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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 323-326

Prosthodontic management of maxillary flabby ridge and the resorbed mandibular ridge


Department of Prosthodontics Crown and Bridge, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission30-Apr-2020
Date of Decision10-May-2020
Date of Acceptance20-May-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Tanvi Balwani
Near Ramakrishna Hotel Subhedar Layout Jhulelal Colony, Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_132_20

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  Abstract 


The management of resorbed mandibular ridge and the flabby ridge has always been a challenge for prosthodontist. Many patients cannot be suitable for implant denture therapy. Hence, in such patients to use a technique with routinely used impression materials becomes a justified option. Hence, the stability of denture in such patients becomes a distinguishable factor between failure and success. This article outlines a combination of different impression materials to improve denture stability in atrophied mandibular ridge, and management of flabby tissue keeping in mind further ridge resorption.

Keywords: Atrophied ridge, flabby tissue, impression technique, neutral zone


How to cite this article:
Balwani T, Dubey SG, Pande S. Prosthodontic management of maxillary flabby ridge and the resorbed mandibular ridge. J Datta Meghe Inst Med Sci Univ 2020;15:323-6

How to cite this URL:
Balwani T, Dubey SG, Pande S. Prosthodontic management of maxillary flabby ridge and the resorbed mandibular ridge. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 23];15:323-6. Available from: http://www.journaldmims.com/text.asp?2020/15/2/323/304242




  Introduction Top


According to GPT-9 Neutral zone is defined as “The potential space between the lips and cheeks on one side and the tongue on the other; that area or position where the forces between the tongue and cheeks or lips are equal.”[1] It becomes a challenge to make impressions of edentulous arches when there is the presence of flabby tissue or bone resorption is present. Hyperplastic or flabby tissues are seen in the anterior region of the maxilla, more often than not as part of “Combination Syndrome.”[2] Alveolar resorption of lower edendulous arch gradually increases with time. It affects the stability and retention of the denture. The ultimate outcome is that the support of the denture is transferred more and more to the peripheral parts. Moreover, the alveolar ridge takes less of the load. Hence, there is a need to solve problems associated with flabby and resorbed ridges.[3] This following case report describes a technique to manage the problem of flabby and resorbed ridges using hobkirks and neutral zone technique, respectively.[3]


  Case Report Top


A 59-year-old male patient reported to the Department of Prosthodontics and Crown and Bridge at SPDC Wardha and complained of loose maxillary and mandibular dentures and asked for new complete denture fabrication. On examination, flabby tissue in the maxillary anterior region was present and tissue blanching was also seen on pressure application [Figure 1]. There was severe ridge resorption seen in the mandibular arch [Figure 2].
Figure 1: Flabby tissue in the maxillary arch

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Figure 2: Resorbed ridge in the mandibular arch

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Her upper and lower dentures were remade quite a number of time but she was not satisfied with it. Due to financial considerations, she did not agree for implants overdenture therapy. Hence, fabrication of a new denture using the neutral zone technique for the lower arch and hobkirks technique for the maxillary arch was planned.[4]

For maxillary ridge the preliminary impression was made using irreversible hydrocolloid in perforated edentulous tray and the primary cast was poured. The special tray was made with a dough method for the final impression.

After that border molding was done in a conventional manner using a green stick impression compound (DPI Pinnacle Tracing Sticks).After that spacer wax was scraped off and the final impression was made with medium body elastomeric impression material (Reprosil Hydrophilic Polyvinyl siloxane impression material, Regular body, and Dentsply International). Then after removing the tray from the mouth, with the help of a scalpel impression material was removed in the flabby tissue region. Relief holes were prepared and the tray was placed in this region with light body elastomeric impression material (Aquasil ultra LV Light body, and Dentsply International) for recording flabby tissue [Figure 3].
Figure 3: Maxillary final impression using Hobkirk's technique

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For mandibular ridge-Primary impressions were made using mucocompressive technique in stock trays in impression compound and casts made in type 2 dental plaster. The full wax spacer is adapted, except in the area of PPS in the maxillary arch and buccal shelf in the mandibular arch.[5] tissue stops in canine and first molar region.

Custom tray fabricated in self-cure acrylic. Sectional border molding using a green stick modeling compound. Final impressions were made with zinc oxide eugenol using selective pressure technique[Figure 4] and the master cast is made in dental stone [Figure 5]a and [Figure 5]b. Record bases made in self-cure acrylic resin and wax occlusion rims made. Jaw relations were recorded. Master casts mounted. Special record base was fabricated for the mandibular arch with two retentive loops [Figure 6].
Figure 4: Mandibular final impression

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Figure 5: The master cast of (a) Maxillary arch. Master cast (b) Mandibular arch

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Figure 6: Special record base

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Admixed material consisting of medium fusing impression compound and low fusing impression compound in the ratio of 3:7 was kneaded and placed following rim shape on the second record base.[6] After placing, the patient was asked to perform actions such as swallowing and speaking to induce sufficient muscle contraction. All the actions were performed clearly and vigorously. Therefore, the form of the neutral zone was refined [Figure 7].
Figure 7: Recording of the neutral zone

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Matrices were fabricated of type II dental plaster for preserving the neutral zone on the cast [Figure 8]. The wax rim was made in space confined by type II dental matrices which exactly duplicated neutral zone on newly formed baseplates on the lower cast. The artificial teeth setting was done within the matrices [Figure 9].
Figure 8: Plaster index

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Figure 9: Teeth arrangement done

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The dentures were fabricated and try in was done and on insertion, dentures had good retention and stability [Figure 10] and [Figure 11]. Follow-up was taken on regular intervals [Figure 12]a and [Figure 12]b. Depicts the frontal photographs of the patient without and with denture, respectively.
Figure 10: Try in

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Figure 11: Denture insertion

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Figure 12: Frontal photographs of the patient (a) before treatment. Frontal photographs of the patient (b) after treatment

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  Discussion Top


Impression making has a pivotal role in fabricating a complete denture. A specific problem is faced when the flabby ridge is present within an otherwise “normal” denture bearing area. An impression technique is necessary which will compress the nonflabby tissues, to obtain optimal support and not displace the flabby tissues. In 1964, Osborne[3] described a technique in which two separate impression trays and materials were used to separately record the 'flabby' and “normal” tissues. Watt and McGregor[3] in 1986 described a technique where impression compound was applied to a modified custom tray and a wash impression with zinc oxide-eugenol was made.

