ANATOMIC

LANDMARKS IN
MANDIBLE
“ As Edwards and Boucher” noted: “Since the
success of complete dentures depends
largely on the relation of the dentures to
anatomic structures which support and limit
them, familiarity with the location and
character of these structures is essential.”

Ref : A contemporary review of the factors involved in complete dentures Part III: Support
T. E. Jacobson, D.D.S.,* and A. J. Krol, D.D.S.* 2
3
 INTRODUCTION

▰ Dentist must fully understand the anatomy of the supporting and

limiting structures involved.
▰ Knowledge of the orofacial anatomy is necessary for making
impressions, recording jaw relations, adjusting dentures, etc.; in fact,
anatomy is involved in nearly every phase of dentistry.
▰ The mandibular denture poses a great technique challenge for dentist
and often a significant management challenge for patient.

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▰ Denture base must extend as far as possible without interfering
with the health and function of the tissues within physiological
limits
▰ Support comes from – body of the mandible

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WHY SUPPORT AND RETENTION PROVIDED FOR
MANDIBULAR DENTURE IS LESS ?

▰ The denture bearing area of mandible -12.25cmsq. as compared to

maxilla - 22.96cmsq.

Less capable of resisting occlusal forces

▰ Nature of bone – Cancellous and porous

▰ movable floor of the mouth  difficulty in establishing a lingual
border seal
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▰ Presence of tongue and its individual size, form and activity – complicates the
impression procedure for lower denture and patients ability to manage denture.
Therefore, retention is threatened.

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 LANDMARKS IN MOUTH LANDMARKS IN IMPRESSION

LABIAL FRENUM  LABIAL NOTCH

LABIAL VESTIBULE  LABIAL FLANGE
BUCCAL FRENUM  BUCCAL NOTCH
BUCCAL VESTIBULE  BUCCAL FLANGE
RESIDUAL ALVEOLAR RIDGE  ALVEOLAR GROOVE
RETROMOLAR PAD  RETROMOLAR FOSSA
PTERYGOMANDIBULAR RAPHAE PTERYGOMANDIBULAR NOTCH

RETROMYLOHYOID FOSSA RETROMYLOHYOID EMINENCE

LINGUAL TUBEROSITY LINGUAL TUBERCULAR FOSSA

ALVEOLINGUAL SULCUS LINGUAL FLANGE

LINGUAL FRENUM LINGUAL NOTCH
BUCCAL SHELF  BUCCAL FLANGE RESTING ON
BUCCAL SHELF 8
CORRELATION OF ANATOMIC LANDMARKS

Ref : Prosthodontic treatment for edentulous patients : Zarb, Bolender : 12th Edition 9
 ANATOMIC
LANDMARKS OF
LIMITING
MANDIBLE STRUCTURES

SUPPORTING
RELIEF AREAS
STRUCTURES

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 LIMITING SUPPORTING STRUCTURES RELIEF AREAS
STRUCTURES
 Mylohyoid ridge
PRIMARY SECOND  Genial tubercle
 Labial frenum STRESS STRESS  Torus Mandibularis
 Labial vestibule BEARING BEARING  Mental foramen
 Buccal frenum
 Buccal vestibule  Buccal  Crest of
shelf alveolar
 Lingual frenum
area ridge
 Alveolingual sulcus
 Retromolar pad
 Pterygomandibular
raphe

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 LIMITING/PERIPHERAL 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
▰ More difficult to record in mandible than in maxilla
▰ Structures on lingual side more complicated

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 LABIAL FRENUM

▰ Active band of fibrous connective tissue

▰ Extension : labial aspect of residual ridge to the lip
▰ Muscle attachment – Incisivus , orbicularis oris

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 CLINICAL SIGNIFICANCE
▰ During final impression this frenum is recorded as LABIAL
NOTCH
▰ Recorded : lifting the lower lip outward , upward and inwards
▰ On wide mouth opening, orbicularis oris muscle is stretched 
narrowing of sulcus
Therefore Impressions narrowest in anterior labial region
If thick  displacement of denture

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▰ Frenum must be relieved by formation of (V) notch
on the labial flange of the denture to avoid ulceration
and poor retention of the denture.

