Flat ridge
Mohamed Ali El Maroush
Ph.D of prosthodontic & Maxillofacial
(Ain Shams University)
Flat Residual Alveolar Ridge
Reason for the difficulty:
The shape of the ridge provides no resistance
to lateral movement of the denture; also,
interference from adjacent musculature is
pronounced.
Flat Residual Alveolar Ridge
Etiology of RRR
I. Anatomic factors
1. Type of bone: cancellous bone is more prone
to resorption than is cortical bone.
2. Size and shape of the ridge: Thin narrow
ridges will resorb more than well-formed
broad ridges, as the force received per unit
area.
Flat Residual Alveolar Ridge
Etiology of RRR
II. Biologic / Metabolic factors
1. Age : RRR generally increases with age.
2. Sex : RRR occurs more in females. This usually
occurs during menopause, as a result of hormonal
disturbances.
3. Nutritional deficiency : Calcium deficiency,
decrease in vitamin C and/or dysfunction of
carbohydrate metabolism, are contributing factors.
Etiology of RRR
II. Biologic / Metabolic factors
4. Systemic health : RRR occurs more in cases such
as:
Uncontrolled diabetes and other debilitating diseases
that may cause tissue destruction and reduce
tissue resistance.
5. Treatment for certain diseases :
a. Radiation therapy reduces regeneration.
b. Hormonal drugs may have an adverse effect on the
hard and soft tissues.
6. Loss of natural teeth: Extraction of teeth as a result
of severe periodontal disease contributes to more
alveolar atrophy than when teeth are lost due to
III. Prosthodontic factors:
1. Long-term wearing of dentures without
serviceability.
2. Improperly constructed dentures with improper
vertical dimension of occlusion, centric relation,
non-balanced occlusion and incomplete coverage of
basal seat area.
3. Continuous wearing of the dentures without rest to
the underlying tissues.
4. Porcelain teeth and/or anatomic teeth with high
cusp angles transmit more force to the underlying
ridge.
IV . Functional factors:
Habits with complete dentures such as bruxism ,
grinding and tapping of teeth may cause RRR.
Management of RRR
Prosthetic Prosthetic
Management Management
With Surgical Without
Intervention Surgical
Intervention
Prosthetic Management With Surgical
Intervention
Ridge
Vestibuloplasty
Augmentation
Distraction
Implant-supported
Osteogenesis
Overdenture
Prosthetic Management With
Surgical Intervention
a-Vestibuloplasty
It is a surgical procedure designed to restore
alveolar height and/or width by detachment of
buccal and/or labial and lingual tissues. These
tissues are positioned at a lower level on the
bone to obtain maximum height of the residual
alveolar ridge.
This could be achieved by one of the
following:
Mucosa advancement or secondary epithelization
procedure or vestibuloplasty with epithelial
Vestibuloplasty
B-Distraction Osteogenesis
This can be done by the help of distraction implant
which contain two mobile endosteal parts which
enable heightening of the alveolar ridge up to 6mm.
ADVANTAGES.
- No need for donor site.
- Simultaneous lengthening of the surrounding soft
tissues as skin , muscles , nerves and blood vessels.
DISADVANTAGES.
- Long treatment period.
- Danger of infection.
Distraction Osteogenesis
Distraction Osteogenesis
Distraction Osteogenesis
Distraction Osteogenesis
C-Ridge Augmentation
Ridge augmentation: This procedure is used
to increase the height and width of the residual
alveolar ridge. A variety of materials have been
used for this purpose:
Autogenous bone from the iliac crest or rib.
Non-autogenous bone.
Hydroxyapatite, (in the granular or block form)
which is injected through one or more
subperiosteal tunnels to build up sufficient
height of the residual ridge.
Ridge augmentation by subperiosteal injection of
hydroxyapatite
Ridge Augmentation
D-Implant-supported
Overdenture
The placement of two or more implants anteriorly in the area
between the two mental foramina can be improve the stability
and retention of the denture.
E-contouring of the prominent genial
tubercles: this is done to provide for an extension in
the sublingual fold space.
F- prominent mylohyoid ridge: its sometimes
recontoured to allow proper extension of the lingual
flange of the mandibular denture.
Root form implants;
Surgical Management
Implant-supported Overdenture
Implant-Tissue Supported
Implant-supported Overdenture
Implant-Tissue Supported
Implant
attachment
Implant-supported Overdenture
Implant-Tissue Supported
Implant-supported Overdenture
Implant-Tissue Supported
Implant-supported Overdenture
Implant Supported
Implant-supported Overdenture
Implant Supported
Prosthetic Management Without
Surgical Intervention
Impression Making
An ideal impression should provide:
Maximum extension without muscle
impingement.
Intimate contact with the tissue area covered.
Proper form of the borders including the
posterior border of the maxillary denture.
Proper relief of hard and sensitive areas.
Primary Impression
Well-formed impression of
(lower) lingual sulcus area
Different impression techniques could be
made according to the condition of the
supporting tissue.
I-Muco-compressive impression technique
II-Butterfly impression technique:
This technique is indicated in case of advanced
resorbed ridge with projecting sublingual
glands.
Three applications of tissue conditioning
material are used for making this impression
with closed mouth technique.
Two application of a viscous tissue
conditioning material, each application is
allowed to remain in the mouth for 8-10
minutes ,then the third and final wash is made
using either a soft tissue conditioning material
III-Dynamic impression technique:
This technique is used to record the range of
muscle action as well as spaces into which the
denture can be extended without displacement.
A special tray is constructed on the primary cast.
Three stops of compound are added to the fitting
surface of the tray.
A compound tongue rest is added in the anterior
region to secure a correct tongue position during
impression making.
Final impression is made using a thin mix of
alginate impression material.
A lower acrylic special tray with metal spurs to aid
retention of the impression material
Occlusal pillars have been built up in green stick to the
correct occlusal height
Establishing the correct occlusal height
Jaw Relation and arrangement of
posterior teeth
Jaw relation registration is carried out using check bite
technique.
Occlusal plane is adjusted nearer to the flat ridge.
A metal denture base is preferred to increase retention
by inter facial surface tension.
Cross-linked cuspless acrylic teeth are used to decrease
the lateral component of force and improve denture
stability.
Setting up of teeth in the neutral zone would help to
achieve denture stability.
Proper contouring of the denture polished surface
improve stability and retention of the denture.
The teeth positioned in the neutral zone
THANK YOU