MANDIBLE

Dr Honey Arora
Post Graduate Student
Department of Prosthodontics and
Implantology

CONTENTS
INTRODUCTION
OSTEOLOGY
MUSCLE ATTACHMENT OF THE MANDIBLE
GROWTH AND DEVELOPMENT
MANDIBLE IN COMPLETE DENTURE

INTRODUCTION
The mandible is derived from Latin word

mandibula, "jawbone.
Also referred as inferior maxillary bone
Is the largest and strongest bone of the
face, serves for the reception of the lower
teeth. It consists of a curved, horizontal
portion, the body, and two perpendicular
portions, the rami.

OSTEOLOGY OF MANDIBLE

BODY OF MANDIBLE
corpus mandibulae

The body is curved somewhat like a

horseshoe and has two surfaces and two
borders.
2 surfaces External
Internal
2 borders Superior or Alveolar
Inferior

STRUCTURES ON THE EXTERNAL SURFACE

MENTAL FORAMEN-

It lies below the interval between the

premolar teeth, on the either side, midway
between the upper and lower borders of the body.
It is the passage of the mental vessels and nerve.
descends slightly in edentulous individuals
Absence of mental foramen and accessory mental
foramina has also been
reported.[1][2]
shape of the MF was oval in
most of the cases.[3] [4]
Central African Journal of Medicine

MENTAL PROTUBERANCEIt is a median triangular projecting

area in the lower part of the midline.
- The inferolateral angles of the protuberance
from the mental tubercules.

EXTERNAL OBLIQUE LINE

It is a faint ridge running backward
and upward from each mental foramen and is
continuous with the anterior border of the
ramus.

INCISIVE FOSSA
It is a depression that lies just
below the incisor teeth on the either side of
the symphysis.

(no. 11 is incisive fossa)

9

STRUCTURES ON THE INTERNAL SURFACE

MENTAL SPINES (GENIAL TUBERCULE / GENIAL
APOPHYSIS)
There are 2 pairs of spines .
1. Superior pair of spine . It gives origin to the Genioglossi
and
2. Inferior pair of spines lies immediately below the first pair,
gives origin of the Geniohyoid.
SPECIAL CASES

- May be fused to form a single eminence.

- A median foramen and furrow
are sometimes seen above
the mental spines( spinous
Foramen)[6]

10

ATTACHMENT OF ANTERIOR BELLY OF

DIGASTRIC
It is an oval depression on the either
side of the mid line jus below the mental
spines for the attachment of anterior belly of
digastric .

11

MYLOHYOID LINE
It extends upward and backward on either side
from the lower part of the symphysis .(figure b)
It gives origin to the mylohyoid.
posterior part of this line - gives attachment to a
small part of the superior constrictor and to the
pterygomandibular raphe.
-Above the anterior part of this line - is a smooth
triangular area against which
the sublingual gland rests.
below the hinder part, an
oval fossa for the submaxillary
gland.
12

13

STRUCTURES PRESENT AT THE BORDERS

SUPERIOR OR ALVEOLAR BORDER
wider behind than in front
is hollowed into cavities, for the reception of
the teeth; these cavities are sixteen in
number.
outer lip of the superior border - on either
side, the buccinator is attached as far
forward as the first molar tooth.

14

INFERIOR BORDER
rounded, longer than the superior, and thicker

in front than behind.

point where it joins the lower border of the
ramus - A shallow groove; for the FACIAL
ARTERY , may be present.

15

RAMUS OF MANDIBLE
ramus mandibul; perpendicular portion

The ramus is quadrilateral in

shape, and has two surfaces, four borders,
and two processes

16

LATERAL SURFACE
- Lateral surface is flat and
marked by oblique ridges at its
lower part.
It gives attachment nearly
the whole of its extent to the
masseter.

17

MEDIAL SURFACE
MANDIBULAR FORAMEN
It provides entrance for the inferior
alveolar nerve and vessels.

18

LINGULA OR LINGULAE MANDIBULAE

it is a sharp spine present in front
of mandibular foramen opening .
It gives attachment to the spenomandibular
ligament

19

MYLOHYOID GROOVE
From the lower and back part of the
lingulae mandibulae is a notch from which the
mylohyoid groove runs obliquely downward
and forward.
It lodges the mylohyoid vessels and nerve.