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 LABIAL VESTIBULE

▰ Extension : From labial frenum to the buccal frenum

▰ Epithelium : Thin, non- keratinized
▰ Muscle attachment : Orbicularis muscle and the
Incisive labi inferioris (which are fairly close to the
crest ridge)
▰ Active muscle : Mentalis
▰ Impression narrowest at this region

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 MENTALIS

▰ It originates from mental tubercles and inserts into

the lower lip

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CLINICAL SIGNIFICANCE

The extent of the denture flange is critical

The muscle of the lower lip pull actively across the denture border,
polished surfaces and teeth

The borders if made thick the denture will displace due to stretching of
orbicularis muscle on the wide opening of mouth

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BUCCAL FRENUM

▰ Fibrous Band
▰ Separates labial and buccal vestibule
▰ Muscle attachment : Depressor anguli oris
▰ Significance : should be cleared in the denture
base to avoid dislodgement

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 CLINICAL SIGNIFICANCE

▰ MOVEMENTS : the cheek is lifted outward, upward,

inward, backward, and forward to simulate
movement of the frenum.
▰ Frenum should be recorded as BUCCAL NOTCH.

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BUCCAL VESTIBULE

▰ EXTENSION:
Anteriorly : buccal frenum
Posteriorly : Retromolar pad
▰ Muscle attachment :
Anteriorly : buccinator
Posteriorly: Pterygomandibular raphe
▰ Distobuccal area : must converge rapidly – to avoid displacement by
the contracting massater muscle
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 CLINICAL SIGNIFICANCE

▰ This area remains an important esthetic consideration because when

smiling the dark space is seen known as BUCCAL CORRIDOR.
▰ Distobuccal border is governed by masseter and buccinator muscle .
(when the masseter muscle contracts, it pushes inward the buccinator
muscle = masseteric notch )
▰ Impressions are widest at this region

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ACTIVATION OF THE MASSATERIC NOTCH AND
DISTAL AREA

▰ Instruct the patient to open wide and then to close against the resting
forces of the fingers
▰ Opening wide  activates the muscles of pterygomandibular raphe by
stretching (which defines the distal extension)
▰ Patient closes against the finger  massater contracts  pushes the
buccinator(situated medially)  MASSATERIC NOTCH

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 MOVEMENTS

▰ The effect of masseter muscle is recorded by asking the

patient to exert a closing force while the dentist exerts a
downward pressure on the tray.
▰ For buccal flange, cheek is moved outward, upward, and
inward.

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 DISTAL EXTENSION

▰ Limited by:
 Ramus
 Buccinator muscle fibres
 Superior contrictor
 Lateral bony boundaries of retromolar fossa
CLINICAL SIGNIFICANCE :
Overextension of denture border into the ramus  compression
of buccinator  causes soreness and limits the function of
buccinator 25
 MODIOLUS/ MUSCULI CRUCULI MODIOLI

▰ Described by Fish
▰ Chiasma of facial muscles of lips and cheek.
▰ LOCATION : near corner of mouth
▰ MUSCLES INCLUDE:
 Orbicularis oris
 Buccinator
 Levator anguli oris
 Depressor anguli oris ISOMETRIC Controls food bolus
 Zygomaticus major CONTRACTION on the occlusal table
 Levator labii superioris
 Risorius
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 Platysma
 CLINICAL SIGNIFICANCE

▰ Denture base must be contoured to permit modiolus

to function freely
▰ In the premolar region, denture flange should be
short and narrow

permit the action that draws the vestibule superiorly and

modiolus medially against denture

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With tooth loss, the modiolus gets displaced and gives
LINGUAL BORDER

▰ Less resistance than labial and buccal borders

▰ Over extension easily causes dislodgment and
soreness
▰ Action of mylohyoid muscle is important

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 LINGUAL FRENUM

▰ Mucous membrane fold seen on elevation of the

tongue
▰ This anterior portion of the lingual flange is called
sublingual crescent area.

