posterior palatal seal prostho 1 [edocfind.com][1]11
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POSTERIOR
PALATAL SEAL
SUBMITTED BY:
ANKUR GUPTA
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Definition
Function
Anatomic consideration
Physiologic consideration
Vibrating line Classification of soft palate
Techniques
Errors in recording PPS Summary
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DEFINITION
It is a soft tissue along the junctionof hard & soft palate on which pressure
with in the physiologic limit on thetissue can be applied by denture to aidthe retention of the denture. (GPT)
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The peripheral seal of maxillary dentureis a area of contact between the mucosa
& peripheral polished surface of thedenture base, the seal prevent passageof air between denture & tissue.
Retention stability of a denture isachieved from adhesion, cohesion &interfacial surface tension that resist
the dislodging forces that actperpendicular to the denture base.
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FUNCTION OF PPS
Stability
Prevention & retention
Compressibility Comfort
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STABILITY:The main function of PPSis to maintain contact with the anteriorportion of the soft palate ( the tissueunder go shallow displacement ) duringfunctional movement of the
somatognathic system ( that ismastication, deglutination & phonation)therefore the main purpose of PPS is
the retention of maxillary denture.
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PREVENTION :It also reduce gagreflex as there is no separationbetween denture base & soft palateduring normal functional movement.
COMPRESSIBILITY :It also reduce
food accumulation beneath theposterior aspect of denture owing toproper utilization of tissue
compressibility.
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COMFORT : reduce patient discomfortcontact occur between dorsum of thetongue & posterior end of denture base.
The correctly placed PPS creates apartial vaccum beneath the maxillarly
denture , this partial vaccum isactivated only one horizontal tippingforces act is very small & hence produce
no irreversible alternation of theunderlying mucosa.
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This pterygomaxillary notch is coveredby pterygomandibular fold which extendfrom the posterir aspect of thetuberocity posterio-inferiorly to insertinto the retromolar pad.
This fold of tissue influence theposterior border seal if the mouth iswide open position during the finalimpression process.
Hamular notch should never be coveredby denture as only covered by thin layerof mucous membrane.
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Fovea palatina are two glandular openingwithin the tissue posterior of hardpalate lying on the either side ofmidline.
Fovea palatina should be used only as a
guideline for the placement of posteriorpalatal seal.
Medial palatal raphe which overlies
medial palatal suture contain little orsubmucosa & will tolerate little or nocompression .
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VIBRATING LINE
The imaginary line acrossthe posterior part of thepalate marking the divisionbetween the movable &
immovable tissue of thesoft palate which can beidentified when the movabletissue are moving. (GPT)
Anterior vibrating line Posterior vibrating line
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ANTERIORVIBRATING LINE
It is an imaginaryline lying at the
junction betweenthe immovabletissues over thehard palate & the
slightly movabletissue of thesoft palate-GPT.
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METHOD OF LOCATINGA.V.L.
Instructing the patient to say AH withshort vigorous bursts due to projection
of the posterior nasal spine. Theanterior vibrating line is not a straightline between both hamular process.
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POSTERIORVIBRATING LINE
Itisanimaginarylineas junctionoftheaponeurosisoftensor vilipalatinimusclesinthemuscularportionofthe
softpalate.-S. Winkler.Itrepresentdemarcation between
thepartofsoftpalatethathaslimited
orshallowmovementduringfunction(quivers) &theremainderofthesoftpalatethatismarkedlydisplacedduringfunctionalmovement.
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Thustheplacementof PPSacrossmid-palatalsuturedemandcarefulattention.
PPS shouldalsoextendintomidpalatalfissuretoensureproperperipheralseal.
Cordlike bandoftissueextending betweentheposteriornasalspine &aponeurosisoftensorvilipalatinimusclesshouldreceiveslightamountofrelief.
Ifthetourspalatiniextendtothe bonylimit
ofthepalateleavinglittleornoroomtoplacethe PPSthenitsremovableisindicated.
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The presence of thick ropy saliva maycreate a problem for maxillary completedenture retention as it create
hydrostatic pressure in the areaanterior to PPS resulting in a downwarddislodging force everted major denture
base.
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METHOD OF LOCATING P.V.L.
Instructthepatienttosay AHina
shortvigorousburstinanormalunexaggeratedfashion. Theposteriorvibratinglinemarksthemostdistal
extensionofthedenturebase.
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CLASSIFICATION OF SOFTPALATE
Itisclassifiedin-
class Iclass II
class III
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CLASS I
It indicate soft palate that is ratherHorizontal as a extend posteriorly withminimum muscular activity.
