Transcript for:
Express Revision Course for Complete Dentures

welcome back to our channel and today's topic is the express revision course for complete dentures as per your request so today's video we are going to talk about the rapid revision course this is express revision wherein we are going to cover only hiding points we are not going to go through the details of complete denture but we are going to go through the high yielding points which are required for competitive exam can be your neat pga exam so without further due let's get started but before we get started make sure you subscribe to our channel before you get lost into the video and also you can find some more interesting videos and the playlist so once you youtube the dental part you will find a playlist in the playlist you have to go through the whole playlist where you'll find more interesting videos so today's topic is the topic of prosthodontics so before get started with the complete dentures let's see what is prosthodontics prosthodontics whenever a patient comes to you in the department of prosthodontics so we have got various departments in the dental college right so it is a dental speciality it is a dental speciality so this speciality it covers the diagnosis first of all you diagnose the patient then you treat the patient then there is rehabilitation that is in the prostate we are going to restore right so rehabilitation and then the maintenance so we are going to do the diagnosis the treatment planning the rehabilitation and the maintenance of oral function comfort and also appearances and more importantly we see the restore the health of the patient right so the dental health of the patient in the prostate we see if there are any missing or deficient teeth that is with the missing or the deficient teeth missing or the deficient teeth and or the maxillofacial tissues and or the maxillofacial tissues using biocompatible substitutes so this is the definition of the prosthodontics according to gpt eight it is a dental specialty pertaining to the diagnosis treatment planning rehabilitation and the maintenance of of oral comfort appearance or health of the patient with a missing or the deficient teeth and or maxillofacial tissues using the biocompatible substitutes also what is cd now complete denture is basically a prosthesis it is a removable prosthesis that replaces the entire dentition right because we are talking about complete here complete see when we are talking about complete this is a entire dentition and when we are talking about the associated structures it the removable it is the complete denture so if we talk about what is a denture denture is basically an artificial substitute of the missing natural teeth and it their adjacent structures so there are various steps in cds steps in cd that means we are going to construct give a denture a complete denture to a patient right so there is no teeth which is present in the oral cavity so we have got two kinds of steps one is the clinical steps one is the clinical step and the other one is the lab steps clinical steps are the steps which we do in the clinics and the lab steps are the steps which we do in the lab so in the dental lab so clinical step first of all is our case history the very first thing when the patient comes to you we take the history of the patient and that we are going to diagnose and that we are going to do the treatment planning then what we do is we prepare the diagnostic cast so we prepare the diagnostic cast of the patient then we see that is there any requirement of mouth preparation that is going to include the pre prosthetic surgery so if any surgery is required suppose if any flabby tissue is there any any terai is present so any surgery which we want to do before giving the denture to the patient or in case there are deep undercuts which are present we want to do the either alveoloplasty alveolectomy so any procedure pre prosthetic surgery will come under mouth preparation then we take the primary impression of the patient and then after making the primary impression we make the primary cause suppose in case you do not want to do there is no requirement for any pre-prosthetic surgery then directly our diagnostic cost will be our primary caste so then we take the primary cast and we prepare the custom tree right then we have got then we take the secondary impression we'll be stocking all all these steps one by one and then after taking the secondary impression we prepared the master cast in the lab and we prepare the occlusal rims and then we take jaw relation in the patient mouth and we do the teeth setting and articulation in the lab articulation and the teeth setting and the teeth setting then we do the trine after we set the teeth in the ah in the articulator then we do trying and after that we check the trine after that we do the processing of the denture and then if everything is correct there is denture insertion insertion and after insertion we are going to recall the patient i mean immediately after instruction insertion we give the post insertion instructions insertion instructions and we are going to call the patient for follow up right if any question is asked based on the clinical steps or based on the lab steps now we know that which all are the clinical steps which all are the lab steps now based on that patient can be of two types i mean four types we can classify the patient according to the types of the mandible the ridge of the mandible the ridge morphology so based on the mandibular height [Music] based on the ridge morphology based on the maxillomandibular relationship and based on the muscle attachment we classify the patient into four types class one is when the patient is having really good bone height in the mandible so that is called as ideal ideally or the patient is minimally compromised there is no compromise in the ridge of the patient so basically what happens is the ridge is going to be really good and we can say that this is an ideal denture right so the base height mandible height is going to be uh greater than 21 millimeter the maximum antibiotic relationship is going to be uh class one maxillomandibular relationship then coming to class two class two is the moderately compromised moderately compromised wherein the height is not great but it's not bad either so there is 16 to 20 millimeters and again the relationship maximum mandela relationship is class 1 in this case so type 3 is substantially compromised substantially compromised in that the bone height of the mandible is 11 to 15 millimeter and the type 4 is severely compromised we are talking about severe resorption of the bone here so severely compromised so we have studied four kinds severely compromised substantially compromised moderately compromised and ideally compromised so these this is the types of the patient based on the mandibular height based on the ridge morphology based on the maxillomandibular relationship and the muscle attachment you have got ideally minimally compromised moderately compromised substantially compromised and severely compromised so now we will be talking about the case history so we will be covering only the highlighting points mental attitude of the patient is very important because lot of time the question has been asked from the mental attitude of the patient so in that we are going to cover the mm house classification so in that we have got mm house classification which was given in original mm house classification which was given in nineteen 1950 okay so there are got again four types the type one is the philosophical attitude of the patient so we are talking about the patient attitude the mental attitude of the patient so the patient has got philosophical attitude this is basically the ideal attitude of a patient you can say so this is the patient is cooperative for the procedure so this is we can say the ideal attitude and then the second one we have is the exacting as the name suggest exacting means the patient is going to tell you the treatment you should do so he'll be talking about the treatment so this is the exacting or the critical kind of patient so basically what happens is patient is going to find faults he'll be complaining all the time so find faults and complaining the patient will be complaining all the times the third we have is the historical kind of patient so historical patient are if you are doing if they i mean if you make them happy they are going to have a good attitude towards the treatment but what happens they have got some previous bad experience so this is the historical or spectacle attitude of the patient so they have got bad previous experience now one more thing i want to tell you you don't have to note down each and everything all the notes whatever i am writing here all the notes will be provided in the link in the description below i'll provide you a link in the description below so you have to visit a website wherein you will find all the notes so whenever you want to revise anything you will find link in the description below so you will have to search for the dis link in the description and it will directly you take away to the notes and see this complete denture express revision we cannot cover in one video because it is going to be lengthy so we are going to cover in two parts so this is the part one which we are going to cover the part two will cover in the next video so talking about the mental attitude of the patient the philosophical is the ideal exacting critical hysterical and the fourth one is the indifference see as the name suggests i have been always telling you you have to look for the name whenever you are reading the question whenever you are attempting any question first and very first thing is most times 10 to 20 percent times the student they know the answer but in a hurry they are doing it wrong and sometimes when there is a negative marking it goes in your negative so indifferent patient so you have to carefully read it as the name suggests see the patient is going to have a different attitude that means the patient does not want the treatment because of the family pressure the patient is seeking the treatment right so that is the indifferent so these but all these classification which we have covered till now the philosophical exacting hysterical indifferent all these type of attitude are based on the patient mind and ah we couldn't it couldn't give us the idea about the patient attitudes toward the dentist or towards the treatment procedure so there is a revised classification which was given in 2003 by gamma and tuch so this is a revised mm house classification in that we have got the ideal attitude which is a really positive attitude that means the patient is looking forward for the treatment the patient is wheeling for the treatment next one is the submitter that means see as the name suggest that means the patient will come and surrender to you so he whatever you do the patient is not going to open the mouth so the patient is going to surrender to the dentist and there is going to be the lack of discrimination and also the because since the patient is submitter so there is going to be it is they are going to be incapable of providing the genuine information so next one we have got is the reluctant as the name suggests reluctant attitude is when the patient is not ready for any kind of treatment the patient is denying the dental treatment so that is the reluctant attitude again we have got the indifferent in the revised also we have ideal we have indifferent indifferent is when the patient comes to you because of the family pressure right and he is indifferent to the dentist in a way that he is less engaged in the dental treatment so the last one in the revised mm house is the resistant resistant patient will be spectacle to the dentist rather than cooperative he will be giving challenges to the dentist so he will not be wheeling for any kind of treatment in fact he will be engaged in the treatment in a negative way so he will argue with the dentist so that kind of attitude the patient will have so guys we have covered the house mm house classification the mental attitude of the patient in that we have covered the philosophical so the question which is asked is the ideal attitude of the patient is the philosophical attitude then we have got the exacting where the patient find faults then hysterical ah then in different revised mm house classification we have ideal submitter reluctant indifferent and the resistance next coming to the shape of the palatal vault so how the palatal vault is based on that is very important to know you know why because the shape actually determines some various factor in the retention of the denture suppose if the patient is having u-shaped palatal vault u-shaped palatal walls means the patient will have like this kind of pallet so this is the most favorable palatal vault