* Zone boundary of the upper jaw
* Zone boundary of the lower jaw
Call paraproteticos elements, a group of tissues that are part of the maxilla and mandible, as well as the oral cavity and be associated with prosthetic devices directly when by action of its own fibers modifies the sulcus space, and indirectly when its fibers are contracted or dilated by the action of other muscle mass, therefore we must take into account as described above as well as its function, insertion, location and morphology, for the proper preparation of a prosthesis. It is also necessary to know the details of each individual oral anatomy because we depend on them for proper prosthetic fitting in each case.
These elements are divided into:
* Muscles: divided into four groups, skin (mirtiforme, orbicularis oris, canine, buccinator, fringe of beard, square, triangular chin and lips), throat (pharynx superior constrictor), suprahyoid (mylohyoid) and tongue (genioglossus, complex muscle of the tongue and soft palate)
* Ligament: Band of fibrous connective tissue, soft, very strong but flexible, connecting bones to each other, for example, comprising a joint.
* Cellular Spaces: Clearance of muscle attachments
* Braces: Media and sides of upper and lower jaw and tongue.* Pit: deep depression where some muscles and ligaments inserted
* Furrows: Slit package through which the vascular and nerve supplies the muscle mass.
Description of insertions of elements paraproteticos:
0 ANATOMICAL OR ONLINE ONLINE INSERTION: The line between stationary and movable area of the zone in the edentulous chapeable. Throughout her braces are inserted, ligaments and muscles paraproteticos covered by the oral mucosa of the maxillary, actively participating in the retention and displacement of the prosthesis.
ANATOMICAL AREA OUTLINE: In the edentulous mucosa is the portion that is immediately above the insertion line and part of the jaw side of the groove. This area should be completely covered by the wings of a vestibular prosthesis.
In the maxilla is related to these elements: the front with the upper lip laterally to the cheeks and then to the pterygoid process (hamular groove) and the soft palate. Vestibular surface of the sidewall is in connection with the inner cheek, lip and cheek thanks to groove, groove superior vestibular (labial or genial).
In the lower jaw are related to the lip forward and laterally to the cheeks, forming the buccal sulcus or inferior vestibular sulcus and the floor of the mouth in the rear, determining the formation of the lingual groove
MAXILLARY AREA OUTLINE TOP
Describe the characteristics of the superior vestibular groove, the groove hamular and soft palate. Starting from the middle line and back out the next elements:
* Frenulum half upper lip, located right in the midline of the superior vestibular groove, is a formation that forms a fold fibrous connecting the inner upper lip with the lip of the vestibule of the mouth tightly inserted in the periosteum and the greater thickness, the fibrous cord is inserted closer to the ridge crest. Is an integral with the lip and q comes down with it and brings down the groove in the lobby.
Has great importance in setting up the bridle a removable prosthesis, as it must take into account that if not respected, the lower the bridle will lower the bottom of the groove and displace the prosthesis down. A poor attempt to retain the strength hurt the frenulum of the patient. To avoid disturbing the patient should be performed in the top flange of the prosthesis, at the junction of the side wings, which coincides with the midline of the upper central incisor, in this place will open triangular cut up, that call relief.
* Muscle mirtiforme: flat ring-shaped and located below the upper middle bridle, comes from the bottom of the pits mirtiformes and lateral incisor alveolar eminence, is directed upward to insert into the deep surface of the skin subtabique and coats the back edge of the orifice of the nostrils. Mirtiforme external fibers are continuous with the transverse posterior fibers of the nose.
Action: reducing the wing of the nose and shrinks across the hole of the nostrils.
In our field we can extend the edges of the prosthesis and in some extreme cases the extent of atrophy bear it.
* Draw upper incisor of semiorbicular: Inside the outer edge of the pit mirtiforme to superior vestibular sulcus.
Action: You have several, for example, occlusive mouth getting her lips and empty the vestibular sulcus. The latter action can scroll down with the lip prosthesis.
* Cell Area: An area without muscle attachments, ligaments and fibrous able to extend the sides of the prosthesis.
* Canine Muscle: Flat and ring, which extends from the pit s the same name, which is located behind and above the canine eminence and reach the base of the alveolar maxilla upward from here then heads back
Action: in combination with other muscles increases the upward angle, which exposes the dog and gives a face of anger or threatening. By bringing the corners up and in helping to implement the modiolus on the flank of the flanges, as well as Coscolla Rodriguez advised not to give too much thickness to the edge of the prosthetic device, so that the muscle can move freely with adequate travel and not too many problems occur.