There is considerable separationbetween anterior & posterior vibratingline does having white PPS area yieldingmore retentive denture base.
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.CLASS II
palatal contour lie between classI&classIII.
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CLASS III
it is seen in conjugation with highV shape palatal vault. There is few mmseparation of anterior & posteriorvibrating line thus there is small PPS
area & less retention.
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TECHNIQUES
There are several establishedtechniques for the placement of PPS.
The important once are:-1. Conventional approach
2. Fluid wax technique
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The rational for the placement of aseal in the impression tray as follows:-
1. To establish positive contactposteriorly to prevent the finalimpression material from sliding down
the pharynx.2. To serve as a guide for positioning the
impression tray, especially if a shim
has been used within the tray toestablish the borders.
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3. To create slight displacement of thesoft palate.
4. To determine if adequate retention &seal of the potential denture border ispresent.
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CONVENTIONAL APPROACH
Afterthespecialtrayisfabricatedtherearecertaininstructionsgiventothepatients:-
1. Torinsewithanastringentmouthwashthatisremovetostringysalivathatmightpreventcleartransfer
marking.Therearestepstobefollowed
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2. Locationofpterygomaxillarynotchisdonebymovingthe Tburnisher
posteriorangletothemaxillarytuberosityuntilitdropsintothepterygomaxillarynotch. Thisis
necessaryastherearetimeswhensmalldepressionintheresidualridgemayresemblepterygomaxillarynotch.
3. Identificationofposteriorvibratinglinethepatientaskedtosay AHinshortburstinanexaggeratedfashion.
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4. Identification of the anterior vibrationline. This is done by asking the patientto say AH with short vigorous bursts
(ValsalvaManeuver can also be used)
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PROCEDURE
Alineisplacedwithanindelible pencil(Thomsonsanitarycolourtransferapplicators)throughthepterygomaxillarynotch &extended 3-4 mmantero-laterallythetuberosityapproximatingthemucogingival junction
sameisdoneontheoppositeside. Thiscompletetheoutliningofpterygomaxillaryseal
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The tray is trimmed until the posteriorvibration line so that it decides the post
extent denture border. Returning to the mouth the palatal fissure are
palpated with the T barnisher or mouthmirror to determine their compressibility in
width & depth. The termination of glandular tissue usually
coincides with the anterior vibrating line.
The anterior vibrating line now markedstranseferred to master cast .this completethe transferring the outline of posteriorpalatal seal area.
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(A) A T burnisher is
used to palpate forthe hamular process.
(B) Palpating for the
pterygomaxillary
notch
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The visual outline is in the shape of cupid bowthe area between the anterior posterior
vibrating line is usually narrowest in the midpalatal region because of the projection ofthe posterior nasal spine.
Kingsley scraper used to score the cast the
deepset area are located on either side ofmidline, one third the distance anteriorlyfrom the posterior vibrating line. It is usuallyscraped to a depth of approximately 1-1.5 mm
. The tissue covering the medial palatal raffaeas little sub mucosa & cannot withstand samecompressive force as the tissue lateral to it
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Thisareaisscrapedtodepthofapproximately 0.5-1 mmwithinthe
outlineofcupidbow &castisscrappedtodepthofhalfamoungtopalataltissueinthatareacanbecompressed
beingtaperedposteriorly.
Failuretotaperthesealposterior
mainlytotissueirritation.
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3. Thepractionerwillbeabletodeterminetheretentive qualitiesofthe
finisheddenture,leavingnothingtochanceattheinsertionappointment.
4. The newdenturewearerwillbeabletorealizetheposteriorextentofthedenturewhichmayeasetheadjustment
periods.
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DISADVANTAGES
1. Itisnotaphysiologictechnique &thereforedependsuponaccuratetransferofthevibratinglines &carefulscrapingofthecast.
2. Thepotentialforovercompressionofthetissueisgreat.
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FLUID WAX TECHNIQUE
Alloftheprocedureremainthesameasconventionaltechniquethatistransferlocation &transfermarkingof
theanterior &posteriorvibratinglineThemarkingarerecordedinfinal
impressiononeofthefourtypeofwaxcanbeusedfortheirtechnique:-
1. Iowawaxwhitedevelopedby Dr. Earl S.Smith.
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2. Korectawaxno. 4,orangedevelopedbyDr. O.C. Applegate.
3. H.L. physiologicpaste,yellow-whitedevelopedby Dr. C.S. Harkins.
4. Adaptolgreendevelopedby Nathan G.
thesewaxaredesignedtoflowatmouthtemperature. Themeltedwaxispaintedintotheimpressionsurface &intheoutlineatsealarea,thewaxapplied
inslightly &excessoftheestimateddepth &allowedtocooltoblowmouthtemperaturetoincreaseitsconsistency&makeitmoreresistentofflow.
