Maxillary Anatomical landmarks

BY-
DR. AKANKSHA NARELA
PG 1ST YEAR
 Contents -
 Introduction
 Intraoral landmarks
 Maxillary Arch
i. Histology
ii. Supporting areas
iii. Peripheral/limiting areas
 Conclusion
 References
 INTRODUCTION

M.M Devan Dictum “Aim of a prosthodontist is not only

the meticulous replacement of what is missing, but also
perpetual preservation of what is present”

A prosthesis must function in harmony with the tissues

that support them and those that surround them.

Hence the dentist must understand the macroscopic as

well as microscopic anatomy of the supporting and limiting
structures of the denture.
This knowledge aids in determining -
i. The selective placement of forces by the denture
bases upon the supporting tissues.

ii. The form of the denture borders that will be

harmonious with the normal function of the limiting
structures that surround them.
INTRAORAL LANDMARKS
 INTRAORAL
LANDMARK

STRESS
SUPPORTING LIMITING
RELIEF AREA BEARING
STRUCTURES STRUCTURES
AREA
Stress Bearing Areas -

Stress
bearing
areas

Primary Secondary
stress stress
bearing areas bearing areas
According to 9th edition of Boucher & 12th edition of
Zarb & Bolender
PRIMARY:
RESIDUAL
RIDGE

STRESS
BEARING
AREA SECONDARY:
MAXILLARY RUGAE
ARCH

RELIEF INCISIVE
AREA PAPILLA,
MEDIAN
PALATAL
RAPHE,
FOVEA
PALATINI.
ACCORDING TO
BOUCHER’s 13 EDITION PRIMARY:
FIRM
TUBEROSITY,
HARD PALATE
ON EITHER
SIDEOF
PALATAL
RAPHE
STRESS
BEARING
AREA
SECONDARY:
MAXILLARY RUGAE,
ARCH ALVEOLAR
RIDGE

RELIEF PALATAL
TORUS,
AREA MEDIAN
PALATAL
RAPHE
,FOVEA
PALATINI.
 Primary stress bearing area -
Areas which are able to resist the vertical forces of
occlusion.

Maxilla

Firm tuberosities

Slopes of the
hard palate on
either side of
palatal raphae
 Secondary Stress Bearing Areas -

Areas that resist the lateral forces of occlusion

and can aid the resistance to the vertical forces.

Maxilla

Alveolar ridge

Rugae area
 Relief Areas -
That portion of the denture which is relieved to
eliminate excessive pressure on specific parts of the
denture supporting tissues.

Maxilla
Incisive papilla

Mid palatine
raphe

Torus palatinus

Sharp bony
prominences

Fovea
palatinae
 Supporting Areas -

•Alveolar ridge (Residual ridge)

•Hard palate
•Incisive papilla
•Palatal rugae
•Median raphe
•Maxillary tuberosity
•Fovea palatinae
 Peripheral / Limiting Areas -

•Labial frenum
•Labial sulcus
•Buccal frenum
•Buccal sulcus
•Distobuccal space
•Hamular notch
•Posterior palatal seal area
Correlation of anatomical landmarks -
No Landmark on mouth Landmark in
. impression
1 Labial frenum Labial notch
2 Labial vestibule Labial flange
3 Buccal frenum Buccal notch
4 Buccal vestibule Buccal flange
5 Coronoid bulge Coronoid
contour
6 Residual alveolar Alveolar groove
ridge
7 Maxillary tuberosity Maxillary
tubercular fossa
8 Hamular notch Pterigomaxillary
seal
9 Posterior palatal seal Posterior palatal
region seal
10 Foveae palatinae Foveae palatinae
11 Median palatine Median palatine
raphae groove
12 Incisive papilla Incisive fossa
13 Rugae region rugae
14 Displacable soft & Butterfly outline
hard palate of pps
 Mucous Membrane -
Mucosa - Submucosa -
Formed by stratified squamous Composed of connective tissue that
epithelium and a subjacent narrow varies from dense to loose areolar
layer of connective tissue is present tissue.
called as lamina propria.

