Crawford et al. 2014, Article ID 104541, 6 pages, 2014. https://doi.org/10.1155/2014/104541, 1Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Mangalore, Karnataka 575001, India, 2Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore-575018, India. Original alveolar crest height is determined by measuring the distance from the inferior border of mandible to the lower edge of the mental foramen after superimposing both the lateral cephalometric radiographs. These impressions will generally lead to a denture which has a good fit … In everyday dental practice one encounters patients who either believe themselves, or subsequently prove themselves, to be gaggers. The current paper describes a simple technique to record flabby tissues in their undisplaced state using readily available clinical materials like polyvinylsiloxanes in varying consistencies. The denture sits on teeth “pilings”, enabling the denture to withstand a much greater occlusal load without movement. Magnusson et al. resident of a country, and use biometric identifiers (e.g. It maintains the blood supply to the repositioned portion of the maxilla & generally results in more predictability with less extensive resorption postoperatively. The handle was placed in the palatal portion of the maxillary tray to ensure visualization of the underlying tissues through the clear acrylic tray and also to facilitate uniform distribution of pressure during impression making (Figure 7). The patient was a denture wearer for the last 5 years and described the existing dentures as “loose.” On examination the patient was completely edentulous in upper and lower arches. Lateral cephalometric radiographs provide an accurate method for determining RRR. 4. reducing the vertical dimension in such cases may be advantageous as this reduces the force applied during mastication. The impression technique plays the substantial role. Residual ridge resorption is a localized loss of bone structure. Alveolar bone exists as support of the teeth. Of all these goals, preservation of the residual ridges is most important. This time is the time taken since extraction to the bone loss in residual ridge resorption. Flabby ridge also called as fibrous ridge or displaceable ridge is mobile soft tissue present on the superficial aspect of the alveolar ridge. A cortical layer of bone is present over the crest of the ridge even during residual ridge resorption, which clearly shows the formation of new bone. A modified technique for edentulous flat ridge lower cases. We don’t come across the ideal ridge in complete denture patients. KNIFE LIKE LOWER RIDGE The patients with a ridge of this type frequently complain of pain during mastication as the pressure exerted on the mandible via denture compresses the soft tissue between the fitting surface & the knife-like process forming the crest of the alveolar ridge. This paper presents case report for prosthodontic rehabilitation of a patient with flabby ridge with McCord and Ahmad impression technique. 2. Umesh Y. Pai, Vikram Simha Reddy, Rushad Nariman Hosi, "A Single Step Impression Technique of Flabby Ridges Using Monophase Polyvinylsiloxane Material: A Case Report", Case Reports in Dentistry, vol. If the teeth are removed, then the alveolar process begins the rate of resorption consistent with the time of edentulism. Class 2- a thick layer of compact bone encompasses a core of dense trabecular bone. The treatment of a patient with prosthodontic needs can be modified according to the type of ridge present as a result of ridge resorption. The buccal and lingual extensions of the tray are adjusted just short of the reflections of the cheek and lip min the mandibular arch Residual ridge resorption is a confined pathologic loss of bone that is not built back by removing the causative factors. In this paper, the authors have proposed a newer technique of impression making of the flabby tissues using a combination of readily available newer and older materials to ensure an accurate and easy impression of these tissues. But in osteoporosis bone resorption is greater than bone formation. Force is the main factor in Residual ridge resorption. Overdentures supported by natural tooth roots have been long-standing & integral part of treatment planning. impression is also the determination of the boundaries of the oral cavity that must be impressed in order to obtain sufficient support for the manufacture of dentures. Bone quality Class 1- Nearly the whole jaw is formed of homogenous compact bone. Gagging during impression making: techniques for reduction. Indicated in bone deficient maxilla where the palatal vault is found to be adequately formed but the ridge height is insufficient. Typically these “flabby ridges” are composed of mucosal hyperplasia and loosely arranged fibrous connective as well as more dense collagenised connective tissues. Neutral zone impression technique shaista173. The treatment options of implant supported prosthesis and surgical excision of the flabby tissue were suggested to the patient. Loss of vertical dimension of occlusion. 