Materials for recording neutral zone

Tench et al.[7] were the first in this field and they proposed modeling plastic impression compounds as the material to be used for recording the neutral zone. Although it is accepted very often, materials such as tissue conditioner, wax, zinc oxide eugenol impression material, silicone material, chairside relining material, and acrylic resin are also preferred for neutral zone recording.

Advantage of modeling plastic impression compound is the ease in use, low cost and availability no matter which materials are used for recording neutral zone two factors should be kept in consideration: the neutral zone should be recorded at an established occlusal vertical dimension, and the material used for recording should be reasonably slow setting so that oral musculature shapes it into proper contour and dimension.[8],[9],[11],[12],[13],[14],[15]


  Conclusion Top


This article provides an approach in the management of Fibrous and resorbed ridges. As implant-retained prosthesis may not be suitable for many patients.[10] This technique utilizes routinely used materials for the fabrication of complete denture which becomes an easier option to achieve acceptable treatment goals.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
The Glossary of Prosthodontic Terms, THE JOURNAL OF PROSTHETIC DENTISTRY, vol 117 issue 5s, Ninth Edition, GPT-9The Academy of ProsthodonticsThe Academy of Prosthodontics Foundations.  Back to cited text no. 1
    
2.
Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent 1972;27:140-50.  Back to cited text no. 2
    
3.
Hobkirk JA. Complete Dentures Dental Practitioner Handbook. Bristol: Wright; 1986. p. 44e45.  Back to cited text no. 3
    
4.
Lynch CD, Allen PF. Management of the flabby ridge: Using contemporary materials to solve an old problem. Br Dent J 2006;200:258-61.  Back to cited text no. 4
    
5.
Cagna DR, Massad JJ, Schiesser FJ. The neutral zone revisited: From historical concepts to modern application. J Prosthet Dent 2009;101:405-12.  Back to cited text no. 5
    
6.
Gupta KL, Agarwal S. Salvation of a severely resorbed mandibular ridge with a neutral zone technique. Indian J Dent Res 2011;22:883.  Back to cited text no. 6
  [Full text]  
7.
Beresin VE, Schiesser FJ. The Neutral Zone in Complete Dentures. Principles and Technique. St. Louis: The C. V. Mosby Co; 1973. p. 1.  Back to cited text no. 7
    
8.
Beresin VE, Schiesser FJ. The neutral zone in complete dentures. J Prosthet Dent 1976;36:356-67.  Back to cited text no. 8
    
9.
Lammie GA. Aging changes and the complete lower denture. J Prosthet Dent 1956;6:450-64.  Back to cited text no. 9
    
10.
Nimonkar S, Belkhode VM, Sathe S, Borle A. Prosthetic rehabilitation for hemimaxillectomy. J Datta Meghe Inst Med Sci Univ 2019;14:99-102.  Back to cited text no. 10
  [Full text]  
11.
Parlani S, Tripathi S, Bhoyar A. A Cross-Sectional Study to Explore the Reasons to Visit a Quack for Prosthodontic Solutions. J Indian Pedod Soc 2018;18:231-8. Available from: https://doi.org/10.4103/jips.jips-24-18. [Last accessed on 2020 Jan 11].  Back to cited text no. 11
    
12.
Sathe S, Karva S, Borle A, Dhamande M, Jaiswal T, Nimonkar S. Comparative Evaluation of the Effect of Three Polishing Agents on Staining Characteristics of Provisional Restorative Material: An in Vitro Study. J Int Soc Prev Community Dent 2019;9:250-5. Available from: https://doi.org/10.4103/jispcd.JISPCD-431-18. [Last accessed on 2020 Jan 11].  Back to cited text no. 12
    
13.
Bhat N, Mentri S, Iliev G, Qahtani F, Godbole S, Mantri S, et al. First Impression of Teeth Design on Others: A Facial and Personality Analysis in the Central Indian Population. Niger J Clin Pract 2019;22:1503-8. Available from: https://doi.org/10.4103/njcp.njcp_135_19. [Last accessed on 2020 Jan 11].  Back to cited text no. 13
    
14.
Pisulkar SK, Agrawal R, Belkhode V, Nimonkar S, Borle A, Godbole SR. Perception of Buccal Corridor Space on Smile Aesthetics among Specialty Dentist and Layperson. J Int Soc Prev Community Dent 2019; 9:499-504. Available from: https://doi.org/10.4103/jispcd.JISPCD_2_19. [Last accessed on 2020 Jan 11].  Back to cited text no. 14
    
15.
Belkhode VM, Nimonkar SV, Agarwal A, Godbole SR, Sathe S. Prosthodontic Rehabilitation of Patient with Mandibular Resection Using Overlay Prosthesis: A Case Report. J Clin Diagn Res 2019;13:499-504. Available from: https://doi.org/10.7860/JCDR/2019/39527.12592. [Last accessed on 2020 Jan 11].  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]



 

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