FLAPPY RIDGE
DONE BY
ALI MOHAMED GAMAL
ESLAM MAHMOUD MENYAWY
WHAT IS A FLABBY RIDGE?
• a superficial area of mobile soft tissue affecting
the maxillary or mandibular alveolar ridges. It
can develop when hyperplastic soft tissue
replaces the alveolar bone
Allen P F, McCarthy S. Complete dentures from
planning to problem solving. London: Quintessence
Publishing, 2003
ETIOLOGY
• Long term denture wear without maintenance (relining or rebasing)
• Loose ill_fitting dentures(main cause) as well wrong centric occluding relation, occlusal
disharmony and traumatic occlusion
• Load concentration on the anterior segment of the ridge as a result of decreased VD
accompanying occlusal wear ex,dentures with anterior porcelain teeth and posterior resin teeth
• Complete maxillary denture opposing natural mandibular anterior teeth and partial denture
• Not removing denture during night to allow the basal seat mucosa toregain its resting form
• Unplanned extractions
COMBINATION SYNDROME/ANTERIOR
HYPERFUNCTION SYNDROME
• Edentulous maxilla is opposed by natural mandibular anterior teet
• Loss of bone form the anterior portion of the maxillary ridge
• Overgrowth of the tuberosities
• Papillary hyperplasia of the hardpalates mucosa
• Extrusion of the lower anterior teeth
• Loss of alveolar bone and ridge height beneath the mandibular
prosthesis
• The cause for this problem is usually inadequate posterior occlusion
LOCATION AND FORMS
• Single or multiple flaps
• Localized or generalized over the entire ridge crest
• Commonly found ,maxillary anterior region associated with amaxillary complete denture
opposing natural mandibular anterior teeth without posterior
• Or mandibular partial denture is present but no longer provides for posterior occkusal
support due to tissue changes
MANAGEMENT/ TREATMENT
• Reversibility of flabby tissue: hypertrophy of the mucosa which does not include fibrous
hyperplasia ,resolve when the source of trauma is removed and start arecvery program
• Irreversibility of flabby tissue: fibrous hyperplasia for the mucosa and necessitates surgical
removal
TREATMENT STEPS
• Removal of the cause
• Remove the denture from the patient mouth till the condition recover
• Elimination of the cause without removing the denture
• Detect any pressure area wih indicating paste(PIP),i.e. correction of pressure areas and
under or overextended denture borders
• Correct the adaptation of the denture base to the underlying tissues using tissue
conditioning material(TCM)this material should be changed every 72 hours the material
will lose its conditioning effect
• Correction of occlusal disharmony by clinical remounting procedure
• Elimination of contact between natural anterior teeth andopposing artificial teeth
• Restoring the lost occlusal vertical dimension (ovd):self curing acrylic resin is applied to the palatal
cusps of the second premolar and first moler of the maxillary denture after Vaseline application to
the opposing mandibular teeth (sears and nelson occlusal pivots)
THIS HELP TO
• Restore the correct vertical dimension
• Restore the correct position of the cndyle
• Eliminate the load on the anterior segment
RECOVERY PROGRAM
• Massage of the soft tissues 2-3 times aday to stimulate the blood supply and aid recovery
• Instruct the patient to dissolve one-half teaspoon of table salt in ahalf glassof warm water
and vigorously swirl the solution against the tissues by inflating and deflating the cheeks
• The removal of the dentures from the mouth for at least 8 out of the 24hours
SURGICAL MANAGEMENT
• This involves removel of the fibrous tissue to leave a firm ridge however removing the
shock absorbing flabby ridge may lead to trauma of the underlying bone(with the patient
feeling soreness) and an increased bulk of denture material. There is also the risk that the
flabby ridge may recur. Removal of the fibrous material may also reduce the height of the
ridge decreasing the chances of a stable denture. However, sometimes ridge
augmentation would be indicated
• Implant-retained prosthesis
PROSTHETIC MANAGEMENT
• Impression techniques:
• Sectional impression techniques/windows technique (two stage)
• One part impression (selective perforation tray)
