BIOLOGICAL CONSIDERATIONS FOR

MAXILLARY IMPRESSIONS
If dentures and their supporting tissues are to coexist for
reasonable length of time, the dentist must fully understand the
macroscopic and microscopic anatomy of the supporting and limiting
structures.

A thorough understanding of their role will determine:

1) The selective placement of forces by the denture bases on the

supporting tissues

2) The form of the denture borders that will be harmonious with the
normal function of the limiting structures around them.

It is convenient to regard the impression or fitting surface of a

denture as comprising two areas: - A stress-bearing or supporting area
and a Peripheral or sealing area.

MACROSCOPIC ANATOMY OF SUPPORTING STRUCTURES

The foundation for dentures is made up of bone covered by mucous
membrane, mucosa and submucosa. In the submucosa are the vessels that
carry blood to the basal seat and the nerves that innervate it.
Each type of tissue found in the oral cavity has its own
characteristic ability to resist external forces. This is important to the
maintenance of health of the tissues of the basal seat and the stability and
support of dentures.

1) SUPPORT FOR THE MAXILLARY DENTURE:The ultimate support for a maxillary denture is the bone of
the two maxillae and the palatine bone. The palatine processes of the
maxillae are joined together at the midline in the median. The two
palatine processes of the maxillae and the palatine bone form the
foundation for the hard palate and provide considerable support for the
denture. More important, however, they support soft tissues that increase
the surface area of the basal seat.
The center of the palate may be very hard because of the layer of
soft tissue covering the bone in the region of the median palatal structure
is extremely thin.

If the hard palate is less resilient than the soft tissues covering the
residual ridges, it should be relieved to prevent a tendency of the denture
to rock or the development of soreness in this region when vertical forces
are applied to the teeth. The relief for the median palatal suture and its
overlying raphe can be developed in the impression making or dentureprocessing procedure or after the denture has been completed. The
various regions in the mouth that have special responsibilities for stress
distribution
The socket surrounding the roof of each natural tooth is the alveolus,
and the bony ridge that supports the teeth is the alveolar ridge.
The bony process remaining after teeth have been lost is the residual
alveolar ridge, which also includes, the mucous membrane that covers the
bone. The nature and relative thickness of the soft tissues in different
parts of the basal seat determine the amount of support these tissues can
provide for a denture.

2) RESIDUAL RIDGE: - The shape and size of the alveolar ridges

change when the natural teeth are removed. The alveoli become mere
holes in the jaw bones and begin to fill up with new bone, but at the same
time the bone around the margins of the tooth socket begins to shrink
away. This shrinkage or resorption is rapid at first, but it continues at a
reduced rate through out life. The resorption of the alveolar process

causes the foundation for the maxillary denture to become smaller and
otherwise change shape.
If the teeth have been out for many years, the residual ridge may
become quite small and the crest of the ridge may lack a smooth cortical
bone surface under the mucosa.

3) STRESS BEARING AREAS: a) RESIDUAL RIDGE

b) RUGAE
c) GLANDULAR REGION OF HARD PALATE

a) RESIDUAL RIDGE: - It is the major or primary stress bearing area

in the upper jaw. The crest of the residual alveolar ridge is covered with a
layer of fibrous connective tissue, which is most favourable for
supporting the denture because of its firmness and position. The artificial
teeth will be placed near this ridge so leverage will be minimal.

b) RUGAE: - In the anterior part of the hard palate are irregularly shaped
rolls of soft tissue that serve no function in humans.
To avoid unseating of the dentures the rugae should not be distorted
during impression technique because rebounding tissue tends to unseat
the denture.
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c) GLANDULAR REGION OF HARD PALATE: - The glandular region

on each side of the midline in the posterior part of the hard palate. To aid
in retention this area should be covered by the denture, and because of
high resiliency at this site it wont provide significant support for the
denture.