20

MANDIBULAR CANAL
The mandibular canal is a canal
within the mandible that contains the inferior
alveolar nerve ,inferior alveolar artery, and
inferior alveolar veins.
runs obliquely downward and forward in the
ramus
then horizontally forward in the body
communicates with alveoli
by small openings
21

Types of mandibular canal [5]

1. TYPE III - the canal is located close to the
lower border of the mandible is the most
common,
2. TYPE II -the canal is noted between the
apices of the first and second molars and the
lower border of the mandible
3. TYPE I -the canal is in close contact with the
apices of the first and the second molars

Hell Period 1990

22

LOWER BORDER
Is marked by oblique ridges on each
side, for the attachment of the Masseter
laterally, and the pterygoideus internus
medially; the sphenomandibular ligament is
attached to the angle between these muscles.

23

ANTERIOR BORDER
Is thin above, thicker below, and
continuous with the oblique line.
POSTERIOR BORDER
Is thick, smooth, rounded, and covered
by the parotid gland.

24

UPPER BORDER
Is thin, and is surmounted by
2 processes the coronoid in front
the condyloid behind,
separated by a deep concavity, the
mandibular notch.

25

CONDYLOID PROCESS
processus condyloideus

Is thicker than the coronoid, and

consists of two portions: the condyle, and the
constricted portion which supports it, the neck.
It forms the articular surface for articulation
with articular disk of tempromandibular joint.

26

THE CONDYLE

It presents an articular surface

for articulation with the
articular disk of the
temporomandibular joint

At the lateral extremity of the

condyle is a small tubercle for
the attachment of the
temporomandibular ligament.

27

THE NECK
The neck is flattened from backward, and
strengthened by ridges which descend from
the forepart and sides of the condyle.
Its posterior surface is convex
its anterior surface presents a depression for
the attachment of the Pterygoideus externus.

28

CORONOID PROCESS
processus coronoideus

Is a thin, triangular eminence,

which is flattened from side to side and varies
in shape and size.
The Coronoid process (from Greek korone, "like
a crown")

29

BORDERS
anterior border - is convex and is continuous
below with the anterior border of the ramus.
posterior border- is concave and forms the
anterior
boundary of the mandibular notch.

30

SURFACES
Lateral Surface - affords insertion to the
Temporalis and Masseter.
Medial Surface -provides insertion to the
Temporalis and presents a ridge from apex till
last molar
Between This Ridge And The Anterior
Border - is a grooved triangular area, the
upper part of which gives attachment to the
Temporalis, the lower part to some fibers of
the buccinator.

31

SYMPHYSIS MENTI
It is the faint ridge on the median
line of the external surface of
the mandible.
This ridge divides below and
encloses a triangular
eminence, the mental
protuberance,
the base of which is depressed
in the center but raised on either
side to form the mental
tubercule.
It serves as the origin for the
Geniohyoid and the Genioglossus

32

ANGLE OF MANDIBLE
It is the junction of the lower border of the

ramus of the mandible with the posterior

border of body of mandible
Provides attachment
- Masseter laterally
- the Pterygoideus internus medially
- the stylomandibular ligament
is attached to the angle
between these muscles.
33

LYMPHATICS
Sub-mandibular: run along the underside of

the jaw on either side, drains the structures in

the floor of the mouth also drain mandibular
teeth except the central incisors.
Sub-mental: These nodes are just below the
chin. They drain the central incisors and
midline of lower lip and tip of the tongue.

34

NERVE SUPPLY
mainy by the 3rd division of trigeminal nerve ->

mandibular nerve
INFERIOR ALVEOLAR NERVE, branch of the
mandibular division -> enters mandibular foramen
and runs forward in the mandibular canal,
supplying sensation to the teeth->at mental
foramen the nerve divides into two terminal
branches: incisive and mental nerves-> The
incisive nerve runs forward in the mandible and
supplies the anterior teeth. The mental nerve
exits the mental foramen and supplies sensation
to the lower lip.
35

MUSCLE ATTACHMENT TO THE

MANDIBLE

INTERNAL SURFACE

36

EXTERNAL SURFACE

37

MUSCLE

ORIGIN AND
INSERTION

BLOOD &
NERVE
SUPPLY

MASSETER
musculus
masseter
( Greek
word
chewing ,
associated
with
anger )

