EVALUATION OF THE FACTORS NECESSARY TO DEVELOP

STABILITY IN MANDIBULAR DENTURES

CORWIN R. WRIGHT, D.D.S., M.S."

University of Michigan, School of Dentistry, Ann Arbor, Mich.

is defined as “The quality of a denture to resist displacement by func-

S TABILITY
tional stresses.“i It is usually the distinguishing factor between success and
failure. Patients who possess the so-called “knack” of wearing mandibular dentures
will enjoy a certain degree of stability. Those not possessing this “knack” present
the dentist with a problem. All of the good that is built into a denture is rather
useless to a patient unless he can keep it in position during ordinary oral functions.
Building stability into mandibular dentures and teaching patients to take advant-
age of the quality are often separate problems. Cooperation of the patient will give
the best results only when the dentist provides specific supervision.
The stresses causing instability come from many directions and are created
during most of the functions of the mouth, The qualities necessary to create and
maintain stability are dependent upon the following factors. (1) retention, (2)
diagnosis, (3) the functions of the mouth, (4) the denture base outline, (5) the
occlusal plane, (6) the arch arrangement, and (7) instruction and education of the
patient.

RETENTION

Retention is defined as “The resistance of a denture to removal in a direction

opposite that of its insertion.“i In other words, it is simply the ability of a mandib-
ular denture to resist an upward displacement. Retention in itself depends upon in-
terfacial surface tension and the intermittent use of a partial vacuum. In order
to create this partial vacuum, which is evident when one attempts to dislodge a
lower denture, the denture border must maintain a seal with certain structures of
the mouth.
Since retention is necessary to hold maxillary dentures in place, and since
a border seal has to be available for this, it might serve a useful purpose to com-
pare the seal areas of the maxillary and mandibular dentures. Retention of a
maxillary denture seldom presents the dentist or the patient with serious problems
because the location of the seal area is fairly constant and it does not move during
ordinary functions of the mouth.

Read before the Academy of Denture Prosthetics in Chicago.

*Professor and Chairman, Complete Denture Department.
414
vo:.ume 16
Number 3
STABILITY IN MANDIBULAR DENTURES 415

Retention of mandibular dentures depends upon a seal in the same manner

as a maxillary denture, but the seal area is not as readily located, and it has con-
siderable movement during ordinary functions of the mouth.

DIAGNOSIS

The examination of edentulous mouths can provide information necessary

to make a diagnosis that will relate directly to the retention and stability of man-
dibular dentures. Many examination charts become too involved in details that
ha.ve little or no direct significance in either the construction or prognosis of the
finished dentures. However, there are some conditions that either affect one’s
ability to construct a satisfactory denture or limit the ability of a patient to adjust to
a mandibular denture. Successful mandibular denture service depends to a large
extent on the patient’s ability to wear dentures. The question is how one can deter-
mine by an examination of the edentulous mouth who has and who does not have
this so-called “knack” of handling a mandibular denture. Patients who have a
normal tongue position are those who have a set of conditions that are conducive
to the retention of the mandibular denture. Those who have a retracted tongue
position lack the ability to develop or to maintain retention without some degree of
training. Clinical experience indicates that the size and condition of the mandibular
ridge does not predict the ability of the patient to gain retention, Retention is avail-
able to all patients regardless of the condition of the ridge. It is mainly the stability
of the denture that is limited by ridge conditions. A poor ridge simply indicates that
its use must be limited by its ability to exert an equal and opposite pressure against
a functional force tending to dislodge it.

NORMAL TONGUE POSITION

When one is examining a patient for tongue position, it is well not to mention
the word tongue. Instruct him to open the mouth only wide enough to accept food.
Many patients acquire the habit of retracting or withdrawing their tongues when
asked by a dentist to open their mouths. This habit, usually developed over a period
o-l years, has to be considered when attempting to examine a patient to determine
how he normally carries the tongue in a rest position. If the patient appears to with-
draw the tongue upon opening, have him swallow and again open. A normal tongue
position has the following characteristics (Fig. 1) : ( 1) It completely fills the floor
of the mouth. (2) The lateral borders rest over the ridge which would normally
represent the occlusal surfaces of the teeth. (3) The tip or apex of the tongue rests
on or is just to the lingual side of the lower anterior ridge (Fig. 1). If one has
natural teeth, the lateral border of the tongue rests on the occlusal surfaces of the
mandibular posterior teeth and on the incisal edges of the anterior teeth or the
crest of the ridge just below the lingual surfaces of the anterior teeth (Fig. 1) . In
other words, with natural teeth in place, one sees only the tongue and the teeth.
F’eople who have trained speaking voices or are good singers always have normal
tongue positions. Observing these people on television will soon make one conscious
of a normal tongue position.
416 WRIGHT

Fig. I.-Normal tongue position in edentulous mouth (left) and one with natural teeth
(right). The tongue fills the floor of the mouth completely, and lateral borders extend onto the
occlusal surfaces of the mandibular teeth.