4) INCISIVE PAPILLA: - It covers the incisive foramen and is

located on the line immediately behind and between the central incisors.
Its position varies in different patients. It is located on the centre of the
ridge after resorption has occurred in mouths that have been edentulous
for a longtime. Relief for the papilla should be provided in every denture
to avoid any possible interference with the blood and nerve supply.

5) POSTERIOR PALATEL AREA: - The posterior palatine foramina

are so thickly covered by soft tissue that they do not need to be relieved
except in extreme cases of resorption. A study of the bony portions of the
palate reveals many sharp spines, which are a source of trouble in ridges
with extreme resorption. These bony spines are difficult to locate when
they are covered by soft tissues of the palate.

6) INCISIVE FORAMEN: - It is located in the palate on the median

line at the lingual gingival of the anterior teeth; it comes nearer to the
crest of the ridge as resorption progresses. Relief should be provided in
the denture to prevent impingement on the nasopalatine nerves and blood
vessels as they pass through the foramen. The location of the incisive
papilla gives an indication as to the amount of resorption of the residual
ridge and thus is an aid in determining vertical dimension and the proper
position of the teeth.

7) ZYGOMATIC PROCESS: - It is one of the hard areas found in

mouths that have been edentulous for a long time. It is also called
maxillary process and is located opposite to the first molar region. To aid
retention and prevent soreness of the underlying tissues relief is required
for dentures in this area.

8) MAXXILARY TUBEROSITY:-The tuberosity region of the

maxilla often hangs abnormally low because, when the maxillary
posterior teeth are retained after the mandibular molars have been lost
and not replaced, the maxillary teeth extrude, bringing the process with
them. Often the low-hanging tuberosity is complicated by an excess of
fibrous connective tissue. This excess soft tissue can prevent proper

location of the occlusal plane if it is not removed. In addition, rough

rough and irregular bone can be irritated by the denture base.

9) TORUS PALATINUS: - It is a hard bony enlargement that occurs

in the midline of the roof of the mouth. It occurs in about 20% of
population. Different types are:a) Soft tissue, loose and flabby
b) This layer of mucosal tissue covering the bone.
The extent of the forms can be determined by palpation and an arbitrary
relief shape that disregards the extent of this hard area should not be used.
Such a relief shape may rub the denture of part of its support area.

MACROSCOPIC ANATOMY OF LIMITING

STRUCTURES (peripheral or sealing area of a denture):The denture base should include the maximum surface possible
within the limits of the health and function of the tissues it covers and
contacts. This means that a denture should be made in such a way that
covers all the available basal seat tissues without causing soreness at the
denture borders and without interfering in the action of any of the
structures that contact or surround it.

The limiting structures of the maxillary basal seat can be analyzed

in different regions. The anterior region extends from buccal frenum to
the other on the labial side of the maxillary ridge and is called the labial
vestibular space. In this region three objective are apparent.
First The impression must supply sufficient support to the upper lip to
restore the relaxed contour of the lip.
Second- The labial flange of the impression must have sufficient height to
reach to the reflecting mucous membrane of the labial vestibular space
without distributing.
Third There must be no interference of the labial flange with the action
of the lip in function.
1) LABIAL FRENUM:- The maxillary labial frenum is a fold of
mucous membrane at the median line. It contains no muscle and has no
action of its own. This band of tissue starts to superiorly in a fan shape
and converges as it descends to its terminal attachment on the labial side
of the ridge. the labial notch in the labial flange of the denture must be
just wide enough and just deep enough to allow the frenum to pass
through it without manipulation of the lip. This fact should be taken into
consideration in the relief for this attachment. The denture borders should
not only be cut lower but also have less thickness adjacent to the labial
notch in the border of the denture. A shallow bead can be formed in the
denture base around the notch to help perfect the seal.
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2) ORBICULARIS ORIS: - It is the main muscle of the lips, lying

infront of and resting on the labial flange and teeth of the denture. Its tone
depends on the support it receives from the thickness of the labial flange
and the position of the arch of teeth.