of the patient then we have got the flat palatal vault the flat parallel vault means suppose this is the maxillary tuberosity and the pallet is flat kind of this is the flat palatal vault so this palatal vault is going to resist the downward pull so there is not go there is not going to be downward movement there is going to be resistance to the downward pull resistance to the downward pull but what happens in this case there is going to be easy dislodgement that means the the denture it can be dislodged in the by the rotational forces by the lateral forces so but there is going to be dislodgement dislodged by lateral or rotational forces lateral or rotational forces so balancing is very important in case of a flat palatal world balanced occlusion is very important we have to give balanced occlusion next comes the third kind of palatal wall which is the v-shaped palatal world v-shaped palatal vault is basically a high narrow palatal wall like this pallet is going to be so deep so this is the high narrow and this is most unfavorable most on palatal vault for the retention and what happens see this is the v shape palatal vault this is a v-shaped palatal wall if it is pressed against the sides so the denture will loosen up and it will slip so talking about we have covered the shapes of the palatal wall the u-shaped palatal vault is the most favorable and the v-shaped palatal vault is the least favorable least favorable and if we talk about bony undercuts we have got undercuts in the maxilla then undercuts in the mandible right so undercuts in the maxilla if they are present in the anterior ridge anterior ridge and lateral to the maxillary tuberosity then we can relieve it in the denture we do not have to go for the surgery but in case in the maxilla if there are severe bony undercuts which are present then before giving the denture in the pre prosthetic surgery we need to remove it surgically okay this is about the maxilla then talking about bony undercuts if are present in the mandible usually they are due to the sharp prominent myelohydrates due to myelohydrates and it should be surgically corrected so surgical correction should be done in case of mandibular bony undercuts which are present now talking about tori torai is a swelling which is bony swelling i must say which is present it can be in the maxilla it can be in the mandible if it is present in the maxilla then there is going to be presence in the midline the see if you can see here there is going to be present in the midline of the heart palette and if you look at mandible it is going to be present between four and five if you can see here it is present between four and five four and five so it is going to be present in the premolar area if you can see this is in the maxilla it is present in the middle of the [Music] heart palette and in the mandible it is going to be present on the a lingual side of the premolars and which is a very important question which is frequently asked so what happens always remember this i am going to give you a very short trick if the swelling is firm and bony then we can keep it and use it as the primary support for the denture so if the swelling is again i'm telling you if the swelling is bony and firm hard then we can use for the primary support of the denture if the swelling we have to again relieve it during the denture by placing the lead tin foil during the processing so but we can still we can keep it and uses and we have talked about in the maxilla also if you have seen we have talked about relieving in the denture so if there is undercut also which is present lateral to the maxillary tuberosity or in the anterior ridge then we can relieve it but if you have seen in the mandible it has to be surgically corrected again the same goes for the mandible if we are talking about in the mandible it should be surgically removed it should be surgically removed so if any deep undercut is present if there is going to be tory present it should be surgically removed there is no option of relieving in the mandible you know why because it is sensitive to pressure because it is sensitive to pressure so very slight amount of pressure also is going to cause pain to the patient and therefore it is surgically removed in the pre prosthetic surgery that means before giving before taking the impression before starting the dental treatment before starting the denture we have to relieve it and the surgical removal before the impression especially when it is close to the floor of the mouth so it should be surgically removed and if we talk about how the story looks like so there is going to be the cancellous bone which is present and it is surrounded by very thin cortical bone so there is going to be the cancellous bone which is surrounded by thin cortical bone and the size if you look at so this is the taurei now size of a maxillary torrent it is small p size to huge size and if we talk about size of the mandibular tori then it is again small p to half hazelnut but when it should be removed in the uh in the maxilla mandible we know that of course for sure it should be removed surgically removed there is no other way that we can relieve it in the denture but when it should be removed in the magazine when it should be kept so in the maxilla it should be removed surgically removed if it is extending if it is extending till the pps posterior partial seal area or if it is interfering with the speech or if it is causal causing poor denture stability you don't have to take the notes you will already by the time you are watching the video you will already find a link in the description box below wherein you will find all the notes so you have to just go through the video and then you can look for the notes so you have to remove it surgically if it is extending till the pps if it is interfering with the speech or if it is causing the poor denture stability if we talk about large tuberosities if they are present when it should be removed and when will it act as the primary stability primary support to the mag to the maxilla so we have got two cases right one is when it is removed so it if it is movable it should be removed surgically and if the large tuberosity is bony and firm then we can use it for the stability of the denture and if you see that i have already told you this that if the swelling is if you have a look at we are talking about the bony and firm will provide stability to the denture we have already talked about this point see if the swelling is firm and bony then it is going to provide the primary support this point we have already talked about previously if the swelling is form and bone it is going to provide the stability to the denture so we have covered the undercuts bony undercuts the palatal shape of the palatal vault and the turret when it should be removed when it is going to give the support to the denture so talking about the anatomical landmarks anatomical landmarks for maxilla we have got stress bearing areas primary and secondary there are two stress bearing areas the primary stress bearing areas and the secondary stress bearing areas right so the primary stress bearing areas are all the slopes i am talking about the shortcut here so you will find all the slopes why do we call it the primary stress bearing area why are we differentiating the stress bearing area into primary and secondary so if we talk about primary stress bearing area there is going to be least resorption okay and what are the primary stress bearing areas these are the horizontal slopes of hard palate and the posterior lateral slopes of the residual ridge right talking about secondary stress bearing areas secondary stress bearing areas we have got the crest of the ridge lets you use another color so prime secondary stress bearing area is the crest of the residual rich then we have got ruggy now again the question can be asked they can directly ask you which of the which of the following is not a secondary stress bearing area so there are three secondary stress bearing areas the crest of the residual ridge see the crest of the residual ridge for maxilla is a stress bearing area crest of the ridge for mandible is a relief area you have to remember this always remember this see the crest of the ridge residual ridge is a secondary stress bearing area for the maxilla for the mandible when we are going to talk about it is the relief area so the crest of the ridge regi as well as the maxillary tuberosity are the secondary stress bearing area crest of the ridge why crest of the ridges stress bearing area in case of maxilla because it provides good support but again it undergoes resorption if we talk about primary uh stress bearing areas they have got least resorption right but if we talk about the secondary stress bearing areas then the secondary stress bearing areas there is going to be some resorption but not that amount that we have to relieve it so there are going to be three secondary stress bearing areas the crest of the rich the rugged and the maxillary tuberosity right then we have got the supporting structures then there are supporting structures i hope that you guys already know this is the if you can see here in the diagram j the pink color one is the crest of the ridge then we have got rage ragi in the h then we have got maxillary tuberosity as you can see the maxillary tuberosity is in the a right the yellow color one this one okay now the supporting areas are the areas which are going to give the support right so the supporting areas is the heart palette is the heart palette reggae jager also supporting areas then we have got the posterior lateral slopes see posterior lateral slopes again is the supporting area and then we have got the maxillary tuberosity so these are the supporting areas then very important is the relief areas relief areas we have got three relief areas in the maxilla incisive papilla why incisive papilla is a relieving area because it has got nasopalatine see now pattern nowadays has changed they are asking the reasoning kind of questions nasopalatine nerves and vessels so even if we ah don't relieve it so there is going to be the pain and burning sensation the patient will complain of we are going to cover in the problems in the end of complete denture so we have got the cuspid eminence that is the canine area and these relief area if you have done the complete denture then you must have placed back spacer so all the area in the selective impression technique we are going to relieve with the help of a back spacer so all these are the leaf areas and the mid palatine raphe where there is going to be the median sutural area palatine raphae because there is a thin mucosa so that is most sensitive area so the another question okay freenum we are going to cover in the end talking about the mandible in the mandible we have got the supporting areas supporting areas we have got two supporting areas the buckle shelf area see buckle shelf area in the mandible again we are going to cover it one by one in detail so the buckle shelf area is the primary stress bearing area you can see for the mandible buckle shelf area is this one one in the pink so this is the buckle shelf area then we have got the residual ridge this is not the crest of the ridge the crest of the ridge is again a relief area residual ridge you have to read it carefully if the question is residual ridge then it is a supporting area but when there is a crest of the ridge when the option is the crest of the ridge crest of the ridge crest of the residual ridge then it is going to be a relief area okay so if the option is if the question is asked from the relief areas then if all of the following are the relief area except and if in the option this a residual ridge is given then you have to mark residual ridge because residual ridge is a supporting area relief area we have got the crest of the ridge here crest of the ridge then we have mental foramen then the genial tubercle taurus tori in the mandible which we call it taurus mandibularis in the maxilla the taurus we call it [Music] we have already covered my lovely students see today we have already covered in the maxilla and in the mandible okay so relief area then coming to limiting structures of the mandible see up now we have not covered limiting structures of the maxilla till now right maxilla we have covered the stress bearing area supporting areas and the relief areas so if we talk about relief areas for maxillitis incisive papilla cusped eminence ah and mid palatine roughing now talking about the limiting structures limiting structures for maxilla for mandible and for both maxilla mandible first of all common structures i am going to write so that is the labial vestibule labial freedom starting from labial freedom then we have got labial vestibule then buccal freedom buckle vestibule then in the maxilla we have got hamlet notch we have got four way palette in it