Management of the mucolabial fold when

developing impressions for complete dentures

D. Ray h&Arthur, D.D.S., MS.*
University of North Carolina, School of Dentistry, Chapel Hill, N.C.
H istorically, much has been published in the litera-
ture about making final impressions for complete den-
tures and complete denture retention and stability.-
Jacobson and Krol- recently reviewed and added to
this information in a three-part article. The authors
maintain that a portion of the impression procedure
should receive further attention. The focus of this article
is the clinical management of the mucolabial fold during
impression procedures, and the border molded individu-
alized impression tray developed on preliminary casts is
the technique of choice.
PRELIMINARY IMPRESSIONS WITH
IRREVERSIBLE HYDROCOLLOID
IMPRESSION MATERIAL
If a stock impression tray is adequate in size, and
especially if the selected tray is too large, the dentist may
grossly distend and distort the mucolabial fold when the
preliminary impression of an edentulous arch is made.
The dentist should first gently distend the upper or
lower lip and visually examine the width of unattached
mucosa (Fig. 1). If the lip is further distended, there will
be a visual awareness of the movement of this band of
loose unattached nonkeratinized tissue on the anterior
labial portion of the residual ridge; in fact, the tissue lifts
from its underlying bony support. A grossly overex-
tended preliminary irreversible hydrocolloid impression
will also cause this to happen (Fig. 2). The effect is
similar for the anterior portion of either the maxillary or
the mandibular ridge. The dentist should be aware of
this when preliminary impressions are made and custom
impression trays are fabricated. For this discussion, the
maxillary ridge will be used to demonstrate the involved
principles.
BORDER MOLDING THE INDIVIDUALIZED
IMPRESSION TRAY
Several errors in technique can result in a distorted
mucolabial fold when border molding. It is assumed that
the individualized impression tray is properly made and
that it has corrected extensions.
*Associate Professor. Ilepartmcnt of Removable Prosrhdontics.
62
Vigorous manipulation of the lip
If the manipulation of the upper lip is too vigorous,
the border material will be displaced in an anterior-
inferior direction (Fig. 3). If the border material is
allowed to cool in this position, the mucolabial fold will
assume its natural configuration when the lip tension is
released (Fig. 4), while the molded border remains in its
displaced position. The result is an anterior form that
does not contact tissue on its superior and inner surfaces.
The subsequent fit and retention of the denture will be
compromised.
Overextended border molding
The mobile labial tissue lends itself to overextension
in the hands of the dentist who is unaware of the danger.
Improperly tempered border material may displace this
unattached tissue excessively (Fig. 5). Overextension
relates to patient complaints of fullness, soreness, and
lack of denture retention. When the overextension is
adjusted in the processed denture to better approximate
the normal mucolabial fold, the denture may not contact
soft tissue on its inner labial surface (Fig. 6).
Thick borders
The mobile labial tissue may lend itself to the
fabrication of a border roll that is much too thick in cross
section. The thickness can distort the mucolabial fold
(Fig. 7), and the patient will subsequently complain
about thickness in the anterior region of the processed
denture. When the dentist reduces the labial polished
surface (trying not to shorten the flange extension), the
tissue will be less distorted and return to its bony
support. When this occurs, the denture flange will be
short of its proper border extension (Fig. 8).
SUMMARY
All patients have loose nonkeratinized unattached
mucosa in the anterior labial vestibule. The degree of
possible distortion varies with each patient and with
different recording techniques. Some distortion is possi-
ble in all patients. Common errors made when manipu-
lating this tissue during impression procedures for
complete dentures have been described. An effort to
JANUARY 1985 VOLUME 53 NUMBER 1
MUCOLABIAL FOLD IN IMPRESSION-MAKING
Muco-lablal Fold
Unattached I Loose
nlerlor Residual Alveolar Ridge
Attached I Kemtinized Gingival Mucosa
Fig. 1. Cross-section of maxillary anterior edentulous ridge. Note band of unattached
loose mucosa and mucolabial fold and bony support for unattached loose mucosa.
Normal Mucc-labIaI Fol
Distoftod Yuco.labirl Fotd
(tissue lilted from bony su
ImpressIon Matwlrl
Attached I Kemlinizad Gingival Yucosa
stock lmpmsion Tmy
Fig. 2. Schematic drawing illustrates distorted mucolabial fold resulting from irrevers-
ible hydrocolloid preliminary impression. Note lifting of loose tissue from bony
support.
compensate for the errors in the finished denture will not
correct them. Manipulation of the mucolabial fold must
be done correctly during the border molding procedure.
If not, the only recourse may be to reline the denture,
and care should be taken not to repeat the errors.
REFERENCES
1. Boucher, C.: Complete denture impressions based on the anato-
my of the mouth. J Am Dent Assoc 31:1174, 1944.
2. Roberts, A. L.: Efforts of outline and form upon denture stability
and retention. Dent Clin North Am, July 1960, pp 293-303
THE JOURNAL OF PROSTHETIC DENTISTRY 63
McARTft L! ft
Womul Yucobbld Fold
Attached I Keratinbd ~tngiv~l &cm
Impression Tray
\
Fig. 3. Schematic drawing shows distorted mucolabial fold resulting from lip distension
during border molding.
,..-- --. .
Am ol Undwoxtwt8ion
Atta&od / Keratlnizod Qinghmt M-
i f
Fig. 4. When lip tension is released, mucolabial fold returns to more normal configura-
tion. Border molding is short of its proper extension.