When their work is synchronized with the triangular help with the action of the orbicularis oris at the corner leading to the flanges, not raise them, when the strap formed by the triangular and the canine, which behaves like a digastric acts simultaneously on both sides, the corner close to the midline of both lips projecting forward, these two factors, the action of the canine-triangular complex produces a decrease in the upper groove and a lower rise.
While the inclusion of the canine is recorded on a higher plane in relation to the position of the limit of mobile and stationary tissue, there have been cases where the fibers involved in the formation of the lateral frenulum.
* Frenulum upper side: are mucosal folds and fibrous and nearly symmetrical pairs presented buccal mucosa, the height d premolars canine muscle caused by switching from the flat bone at the deep surface of orbicularis oris, the development is usually less than the middle and is generally not one but multiple. When your development is large or set too low, preprosthetic surgery may be needed in total edentulous.
* Buccinator muscle: This is a muscle, rectangular, its largest hub is in the anterior-posterior, is the most important part of the cheek or cheek, is a flat muscle, their central fibers are more spacious than the peripheral in front cuts like a c open inward, her height is marked from one to another alveolus and its length is from the corner to the retromolar region.
a) In the outer table of the alveolar process of maxilla at the level of the molars.
b) alveolar ridge of the lower molars and in the very back of the line external oblique, retromolar fossa.
c) Backward pterigomaxilar the ligament or aponeurosis, buccinatofaringea, other fibers are lost in the tendon of the temporal and the superior pharyngeal constrictor, from these areas of origin, the muscle fibers converge to the internal plane of the commissure mouth, to intersect with canine muscles, zygomaticus major and triangular, ending in the deep surface of the skin and mucosa.
Action: This muscle is widening the transverse diameter of the mouth, cheeks puffed and positional changes occur in both buccal grooves, the upper descending and ascending the bottom.
When the edge of a prosthesis is too long can lead to injury in the mucosa, much enhanced by the effect of the action of the pterygoid.
This muscle also has the action, when it shrinks, compressing the solid or liquid content of the oral cavity and then facilitates the transfer to the pharyngeal (swallowing). If the cheeks are distended by air is conditioned to the act of blowing or whistling also helps send the food back and continue chewing.
When the mouth is empty and relaxed orbicularis, buccinator muscle contraction pulls out the corners, so that makes the mouth hole is enlarged in the transverse direction which results in skin folds cheeks hollow arched to commissural (muscle of laughter free) check the action of the buccinator, in the states of bitterness, resignation and sorrow, as well as some smiles (forced or suppressed) muscle of irony.
We can say that the buccinator is a versatile muscle that contracts in various states of mind and expression also includes the other muscles of the face involving the muscles of the face.
* Groove hamular: in this region is recorded over the top of the buccinator, which goes towards buccinato-pharyngeal fascia at its insertion into the hook of the internal wing of the pterygoid process.
* Veil of the palate: A movable partition (muscle membrane), which prolongs the palate down and back, separating the nasal portion of the oral pharynx. The soft palate is a quadrilateral and its measure is 4 cm in length and 1 cm. thick (approximate measurements).
The soft palate has two faces and four edges: the antero inferior (concave and smooth)
And has a half anteroposterior projection extending in the raphe veil of the palate and the back is continuous with the floor of the nostrils. The anterior border coincides with the leading edge of the palate. lateral edge is attached to the bottom of the pterygoid process and the inner wing hook, is often confused with the side walls of the pharynx. On the other hand, the rear edge in the middle part has an extension, the uvula on each side, with two folds, anterior and posterior pillars of the soft palate.
The anterior pillar is clear from the front of the veil near the base of the uvula. He leans out, down and forward, ending at the lateral border of the tongue, at the junction of the oral portion of the pharyngeal portion of this edge, the anterior pillars, uvula and tongue base.
In the rear pillars comes from the back of the kiss of the uvula, below and behind the anterior pillar. Is directed outward, down and back off into the side wall of the pharynx.
The rear pillars beyond the previous inward, so they are visible through the hole mouth.
The importance of this prosthesis is that if it exceeds the limits of the prosthesis cause nausea, regardless of the trouble that it would.
BOUNDARY ZONE OF LOWER JAW
* Labial Frenum lower middle: The frenulum is a fiber fabric, usually crescent shaped. This is located in the vestibular sulcus mediadle line, ie the crescent-shaped wall extends from the lobby to the inner lip.
This bridle is inserted from the midline of the alveolar ridges below the free and attached gingiva. This presented perpendicularly to the frenulum is a muscle therefore stop.
