Podcast
Questions and Answers
What anatomical feature marks the posterior limit of extension for an upper saddle without a distal abutment tooth?
What anatomical feature marks the posterior limit of extension for an upper saddle without a distal abutment tooth?
Which area serves as a major support region for the mandibular residual ridge?
Which area serves as a major support region for the mandibular residual ridge?
Where is the retromolar pad located, and what is its significance?
Where is the retromolar pad located, and what is its significance?
What role does submucosal thickness play in denture design?
What role does submucosal thickness play in denture design?
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Which structure is associated with the attachment of the mylohyoid muscle?
Which structure is associated with the attachment of the mylohyoid muscle?
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How does the prominence of the mylohyoid ridge change over time?
How does the prominence of the mylohyoid ridge change over time?
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What is the purpose of extending the lingual flange of a free-end saddle into the retromylohyoid area?
What is the purpose of extending the lingual flange of a free-end saddle into the retromylohyoid area?
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Which of the following describes the character of the posterior part of the retromolar pad?
Which of the following describes the character of the posterior part of the retromolar pad?
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What soft tissue structure overlies the incisive canal?
What soft tissue structure overlies the incisive canal?
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Where does the labial surface of the natural central incisor lie in relation to the incisive papilla?
Where does the labial surface of the natural central incisor lie in relation to the incisive papilla?
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What are rugae in the context of the hard palate?
What are rugae in the context of the hard palate?
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What is the palatine raphe?
What is the palatine raphe?
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What is the purpose of relieving a mucosally supported denture over the palatine torus?
What is the purpose of relieving a mucosally supported denture over the palatine torus?
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Where should the posterior border of a partial denture connector be positioned if covering a large area of palate?
Where should the posterior border of a partial denture connector be positioned if covering a large area of palate?
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What describes the structures found in the midline of the palate?
What describes the structures found in the midline of the palate?
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Why should partial dentures be designed to leave rugae uncovered?
Why should partial dentures be designed to leave rugae uncovered?
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What effect does the contraction of the mentalis muscle have on the labial sulcus?
What effect does the contraction of the mentalis muscle have on the labial sulcus?
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How does lateral movement of the mandible affect the buccal sulcus at the maxillary tuberosity?
How does lateral movement of the mandible affect the buccal sulcus at the maxillary tuberosity?
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What happens when there is marked resorption of the underlying bone?
What happens when there is marked resorption of the underlying bone?
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What is the role of the polished surface of the buccal flange in denture retention?
What is the role of the polished surface of the buccal flange in denture retention?
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Which intraoral examination component focuses on the visual assessment of dental conditions?
Which intraoral examination component focuses on the visual assessment of dental conditions?
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What anatomical structure does the frenum contain?
What anatomical structure does the frenum contain?
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What role do denture flanges play in relation to the sulcus?
What role do denture flanges play in relation to the sulcus?
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What is the function of the modiolus during mastication?
What is the function of the modiolus during mastication?
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What effect does the overextension of the denture flange in the distobuccal sulcus have?
What effect does the overextension of the denture flange in the distobuccal sulcus have?
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Which muscles are primarily involved in the closing movement of the mandible?
Which muscles are primarily involved in the closing movement of the mandible?
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Which of the following statements regarding the buccinator muscle is true?
Which of the following statements regarding the buccinator muscle is true?
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What can insufficient clearance by denture borders cause concerning the frenum?
What can insufficient clearance by denture borders cause concerning the frenum?
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What is the result of not contouring the buccal flange in the premolar region?
What is the result of not contouring the buccal flange in the premolar region?
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What factors should be assessed regarding the firmness of teeth during an examination?
What factors should be assessed regarding the firmness of teeth during an examination?
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Which type of restoration is often needed for maxillary molars in conventional preparations?
Which type of restoration is often needed for maxillary molars in conventional preparations?
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What does the assessment of restorations' condition involve?
What does the assessment of restorations' condition involve?
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For canines, which type of restoration provides an ideal surface for a cingulum rest?
For canines, which type of restoration provides an ideal surface for a cingulum rest?
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In which cases is a cingulum rest typically feasible for incisors?
In which cases is a cingulum rest typically feasible for incisors?
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What is likely the reason for replacing amalgam restorations in maxillary molars?
What is likely the reason for replacing amalgam restorations in maxillary molars?
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What is an ideal strategy for the condition of soft tissue during examinations?
What is an ideal strategy for the condition of soft tissue during examinations?
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What type of restoration is recommended for mandibular molars in conventional preparation?
What type of restoration is recommended for mandibular molars in conventional preparation?
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What is a common result of the action of the tongue and muscles affecting denture borders?
What is a common result of the action of the tongue and muscles affecting denture borders?
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What could indicate a need to change restorative fillings during an intraoral examination?
What could indicate a need to change restorative fillings during an intraoral examination?
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Study Notes
Denture Bearing Areas
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Incisive Papilla: Soft tissue overlying the incisive canal, containing nerves and vessels supplying the anterior part of the palatal mucosa. The labial surface of the central incisor is approximately 8-10mm anterior to the center of the papilla.
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Rugae: Irregular transverse ridges in the anterior hard palate. This area provides fine tactile discrimination, and partial dentures should be designed to leave this area uncovered as much as possible.
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Palatine Raphe: Mucosal ridge running longitudinally in the midline of the palate.
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Palatine Torus: Developmental bony prominence found in the center of the palate. It is often covered by relatively incompressible mucoperiosteum, and dentures may need to be relieved over the torus to prevent rocking.