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Theimpressioniscarriedtomouth &heldundergentlepressure 4-6 minute
toallowthematerialflowpositionofhead &tongueduringthisisprocedure.
Thesoftpalateshouldbeimpressioninitmostfunctionallydepressedpositionsthatisbykeepingfrankfortplane 30
belowthe Hz &thetongueisfirmlypositionedagainstmandibularanteriorteeth.
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ADVANTAGE-THISPOSTION
1. Softpalateisimpressioninitsmostfunctionallydepressedposition.
2. Theflowofsaliva &impression
materialintothepharynxisprevented.After 4-6 minutesimpressiontrayisremovedfromthemouth &examined
foruniformcontact.Ifthetissuecontacthasnotestablishedthewaxwillappeardull.
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Ifthetissuecontacthasbeenestablisheditwillappearglossy.
Ifexcesswaxprotrudedoutofthetrayitshouldberemoved.
A Secondaryimpressionisreinserted &heldfor 3-5minutesundergentlepressure
followedby 2-3 minutesoffirmpressureappliedtomidpalatalareaoftheimpressiontray,uponremovaloftrayfromthemouthitiscarefulexaminedtoseewaxterminatein
featherededgeneartheanteriorvibratingline.
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Itabuttjointispresent &properflowhasnotbeentakenplace &impressiontrayisreinserted.
Ifthewaxisoverextendeditshouldbecarefultrimmedthescalpel.
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ADVANTAGES
1. Itisphysiologictechniquedisplacingtissueswithintheirphysiologicallyacceptablelimits.
2. Overcompressionoftissueisavoided.3. Posteriorpalatalsealisincorporated
intothetraildenturebaseforadded
retention.4. Mechanicalscrappingofthecastisavoided.
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DISADVANTAGES
1. Moretimeisnecessaryduringtheimpressionappointment.
2. Difficultyinhandlingthematerials &addedcareduringtheboxingprocedure.
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ERROR INRECORDINGOFPPS
1. Underextension
2. Underpostdamming
3. Overpostdamming4. Overextension
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2. Reducethepatientanxietytogagging.
3. Improperdelineationoftheanterior &posteriorvibratingline.
4. Prevention:Excessivetrimmingoftheposteriorborderofthecast.
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2. OVER EXTENSION
1. Thedenturebasecanleadtoulcerationofthesoftpalate &painfuldegulutition.
2. Themostfrequentcomplaintfromthe
patientwillbethatswallowingispainful &difficult.3. Thehamuliarecoveredbythedenturebase
,thepatientwillexperiencesharppain,
speciallyduringfunction.4. Prevention: Theseregionaretrimmed &poslished
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4. Thepterygoidhamulimustneverbecoveredbythedenturebase.
5. Theoverextensioncanberemovedwithabur &thencarefullyrepolished.
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3. UNDER POSTDAMMING
1. Thiscanoccurduetoimproperheadpositioning &mouthpositioning. E.g.themouthiswideopenwhilerecordingtheposteriorpalatalsealthemucosaoverthehamularnotchbecomesstretched. Thiswillproduceaspace
betweenthedenturebase &tissue.
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2. Inserting a wet denture into a patientsmouth & inspecting the posterior border
with the help of mouth mirror. If airbubble are seen to escape under theposterior border it indicates under
damming.3. Prevention: The master cast canscraped in the posterior palatal area orthe fluid wax impression can be
repeated with proper patient position.
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4. OVER POSTDAMMING
1. Thiscommonlyoccurduetoexcessscrapingofthemastercast. Itoccurmorecommonlyinthehamularnotchregion.
2. Pterygomaxillarysealarea,thenupon
insertionofthedenturetheposteriorborderwillbedisplacedinferiorly.
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3. Prevention: Reduction of the dentureborder with a carbide bur, followed bylightly pumishing the area while
maintaining its convexity.
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SUMMARY
So,itisconcludedthattheexistenceofposteriorpalatalsealplaysamajorroleinthedevelopmentofstability,retention &prevention,compressibility &comfortofthecompletedenture.
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REFERENCES
Sheldon Winkler,Essentialsofcompletedentureprosthodontcs.secondedition.
Zarb Bolender,Prosthodontic Treatmentforedentulouspatients,twelfthedition.
Boucher,sProsthodontictreatmentforedentulouspatient,ninthedition.
Deepak Nallaswamy,Textbookofprosthodontics,firstedition.
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