MANAGEMENT OF SPECIAL

COMPLETE DENTURE CASES

(1) ADVANCED RESORPTION OF

THE RESIDUAL ALVEOLAR
RIDGE (FLAT RIDGE)

Dr. Basheer Ali Sa’ad

Introduction
The residual ridge which constitutes the foundation for dentures
consists of the denture bearing mucosa, the submucosa,
.periosteum and the underlying residual alveolar bone

Edentulius ridges are subjected to continuous bone resorption.

This is due to loss of tensile stimulation provided by the
periodontal ligaments. Wearing dentures is almost
accompanied by alveolar bone loss. The change of force
distribution during mastication from tension to compression
.causes additional bone loss
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The loss of alveolar bone is more pronounced in the

mandible than in the maxilla. The differential between

the mandible and the maxilla attributes to the mandible

.providing a smaller surface area for support

Bone resorption in the mandible may be severe, to the

extent that the mental foramen may be located near or

.directly at the crest of the ridge

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Factors affecting
Alveolar Bone Resorption

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:Biologic / Metabolic Factors
.A- Age: osteoportic changes in the human skeleton

B- Sex: Frequently in females during menopause, due to the

reduction in estrogen hormone which in turn causes
.demineralization and osteoporosis of the bone

C- The patient’s general health: uncontrolled diabetes,

anemia, hypertension, distrub the normal metabolic
processes and lower the resistance of tissues to
.inflammation and bone resorption

D- Nutritional deficiencies: Calcium deficiency, decrease in

vitamin C content, protein utilization 5
:Functional/Prosthodontic factors
A- Faulty impression: Excessive pressure exerted on the
mucosa while making the impression initates sorness
inflammation of the denture bearing mucosa

B- Excessive vertical dimension of occlusion. This transmits

excessive pressure on the ridges

C- Discrepancy between centric relation and centric occlusion

D- Excessive forces

E- Long-term wearing of dentures without serviceability

F- Parafunctional habits bruxism and clenching 6
:Treatment
Hyperplastic tissue (flabby ridge), which replaces the bone

of the residual ridge, is in compatible with the demand for

.healthy denture supporting tissues

These tissues contribute to excessive vertical and horizontal

denture movement they present an unstable and undesirable

denture base foundation and should be treated with the goal

.of establishing a firm, immobile denture foundation

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Flabby ridge
Hyperplasia of the soft tissues under a complete denture is the
result of fibro-epithelial response to chronic ridge sorness caused by
.denture wearing
The lesion may be localized, or generalized over the entire ridge crest
area. Palpation is made hypermobile tissue during oral examination.
Palpation will disclose freely movable tissues, that may be rolled or
.in some cases pendulous, fissured and/or inflammed

Fibrous hypermobile crest ridges do not supply stability or

support for dentures. Its etiology is multifactorial, and the
:following can be listed as probable causes
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:Gradual ridge resorption -1
Rapid resorption on the lingual and labial sides of the lower
alveolar ridge frequently results in a narrow knife edge
.ridge
The gingiva overlying this bone become rolled and the soft
tissue proliferates leaving
Cordlike soft tissue ridge crest. This cord like ridge may -
extend from one retromolar pad to the other or may be
limited to the anterior region of the atropic mandibular
.ridge
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:ILL fitting denture bases -2
ILL fitting denture bases from constant unbalanced

occlusal forces in a localized area. Develop from

excessive pressure created by heavy contacts of the

opposing teeth in the same region result of shifting

.of the denture base from deflective occlusal contacts

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:Anterior hyperocclusion -3
Anterior hyperocclusion will place excessive forces in the
anterior region of the residual ridge, leading to rapid bone
resorption. And replaced by hyperplastic flabby tissues.
This condition is commonly seen in the anterior region of
the maxilla. Excessive forces in the anterior region may
:result due to

A- Maxillary complete denture opposing either a

complete set of natural teeth or bilateral distal extension
.partial denture supported by the natural anterior teeth 11
B- Combination of porcelain anterior teeth with acrylic resin
posterior teeth in the same denture. The low wear resistance
of acrylic resin teeth results in hyperocclusion of the
anterior porcelain teeth that will traumatize both the
.anterior upper and lower foundation tissues

C- Interference between upper and lower anterior teeth due to

lack of anterior clearance during mandibular movement.
This may result due to steep incisal angle caused by deep
vertical overlap without sufficient horizontal overlap to
provide anterior clearance during functional and
.parafunctional mandibular movement 12
D- long-term denture wearing without regular maintenance

and, serviceability. Since the residual ridges resorb

continuously then even the best-fitting dentures gradually

loose their adaptation to the underlying basal seat and

occlusal changes are brought about. Recall schedule the

importance and the need for servicing complete denture a

6-12-month interval is the suggested time between recall

.appointments for most complete denture patients

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Instability of the denture )4
.Causes by under extentended denture flanges