ORIGIN
Zygomatic arch

Blood
supply

INSERTION
Coronoid process
and ramus of
mandible

Masseteric
Artery

TEMPORALI
S
musculus
temporalis

ORIGIN
Temporal line on
the parietal bone
of the skull

Nerve
supply:

ACTION &
CLINICAL
SIGNIFICANCE

Elevation and
retraction of the
mandible
Antagonist
muscle
platysma

Masseteric
Nerve

INSERTION
Coronoid process
of mandible

Blood
supply :
Deep
temporal
artery

Nerve
supply:
Mandibular
nerve

Elevation and
retraction of the
mandible
Antagonist
muscle platysma

38

MUSCLE

ORIGIN AND
INSERTION

MEDIAL
PTERYGOID
musculus
pterygoideu
s internus

ORIGIN
Medial surface of
lateral pterygoid plate
of sphenoid, palatine
bone , pterygoid fossa

BLOOD &
NERVE
SUPPLY
Blood
supply:
Medial
pterygoid
artery
Nerve
supply:

Elevates
mandible,
closes jaw,
helps lateral
pterygoids in
moving the jaw
from side to
side

Blood supply:
Lateral
pterygoid artery
Nerve supply:
lateral pterygoid
Nerve

Depresses
mandible,
Protrude
mandible, side
to side
movement of
mandible

INSERTION
Inner surface of
ramus ,
Medial pterygoid
Angle of the mandible
Nerve
LATERAL
PTERYGOID
m.
pterygoideu
s externus

ORIGIN
Superior head:
lateral surface of the
greater wing of the
sphenoid
Inferior head: lateral
surface of the lateral
pterygoid plate
INSERTION

ACTION

39

MUSCLE

ORIGIN AND
INSERTION

DEPRESSO
R
ANGULI
ORIS
(musculus
depressor
anguli oris)

ORIGIN
along the oblique
line of mandible
lateral aspect of
mental tubercle of the
mandible
INSERTION
modiolus

DEPRESSO
R LABII
INFERIORIS
musculus
depressor
labii
inferioris

ORIGIN
Oblique line of
mandible, between
symphysis and
mental foramen
INSERTION
Skin of the lower lip

BLOOD &
NERVE
SUPPLY
Blood
supply:
Facial artery
Nerve
supply:

ACTION

Depresses
the mouth as
in frowning

Mandibular
branch of facial
Nerve
Blood supply:
Facial artery
Nerve supply:
Mandibular
branch of facial
Nerve

Draws the lip

downward
and laterally

40

MUSCLE

BUCCINATO
R
musculus
buccinator

ORIGIN AND
INSERTION
ORIGIN
Posterior alveolar
process of maxilla
and mandible
INSERTION
modiolus

ORBICULARI
S
ORIS

ORIGIN
Near midline on
anterior surface of
maxilla and mandible
and modiolus at
angle of mouth
INSERTION
Mucous membrane
of margin of lips and
raphe with

BLOOD &
NERVE
SUPPLY

ACTION

The buccinator
compresses the
cheeks against
the teeth and is
used in acts such
as blowing. It is
an assistant
buccal branch muscle of
of facial nerve mastication
(chewing).

Blood
supply :
Buccal
artery
Nerve
supply:

Blood supply
:
Facial artery
Nerve
supply:
buccal branch
of facial nerve

Narrows orifice
of mouth, purses
lips and puckers
lip edges

41

MUSCLE

ORIGIN AND
INSERTION

MENTALIS
(so named
because it is
associated
with thinking
or
concentration
and use to
express
doubt)

ORIGIN
Symphysis of
mandible

PLATYSMA

ORIGIN
subcutaneous tissue
of infraclavicular and
supraclavicular
regions

INSERTION
Skin of chin

BLOOD &
NERVE
SUPPLY

Blood
supply :
Buccal
artery
Nerve
supply:

ACTION

elevates and
wrinkles skin of
chin, protrudes
lower lip

mandibular
branch of
facial nerve

INSERTION
base of mandible;
skin of cheek and
lower lip; angle of

Blood supply
:
branches of
the
Submental
artery and
Suprascapular
artery
Nerve

Draws the
corners of the
mouth inferiorly
and widens it (as
in expressions of
sadness and
fright). Also
draws the skin of
42
the neck

MUSCLE

GENIOGLOSS
US
musculus
genioglossus

ORIGIN AND
INSERTION
ORIGIN
Superior part of
mental spine of
mandible
INSERTION
Dorsum of tongue
and body of hyoid