and we have got pps area in the mandible one more frenum is extra which is present in the lingual area right here so that is our lingual freedom lingual freenum then we have got alveolingual sulcus then there is a retromolar pad this one white one is the retromolar pad area and the telego mandible or rafi again terigo mandibular ref is also limiting structures don't get confused now there is one more question which is frequently asked which is the number of freenum which are present in maxilla so now we are going to write the number of freenum in the maxilla and in the mandible so in the maxilla if you count have a look we have got one here buccal e right then we have got here one c and one we have got here which is our i so we have got three freedom in the maxilla which is maxilla we have got three right one in the label and two in the buckle one in the labial and two in the buckle if we talk about mandible we have got one labial two buccal and we have got one lingual also the lingual freedom so there are four in the mandible so one in the labial two in the buccal and one in the lingual so number of phrenide is also asked so we have covered now will be covering one by one all the anatomical landmarks i wish you well for your neat exam and you're intelligent you can do this you have the potential to do it you're hard working how do i know instead of watching entertainment videos you choose to invest your time learning and studying with us so without wasting much time let's get back to the topic so talking about the maxilla now the ultimate support for maxillary denture support for maxillary denture is from the palatine bone which is the palate and the palatine process process of the maxilla right of course palatine process is present in the maxilla so the support ultimate support for the maxillary denture is from the palatine bone and the palatal bone and the palatine process of the maxilla talking about buckle freedom in the maxilla so the buccal freedom we have to learn the muscle attachments for the buccal freedom so the buccal freenum is what see buccal freedom we need to give clear we need to clear the buccal phenom because there are muscle attachment to the buccal phenom so there are three muscles attachment which will be studying which is the levator anguli oris oris which is going to attach beneath the freedom the orbicularisaurus which is all over the mouth which pulls the preenum freedom forward and the buccinator and the buccinator which is going to pull the freedom in the backward direction so the levator anguli oris is going to attach beneath the freedom beneath the freedom then the orbicularis oris is going to pull the freedom in the forward direction ok in the forward direction and the buccinator is going to pull the freedom in the backward direction so how do we learn it see for word r orbicularis or s then we have got buccinator b which is the backward so we can learn it orbicularis or is forward and buccinator backward then we are going to talk about the hamlet notch as you can see the hammer notches are in the k here they are they are behind the maxillary tuberosity and the hamular notch and the hamlet notch are basically as you can see they are the soft tissue depressions so there is going to be depression what is the meaning of a notch basically notch means the depression right so they are the depression between the distal surface of the maxillary tuberosity once i erase it you can see here see they are present in the distal surface of the maxillary tuberosity and the hamulus of the televoid plate so hamlet notch is present between the distal surface of the tuberosity tuberosity and the hamulus of the medial pterygoid plate medium therivoid plate the most important thing about hamlet's hammer notch is that it is going to mark the posterior border of the maxillary denture posterior border of the maxillary denture maxillary denture so this is going to be a center of the deepest point center or part of the deepest part of the notch we mark as the posterior palatal seal area so this particular fellow is our hamlet notch which is labeled as k so this is the hamlet notch next one we have is the four-way palette in a four-way palatini if you see here fovea palatini are marked as l these two uh white dots so in the palette suppose here there are two mucosal gland openings so 4v palette any other mucosal gland openings posterior to the heart palette they are posterior to the heart palate and they are not found in every individual they are not present in every individual ok and denture should extend [Music] beyond beyond the see denture should extend beyond the one to two millimeters to the fovea pelleting now if you forget it you can see here denture is going to extend one to two millimeter beyond the fovea palatini if you can look here fovea palatini they are prior to the posterior palatal seal area this is the posterior palatal seal area and they are one to two millimeters they are one to two millimeters beyond the adventure should extend beyond the phobia palatini and they are only used as guideline for pps used as guideline for pps placement so they are present on the soft palate two millimeters behind the vibrating line on the soft palate two millimeters behind the vibrating line right so these are basically mucosal gland openings and then denture should extend this is the distal border of the denture distal border of the denture so the distal border should extend behind the fovea palatini not ah not up front of the fovea palatini but behind the foveopalatini so we have covered hamlet notch phobia palatini now talking about the soft palate soft palate the classification is very very very important for competitive exam point of view and the classification was given by again house so the classification was given by mm house so i am going to draw here this is type one okay this one is type one so this is the junction of the hard and the soft parrot i'm gonna draw right here junction junction of hard palate and soft palate okay this is type one type one wherein we have got more than five millimeter so we have got more than five millimeter area for the retention so the tissue availability i must say for the post dam now post damming is our pps again is also known as post damming so this is ideal for the retention of the denture if there is going to be presence of the soft palate type one then this is the ideal for the retention of the denture then second one we have is the when the soft palate is going like this okay and the area available or the tissue available for pps or the post damming is between one to five millimeter so the tissue availability for the post damming is one to five millimeters and the type three we have is the when the palette is like this and the tissue availability is very less it is less than one millimeter so if the tissue availability is less than one millimeter which is i am so sorry guys which is poor for the retention which is poor for the retention of the denture so the ideal is the type 1 or the class 1 soft palate class 2 is 1 to 5 millimeter of tissue availability class 3 is when there is less than 1 millimeter of tissue availability this is one classification the another classification i can write is when there is going to be horizontal or little muscular movement that means the more area is covered if you see here [Music] okay now you can make out right so if there is going to be more tissue coverage then it is a type one because more than five millimeter of the area tissue is available for the post damming so if it is ok if i say this is the widest pps is recorded in case of class 1 then we have got the class 2 wherein the soft palate is at an angle of somewhere around 45 degrees to the hard palate if i say that in class 3 it is somewhere around 70 degrees to the heart palette so class 3 is seen in the v-shaped palatal vault v-shape palatal vault now the amount of posterior tissue the amount of tissue uh which is available for post damming which i have which i've highlighted here this area right this area one five millimeter more than five millimeter in class one one to five millimeter in class two and class three it is less than five millimeter amount of posterior tissue will give us the pps area so the amount of posterior tissue which is for class one it is more than five millimeter for class two it is one to five millimeter and for class three ah is one less than one millimeter will give us pps area and more the pps area we know that more the pps area more will be the retention of the denture so that's why that's why there is going to be the most retentive soft palate is the class 1 palette for the maxillary denture so talking about the posterior palater seal area posterior palatal seal area we also known at post damming so this is basically the junction it is a soft tissue along the junction of the heart and the soft palate on which we can apply pressure within the physiological limit to aid in the retention of the denture so very important point here in the pps's see pps posterior palatal seal area this is the posterior palatal seal area right so this pps area first of all it is present on the soft tissue right then it is present at the junction of the hard and the soft palate hard palate and the soft palate then on which we can apply pressure because once we study the pps techniques technique of recording pps we are going to trim the cast so we are going to put a little extra resin over there so that means we can apply pressure on which pressure can be applied in within the physiologic limit this is very important can be applied within the physiologic limit to eat in the i'm so sorry guys again to aid in the retention of the denture in the retention of the denture now this aid in the retention of the denture is very important because there are so many functions for pps but all the options which are given to you are an example of the function of the pps but the most important function over here is our the retention of the denture so retention of the denture is the most important function of the pps now talking about the pps again posterior palatal seal area it is a combination of two things one is the post palatal seal plus it is terego maxillary seal let us write it with other color plus maxillary notch or i can say hamlet notch so this is the terry go this particular resort this particular resort there you go maxillary seal ok and this guy over here is our post palatal seal so this is the post parallel seal this particular resort there you go maxillary seal so pps is a combination of terry go post palatal sealant terry maxillary seal or telego maxillary notch or hamlet notch seal i can also write the seal [Music] here we have got palatoglossus muscle so let us draw above which we have got the heart palette and the soft palate suppose this is the heart palette here is the heart palette and this particular fellow is our soft palate so this is the soft palate this is the heart palette this is the heart palette now we have got the soft palate over here okay this is the soft palate now from the soft palate the muscle which is going to the tongue is the palate of glasses glosses means tongue palate means from the palate so arising from the palate going to the tongue is the palate of glosses then we have got up in the cranium base we have got tensor valley palatini and at the other side we have got the levator valley palatine see all this will be covering in the anatomy also so i just want you to remember that tensorville palatini this is the tensor willy palatine which is the most important muscle uh for of the soft palate as it forms the palatine heponeurosis so the tensor valley palatine which is arising from the eustachian tube from the base of the skull attaching the soft palate is our it marks the posterior vibrating line so at the junction of the aponeurosis of tensor valley palatal and the muscular portion of the soft palate so posterior vibrating line very important posterior vibrating line marks the most distal extension of the denture base so if the question is asked what marks the most distal extension of the denture base anterior pps is given anterior vibrating line is given posterior vibrating line is given so you have to mark the posterior vibrating line as it marks the most distal extension of the denture base now what are the functions of posterior palatal seal area or we can say poster damn what is the significance what uh what is the function so very very very important function is to aid in the retention all the options will be given but if retention is given you have to mark retention of the denture also it reduces the gag reflex as there is going to be no gap between the denture base and the soft palate so the denture base and the soft palate that means the pps is so adapted well that there is going to be no space between the denture and the tissues so there is going to be reduced