3) BUCCAL FRENUM: - The denture border between the labial and

buccal frena is known as the labial flange. The buccal frenum is
sometimes a single fold of mucous membrane, sometimes double, and in
some mouths, broad and fan shaped.
It requires more clearance for it action than the labial frenum does. The
border of the denture should be functionally molded to fit exactly the
depth and width of this frenum when it is in function, being moved.
Inadequate provision for the buccal frenum or excess thickness of the
flange distal to the buccal notch can cause dislodgement of the denture
when the cheeks are moved posteriorly as in a broad smile.

4) BUCCAL VESTIBULE: - Is opposite the tuberosity and extends

from the buccal frenum to the hamular or pterygomaxillary, notch. The
size of the buccal vestibule varies with the contraction of the buccinator,
the position of the mandible and the amount of bone lost from the

maxilla. When the mandible moves forward or to the opposite side, the
width of the buccal vestibule is reduced. The size and shape of the
posterior part of the buccal vestibule are altered by the lateral movements
of the mandible.

5) HAMULAR NOTCH: - It is situated between the tuberosity of the

maxilla and the hamulus of the medical pterygoid palate. It is used as a
boundary of the posterior border of the posterior border of the maxillary
denture back of the tuberosity. The posterior palatal seal must be placed
through the centre of the deep part of the hamular notch, since no muscle
or ligament is present at a level to prevent the placement of extra
pressure.

6) PALATINE FOVEA REGION:-The Foveae palatinae are

indentations near the midline of the palate formed by a coalescence of
several mucous gland ducts. They are close to the vibrating line and
always in soft tissue, which makes them an ideal guide for the location of
the posterior border of the denture.

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7) VIBRATING LINE OF PALATE:-It is an imaginary line drawn

across the palate that marks the beginning of motion in the soft palate
when the patient says ah. It extends from one pterygomaxillary notch to
the other. At the midline it usually passes about 2mm in front of the
foveae palatinae. This line should be confused with the junction of the
hard and soft palates, since the vibrating line is always on the soft palate.
This is not a well-defined line and should be described as an area rather
than a line. The distal end of the upper denture must extend at least to the
vibrating line. In most instances the denture should end 1 or 2 mm
posterior to the vibrating line.

MICROSCOPIC ANATOMY OF SUPPORTING TISSUES

The microscopic anatomy of the supporting tissues of the upper
impression will be described for the
1. Crest of the upper residual ridge, the 2. slopes of the residual ridge, and
the 3. Palatal tissues.
The mucous membrane covering the crest of the upper residual
ridge in a healthy mouth is firmly attached to the periosteum of the bone
of the maxillae by the connective tissue of the submucosa.

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The submucosal layer, though relatively thin in comparison to other

parts of the mouth, is still sufficiently thick to provide adequate resiliency
for primary support of the upper denture.
The outer surface of the bone in the region of the crest of the upper
residual ridge may be compact in nature, being made up of haversian
systems. This compact bone, in combination with the tightly attached
mucous membrane, makes the crest of the upper residual ridge
histologically best able to provide primary support for the upper denture.
One should take advantage of the nature of this tissue when providing for
additional stress to be placed on the crest of the ridge of the upper jaw
during final impression making.
The soft tissue covering the hard palate varies considerably in
consistency and thickness in different locations even though the
epithelium is keratinized throughout. Anterolaterally, the submucosa of
the hard palate contains adipose tissue and posterolaterally it contains
glandular tissue. These tissues should be recorded in a resting condition,
because when they are displaced in the final impression they tend to
return to normal form within the completed denture base, creating an
unseating force on the denture or causing soreness in the patients mouth.
Proper relief of the final impression tray aids in recording these tissues in
an undistorted form.