RETRACTED TONGUE POSITION

The retracted tongue position is sometimes referred to as an awkward tongue

position, and has the following characteristics (Fig. 2) : (1) The tongue is pulled
back into the mouth and the floor of the mouth is exposed. (2) The lateral borders
are either inside or posterior to the ridge. (3) The tip of the apex of the tongue
sometimes lies in the posterior part of the floor of the mouth or may be withdrawn
into the body of the tongue.
Normal tongue positions occur in about three of every four patients examined.
Although everyone has a normal tongue position at birth, some lose it, and as a
result they acquire a retracted tongue position. When natural teeth are present,
a retracted tongue position has little effect on the ordinary functions of the mouth.
It is only when a person attempts to achieve perfection in some specific function
or becomes edentulous that a retracted tongue position becomes a problem. In
order to understand the relationship between a normal and retracted tongue and
its significance to denture service, it is necessary to discuss some of the functions
of the mouth.
The three structures of the mouth that are of importance to one constructing
dentures are the tongue, the teeth, and the medial roll of the buccinator muscle.
Each structure is equally as important as the others, and the teeth by themselves
represent only one third of the mechanism necessary to chew food. An under-
standing of how these structures function will enable one to build into dentures the
ingredients necessary to gain retention and maintain stability. Since there are three
structures, I will consider them first individually and then as they work in unison.

TONGUE

The tongue is considered to be the fastest acting and most accurate muscular
organ of the body. The tip of the tongue possesses the greatest concentration of
nerve innervation found anywhere. It can detect two pins less than one millimeter
apart, a property often referred to as the limen of twoness. The tongue is fastened
primarily to the hyoid bone and does not necessarily move automatically with the
mandible. When one extends the tongue outward, about two thirds of its mass is
visible, and the remaining third forms the base. The tongue consists of two sets of
Volume
Number 417

Fig. 2.-Retracted tongue positions showing (left) the failure of the tongue to flll the floor
of the mouth, and (right) its lateral borders inside the mandibular posterior teeth.

muscles: namely, the intrinsic and the extrinsic muscles. The intrinsic muscles are
the large muscles forming the mass of the tongue, furnishing its speed and power.
The extrinsic muscles are the smaller peripheral muscles that give the tongue its
minute accuracy. Because of its accuracy, the tongue tends to act as a fluid, in that
it fills and assumes the shape of the space it occupies.
The tongue functions primarily by the touch and pressure system, in contrast
to the skeletal muscles which function by kinesthesis. Kinesthesis is the property
a muscle possesses that enables it to function by memory. If one reaches for some-
thing repeatedly with his arm, it soon becomes possible to locate the object by
muscle memory. This is not true of the tongue because it functions primarily as the
result of touch and pressure. This simply means that by touching something, it
creates a stimulus that elicits a specific function. For instance, if I were to ask you
what position your tongue is in at present, you would be unable to determine this
until your tongue touches something. Then, of course, your tongue would no longer
he in its original position.
The tongue takes part in the functions of sucking, swallowing, receiving food
into the mouth, mastication, vocalization, and speech. In speech alone, which
encompasses the most accurate and fastest mechanisms of the body, the tongue
plays an intricate part in the formation of the sounds of vowels and consonants.
Whenever function occurs within a muscle or group of muscles, such as the
tongue, there is an optimum position from which it can most easily start and most
effectively perform these functions. In the case of the tongue, it is the “normal
tongue position.” This is in contrast to a less desirable position, ordinarily referred
to as a “retracted tongue position.”