food accommodation accumulation so food cannot go inside because there is no space right so that also will result in patient discomfort so reduced patient discomfort as the posterior end is closely bound to the soft palate tissues so also what happens when we are using the methyl methacrylate the acrylic resin there is going to be shrinkage during the polymerization of the acrylic resin and since we have marked the pps we have made the ppas in the denture so where whenever there is going to be polymerization shrinkage volumetric shrinkage from the resin so that will be compensated by the pps so it also compensates for the volumetric shrinkage during the polymerization of the resin methyl methacrylate okay and it creates a seal a vacuum between the denture and the tissues and most importantly it airs in the retention of the denture which is very important function of the pps so the most important function the most common function is the retention of the denture so whenever we are recording the pps so while recording the pps or we can say post damn right so the patient head should be tilted now imagine see why are we recording this pps so that there is no uh no food which is accumulated between the tissues and the denture right so when the patient is eating the food should not go from behind up in the denture and the tissues so we want to be denture to be retentive when the patient is an expansion so we want the denture should not come out when the patient is eating food how do we eat food does our mouth is parallel to the floor no we slightly bend our head down so whenever see whenever we are eating food we don't eat like this straight right we don't eat like this what we do we slightly bend our mouth like this right while we are eating food so we slightly bend it so the head should be tilted like you have to just now you are listening to the lecture you are sitting you have to just imagine that food is in your hand and you are trying to eat you are going to slightly bend your head down so that is how the ppa should be recorded so the patient head should be tilted downwards like how we eat by the 30 degrees so this is very important point that how we record the pps while recording the pps the head should be tilted downward by 30 degrees so there is going to be tilting of the head right what are the techniques of recording the pps so we have got three techniques one is the conventional technique so the first one is the conventional technique another one is the fluid wax technique and the third one is the arbitrary scraping of the master cast arbitrary scraping of the master cast [Music] so the three technique is the conventional technique the fluid wax arbitrary scraping of the master cast we also call it empirical method so talking about the conventional approach conventional approach is via an instrument known as t burnisher so as you can see this is a t burnisher okay and it has got two ends one is with the ball so this is the ball end of the t burnisher so we do we take a ball end of the t burnisher we go posterior to the tuberosity and until we feel a drop now let us have a look at here here this is the maxillary tuberosity right this whole area so what we do is we take the t burnisher the ball end and we go posterior ball end should be buckley see this ball and of the t burnisher it should be buckley and the other straight end should be palatally so we take the ball end of the tee burnisher and we feel this drop this hamlet notch drop because notch there is a depression right so we feel this depression and we mark it until we feel first of all we take the t burnisher this ball end towards the buckle see for b for ball and b for buckle you can also remember it this way so b for ball and b for buckle so we mark a line with the indelible pencil so with the t burnisher we mark the line the line using an indelible pencil indelible pencil is a pencil which runs on the skin mucosa so we use this pencil to marks mark and through the notch extending three to four millimeters anterior lateral to the tuberosity approximating the mucoin java junction and then we ask the patient to say ah in the short an exaggerated manner and we then mark the posterior vibrating line then we connect both the lines anterior vibrating posterior vibrating then we do the scraping of the master cast scraping of the cast how do we do scraping suppose this is the posterior vibrating line right so in the posterior vibrating line we go one two three from the midline this is posterior vibrating line from in the middle this is the middle suppose in the middle we go one third in the deepest part and then we scrape one to one point five millimeter okay and in the mid palatine rafi in the mid palatine refe area we cannot put more pressure in the mid palatine because we have already studied that mid palatine refa is a relief area so its basically a relief area we cannot go much deep we cannot put more pressure so in the mid palatine area we scrape point five to one millimeter this is the conventional approach then talking about the second one we have is the fluid wax technique also known as physiologic method also known as functional method why physiologic method because this is a physiologic technique of displacing the tissues within the physiological limits why functional method because we are going to take the mouth temperature of axis mouth temperature waxes to record the pps pps what are the waxes which we use you can write wow so white color wax is the iova x okay o is the orange color which is our corrector wax number four so this all these questions can be asked which of the following is a mouth temperature wax which of the following is not a mouth temperature wax yellow yellow white color is h physiologic based ok so fluid wax technique in the pps area we are going to put the wax and the mouth temperature waxes which will be flowable at the room temperature but they are going to set inside the mouth so the white wow you can remember w iowa white orange corrector orange o is there yellow and then physiologic paste so these all three are the mouth temperature waxes which are very important which can be asked in the exam now the glossy if the area is glossy that means there is going to be tissue contact now you need to remember one more thing while when we are doing the border molding if there is going to be the glossy area that means there is no tissue contact but if we are talking about wax in here wax i am going to write wax glossy if it is dull area if it is dull area then it then there is no tissue contact okay and if we talk about in the border molding we take green stick right low fusing green stick it is opposite that means glossy area in the green stick will not record the tissue and dull area will record that means if the area is dull opposite to wax that means if the area is dull there is no tissue contact and if the area is glossy oh sorry if the area is dull that means there is going to be tissue contact if the area is glossy there is no tissue contact for green stick this is for green stick this is for green stick low fusing this one glossy area tissue contact is for waxes so you need to remember both of these points as well okay next one third one we have is the arbitrary scraping of the master cost or we can say empirical method there are so many authors which have given their own scraping width and depths ok so we are going to talk about now arbitrary scraping of the master cast if we look at the three methods conventional method the fluid wax and the arbitrary scraping of the mastercard this arbitrary scraping of the master cast is actually the least acceptable method out of all three the three are conventional method the fluid wax technique and arbitrary scraping of the master cost and once you see suppose this is the maxillary ridge this is also this is also my auxiliary ridge ok this one is our anterior vibrating line and this is our posterior vibrating line now we are going to talk about width how much we are going to scrape from the cast and here we are going to talk about the depth both in the millimeters if they are asking the depth if they are asking the width we know that mid depth means we are going inside in the tissues we are going we are scraping the master cast from the deep inside so when we are talking about depth that means we cannot go in the mid palatine ref area because that is the relief area so the depth in the mid palatine refi is going to be the least then from least we are going to the max for the depth so here 1 then 2 and then 5 in the hamlet area then 2 and 5 if we are talking about width here this was the depth now we are talking about width here okay width we have now width we cannot take c here in the hamlet area the width is low and here the width is maximum right so the lowest is going to be here 2 and two let's write two then we have got six maximum and then in the middle is four so this is the width in the millimeters now guys this is the ridge and this particular fellow is our posterior palatal area ok this is the pps area now scraping of the master cast width if we are going width wise then least in the hammer area if we are going depth wise that means inside how much we are scraping into the depth that means least in the mid palatine area because mid palette and refe is the relief area now this is recording the pps we have covered recording the pps three methods we have covered the conventional the fluid wax and the arbitrary scraping of the master cast which is least acceptable conventional we are using the t burnisher t burnisher fluid wax we are using the mouth temperature waxes mouth temperature waxes to record the pps and then arbitrary scraping of the master cast wherein we are going to scrape the master class now talking about improper pps improper pps it can be the extension that means the we have over extended the denture that means we have gone beyond the pps area that is the extension or if suppose if there is over extension that means we have gone behind or beyond the posterior vibrating line that means over extended and if we are talking about under extended that means we have come close to phobia palatini we have already talked about phobia palatini after phobia palatini there should be minimum of somewhere around to one to two millimeters then the another one is the poster dam that means how much we have scraped that means if we have scraped more scraped more means we have scraped the master cast more that means there is going to be lot of tissue compression because we have increased the area of the pps right so under ex extension again we have got under and over that means suppose if the this is a denture ok suppose if this is the denture of the patient okay this is the denture over extended means i have extended beyond the pps under extension means i have marked behind the pps post damming means we are talking about thickness over here suppose this is the tissue surface of the denture this is the polished surface of the denture so this is the pps right so this is the tissue surface and this is the polished surface ok now if there is going to be the over poster damning that means i have compressed the tissue more under means there is going to be less of the tissue compression so this is over and this particular guy is under this is extension and this is poster damn right so pose damning also under post damning and over poster damning right so first one by one will cover first of all we are going to cover extension so under extension under extension that means the denture the distal extension of the denture is behind it is above the posterior vibrating line that means we are using this happens when we are using the fovea palatini as a landmark as a landmark okay and suppose when you when you are taking impression ah and then patient is having gag reflex so because of that the denture trial basis you have trimmed it so that means you have shortened the length because under extended this is under extended ok that means because of the gagging of the patient you have shortened the distal border of the denture so that is going to be gagging of the patient gagging means the patient is having the feeling of vomiting while recording right and the most common the most common failure of the seal of denture is due to under extension that means when the seal fails that means if the upper denture is not retentive it is falling down again and again so fa causing off the failure of seal that means there is not going to be a retentive maxillary denture there is going to be failure in the breakage in the seal is due to the under extension of our denture so right so this is about the under extension the cause of the failure of c now talking about over extension over extension means you have over extended the distal surface of the denture that means not whole of the denture will not be over extended there are going to be some