NEET MDS Lessons
Prosthodontics
Anatomy of Maxilary Edentulous Ridge
LIMITING STRUCTURES
A) Labial & buccal frenum
- Fibrous band covered by mucous membrane.
- A v-shaped notch (labial notch) should be provided very carefully which should be narrow but deep enough to avoid interference
- Buccal frenum has the attachment of following muscles; levator anguli
- It needs greater clearance on buccal flange of the denture (shallower and wider) than the labial frenum.
B) Labial & buccal vestibule (sulcus)
- Labial sulcus is bounded on one side by the teeth, gingiva and residual alveolar ridge and on the outer side by lips.
- Buccal sulcus extends from buccal frenum anteriorly to the hamular notch posteriorly.
- The size of the vestibule is dependant upon:
i) Contraction of buccinator muscle.
ii) Position of the mandible.
iii) Amount of bone loss in maxilla.
C) Hamular notch
It is depression situated between the maxillary tuberosity and the hamulus of the medial pterygoid plate. It is a soft area of loose connective tissue.
- it houses the disto-lateral termination of the denture.
- Aids in achieving posterior palatal seal.
- Overextension causes soreness.
- Underextension poor retention
D) Posterior palatal seal area (post-dam)
It is a soft tissue area at or beyond the junction of the hard and soft palates on which pressure within physiological limits can be applied by a complete denture to aid in its retention.
Extensions:
1. Anteriorly – Anterior vibrating line
2. Posteriorly – Posterior vibrating line
3. Laterally – 3-4 mm anterolateral to hamular notch
SUPPORTING STRUCTURES
A) Primary stress bearing area / Supporting area
1. Posterior part of the palate
2. Posterolateral part of the residual alveolar ridge
B) Secondary stress bearing area / Supporting area
1. The palatal rugae area
2. Maxillary tuberosity
RELIEF AREAS
A) Incisive papilla
- Midline structure situated behind the central incisors.
- It is an exit point of nasopalatine nerves and vessels.
- It should be relieved if not, the denture will compress the nerve or vessels and lead to necrosis of the distributing areas and paresthesia of anterior palate.
B) Mid-palatine raphe
- Extends from incisive papilla to distal end of hard palate.
- Median suture area covered by thin submucosa
- Relief is to be provided as it is supposed to be the most sensitive part of the palate to pressure
C) Crest of the residual alveolar ridge
D) Fovea palatinae
Few areas like the cuspid eminence , fovea palatinae and torus palatinus may be relieved according to condition required.
| Topic | Key Answer | Clinical Pearl |
|---|---|---|
| Retromolar pad | Superior constrictor + Buccinator + Temporal tendon | Posterior extension landmark |
| Distobuccal border | Coronoid process | Limits lateral extension |
| Food lodgement | Decreased flange length | Extend borders adequately |
| PPS function | Retention via partial vacuum | Seals against soft palate |
| Submucous fibrosis | Addition silicone | Best flow properties |
| Glossy wax | Intimate tissue contact | Quality indicator |
| Vibrating line | Soft palate location | PPS placement guide |
| Occlusal plane | Parallel to interpupillary/Camper's | Esthetic reference |
| Buccal frenum | Levator anguli oris | Border extension guide |
| Masseteric notch | Masseter over buccinator | Contouring landmark |
The mental attitude of patients towards complete dentures plays a significant role in the success of their treatment. Understanding these attitudes can help dental professionals tailor their approach to meet the needs and expectations of their patients. Here are the four primary mental attitudes that patients may exhibit:
1. Philosophical (Ideal Attitude)
- Characteristics:
- Accepts the dentist's judgment without question.
- Exhibits a rational, sensible, calm, and composed disposition.
- Open to discussing treatment options and understands the importance of oral health.
- Implications for Treatment:
- This type of patient is likely to follow the dentist's recommendations and cooperate throughout the treatment process.
- They are more likely to have realistic expectations and be satisfied with the outcomes.
2. Indifferent
- Characteristics:
- Shows little concern for their oral health.
- Seeks treatment primarily due to pressure from family or friends.
- Requires additional time and education to understand the importance of dental care.
- Their attitude can be discouraging to dentists, as they may not fully engage in the treatment process.
- Implications for Treatment:
- Dentists may need to invest extra effort in educating these patients about the benefits of complete dentures and the importance of oral health.
- Building rapport and trust is essential to encourage a more proactive attitude towards treatment.
3. Critical/Exacting
- Characteristics:
- Has previously had multiple sets of complete dentures and tends to find fault with everything.
- Often has high expectations and may be overly critical of the treatment process.
- May require medical consultation due to previous experiences or health concerns.
- Implications for Treatment:
- Dentists should be prepared to address specific concerns and provide detailed explanations about the treatment plan.
- It is important to manage expectations and ensure that the patient understands the limitations and possibilities of denture treatment.
4. Skeptical/Hysterical
- Characteristics:
- Has had negative experiences with previous treatments, leading to doubt and skepticism about the current treatment.
- Often presents with poor oral health, resorbed ridges, and other unfavorable conditions.
- May exhibit anxiety or hysteria regarding dental procedures.
- Implications for Treatment:
- Building trust and confidence is crucial for these patients. Dentists should take the time to listen to their concerns and provide reassurance.
- A gentle and empathetic approach is necessary to help alleviate fears and encourage cooperation.
- It may be beneficial to involve them in the decision-making process to empower them and reduce anxiety.