TEETH

The primary function of the teeth deals with food. Moreover, bringing the
teeth together creates desirable leverages for swallowing. The function of incision
is carried out by the central and lateral incisors, while tearing food is done by the
cuspids. The mandibular first bicuspid neither tears nor chews foods, but performs
other functions that, while important, are often overlooked. In normal dentitions,
it is the only posterior tooth that is not positioned directly over the center of the
alveolar ridge, but usually inclines somewhat toward the cheek. The buccal surface
of the bicuspid forms a point of fixation for the medial roll of the buccinator and
 J. Pros. Den.
418 WRIGHT
May-June, 1966

other muscles at the corner of the mouth that are commonly known as the purse-
string muscles. This activity helps to keep the saliva and food inside the mouth
during chewing and swallowing. It provides the buccinator with sufficient leverage
so that, with the aid of the tongue, it appears to create a peristaltic movement
necessary to the function of chewing. Also, the fixation of the medial roll of the
buccinator helps to prevent chewed food from passing forward into the anterior
part of the mouth.
The second bicuspid assists in the mastication of food, while the first molar
initiates all of the chewing. The second molar may assist in chewing, but it ob-
viously must have functions other than that of chewing.

MEDIAL ROLL OF BUCCINATOR.

The medial roll of the buccinator is a band of muscle fibers within the larger
buccinator muscle. Originating in the pterygomandibular raphe, the fibers extend
forward to the corner of the mouth. The roll appears to be approximately one-half
inch wide inferiosuperiorly and one-quarter inch in width. At rest, the center of
the medial roll is slightly above the occlusal surfaces of the mandibular posterior
teeth. Its main function is to form the buccal wall of the food trough and to re-
trieve food that is forced into the buccal pouch. There is an inclination to minimize
its significance in the over-all function of mastication, but it is as important to
chewing as either the teeth or the tongue. To substantiate this statement, one has
only to observe that if the motor supply to this muscle has been destroyed, a pa-
tient can never again use this side of his mouth for chewing.

FUNCTIONS OF THE MOUTH

An understanding of the combined functions of the tongue, teeth, and buc-

cinator will inevitably lead to better denture construction. Since we build dentures,
it is only reasonable that we should know how they function in the mouth and
what soft structures of the mouth work so intimately with the teeth in the per-
formance of these functions.

HOW FOOD IS RECEIVED INTO THE MOUTH

As food is directed toward the mouth, it is necessary for the tongue to be in a

normal position for the reception of food. If it is in a retracted position, it must

Fig. 3.-The tongue position as food is received in the mouth. Note that the tongue must
be in a normal position.
Volume 16 STABILITY IN MANDIBULAR DENTURES 419
Number 3

assume a normal position. As the food enters the mouth, it is touched by the tongue
(Fig. 3). This serves a twofold purpose in that the tongue controls the extent
th.at food penetrates past the incisors and, touching the food, keeps the tongue in a
normal position. The food is then incised by bringing the teeth together. If one
has the patient open the mouth immediately following incision, it will be seen that
the food is always on the top of the tongue (Fig. 4). This serves the purpose of
preventing the food from falling into the floor of the mouth (Fig. 5) and of having
it in position so that it can be placed ready for chewing.

THE FUNCTION OF CHEWING FOOD

Following incision, the food is placed by the tip of the tongue onto the occlusal
surface of either the right or left mandibular first molar (Fig. 6). Patients usu-
ally continue to place food on one side and, therefore, most people are either right-
or left-side chewers. There are those who shift the food back and forth during con-
tinued chewing, but return it to the starting side before swallowing. Since the tip
of the tongue is a necessary adjunct to chewing food, it is impractical, if not im-
possible, to chew effectively on both sides of the mouth at the same time. Chewing
only on one side seems quite logical, in that it permits the other side of the mouth
to create a more orderly bolus of food for swallowing. Also the swallowing groove
(the groove seen on the posterior part of the tongue when a patient says “ah”) is
always on the side opposite the chewing side.

Fig. 4 (left).-Following incision the food is always on the apex or tip of the tongue.
Fig. 5 (right).-Shows what would happen to food if the tongue were not in a normal posi-
tion, This, of course, never happens since the tongue is always in a normal position for the re-
ception of food.

Fig. B.-The tongue is placing food onto the occlusal surface of the mandibular first molar.
 WRIGHT J. Pros. Den.
420 May-June, 1966

FOOD TROUGH

After the food has been placed on the occlusal surface of the first molar, the
medial roll of the buccinator moves inward toward the teeth to form the buccal
wall of the food trough, while the tip of the tongue moves to form its lingual
wall. With the formation of the food trough, the food is ready to be chewed (Figs.
7and8).