areas we are talking about some areas are going to be over extended and see very important point is pericoid hamulus should never ever be covered by denture should not never be covered by denture never be covered if it is covered then the patient if covered then the patient will complain of pain during function pain during function and also patient will complain of difficulty in swallowing right so there are two scenario one is when the denture is under extended another one is when the denture is over extended so extension part is done now talking about the poster damming so post damming is when there is going to be under post damning when there is under poster damning so under poster damming means we have not scraped enough the master cost we have scraped the master class less so what happens when the patient opens the mouth wide so wide open mouth we take impression so there is going to be the stretching of the teres mandibular fold wide open mouth and how do we check this post under the under poster damming post damming is pps ok under poster damning is the pps is not marked properly that means the scraping of master cast is less see post damming that means this is the arbitrary scraping of the master cast if we have not instead of going depth we are talking about under means depth is less that means if we are supposed to scrape two millimeters and five millimeter one millimeter like that and we have scraped it very less where we are supposed to go by two millimeters we are not going to millimeters we are going point five millimeter like that okay so under post damming how do we check we take a wet denture we place in the mouth we slowly firmly press it from the mid palatan refi and if you see any bubbles escaping beneath the denture then the denture is under post dam that means checked with checked with wetted denture and if we see bubbles if bubbles escaping or coming out of the denture that means under poster damming is there and how do we correct it correction we scrape the master cast more the master cast and using the fluid wax technique but patient should not open mou open the mouth wide fluid wax technique ok talking about the fourth one which is our over poster damming so over post damning is when there is too much scraping of the master cast right too much scraping of the master cast see when there is too much scraping there is post drumming when there is moderate scraping what will happen then there is going to be the tissue irritation tissue irritation and one more thing i want to tell you if there is too much scraping of the master cast it is going to displace too much of the tissue especially in the terrible maxillary seal area so because of that there is going to be displacement of too much of the tissue because we have scraped it more then there is a compression of the tissue more so there is going to be the displacement of too much tissues and especially which tissue we are talking about here is the terry maxillary seal [Music] we have already covered two parts of the pps one is the terrygo maxillary seal if you can see here we have covered the two parts of the pps one is the post palatal seal and one is the telego maxillary seal so too much scraping is there at the terrarium auxiliary seal and if you remember telego maxillary seal the scraping we are doing is five millimeters and if we are going more than five millimeters then there is going to be over post damming so how do we correct it we reduce the area slightly correction how do we do it we reduce the area slightly because there is going to be thickness of the denture if there is see if there is depression more more marked depression here we have scraped too much that means the master the denture base in this region is going to be thicker so what do we do we want to insert less pressure on the tissues so therefore we are reducing the area slightly and then slightly polish and pumice it what happens if we place pps too deeply too deeply it will result in displacement of the denture anteriorly denture anteriorly okay so we have covered if the pps is too deeply covered there is going to be displacement of the denture anteriorly over post damming is too much scraping under is less scraping let me write once again is under scraping under scraping okay then we have studied extensions the fovea palatini we use as landmark then we have under extended it that is the main cause of the failure of the seal of the denture very important for exam viewpoint see now you have to understand it improper pps can be extension can can be post damning right so it can be extension it can be post damning extension is when there is under extension and over extension post damming is under post damning over post damning right then we have got under extended most common failure over extended when we are go we have gone beyond the pps let me write it when we have gone beyond the posterior vibrating line ok so talking about the mandible mandible we have already covered the supporting areas what are the supporting areas on the mandible very important supporting areas of the mandible are very important we have covered shelf area or in the option if buccal shelf area is not given if there is external oblique given right so buckle shelf area we know that this particular area is the buckle shelf area okay as you can see here this is the buckleshalf area so the buccal shelf area is between the buckle freedom as you can see here it is between the buckle freedom and between the anterior border of the meseta muscle so the buccal shelf area now this is a supporting structure that means there is going to be we can put pressures on it right so there is going to be increase all other rest most of the things will decrease in size when there is a resorption of the ridge mandibular is option we know that mandible there is more resorption right so buckle shelf area is increased in resorption it is so surprising that most of mostly what happens is with the increase in the resorption rest of the things shrunken down right but increase in the resorption there is going to be increase in the buccal shelf area so buckle shelf area is the supporting area it is going to take up all the loads take up all the occlusal forces because it lies perpendicular to the occlusal forces and if we talk about average mandible average mandible it is four to six millimeters and if we talk about narrow mandible then it is two to three millimeter wide so there is going to be large nutrient canals present intact cortical plate and also one more thing i would i would like to add is the buccinator muscle buccinator muscle whenever we are talking about buckle areas we will be talking about the buccinator muscle so you can remember b for buckle b for b u b u double c b u double c buccinator now the because of the muscle attachment there is reduced resorption and this is the reason that it is a supporting area because there is going to be muscle attachment and because of that there is going to be lesser absorption but when ridge is flat when the crest of the ridge is almost flat then the buccinator ah then this buccal shelf area is almost attached to the crest of the ridge that means buccinator is almost attached to the crest of the ridge but you will be telling mambuccinator muscle is attached to the buccal shelf area then why are we covering it because this muscle is inactive therefore we can cover it by the denture okay so this is about the buccal shelf area and if we talk about the buccal shelf area this if you can see here let me again draw it see this is the buccal shelf area okay okay let's see this is the ridge i am drawing it from the this side this is the ridge this particular area is the buckle shelf area right here as you can see here we have zoomed in this section is the buccal shelf area now buckle shelf area is surrounded measly by the rich crest of the ridge okay laterally by the external obliques don't have to write this externally by the medially by the ridge rest of the ridge then distilling that means we are talking about if this is the buckle shelf area distally there is going to be the presence of retromolar pad as you can see distal there is going to be retromolar pad so distal to buccal shelf area there is going to be retromolar pad as you can see here distal to it is the retromolar pad which is the pier shaped pad then laterally we have got external oblique range okay second one this is the first supporting area the second supporting area we have is the residual alveolar ridge right crest of the ridge in the mandible is a relief area crest of the ridge in the maxillary is a supporting as well as it is a secondary stress bearing area right so now talking about the relief areas relief areas relief areas we have got crest of the ridge we have already covered this mental foramen genial tubercle and tori and taurus mandibularis now we have covered that the right if present in the maxilla torus platinus is can be relieved by the denture by the tinfoil spacer or can be surgically removed but tori in the mandible it should be surgically removed before starting with the impression procedure surgically removed right now external oblique ridge if in the option external supporting areas question has been asked and there is going to be ah the external oblique ridge also given that external oblique ridge can be also act as a supporting area this is a smooth ridge which is present on the buccal surface which is extending from the anterior border of the ramus and forward till the foramen area now talking about the limiting structures in the mandible [Music] so limiting structures we have got the labial freedom labial labial freedom is present in the maxilla as well as in the mandible also so labial freedom is same as the maxilla but here it is active so labial freedom is active in case of mandible ok limiting structures let me write mandible ok then there is going to be the muscle attachment which is orbicularis oris cumulative oris also there can be inserious missile now this labial freedom it is sensitive it is active and it get narrowed that means decrease in the size when the patient opens the mouth so it get narrowed on wide opening right then there is a lingual freedom which is present in the lingual area then we have got the retromolar pad which is very important which is a peer shaped pad so retro molar pad as you can see here it is a pier shaped pad pear shaped like this this is our retromolar pad so which is known as pier shape pad because the shape is pier now this peer shape pad name was given by credock retromolar pad on the other hand was given by psycher so the peer shaped pad term was given by kredoc and the retromolar pair was given by psycher and if the question has been asked that peer shaped path do not get confused with the retromolar pad because retro mode are pad by cycle and pier shape pad by credoc now what are the insertion muscle insertions if you look at this is a retromolar pad suppose this is a retromolar pad right pear shaped pad which is here we have got the this is the crest of the ridge now crest of the ridge posteriorly is the tendon of temporalis laterally is the buccinator as we know that towards the cheek is always buccinator so suppose this is the buccal area this is the lingual and here we are going to have the tongue right so tongue is going to be here like this right so this is the area of the tongue and buckley we have buccinator so b for buccinator b for buckle remember this so laterally we have got buccinator and if we talk about medially that means towards the midline that means towards the tongue so we will have the pharynx right so the laterally is the buccinator and medially is the terego mandibular refe terigo mandibular repha and superior constrictor of pharynx because medially we will have pharynx and superior constrictor pharynx so if the question is asked which of the following muscle is not an insertion for the retromolar pad so if the option which is out of these four temporalis buccinator terrible mandibular refe and the superior constrictor of pharynx will be the option so the muscle attachment is again very important question and another one we have is the main objective of the retromolar pad is the retention so main objective is the retention so retromolar pad helps in the retention of the mandibular denture so this is the again one of the question that can be asked right so what is ah we are talking about the retromolar pad right so this aids in also the stability of the denture also the retention of the denture but if the option is retention of the denture then this should be marked also help in the stability of the denture because it is resisting the movement of the denture base right because distal end of the denture is covering now two third and distal end of the denture should cover two third of the retromolar pad so that means this is going to be the insertion of the denture