https://userupload.net/425bp76da7o7 Since the beginning of twentieth century much has been written and rewritten about the impression techniques for complete dentures; but the subject has remained as vague and inconclusive. There are several reasons for this. The most important one is that nearly all publications on this subject have an empirical basis. Hardly any research work has been done to prove or disprove the advantages of the various impression techniques. Another reason for the prevailing confusion lies in not recognizing a number of variable factors which are associated with the impression procedure. The number of variable factors associated with the impression procedures are so many that a single standardized technique is not possible. These include a number of impression materials each having their own manipulative qualities; the patients with their individual anatomical variations, and the operator’s ability and experience.

1. BIOLOGICAL CONSIDERATIONSBIOLOGICAL CONSIDERATIONS
OF MAXILLARY ANDOF MAXILLARY AND
MANDIBULAR IMPRESSIONSMANDIBULAR IMPRESSIONS
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2. CONTENTSCONTENTS
 IntroductionIntroduction
 Oral mucosaOral mucosa
 Biological considerations of maxillary impressionsBiological considerations of maxillary impressions
• macroscopic anatomy- supporting structuresmacroscopic anatomy- supporting structures
limiting structureslimiting structures
• microscopic anatomy- supporting structuresmicroscopic anatomy- supporting structures
limiting structureslimiting structures
 Biological considerations of mandibular impressionsBiological considerations of mandibular impressions
• macroscopic anatomymacroscopic anatomy
• microscopic anatomymicroscopic anatomy
 Related anatomic structuresRelated anatomic structures
 ConclusionConclusion
 referencesreferences

3. INTRODUCTIONINTRODUCTION

4. Oral mucosaOral mucosa
Divided into 3 categories depending onDivided into 3 categories depending on
location in the mouth:location in the mouth:
1)1) Masticatory mucosaMasticatory mucosa: covers the crest of: covers the crest of
residual ridge including residual attached gingivaresidual ridge including residual attached gingiva
and hard palate.and hard palate.
2)2) Lining mucosaLining mucosa: covers the mucous membrane: covers the mucous membrane
not firmly attached to periosteum.not firmly attached to periosteum.
3)3) Specialized mucosaSpecialized mucosa: covers the dorsal surface: covers the dorsal surface
of tongue.of tongue.

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6. BIOLOGIC CONSIDERATIONS OFBIOLOGIC CONSIDERATIONS OF
MAXILLARY IMPRESSIONSMAXILLARY IMPRESSIONS

7. Supporting structures
 incisive papilla
 palatal rugae
 median palatine raphe
 maxillary tuberosity
 residual alveolar ridge
 fovea palatini
Limiting structures
 Labial and buccal frena
 Labial and buccal vestibules
 pterygomaxillary notch
 Posterior palatal seal area
 Coronoid bulge

8. MACROSCOPIC ANATOMYMACROSCOPIC ANATOMY
Supporting structures:Supporting structures:
 Residual ridge:Residual ridge:
primary stress bearing area.primary stress bearing area.
With continuous resorption. . .With continuous resorption. . .

9.  Rugae –
Raised areas of dense connective tissue in the anterior 1/3 of the
palate.
This area resists anterior displacement of the denture and is a
secondary support area.
No function
While making impressions. . .

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11.  Incisive papilla - Is a pad of fibrous connective
tissue overlying the orifice of the nasopalatine
canal.
Pressure in this area will cause a disruption of
blood flow and impingement on the nerve, causing
the patient to complain of pain or a burning
sensation. The denture should be relieved over
this area.

12.  Tuberosity - is an important primary denture
support area.
It also provides resistance to horizontal
movements of the denture.
In the absence of mandibular molars. . .

13.  Fovea palatinae – two small pits or depressions in
the posterior aspect of the palate, one on each side of
the midline, at or near the attachment of the soft
palate to the hard palate.
Guide for posterior border of denture.

14. Bone of the basal seatBone of the basal seat
 Incisive foramenIncisive foramen
locationlocation
with resorption. . .with resorption. . .
relief area.relief area.
determining vertical dimension.determining vertical dimension.