In edentulous people – mucosa Thickness varies and may contain

covering hard palate + crest of residual glandular, fat or muscle cells and
ridge + residual attached gingiva = transmits the blood and nerve supply
Masticatory Mucosa. to the mucosa.

Characterized by well defined Attachment occurs between

keratinized layer on the outermost submucosa and periosteal covering of
surface. the bone and it makes the bulk of the
mucous membrane.
Mucous Membrane -

Oral Mucous Membrane

Alveolar Ridge (Residual Ridge) -

The residual ridge is the remnant of the alveolar

process which originally contained sockets for
natural teeth.

After natural teeth are extracted, the alveolar ridge

can be expected to get smaller (resorb).

The rate of resorption varies considerably from

person to person.
 Histology of the mucous
membrane covering the
crest of the residual ridge

• The submucosal layer is

submucosa sufficiently thick to provide
resiliency for support of
complete denture
• The bone covering the crest
of the upper ridge is often
compact.
• Thus the crest is the primary
stress bearing area.
 Hard Palate -

•The hard palate is made up of the anterior two-

thirds of the palatal vault supported by bone
(palatine processes of the maxillae and the
horizontal plates of the palatine bones).
• The palatine process are joined together at the
medial suture.
CONFIGURATION OF HARD PALATE :- Hard palate has
been classified by various authors :
Nichols - Tapering
Square
Arched /flat
Heartwell ,Elinger Shay - based on different slopes
V- shaped Flat
U-shaped High
Medium
 Gland
Adipose tissue
tissue

Anterolateral part of the hard Posterolateral part of the hard

palate, with abundant adipose palate, with abundant gland
tissue tissue
 Incisive Papillae -

•It is a pad of fibrous connective tissue overlying

the orifice of the nasopalatine canal.

Significance :
1. Stable landmark and gives its relation to
incisive foramen through which the
neurovascular bundle emerge and lie on the
surface of bone.
2. It is a biometric guide giving information on
positional relation to central incisors which are
about 8-10 mm anterior to incisive papilla.

3. Biometric guide which gives us

information about location of maxillary canines
(A perpendicular drawn posterior to the centre of
incisive papilla to sagittal plane passes through
canines).
Clinical Consideration : During final
impression procedure, care should be taken not
to compress the papilla. Hence the incisive
papilla should be relieved with a spacer.
Reason :
a. Compression of blood vessels obliteration
of the lumen  deprive nutrition to tissues 
breakdown of tissues.
b. Pressure on nerve causes parasthesia in the
region of upper lip.
 N. P. nerve and
vessles

Nassopalatine nerve and vessels in

submucosa layer
 Palatal Rugae -

• They are raised areas of dense connective tissue

radiating from the median suture in the anterior
1/3rd of the palate.
•It is seconadary stress bearing area.

Significance :
1.Said to be concerned with phonetics.
2.Increase the surface area of the foundation
and thus supplement the values of retention.
3.It is the denture stabilizing area in the
maxillary foundation.
 Mid palatine suture -
•It is the area extending from the incisive papilla to
the distal end of the hard palate.

Significance :

1.Area of sutural joint and covered with firmly

adherent mucous membrane to the underlying
bone with little submucosal tissue.
2.This sutural joint is formed by the median
fusion of two maxillary processes and two
horizontal plates of palatine bone.
3. Function of sutural joint is growth and
sometimes there will be overgrowth of the bone
at the sutural joint resulting in torus palatinus.

Clinical Considerations : During final

impression procedure this raphe is relieved in
order to create an equilibrium between the
resilient and non resilient tissues.
 Thin
submucosa

h/p of mid palatal suture showing

thin submucosal layer
 Hamular Notch -

•It is a narrow cleft of loose areolar tissue which is

approximately 2mm in extent antero-posteriorly.
•It is situated between the distal surface of the
tuberosity and the hamulus of medial pterygoid plate.
•Located by using T-burnisher.

