29 DEC 2021 · GAG REFLEX: 1. Excess thickness of PPS (main reason) 2. Over extension of denture tray 3. Under the extension of denture tray 4. Over post dam 5. Under post dam SYSTEMIC REASONS OF GAG REFLEX If the patient had no gag for years after delivery of the new denture, and then recently develops the gag reflex on denture use – then suspect systemic problem & is definitely not due to the denture itself SYMPTOMS OF OVEREXTENDED MAX DISTO-PALATAL END 1. Ulcer 2. Sure throat 3. Dysphagia

29 AUG 2020 · MENTAL ATTITUDE -By MM Hose 1. PHYSIOLOGICAL - Cooperative - Good prognosis 2. EXACTING - Patient will have previous history of denture wearing - Needs exactly as their prev denture - Demanding attitude 3. INDIFFERENT 4. HYSTERICAL - Seen in pedo cases - Temper & tantrum* - Poor prognosis - Hand-over-mouth behavior management is to be used here- HOME

29 AUG 2020 · MAXILLARY DENTURE PRIMARY STRESS-BEARING AREA Posterolateral slopes of the hard palate PRIMARY RELIEF AREAS Mid-palatine raphae Incisive papilla - Why it needs relief? Contains nasopalatine nerve* & not incisive nerve OK! - When compressed, causes paresthesia of anterior palate* Rugae - Secondary relief – optional answer for primary relief OK! PRIMARY RETENTION AREA Post Palatal Seal area THE MOST IMPORTANT FACTOR PROVIDING RETENTION OF A CD IS THE PERIPHERAL SEAL. PP Seal: At the soft palate SOFT PALATE: - Supplied by the accessory nerve of the Vagus nerve - Thus any patient with vagus nerve damage – will not be able to record PPS – thus no retention here

29 AUG 2020 · Anterior Vibrating Line: At the junction of immovable hard palate & slightly movable soft palate (cupid bow shape) RECORDING ANT. VIBRATING LINE: - During border-molding – short & vigorous “hah” - Ask the patient to blow through closed nostrils – Valsavan Maneuver - Soft palate should be depressed & inferior* - Hold head at 30° flexion - Fox plane angulation – 30° - While recording soft palate should fall gradually* for easy recording Posterior Vibrating Line: At the junction of slightly movable soft palate & highly movable soft palate - PPS recording angulation – 30° - It is a straight line*, from one hamular notch to the other - Anatomically – the junction between aponeurosis of tensor veli palatini & muscular portion of soft palate*

29 AUG 2020 · Hamular Notch / Pterygomaxillary notch - Depression distal to the maxillary tuberosity - Used as a landmark for posterior extension of the maxillary denture RECORDS ON THE IMPRESSION – Anatomical Structures 1. Ant. vibrating line 2. Post. Vibrating line important 3. Hamular notch 4. Fovea palatine --------- least important NB : PPS is marked on cast using – Lecron’s carver* PARTS OF PPS: - PPS area - Pterygomaxillary area Ant. Vibrating Line Post. Vibrating Line BORDERS OF PPS: - Ant vibrating line - Post vibrating line - Hamular notch - Fovea palatine FUNCTION OF PPS: - Improves retention - Completes the border seal of the maxillary denture - Compensation of polymerization shrinkage - Prevent food lodgement NB : If food lodgement is not prevented – causes gag reflex – glossopharyngeal nerve involved here

29 AUG 2020 · LIMITING STRUCTURES – MAXILLA 1. ANTERIORLY- Labial vestibule which extends from right buccal frenum to to left. FRENUM - 1 labia & 2 buccal - Should reline (2mm) - If not will lose frenum & cause pain for the patient NB: If high labial frenum --> Do frenectomy, it is safe as it has no muscle attachment but only fibrous tissue 2. LATERALLY- on either side, buccal vestibule extending from the buccal frenum till hamular notch POSTERIOR EXTENSION OF TRAY: - Post vibrating line*** - Hamular notch** not hamular process (which is beyond the notch itself OK) - Approx 2mm anterior to Fovea palatine * NB: If tray extension crosses & goes beyond hamular notch ie up until the hamular process then the patient will c/o pain. Therefore it must extend up to hamular notch only OK!

29 AUG 2020 · MANDIBULAR DENTURE PRIMARY STRESS BEARING AREA Buccal Shelf Area - Because it is made of cortical bone - It is perpendicular to masticatory forces / occlusal plane TRetromolar pad is Secondary stress-bearing area - It provides retention, support & stability - It adds another plane to the movement of the denture Posterior most extension- 2/3rd height of the retromolar pad Mandibular dentures do not rely on suction unlike max dentures, they get maximum stability by covering as much basal bone as possible without impinging on the muscle attachments.

29 AUG 2020 · LIMITING STRUCTURES – MUSCLES 1. Mentalis Muscle: The mandibular anterior area from left buccal frenum to right buccal frenum. 2. Buccinator Muscle: The determination of the depth & width of both max & mand denture into the buccal vestibule is the buccinator muscle; thereby preventing food lodgement there. 3. Massetric muscle: Distobuccal flange of denture is limited by this muscle. If over-extended, the patient experiences extreme soreness. 4. Genioglossus Muscle: Denture extension into the lingual vestibule is determined by the genioglossus muscle (1st PM to contralateral side 1st PM). 5. Mylohyoid Muscle: Denture extension in the alveo-lingual sulcus is determined by oral diaphragm / mylohyoid muscle. 6. Retromylohyoid Area : a. Superior Constrictor Muscle: Disto-lingual aspect of mandibular denture is determined by the superior constrictor muscle of the pharynx. b. Palatoglossus Muscle: Post most extension is determined by palatoglossus; whereas post most height is determined by 2/3rd of the retromolar pad.

29 AUG 2020 · MUSCLES AND POST-INSERTION PROBLEMS ASSOCIATED: 1. If patient c/o pain & dislodgement o If the anterior lingual sulcus is over-extended o Genioglossus – ant region - Helps protrusion o It is the safety muscle of the tongue 2. If denture dislodges during mouth opening o Due to overextended denture at Mylohyoid – PM, M region 3. If sore throat, pain, dysphagia o Due to over extended flange in the post most part – Palatoglossus – 3rd M region o Or even at the massetric area 4. If difficulty in swallowing o Due to over extended – Superior Constrictor – distolingual part

29 AUG 2020 · RESIDUAL RIDGE RESORPTION: ¤ Severe/fast in 6 months (to 1 year) ¤ That’s why the patient complains of the loose denture during this period ¤ Pattern in Max- results in the short maxilla ¤ Pattern in Mand- results in no change ¤ Therefore CD patients have Class 3 ridge which is expected ¤ Mand ridge resorption is 4 times faster than Max ¤ Maxillary – upward & inward direction ¤ Mandibular – outward & downward direction ¤ Alveolar bone function – to hold teeth, therefore alveolar bone resorbs only after teeth loss OK! FACTORS INCREASING RIDGE RESORPTION: 1. Diabetes 2. Bruxism 3. Osteoporosis ( especially females- during menopause ) NB: Female patients at Menopause (40yrs) - Pain due to xerostomia - Loose denture due to ridge resorption related to osteoporosis