GENIOHYOID
musculus
geniohyoideus

ORIGIN
Inferior mental spine
on the inner surface
of the symphi
INSERTION
Body of hyoid bone

BLOOD &
NERVE
SUPPLY

Blood
supply:
Lingual artery

Nerve
supply:
Hypoglossal
nerve
Blood supply
:
Lingual artery
Nerve
supply: C1
and
Hypoglossal
nerve

ACTION

Inferior fibers
protrude the
tongue, middle
fibers depress
the tongue, and
its superior fibers
draw the tip back
and down
Elevates the
tongue,
depress the
mandible ,
helps in
deglutition

43

MUSCLE
ANTERIOR
BELLY OF
DIGASTRIC
musculus
digastricus

MYLOHYOI
D
musculus
mylohyoideu
s

ORIGIN AND
INSERTION
ORIGIN
digastric fossa
(mandible)
INSERTION
Intermediate
tendon (hyoid
bone)

ORIGIN
inner surface of
mandible off the
mylohyoid line
INSERTION
body of hyoid bone
and median raphe

BLOOD & NERVE

SUPPLY

Blood supply:
anterior belly Submental branch
of facial artery;
Nerve supply:
mandibular
division (V3) of the
trigeminal (CN V)
via the mylohyoid
nerve
Blood supply :
mylohyoid branch
of inferior alveolar
artery
Nerve supply:
mylohyoid nerve

ACTION
Opens the jaw
when the
masseter and
the temporalis
are relaxed.

Raises oral
cavity floor,
elevates hyoid,
elevates
tongue,
depresses
mandible
44

MUSCLE

ORIGIN AND
INSERTION

SUPERIOR
ORIGIN
CONSTRICTO pterygoid hamulus,
R
pterygomandibular

raphe, posterior end

of the mylohyoid line
of the mandible, and
side of tongue.
INSERTION
median raphe of
pharynx and
pharyngeal tubercle.

BLOOD & NERVE

SUPPLY

Blood supply:

ACTION
deglutition

Ascending
pharyngeal artery
and tonsillar
branch of facial
artery
Nerve supply:
pharyngeal plexus
of nerves(IX , X
and cervical
sympathetic
ganglion )

45

LIGAMENT

ORIGIN AND
INSERTION

STYLOMANDIBULA ORIGIN
R
Apex of styloid process
LIGAMENT
of the temporal bone

INSERTION
to the angle and
posterior border of the
angle of mandible
SPHENOMANDIB
ULAR
LIGAMENT

ORIGIN
the ligament that
attaches to the spine of
the sphenoid bone
superiorly
INSERTION
the lingula of the
mandible inferiorly

DESCRIPTION
Paired , it is the
thickening of parotid
fascia,
from its deep surface
some fibers of the
Styloglossus take
origin.
paired; pterygoid
fascia thickening and
is a remnant of the
Meckel's cartilage
limit distension of
the mandible in an
inferior direction.
its related to
lateral pterygoid
(laterally ) and
medial pterygoid
(medially)

46

PTERYGOMANDIBUL
AR RAPHE
(LIGAMENT)
Tendinous band of
buccopharyngeal
fascia

passes between the tip

of the hamulus of the
pterygoid bone and
the internal surface of
the mandible at a point
just posterosuperior to
the posterior limit of
the mylohyoid ridge

medial surface covered by the

mucous membrane.
lateral surface - is
separated from the
ramus of the
mandible by a
quantity of adipose
tissue.
posterior bordergives attachment to
the superior
pharyngeal
constrictor muscle.
anterior border
attaches to the
posterior edge of the
buccinator

47

GROWTH AND
DEVELOPMENT

48

Prenatal
Week 6 - Intramembranous ossification center develops lateral to
Meckel's cartilage.
Week 7 - Coronoid process begins differentiating.
Week 8 - Coronoid process fuses with main mandibular mass.
Week 10 (approx) - Both condylar and coronoid processes are
recognizable and anterior portion of Meckel's cartilage begins to
ossify.
Weeks 12-14 - Secondary cartilages for the condyle, coronoid, and
symphysis appear.
Weeks 14-16 - Deciduous tooth germs start to form.
Birth
At birth mandible still has separate right and left halves.
Postnatal
Year 1 - Fusion of right and left halves of mandible at the symphysis.
Infancy and childhood - Increase in both size and shape of the
mandible; eruption and replacement of teeth.
Year 12-14 - All permanent teeth emerged except third molars.