The importance of the respect of a prosthesis is that the frenulum is working with the lip (in case the lower body), so when a prosthesis is not complied with the frenulum will not only be annoying and painful for the patient but also irritate the frenulum area and cause the prosthesis down.
* Tassel beard or chin: chin fringe muscle is a muscle that inserts into the mandible or jaw bone (c, odd, central and asymmetric, horseshoe-shaped, formed by the union of the two bones that form a cleft chin called apophysis) therefore means that this is a muscle that is located on the beard, are two small bundles located on each side of the midline, is placed in the triangular space that defines the depressor muscle lower lip on either side of the midline, in the triangular space between the two boxes on the chin. This muscle is cylindrical and extends about 7 mm.
This muscle is inserted above the mandible below the incisor and canine eminences, under the gums, the skin under the chin, but it is inserted into the skin of the chin. His inclusion is thus perpendicular type it coincided muscle, muscle butt.
The importance prosthetic that has the same order it is the lower lip down and out, so that in view of the man did not notice the lack of teeth, producing an elevation in the groove, to respect the right space to build a prosthesis will get I was not slipping or out, independent of patient discomfort.
* Orbicularis oris muscle: One of the major muscles, like all circular, surrounded by what we say it is an elliptical-shaped muscle located on the thickness of the lips. It has an area of approximately 7.5 mm.
Its insertion in the mouth is a little lower than the fringe of the chin, the deep layer of the lips, on both sides, is reinforced by the compressor muscle of the lip. It is located at the lateral incisor and canine fossa in the chin, mouth steaks supplied by the upper and lower face.
Action: It has fibers that are marginal and are on the edge of the lips, and fibers that are peripheral. The marginal to the contract are responsible for compressing the lips to teeth. The peripheral, however, the mouth stretched forward by making the act of kissing or whistling.
* Triangular muscle of the lips: A broad, thin muscle that runs from the external oblique line of the jaw to the lip commissure. Covered by skin, muscle covers the square of the beard, orbicularis and buccinator.
It is innervated by the fillets mentalis cervicofacial branch of the facial.
Action: lowers the labial commissure, ie the corner depressor, and takes it out and down. It is known as the muscle tears and reflecting feelings like contempt, disgust, sadness, crying, etc..
While prosthetic devices fail to reach the muscle, they can influence whether the prosthesis is overextended.
* Muscle square of the chin shape is flat and thin, it is located, as mentioned earlier, below the triangular muscle of the lips and its insertion in the inner third of the external oblique line of the jaw above the insertion of the triangular. It goes in and up, contrary to the triangular. Ends in the skin of the lower lip.
It is innervated by the fillets mentalis cervicofacial branch of the facial.
Action: pull down and out for half the lower lip, ie, eversion (turning) of the lip.
It should be noted, as in the triangular muscle that if the prosthesis is overextended can potentially cause problems with this muscle.
* Lateral Frenulum: A multiple bridle but in a much smaller scale than the upper lip frenum half which nevertheless must be considered when making a prosthesis. It is located behind the muscle insertion Canino.
* Trench retromilohioidea: Also called pit retroalveolar Neil. It is an area that assumes great importance in prosthodontics because there is where you run the edge of complete dentures to obtain adequate peripheral seal and a comfortable prosthesis use. Joins the back row with the tongue and subsequently in the palatologloso limited.
* Cell Area: As we saw earlier this space is free of insertions, contributing to prolonged denture edges. Located behind the fibers of the triangular and forth over the buccinator, in place of the portion that corresponds to the maxillary premolar teeth and first molar, where the mental foramen, and is known as the surgical anatomy Chompret-L’Hirondel quadrilateral.
* Insert bottom of the buccinator: paraprotetico element already discussed in the maxilla.
* Groove Back: The portion which relates the buccal groove and lingual groove, behind the pear-shaped papilla.
Fold of mucosa that can be viewed with the mouth open, and where does the passage of the buccinator, which reaching the lingual plane will be inserted into the aponeurosis buccinatofaringea to make back the masseter and temporal tendon.
* Trench Nell retromilohioidea or retroalveolar
* Muscle superior pharyngeal constrictor: Thick flat and thin, incurved, which together with the opposite side form a concave muscle channel previously separated from the mucosa in the submucosa.
The superior pharyngeal constrictor arises from the bottom of the back edge and the hook of the pterygoid process (portion pterigofaringea) pterygomandibular raphe separating it from the buccinator (pharyngeal portion) and the rear end of the mylohyoid line (portion milofaringea .) The muscle fibers are attached below in a narrow beam (glossopharyngeal or muscle faringogloso portion) that extends above the edge of the tongue.