distal end of the denture let us mark it from some other color so this is going to be the distillate distal end of the denture as we know that distillate of the denture is on covers the two third of the retromolar pad right so this is the retromolar pad now if we talk about myelohyoid space so this particular space this particular space is the retromyelohyde space retro myelohyde space which is distilled to the alveolingual sulcus so this particular part is the alveolingual sulcus right this is the alveolingual sulcus which is lingually so this particular part is the alveoli lingual sulcus and distal to it is our retro myelohyde space so talking about retro myelohyde space retro myelohyde space is distal to the lingual sulcus and retro myelo height space let us just draw one more diagram over here in order to understand it better suppose these are the two premolars we are talking about denture this is the molar right so suppose this is the distal extension of the denture so this is the distal extension of the denture right so retromyelohyde space is will be covering this particular part this particular part right this is the retromyeloheart space now retro myeloheight space is bounded medially by medially means towards the midline and if we see towards the midline is our tongue so soft palatal palatal region so that is the anterior tonsillar pillar anterior tonsillar pillar then we have got posteriorly what is posteriorly posteriorly is our retromyelohyde curtain retro milo hyoid curtain now understand this that first of all we have got retromalohat space and behind this space or i can say posterior to this space is the retromylar retro myeloid carton and posterior to retro myeloid hydrocarton is the retro myelohyde fossa right so retromylo had carton and posterior to it posterior to it is the retro milo higher fosa right let's talk let's talk about once more so first of all we have got the retromylohide space which is posterior to the alveolingual sulcus so this is the this particular is the alveolingual circus then we have got one second so guys this is our retro mi this is alveolingual sulcus posterior to it is the retromyelohyde space and posterior to the retromylo height space is the retromyelohyde curtain and posterior to the retromyelohyde curtain is the retromyelohyde fossa right so we have talked about medially posteriorly then laterally laterally means buckle area towards the buckle area we have got the mandible so laterally we have got the mandible and the telego mandibular refe terego mandibular referee which is the tendinous insertion of superior constrictor pharynx and the buccinator we know that buckley laterally means buckley two or buccally is always going to be the super buccinator and also um this terego mandibular refe it arises from the hamular process of the medial pterygoid and get attached to the myelohyde ridge so anteriorly we have lingual tuberosity of mandible tuberosity of mandible and posteriorly i mean sorry inferiorly inferiorly inferiorly we have got myelohyde muscle that means inferior to it milo hired muscle now we have all uh studied this in the surgery suppose this is the mandible this part is the ramus so this is the mandible here we have got myelohyde muscle so this is the myelohyde muscle myelohyde muscle then here we have got sublingual ground above this we have got sublingual gland above to the myelohead muscle and below to the myelohyde muscle we have submandibular gland right submandibular gland so guys the myelohead myelohyde muscle above this we have got sublingual gland and below this we have got submandibular gland right now talking about the retromyelohyde fossa retro myelohyoid fossa we have already covered that first of all is the alveolingual sulcus posterior to the alveoli sulcus is our posterior to the alveolar surfaces are retro myelohyde space this is the retromylohide space posterior to the retromyelohyde space we have retro myo hydride curtain and posterior to the retromyelohyde curtain we have got retro myelohyde fosa so the retromyelohyoid fosa is the lateral thought form is the lateral throat form right so this is the lateral thought form which is also known as the lateral thought form so lateral thought form is this particular part one second so this particular part is our ok one second this particular part this particular part is going to be the lateral throat form so how deep it is again we have to draw it again suppose these are the premolars then we have got molars then we have got molars now this is the distal extension of the board this distal part of the denture right so this is the distal part of the denture and this distal part of the denture is the lateral thought form which lies in the retro myoware have hired fosa that is why we also call it the lateral thought form now how this lateral thought form is now class 1 if we talk about which is the deep one so class one is going to be like this this is class one so class one is the ideal lateral throat form or ideal retromylo hydrofosa which can accommodate a long and wide flange area flange then we have got two which is the moderate one so this particular fellow is the two which is the moderate to so which is the moderate half as half long and narrow as class 1 and twice long and narrow as class 3 so coming to the third one which is the shallow lateral thought form so shallow lateral thought form the broad ends are two to three millimeters below the milo hydrogen so this is the minimum length thickness so guys this is the class three okay so this is the class 3 which is the shallow so this is the border ends two to three millimeter below the myelo hydrangea myelohydridge and this is the minimum length thickness so now talking about albiolingual sulcus albio lingual sulcus okay one more thing i wanted to tell you about the myelohyde muscle is that see if we talk about the hired muscle now this myelohyde muscle let me write it here again myelohyoid muscle what happens this myelohyde muscle when we are swallowing so because since it is present uh in the base of the floor of the mouth so what happens while during the swallowing this myelohyde muscle contracts and when this muscle contracts it raises the floor of the mouth raises the floor of the mouth now what happens when it raises the floor of the mouth therefore when the denture is over extended in the lingual flange area so if suppose if the denture is extending and are going deep into the myelohyde muscle then there is going to be the displacement of the denture because this myelohyde muscle contraction is going to raise the floor of the mouth and if this is if the denture is overextended overextended what will happen it will push it will raise the floor of the mouth and it will displace the denture by raising the floor of the mouth because of the contraction of the muscle of myelohyde and causing the soreness due to the vertical forces right so when this myelohead muscle is contracted the denture flange must be parallel to the parallel to the myelohyde muscle right so talking about alveolingual sulcus we were at algolingual sulcus but before we proceed with the alveolingual cell curse let's see what is mesetric notch so basically mesetic notch is recorded mysitric notch is recorded somewhere here okay let me write it mesatrick notch so mesetric notch is due to the first of all where it is attached buckle to the crest of the mandibular ridge and the retromylo lateral molar pad in the dystopical corner so it is formed by the action of mesetter on the buccinator action of mesetra on the buccinator and it is recorded in the mandibular impression so talking about alveolingual sulcus now this is the alveolingual sulcus right this particular part is the alveoli angle sulcus so whole of this area is the alveoli angular sulcus so posteriorly it is the lateral thought form if we talk about the posterior part of the alveolar sulcus posterior part is known as the lateral throat form lateral throat form so we have got three regions of the albiolingual sulcus anterior region which is from the lingual phrenum from the lingual frenum up to the pre myelohyde fosa [Music] then we have got the middle portion which is from the pre myelohyde fosa to the distal end of the myelohydridge and the third one is the posterior region so posterior region is our lateral thought form so posterior region of the alveolingual sulcus is the lateral thought form which is also known as retromylohyde fosa which we have just now covered which is also known as retro myelohyoid fosa right so this is the posterior part of the alveolingual sulcus now the denture flange in this area particularly forms a typical s shape typical s form of the lingual flange lingual flange of lower denture right now in the people with the knife edge ridge suppose if the person is having a knife edge ridge knife edge rich people there should be a broad surface area because we want to distribute the forces so broad or the large surface area that should be covered by the denture to distribute the occlusion load large surface area right then there is no suction in the mandibular denture like maxillary denture there is a retention while we are taking secondary impression we get a very good retention in the maxilla but we do not get in the mandible so retention in the mandible adventure it actually depend upon the maximal bone coverage that means we have to include a large surface area so that depend on the maximal bone coverage right see maxillary denture what happens if there is a good peripheral seal if we have recorded pps well if we have recorded pps well then there is going to be good retention but in case of mandibular denture while we are taking impression of a resolved ridge we hardly get the suction we hardly get the good retention we hardly get the peripheral seed so in that case the retention of the mandibular denture is actually retention depends on the maximal bone coverage right so it basically depend on the stability snowshoe effect right so large surface area should be covered so the retromolar area should be covered retromolar area should be covered because we want to include the large surface area in order to get a stability in order to get a retention in the mandibular denture so the retromolar area should be covered otherwise what will happen otherwise there is going to be resorption of the ridge and there is going to be otherwise let me write it otherwise ridge resorption and otherwise poor stability will also be there right so the most important factor most important factor for the retention is what most important factor for the retention is the peripheral seal right and secondary peripheral seal secondary ok and secondary peripheral seal is for the mandible denture is the anterior lingual border so apart from retromolar area first thing is retention is due to the in the mandible is due to the retromolar area retromolar pad which is going to provide the primary peripheral seal and the secondary peripheral seal is due to the anterior lingual border of the denture right and retention for the maxillary if we talk about retention for the maxillary is due to interfacial surface tension interfacial surface tension right so one more thing one more important thing is that if the saliva is even and thin if the saliva is if the saliva is thin and even then there is going to be perfect adaptation so retention will come and the denture base we are talking about good retention right let me write good here good retention one is the saliva should be even and thin another one is the denture should cover large surface area so that the occlusal forces are distributed well and the stability good stability will come large surface area so closeness to the denture to the soft tissues is due to the improved capillary action right so the adaptation good adaptation is due to capillary action and one more very important point very important point thick pasty saliva is due to sympathetic innervation sympathetic stimulation and excessive ropey saliva excessive roping thick rupee see both we are talking about thick here thick pasty saliva is due to sympathetic and thick ropey i'm sorry thick pasty saliva is due to sympathetic and watery saliva is due to parasympathetic due to parasympathetic stimulation and if we talk about excessive if we talk about excessive saliva excessive thick ropey saliva or if there is even lack of saliva an another term can be used as the zero stomach the patient is having zero stomia if there is too much saliva too much ropey thick saliva or if saliva is not present both the cases there is going to be decrease in the retention of the denture right so thin mucosa can be present in the maxilla can be present in the mandible if we are talking about in the maxilla if we talk about in the mandible in the in the maxilla thin mucosa in can be in the region of taurus platinus paletinus and mid palette in raphael and if we talk about