49

BODY OF MANDIBLE
The mandible makes its structure in the sixth

week of foetal life.

It is ossified in the fibrous membrane covering the outer
surfaces of Meckel's cartilages, derrivative of first brachial
arch
These cartilages form the cartilaginous bar of the mandibular
arch and are two in number, a right and a left.

50

Their proximal or cranial ends are connected with the

ear capsules, and their distal extremities are joined to

one another at the symphysis by mesodermal tissue.

MALLEUS

INCUS

51
51

Meckels cartilage has a close, relationship to the

mandibular nerve, at the junction between posterior

and middle thirds, where the mandibular nerve divides
into the lingual and inferior alveolar nerve.

52

The lingual nerve passes forward, on the medial side

of the cartilage, while the inferior Alveolar lies lateral

to its upper margins & runs forward parallel to it and
terminates by dividing into the mental and incisive
branches.

53

 LINGULA is replaced by fibrous tissue, which persists to

form the sphenomandibular ligament & the perichondrium

of the cartilage persist as sphenomallular ligament.
Between the lingula and the canine tooth the cartilage

disappears, while the portion of it below and behind the incisor

teeth becomes ossified and incorporated with this part of the
mandible.

54

REMANATS OF MECKEL
CARTILAGE
Greater part of Meckels cartilage disappears

without contributing to the formation of mandible.

Small part of cartilage near the midline is the site
of endochondral ossification. Here it calcifies and is
destroyed by chondroblasts and are replaced by
connective tissue and then by bone.
Small irregular bones known as mental ossicles
develop in it and by the end of first year fuse with
the mandibular body.
At the same time two halves of mandible unite by
ossification of the symphyseal fibrocartilage.
55

The ramus of the mandible develops by a rapid spread of

ossification backwards into the mesenchyme of the first

branchial arch diverging away from Meckels cartilage.
This point of divergence is marked by the mandibular
foramen.

Mandible of human embryo 95 mm. long. Outer aspect.

Nuclei of cartilage stippled.
56

Somewhat later, accessory nuclei of

cartilage make their appearance:
a wedge-shaped nucleus in the condyloid
process and extending downward through the
ramus.
a small strip along the anterior border of the
coronoid process.
.

Mandible of human embryo 95 mm. long. Outer

aspect. Nuclei of cartilage stippled.

57

The condylar cartilage:

Carrot shaped cartilage appears in the region of the

condyle and occupies most of the developing ramus. It

is rapidly converted to bone by endochondral
ossification (14th. WIU) it gives rise to -> Condyle
head and neck of the mandible.
The posterior half of the ramus to the level of inferior

dental foramen

58

The coronoid cartilage:

It is relatively transient growth cartilage center ( 4 th. -

6th. MIU). it gives rise to -> Coronoid process.

The anterior half of the ramus to the level of inferior

dental foramen

59

GROWTH OF MANDIBLE

60

Growth of the mandible

I. Growth by secondary cartilage
II. Development of the alveolar process

III. Subperiosteal bone appositionand bone resorption

61

I. Growth by secondary cartilage

( mainly condylar cartilage )
Increase in height
of the mandibular ramus
Increase in the over all length
of the mandible
Increase of the inter condylar
distance

62

II DEVELOPMENT OF ALVEOLAR PROCESS

bone apposition occurs at the crest of the alveolar process and

the fundus of the alveolus contributing to the growth of

mandible in height.

63

III. Subperiosteal bone apposition

and bone resorption:
Bone
deposition

Bone
resorption

Result in

External
surface of the
mandible

Inner surface
of the
mandible

Increase the
transeverse
dimension

Posterior
border of the
ramus
Anterior
border of the
coronoid
process

Anterior
border of the
ramus
Posterior
border of the
coronoid
process

Adjust the
thickness of
the ramus
Displacement
of the
coronoid
process

64

COMPLETE DENTURES

65

ANATOMICAL LANDMARK
The available area of support from an edentulous mandible is

14 cm2 while the same for the edentulous maxilla is 24cm2 .

