. It is the area of compressible
tissue located lateral to the midline and in the posterior
third of the hard palate. The distal extent of this area is
the vibrating line, while the anterior border Is indistinct.

anterior border is indistinct. The redundancy of the tissue in this area is caused by the
presence of mucous glands surrounded by abundant loose connective tissue. The depth
of compressible tissue is evaluated using palpation and noted for future reference. This
information will be used following master cast fabrication and is important in maxillarv-
denture retention.

Mandibular Arcii

In the lower jaw. a triangular area of thick mucosa is found distal to the last molar, basi-
cally on the crest ofthe ridge, and is referred to as the letromolai pad (Figiue 3-12). This
pad is extremely important in denture construction from botii a denture extension and
plane of occlusion standpoint. The retromolar pads should be covered by tJie denture,
and Uie plane of occlusicm is generally located at the level ofthe middle to upper-third
of this pad. Extending from the hamulus above to the area of the retromolar pad below
is the pterygomandibular raphé fold (Figure 3-13). The pteiygomandibular raphé, which
underlies the fold, is tlie jtmction between the buccinator (cheek muscle) and the supe-
rior constrictor muscle of the phar^'nx. It is often visible in the maxillary impression and,
when present, is an excellent landmark for determining the distal extent of the maxillary
denture. It is usually insignificant when making the mandibular impression.
Just buccal to the crest of the mandibular ridge in the distal-buccal comer of the
arch is an area known as tlie masseter notch, or groove area (Figtne 5-14). It is impor-
tant in mandibular denture fabrication because of its influence on impression making. It
is a diagonal directed line that runs from the depth ofthe vestibule in the anterior to the
 Anatomy ofthe Edentulous Ridges 35

Figure 3-12 In the lower jaw, a triangular area of thick

mucosa is found distal to the last molar, basically on the
crest of the ridge, and is referred to as the retromolar pad.
This pad is extremely important in denture construction
from both a denture extension and plane of occlusion
standpoint.

crest of the ridge in the posterior. It is formed by the actions of the masseter muscle.
Because there is often a fatty roll of tissue overlying the buccinator muscle, medial to the
masseter muscle, Lhis cheek area must often be lifted to eliminate the fatty roll, particu-
larly when making the final impression (Figure 5-15). If clinicians do not properly eval-
uate this area, the resultant completed mandibular denture is overextended. This
overextension will cause significant discomfort to the patient and/or the mandibular
denture will become dislodged on opening.

Figure 3-13 Extending from the hamulus above to the

area of the retromolar pad below is the pterygomandibu-
lar raphé fold.
36 Textbook of Complete Dentures

Figure 3-14 Just buccal to the crest of the mandibular

ridge in the distal-buccal corner of the arch is an area
known as the masseter notch, or groove area (A). The
most distal extent of the inner surfaces of the mandibular
ridges ends in an area called the retromylohyoid area, or
fossa (B).

The buccal shelf (Eigure 3-16) is located on the mandibular arch and is important
to mandibular denture fabrication because it is tbe primarv' stress-bearing area of tlie
mandibular arch. It is an area bounded on the medial side by the crest of the residual
ridge, on the lateral side by the external oblique ridge, in the mesial area by the buccal
frenulum, and on the distal side by the masseter muscle. It is just anterior to the pre-
masseteric notch area. The buccal shelf consists primarily of thick cortical bone, in
contrast to the crest of the ridge, which is fenestrated and consists of thin cortical bone
overlying more cancellotis bone.

Figure 3-15 Because there is often a fatty roll of tissue

overlying the buccinator muscle, this cheek area must
often be lifted to eliminate the fatty roll, particularly when
making the final impression.
 Anatomy of the Edentulous Ridges 37

Figure 3-16 The buccal shelf (B) is located on the

mandibular arch and is important to mandibular denture
fabrication because it is the primary stress-bearing area
of the mandibular arch.The residual ridge (A).

