THE SIGNIFICANCE OF ANATOMIC LANDMARKS

IN COMPLETE DENTURE SERVICE

BERNARD D. LYNN, D.D.S.

Detroit, Mich.

in COlllpkk denture SW-Vice can-

T notHE IMPORTANCE OF ANATOMIC REFERENCES
be overemphasized. No prosthesis is totally adequate that violates the
foundation on which the dentures rest. Yet too often an untenable situation is pre-
sented with the patient whose restorations are less than desirable, and the error is
the responsibility of the dentist.

EDENTULOUS ORAL CAVITY

The edentulous oral cavity may be regarded as a cube. The anterior aspect
is formed by the lips ; the lateral walls are established by the flexible cheeks ;
the superior surface is comprised of the hard and soft palates and the residual
maxillary ridges; the posterior section is bounded by the anterior surface of the
fauces; and the movable base is the tongue, the mandibular residual ridge, and
structures attaching to the mandible (Fig. 1) .
Complete dentures are related to and affect all sides of the cube. The purpose
of this article is to review the topographic anatomy of the edentulous mouth
so that complete dentures may be more acceptable to patients.

EDENTULOUS MAXILLARY STRUCTURES

The labial frenum is usually located at the most anterior aspect of the edentu-
lous maxillae. The frenum is formed by the mucus membrane and forms a fold
in midline which helps to connect the upper lip to the residual ridge. Failure to
completely accommodate for this structure contributes to the instability of the
denture. Lateral to the labial frenum is the buccal frenum. The space between the
labial and buccal frenums is the maxillary labial vestibule.
In the region of the first molar and superiorly to it is the lower aspect of the
zygomatic process. The buccinator muscle has its most anterior attachment to the
bone approximately as far forward as the beginning of the zygomatic process on
the outer surface of the maxillae in the molar region. The rounded posterior end
of the alveolar process is the maxillary tuberosity. The depression immediately
posterior to the tuberosity is the hamular or pterygomaxillary notch.
The palate is a concave surface with its greatest curvature in a transverse
direction. The incisive papilla is a small, rounded fleshy prominence in the mid-
line, normally just behind the crest of the residual ridge. The papilla overlies the
Volume 14 COMPLETE DENTURE SERVICE 457
Number 3

Fig. l.-Many anatomic structures and landmarks are related to complete dentures. The lo-
cation and function of these structures is of fundamental importance to all dentists.

incisive foramen through which pass the nasopalatine nerves and the palatine
vessels. Pressure on this structure by a denture can lead to pain or a burning
sensation under the maxillary denture.
The anterior part of the palate is transversed by palatine rugae which are
ridges of connective tissue covered by mucosa. The rugae curve away on either
side of the midline and extend to the level of the first molar teeth.
Extending posteriorly in the midline of the palate is the palatine raphe. The
soft tissue covering the raphe is very thin and less resilient than the fibrous tissue
covering the residual ridges and necessitates relief in the denture base. This region
is designated as a primary relief area. An exostosis known as the palatine torus may
be found in the center of the hard palate. Tori are inconstant as to site, shape or
size. They must be accommodated for either in the impression or by surgical inter-
vention when necessary.
 J. Pros. Den.
458 LYNN
May-June, 1964

The palatine foveae are located on either side of the median line 2 mm. back
of the vibrating line. These two pits are not always present and do not always
mark the posterior edge of the hard palate, since the bony palatine edge may be
a variable distance in front of or behind these minute orifices in the mucosa. The
vibrating line marks the junction of the freely movable with the relatively immovable
part of the soft palate. The posterior border of the upper denture should coincide
with this line of flexion. Continuing posteriorly, the uvula projects downward from
the margin of the middle of the soft palate.

EDENTULOUS MANDIBULAR STRUCTURES

The mandibular labial frenum is the most anterior landmark in the lower
dental arch and is composed of a band of fibrous connective tissue and mucous mem-
brane that helps attach the orbicularis muscle. The lower labial frenum is usually
less pronounced than its maxillary counterpart. The region between the labial and
buccal frenums is called the mandibular labial vestibule. The distal boundary of
this space is the mandibular buccal frenum.
The external oblique ridge can be palpated in the molar region on the buccal
side of the residual ridge. The buccinator muscle attaches near the crest of the
residual ridge and on the buccal shelf of the mandible. The space between the
external oblique ridge and the crest of the residual ridge is called the buccal
shelf. Distally, the buccal vestibule is influenced by the masseter muscle when it
contracts to produce closing force on the mandible.
The external oblique ridge is continuous with the anterior border of the
ramus. The buccal side of the triangular shaped retromolar pad is next to the
cheek.
The medial side of the retromolar pad is on the lingual side of the residual
ridge distal to the end of the mylohyoid ridge. The base of the pad extends to the
medial border of the ascending ramus of the mandible and its apex is on the
crest of the residual ridge just distal to the position of the distal side of the
last molar tooth. The most distal end of the mandibular denture should include this
landmark, The pterygomandibular raphe extends from the medial posterior SLI-
perior corner of the retromolar pad to the pterygoid hamulus.
Lingually, the most posterior part of the alveolo-lingual s~~lcus is the retro-
mylohyoid fossa. Its distal boundary is the retromylohyoid curtain that is SLIS-
pended from above by the superior constrictor of the pharynx. ‘The buccal side of
the retromylohyoid space or fossa is bounded by the mucous membrane covering
the distal end of the mylohyoid muscle, back of the end of the mylohyoid ridge.
This space is registered in the impression when the tongue is thrust forward.
Anteriorly, the mylohyoicl muscle attaches to the mylohyoid ridge and controls
the form of the border of the lingual flange of the denture in the molar region.
The lingual anterior region is influenced by the action of the genioglossus muscle.
An exaggerated complete range of tongue movements should be registered on the
impression of this region so the border of the lingual flange will not inhibit the
action of the tongue. The lingual frenum is an elevated fold of mucosa found in the
midline. It is most prominent when the tongue is raised. The lingual frenum
 COMPLETE DENTURE SERVICE 459

continues on and coalesces with the genioglossus muscle on the inferior aspect of
the anterior end of the base of the tongue.

SUMMARY

Certain anatomic structures related to the edentulous mandible and maxillae

control the form of the borders of complete dentnrrs. These structures and their
effect upon the dentures have been described.

REF,ERENCES

1. Boucher, C. 0. : Complete Denture Impressions Based Upon the Anatomy of the Mouth,
J.A.D.A. 31:1174-1181, 1944.
2. Edwards, L. F., and Boucher, C. 0.: Anatomy of the Mouth in Relation to Complete
Dentures, J.A.D.A. 29:331-345, 1942.
3. Morris’ Human Anatomy, edited by C. M. Jackson, ed. 8, Philadelphia, 1925, P. Blakiston’s
Son & Co., p. 1134.
4. Shapiro, H. : Maxillofacial Anatomy With Practical Applications, Philadelphia, 1954,
J. B. Lippincott Co., p. 151.
5. Sicher, H.: Oral Anatomy, ed. 2, St. Louis, 1952, The C. V. Mosby Company, p. 178.
6. Wheeler, R. C.: Textbook of Dental Anatomy and Physiology, ed. 2, Philadelphia, 1950,
W. B. Saunders Co., p. 299.
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