3. with the preservation of teeth for an overdenture, there is also the preservation of the periodontal membrane that surrounds these teeth. The two impression techniques described in this paper requires the same amount of appointments as required for the fabrication of the normal complete denture. Transpositional flap vestibuloplasty ( Lip Switch), Vestibule and floor of the mouth extension procedure. This preserves proprioceptive impulses supplied by the periodontal membrane. More precise esthetic and phonetic assessments of the existing prostheses are accommodated, and prescriptive changes may be referenced to the current tooth arrangement. What are Teeth numbers and names – Tooth Numbering System? They provide enhanced prosthesis retention & stability, & their influence on adjacent bone levels appears to be similar. Similar to the lower impression a monophase impression of addition silicone was made (Figure 15). Anterior rotation of the mandible and increase in relative prognathia. Class D- Moderate resorption of the basal bone occurs. This article presents a technique to overcome the difficulties encountered in impressing the severely resorbed mandibular ridge using elastomeric impression materials and a modified special custom tray. The design of the denture should aim at reducing the amount of force on the ridge, thereby reducing residual ridge resorption. 7 out of 10 completely edentulous patients have resorbed mandibular ridge. Class B- Moderate residual ridge resorption occurs. Farrier S(1), Pretty IA, Lynch CD, Addy LD. Neil classified residual ridge resorption in relation with the floor of the mouth and mylohyoid ridge: Class 1: 0.5 inch space exists between mylohyoid ridge and the floor of the mouth. A primary impression of the upper and lower arches was taken with alginate (Neocolloid; Zhermack) in the edentulous trays. FLAT LOWER RIDGE The shape of the ridge provides no resistance to lateral movements of the denture. The purpose of this article is to highlight the clinical problems encountered in the treatment of edentulous patients with atrophic (flat) mandibular ridges. MAXILLARY HYDROXYAPATITE AUGMENTATION Eliminates the need for donor site surgery & is easily placed in an outpatient setting It can be used to contour or eliminate minor ridge irregularities & undercut areas in the maxilla. The relief wax was removed and multiple holes were drilled in the “supporting tray (Figure 14).” Placement of multiple relief holes was done to ensure prevention of pressure build-up in the flabby area thereby leading to inadvertent tissue compression. The history of complete denture impression procedures has been influenced largely by the development of impression materials from which new techniques and ideas arose. This technique helps in maintaining the contour and recording the details of the tissues without displacing the flabby tissues. The advantage of choosing monophase impression material is that, due to the inherent nature of the material, different consistencies can be achieved by varying the pressure applied on the material during mixing. Prosthodontic literature has documented various impression techniques for overcoming the problem of the flabby ridge. In terms of patient economics and time taken for the completion of procedure, the implant supported prosthesis has its drawbacks. Tray adhesive was applied. [5] described a technique where two impression materials are used in a custom tray using zinc oxide and eugenol over the normal tissues and impression plaster over the flabby area. If the flabby tissue is compressed during conventional impression making it will later tend to recoil and dislodge the overlying denture [2]. It also acts as a stopper for the tray in the final impression procedure. Flabby ridge is predominantly seen in the upper anterior region and is commonly associated with features of combination syndrome, as mentioned by Kelly [1]. There are five special impression techniques for taking an impression of a resorbed ridge. Implant prosthesis take the support from the underlying bone hence minimal or no support is needed from the tissue area. Review articles are excluded from this waiver policy. The rate of resorption varies among different individuals and also in the same individual at different times. Thus, over the years, several impression techniques have been suggested for the impression of a flabby tissue ridge which will support the flabby tissue but at the same time will not displace it. Vestibuloplatsies are the soft tissue surgeries performed to provide an enlarged area of fixed tissue in primary denture bearing or implant area & to improve extension in the area of