The tongue (Figure 3-17) is located in the floor of the mouth. It is important to
become familiar v\ith the nomial features of the tongiie because many systemic disease
processes, such as iron deficiency anemia and pernicious anemia, for example, can cause
changes in the tongue. Early recognition of these changes may help in the discovery of
serious .systemic illness. The tongue is important in denture construction because of its
significant mobility and because of its involvement with deglutition and speech. Its activ-
ities must be accounted for when making impressions and when arranging the teeth on
the mandibular denture. The doi-sum of the anterior two-thirds of tlie tongue is rough
because ofthe presence of projections known as lingual papillae. The junction between

Figure 3-17 The tongue is located in the floor ofthe

mouth. It is important to become familiar with the normal
features of the tongue because many systemic disease
processes can cause changes in the tongue.
38 Textbook of Complete Dentures

Figure 3-18 The ventral surface of the tongue is

anchored to the floor by a mucous membrane fold
known as the lingual frenulum.

the anterior two-thirds and the posterior one-tliird of the tongue is denoted by a V-
shaped sulcus called the sulcus limitans. Along this sulcus are 10-13 larger papillae known
as the circumvallate papillae. To observe these papillae, the tongue has to be pulled
forward. In many patients, several normal fissures can be obsen'ed in the dorsum of the
tongue. The ventral surface ofthe tongue (undersurface) is anchored to the floor by a
mucous membrane fold known as die lingual frenulum (Figures 3-18 & 3-19). Along the
sides of the lingual frenulum slighdy tortuous vessels can be seen glistening through tlie
thin and smooth mucous membrane of the tongue. These vessels are branches of the
lingual arteiT (linguae profundus) and the lingual vein (ranine vein). Branches ofthe
lingual nei-ve accompany these vessels. Careful handling of tlie dental instruments inside
the mouth is advisable as injury to the vessels and nerves could occur.

Figure 3-19 The ventral surface of the tongue showing

veins on both sides of the lingual frenulum.
 Anatomy of the Edentulous Ridges 39

Figure 3-20 In the floor of the mouth, on both sides,

prominent folds of mucous membrane called the
sublingual folds are usually seen.

In tlie floor of the mouth, on both sides, prominent folds of mucous membrane
called the sublingual folds are usually seen (Figure 3-20). At Lhe medial end of each fold
is a little swelling referred to as the sublingual canmcle, where the subniandibular sali-
vary gland duct opens into tbe oral cavity (Figure 3-21, A). -Along the sublingual fold,
one can see numerous tiny orifices for tiie ducts of the sublingual salivarv glands. The
orifice ofthe large parotid gland is found in the mucous membrane ofthe cheek oppo-
site to the upper second molar. The parotid orifice is gtiarded by a mucous membrane
swelling called tiie parotid papilla (Figure 3-22). The orifice of tlie parotid has been

Figure 3-21 At the medial end of each fold is a tittle

swelling referred to as the sublingual caruncle; this is where
the subnnandibular salivary gland duct opens into the oral
cavity (A). Some patients exhibit bilateral bony promi-
nences of the inner surface of the mandible in the region
of the premolar teeth called the torus mandibularis (B).
40 Textbook of Complete Dentures

Figure 3-22 The parotid orifice is guarded by a mucous

membrane swelling called the parotid papilla.

used as a landmark to help determine the level ofthe plane of occlusion. Because of its
position, however, il is veiT diñiciilt to visualize in many patients without mo\'ing the
cheek to an unnatural position.
Along the inner surfaces of the middle to posterior one-third of the mandible, bony
ridges knowTi as the niylohyoid, or internal oblique ridges (site for attachment of the
mylohyoid muscles) can be palpated. Occasionally prominent sharp, bony ridges musl be
surgically reduced prior to making complete dentures to minimize patient discomfort.
These are important structures because ofthe attachment ofthe mylohyoid muscles and
the influence of tliese muscles on the denture flanges.
Some patients will exhibit bilateral bony prominences of the inner surface of
tlie mandible in the region ofthe premolar teeth called the torus mandibularis (Figure
3-21, B). These prominences must usually be removed prior to denture fabrication.

Figure 3-23 In patients suffering from atrophied

mandibles, the residual ridge resorbs to the level of the
genial tubercles, which can easily be palpated. (A) residual
ridge, (B) genial tubercles
 Anatomy of the Edentulous Ridges 41

TTie most distal extent of the inner surfaces of the mandibular ridges ends in an
area called the retromylohyoid area, or fossa (Eigure 3-14, B). The fossa is bound later-
ally by the mandible and the most anterior border of the medial pterygoid muscle and
medially by tbe tongue. Tlie fossa is distal to the most posteriorfibei-sof the mylohyoid
muscle. The impression materia! may extend into the fossa. The opposing retromylohy-
oid areas are usually undercut, in relation to each other. One difficulty encountered
when fabricating tbe mandibular denture is that these bilateral undercuts may greatly
compHcaie the process of making preliminai^ and final impressions. The dentures may
also reqtiire significant adjustments in these areas at the time of insertion.
In patients suffering from atrophied mandibles, the residual ridge resorbs to the
level of the genial tubercles, which can be easily palpated (Eigure 3-23). Tliese bony
midline lingual projections offer attachment to genioglossi and geniohyoid muscles. The
dentures should be trimmed around the genial tubercles in those cases.