Significance :
•Constitutes the lateral boundary of posterior
palatal seal area in maxillary foundation.
•The pterygomandibular raphe attaches to hamulus.
Clinical Consideration :
1.Denture should not extend beyond the
hamular notch, failure of which will result in :
a.Restricted pterygomandibular raphe
movement.
b.When mouth is wide open the denture
dislodges.
 Maxillary Tuberosity -

•It is the distal most part of the residual alveolar

ridge and presents the hard tissue landmarks.
•They are primary stress bearing area.
Significance : The last posterior tooth should not
be placed on the tuberosity.
Clinical Significance :
•Often there is lateral and vertical growth of
tuberosity and the area assumes importance when
maxillary antrum extends laterally with undercuts at
the tuberosity region.
•It is important to prevent oro-antral fistula so
it is important to have radiograph before
resection of the tuberosity.
•It can be used for the retention of the denture.
 Fovea Palatine -

•They are the remnants of ducts of coalescence.

•Usually two in number on either side of the midline.
•They indicate the vicinity of posterior palatine seal
area.
• Its position also influences the position of the
posterior border of the denture.
•Denture can extend 1-2 mm across it.
•In patients with thick saliva, the fovea palatine
should be left uncovered or else thick saliva flows
between the tissue and increase the hydrostatic
pressure and hence lead to denture displacement.
Peripheral
/ Limiting
areas
 Labial Frenum -

•It appears as a fold of mucous membrane

extending from the mucous lining of the lip to
the crest of residual ridge on the labial surface.
•It may be single .
•It may be narrow / broad.
•It contains no muscle fibers of significance.
•It starts superiorly as a fan shape and converges
as it descends to its terminal attachment on the
labial side of the ridge.
Clinical Consideration :
1.Sufficient relief should be given during final
impression procedure and in completed
prosthesis because overriding of function of
frenum will cause pain and dislodgement of
denture.
2.During impression procedure the lip should be
stretched horizontal outwards for the proper
recording of frenum.
3.If frenum is attached close to the crest
frenectomy is done, failure of which will lead to
the denture border being placed on the bone
tissue which will cause decreased border seal.
 Labial Vestibule -
•It extends on both sides of the midline from labial
frenum anteriorly to the buccal frenum posteriorly.
•It is bounded laterally by the labial mucosa,
medially by maxillary residual alveolar ridge.
•It is lined by linig mucosa.
•Reflection of the mucous membrane superiorly
reflects the height. The area of mucous membrane
reflection has no muscle.
Clinical Consideration :
For effective border contact between denture and
tissue, vestibule should be completely filled with
impression material.
 Buccal Frenum -

•Fold or folds of mucous membrane extending from

mucous membrane reflection area to the slope or
crest of residual alveolar ridge.
•It forms the dividing line between the labial and the
buccal vestibule.
Significance :
•LEVATOR ANGULIORIS (CANINUS MUSCLE) lies
beneath it and affect position of frenum.
•ORBICULARIS ORIS muscle pulls frenum forward.
•BUCCINATOR MUSCLE pulls frenum backword.
Clinical Consideration:

1.During final impression procedure and in

final prosthesis sufficient relief should be
given for the movement of frenum because
over-riding of function of frenum will cause
pain and dislodgement of denture.

2.During impression procedure the cheek

should be reflected laterally and posteriorly.

3.If frenum is attached close to the crest of

alveolar ridge, frenectomy is called for.
 Buccal Vestibule -

Boundaries :

• It is bounded anteriorly by the buccal frenum,

laterally by the buccal mucosa and medially by
residual alveolar ridge.
•Size of vestibule varies with contraction of
BUCCINATOR MUSCLE, POSITION OF
MANDIBLE , AND AMOUNT OF BONE LOSS
FROM MAXILLA.
Clinical Consideration :

1.During impression procedure the vestibule

should be completely filled with impression
material for proper border contact between
denture and tissues.