FUNCTION OF CHEWING

With the formation of the food trough, chewing starts and the chewing pat-
tern that is followed will usually depend upon the food being chewed. Food that
stays fairly intact while being chewed presents fewer problems than food which
disintegrates. However, for purposes of illustration, we will discuss the chewing of
food that breaks up easily, with some of it falling into the buccal space and some
onto the floor of the mouth. That which falls into the buccal vestibule is retrieved
by the medial roll of the buccinator, while that which falls onto the floor of the mouth
is picked up by the tongue and replaced on the first molar. On occasion, the tongue
has to help the buccinator retrieve food from the buccal vestibule. Once the food is
back on the molar, the food trough is again formed and chewing starts. At this point,
the opening and closing movements of the jaw seem to be controlled by the tongue.
It is only on rare occasions that the signals get crossed and one bites the tongue.
During the continuous chewing of food, some of it passes to the second bicus-
pid which also assists in the chewing. This movement of food is easily understood
when one considers the scissorlike action of the jaws. As a result of this action,
some food continues past the second bicuspid to the first bicuspid. At this point, an
entirely separate function seems to take place which not only prevents food from
passing further anteriorly, but appears to place it back on the surface of the first
molar. As previously stated, the most important function of the first bicuspid is to
afford a point of fixation for the medial roll of the buccinator (Fig. 9), so that, in
conjunction with the tongue, it provides what appears to be a form of peristaltic
movement to force the food back onto the surface of the first molar so that chewing
can be resumed. The amount of chewing that occurs depends upon the type of food
and the chewing habits of the patient. There appear to be many slight variations in
both the mechanics of chewing and in patient’s chewing habits. However, the object

Fig. ‘I.-The tongue and buccinator muscle form the food trough.
VC~llmW 16
N~~mber 3
STABILITY IN MANDIBULAR DENTURES 421

Fig. S.-The diagram illustrates the formation and function of the food trough during the
chewing of food.

of this discussion has been served when attention is focused on the harmonious rela-
tionship that must exist between the tongue, the teeth, and the medial roll of the buc-
cinator in order to carry out the function of receiving food into the mouth and the
subsequent chewing of this food.

THE BORDER SEAL OF THE MANDIBULAR DENTURE

The lingual border seal area of the mandibular denture is the floor of the mouth
and the lateral throat form. These structures are extremely active, and it is dif-
ficult to know exactly where these structures should be when the impression is
made.

THE FLOOR OF THE MOUTH

The floor of the mouth functions at both a high level and a low level and at
many intermediate levels. Somewhere between the high and low levels is a level
referred to as the “normal” level. The floor of the mouth is at the high level when
the tongue reaches into either cheek or up to the roof of the mouth (Fig. lo), while
it is at the low level when the tongue drops below the level of the occlusal surfaces
of the mandibular teeth (Fig. 11). An example of the low level would be when the
 J. Pros. Den.
422 May-June, 1966

Fig. 9.-The corner of the mouth is in contact with the buccal surface of the mandibular
flrst bicuspid.

Fig. 10 (left).-The uplifted tongue raises the floor of the mouth to the “high level.”
Fig. 11 (right).-Dropping the tongue downward relaxes the floor of the mouth.

Fig. Z-The normal position of the floor of the mouth is acquired and maintained when
the tongue is in a normal position.

tip of the tongue reaches down to retrieve food that has fallen off the teeth during
the function of chewing.
The normal position which is somewhere between the high and low level, can
be determined accurately only by having the patient place the tongue in a normal
position (Fig. 12). There is no other way to accurately determine this normal level
of the floor of the mouth.

LATERAL THROAT FORM

The lateral throat form is that part of the mouth in contact with the disto-
lingual extension of the denture. This area serves as the limiting factor in the down-
vo: ume 16
Number 3 STABILITY IN MANDIBULAR DENTURES 423

ward and backward extension of the lingual flange. It is formed by the styloglossus
and palatoglossus muscles as they pass from the lateral walls of the throat into the
sides of the tongue in the region of the taste buds (Fig. 13). The lateral throat
form, like the floor of the mouth, moves with the tongue, and therefore, the tongue
controls all of the positions that the lateral throat form assumes.
The only accurate method to maintain the floor of the mouth and the lateral
throat form in their normal positions is to have the tongue in a normal position.
Any position of the tongue other than normal fails to establish a usable lingual
seal area for the mandibular denture.

