Review

A Review On Posterior Palatal Seal

Sudhakara V Maller 1, Karthik. K. S. 2
- Professor & Head Of The Department Of Prosthodontics, Ksr Institute Of Dental Science And Research, Tiruchengode. - Senior Lecturer, Department Of Prosthodontics, Ksr Institute Of Dental Science And Research, Tiruchengode. Address for correspondence : Sudhakara V Maller, Department Of Prosthodontics KSR Institute Of Dental Science And Research, KSR Kalvinagar, Tiruchengode, Namakkal Dist- 637215. Phone Number: 9443051313. E- Mail Id: drmallers@in.com
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Abstract: Recording and replicating the extent of posterior palatal seal and its borders is one of the most important steps in successful treatment of the edentulous patients. Recording of the anterior and posterior vibrating lines determines the posterior most extent of the denture and proper incorporation of post-dam in the edentulous maxillary denture. Incorporation of this post-dam reproduces exact seal in the maxillary denture for proper retention. The aim of this article is to provide some background about the importance of recording posterior palatal seal and methods of recording posterior palatal seal for retentive longevity of complete denture prosthesis treatment. Keywords: Posterior Palatal Seal, Vibrating Lines, Denture Retention

Introduction: Complete dentures may suffer from a lack of proper border extension, but none are more important than the posterior limit and the posterior palatal seal on maxillary complete dentures. The posterior border is terminated on a surface that continues and is movable in varying degrees and not at a turn of tissue as are the other denture borders. Deficiencies of the distal border may be in the length of the denture base, or the depth of the posterior palatal seal or both. These errors may lead to inadequate retention, due to the lack of peripheral seal8. So it is important to discuss the factors associated with complete denture retention, the importance of the posterior palatal seal, its location, design, placement and influence on processing. Posterior palatal seal is described as the soft tissues along the junction of hard and soft palate on which pressure with in physiologic limits of the tissues can be applied by a denture to aid in retention of the denture. (GPT) Historical review 1883: Ames and the Greene brothers introduced atmospheric pressure as a means of denture retention and recommended the use of functional denture borders as opposed to passive borders in the fabrication of complete dentures. 1886: Wilson described adhesion as the primary determinant in denture retention. 1907: Green brothers "Modeling compound"

1920: Hall revived interest in the use of atmospheric pressure as a retentive factor by interpreting and demonstrating the functional denture borders. 1948: Stanitz used a lab model to suggest that atmospheric pressure is in equilibrium with fluid pressure exerted on molecules within a capillary tube with a liquid level in a container as well as the attraction of two glass slabs. These models explained how fluid film contributed to denture retention. 1951: Craddock described the gripping action of the buccinator muscle on the buccal flange of the mandibular denture and also coined the term "pear shaped pad". 1962: Stamoulis believed that atmospheric pressure combined with intimate tissue contact and peripheral 1 seal comprise the most critical retentive forces . Retention is the resistance in the movement of a denture away from its tissue foundation especially in a vertical direction. A quality of a denture that holds it to the tissue foundation and /or abutment teeth. GPT-7. 1964: Fish discussed determinants of retention and differentiated between tissue, polished, and occlusal surfaces and how each permits the dentist to incorporate mechanical, biologic, and physical factors of the denture retention. Determination of vibrating lines and adding of posterior palatal seal is observed as an important steps in retention of maxillary dentures. Vibrating lines lies at the junction of soft palate and the hard palate. Soft palate is a movable, muscular fold, suspended from the posterior border of
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A Review On Posterior Palatal Seal

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the hard palate. It separates the nasopharynx from oropharynx. Vibrating lines are imaginary lines across the posterior part of the palate, marking the division between the movable and immovable tissues of soft palate. This can be identified when the movable tissues are in function. The anatomic structures the help in recording of these vibrating lines are palatine aponeurosis, hamular process, median palatal raphe, fovea palatini, Posterior palatal seal: it is a seal area at the posterior border of maxillary denture. It can be divided into 2 areas pterygomaxillary seal, Post 3 palatal seal Pterygomaxillary: seal extends through pterygomaxillary notch continuing 3-4mm anterolaterally, approximating the mucogingival junction. It occupies entire width of hamular notch (loose connective tissue lying between pterygoid hamulus of the sphenoid bone and distal portion of maxillary tuberosity). The notch is covered by pterygomaxillary fold (extend from posterior aspect of tuberosity to pad). This fold influences the posterior border seal if mouth is wide open during final impression procedure. Post palatal seal: is an area between anterior and posterior vibrating line found medially from one tuberosity to other. It appears to be a cupids bow. VIBRATING LINES: These are imaginary lines which delineate the PPS. There are two vibrating lines, Anterior vibrating line Posterior vibrating line ANTERIOR VIBRATING LINE:- It demarcates zone of transition between no movement of the tissue overlying hard palate and some movement of the tissue of the soft palate. It serves as an anterior border of PP'S. It extends laterally into pterygomaxillary notch . It always occurs in soft palate. Methods of eliciting anterior vibrating line:Valsalva manouevre ask patient to blow air gently through nose with nostrils closed with fingers. Ask patient to say 'ah' with short vigourous bursts. POSTERIOR VIBRATING LINE:- Imaginary line at the junction of the aponeurosis of the tensor veli