2.When the vestibular space that is distal and

lateral to the alveolar tubercles is properly filled
with denture flange the stability and retention of
the maxillary denture is greatly enhanced.
3.The buccal flange borders depend upon
movement of ramus of mandible at the distal end
of buccal vestibule and hence the patient should
move the mandible laterally and protrusively to
make sure the mandible does not interfere with
these functions.

4.To effectively record the maxillary buccal sulcus

the mouth should be half way closed because wide
opening of the mouth narrows the space and does
not allow proper contouring of sulcus because the
coronoid process of mandible comes closer to the
sulcus.
N. S. Arbree, D.D.S.,* A. A. Yurkstas, D.M.D., M.S.,** and J. H. Kronman, D.D.S., Ph.D.***
Tufts University, School of Dental Medicine, Boston, Mass

Also known as
 Buccal space or vestibule,
 Buccal pocket,
 Tuberosity sulcus,
 Distobuccal angle of the buccal vestibule,
 Buccal sulcus
 Buccal pouch,
 Buccal mucous membrane reflection region
 Postmalar area
 The coronomaxillary space: Literature
review and anatomic description
 The coronomaxillary space is that anatomic region that lies
medial to the coronoid process and lateral to the maxillary
tuberosity.

 It is bounded
anteriorly -by the base of the zygomatic process.
posterior boundary-pterygomaxillary or hamular notch
inferior boundary - crest of the residual ridge.

 The coronomaxillary flange of the maxillary denture is that

portion of the buccal flange that extends from the
zygomatic eminence to the hamular notch
Muscular influence

Muscles affecting distobuccal space

interaction b/w buccinator& masseter
Superior constrictor of pharynx
Medial pterygoid muscle , temporalis muscle
Pterygomandibular raphae
 The coronoid process may be relatively straight
or vertical in some individuals . For these
patients opening of the mandible can result in
narrowing of the space.
 In some individuals, however, the coronoid
process appears to flare laterally at its height
With a stronger temporal muscle insertion, this
flare can be increased.
 If the individual with a lateral flare of the
coronoid process is observed during opening,
the space often remains the same or becomes
wider.
 Various studies demonstrates alteration in
coronomaxillary space on wide opening of mouth, and
some says no change in opening.
 If the coronomaxillary space broadens or remains the
same size on opening , the functional filling of this
space with the denture flange becomes important.”
 If the space is not completely filled or even slightly
overfilled,‘,’ maximum retention may be lost.
 In this instance it is advisable not to have the patient
open wide, protrude, or move laterally during border
molding or impression procedures.“,’
 A gentle molding of the region by pulling the cheek
out, down, and in will be more successful
 Posterior Palatal Seal Area -

•It is also called as Post dam, Post palatal seal .

•Defined as – The soft tissue area at or beyond the junction

of the hard and soft palates on which pressure, within
physiologic limits, can be applied by a denture to aid in its
retention. (GPT -7)

•Hardy and Kapur stated that retention and stability that

is achieved from adhesion ,cohesion and interfacial surface
tension are able to resist those dislodging forces that are
perpendicular to the denture base.
Horizontal and lateral torquing of the maxillary denture
can be resisted only by adequate border seal.
• Boundaries of posterior palatal seal area –
i. Anteriorly – Anterior vibrating line
ii. Posteriorly - Posterior vibrating line
iii. Laterally – Pterygomaxillary notch
 Anterior Vibrating line –

• An imaginary line located at the junction of the

attached tissues overlying the hard palate and the movable
tissues of the immediately adjacent hard palate.

•Shape – bow shaped anteriorly, sometimes referred to as

“Cupid’s Bow”.

•Located by –
a) Valsalva Maneuver - Both the nostrils are held firmly
while the patient blows gently through the nose. This
positions the soft palate downwards at its junction with
the hard palate.
b) Patient is asked to say “ah” with short vigorous bursts.
.
 Posterior vibrating line –

• An imaginary line at the junction of the

aponeurosis of the tensor veli palatini and the
muscular portion of the soft palate.