denture flanges by removing the dislodging effects of muscle attachments in denture bearing or vestibular areas. In the window technique, studies have proposed to record the impression along with the peripheral seal followed by preparation of window and recording of displaceable tissues with a low viscosity impression material (impression plaster) ( McCord and … Other factors that must be considered include surgery, discomfort and inconvenience, general health of the patient, and risk of surgical complications or implant failure [4]. Author information: (1)Cardiff University Dental Hospital, Heath Park, Heath, Cardiff CF14 4XY. These prosthetic factors include broad coverage area, decreased number of dental units, decreased buccolingual width of the teeth, improved tooth form, avoidance of inclined planes, centralization of occlusal contacts, adequate interocclusal distance during rest jaw relation. The maxillary borders were recorded by selective pressure impression technique using green stick compound (Figure 13). This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Breathe through your nose and lift your feet off of the chair are simple and quick ways to distract the reflexive action, particularly if the first time the reflex becomes apparent is while making the impression. Class 2: Less than 0.5 inch space exists between mylohyoid ridge and the floor of the mouth. Local bone-resorbing factors like endotoxins, osteoclast activating factor (OAF), prostaglandins, human gingival bone- resorption stimulating factor, heparin and trauma lead to residual ridge resorption. The specific obj … Sign up here as a reviewer to help fast-track new submissions. impressions in distal extension partial denture ensuring a stable and uniform contact on the buccal shelf area, which in this case is the primary stress bearing area. Many impression techniques have been proposed to help overcome this difficulty. 2. careful blocking out of the undercut areas on the model. A Single Step Impression Technique of Flabby Ridges Using Monophase Polyvinylsiloxane Material: A Case Report, Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Mangalore, Karnataka 575001, India, Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore-575018, India. Achieved using iliac crest bone grafts, tightened with rigid fixation Disadvantage: this technique does not correct the irregularities of denture bearing areas such as superior border changes or disclosed position of mental nerve which results from mandibular atrophy. A window technique is used for impression of flabby ridge using a close fitting custom tray with a window (Watt et al., 1986). This clinical case report presents a case of severely resorbed ridge managed using the cocktail impression technique to improve mandibular denture stability in an atrophic mandibular ridge. Microscopic studies show the presence of osteoclasts on the external surface of the crest of residual ridges. Order 4 to order 5: more resorption They are: Residual ridge resorption and anatomic factors The presence of more bone will lead to more residual ridge resorption. These pieces of bone are frequently tightened to the mandible with small rigid fixation screws, reducing graft mobility. The impressions were poured with dental stone and the displaceable tissues were identified on the cast. A mandibular custom tray was fabricated with autopolymerising clear acrylic (Figure 8). Normally bone formation is equal to bone resorption. Thus the use of overdentures preserves the alveolar bone. The Buccal shelf area was recorded by using mucocompressive impression material like impression compound Type 1 (Y Dents, Mumbai, India) (Figure 9). Class 4- a thin layer of compact bone surrounds a core of low-density trabecular bone. SELECTIVE IMPRESSION TECHNIQUE. A monophase impression material was preferred as it has the desirable thixotropic property thereby ensuring adequate flow under pressure (Figure 12). 1969 Feb 4;126(3):134-5. It proceeds slowly over a long period of time, flowing from one order to the next order. Studies on mandibular overdentures retained by implants have shown that the bone height is maintained in the area where implants were located. Prevention of the deficiency of hormones, vitamins, and minerals. It maintains teeth as part of the residual ridge. An accurate impression is the foundation of a good functional prosthesis as it determines the retention and comfort of the prosthesis. A spaced special tray for an Impression Compound Impression Is then constructed on this model. Earlier studies show that prevalence of flabby ridges vary in either arches, with edentulous maxillae prevalence being 24% and edentate mandibles 5% [2, 3]. * Mucostatic impression technique, which aims to achieve support from the other firm areas of the arch and maximizes retention. Three major factors lead to residual ridge