DENTURE BASE OUTLINE

A properly formed denture base outline develops a seal that can be maintained
du.ring most of the normal oral functions. The technique used for forming the im-
pression is not as important as the denture base outline.
The labial flange from one buccal frenum to the other buccal frenum (Fig. 14)
is most accurately trimmed by eye. The muscles of the lower lip are not conducive
to the so-called “muscle-trimming” (border molding) method, because of the fact
that the muscle fibers are parallel to the oral orifice. An example of the inability of
this muscle to trim accurately is demonstrated when food drops into the labial fold.
To remove this food by muscular action is extremely difficult, and the normal pro-
cedure for the patient is to reach into the fold with the tongue and sweep the food
to the corner of the mouth where there are muscles at right angles to the opening.
Here the food is easily retrieved and placed on either the teeth or the tongue.
The buccal flange from the buccal frenum to the retromolar pad is extended to
cover the external oblique line. The landmark is well defined, and trimming with a
knife is probably the most practical method. Overextension in this region invari-
ab’ly results in soreness. The posterior border is extended for complete coverage
of the retromolar pad (Fig. 15).
The only part of the border outline that is entirely arbitrary is the distolingual
ex.tension of the lingual flange which is limited by the lateral throat form. This is
the beginning of the seal area of the lower denture. This border should extend
downward and backward from the retromolar pad at an angle of approximately
4:; degrees (Fig. 16). It is practically impossible to check the exact position of the
lateral throat form and determine by eye the distolingual ,extension. However,
st,udies2v3show that when the tongue is in a normal position, thus creating a normal
position for the lateral throat form, an extension of the distolingual flange as de-
scribed will approximate the desired length’ for most patients. Furthermore, slight
overextensions in this region are easily adjusted within the first few days of wearing
the dentures.
The only remaining problem is to determine the length of the lingual flange.
Its length must be such that it maintains contact with the floor of the mouth when
the floor is at its normal level. Here again is a situation where it is just about impos-
silble to check, visually, the position of the floor of the mouth and arbitrarily deter-
mine by eye the extent downward of the lingual flange. Studies2* 3 indicate that the
level of the floor of the mouth in its normal position (determined by having the
 Fig. 13.-The styloglossus muscle inserting into the tongue in the region of the taste buds.
This muscle forms the posterior wall of the lateral throat form.

Fig. 14.-The labial flange area that must be trimmed by eye.

Fig. 15.-The denture outline extends from the buccal frenum along the external oblique
line to the top of the retromolar pad.

Fig. X.-The distolingual border extends from the top of the retromolar pad downward at
approximately a 45 degree angle posteriorly to the floor of the mouth. Left, the outline on the
cast; right, an occlusion rim.
Volume 16 STABILITY IN MANDIBULt\R DENTURES
Number 3 425

tongue in a normal position) is about the level of the internal oblique line. There-
fore, to secure a seal, an extension downward of two millimeters pnto the floor of
the mouth is necessary (Fig. 17). Most of the movements of the tongue necessary
to carry out its normal functions occur above the mandibular teeth, but it appears
that the two millimeters of extension below the internal oblique ridge provides
the necessary seal for these movements without the problem of o&extension.
A diagnostic impression that covers the areas described will enable one to
secure a study cast from which it is possible to develop an accurate tray. The only
fla.nge length necessary to check in the mouth is that of the labial flange, and even
that should not be checked until the wax occlusion rim is formed on the tray.

OCCLUSAL PLANE

Any attempt to establish an occulsal plane must be an approximation. How-

ever, enough facts have been learned from the observation of hundreds of mouths
with natural teeth so that we are able to locate occlusal planes for edentulous mouths
quite accurately. The requirements for establishing the occlusal plane are : (1) The
occlusal surfaces in the region of the mandibular first molars are approximately
two millimeters below the top of the retromolar pads (Fig 18). (2) The remaining
plane anteriorly is parallel to the crest of the residual ridge. This is not always easy
to determine and depends somewhat upon judgment. However, as an added

Fig. 17.-The lingual flange extends downward approximately 2 mm. beyond the level of the
internal oblique line.