• Controlled lateral pressure techniques
• Palatal splinting using a two part tray system
• Selective displacement techniques/selective composition flaming technique
• Two part impression technique :mucostatic and mucodisplacive combination
Addison P I. Mucostatic impressions. J Amer DentAssoc 1944;
31: 941
• The jaw relation is recorded using check bite technique
• Cross linked cuspless acrylic teeth re used to dcrease the lateral component of force
• After denture insertion, the patient is instructed for periodic check up of the denture
SECTIONAL IMPRESSION TECHNIQUE/WINDOWS
TECHNIQUE (TWO STAGE)
• Preliminary impression alginate loaded in astock tray
• Poured impression and accustom tray is constructed om the model
• Custom tray:close fitting with window over the area corresponding to the flabby ridge
• Taken an impression in zinc oxide eugenol or low viscosity silicone
• Injected low or medium viscosity silicone (mucostatic)over the flabby ridge with the
secondary impression in place
• Removed as one impression
ONE PART IMPRESSION TECHNIQUE(SELECTIVE
PERFORATION TRAY)
• The degree of mucosal displacement is minimal,(modified conventional technique)
• Preliminary impression :alginate in stock trays after appropriate border correction
• Fabrication of spaced special tray with perforations from the primary cast
• Secondary impression low viscosity impression material (impression plaster low-viscosity silicone
or alginate) in spaced special tray
CONTRALLED LATERAL PRESSURE TECHNIQUE
ADMINISTERED IN A FIBROUS POSTERIOR MANDIBULAR
RIDGE
• Preeliminar impression: alginate + convencional tray .
• Making special tray with border moulding through green stick tracing compound.
• Removed green stick over the fibrous crestal tissue with a heated instrument and vent
holes are made in the tray in this region.
• Second impression:with liht body silicone material + special tray ,which is applied on the
buccal and lingual aspects of green stick in the area.
• The perforation allows the excess material to flow [Link] the green stick extensions
exert even bilateral pressure on the fibrous ridge, it will assume resting central position.
PALATAL SPLINTING USING A TWO-PART TRAY SYSTEM
TWO OVERLYING IMPRESSION TRAYS
• A primary model is constructed using the fitting surface contour of a previous denture.
• Palatal tray: create space on the mobile area with wax and rod in the center
• First impression: low viscosity zinc oxide paste impression in palatal [Link] upward force
is maintained until it is apparent that the mobile ridge is just beginning to have pressure
applied to it
• Second impression: special tray impression is made completely encompassing the first
tray. It should be inserted from in front,back wards.
selective displacement technique/ SELECTIVE COMPOSITION FLAMING
TECHNIQUE
this technique aims to displace but not distort the flabby ridge as if in function
• Preliminary impression: mucostatic impression material(eg impression plaster alginate)+cast in stone.
• Spaced customized tray compound impression taken of the preliminary model(reduces the risk of
displacing the flabby ridge)
• The impression is tried in the mouth and should be quite retentive.
• The impression is removed and warmed all over except for flabby ridge area.
• The impression is taken in the mouth,the flabby ridge is compressed but not distorted as the other
portions of the impression compound(which are warm) sink into the tissues.
• The impression is removed inspected and retried in the mouth to check that it is [Link] any instability
occurs then the impression should be reheated and re-taken.
TWO PART IMPRESSION TECHNIQUE: MUCOSTATIC
AND MUCO DISPLACIVE COMBINATION
• Preeliminar impression: alginate + convectional tray + primary cast.
• The displaceable tissue can be marked on the impression and transferred to the primary cast.
• Special tray: a close fitting cold-cured or light-cured acrylic base with uncovered flabby ridge
area.
• Secondary impression: special tray + zinc oxide-eugenol or medium-bodied silicone.
• Applying or syringing a thin mix of impression plaster or ligt-bodied silicone in displaceable
mucosa with the secondary impression in place
• Removed as one impression