The landmarks can be broadly grouped into:

Limiting structures:
Labial frenum
Labial vestibule
Buccal frenum
Buccal vestibule
Lingual frenum
Alveololingual sulcus
Retromolar pads
Pterygomandibular raphe.
66

 Supporting structures:
Buccal shelf area
Residual alveolar ridge
Relief areas:
Crest of the residual alveolar ridge
Mental foramen
Genial tubercles
Torus mandibularis.

67

LIMITING STRUCTURES
These are the sites that will guide us in having an optimum
extension of the denture so as to engage maximum surface
area without encroaching upon the muscle actions
Encroaching upon these structures will lead to dislodgement
of thedenture and/or soreness
of thearea while failure to
cover the areas upto the
limiting structurewill imply
decreased retention stability
and support.

68

SUPPORTING/ STRESS BEARING

AREA
Masticatory forces produce quite a pressure
on the underlying structures and not
everyplace beneath the denture can take
such stress hence we need to know the
areas which can bear the stresses well.
These can be divided into1.Primary stress bearing area
2.Secondary stress bearing area

69

PRIMARY STRESS BEARING AREA

These are the areas that are most capable to take
the masticatory load providing a proper support
to the denture.
Are at right angle and usually do not resorb

easily ( buccal shelf area )

Properties :1.Tightly adherent sufficient fibrous connective
tissue with an overlying keratinized mucosa
2.Presence of cortical bone cover
3.Should be at right angles to the vertical occlusal
forces.
4.No underlying structures should be present that
will get harmed due to stress.
70

SECONDARY STRESS BEARING AREA

Area of edentulous ridge that are greater
than or at right angle to occlusal forces but tend
to resorb under load.
Mandibular:- ridge slopes
Secondary stress bearing area

Secondary stress bearing area

71

RELIEF AREAS
These are the areas which either resorb under
constant load or have fragile structures within
or are covered by thin mucosa which can be
easily traumatized
& hence should be relieved.

72

LABIAL FRENUM
Fibrous band extending from
the labial aspect of the residual
alveolar ridge to the lip.
Give attachment to orbicularis oris and incisivus.
Active and sensitive frenum
The activity of this area tends to be vertical so
the labial notch on the denture should be narrow.

73

LABIAL VESTIBULE
Extends from the labial frenum to the buccal

frenum on each side.

Potiential space bounded by
- mucolabial fold
- orbicularis oris
- labial aspect of residual alveolar ridge
Mentalis quite active in this region.

74

CLINICAL SIGNIFICANCE
Extent of denture is limited because of
muscle inserted close to the ridge .
Muscles of lip actively pull across the
denture.(on opening mouth wide
orbicularis muscle is stretched->
narrowing the sulcus -> displacing
denture )
Impression are narrower in this region.
Tone of the skin of lip and orbicularis
depends on the thickness & position of
the flange.
HISTOLOGY
-Epithelium is thin and non-keratinized
- Submucosa formed by loosely
arranged connective tissue fibre mixed
with elastic and muscle fibre.
75

BUCCAL FRENUM
It overlies the depressor anguli oris muscle

Clinical significance
- Clearance must be achieved in the denture to
avoid dislodgement of the denture

76

LINGUAL FRENUM
Accomodated within

sublingual cresent
area .
Vary in width and
height.
Overlies the
genioglossus muscle
which takes origin
from mental spine
Fold of mucous
membrane from
tongue to the

77

BUCCAL VESTIBULE
It extends posteriorly form buccal frenum to the

retromolar pad .
Houses the buccal flange
Clinical significance
Impression is wide in this region
It is nearly 90 degree to the biting forces , providing
denture with greates surface for the resistance to the
vertical occlusal forces.

78

Buccinator muscle in buccal vestibule

The extent of the buccal flange is
highly influenced by the buccinator muscle,
which extends from
- Modiolus (anteriorly)
- Pterygomandibular raphe ( posteriorly )
Clinical significance: Denture should completely
cover the vestibule and
buccal shelf
Action of buccinator muscle
moulds the buccal flange.
79

External oblique ridge

It is a ridge of dense bone
extending from jus above the mental foramen
and distally , becoming continous with
anterior border of the ramus
Gives attachment to buccinator muscled
fibres.
Clinical significance:- Can be used as guide for extent of denture
laterally

80

Masseter notch
It accomodates the masseter muscle in
the distobuccal area of the denture
Magnitude of its force is exerting the molar
region.
Clinical significance : Overextension soreness of the tissue &
dislodgement of the denture

81

It is recorded by masseter muscle contraction,

its fibres runs ouside and behind the

buccinator -> contraction of masseter
->pushes inward against the buccinator
muscle -> producing bulge.
Movements
- downward pressure in 2nd premolar region
by dentist and forces exerted by the closing of
the mouth.