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The submucosa in the region of the median palatal suture of the

maxillary bones is extremely thin. The mucosal layer is practically in
contact with the underlying bone. Little or no stress can be placed in this
region during the making of the final impression or in the completed
denture if not the denture tend rock over the centre of the palate when
vertical forces are applied to the teeth.

MICROSCOPIC ANATOMY OF LIMITING STRUCTURES

1) VESTIBULAR SPACES
2) HAMULAR NOTCH
3) VIBRATING LINE

The microscopic anatomy of the limiting tissues of the upper denture will
be described for the vestibular spaces, the hamular notches and the
posterior palatal seal area in the region of the vibrating line.

1) Vestibular spaces: - A histologic section of the mucous membrane

lining the vestibular spaces depicts a relatively thin epithelium that is
nonkeratinized. The submucosal layer is thick and contains large amounts
of areolar tissue and elastic fibres. The nature of the submucosa in the

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vestibular spaces makes this tissue easily movable. Thus the labial/buccal
flanges of the upper impression can easily be overextended or
underextended.

2) Vibrating line: - The submucosa in the region of the vibrating line on

the soft palate contains glandular tissue similar to that in se the
submucosa in the posterolateral part of the hard palate. However, because
the soft palate does not rest directly on bone, the tissue for a few
millimeters on both sides of the vibrating line can be repositioned in the
impression to improve the posterior palatal seal.

3) Hamular notch: - The submucosa of the mucous membrane

contained within the hamular notch (the space between the posterior
part of the maxillary tuberosity and the pterygoid hamulus) is thick
and made up of loose alveolar tissue. Additional pressure can also be
placed on this tissue at the centre of the notch to complete the
posterior palatal seal. Space is provided in the final impression tray
except in the region of the vibrating line and through the hamular
notches before the final impression is made.

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CLINICAL CONSIDERATIONS OF MICROSCOPIC ANATOMY

A Knowledge of the microscopic anatomy of the oral mucous
membrane has direct clinical implications for dentists and directly affects
their success when they treat edentulous patients.
Histologically, removing the dentures from the mouth for 6 to 8
hours a day, preferably during periods of sleep, allows keratinization to
increase and the signs of inflammation, often found in the submucosa
when dentures are worn, to be dramatically reduced.
Nerves in the mucous membrane of the residual ridges in elderly
edentulous persons are greatly reduced, and those present are confined
mostly to the lamina propria adjacent to the underlying bone.
Alveolar and gingival arteries show signs of sclerosis. Age also plays a
major role in the ability of the oral mucous membrane to recover from
compression loading caused by pressures from the denture base.
The immediate changes in the form of the supporting mucous
membrane by pressures from the denture base seriously compromise
correction of the occlusion of dentures in the patients mouth or
correction of parts of final impression by the addition of impression
material directly to the defect rather than a remaking of the total
impression

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Residual ridge: - The portion of the residual bone and its soft tissue
covering that remains after the removal of teeth.
Stress-bearing area: - The surfaces of oral structures that resist forces,
strains, or pressures brought on them during function.
Rugae: - An anatomic fold or wrinkle of fibrous connective tissue located
in the anterior third of the hard palate.
Incisive papilla: - The elevation of soft tissue covering the foramen of the
incisive or nasopalatine canal.

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REFERENCES

1. Heartwell

CM,

Rahn

AO

:Syllabus

of

Complete

Dentures.ed 4.
2. Levin B :Impressions for Complete Dentures
3. Winkler

S:

Essentials

of

Complete

Denture

Prosthodontics, ed 2
4. Zarb GA, Bolender CL, Hickey JC, Carlsson GE:
Bouchers

Prosthodontic

Treatment

of

Edentulous

Patients ed 10.

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DEPARTMENT OF PROSTHODONTICS

Seminar on

BIOLOGICAL CONSIDERATIONS FOR

MAXILLARY IMPRESSIONS

Presented by

Dr. Ravi verma pothuri

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