in the mandible it can be due to mandibular tauri or the myelohyde area right now talking about the tongue will be covering two classifications in the tongue one is going to be the tongue size another one is the position of the tongue the tongue size will be covering the house classification the position will be covering the rights classification right so starting with the tongue size classification so the house classification on the tongue size on the tongue size so class one is the normal tongue wherein there is going to be normal development normal function and sufficient teeth are present teeth are present class 2 is going to be what happens in class 2 if you have seen any elder individual older adult who is not wearing teeth who's been edentulous for quite some time so when the teeth are absent for a long period of time then you know what the tongue tries to sit in the hole of the oral cavity because there is no restriction from the teeth right so when the teeth are absent when the teeth are absent from a long duration from a long time right so there is going to be change in the form and the function of the tongue change in the form and function of the tongue now class 3 is when there is actually excessive large tongue what happens when there is going to be a large tongue this large tongue will cause the poor denture stability it will not let the denture sit it will not let the denture be stable in the mouth right so next one is our right classification which is based on the position of the tongue so how the tongue is positioned tongue position ok so class 1 again it has got three classes class one is what happens suppose this is the this is a mandibular teeth okay so what happens in class one when the tongue lies normally in the floor of the mouth is the class one ok so when the tongue is actually this is our tongue this is the class one when the tongue lies in the floor of the mouth it is the ideal class one is usually ideal so it is the ideal position when tongue lies in the floor of the mouth so slightly below the incisal edges slightly as you can see slightly below the incisal edges of the mandible or anterior coming to class 2 class 2 is when the tongue is flat and broad broad but what happens tip is a normal position normal position so the positioning of tongue is still normal coming to class 3 right classification based on the tongue position what happens in class 3 this is the lower anterior suppose so class 3 is when the tip of the tongue is actually curled so in the in case of class 3 you will find that tip of the tongue is actually curled upwards so this is a class three tongue is retracted retracted depressed in the floor of the mouth depressed in the floor of the mouth and the tip is curled upward curled upwards so we have covered two classifications for the tongue one is the based on the how the tongue size which is the house classification tongue position which is the right classification so house classification tongue size tongue size we have covered ah class one is the normal and class one for right also is the ideal term so one is the tongue size another one is the tongue position now that we have covered the hiding points in the case history let us go through the impressions and the impression the first impression we take is the diagnostic impression and after that if any pre-prosthetic surgery is required then we go for pre-prosthetic surgery and after that we take the primary impression right so primary impression is taken with the help of a stock tray stock tray is a pre-formed tray it can be of steel can be of plastic so primary impression the clearance between the impression and the tray so suppose this is the tissue surface while we are placing a tray over here right so this is a tree the prime space between the this is the tissue surface then we have got the tray right so between the space or the clearance between the primary impression i mean sorry between the stock tray and the ridge is usually five millimeters right so the clearance between the ridge and the stock tray see you have to read the question carefully if the question is asked between the ridge and the stock tray then it is stock tray then it is six millimeter i mean minimum of five it is six six millimeter minimum it should be five right and for alginate this clearances three millimeters so primary impression ah the materials in case of complete denture we use that impression compound impression compound which is usually used for an ideal ridge that is a well defined ridge then alginate in case of deep undercuts in case of undercuts and impression plaster impression plaster in case of flabbit issues case of flabber tissues right so these all are the material which we use for taking primary impression now coming to the theories of impression we have got theories of impression three theories muco compressive varin while taking the impression muco means mucosa compressive means we are putting pressure on the mucosa the second one is the mucostatic static means there is no pressure which is applied muco means on the mucosa because since there is no pressure which is applied so it is also known as passive impression the third one we have is the selective pressure technique or selective pressure theory selective pressure as the name suggests selectively we are putting pressure so pressure in the stress bearing areas and relief in the relief areas so the first one we have is the muco compressive muco compressive as the name suggests we are going to compress the mucosal tissues and it was given by karl jones now you can remember it c for compressive and c for card so it is in form of functional and displaced form because since we are applying pressure so the mucosa or the soft tissues are displaced in this then the material which is used for the muco compressive technique so the materials are impression compound [Music] right which is the most important and we have got waxes then soft liners then also elastomers then zoe paste right next coming to second one is the mucostatic mucostatic also known as passive impression and as the name suggests muco means mucosa static means there is no pressure which is applied and that is the reason that it is also known as the passive impression and it was first proposed by richardson and popularized by henry page so you can remember it p for passive and p for page then there is no border molding which is required for mucostatic because we are not putting pressures since we are not putting pressures so an oversized tray is used so oversized tray is used right then the impression is taken in the relaxed state relax state now one more thing which i want to tell you is that which i forgot to tell you in the muco compressive what happens since we are putting pressure on the tissues right in muco compressive we are compressing the tissue since we are compressing the tissue so there is a constant pressure and because of this constant pressure which is applied on the tissue because of that there is going to be increase in the ridge resorption right so there is going to be increase in the residual resorption in case of muco compressive talking about mucostatic since there is no pressure we are taking impression in the relaxed state and because of that there is going to be the poor peripheral seal and because of the poor peripheral seal because the seal proper seal is not provided because of poor piracy the prime this peripheral seal is the main component of retention right so the primary retention is due to the peripheral seal and secondary we have talked about the anterior lingual right so the if there is not proper peripheral seal if there is a poor peripheral seal because of that there is going to be the poor retention of the denture but on the other hand in the mucostatic there is going to be the poor retention but on the same way on the same side there is going to be good stability so in though the retention is poor for mucostatic or the passive impression but the stability is good and the example for this is the impression plaster which we use for recording the flabby tissues impression plaster this is same like a gypsum product so beta hemihydrate crystals same like how we mix the plaster of paris the same way we mix it so coming to the third one we have is the selective pressure technique in the selective pressure theory there is going to be the pressure which is applied in the selective area right as the name suggests applying pressure selectively so pressure in the stress bearing area and non pressure or we are giving relief in the non-stick in the relief areas or non-stress bearing areas leaf areas so that is the mid palatine referee usually so the material of choice for selective pressure technique is zinc oxide eugenol impression place impression paste or the medium body elastomers medium body elastomers right so this selective pressure technique we are putting pressure selectively everywhere on the whole of the ridge pressure is not uniform we are putting pressure on the stress bearing area we have covered in the anatomy non pressure in the relief area that also we have covered in the anatomy the selective pressure theory was introduced by wilson and advocated by voucher in 1943 ah and introduced by wilson in 1920 so this is about the impression theories we have covered muco compressive carl jones cc is there mucostatic which is the passive impression then page and then selective impression by the voucher which is the complete denture book which we all know so what happens when we are taking too large tray so first of all we check this tray size in the patient what happens when we are not checking the tray size and or we do not know how to check the tray size and we are taking impression so if there is a too large tray we take what happens there is going to be the distortion there is going to be distortion of the tissues around the border of the impression distortion of the tissues around the borders of the impression because the tray is too large definitely the borders are going to get distorted right so borders of the impression what happens if the tray is too small what happens if the tray is too small then the tissues will not get recorded why if the tissues will not get recorded because the border tissue will collapse border tissues will collapse inward inside because the tray is small into the ridge into the ridge and because of that there is going to be reduced support of the denture so if the tray is large then there is going to be distortion around the borders because tray is large border will not get will not correctly or accurately recorded if the tray is small the border tissues will collapse inward into the residual ridge and there is going to be reduction in the support of the denture since we are talking about the materials impression materials lets talk little bit about the materials even though will be covering impression materials in the dental material in detail but the impression materials are classified majorly into two groups so the impression materials are classified in inelastic and we have got the elastic impression materials right so inelastic impression inelastic impression as the name suggests in elastic they are not elastic so the impression material become rigid and it get fractured or even it get distorted when it is removed from the undercuts so they are not compressing the tissue so inelastic materials can be um impression plaster also it can be zoe so all the mucostatic impression materials will come under inelastic elastic means the tissues are the impression is elastic so it is going to be the muco compressive kind that is the elastomers so all the elastomers right like polysulfide polysulfide then we have got condensation silicon then we have got additional silicon then we have got polyether so all the elastomers will come under elastic impression materials right so all these poly sulphide condensation silicon addition silicon they are hydrophobic rest of the elastomer we left with only one which is the polyether which is the hydrophilic hydrophilic so hydrophobic means it is going to repel the water if we are pouring the cast there may be bubbles which can come so for that we are adding surfactant surfactant is added to hydrophobic hydrophobic materials so that the bubbles won't come and in fact the disinfection of the hydrocolloid is also again asked disinfect disinfection of hydrocolloids hydrocolloids we have got reversible irreversible uh reversible hydrocolloid is the agar agar irreversible hydrocolloid we have is the alginate so we disinfect wire 1 is to 10 dilution of the bleach which is the household bleach or we can use the ido4 or even phenols can be used but remember that when we are using these things it should be time should be less than 10 minutes it should not exceed more than 10 minutes that we know now talking about impression plaster impression plaster is as we know