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2. Development:
a. Epithelium: Anterior 2/3rd from the fusion of the lateral lingual swellings and
tuberculum impar i.e., from the first branchial arch
Posterior 1/3rd from the cranial half of the hypobranchial eminence. i.e., from the
third branchial arch
Posteromost part: From the fourth arch
b. Muscles of tongue develop from the occtpttal myotomes
c. Connective Tissue: develops from local mesenchyme
3. Muscles of Tongue:
The middle fibrous septum divides the tongue into right & left halves. Each half
contains 4 extrinsic & 4 intrinsic muscles. The intrinsic muscles are completely
within the tongue, their activities alter the form of the tongue.
Inferior Longitudinal:
Is a narrow band of muscle situated on the undersurface of the tongue. Between
the genioglossus and hyglossus. It extends from the root to the apex of the tongue.
Some of its fibers being connected to the body of the hyoid bone.
Action: Shortens the tongue and makes its dorsum convex.
Superior Longitudinal:
Origin: From sub mucous fibrous layer close to the epiglottis and from the median
fibrous septum
Insertion: The fibers runs towards the edges of the tongue & some fibers inserted
to the mucous membrane.
Action: The muscle shortens the tongue and makes its dorsum concave
Transverse Muscle:
This muscle extends from the median fibrous septum to the margins
Action: Makes the tongue narrow and elongated.
Vertical muscle:
Found at the borders of the tongue
Action: Makes the tongue broad & flattened.
Extrinsic Muscles:
Extrinsic muscles have their origin outside the tongue but their course terminates
within it. Contraction of these muscles maintains a certain position of the tongue
or shifts the tongue to other positions.
Extrinsic muscles connects the tongue
To the mandible (Genioglossus)
To the Hyoid bone (Hyoglossus)
The Styloid (Styloglossus)
The Palate (Palatoglossus)
Genioglossus:
Origin: From genial tubercle on the inner surface of the mandible at its lower
border in the midline
Insertion: Anterior fibrous inserted into the tip of the tongue and most of the
posterior fibers inserted to the base of the tongue
Action: Acts as protractor and depressor of the tongue.
Styloglossus:
Origin: From the anterior surface of the styloid process and enters the near the
tongue
Action: Move the tongue backward & upward
Hyglossus:
Origin: From the whole length of the greater corner and the front of the lateral
part of the body of the hyoid bone.
Insertion: The fibers runs upward to be inserted in to the side of the tongue
between Styloglossus and inferior longitudinal muscles of the tongue
Action: Depress the tongue.
Palatoglossus:
Arises from the oral surface of the palatine aponeurosis, descends in the
palatoglossal arch to the tongue. At the junction of its oral and pharyngeal parts
Action: draws the tongue and soft palate together.
4. Arterial supply:
Tongue is chiefly supplied by the lingual artery, a branch of external carotid artery. The
root of the tongue is supplied by the tonsillar and ascending pharyngeal arteries
5. Venous drainage:
The deep lingual vein is the largest and principle vein
6. Lymphtic drainage
- The tip of the tongue drains bilaterally to the submental nodes
- The right and left halves of the remaining part of the anterior 2/3 of the
tongue drain unilaterally to Submandibular nodes
- The posterior 1/3 drains bilaterally to the jugu loomohyoid nodes
7. Nerve Supply:
Motor nerve supply: all intrinsic and extrinsic muscles except the
palatoglossus are supplied by the hypoglossus nerve. The
palatoglossus muscles supplied by the cranial dart of the accessory,
nerve through the pharyngeal dlexus
Sensory nerve supply: the lingual nerve is the nerve of the general
sensation and chorda tympani nerve is the nerve of taste sensation
for anterior 2/3 of the tongue
Glosspharyngeal nerve is the nerve for both general sensation and
taste sensation for posterior 1/3 of the tongue
The posterior most part supplied by the vagus nerve, through the
internal laryngeal nerve
c) Alvelolingual sulcus:
The space between the residual ridge and the tongue is the alveolingual sulcus. This is
the part, which is available for the lingual flange of the denture, extends from the
lingual frenum to the retromylohyoid curtain
The Alveololingual sulcus is described in 3 regions
The anterior region
The middle region
The posterior region
When the floor of the mouth is raised, this gland comes quite close to the
crest of the ridge and reduces the verticle space available for the flange
extension in the anterior part of the mouth
- A concave area in the mandible inferior and distal to the mylohyoid
ridge is the Submandibular fossa. It has a little significance in
impression making except that it is necessary to be aware of its
configuration.