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Vibrating Line: Junction where the movable mucosa of the soft palate meets the static mucosa of the hard palate. When covering a large area of the palate with a partial denture connector, the posterior border should be positioned on the compressible tissue just anterior to the vibrating line.
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Palatine Fovae: Orifice of ducts from the minor palatine glands, often located near the vibrating line.
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Hamular Notch: Mucosal depression posterior to the maxillary tuberosity, overlying the space between the pterygoid hamulus and maxillary tuberosity. It marks the posterior limit of extension of an upper saddle when no distal abutment tooth is present.
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Palatine Submucosa: Variations in thickness of the submucosa affect the compressibility of the denture-bearing surface. This impacts the degree of mucosal support offered by a partial denture.
Mandibular Surface Anatomy
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Buccal Shelf: Lies between the crest of the ridge and the external oblique ridge. It's a broad, horizontal surface covered with smooth cortical bone, making it a major support area for the mandibular residual ridge and important for free-end saddle support.
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Retromolar Pad: The anterior part is firm and fibrous, forming a significant part of the denture-bearing area. It offers support for the denture and helps resist posterior displacement. The posterior part is mobile and falls outside the denture-bearing area. A point halfway up the retromolar pad can be used to indicate the occlusal plane level in the absence of posterior teeth.
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Mylohyoid Ridge: Bony ridge to which the mylohyoid muscle attaches. As resorption of the residual ridge proceeds, the prominence of the mylohyoid ridge increases, predisposing to mucosal soreness beneath the denture in this area.
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Retromylohyoid Area (Lingual Pouch): The part of the lingual sulcus behind the mylohyoid ridge, posteriorly. If possible, the lingual flange of a free-end saddle should extend into this area for optimal stability.
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Mandibular Tori: Developmental bony swellings occasionally found lingually in the premolar region. They can interfere with the optimal positioning of lingual connectors and may require surgical removal.
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Sulcus: Mucosal fold between the ridge and the cheeks, lips, or tongue. Denture flanges usually need to fill the dimension of the sulci. It is important to obtain an accurate recording of the lingual sulcus to determine the position of the lingual connectors.
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Frenum: Fold of mucous membrane crossing the sulcus. It contains fibrous submucosa but no muscle fibers. Adequate clearance by denture borders is required to allow unhindered movement of the frenum during function.
Anatomy of the Buccal Sulci
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Modiolus: Decussation of muscle fibers near the angle of the lips, fixing the corner of the mouth and closing the buccal sulci during function and mastication.
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Masseter Muscle: During clenching, the anterior border of the masseter muscle bulges into the distobuccal sulcus area. Overextension of denture flanges in this area can lead to soreness and displacement.
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Buccinator Muscle: Contraction of the buccinator muscle raises a soft tissue band at the occlusal plane level. The polished surface of the buccal flange should be shaped to direct the force of this activity towards the ridge, aiding in denture retention.
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Mentalis Muscle: Contraction of the mentalis muscle elevates the soft tissue of the chin, reducing the depth and width of the labial sulcus. This can exert considerable pressure on the labial flange, leading to posterior and upward displacement, especially with significant ridge resorption.
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Tongue Movement: Tongue elevation raises the sublingual folds, reducing the depth and width of the sulcus, particularly with advanced ridge resorption.
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Lateral Mandibular Movement: During lateral movement, the coronoid process on the non-working side comes near the buccal aspect of the maxillary tuberosity, reducing the width of the buccal sulcus in this region.
Patient Work Up
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Patient Interview: Includes information gathering, including medical and dental history, chief complaint, and history of present illness.
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Extraoral Examination: Physical examination of the patient’s face, head, and neck.
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Intraoral Examination: Includes visual and digital examination of the oral cavity.
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Visual Examination:*
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Position of teeth
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Number of teeth
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Caries
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Condition of soft tissues
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Existing restorations
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Oral hygiene
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Occlusion and vertical space
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Relationship of the mandible and maxilla in centric and eccentric positions
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Digital and Exploratory Examination:*
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Firmness of teeth
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Pocket depths
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Extent of caries
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Tooth sensitivity
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Condition of restorations
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Condition of soft tissue
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Action of the tongue and muscles affecting denture borders
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Assessment of Restorations:*
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Determine if restorations need to be changed.
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Plan for the type of restorations needed for abutment teeth.
Site Selection and Preferred Surfaces for Restorations
- Maxillary Teeth:*
- Molars and Premolars: Conventional preparations in the mesial or distal fossae are ideal for full crowns, 3/4 crowns, inlays, or onlays. Gold alloys are preferred, while amalgam restorations should be replaced with gold if a clasp connector contacts the proximal surface of the restoration.
- Canines: Cingulum rests in gold are ideal, with full crowns or 3/4 crowns sometimes necessary.
- Incisors: Cingulum rests are preferred, replacing amalgam with gold if needed.
- Mandibular Teeth:*
- Molars and Premolars: Conventional preparations in the mesial or distal fossae are ideal for full crowns, 3/4 crowns, inlays, or onlays. Gold alloys are preferred, while amalgam restorations should be replaced with gold if a clasp connector contacts the proximal surface.
- Canines: Incisal rests (usually) with full crowns or inlays are ideal.
- Incisors: Incisal rests are sometimes possible, but often require multiple teeth splinted together for support.
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Description
Test your knowledge on denture bearing areas including the incisive papilla, rugae, and palatine torus. Understand their anatomical features and significance in denture design. This quiz is essential for dental students or practitioners focusing on prosthodontics.