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 SUBLINGUAL CRESCENT AREA

▰ sublingual crescent : the crescent-shaped area at the

anterior floor of the mouth formed by the lingual wall
of the mandible and the adjacent sublingual fold. It is
the area of the anterior alveolingual sulcus (GPT 9)
▰ Extension of denture  completes the border seal
▰ Coverage of this area  increases stability

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 SUBLINGUAL GLAND REGION

▰ Location : premolar region, above mylohyoid muscle

▰ The lingual flanges of the lower denture should not
extend in this area because with excessive resorption
of the mandible the gland may bulge superiorly
above the body of mandible.

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MYLOHYOID MUSCLE

▰ Forms the floor of mouth

▰ Origin – Mylohyoid ridge
▰ Extension :
Medially: it combines with the fibres from the opposite side
Posteriorly: extend till hyoid bone
▰ Mylohyoid ridge-
molar region – sharp & distinct
Anteriorly - Indiscernible

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 CLINICAL SIGNIFICANCE

During swallowing – muscle contracts, raises floor of

mouth
Therefore, lingual flange must be parallel to the muscle
for successful denture.

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JACOBSON T.E, KROL A.J A CONTEMPORARY
REVIEW OF THE FACTORS INVOLVED IN THE
COMPLETE DENTURES. PART II: STABILITY
1983;49(3): 165-172

34
JACOBSON T.E, KROL A.J A CONTEMPORARY REVIEW
OF THE FACTORS INVOLVED IN THE COMPLETE
DENTURES. PART II: STABILITY 1983;49(3): 165-172

▰ Most desirable -- The lingual slope approaches 90 to

the occlusal plane  resistance towards horizontal
forces
▰ When contracted the anterior mylohyoid muscle
tenses the floor and limits the extension
▰ Any flange below mylohyoid must extend incline
medially to allow the mylohyoid muscle contraction.

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EXTENSION OF FLANGE WRT TO
MYLOHYOID MUSCLE

▰ flange below the ridge : direct medially towards the

muscle guides the tongue to rest on it
▰ flange above the ridge : vertical forces might break
the seal . Leads to displacement
▰ Flange below the ridge and in the undercut : causes
soreness

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 RETROMYLOHYOID FOSSA

▰ Posterior to mylohyoid muscle

▰ Lingual flange typical S shaped curve
▰ Retromylohyoid fossa: bounded by retromylohyoid curtain

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RETROMYLOHYOID CURTAIN
BOUNDARIES:
▰ Posterolateral – Superior constrictor
▰ Posteromedial- Palatoglossal muscle, lateral surface
of tongue
▰ Inferior wall : overlies submandibular gland

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CLINICAL SIGNIFICANCE

▰ Denture border should extend posteriorly to contact the

retromylohyoid curtain when tip of tongue is placed against
the front part of upper residual ridge

▰ Contraction of medial pterygoid muscle  bulge in the wall

of retromylohyoid curtain  influence the contours of
distolingual flange

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 ALVEOLINGUAL SULCUS

▰ Space between tongue and residual ridge

▰ EXTENSION : lingual frenum to the retromylohyoid
curtain
▰ Divided into anterior region, middle and posterior
region

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 THE ANTERIOR REGION

▰ Extension :
Lingual frenum to the mylohyoid ridge curves above the sulcus
▰ A depression is seen premylohyoid fossa which is recorded as
Premylohyoid Eminence in the impression
About the flange
▰ It should touch the floor of the mouth when asked to touch the
tongue at the anterior ridge
▰ It gets larger when extends into premylohyoid fossa

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THE MIDDLE REGION

▰ Extensions :
Premylohyoid fossa to the distal end of the
mylohyoid ridge.
▰ About the flange:
 Shallower
 Slope medially
 Can extend below the ridge
 Tongue rests on the flange for stability and
peripheral seal
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 THE POSTERIOR REGION

▰ The denture flange in this region should turn laterally towards

the ramus of the mandible to fill up the fossa and complete the
typical S-form of the lingual flange of the lower denture.