- Posterior Region (Retromylohyoid Region)
This part of the Alveololingual sulcus is the retromylohyoid space or
fossa. Also referred to as the lateral throat form. Ridge to the
retromylohyoid curtain
Being bounded on the lingual by the anterior tonsillar pillar (distal end
of the retromylohyoid curtain and superior constrictor) and on the buccal
by the mylohyoid muscle, mandibular ramus and retromolar pad. The
superior support for the retromylohyoid curtain is provided by part of the
superior pharyngeal constrictor the action of this muscle and of the
tongue determines the posterior extent of the lingual flange
Relationship of the medial pterygoid to the superior constrictor,
contraction of medial pterygoid, which lies posterior to the superior
constrictor causes the retromylohyoid curtain, to move anteriorly, thus
limiting the space in the retromylohyoid fossa for Retromylohyoid
eminence at the posterior end of the lingual flange
Neil described this important area and noted that the denture could have three possible
lengths, depending on the tonicity, activity and anatomic attachments of the adjacent structures.
Classification:
Class I: Throat form: Indicates that the anatomical structures will accommodate a fairly long and
wide flange. The thickness varies greatly the horizontal border is usually 2-3mm thick, but a
thicker border of 4-5mm should be used for better seal if the border is flat.
Class II: Throat form: is about half as long and narrow as the class I and about twice as long as a
class III.
Class III: Throat Form: Has minimal length and thickness. The border usually ends 2-3mm
below the mylohyoid ridge or sometimes just at the ridge. The thickness should be no more than
approximate 2mm or it may even end in a knife-edge if the border terminates at the mylohyoid
ridge.
The Role of these Muscles During Impression Procedure
A preliminary impression is made with the operators material of choice
A plaster cast is obtained
On this cast a design of the desired peripheral outline is made which should be slightly
shorter than the desired completed denture outline.
The resin tray is made. The tray thickness should be 2mm fro ease of handling.
The tray should be checked in patients mouth
The resin tray inserted into the mouth and stabilized by placing two index fingers in
premolar region. The patient is asked to bring the tongue straight out. If the tray rises
vigorously from the posterior region. The distolingual flange in the retromylohyoid space
is shortened to where a minimal displacement of the tray occurs during protrusive tongue
action.
The left lingual border of the tray below the molar and premolar area is checked, by
having the patient bring the tongue tip in contact with the right buccal mucosa and noting
the degree displacement of the left segment of the tray in the first molar area.
The opposite side is checked in the same manner
After necessary correction the tray usually presents a shortened border in the first molar
region, blending into a longer section of flange in the retromylohyoid space because of
the resorption and muscle pattern the border configurations are not necessarily
symmetrical.
BORDER MOLDING THE LINGUAL FLANGE
The lingual flanges are border molded in 5 steps. Low fusing impression
compound is used.
I Step: With the tray in the mouth the length and thickness of the flange in the anterior region are
observed, relative to the available space, in the Alveololingual sulcus, as limited by the lingual
frenum, sublingual folds & submaxillary coruncles if space can be seen between the lingual
border of the tray and these limiting structures with the tongue slightly raised, more impression
material is added in this region. If the tongue encroaches on the limiting structures the lingual
border is molded. When the tray appears to fill the available space the impression compound is
added between the premylohyoid eminences and softened, tempered and the tray is placed in the
mouth, patient is instructed to protrude the tongue, this movement creates functional activity of
the anterior part of the floor of the mouth, including the lingual frenum and determines the length
of the lingual flange of the tray in this region. Both premylohyoid eminences are usually visible
after this procedure.
II Step: The impression compound is added in the anterior region i.e., from premolar to premolar.
The material softened, tempered and the tray is placed in the patients mouth and the patient is
asked to push the tongue forcefully against the front part of the palate. This action causes the
base of the tongue to spread out and develops the thickness of the anterior part of the lingual
flange
III Step: The impression compound is added to the lingual borders in the molar regions on both
sides of the tray between the premylohyoid and postmylohyoid eminences the compound is
heated and tempered, and then the tray is placed, in patients mouth. Patient asked to protrude the
tongue and to move the tongue from side to side. This develops the slope of the lingual flange in
the molar region to allow for the action of mylohyoid muscle
The lingual flange shorter anteriorly than posteriorly at the premylohyoid fossa in the canine
premolar regions. The flange becomes longer and extends below the level of the mylohyoid
line. It must slope towards the tongue more or less parallel to the direction of the fibers of the
mylohyoid muscle in the molar region.
