ANATOMICAL LANDMARKS MANDIBLE

Mandible is the movable member of the stomatognathic system. The total area of support from the mandible is less than from the maxilla. Available denture bearing area is 14sqmm. The bony foundation for the mandibular denture become shorter vertically and narrower buccolingualy Less bony support Bony crest narrower and sharper

Supporting structures
Crest of the residual ridge Buccal flange area External oblique ridge Mylohyoid line Mental foramen area Torus mandibularis

Crest of the residual ridge

Is covered by fibrous connective tissue But underlying bone is thin and cancellous containing nutrient canals so is a releif area It has spongy bone in the molar region

Buccal flange and buccal shelf

Is a primary stress bearing area Is an area between the buccal frenum and edge of masseter Boundaries Medially- crest of the ridge Ant-buccal frenum Lat- external oblique line Distal retro molar pad

It is a wide area and at right angles to vertical forces and is covered with smooth cortical bone. Inferior part of the buccinator is attached in the buccal shelf thus contraction does not lift the lower denture. Muscle fibers run antero posteriorly paralleling the bone. The tray come to direct contact with mucosa of buccal shelf and soft tissue is slightly displaced as the final impression is made

The external oblique lineis a ridge of dense bone extending from the mental foramen and become continuous with the anterior border of the ramus of the mandible. In most individuals it is the anatomic guide for the lateral termination of the buccal flange of the lower denture

The mental foramen

Is located on the lateral surface of the body of the mandible between the first and second premolars, about half way from the alveolar crest and the lower border. If the resorption is greater it occupies a superior position and the denture base must be relived over the foramen

The mylohyoid line

Is an irregular rough bony crest extending from the third molar region to the lower border of the mandible in the region of the chin. It is more prominent in the third molar region to the 2nd premolar region. The lingual flange must extend inferior to and not lateral to the mylohyoid line

The lingual tuberosity

Is an irregular bony prominence on the distal end of the mylohyoid line The mental spine is situated on the lingual aspect of the mandibular body

Torus mandibularis
Is a bony prominence found near the I &II premolar between the soft tissue and the floor of the mouth Covered by extremely thin mucous membrane may be irritated with slight movement. It may be removed surgically without breaking the border seal

Limiting structures
Labial frenum Labial vestibule Buccal frenum Buccal vestibule Masseter muscle region Distal extension of mandibular impression Retromolar region Mylohyoid muscles and ridge sublingual gland region Lingual frenum and lingual notch Lingual vestibule

Labial frenum
Contains a band of fibrous connective tissue that is attached to the orbicularis oris Sensitive and active It is accommodated by a groove on the mandibular denture

Labial vestibule
Is the area extending from the labial frenum to the buccal frenum. The denture should not be extended beyond the mucolabial fold as it is limited by the fibers of the orbicularis oris and the incivious labi inferioris which is fairly close to the ridge Tone of the lip depends on the thickness of the flange and position of teeth

Recording labial and buccal flanges

The labial frenum is molded by moving the lip outward, upward and inward.

Buccal frenum
Overlies the depressor anguli oris Connected to the buccal frenum in maxilla as a continuous band through the modiolus at the corner of the mouth Clearance must be achieved in the denture base to avoid displacement of the denture The fibrous and muscular tissues pull actively across the denture borders Denture must be extended less in this region

Buccal vestibule
Extends from the buccal frenum posteriorly to the outside back corner of the retromolar pad and from the crest of the ridge Overlies buccal shelf and ex oblique line Buccinator attached to oblique ridge Buccinators action occurs in horizontal direction so it cannot lift the denture Buccinator extends from modiolus to the pterygomandibular raphae

Recording the buccal frenum

The buccal frenum is recorded by moving cheek outward, upward backward and forward. To record the disto buccal sulcus the cheek should be well retracted and moved upward and inward.