resorption. Clinically, the soft tissues overlying the residual ridges may range from normal to inflamed, edematous, ulcerated, indented or abused tissue. Share; Like; Download ... Muaiyed Mahmoud Buzayan ... Resorbed ridge seminar koto Kushal Singh. So you need to understand the residual ridge resorption. Residual ridge resorption is directly proportional to force. spaced or closely adapted).Mucostatic means that the impression is taken with the mucosa in its normal resting position. Mccord and Tyson’s technique for flat mandibular ridges is followed for a definitive impression. Fig.5: Impression with border molding completed. The techniques of persuasion that helped to shape the modern world were developed for and during the Great War (1914-1918). Another reason for flabby tissue is unplanned and uncontrolled dental extraction [4]. Treatment: a peripherally adapted impression having an adequate extension on to the retromolar pads & teeth set up to produce balanced articulation. The upper tray is kept properly seated in position by the operator’s thumb and index fingers. Tray adhesive was applied. Copyright © 2014 Umesh Y. Pai et al. The patient was not willing to undergo surgical procedures so it was decided that upper and lower complete dentures will be fabricated with a different impression technique. Once set, the entire impression is removed. While considering force, one must also consider: Also, force applied to the bone is affected inversely by the damping effect of the underlying tissue. This ridge resorption can continue till only a thin cortical plate is left on the inferior border of the mandible, and in maxilla it continues till there is no alveolar process left. But this is labeled as a disease because of the wide variation in the rate of residual ridge resorption. A 68-year-old male patient came to the OPD of the Department of Prosthodontics with a chief complaint of replacement of missing teeth in upper and lower arches. A NOVEL IMPRESSION TECHNIQUE FOR FLABBY RIDGE MANAGEMENT IN EDENTULOUS PATIENTS – A CASE REPORT: Nidhi Beria,Rajeev Singh,Asha M. Rathod,Gaurang Mistry,Charusheela Sardar: INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH. Order 3 to order 4: resorption on labial and lingual aspects A variety of impression techniques have been suggested for flabby ridge cases, such as using two materials on a single custom impression tray, a two-tray impression with different impression materials incorporated together intraorally, a window impression, and using impression compound on a custom tray with a wash impression material application. Treatment: 1. alveolectomy to reduce the sharp process 2. relief for the knife-like ridge area 3. construction of denture having resilient lining. Until this is determined, it is essential to analyze our patients in regard to the various possible factors to best of our ability, to seek consultation concerning possible metabolic factors, & to perform prosthodontic care of our patients within our best capabilities. Bone remodeling takes place even in the presence of this pathologic osteoclastic activity. However, resorption of the posterior residual ridge was increased when compared with similar sites in the patients treated with implant-supported fixed prostheses. OVERDENTURES Any removable dental prosthesis that covers & rests on one or more remaining natural teeth, the roots of natural teeth, &/or implants. In this paper, the authors have proposed a newer technique of impression making of the flabby tissues using a combination of readily available newer and older materials to ensure an accurate and easy impression of these tissues. The panoramic radiograph technique described by Wical and Swoope is a simple, useful method for determining RRR. It seems, therefore, prudent to suggest that younger edentulous patients would benefit from fixed prostheses supported by implants, whereas overdentures should be recommended for elderly edentulous patients. The method uses functional impressions in existing maxillary and mandibular dentures to create master casts and to act as stabilized carriers for jaw relation records. Technique 1: Distraction. Branemark classified residual ridge resorption depending on bone quality and quantity: Bone quantity Class A- Most utmost of the alveolar bone is present. Various techniques have been recommended and there is controversy as to whether a mucodisplacive technique which compresses the mobile tissue aiming to achieve maximum support from it or whether a mucostatic technique with the aim of achieving maximum retention should be employed. Aim: This article described a physiological impression technique to design denture surfaces by the action of the surrounding musculature during functional movements based on "neutral zone concept" in patients with severely atrophied mandibular ridge. 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