If the flange slope towards the tongue and extends below the mylohyoid ridge. The tongue
can rest n top of the flange and aid in stabilizing the mandibular denture. Id addition the slope
of the lingual flange in the molar region provides space for the floor of the mouth to be raised
during function, without dislodging the mandibular denture. The seal of the mandibular
denture is maintained during the movements of floor of the mouth because the lingual flange
remains in contact Alveololingual sulcus.
IV Step: The compound on the border of the flange on both sides in molar region is heated to
a depth of 1-2mm. The tray is placed in the mouth and the patient instructed to protrude the
tongue. The action of the mylohyoid muscle, which rises the floor of the mouth during this
movement, determines the length of the flange in the molar region.
V Step: Impression compound on the distal end of the flange is heated and the tray is placed
in the mouth, the patient is instructed to protrude the tongue to activate the superior
constrictor (which support the retromylohyoid curtain). The contraction o the medial
pterygoid muscle, acting posteriorly on the retromylohyoid curtain, can limit the space
available for the border of the impression in the retromylohyoid fossa.
TONGUE POSITION:
The position of the tongue has great importance when the height of the occlusal surface is
selected for a complete mandibular denture. The tongue cannot be expected to handle food
efficiency when the occlusal plane is moved away from the margins of the tongue, and
certainly not if the plane is placed too high and combined with a narrow dental arch such as
tooth position, accentuated by lingually overchanging cusps, permits the tongue easily to lift
the mandibular denture away from its foundation as the mouth is closed and the tongue seeks
its usual position in contact with the palate.
Tongue Position:
Tongue position is important to the prognosis of the mandibular denture
Class II: The tongue flattened and broad ended but tip is in a normal position.
Class III: The tongue retracted and the depressed in the floor of the mouth with tip curled
upward, downward or assimilated to the body of the tongue.
The most common complaint of complete denture patients concerns the loose mandibular
denture patient should be educated with all mandibular dentures.
1. Although the area of the mandibular denture basal seat is approximately 1/3 of the
maxillary denture both are subjected to same occlusal loads & thrusts.
2. The mandibular denture is surrounded lingually as well as buccally by muscles all of
which have potential for denture base disruption.
3. Last and important the mandibular denture depends on proper tongue position to maintain
adequate peripheral seal and stability
In order to determine whether the patient has a normal tongue position or an abnormal
retracted tongue position, ask the patient to open just wide enough to accept food the
dentist should see only the dorsal surface of the tongue and it should be in an intimate
contact with the lingual surface of the denture. The mandibular denture should be stable
and able to resist gentle push on the mandibular incisors. This will demonstrate and
reinforce the importance of tongue position to the patient.
If on the other hand, the dentist sees the occlusal surfaces of the teeth, lingual
surface of the denture and anterior floor of the mouth the tongue is in a retracted position
the denture will be unstable have no retention and will be easily dislodged or a gentle
push on the mandibular incisors. The patient will complain the denture is loose and
floots.
The diagnosis of a retracted tongue position is uncomplicated but the treatment can be
difficult.
1. Make the patient aware of the importance of tongue position.
2. Demonstrate the proper tongue position and subsequent increase in denture
stability & retention while the patient looks in a mirror
The patient must practice opening and closing while the tongue assumes a
normal position. Once practiced, the enhancement of mandibular denture
stability should be enough to reinforce the normal tongue position.
The Role Of Musculature Of Tongue And The Floor Of The Mouth In Stabilizing The
Mandibular Denture Along With The Muscles Of Cheeks And Lips
The musculature of the denture space is divided in 2 groups
Those muscles which primarily dislodge denture during activity and
Those muscles that fix the denture by muscular pressure on the polished surface
of the denture.
These muscles divided according to their location on the vestibular or lingual side of the
denture and to their dislodging and fixing actions
Dislocation muscles Fixing Muscles
Vestibular: Buccinator
Masseter Orbicularis Oris
Mentalis
Incisivus labii
Inferioris
Lingual:
Internal pterygoid Genioglossus
Palato glossus Longitudinal
Styloglossus Verticle
Mylohoideus Transverse
The mechanism by which the stabilization of mandibular denture is achieved by the action of
musculature is divided as
Active Muscular Fixation &
Passive Muscular Fixation
Active muscular fixation of a lower denture is demonstrate by opposing forces exerted by the
right & left buccinator muscles as represented by the finger holding the denture.
A frontal section through the polished surfaces indicates their correct inclination. Note that by
extending the primary supporting surface horizontally, the lingual and buccal polished surfaces
can be wedged below the cheeks and tongue.
The mandibular denture wedged into space below the tongue and the lower lip & cheeks.
IN SUMMATION
LIST OF REFERENCES