The fibers of the superior pharyngeal constrictor perform a curved path posteromedial, upper management following a cross and a little more oblique inferiorly below. End intersecting the midline with the opposite side, forming a tab attached to the ascending pharyngeal tubercle.
His relationship with the buccinator back, and between the buccinator and orbicularis oris forward, forming a complex called Complex orbico muscle-buccinatofaringeo work synergistically in the movements of chewing and swallowing.
Its importance is marked by prosthetic \ s changes occur in the position of the ligament pterigomaxilar.
* Mylohyoid muscle: Muscle wide, flat and thin, extending transversely from the medial side of the mandible to the hyoid bone and median raphe mylohyoid.
At the top is inserted through short tendinous fibers along the entire line mylohyoid fibers are too short to earlier, nearly horizontal, its length increases from front to back, becoming progressively more oblique inferomedial. Both the anterior and the middle fibers end in a tendinous raphe media to be from the jaw to the hyoid bone, and later inserted into the front of the hyoid, lower than the geniohyoid and along the bottom edge of the bone.
Both mylohyoid joined by the median raphe from the mandibular symphysis to the hyoid bone together form a muscular septum on which rest in the middle of geniohyoid, at the top and sides of the tongue sublingual glands.
It works by raising the hyoid bone and tongue.
* Genioglossus muscle and lingual frenulum: a fan has flattened transversely. Previously inserted, by short tendinous fibers in the superior mental spine. From there the fibers are radiated toward the back of the tongue, the anterior fibers go to the top of the tongue superoanterior incurved, the middle fibers are diverted to the mucosa of the dorsum of the tongue and lingual aponeurosis, the lower fibers end in the top of the body of the hyoid bone. This muscle is separated from the opposite side by a thin layer of cellular tissue, sometimes cross in the vicinity of the septum by intersecting fibers of both muscles at the bottom.
The lower fibers of the genioglossus moves the hyoid bone and tongue superoanterior, half a mile away also attract above, and the previous rollback inferoposterior corner of the tongue. When fully contracted, the genioglossus retracts the tongue to the floor of the mouth.
Lingual braces are a fold of mucous tissue medial fibrous structure extending from the posterior extremity of the ridge channel or medium to the middle of the groove alveololingual.
Its importance is most notable prosthetic higher the residual ridge resorption.
Having located, recognized, and verified the anatomical elements that make up the group Paraprotetico described above: anatomical line 0, line 0 functional, anatomical area boundary, boundary zone of the upper jaw area jawline and all inserts muscles, braces and ligaments in order from the midline backward and out, all equally important we must consider first the time elapsed since the loss of teeth and that the longer the period devoid of the same higher absorption bone and inserts are closer and lip muscle mass, therefore get less space for prosthetic retention
We say that in line 0 anatomically or insertion line in theory we find a scalloped line, decreasing the length of the sidewalls prosthetics when we find one or frenum muscle attachment to the prosthesis does not move down and preserving soft tissues of the mouth of which we will use as key elements of retention and may extend longitudinally on the same flank when insertion is further away from the rim or where to find free cell space, ie without inserts.
Prosthetic edges must submit its outline reflected in a line failure along the corresponding mucosa, where making a bad point or a portion, may ulcerate the patient’s oral mucosa, then we reduce the edge to find a good tolerance limit in the extension.
In the lower denture we can avail ourselves of the language as an element of retention and its importance in the retention and stability of the prosthesis is critical.
We must be clear that the dental anatomy of each individual is unique, and pay special attention to their anatomical shape, and prosthetic restoration if properly tailored to contribute to good retention and durability.
Here are some of the points that a prosthetist must take into account in setting up a denture:
* Retention: depends on physical factors such as atmospheric pressure, adhesion and other biological and paraproteticos elements. It’s the perfect relationship between the prosthesis and body, for it will not be moved.
* Stability: once understood that the soft tissues, which will retain the prosthetic devices, we make a good adaptation to the prosthesis in order to prevent displacement. And placed before chapeable area, which is the area where the prosthesis should settle studied the health of the soft tissues.
* Support: in this field is the bone through the gum, being covered with the same, which supports the pressure of chewing forces.
Functional and Applied DENTAL ANATOMY
Mario Ricardo Rodolfo Eduardo Fig’un-Garino-
C. O. Boucher
PROSTHESIS FOR Toothless
ATLAS OF HUMAN ANATOMY
Frank H Setter
H. Rouviere and A. Delmas