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CLINICAL SIGNIFICANCE

▰ Patient is asked to Protrude the tongue out - this gives the length of the
flange
▰ Patient is asked to touch the cheeks with the tongue - width of the
flange
▰ Action : This activates the mylohyoid muscle  Raises the floor of
the mouth And helps in maintaining seal and stability by recording
the borders

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▰ Finally, the patient is asked to open wide. If the tray
is too long, a notch will be formed at the
posteromedial border of the retromolar pad,
indicating encroachment of the tray on the
pterygomandibular raphe, and the tray must be
adjusted carefully

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 RETROMOLAR PAD

▰ Defines the posterior limit

▰ Sicher – A soft tissue elevation of mucosa that lies
distal to 3rd molar
▰ Triangular soft pad of tissue
▰ Mucosa : thin, non-keratinized epithelium
▰ Submucosa : loose areolar tissue,
glandular tissue

Makes it resilient
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▰ Located posteriorly to pear shaped pad
▰ Rarely resorbs due to active temporalis muscle
attachment on coronoid process

BOUNDARIES
▰ POSTERIORLY: Temporalis tendons
▰ LATERALLY: Buccinator
▰ MEDIALLY: Pterygomandibular raphe and superior
constrictor
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 RETROMOLAR PAPILLA

▰ The small raised tissue at the anterior end of the

retromolar pad
▰ Forms the pear shaped pad

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 PEAR SHAPED PAD

▰ Term coined by – ‘Craddock’

▰ Area formed by the residual scar of the extracted
molar and the retromolar papilla
▰ Mucosa – attached gingiva

PEAR SHAPED PAD = SCAR OF EXTRACTED 3RD MOLAR + RETROMOLAR PAPILLAE 49

JACOBSON T.E, KROL A.J A CONTEMPORARY REVIEW OF
THE FACTORS INVOLVED IN THE COMPLETE DENTURES .
PART III: SUPPORT . J PROSTHET DENT 1983;49(3): 306-
313

▰ PEAR SHAPED PAD AREA – keratinized Residual scar of

the third molar
Not a favorable denture bearing area
▰ Associated with – Buccinator(from buccal shelf) , Superior
Constrictor , Temporalis and firmly bound Masticatory
musosa.
▰ If the denture gets short : more rapid resorption and poor
settling of the denture base is seen

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HOW TO DISTINGUISH ?

▰ PEAR SHAPED PAD ▰ RETROMOLAR PAD

Lighter color Less keratinised
Overlying mucosa- firmly More vascular
bound More resilient
More keratinized Contains glandular tissue
Submucosal layer that can
tolerate gentle posterior
seal
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• The junction between the pear shaped pad and the retromolar
pad demarcates the distal border of the properly extended
mandibular Complete Denture.

• Lammie and Krol – Beading this region at junction  ensures

proper peripheral seal

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CLINICAL SIGNIFICANCE

▰ Helps in maintaining the occlusal plane by posterior

teeth arrangement .
▰ Teeth should not be placed on the retromolar pad
▰ Denture base should extend on posterior two third
over the retromolar pad

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 PTERYGOMANDIBULAR RAPHE

▰ The pterygo mandibular raphe or ligament originates

from the pterygoid hamulus of medial pterygoid plate
and attaches to distal end of mylohyoid ridge.
▰ Raphe is a tendinous insertion of two muscles
▰ Posteromedially : Superior constrictor
▰ Anterolaterally: Buccinator

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 STRESS BEARING /SUPPORTING STRUCTURES

Stress-bearing region : 1. the surfaces of oral structures that resist forces, strains, or pressures
brought on them during function;
2. the portion of the mouth capable of providing support for a denture;
syn, DENTURE FOUNDATION AREA (GPT 9)

PRIMARY SUPPORT AREAS SECONDARY SUPPORT AREAS

▰ Areas that are at right angles to ▰ Areas on which forces are greater than at
occlusal forces right angles to occlusal forces or are
parallel to them
▰ Usually do not resorb easily
▰ They resorb under load
▰ Mandible – Buccal shelf area
▰ Anterior ridges resorb more than
posterior ridges.
▰ Mandible- Crest of alveolar ridge
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 BUCCAL SHELF AREA

▰ The area between the buccal frenum and the anterior border of
masseter
▰ Boundaries
▰ Laterally - external oblique line
▰ (Medially) - the slopes of residual ridge,
▰ Anteriorly - buccal frenum
▰ Posteriorly - retro molar pad.