64
JANUARY 1985 VOLUME 53 NUMBER I
MUCOLABIAL FOLD IN IMPRESSION-MAKING
Normal Wuco-labial Fold
Dislorted MucO-labial Fold
Over.sxtend& Border Moulding
Unallached I Loose Mucosa
Attached I Kemtinized Gingiral Mucosa
Fig. 5. Overextended border developed with bordering compound. Mucolabial fold has
been distorted.
peripheral
-labial Fold
Adjusted Paripheml Extension
Unaltached I LOOM Mucoss
Attached I Kerallnized Ginglval Mucosa
Fig. 6. Overextended denture adjusted to approximate mucolabial fold. Note that there
is no tissue contact of denture flange on its inner superior aspect.
THE JOURNAL OF PROSTHETIC DENTISTRY 65
McARTHUR
Fig. 7. Distorted mucolabial fold results from border that is too thick in cross section.
Area of Under-extension efter Adjus
Muco4abial Fold
Peripheral Extmsion Prior to Adjwtmenl
Adjusted Peripheral Extension
i-i,
i
Unattached I Loose Mucosa
j
Anterior Residual Alvaotar Ridge
Processad Maxillary Dantura Atlached I Keratinized Gingival Mwosa
Fig. 8. Denture flange reduced on its polished labial surface. Note resultant lack of
proper denture extension.
66
JANUARY 1985 VOLUME 53 NUMtlER 1
MUCOLABIAL FOLD IN IMPRESSION-MAKING
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Friedman, S.: Edentulous impression procedures for maximum
retention and stability. J PROSTHET DENT 7:14, 1957.
Lott, F., and Levin, B.: Flange technique: An automatic and
physiologic approach to increased retention, function, comfort,
and appearance of dentures. J PROSTHET DENT 16~394, 1966.
Fry, K.: The retention of complete dentures. Br Dent J 44:97,
1923.
Moses, C. H.: Physical considerations in impression making. J
PROSTHET DENT 3~449, 1953.
Howland, C. A.: The retention of artificial dentures. Dent Digest
27~159, 191.
Stamoulis, S.: Physical factors affecting the retention of complete
dentures. J PROSTHET DENT 12:857, 1962.
Brill, N.: Factors in the mechanism of full denture retention-A
discussion of selected papers. Dent Pratt (Bristol) l&9, 1967.
Stanitz, J. D.: An analysis of the part played by the fluid film in
denture retention. J Am Dent Assoc 32:445, 1948.
Snyder, F. C., Kimball, H. D., Bunch, W. B., and Beaton, J. H.:
Effect of reduced atmospheric pressure upon retention of den-
tures. J Am Dent Assoc 32~445, 1945.
Tyson, K. W.: Physical factors in retention of complete upper
dentures. J PROSTHET DENT 18~90, 1967.
Skinner, E. W., and Chung, P.: The effect of surface contact in
the retention of a denture. J PROSTHET DENT 1:229, 1951.
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Tilton, G. E.: The denture periphery. J PROWHET DENT 2:290,
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Lammie, G. A.: The retention of complete dentures. J Am Dent
Assoc 55:502, 1957.
Edwards, L. F., and Boucher, C. 0.: Anatomy of the mouth in
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Barone, J. V.: Physiologic complete denture impressions. J
PROSTHET DENT 13~800, 1963.
Jacobson, T. E., and Krol, A. J.: A contemporary review of the
factors involved in complete denture retention, stability and
support. Part I: Retention. J PROSTHET DENT 49:5, 1983.
Jacobson, T. E., and Krol, A. J.: A contemporary review of the
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Rqmnt reques1s to:
DR. D. RAY MCARTHUR
UNIVEKSITY OF NORTH CAROLINA
SCHOOL OF DENTISTRY 209 H
CHAPEL HILL, NC 27514
The ala-tragus line in complete denture
prosthodontics
F. W. van Niekerk, B.D.S., D.D.S.,* V. J. Miller, B.Ch.D., B.Sc., M.R.I.C., C.Chem.,* and
R. E. Bibby, B.M.Sc., B.D.S., M.M.Sc., M.Dent.**
University of the Western Cape, Faculty of Dentistry, Tygerberg, Republic of South Africa
M any methods have been used to establish the
occlusal plane in complete denture prosthodontics. How-
ever, no single method seems to be fully accepted.z2
Anteriorly, esthetic considerations help define the occlu-
sal plane, and posteriorly the tongue, retromolar pad,
and Stensons duct are considered.1-5 Some dentists bisect
the space between the residual ridges.6
The technique of using the ala-tragus line (Campers
line) to establish the occlusal plane is well docu-
mented.2,4~7- However, definitions of the ala-tragus line
cause confusion, because the exact points of reference do
not agree. For example, the Glossary of Prosthodontic
TermslO states that the ala-tragus line runs from the
inferior border of the ala of the nose to the superior
*Senior Lecturer, Prosthetic Department.
**Professor and Head, Orthodontic Department.
THE JOURNAL OF PROSTHETIC DENTISTRY
border of the tragus of the ear, while Spratley describes
it as running from the center of the ala to the center of
the tragus; and Ismail and Bowman2 define it as a line
that passes from the ala of the nose to the center of the
tragus of the external auditory meatus. The latter plane
proved unsatisfactory in our prosthetic clinic, because
the plane thus established often allowed insufficient
space to arrange the maxillary molar teeth. Therefore,
the posterior reference point was dropped to the inferior
border of the tragus (Fig. 1). This article concerns the
relationship of the newly defined ala-tragus line to an
occlusal plane established with criteria that ignore the
ala-tragus line during jaw registration procedures.
MATERIAL AND METHODS
Thirty-three sets of complete dentures were made
with criteria other than the ala-tragus line used to
67