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Fig. 1. Waxed anatomic model, A, and diagram, B, illustrate attachments and fiber
direction of mylohyoid muscle. C, Cross-sectional diagram of a mandibular denture
indicates relationship of lingual flange to underlying mylohyoid muscle. Posteriorly, as
a result of the more vertical fiber direction, flange may be extended more inferiorly than
anteriorly. Dotted lines represent an activated mylohyoid muscle.
Fig. 3. Tapered, round, and square ridges diagrammatically in cross section. Potential
for denture stability increases as a residual ridge becomes more square shaped.
dynamic seating and stabilizing action directed toward (Fig. 4). The maxillary buccal flange should incline
the prosthesis. laterally and superiorly. The mandibular buccal flange
The denture border must be extended to contact the should incline laterally and inferiorly, and its lingual
movable tissues. Optimal extension also enhances sta- flange should incline medially and inferiorly. Such
bility and support. The actions of the levator anguli inclinations will provide a favorable vertical component
oris (caninus), incisivus, depressor anguli oris (triangu- to any horizontally directed forces.
laris), mentalis, mylohyoid, and genioglossus muscles To direct a seating action on the mandibular den-
can lead to dislodging forces if the denture base does not ture, the tongue should rest against a lingual flange
provide freedom for these muscles to function. Proper inclined medially away from the mandible and some-
border or muscle molding prior to the final impression what concave (Fig. 5). The degree of inclination
ensures optimal border extension. depends on the balance of the muscular forces of the
The external surface should be developed to harmo- tongue as opposed to the mylohyoid and superior
nize with the associated functioning musculature of the constrictor muscles.5 Some authors recommend posteri-
tongue, lips, and cheeks. Fish4 believed that the con- or extension of the lingual flange to fill the retromylo-
tours of the polished surface provided the principal hyoid space to permit the base of the tongue to
factor governing complete denture stability. In 1933 he contribute to the neuromuscular control of the prosthe-
wrote that “it is not so widely understood that the sis.“’ Inclination of the lingual flange must be designed
actual shape of the whole of the buccal, labial, and to guide the tongue to rest over the flange and permit
lingual surfaces can wreck the stability of a den- any horizontal forces generated against the denture
ture just as completely as a bad impression or wrong base to be transmitted as seating forces.
bite.” In order to appreciate this principle, it is Generally, the buccal and labial flanges of the
necessary to understand the anatomy and function maxillary and mandibular dentures should be concave
of the muscles that comprise the tongue, lips, and to permit positive seating by the cheeks and lips (Fig.
cheeks. 6). The primary muscles of the lips and cheeks are the
orbicularis oris and buccinator muscles, respectively.
INFLUENCE OF OROFACIAL These muscles are active during speech, mastication,
MUSCULATURE and deglutition. The proper contour of the denture
The basic geometric design of denture bases should flanges permits the horizontally directed forces that
be triangular. In a frontal cross section, the maxillary occur during contraction of these muscles to be
and mandibular dentures should appear as two trian- transmitted as vertical forces tending to seat the
gles whose apexes correspond to the occlusal surface prosthesis.
Fig. 9. A, Mounted casts depict a severe skeletal Class III edentulous patient. B, To
minimize anterosuperior shunting of maxillary denture during function, posterior
occlusion must be developed beyond anteroposterior midline of denture-supporting
area to include line drawn across land area of cast. C, Completed wax-up demonstrates
necessary occlusal contacts.
degree teeth set on a curve may provide the desired First, lateral tilting forces directed against the teeth are
occlusal contacts while eliminating the interlocking of magnified as the plane is raised. Second, the mandibu-
opposing anatomic teeth. lar denture need:sto be controlled by the musculature of
The subject of occlusion is filled with widely diver- the tongue, lips, and cheeks. An elevated occlusal plane
gent opinions. As concluded by the International prevents the tongue from reaching over the food table
Prosthodontic Workshop of 1972: “More long-term into the buccal vestibule. This compromises stability
statistical investigations are necessary to compare the and makes control of the food bolus and denture more
various occlusal designs so that more definable guide- difficult. A raised mandibular occlusal plane is usually
lines may evolve.“” Until then, dentists must rely on present when the vertical dimension of occlusion is
clinical experience in selection of posterior tooth form increased excessively. Various anatomic landmarks,
and appropriate occlusal schemes. such as Stensen’s duct and retromolar pad, should be
used to determine an acceptable level of the occlusal
TOOTH POSITION AND OCCLUSAL PLANE plane. Bisecting the interridge distance improves the
Other considerations relating to the occlusal surface mechanical advantage of the mandibular denture; but,
include the position of the teeth and the level of the if excessive mandibular ridge resorption has occurred,
occlusal plane. Anterior and posterior teeth should be the occlusal plane would be too low since less resorp-
arranged as close as possible to the position once tion usually occurs on the maxillae.
occupied by the natural teeth, with only slight modifi-
RIDGE RELATIONSHIPS
cations made to improve leverages and esthetics.