Masseter muscle region

The distobuccal border of the mandibular denture must converge rapidly to avoid displacement by the contracting pressure of the masseter muscle. Masseter muscle runs at right angles to the buccinator When masseter contracts it pushes the buccinator and tissues inward against the denture and alters the size and shape of the distobuccal end of the lower buccal vestibule reducing the space in that region (dislodging force

Masseter muscle pushes the buccinator towards the retromolar pad. The denture base must be contoured to accommodate this massetric notch. One can register the masseter pull on the impression by softening the compound with an alcohol flame along the disto buccal border tempering in warm water After seating in the impression in patients mouth exert downward pressure by placing the index fingers on the impression in the 2nd premolar region and instructing the patient to exert a closing force. these opposing forces will cause the masseter to contract and trim the compound in that area recording the masseteric notch

Distal extension of the mandibular impression

Limited by the ramus of mandible By buccinator fibers By sharpness of bony boundaries of retromolar fossa If the impression is extended on to ramus the buccinator will be compressed between the hard denture border and sharp external oblique ridge

Retromolar region and pad

Is a triangular pear shaped soft pad of tissue in the distal end of the mandibular ridge It must be covered by the denture for the perfect border seal. Aids in the stability of the denture by adding another plane to resist the movement of the base

Contents Some glandular tissue Fibers of temporalis tendon From buccal side- buccinator From lingual side- superior pharyngeal constrictor Supero posterior inside cornerpterygomandibular raphe These structures prevent the placement of extra pressure during the impression procedure

Retromolar papilla
Is a small pear shaped area anterior to the pad Is a dense fibrous connective tissue Retro molar pad should be registered in a resting position in the final impression

Recording the retromolar pad

To record the distal end of the try the patient is asked to open the mouth wide. If notch is produced in the posteromedial end of the try it indicates that the tray is over extended up to the pterygomandibular raphe

Sublingual gland region

Rest above the mylohyoid muscle. When the floor of the muscle is raised the gland come close to the crest of the ridge and reduces the vertical space available for the flange extension in the anterior part of the mouth

Lingual frenum& lingual notch

Extremely resistant and active and wide Should be registered in function In function it come close to the ridge At rest it is much lower Overlies the genioglossus muscle

Lingual vestibule
Occupies the alveolingual sulcus Distal end extend to the retromylohyoid curtain Anteriorly influenced by mylohyoid Flange extend below the mylohyoid ridge to occupy the alveolo lingual sulcus. Flange leaves the bony attachment at the mylohyoid ridge and slopes inward under the tongue to fill the alveololingual sulcus Thus there is a space between the flange and mucous membrane when the muscle is relaxed and there is contact when the tongue is raised and thrust out

Recording the lingual frenum

The anterior lingual border is molded by asking the patient to protrude his tongue to touch the anterior part of palate. Protrusion records the length of lingual flange Touching the anterior part of hard palate helps to establish the width of the flange.

Mylohyoid muscle & ridge

Mylohyoid muscle arise from the whole length of the mylohyoid line extending from about 1 cm back of the distal end of the mylohyoid ridge to the lingual anterior portion of the mandible at the symphysis This ridge is near the inferior border in the incisal region but become progressively higher on the posterior border, so posterior part affect the lingual impression in swallowing and tongue movements

The lingual flange should extend inferior but not lateral to the mylohyoid line. The movement of tongue and displacability of the floor of the mouth will determine the length of the flange. If the flange is properly shaped it will complete the lingual border seal in the retromylohyoid fossa and guide the tongue on top of the flange

Recording the mylohyoid

Protrusion of the tongue record the movement of the mylohyoid muscle. This raises the floor of the mouth. The lingual flange recorded will be lingually sloping nd parallel to the direction of the mylohyoid muscle. Increse in the thicknes odf the posterior part otf the lingual flange can interfere with the action of the mylohyoid muscle.

While border molding the distal end of the lingual flange the action of the mylohyoid curtain should be recorded. The superior constrictor and the medial pterygoid determine the position of he retromylohyoid curtain Superior constrictor- by protruding the tongue Medial pterygoid- by asking the patient to forcefully close against resistance