82

CREST OF ALVEOLAR RIDGE

Relief area

Microscopically
Mucous membrane ->
keratinized layer
submucosa is attached to the
periosteum.
Covered by fibrous connective
tissue.
Bone -> cancellous and
without good cortical plate
covering.
Clinical significance :- Should be relieved during
impression making.

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BUCCAL SHELF AREA

Primary stress bearing area
Consist of horizontal shelves 0f bone

so called buccal shelf (by sheldon

winkler 2nd edition )
Bounded by :- medially -> crest of residual
alveolar ridge
- anteriorly -> buccal frenum
- laterally -> external oblique
ridge
- distally -> retromolar pad
84

Wide and perpendicular to the vertical

occlusal forces , so offers excellent resistance

to such forces -> serving as primary stress
bearing area.
Buccinator muscle fibres runs
anteroposteriorly, paralleling the bone and
denture doesnot resist the contracting forces
of the muscle.

85

Microscopically
Mucous membrane -> loosely attached and

less keratinized than crest of residual ridge

Thicker submucosal layer
Fibres of buccinator are found running
horizontally in submucosa
Bone -> compact thus making it suitable as
primary stress bearing area
Buccinator fibres -> runs horizontally allows
denture to rest without damage to the muscle
or dislodgement of denture

86

MYLOHYOID RIDGE
Irregular rough, bony crest extending from the 3 rd molar region

to the lower border of the mandible

Prominent -> 3rd molar the 2nd bicuspid.
Levels of attachments of mylohyoid muscle :- anteriorly-> close to the
inferior border of mandible
- posteriorly ->close to the
alveolar crest

87

Clinical significance : Mucous membrance can be easily

traumatized by denture.
Area under ridge is undercut
Lingual flange of the mandible should
extend inferior but not lateral to the
mylohoid line
Buccal
Mylohyoid
Ridge
Attachments
To Hyoid
88

LINGUAL TUBEROSITY
Irregular area of bony prominence at the distal

termination of the mylohyoid line

Prominent -> acts as undercut

89

MENTAL FORAMEN
It is located on the lateral surface of the
mandible, between the 1st and 2nd bicuspid , halfway
between the lower border and the alveolar crest.
Clinical significance : Extensive loss of alveolar
ridge -> foramen occupies
more superior position.
Should be relieved over
the foramen
If not relieved -> can
occlude the mental nerve and
blood vessels -> causing numbness of the lip
90

GENIAL TUBERCULE / MENTAL

SPINE
Situated on the lingual aspect of the symphysis

area slightly above the border.

Divided into :- superior -> genioglossi attachment
- inferior -> genohoid attachment
Clinical significance: Extensive loss -> superior
positioning of spine ->
soreness -> surgical
procedure indicated.
91

RETROMOLAR PAD
Pear shaped pad
Triangular soft pad of the tissue at the distal end of

the lower ridge.

Microscopically
- Composed of a thin nonkeratinized epithelium and
loose areolar tissue
Submucosa contains :
> glandular tissue
> fibres of buccinator and superior constrictor
>pterygomandibular raphe
> tendons of temporalis
92

Clinical significance : Usable guide on the cast for the

distal extension of denture
Action of the muscles in
retromolar pad , limits the
extent of the denture -> So
denture base should extend
approximately to 2/3rd over
the retromolar pad. (zarbbolender 12th edition )
Should be covered by denture
(sheldon winkler 2nd )
Aids in the stability of the
denture by adding another
plane to resist movement of the
denture.
93

RETROMOLAR PAPILLA
Is a small pear shaped area of gingival tissue

that remains fused to the scar after loss of the

last molar.
This small , hard pale pear shaped tissue is
situated at the base of the retromolar pad,
approximately at the centre of the ridge.