it is a kind of a gypsum product type one we have we will cover in the dental materials that gypsum product are classified into five types so impression plaster is the type one or a gypsum product so impression plaster is the type of gypsum product now what happens because cast is also made up of gypsum product impression is also made up of gypsum product so in the impression plaster there is something known as potato starch which is added so what happens this potato starch will uh like separate the cast from the impression for separation of caste from impression right in the hot water bowl we are going to put the impression plaster the starch in the impression plaster swells up and breaks the impression and thereby we separate the impression from the cast then also we have got impression compound impression compound which is our reversible thermoplastic material that means we require water so the water bath temperature is 64 degree celsius then the technique is wet kneading that means we put it in the water bowl and then like a dough how we mix a dough like that we mix it so more talking more about little bit more about the impression what are the objectives of impression so the objectives of impression is retention stability support and the preservation of the structures that's it very simple objectives right so the objective is retention retention is the resistance to the displacement away from the tissue surface so it is a mucosa bone phenomena it goes on bond phenomena so it is resistance of displacement resistance to displacement away from the tissue surface right then we have got support second one we have is the support so support is when we are talking about resistance to the occlusal forces occlusal forces right in the vertical direction so this is a bone bond phenomena or we can say snowshoe effect that means that means more the surface area less is the load right how we walk in the snow while during snow how we walk is uh large surface area right so that gives us support third one we have is the stability so stability is the resistance to the lateral forces lateral shifting or the anterior posterior shifting then the last one is the preservation of the remaining structures remaining structures then very important points that can be asked is again the atmospheric pressure this is a straight away point atmospheric pressure or also known as emergency retention force emergency retentive force which is going to hold up the maxillary denture right or the temporary restraining forces temporary re-straining forces so this is 14.7 lb per square inch right very important this has been asked couple of times in different exams so the atmospheric pressure is 14.7 lb per square inch also we have got a couple of things with the number 14 so 14 centimeter square is the mean denture base area for the edentulous mandible right then we have got weight of atmospheric pressure which is also 14 so 14 just now we have covered 14.7 lb per square inch which is our atmospheric pressure so weight of atmospheric pressure so we have got two things to remember for from fourteen one is the main denture surface area the mean denture base area for the mandible and another one is another one is the weight of the atmospheric pressure this is about the mandible the edentulous area main denture base area for the mandible is 14 centimeter square what about the mean denture base area area for edentulous maxilla it is twenty four see very easy to remember twenty four centimeter square so for the mandible it is fourteen and for maxillitis twenty four so guys we'll cover the seed into three parts of from second part will be starting from the residual ridge resorption and the jaw relation and articulation and the third part will cover rest of the cd so let's just revise whatever we have covered till now so we have covered case history in the case history first of all steps are not that important so clinical steps and the lab steps you know that types of four type of patient ideally moderately substantially compromise severely compromised mental attitude is again important so we have got the philosophical which is the ideal attitude of the patient and exacting where the patient find fault he want exact treatment hysterical bad previous experiences makes the patient hysterical attitude indifferent because of the family pressure the patient has come to the dentist the attitude is different again revised mm house classification ideal submitter reluctant indifferent resistant shape of the palatal wall u-shaped parallel wall which is the most favorable then flat palatal wall which is going to resist the downward but it is going to produce the dislodged rotational or lateral movements or forces all right and v-shaped parallel wall which is the least favorable right which is not good for the retention of the denture then bony undercut maxilla either it can be relieved or we have to remove it surgically if it is present in the anterior ridge area or if it is present lateral to the maxillary tuberosity then it can be relieved in the denture and if it is relieved into the denture it is going to provide the primary support that means we have talked about firm and bony swellings they are going to give the primary support so the maxilla it is it can be relieved or surgically but if we talk about in the mandible we have to surgically remove it so there is no other way out we have to surgically remove the bony undercuts that are present in the mandible again same goes for the torai if the torah is present in the mandible it has to be removed there is no other way out then we can keep it in the maxilla we can keep it or we can remove it when we have to remove it if it is extending till the pps area if it is interfering with the speech or if it is causing the poor denture stability right and then uh teri is present in the maxilla in the middle of the heart palette in the mandible and the lingual side of the premolars then the last tuberosity again bony and firm swelling if it is present then the stability it is going to provide the primary stability to the denture coming to anatomical landmarks maxillary stress bearing area primary and secondary primary we have got all the slopes so the primary why do we call it primary stress bearing area because there is going to be least resorption and it is seen in the horizontal slopes of the heart palette all the slopes and the posterior lateral slope of the residual ridge secondary we have got three things crest of the residual ridge rugged and the maxillary tuberosity then coming to the supporting areas we have got heart palate rugged posterior lateral slopes maxillary tuberosity and the relief areas when we are not supposed to put pressure by the denture these are the incisive papilla then we have got the cusped eminence and the mid palatine rafi then the next one is the number of freenum which are present in the maxilla there are three in the mandible there are four then coming to mandible support area is the buccal shelf area and the residual ridge area right so the buckle shelf area again very important then relief areas we have got the crest of the ridge mental forum and genealogy worker taurus mandibularis limiting structures both in the maxilla mandible are the labial phenom labial vegetable buckling buccal vegetable and in the maxilla hamlet notch phobia palette and pbs and the mandibular lingual freedom alveoli lingual sulcus retromolar pad and terrible mandibular refe support to the maxilla is usually by the palatine bone and the pelton process of the maxilla buckle freenum is uh going to do the the buccal freedom is pulled for in a forward direction by the orbicularis or s r r i am sorry r r you have to remember right and buccinator backward pull bb then we have got the hammer notch hamlet notch is the notch or the depression present distal to the tuberosity so distal part here and it is going to mark the posterior border of the denture maxillary denture so fovea palatini these are the mucosal gland openings which are present posterior to the heart palette and the denture should extend beyond one to two millimeter to the phobia palatine that means denture should will end behind the fovea paletoni then we have studied the classification of the soft palate ideal type one which is more than five millimeter which is almost the horizontal then we have got the one to five millimeters which is the type two and the angle is 45 degree type 3 which is poor for the retention and less than 1 millimeter of the tissue support is there then amount of post posterior tissue will give us the pps area more the ppis area more is the retention pps area is classified into two types i mean it is composed of two parts the posterior palatal seal area and the terego maxillary notch or the telego maxillary seal area or the hamlet notch the vibrating line anterior vibrating line which is cupid bow shape and we have also studied that the two method to measure the anterior vibrating line will silva manure or are in a short vigorous manner or short victories burst ah is so posterior vibrating line it is ah in an exaggerated manner so we have covered that posterior vibrating line the most distal extension of the denture base is marked by the posterior vibrating line pps post damp which is very important for the retention point of view and while recording the pps the head of the patient should be tilted downward by 30 degree then we have studied the technique of recording the pps conventional fluid wax and arbitrary scraping of the master cast conventional approach with the help of a tea burnisher fluid wax technique with the help of mouth temperature waxes in the in that we have the mouth temperature waxes such as io of x corrective x number four and hl physiologic paste then the glossy surface in the wax shows the tissue contact on the other hand in the green stick the glossy surface show no tissue contact so arbitrary scraping of the master cast width and depth so ah width is going to be most uh least in the hamlet notch area and most is distal to the mid palatine raphe and depth is going to be least inside the least is going to be mid pallet and refe because we cannot put pressure on the mid palatine raphe and it is going to be most in the hamlet notch area then there is improper pps the most common cause of the failure of seal is due to the under extension of the pps or the post dam right then we have studied the under or over post damming then mandible buckle shelf area we have studied which is the supporting area relief areas limiting structures we have studied about the retromolar pad area and the main objective is to provide the retention and we cover till the two third of the retromolar pad area and we have also studied the muscles attachment right then we have studied the retro myelohyde space and retro myelohyde space myelohyde muscle when the it contracts it raises the floor of the mouth so whenever we are marking the distal border of the denture it should not be over extended otherwise the patient will have difficulty in swallowing and patient will complain of pain then we have studied the retromylo head fossa or the lateral throat from three kinds of lateral thought from alveolingual sulcus and the alveoli angle circuit posterior border is the lateral thought form itself which is the retromylo height fossa which is s in shape then the retention of the mandibular denture is due to the maximal bone coverage which is the stability the most important factor for the retention is the peripheral seal right then we have studied the thick see we have studied the excessive thick ruby saliva or lack of saliva will reduce the retention of the denture right then we have studied the classification of the tongue based on the size and based on the position then we have studied the clearance between the ridge and the stock is six millimeters theories of impression cc muco compressive carl jones muco static passive impression page and selective pressure theory by the voucher and we have studied the impression materials little bit impression materials will cover in the dental material also objectives of impression atmospheric pressure which is 14 and which is the main denture base area for the edangelous mandible is also 14 centimeter square while for maxilla it is 24 centimeters square so that is about the part one of the complete denture express revision i hope that you guys are benefited from the videos you guys uh get good marks i know that you are going to score well in your exams and you have understood it so if there is anything way i can help you out feel free to comment in the comment section below with your preparation i'll do my best to help you out for your exam preparation all the best to you and the continuation video will be published in the you can check out in the playlist you will find in the playlist so guys all the best prepare well see you soon take care bye