.Poor systemic health of the patient )5

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Treatment of hyperplastic
: flabby ridge
Treatment of hyperplastic flabby ridges is based on the
.severity of the condition

A- If the movable tissue is localized and not expected to interfere

with denture stability, then these tissues can be retained and a
conservative prosthetic technique should be employed. Two
techniques may be used either singly or in combination
depending on the severity of the condition to achieve healthy

:mucosal state. This includes 15

Tissue rest accompanied by proper -1
oral hygiene

Relining the denture with tissue -2

conditioning material

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To achieve the maximum benefit
from tissue conditioning material
:the followed should be considered
Denture base extension should be adequate. Whenever the -1

denture base is short, it should be extended to the functional depth

of the vestibule

Centric occluding reltion should be checked and corrected. -2

Autopolymerized acrylic resin can be used to restore the lost vertical

dimension. Centric occlusion should hormonize with centric relation

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Enough room should be created for the tissue -3
conditioning material. All undercuts and some of denture
basal surface are reduced to a depth of 1 mm or more
.leaving the borders intact

The selected material must be properly propotioned, -4

mixed and applied to the dry denture basal surface.
#The loaded denture is placed in position and the
patient is guided to close in centric position. A new
application of the material is needed every three to four
days until the tissue have recovered. When the tissues

a ssume their normal non-inflammatory condition,

.dentures con be fabricated 18
:Denture construction
All principles and techniques for denture construction

should be directed to minimize the forces

transmitted to those movable supporting tissues in

.order to stabilize the denture

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:A) Secondary impression technique
They need to be recorded in their resting position using freely flowing
.impression material

If these tissues are displaced during taking the final impression they will
.tend to rebound creating unseating forces and denture instability

Movement of the denture in any direction on their basal seat causes

additional tissue damage. A selective pressure impression technique is
required to decrease occlusal forces over the affected area and
distributes them over favorable areas capable to tolerate masticatory
forces. Sufficient relief and escape holes drilled in the special tray
opposite to the hyperplastic tissues will ensure relief of pressure over
.this area and proper load distribution 20
A sectional impression technique is preferred if the

hyperplastic tissue is present on the anterior maxillary

ridge. In this technique secondary impression of the

arch is made using zinc oxide eugenol in a special tray,

the labial portion of the ridge is removed, and

impression plaster is painted in the labial ridge crest

with a brush. This technique ensure relief of pressure

.over this area

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:B) Centric occluding relation record
Since centric jaw relation, is basically a relation between
the jaw bones, a different relation can thus result from
displacement of the recording bases over their
supporting tissues. Centric occluding relation should
be recorded with the least possible displacement of the
supporting tissues by applying minimal closing forces
on an easily displaceable recording material. Static
interocclusal record, using softened wax will minimize
the amount of tissue displaceability
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C) Occlusal form and arrangement
: of posterior
To effectively control the amount of horizontal*
displacing forces, 1-flat cuspless teeth are indicated, 2-
Proper vertical orientation and inclination of the
occlusal plane, together with 3-placement of the teeth
in a central position in relation to the residual ridge and
.tongue will enhance lever balance and denture stability
Reduction of the buccolingual width of the occlusal table,
and using fewer number of artificial teeth will ensure
better centralization of the occluding forces 25
An extensive soft tissue lesion that interferes with denture )2
stability should be surgically reduced. A small, more stable
ridge offers better denture foundation than does a large
.unstable ridge

:Alveolar ridge augmentation )3

Recently, preservation of the mobile tissue and augmenttion

of the underlying ridge with a ridge augmentation material
has been used. Hydroxyapaptite, is one of the materials used
the chemical structure of dense, nonporous form of
hydroxyapatite is similar to that of bone minerals, and
.therefore it can unite chemically with bone 26
:Epulis fissuratum
Fibrous hyperplasia occuring around the border of a denture is
called “Epulis Fissuratum”. Denture flange . The lesion may vary
from small single folds to multiple folds or redundant soft tissue.
The condition is most commonly observed around the vestibular
borders of an immediate denture when the patient does not
return for a second denture. Treatment of this lesion consists of
removal of the denture or shortening the flange to permit tissue
rest and healing, in most of the cases tissue rest is enough to
cause regression and healing of the lesion. Long standing cases
.may require surgical removal 27
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THANK YOU

Dr , Basheer