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16.  Zygomatic process:Zygomatic process:
location- opposite 1location- opposite 1stst
molar regionmolar region
relief arearelief area

17.  Torus palatinusTorus palatinus: a hard bony enlargement that: a hard bony enlargement that
occurs in the midline of the roof of the mouth.occurs in the midline of the roof of the mouth.
Should be relieved.Should be relieved.

18. Limiting structures:Limiting structures:
 Frenum - folds of mucous membrane and do
not contain significant muscle fibers. High
frenum attachments will compromise denture
retention and may require surgical excision
(frenectomy).

19.  Buccal frenumBuccal frenum::
amount of clearance.amount of clearance.
muscles affecting it (caninus, orbicularis oris,muscles affecting it (caninus, orbicularis oris,
buccinator)buccinator)

20.  Labial vestibule –
thickness of labial
flange. . .
 Buccal vestibule-
thickness of distal end of
buccal flange. . .

21.  Coronoid bulge - the patient is instructed to
open wide, protrude and go into lateral
movements. The width of the distobuccal flange
will then be contoured by the anterior border of
the coronoid process.

22. Hamular Notch - this narrow cleft extends
from the tuberosity to the hamulus of medial
pterygoid plate.
The pterygomandibular ligament attaches to the
pterygoid hamulus.
Extension of the denture. . .

23.  Posterior palatal seal area - distal to the
junction of the hard and soft palate at the vibrating
line.
Enhances retention & maintain the peripheral seal of
the maxillary denture

24. MICROSCOPIC ANATOMYMICROSCOPIC ANATOMY
Supporting structures:Supporting structures:
 Crest of residual ridge:Crest of residual ridge:
mucous membrane-mucous membrane-
bone-bone-

25.  Hard palate:Hard palate:
anterolatreally…anterolatreally…
posterolaterally…posterolaterally…

26.  Median palatine sutureMedian palatine suture::
thin sub mucosathin sub mucosa
non resilientnon resilient
denture tends to rock if not relieveddenture tends to rock if not relieved
bone
sub mucosa
mucosa

27. Limiting structures: (microscopicLimiting structures: (microscopic
anatomy)anatomy)
 Vestibular spacesVestibular spaces::
Thick mucosa containing large amounts of areolar tissue.Thick mucosa containing large amounts of areolar tissue.
Easily overextended in impressions.Easily overextended in impressions.

28.  Hamular notchesHamular notches::
Additional pressure can beAdditional pressure can be
placed on this tissue at theplaced on this tissue at the
centre of the notch tocentre of the notch to
complete the posterior palatalcomplete the posterior palatal
seal.seal.
No space provided inNo space provided in
impression tray in this region.impression tray in this region.

29. Ideal maxillary ridge:
 Abundant keratinized
attached tissue
 Square arch
 Palate U-shaped in cross-
section
 Moderate palatal vault
 Absence of undercuts
 High frenum attachments
 Well-defined hamular
notches

30. Biological considerations inBiological considerations in
mandibular impressionsmandibular impressions

31. Supporting structures
 residual alveolar ridge
 Buccal shelf area
 retromolar pad
Limiting structures
 labial and buccal frena
 lingual frenum
 Alveololingual sulcus
 retromylohyiod curtain
 masseteric notch

32. MACROSCOPIC ANATOMYMACROSCOPIC ANATOMY
Supporting structures:Supporting structures:
 Alveolar ridge - High rate of resorption when
excessive pressure is applied to this area.
underlying bone is cancellous.
Generally relieved.

33.  Buccal Shelf - bordered
externally by the external
oblique line and internally by
the slope of the residual
ridge.
 This region is a primary
stress bearing area in
mandibular arch.
 The buccal shelf is a prime
support area because it is
parallel to the occlusal plane
and the bone is very dense.

34.  Retromolar pad: One constant, relatively unchanging
structure on the mandibular denture bearing surface is the
retromolar pad .
 The pad contains glandular tissue, loose areolar connective
tissue, the lower margin of the pterygomandibular raphe,
fibers of the buccinator, and superior constrictor and
fibers of the temporal tendon.
 The bone beneath does not resorb secondary to the
pressure associated with denture use. The retromolar pad is
one of the primary support areas.

35. Bone of the basal seatBone of the basal seat
 External Oblique ridge–
• A ridge of dense bone from the mental foramen,
coursing superiorly and distally to become continuous
with the anterior region of the ramus.
• This line is the attachment site of the buccinator
muscle and an anatomic guide for the lateral termination
of the buccal flange of the mandibular denture.