palatini muscle and the muscular portion of the soft palate. It demarcates the part of soft palate that has limited /shallow movement during function (quivers) and the remainder of soft palate that is markedly displaced during functional movements. It is elicited by asking the patient to say 'ah' in short bursts in a normal, unexaggerated fashion. Posterior vibrating line marks the most distal extension of denture base. RATIONALE AND IMPORTANCE OF POSTERIOR 4 PALATAL SEAL Addition of PPS transforms a base with adhesive retention into very stable base with resistance to horizontal forces. It forms a partial vacuum when subjected to force and enhance retention and stability. The partial vacuum created does not damage oral structures and lasts for a very short duration. Care should be taken not to give excessive border seal as it occurs with over scrapping .Adequate distal extension of denture base within physiologic limit helps in increasing surface area coverage. IMPORTANCE AND FUNCTIONS OF PPS 1. It maintains contact of denture with soft tissue during functional movements of stomatognathic system, by which it decreases gag reflex. 2. Decreases food accumulation with adequate tissue compressibility. 3. Decrease patient discomfort of tongue with posterior part of denture. 4. Compensation of volumetric shrinkage that occurs during the polymerization of PMMA 5. Increases retention and stability by creating partial vacuum. 6. Increased strength of maxillary denture base. III. Designs of the posterior palatal seal The most common Posterior palatal seal configuration described by Winland and Young. 1. A bead posterior palatal seal 2. A double bead posterior palatal seal 3. A butterfly posterior palatal seal 4. A butterfly posterior palatal seal with a bead on the posterior limit 5. A butterfly posterior palatal seal with the hamular notch area cut to half the depth of a #9 bur 6. A posterior palatal seal constructed in reference to House's classification of palatal forms; PARAMETERS OF PPS PPS has specific characteristics with different 2, 5, 6 parameters :
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A Review On Posterior Palatal Seal

Sudhakara Maller & Karthik

1. Size. 2. Shape 3. Location 4. Displacibility. 1) Size Silverman performed a study on 92 patients evaluating the PPS clinically radiographically, histologically and found the following findings:The greatest mean anteroposterior width of PPS is 8.0 mm (with 5-12 mm of range). The mean width was found to be different for right (8.2mm) and left side (8. l mm). The interhamular notch was found to be 35.8 mm (25-48mm range) The interhamular notch distance was found to be different for males (37.1 mm) and females (35.6 mm) 2] Shape Class I a butterfly shaped pps with 3 - 4 mm width. Class II- pps is narrow with 2 3 mm of width. Class III a single beading made on the posterior vibrating line 3] Location Location of PPS is not consistent and show lot of variation, but on an average anterior vibrating line is 1.31 mm distal to fovea palatini . 4] Displacement /Compressibility Lot of variation has been found within the PPS. But low compressibility has been observed in midpalatal raphe and hamular notch region. High compressibility has been in the lateral part of cupids bow. It's variation depends on the form of palatal vault: Class I_palate - shallow PPS Class II palate - medium PPS Class III palate - deep PPS 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. Configuration of hard palate2,5: Hard palate has been classified by Various authors : Nicholas Tapering, Square, Arched /flat Heartwell, Elinger, Sharry - based on different slopes, Flat High Medium

Curing method: the cause of dimensional change of 9 pps are : Polymerization shrinkage [8 %] Linear shrinkage during cooling [0.44 %] DENTURE BASE THICKNESS: - the effect of thickness of denture base on pps has been interpreted with contradictory statements:B. LEVIN - advices use of thin denture base for class I soft palate ( pps is not deep but wide) and thicker denture bases for class III soft palate ( pps is deep but not wide) ,medium thickness for class II soft palate . Effect of head position on pps : The maximum depression (downward and forward position) of the soft palate when FH plane is 30 degrees to the horizontal plane and tongue is firmly positioned against mandibular anterior teeth. A properly positioned maxillary tray handle can serve as substitute for missing incisors. At no time the patient should protrude the tongue beyond the approximated position of the incisal edges as this will fore-hasten the posterior border on the final impression. The head and tongue translates the mandible anteriorly. The soft palate will be brought downward and forward due to indirect attachments of mandible and insertion of palatoglossus muscle into the side of the tongue. Flexion of the head also contributes to moving excess impression material and saliva out of the mouth, rather than progressing down the pharynx, while maintaining the 30 flexion of the head and anterior tongue position. The patient is asked to rotate the head so that all functional positions of the soft palate are recorded. Different methods of recording PPS: 1) Conventional method. 2) Fluid wax technique. 3) Arbitrary scraping. I) CONVENTIONAL APPROACHSilverman: Ask patient to have astringent mouthwash to remove stringy saliva and keep his head upright. Dry the pps area with gauze and palpate for the hamular notch using a T burnisher / mouth mirror. Mark them with an indelible pencil or note visually to ensure that they are not covered by the denture. T-burnisher is passed along posterior angle of maxillary tuberosity until it drops into the pterygomaxillary notch. Extend the mark from the pterygomaxillary notch 3-4mm antero-lateral to the maxillary tuberosity, approximating the mucogingival
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A Review On Posterior Palatal Seal