The superior-inferior position of the occlusal plane A problem of stability is the offset ridge relations
is also a factor to be recognized. A mandibular occlusal seen in prognathic and retrognathic patients. Normal
plane that is too high can result in reduced stability. dental relationships of the artificial teeth set on ridges
that are in severe posterior crossbite can adversely 4. Fish, W. E.: Using the muscles to stabilize the full lower
affect stability. In complete dentures the normal tooth- denture. J Am Dent Assoc Zlh2163, 1933.
5. Roberts, A. L.: Principles of full denture impression making
to-tooth position may have to be altered to provide a and their application in practice. J PROSTHET DENT 1:213,
relationship that can enhance the stability. Weinberg2’ 1951.
recognizes the need to set teeth in crossbite when the 6. Roberts, A. L.: Effects of outline and form upon dental
ridges are in a severe crossbite relation. stability. Dent Clin North Am, July 1960, pp 293-303.
7. Edwards, L. F., and Boucher, C. 0.: Anatomy of the mouth in
The Class III patient frequently displays a lower
relation to complete dentures. J Am Dent Assoc 29331,
arch anterior to the upper arch in centric relation. 1942.
Sufficient mandibular posterior occlusion must be 8. Shanahan, T. E. J.: Stabilizing lower dentures on unfavorable
developed so that contact against the maxillary denture ridges. J PROSTHET DENT 12~420, 1962.
extends posteriorly more than half the distance from 9. Lundquist, D. 0.: An electromyographic analysis of the
function of the buccinator muscle as an aid to denture retention
the incisive papilla to the hamular notch (Fig. 9).
and stabilization. J PROSTHET DENT 9:44, 1959.
Without this contact the maxillary denture would tip 10. Fry, K.: The retention of complete dentures. Br Dent J 4497,
anterosuperiorly, traumatizing the maxillary anterior 1923.
ridge and loosening the maxillary denture. 11. Schiesser, Jr., F. J.: The neutral zone and polished surfaces in
The severe retrognathic or prognathous ridge rela- complete dentures. J PROSTHET DENT 14:854, 1964.
tionship can be remedied only to a limited extent 12. Beresin, V. E., and Schiesser, F. J.: The Neutral Zone in
Complete and Partial Dentures, ed 2. St. Louis, 1978, The
through prosthetic treatment. While some compromises C. V. Mosby Co.
in the ideal tooth-to-ridge and tooth-to-tooth relation- 13. Lott, F., and Levin, B.: Flange technique: An anatomic and
ships may be made, the range of correction of such physiologic approach to increased retention, function, comfort,
skeletal cosmetic deficiencies without surgical interven- and appearance of dentures. J PROSTHET DENT 16~394,
tions is limited. 1966.
14. Payne, S. H.: A posterior setup to meet individual require-
CONCLUSION ments. Dent Digest 4220, 1941.
15. Pound, E.: Utilizing speech to simplify a personalized denture
Both complete denture stability and retention are service. J PROSTHET DENT 24:586, 1970.
essential in providing successful prosthetic treatment. 16. Becker, C. M., Swoope, C. C., and Guckes, A. D.: Lingualized
The factors that contribute to these properties are occlusion for removable prosthodontics. J PROSTHET DENT
38:601, 1977.
highly interrelated, and the constant interaction 17. Woelfel, J. B., Hickey, J. C., and Allison, M. L.: Effect of
between stability and retention often makes them posterior tooth form on jaw and denture movement. J PROS-
indistinguishable. The factor of stability involve the THET DENT 12~922, 1962.
tissue, occlusal, and polished surfaces of the denture. 18. Frechette, A. R.: Complete denture stability related to tooth
Care must be taken in the development of all three of position. J PROSTHET DENT 11:1032, 1961.
19. Lang, B. R., and Kelsey, C. C., editors: International Prostho-
these surfaces to ensure optimal stability of the final
dontic Workshop on Complete Denture Occlusion. Ann Arbor,
prosthesis. Mich., 1972, The University of Michigan, p 132.
20. Weinberg, L. A.: Tooth position in relation to the denture base
REFERENCES foundation. J PROSTHET DENT 8~398, 1958.