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 CLINICAL SIGNIFICANCE

▰ Acts as a primary stress bearing area, reasons for which are :-

Structure of bone – intact cortical shelf
Direction of force- at right angles to vertical
occlusal forces
Direction of muscles – longitudinal anteroposterior
direction  denture base rest directly on
buccinator

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JACOBSON T.E , KROL A.J . A CONTEMPORARY VIEW
OF THE FACTORS INVOLVED IN COMPLETE
DENTURES. PART III: SUPPORT. J PROSTHET DENT
1983;49(3): 306-313

▰ Covered by mucosa and sub mucous layer of

glandular connective tissue
▰ Buccinator muscle fiber attaches inferiorly to buccal
shelf
▰ Fibres runs longitudinally anteroposterially
permitting to rest on the muscle without
displacement.

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CREST OF ALVEOLAR RIDGE

Considered as a Secondary Support Area

Why not primary support area ?

▰ a) Lack of muscle attachment
▰ b) Presence of cancellous bone
▰ c) Porosity and roughness
▰ d) Rapid resorption

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RELIEF AREAS

▰ Relief area : that portion of the dental prosthesis that is reduced to

eliminate excessive pressure (GPT 9)
▰ Mandibular relief areas include :
• Mylohyoid ridge
• Genial tubercles
• Mental foramen
• Torus mandibularis

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MYLOHYOID RIDGE

▰ Runs along lingual surface of mandible .

ANTERIORLY : attached to mylohyoid muscle & lies close to
the inferior border of mandible.
POSTERIORLY – after resorption it often flushes with superior
surface of residual ridge

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 CLINICAL SIGNIFICANCE

▰ Sharpness of ridge is hidden by overlying thin soft

tissue , therefore, has to be relieved.

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MENTAL FORAMEN

▰ Lies b/w 1st & 2nd premolar region labially.

▰ Opening for mental nerves & vessels.
▰ CLINICAL SIGNIFICANCE – Due to ridge resorption, it may
lie close to crest of the ridge ridge.

▰ Denture Base may exert Pressure over nerves

( if not relieved) may produce parasthesia of lower lip

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 GENIAL TUBERCLES/SPINAE MENTALIS

▰ Pair of bony tubercles found Anteriorly on lingual side of

body of mandible
▰ Due to resorption,it may become increasingly prominent
making denture usage difficult

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 CLINICAL SIGNIFICANCE
▰ In markedly resorbed mandibles  genial tubercles
provide bony foundation which is resistant to
resorption

Active muscle attachments- Genioglossus and

Geniohyoid

Then why it cannot be used as Primary stress bearing

area??
Due to Friable overlying mucosa, making it a relief
structure 65
 TORUS MANDIBULARIS
▰ Abnormal bony prominence usually found bilaterally
& lingually near the 1st & 2nd premolar midway b/w
soft tissues of the floor of mouth & crest of alveolar
ridge .
▰ Covered by extremely thin mucosa which is easily
traumatized.
▰ Sufficient relief must be provided
▰ If not, it has to be surgically removed pre-
prosthetically

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 REFERENCES

▰ Bolender Z. Prosthodontic treatment for edentulous patients .12 th ed.

▰ Bolender Z. Prosthodontic treatment for edentulous patients 11 th ed.
▰ Bernard & Levin - complete denture
▰ Heartwell CM. Textbook of Complete Dentures. 5 th ed
▰ Swensons’s Complete denture – 5th Ed
▰ Winkler S. Essentials of complete denture prosthodontics. 2 nd ed.
▰ Jacobson T.E , Krol A.J . A Contemporary view of the factors involved in
complete dentures. Part II: Stability . J Prosthet Dent 1983;49(3) :165- 172
▰ Jacobson T.E , Krol A.J . A Contemporary view of the factors involved in
complete dentures. Part III: Support. J Prosthet Dent 1983;49(3): 306- 313
67
THANK YOU.