Sudhakara Maller & Karthik

junction . This completes marking of pterygomaxillary seal. Ask patient to say 'ah in short bursts in an unexaggerated fashion. Observe movements of soft palate and mark posterior vibrating line and then connect it to the pterygomaxilliary seal. Advice patient not to close mouth to prevent smudging of markings. The resin /shellac tray is then inserted into the mouth and seated firmly into place. Upon removal from the mouth, the indelible lines should be transferred on the tray. The tray is then returned to the master cast to complete the transfer of the posterior extension. Mark anterior vibrating line using a) T-burnisher (by checking the compressibility, in width and depth) - usually termination of glandular tissue coincides with anterior vibrating line. b) Valsalva maneuver: - place special tray inside the mouth and get the markings on the tray which is later transferred to the master cast. The area of cast before the anterior and posterior vibrating lines is usually narrow in midpalatal region due to the presence of posterior nasal spines. Master cast is scored using a Kinsley scraper. Deepest area of seal is located on either side of midline (l/3rd distance anteriorly from posterior vibrating line). It is scraped approximately 1.0 1.5mm. The tissue covering the median palatal raphe has little sub-mucosa and cannot withstand the same compressive forces as the tissues lateral to it. The area is scraped to the depth of approximately 0.5-1.0mm. Within the out line of the cupids bow, the cast is scraped to a depth of about half the amount to which the palatal tissues in the area can be compressed, being tapered progressively shallower anteriorly until it feathers out in the area of the anterior vibrating line. Then add additional amount of resin on tray over scraped area and try in patient's mouth by asking him to say 'ah', and then check for any gap between tray and soft palate. If gap is found then repeat scraping till adequate seal is attained. Advantage: 1. Highly retentive trial bases make recording jaw relations easier and precise. 2. Give psychological confidence to patient that retention will not be a problem in complete denture. 3. Dentist is able to determine the retention of final denture. 4. Patient will be able to realize the posterior extent of denture, which may ease the adaptation period.

Disadvantages: 1. Not a physiological technique and therefore depends upon accurate transfer of vibrating line and careful scrapping. 2. Potential for over compression is more. II) FLUID WAX TECHNIQUE: Start with locating and transfer of anterior and posterior vibrating line similar to conventional approach. Then with markings made, final impression is made using ZOE/impression plaster (not with elastomeric impression material as they are resilient, non adherent to wax and distort wax when reseated into oral cavity). Impression waxes used are: a] IOWA wax (white)- Dr.Earl. S. Smith. b] KORECTA wax no.4 (orange)- Dr. O. C. Applegate c] K.I physiologic paste (yellow - white) Dr. C.S Howkins. d] Adaptol (green) Dr.Nathen G. Kyne. The melted wax is painted into the impression surface (within the outline of the seal area). The wax is applied slightly in excess of the estimated depth and allowed to cool below mouth temperature to increase its consistency and make it more resistant to flow. This impression is carried to the mouth and held in place under gentle pressure for 4-6 min allowing time for the material to flow. Head position is critical (the FH plane to be at 30 to the horizontal plane) After 4 min remove impression tray and trim excess (or) if no tissue contact is established then add and redo the procedure. Ask the patient not to rinse with cold water, between the procedure (contraction of tissues and act to decrease flow properties of wax). Examine the surface morphology of wax at anterior vibrating line. It should be a brief edge, if a step is found this indicates poor flow of material. Advantages: 1. It is physiologic technique of displacing tissues. b) No over compression of tissues. c) PPS is incorporated into trial denture base for added retention. d) No mechanical scraping of cast. Disadvantage: a) Time consuming. b) Cumbersome procedure. - Difficulty in handling material and additional care to be taken during boxing procedure.
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A Review On Posterior Palatal Seal