Fig. 18 (left).-A wax occlusion rim has been trimmed to the approximate position of the
average occlusal plane.
Fig. 19 (right).-A wax occlusion rim has been carved to the approximately correct arch
arrangement for mandibular teeth.
 3. Pros. Den.
426 WRIGHT
May-June, 1966

reference check, the top of the wax rim in the region of the mandibular first bicuspid
should never be above the corner of the mouth. The corner of the mouth follows
the mandibular first bicuspid during the function of chewing, and placing this tooth
too high creates problems for the musculature at the corner of the mouth.
The study2J of functions of the mouth during chewing shows an intimate
relationship between the tongue, the mandibular posterior teeth, and the buccinator
muscle. If the occlusal plane is incorrectly located, it results in malfunctions of the
soft structures. An occlusal plane that is too high forces the tongue into a new
position that is higher than its normal position. This causes the tongue to lose much
of its accuracy. Futhermore, the higher position of the tongue causes the floor of
the mouth to raise and create undue pressure on the border of the lingual flange.
All of this can lead to disruption of the normal position of the floor of the mouth
and result in a partial loss of the border seal. An occlusal plane that is too high
creates unnecessary troubles, while an occlusal plane that is slightly low causes
no problems for denture patients.

ARCH ARRANGEMENT

The term “arch arrangement” is used to indicate the buccolingual relationship

of the teeth, to either the crest of the ridge or the stress-bearing area, and is used
only in reference to the positions of the mandibular teeth. The functions of the
mouth clearly indicate the importance of the buccolingual relationship of these teeth
to the tongue and the medial roll of the buccinator muscle. The natural tendency
is to set the mandibular posterior teeth in too far so that the dental arch is too
narrow. This has an unfavorable effect on the normal tongue position and dimin-
ishes the effective functioning of the medial roll of the buccinator.
The general rule for establishing a satisfactory arch arrangement is to set the
anterior teeth on the anterior part of the crest of the ridge with an incisal tilt of
about twenty degrees, and to set the posterior teeth over the center of the stress-
bearing part of the basal seat. In other words, when one looks down on the occlusal
surfaces of the posterior teeth, an equal amount of the denture base will be seen on
both the buccal and lingual sides of the teeth (Fig. 19).

EDUCATION OF THE PATIENT

Every patient should be informed regarding the care and proper use of his
dentures. There are many patients who will disregard reasonable limitations in the
use of their dentures, and this often results in considerable inconvenience and the
need for adjustments. Failure to heed the dentist’s advice will eventually lead to
damage to the supporting tissues.
Patients who have a retracted tongue position present the dentist with the
added responsibility of guiding the patient through a retraining period. This can be
accomplished by showing the patient the normal tongue position and demonstrating
its significance. Those failing to respond to this simple treatment can be given a
series of tongue exercises.
These exercises were developed by speech pathologists and tend to strengthen
the larger muscles responsible for keeping the tongue in its normal position (Figs. 20
 427

Fig. Zl.-Tongue exercise No. 2. The tongue is swung rapidly from side to side.

Fig. 22.-Tongue exercise No. 3. The tongue is fully extended and then quickly retracted.

to 23). The dentures should be removed and the exercises practiced twice daily
for periods of five to ten minutes. Young patients usually respond within two or
three weeks while older patients may require more time. Unfortunately, a few pa-
tients will never enjoy a satisfactory result. These patients will never get the
“knack” of wearing mandibular dentures. However, it is usually obvious to them
428 WRIGHT J. Pros. Den.
May-June, 1966

Fig. 23.-Tongue exercise No. 4. The tongue is first raised to its highest position well for-
ward in the mouth (left) as the sound ‘lee” is articulated and dropped down (right) as the
sound “yhh” is articulated.

that their failure to master their denture problem is not the fault of the dentist, but
rather the fault of their own inability to master the normal tongue position.