36.  Mental Foramen –
• The anterior exit of the mandibular canal and the
inferior alveolar nerve.
• In cases of severe residual ridge resorption, the
foramen occupies a more superior position and the
denture base must be relieved to prevent nerve
compression and pain.

37.  Mylohyoid ridgeMylohyoid ridge::
mylohyoid musclemylohyoid muscle arises from the mylohyoid ridge of
the mandible.
Determines the lingual extension of the denture. Flange
shouldn't extend into the undercut below the
mylohyiod ridge.

38. Limiting structures:Limiting structures:
 Labial frenum - histologically and functionally
the same as in the maxilla (mucous membrane
without significant muscle fibers)

39.  Labial vestibule - limited inferiorly by the mentallis
muscle, internally by the residual ridge and labially by
the lip.
 Mentalis - elevates the skin of the chin and turns the
lower lip outward.
Dictates the length and thickness of the labial flange
extension of lower denture.

40.  Buccal frenum –
Buccal frenum connects as a continuous band
through the modiolus at the corner of the
mouth up to the buccal frenum attachment on
maxilla.
Histologically and functionally the same as in the
maxilla.

41.  Masseter Groove - the action of the masseter
muscle reflects the buccinator muscle in a superior
and medial direction.
The distobuccal flange of the denture should be
contoured to allow freedom for this action otherwise
the denture will be displaced or the patient will
experience soreness in this area.

42.  Lingual frenum - overlies the genioglossus muscle,
which takes origin from the superior genial spine.
 Sublingual folds - formed by the superior surface
of the sublingual glands and the ducts of submandibular
glands.

43.  Alvelolingual sulcusAlvelolingual sulcus::
anterior regionanterior region
middle regionmiddle region
posterior regionposterior region
Premylohyoid
eminence
Retromylohyoid
eminence

44. ‘S’ shaped alvelolingual sulcus

45.  Retromylohyoid space - lies at the distal end of
the alveolingual sulcus. Bounded medially by the
anterior tonsilar pillar, posteriorly by the
retromylohyoid curtain , laterally by the mandible and
pterygomandibular raphe, anteriorly by the lingual
tuberosity of the mandible and inferiorly by the
mylohyoid muscle.
 ***The retromylohyoid space is very important for
denture stability and retention.

46.  Ideal mandibular ridge:
• Well defined retromolar
pad
• Blunt mylohyoid ridge
• Deep retromylohyoid
space
• Low frenum attachments
• Absence of undercuts
• Abundant attached
keratinized mucosa

47. Related anatomic structuresRelated anatomic structures
 Muscles of soft palate:Muscles of soft palate:
a) levator veli palatinia) levator veli palatini
b) tensor veli palatinib) tensor veli palatini
c)pharynopalatinusc)pharynopalatinus
d)musculus uvulaed)musculus uvulae
e)glossopalatinuse)glossopalatinus

48.  Muscles of the pharynx:Muscles of the pharynx:
superior constrictorsuperior constrictor (D)(D)
medial constrictormedial constrictor (E)(E)
inferior constrictorinferior constrictor (F)(F)
stylopharyngeusstylopharyngeus
pharyngopalatinuspharyngopalatinus

49. CONCLUSIONCONCLUSION

50. LIST OF REFERENCESLIST OF REFERENCES
 BOUCHER’S Prosthodontic treatment for edentulousBOUCHER’S Prosthodontic treatment for edentulous
patients.patients.
 Impressions for complete dentures.Impressions for complete dentures.
BERNARD LEVINBERNARD LEVIN
 Clinical dental prosthetics.Clinical dental prosthetics.
HRB FENN, KP LIDDELOW, AP GIMSONHRB FENN, KP LIDDELOW, AP GIMSON
 Prosthetic treatment of edentulous patients.Prosthetic treatment of edentulous patients.
R M BASKER, J C DAVENPORT.R M BASKER, J C DAVENPORT.
44THTH
editionedition
 Essentials of complete denture prosthodonticsEssentials of complete denture prosthodontics
SHELDON WINKLERSHELDON WINKLER
22NDND
EDITIONEDITION