Introduction
The teeth are carried by two bones: the maxilla, fixed to the skull, and the mandible, the only movable bone of the face. Their landmarks decide how a prosthesis is supported, where nerves can be pressed and how far a denture may extend.
The maxilla
The upper jaw is a pair of bones, right and left, joined by a suture in the midline. Each half is an irregular, hollow bone: a body containing the maxillary sinus, and four processes.
The body has four surfaces: anterior (facial), infratemporal, orbital and nasal. Landmarks to know include the incisive fossa, canine eminence, infraorbital foramen, maxillary tuberosity and incisive canal.
The maxillary sinus lightens the skull, gives resonance to the voice and warms and moistens the air we breathe. It lies close to the roots of the upper posterior teeth, so infection can spread between the sinus and the mouth.
The mandible
The largest and strongest bone of the skull. It has one horizontal body and two vertical rami, and is attached to the skull only by the TMJs, ligaments and muscles.
Outer surface
- Symphysis: the midline fusion of the two halves, with the mental protuberance and a mental tubercle on each side.
- Alveolar eminences: bulges over the roots; over the canines they are the canine eminences.
- Mental foramen: near the apex of the second premolar, 13–15 mm above the lower border in most people. It lets out the mental nerve and vessels.
- External oblique ridge: runs from the canine region up to the front edge of the ramus.
- Angle: where the lower border meets the back of the ramus; the masseter inserts on its outer surface.
- Coronoid process: the front process of the ramus; the whole temporalis tendon inserts here and on the front edge of the ramus.
- Condylar process: head and neck; the head sits in the mandibular fossa with the disc between, and the lateral pterygoid attaches to the front of the neck.
Inner surface
- Genial tubercles: on each side of the midline; the genioglossus and geniohyoid attach here.
- Mylohyoid line: a ridge from the molars toward the genial tubercles where the mylohyoid (floor of the mouth) attaches. Above it lies the sublingual fossa, below it the submandibular fossa.
- Temporal crest: runs down from the coronoid to near the third molar; part of the temporalis tendon attaches here.