RESIDUAL RIDGE RESORPTION

PRESENTED BY- DR. BALPREET KAUR

MDS 1ST YEAR
DEPARTMENT OF PROSTHODONTICS
CONTENTS
1. Introduction
2. Definitions
3. Classification of RRR
4. Pathology of RRR
5. Pathophysiology of RRR
6. Pathogenesis of RRR
7. Changes in maxilla and mandible
8. Epidemiology of RRR
9. Etiology of RRR
10. Management of RRR
11. Conclusion
12. References
INTRODUCTION
• After tooth extraction, a cascade of inflammatory reactions is immediately
activated, and the extraction socket is temporarily closed by the blood clot.

• Epithelial tissue begins its proliferation and migration within the first week
and the disrupted tissue integrity is quickly restored.

• The most striking feature of the extraction wound healing is that even after
the healing of wounds, the residual alveolar ridge bone undergoes a life-long
catabolic remodeling.
• The size of the residual ridge is reduced most rapidly in the first 6 months, but
the bone resorption activity continues throughout life at a slower rate,
resulting in removal of a large amount of jaw structure.

• This unique phenomenon has been described as RESIDUAL RIDGE

RESORPTION (RRR).

• Residual ridge resorption( RRR) is a major oral disease which causes

impairment of the stomatognathic system.

• Due to this the treatment of the edentulous patients requires a maintenance

phase that must be carried out for the remaining life of the patient.
 DEFINITIONS
WHAT IS RESIDUAL BONE ?

That component of maxilla or mandibular

bone that remains after the teeth are lost.
{GPT 10}

WHAT IS RESIDUAL RIDGE?

The portion of the residual bone and its soft tissue

covering that remains after the removal of teeth. {GPT
10}
WHAT IS RESIDUAL RIDGE RESORPTION?
Completely mandibular residual edentulous alveolar ridge covered ... [Internet].
[Link]. [cited 2023 Dec 15].
A term used for the diminishing quantity and
quality of the residual ridge after extraction.
{GPT 10}
CLASSIFICATION OF RRR

A. ATWOOD’S CLASSIFICATION

Order 1 - Pre- extraction

Order 2- Post- extraction
Order 3- High, well-rounded
Order 4- Knife edge
Order 5- Low, well-rounded
Order 6- Depressed

Atrophy of the residual alveolar ridge following tooth loss in an ... [Internet]. [Link]. [cited 2023 Dec 15]

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

 B. ACCORDING TO LEKHOLM AND ZARB

On the basis of quality of residual alveolar bone

Type 1- Almost the entire jaw is composed of

homogenous compact bone.

Type 2- A thick layer of compact bone

surrounds a core of dense trabecular bone.

Type 3- A thin layer of compact bone

surrounds a core of dense trabecular bone.

Type 4- A thin layer of compact bone

surrounds a core of low- density trabecular Title: 10: Available Bone and Dental Implant Treatment Plans | Pocket ... [Internet].
bone. [Link]. [cited 2023 Dec 15]. Available from:
[Link]

Juodzbalys G, Kubilius M. Clinical and Radiological Classification of the Jawbone Anatomy in Endosseous Dental Implant Treatment. Journal of Oral and Maxillofacial Research. 2013 Jun 12;4(2).
Classification of bone quantity and quality, adapted from Lekholm ... [Internet]. [Link]. [cited 2023 Dec 15]
C. ACCORDING TO MISCH

Resnik R. Misch’s Contemporary Implant Dentistry E-Book. Elsevier Health Sciences; 2020
D. ACCORDING TO LINKOW AND CHERCHEVE

Class I- Bone consists of evenly

spaced trabeculae with small
cancellated spaces.

Class II- Bone has slightly larger

cancellated spaces with less
uniformity of osseous pattern.

Class III- Large, marrow filled

spaces exist between bone
trabeculae.

Resnik R. Misch’s Contemporary Implant Dentistry E-Book. Elsevier Health Sciences; 2020
E. ACCORDING TO AMERICAN COLLEGE OF PROSTHODONTICS
BASED ON BONE HEIGHT( MANDIBLE ONLY) -

Type I- Residual bone height at the least vertical height of mandible is 21 mm or greater.

Type II- Residual bone height of 16- 20 mm.

Type III- Residual bone height of 11- 15 mm.

Type IV- Residual bone height of 10 mm or less.

McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH. Classification System for Complete Edentulism. Journal of Prosthodontics. 1999 Mar;8(1):27–39.
 Type I

Type II

McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH. Classification System for Complete Edentulism. Journal of Prosthodontics. 1999 Mar;8(1):27–39.
 Type III

Type IV

McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH. Classification System for Complete Edentulism. Journal of Prosthodontics. 1999 Mar;8(1):27–39.
BASED ON RESIDUAL RIDGE MORPHOLOGY( MAXILLA ONLY) -

Type A- Anterior labial and posterior buccal vestibular depth, palatal morphology,
tuberosity, hamular notch is present. Tori is absent.

Type B- Posterior buccal vestibule is lost. Palatal vault is present. Poorly defined
tuberosity and hamular notch. Tori is present.

Type C- Anterior labial vestibule is lost. Palatal vault offers minimum resistance.
Mobile anterior ridge. Tori is present. Minimum support.

Type D- Loss of anterior and posterior vestibule. Palatal vault offers no resistance.
Tori is present. Redundant anterior ridge. Prominent anterior nasal spine

McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH. Classification System for Complete Edentulism. Journal of Prosthodontics. 1999 Mar;8(1):27–39.
McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH. Classification System for Complete Edentulism. Journal of Prosthodontics. 1999 Mar;8(1):27–39.
McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH. Classification System for Complete Edentulism. Journal of Prosthodontics. 1999 Mar;8(1):27–39.
F. BASED ON WICAL AND SWOOPE

Class I- Upto one- third of the original

vertical height lost.

Class II- From one- third to two- third of the

vertical height lost.

Class III- Two- third or more of the

mandibular height lost.

Residual Ridge Resorption A Challenge To Conquer: A Review [Internet]. [Link]. [cited 2023 Dec 15].

Wical KE, Swoope CC. Studies of residual ridge resorption. I. Use of panoramic radiographs for evaluation and classification of mandibular resorption. The Journal of Prosthetic Dentistry [Internet]. 1974 Jul 1 [cited 2020 Mar 25];32(1):7–12.
Available from: [Link]
 PATHOLOGY OF RRR

GROSS PATHOLOGY MICROSCOPIC PATHOLOGY

Unhealed maxillary and mandibular residual ridges with severe ... [Internet]. [Link]. [cited 2023 Dec 16]. Available from: [Link]
 GROSS PATHOLOGY
• In layman terms RRR is- “ my gums have shrunk.”

• Primarily a localised loss of bone.

• The basic structural change in RRR is a reduction in the

size of the bony ridge under the mucoperiosteum.

• Numerous longitudinal radiographic cephalometric

studies have provided excellent visualization of the
gross patterns of this bone loss from a lateral view Pre-operative completely edentulous residual alveolar ridge ... [Internet].
[Link]. [cited 2023 Dec 16].
point .

• The careful superimposition of portions of tracings of

these lateral cephalograms has clearly shown the
gross reduction of bone in size and shape that occurs
on the external surface on the labial, crestal, and
lingual aspects of the residual ridge.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

Figure 3-1 Tracings of three lateral cephalographs with the maxillae and mandibles carefully superimposed.
Note the changes in the shape of the residual ridges following the extraction of remaining teeth 50 months
before. (From Atwood DA: Postextraction changes in the adult mandible as illustrated by microradiographs of
midsagittal sections and serial cephalometric roentgenograms. J Prosthet Dent 1963;13: 810-824.)
• Gross finding seen on dry
specimens is that while external
cortical surfaces of the maxilla and
mandible are uniformly smooth, the
crestal areas of residual ridges have
a different appearance and show
many more porosities and
imperfections. An edentulous mandible, Order IV, knife-edge residual
ridge.
• Bones with the most severe RRR
(Orders V and VI) may display the
gross porosity of medullary bone on
the crest of the ridge and
eventually may even display the
uncovering of the inferior alveolar
canal on the mandible

An edentulous mandible, Order VI, depressed residual ridge.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

Lateral cephalometric
radiographs provide the
most accurate method for
determining the amount of
residual ridge and the rate
of RRR over a period of
time.