Sudhakara Maller & Karthik

III) ARBITRARY SCRAPING:Winkler- Arbitrarily mark anterior and posterior vibrating line and scrape about 1- 1.5mm. It is the least accurate method used to mark the PPS. There is a high potential for over post-damming as it is a non physiologic technique of recording. Light bodied elastomers have also been used to record the pps along with putty impression procedures. WHEN TO RECORD PPS: There are two schools of thought as to when to record pps. a) Before try in - provide the patient with psychological confidence b) After try in - prevent displacement of occlusal rim in posterior region leading to occlusal error in 2nd molar region due to improper seating of bases during jaw relation. PROBLEMS WITH PPS11: 1. Under-extension of denture:It is the most common cause of seal failure and mainly occurs due to use of fovea palatinea as a guideline for marking anterior and posterior vibrating line. By doing so 4 - 12 mm of tissue coverage loss occur leading to decreased retention. 2. Over extension: It mainly occurs due to over extension of denture base by dentist for increased retention causing physiological violation of soft palate musculature. It mainly shows with symptoms of: A] Mucosal ulcerations B] Physiological violation of soft palate musculature. C] Sharp pain if pterygoid hamulus is covered. D] Painful swallowing. It can be managed by selectively relieving the pressure areas and decrease the distal length. 3. Under post-damming: mainly occurs due to Due to improper depth of post-damming, Use of improper technique Recording PPS in a wide open position -causes toughening of pterygomandibular ligament which shorten the pterygomaxillary seal. It can be diagnosed using 2 tests:Seat dentures in patient's mouth and ask patient to say 'ah', and with mouth mirror view for any gap. Place wet denture base and press slowly in midpalatal region and bubbles escaping at any point on distal denture border indicates area of under post damming.

4. Over post-damming:Commonly occurs due to aggressive scraping of cast. If it occurs in Pterygomaxillary seal the denture is displaced downward. If moderate post-damming is present then mild irritation is found. It can be overcome by selectively relieving denture border with a carbide bur, followed by light pumicing. Addition of pps to existing denture:Existing denture may have poor length and depth of PPS. Properly examine existing dentures. If there are other problems in the dentures (vertical dimension, centric, esthetics etc.) then new dentures are to be made. If only PPS is short then correction should be undertaken. Different authors using different materials have advised various techniques, 1) Heat cure material. 2) Self cure acrylic resin. 3) Light cure resin. Summary: The placement of the correct posterior palatal seal is not a difficult procedure once the anatomy and physiology of the area are understood. Careful examination during the diagnostic phase of the treatment can alleviate many potential problems. Following established techniques for the placement of the border seal will ensure a more retentive prosthesis for the patient, whose satisfaction is the main concern of the prosthodontist.
References: 1. Blahoua, Z. and Neuman, M. Physical Factors in the Retention of Dentures. J Prosthet Dent 1971.25: 30-5. Nikoukari, H. A study of posterior palatal seals with varying palatal forms. J Prosthet Dent 1975.34: 605-613. Sidney I Silverman, DDS. Dimensions and displacement patterns of the posterior palatal seal. J Prosthet Dent 1971.25:470-488. Hardy, I.R. and Kapur, K.K. Posterior border seal - Its rationale and importance. J Prosthet Dent 1958.8:386-397. Stephen Galzier, BS, David N Firtell, DDS, MA, and Larry L Harmon, DDS. Posterior peripheral seal distortion related to height of maxillary ridge. J Prosthet Dent 1980.43:508-510. W i n l a n d , R D a n d Yo u n g J M . M a x i l l a r y complete denture posterior palatal seal: Va r i a t i o n s i n s i z e , s h a p e a n d l o c a t i o n . J. Prosthet Dent 1973.29:256-261. Avant, W. E. A comparison of complete denture bases having different types of posterior palatal seal. J Prosthet Dent 1973.29:484-493.
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A Review On Posterior Palatal Seal

Sudhakara Maller & Karthik

Chen, M. Reliability of the Fovea Palatini for Determining the Posterior Border of the Maxillary Denture. J Prosthet Dent 1980.43:133-137. 9. Firtell, D. et al. Posterior Palatal Seal Distortion Related to Processing Temperature. J Prosthet Dent 1981.45:598-601. 10. Barco MT, et al. The effect of relining on the accuracy and stability of maxillary complete dentures- An in vitro and in vivo study. J. Prosthet Dent 1979.42: 17-22.

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11. Sheldon Winkler. Essentials of complete denture prosthodontics, second edition. 12. George A. Zarb, Charles L. Bolender. Boucher's Prosthodontic Treatment for Edentulous Patients, tenth edition. 13. Alexander R. Halperin, Gerald N. Graser: Mastering the art of complete dentures. Quintessence Publishing Co., Inc. 1988.

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