94

LINGUAL VESTIBULE /
ALVEOLINGUAL SULCUS
It can be divided into three areas
anterior vestibule/sublingual crescent area/

anterior sublingual fold

the middle vestibule/ mylohyoid area
the distolingual vestibule/ lateral throat form/

retromylohyoid fossa

95

Anterior lingual vestibule

This extends from the lingual frenum to where the

mylohyoid ridge curves down below the level of

sulcus. Here a depression the premylohyoid fossa
can be palpated.
This is mainly influenced by the genioglossus

muscle, lingual frenum and some part by anterior

portion of sublingual glands .

96

Middle vestibule:
This is the largest area and is mainly influenced

by mylohyoid muscles and somewhat by

sublingual glands.
The mylohyoid muscle is the largest muscle in the
floor of the mouth whose principal function occurs
during swallowing. Its intra oral appearance is
misleading because the membranous attachment
makes the muscle appear to be horizontal when
contracting.
97

 Nagel and sears have shown that at maximum

contraction the fibers are still in a downward and

forward direction so that a denture can be
extended below the muscle attachment along the
mylohyioid ridge.
The lingual borders in the mylohyoid areas are
formed by contact with the mylohyoid muscle in
functional, but not extreme, contracted or
elevated positions.
The average mylohyoid border is 4-6 mm beyond
the mylohyoid ridge in fair to good ridge it is
about 2-3 mm . If the ridge is flat it is often
advantageous to make mylohyoid border thicker
(4-5mm or more).

98

Distolingual vestibule:
The lateral throat form is bounded anteriorly by

mylohyoid muscle, laterally by pear shaped pad,

posterolaterally by superior constrictor,
posteromedially by palatoglossus and medially by
tongue.
The so called s curve of the lingual flange of the
mandibular denture results from stronger intrinsic
and extrinsic tongue muscles, which usually place
the retromylohyoid borders more laterally and
towards the retromylohyoid fossa, as the oppose
weaker superior constrictor muscle.

99

LATERAL THROAT FORM

The posterior limit of the mandibular denture is

determined mainly by the palatoglossus muscle and

somewhat by weaker superior constrictor muscle this is
area is called posterior/ retromylohyoid curtain.

Neil described this area and noted that the denture

could have three possible lengths, depending on the

tonicity, activity, and anatomic attachments of the
adjacent structures Class III lateral throat form has minimum length

and thickness. The border usually ends 2-3 mm below

the mylohyoid ridge or sometimes just at the ridge.
100

 Class I throat form: The horizontal border is

usually 2-3 mm thick, but a thicker border of 4-5

mm should be used for better seal if the ridge is
flat. The retromylohyoid curtain area should be
thinner, about 2-3 mm, and very rounded and
smooth.
Class II throat form is about half as long and

narrow as class I and about twice as long as class

III.

101

COMPARISION BETWEEN EDENTULOUS

MAXILLA AND MANDIBLE
Maxilla-

Mandible-

1.Has more
supporting areas
2.Limiting structures
are less in number
and have a less
stronger influence
over the denture
border

1.Has less
supporting area.
2.Limiting
structures are
more in number
and have a
stronger influence
over the denture
border

102

REFRENCES
1. de Freitas V, Madeira MC, Toledo Filho JL,

Chagas CF. Absence of the mental foramen

in dry human mandibles. Acta Anat (Basel).
1979; 104(3): 353-355.
2. Dharmar S. Locating the mandibular canal in

panoramic radiographs. Int J Oral Maxillofac

Implants. 1997; 12: 113-117.

103

3.

Mbajiorgu EF, Mawera G, Asala SA, Zivanovic S.

Position of the mental foramen in adult black
Zimbabwean mandibles: a clinical anatomical study.
Central African Journal of Medicine 1998; 44: 24-30.
4. Gershenson A, Nathan H, Luchansky E. Mental
foramen and mental nerve: changes with age. Acta
Anatomica 1986; 126: 21-8.
5.
Zografos J, Kolokoudias M, Papadakis E Dental
School, University of Athens, Greece. Hell Period
Stomat Gnathopathoprosopike Cheir. 1990
Mar;5(1):17-20.

104

6. Sheller WR and wisewell OB. Lingual foramen

on the mandible. Anat rac 1954; 119 387-390
7. Sheldon winkler 2nd edition OF ESSENTIALSOF
COMPLETE DENTURE PROSTHESIS
8. Charles m. heartwell, Jr, urthur O. Rahn .
Syllabus of complete denture 4th edition
9. Grays anatomy 39th edition
10. Zarb and Bolender 12th edition .
Prosthodontic treatment of edentulous patient

105