1. What is the name of the site where the mucous membrane lining of the
lips and cheeks reflects and joins the unaltached gingira or alveolar mucosa?
Some people call tiiis the muct>buccal fold—a term that is inaccurate.
2. Besides location, what is one major difference between the upper medial
labial frenum, or frenulum, and the buccal frenuia?
3. Eollowing full mouth extractions, the alveolar ridges undergo significant
bone loss in most patients. Compare the amount of bone loss of the
mandibular and maxillary arches.
4. Why is the incisai papilla a good landmark to note when contouring occlu-
sion rims and positioning tlie denture teeth?
5. Why is the location of the fovea palatini important to note in the edentulous
patient?
6. The maxillary complete denture should not cover the hamular process, or
hamulus; why then is the location of the hamular process important?
7. \Miat structure is located distal to the last mandibular molar and why is it
important in the making of complete dentures?
8. JiLSt buccal to the crest of the mandibular ridge in the distal-buccal comer
of the arch is an area known as the masseter notch, or groove area. Why is
this area of interest when fabricating a mandibular denture?
9. WTiat and where is the buccal shelf and why is it important in the fabrication
and wearing of mandibular complete dentures?
10. What is the area that determines the most distal lingual extent of a
mandibular complete denture and what difficulties may the clinician
have with this area?
42 Textbook of Complete Dentures

1. The fornix of tlie vestibule is the site where the mucous membrane lining
of the lips and cheeks reflects and joins the tmattached gingiva, or alveolar
mucosa.
2. The upper medial labial frenum, or frenulum, does not contain muscle
fibers, in contrast to the buccal frenula.
3. Studies indicate that the mandibuiar ridge resorps approximately four times
as much as the maxillary arch.
4. The incisai papilla is a good landmark when contouring occlusion rims and
positioning tlie dentures because studies indicate that the facial surfaces
ol the natural central incisors, when present, are approximately 8-10 mm
anterior to the middle of tlie incisai papilla, and the tips of the canines are
approximately in line with the middle of the incisai papilla.
5. The fovea palatini are two depressions that lie bilateral to the midline of the
palate, at the approximate junction between the soft and hard palate, and
denote the sites of opening of ducts of stiiall mucous glands of the palate.
They are often useful in the identification of tlie vibrating line because they
generally occur within 2 mm of the vibrating line.
6. The hamular process, or hamtiltis, is a bony projection ofthe medial plate
ofthe pter\goid bone and is located distal to tbe maxillarv' tuberosity. L>ing
between the maxillary tuberositv' and the hamulus is a groove called the
hamular notch. This notch is a key clinical landmark in maxillar)' denture
construction because the maximum posterior extent of tlie denture is the
vibrating line, which runs bilaterally through the hamular notches.
7. In the lower jaw, a triangular area of thick mucosa is found distal to the last
molar, basically on the crest of the ridge, and is referred to as tlie retromolar
pad. This pad is extremely important in denture construction from both a
denture extension and plane of occlusion standpoint. This pad should be
covered by the denture, and the plane of occlusion is generally located at the
level of the middle to upper one-third of this pad.
8. This area is important in mandibular denture fabrication because of its influ-
ence on impression making. Becau.se there is often a fatty roll of tissue overly-
ing the masseter muscle, this cheek area tnust often be lifted to eliminate the
fatty roll, particularly when making the final impression. Clinicians may not
properly evaluate this area and the resultant completed mandibular denture
is overextended, causing dentute instability and tissue initation.
9. The buccal shelf is located on the mandibular arch and is important to man-
dibulai" denture fabrication because it is the primary stress-bearing area of the
mandibuiar aich. It is an area bounded on the medial side by the crest of the
residual ridge, on the lateral side by the external oblique ridge, in the mesial
area by the buccal frenulum, and on the distal side by the masseter muscle.
It is just anterior to the masseter notch area.
 Anatomy of the Edentulous Ridges 43

10. The most distal extent of the inner surfaces of the mandibular ridges ends
in an area called the retromylohyoid area, or fossa. This area is the most
distal extension of the mandibular denture, and the opposing retromylohy-
oid areas are usually undercut in relation to each other. One difficulu-
encoimtered when fabricating the mandibular denture is tliat these bilateral
undercuts may greatly complicate the process of making the preliminar}-
and final impressions. The dentures may also require significant adjustments
in these areas at the time of insertion.
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