• Located by - it can be visualised when the

patient says “ah” in a normal un exaggerated
fashion
Significance :

1) It maintains contact of denture with soft tissue during

functional movements of stomatognathic system
(mastication, deglutition and phonation etc.)

2) Decreases gag reflex.

3) Decreases food accumulation with adequate tissue

compressibility.

4) Decrease patient discomfort of tongue with posterior

part of denture
5) Compensation of volumetric shrinkage that occurs
during the polymerization of PMMA.

6) Permits normal movement of muscles and

ligaments.

7) Increases retention and stability by creating a

partial vacuum.

8) Increased strength of maxillary denture base.

 Classification of PPS based on
soft palate configuration
(BERNARD LEVIN)-
 Class I:- Greater than 5 mm
of movable tissue available
for post damming. It is the
ideal for retention. Usually
thin denture base is
advisable.
 Class II: - 1-5 mm of movable
tissue available for post
damming, good retention is
usually possible. A medium
thickness of denture base is
quite adequate.
 FACTORS INFLUENCING PPS
The accuracy of PPS reproduction in complete
denture depends on various factors :-

 Configuration of hard palate.

 Investing medium
 Factors involved in processing of acrylic resin.
 Denture base thickness.
 Head position
 Methods to record pps

 PPS determination methods can be broadly categorized

based on stage of denture construction as follows:
 PPS determination in final impression stage.
 PPS determination or designing on master cast.

 Recording PPS in Secondary Impression

Appointment Stage
 Determining PPS on Master Cast
1. Boucher's Technique
2. Bernard Levin's Technique
3. Swenson's Technique
4. Calomeni, Feldman,Kuebker's Technique
5. Pound's Technique
6. Apple Baum
7. Winkler's Technique
8. Silverman's Technique
9. Hardy and Kapur Technique
 Conclusion -

•The basic goal of a successful complete denture therapy is

reaching the patients expectations in fulfillment of better
masticatory ability, unaltered speech and a better esthetics.

•Extensions of the borders to get a good seal facilitates the

clinician to obtain the compromised treatment approach.
The clinician should have the anatomical knowledge to
fabricate prosthesis which inturn aids in proper
maintenance of stomatognathic system.
•The knowledge of oral anatomy, microscopic as well as
macroscopic better equips us as prosthodontists to -

i. Decide how to make the impression.

ii. What material to use?

iii. How to plan the treatment?

•All this will result in a successful prosthetic treatment

1. Zarb,Bolender,Carlson – Boucher’s prosthodontic treatment for
edentulous patients,12th edition

1974
2. Sharry J.J. – Complete denture prosthodontics;ed.3.New York,

3.Heartwell Charles – syllabus for complete dentures Ed.4,Philadelphia

4 .Sheldon Winkler – Essentials of complete denture Prosthodontics,ed.2

5. O Boucher – Swenson’s complete denture Prosthodontics,ed.6

11.Benard Lynn,Detriot,Mich – Significance of anatomic landmarks in
complete denture service,JPD,1964,14:456-459

12.H.R.Kolb-Variable denture limiting structures of the

edentulous mouth,Part 1 ,maxillary border areas,JPD 1966,16:194-204
13.Colie H Millsap-The posterior palatal seal area for complete denture.
DCNA,Nov.1964,663
14’.Nallaswamy-Textbook of prosthodontics,ed. 1

15.Inderbir Singh-Textbook of human histology with colour atlas,ed.3

16.Elinger-synopsis of complete denture prosthodontics,ed.1

17.Orban-Oral histology & embryology,ed.10

18.N. S. Arbree, D.D.S.,* A. A. Yurkstas, D.M.D., M.S.,** and J. H. Kronman, D.D.S.,

Ph.D.***Tufts University, School of Dental Medicine, Boston, Mass