TONGUE EXERCISES

Exercise No. I.-Thrusting the tongue out and in, in rapid succession. This
causes an alternating action of the posterior and anterior fibers of the genioglossus
muscles (Fig. 20).
Exercise No. Z.--Swinging the tongue sideways with great rapidity. The
tongue should be out beyond the lower lip about one-half inch (Fig. 21). This
causes an alternating activation of the styloglossus muscles while the tongue is held
in its narrowed high position by the transversus muscles.
Exercise No. 3.-Thrusting the tongue out to its most extended position and
pulling it back quickly (Fig. 22). On extension, this action is produced by the
posterior fibers of the genioglossus muscles, and, on retraction, it is the action of
the anterior fibers of the genioglossus with assistance from the styloglossus and
hyoglossus muscles.
Exercise No. 4 .-Raising the tongue to its highest position well forward in the
mouth through the articulation of “eeyuh” (Fig. 23). To get the full benefit of this
exercise the “ee” should be spoken on as high a pitch as possible before saying the
“yuh.” This produces an action of the styloglossus, stylohyoid, stylopharynegeus,
the levators and palatopharyngi, the tensors and the palatoglossi, the posterior fibers
of the genioglossus as well as the intrinsic muscles of the tongue shaping the “ee”
vowel.

CONCLUSIONS

1. Retention is a prerequisite to stability. Some degree of retention must be

present for mandibular dentures to have the quality of stability.
2. In order to provide the property of retention, a border seal area must be
available.
3. The seal areas for mandibular dentures are the floor of the mouth and the
lateral throat forms.
Volume 16
Number 3 STABILITY IN MANDIBULAR DENTURES 429

4. The floor of the mouth and lateral throat forms make extensive movements
to carry out the complex functions of the oral cavity.
5. The floor of the mouth has three levels.
6. The high level of the floor of the mouth accommodates for those functions
of the tongue which require it to be more than moderately extended.
7. The low level of the floor of the mouth accommodates for the movements
of the tip of the tongue as it moves to the floor of the mouth, such as when it re-
trieves food.
8. The normal level of the floor of the mouth, along with the corresponding
position of the lateral throat form, serves to satisfy the tongue for practically all
of its functions.
9. The normal tongue position places the floor of the mouth and the lateral
throat forms in their normal positions.
10. The floor of the mouth at its normal level appears to be approximately
even with the internal oblique lines on the body of the mandible.
11. The lateral throat form appears to make an angle of approximately 45
degrees downward and backward from the posterior border of the retromolar pad.
12. The lingual flanges of average mandibular dentures should be extended
downward one to two millimeters below the internal oblique line to make the border
seal.
13. The distolingual extension into the lateral throat form should extend from
the retromolar pad backward and downward making an angle of approximately
45~degrees with the floor of the mouth and be continuous with the border of the
lingual flange.
14. A wax occlusion rim must be in place before the mandibular tray is placed
in the mouth. This occlusion rim should simulate the correct occlusal plane and the
proper arch arrangement.
15. Since the tongue functions primarily by touch and pressure, a wax oc-
clusion rim simulating the occlusal plane and arch arrangement will facilitate the
maintaining of a normal tongue position.
16. To test a tray, it is necessary to have the tongue in a normal position in
order to secure the seal. This would then serve as the starting point for testing the
tongue movements.
17. All procedures leading to completing a lower impression should be done
with the tongue in its normal position.
18. When testing the finished impression, one should keep in mind that ex-
tensive movements of the tongue can cause dislodgment.

SUMMARY

The border seal area for the mandibular denture extends downward to the floor
of the mouth and posteriorly into the lateral throat form. These areas undergo ex-
tensive movement during many of the functions of the oral cavity. It is important for
the dentist to know what tongue positions are necessary to maintain a seal during
the major functions of the mouth. It is also essential to know the relationship be-
tween normal tongue position and the floor of the mouth and lateral throat forms.
430 WRIGHT J. Pros. Den.
May-June, 1966

It, therefore, becomes possible for the dentist to instruct the patient so that these
positions will remain constant during the making of a mandibular impression and
when retention is tested.
Retracted tongue positions are not compatible with stability. Therefore, rec-
ognition of normal and retracted tongue positions and means of improving retracted
positions are important adjuncts to successful denture service.

REFERENCES

1. Boucher,o,p$ Current Clinical Dental Terminology, St. Louis, 1963, The C. V. Mosby
2. Wright, C. R.: Muyskens, J. H., Strong, L. H., Westerman, K N., Kingery, R. H., and
Williams, S. T.: Study of the Tongue and its Relat’ion to Denture Stability,
J.A.D.A. 39:269-275, 1949.
3. Wright, C. R., Swartz, W. H., and Godwin, W. C.: Mandibular Denture Stability, Ann
Arbor, 1961,The Overbeck Company.
610 STRATFORDDR
ANN ARBOR,MICH.