Gross bone loss ot residual ridges is revealed by careful superimposition of portions of two
cephalometric radiographs made 16 years apart. The actual bone loss in the anterior part of the
ridge of the mandible was 13 mm in height (a 41 percent reduction) and 60 mm 2 in cross-
sectional area (a 24 percent reduction). (From Atwood D A : Reduction of residual ridges: A major
oral disease entity. J Prosthet ent 1971;26:266-279.)

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

RRR does not stop with the residual ridge, but may go well below where the apices of the teeth
where, sometimes leaving only a thin cortical plate on the inferior border of the mandible or
virtually no maxillary alveolar process on the upper jaw.

Panoramic radiograph showing severe RRR in both maxilla and mandible in marked contrast
to the dentulous area th at supports three mandibular teeth.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

MICROSCOPIC PATHOLOGY

• Aberrant osteoclastogenesis on the

external alveolar bone surface is
not a part of physiological bone
remodeling, but may be regulated
by the oral barrier tissue and
function.

• We propose that osteoclasts

associated with oral barrier tissue
are primarily responsible for
residual ridge resorption because
oral barrier osteoclasts reside in the
resorption pits on the external
surface of the alveolar bone without
coupled osteoblastic bone
formation, resulting in the net loss
of bone structure.

Kondo T, Kanayama K, Egusa H, Nishimura I. Current Perspectives of Residual Ridge Resorption: Pathological Activation of Oral Barrier Osteoclasts. Journal of Prosthodontic
Research. 2023
A microradiographic study of 21
edentulous mandibles has shown
wide variation in the
configuration, density, and
porosity of not only the residual
ridges but also the entire cross-
section of the anterior mandible.

Radiographs of midsagittal sections of eight mandibles illustrating various orders of

residual ridge form: (upper, left to right)
preextraction, postextraction, high well-rounded; (lower) knife edge, low well-
rounded with and without cortical layer on crest of ridge, and depressed without
cortex on crest.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

In addition, there was
microradiographic evidence of
mandibular osteoporosis including-:
- increased variation in the density
of osteons.
- increased number of incompletely
closed osteons.
-increased endosteal porosity.
- increased number of plugged
osteons in about half the
specimens.

A microradiograph of the inferior border of a mandible showing evidence of

moderate osteoporosis with increased variation in the density of osteons, increased
number of incompletely closed osteons, and increased endosteal porosity ( x 15).

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

PATHOPHYSIOLOGY OF RRR
• It is a normal function of bone to undergo constant remodeling throughout life
through the processes of bone resorption and bone formation.

• During growth- Increased bone formation.

• During osteoporosis- It is generalized increased bone resorption.

• In periodontal disease- There is localized destruction of bone around teeth.

• RRR is a localized pathologic loss of bone.

• Yet the physiologic process of internal bone remodeling goes on even in the
presence of this pathological osteoclastic activity that is responsible for the loss of so
much bone substance.

• This means that new bone has been laid down inside the residual ridge in advance of
the external osteoclastic removal of bone.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

• According to Enlow’s V principle, remodeling must take place in three dimensions
such that certain portions of bone become narrower to the extent that all existing
cortical bone in that area is removed by external osteoclastic activity and is replaced
by a new cortical layer that is formed by simultaneous endosteal bone formation.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

PATHOGENESIS OF RRR
ORDER I- Pre extraction-: The tooth is in its
socket with thin labial anad lingual cortical
plates merged with the lamina dura.

ORDER II- Post extraction-: The healing

period includes clot formation and
organisation, filling of the socket with
trabecular bone and epithelisation over the
socket site. The edges of the residual ridges
are still sharp.

ORDER III- High, well-rounded residual

ridge-: Sharp edges are rounded off by
external osteoclastic resorption

.
Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021
 ORDER IV- Knife- edged-: As resorption
continues from the labial and lingual aspects,
the crest of the ridge becomes increasingly
narrow

ORDER V- Low, well- rounded-: As the

process continues, the knife edge become
shorter and eventually disappears.

ORDER VI- Depressed-: Eventually this

too resorbs leaving a depressed ridge

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

• RRR is a chronic, progresive, irreversible, and cumulative in which
regrowth has not been seen.

• Patient with most RRR in pre extraction stage tends to have high RRR at
later stages of the study as well.

• In seperate studies Tallgren and Atwood and Coy found that mean ratio of
anterior maxillary RRR to anterior mandibular RRR is 1:4

• Therefore it can be said that RRR is greater in mandible than maxilla but it
can be opposite in some patient,

• Hence one must treat the particular patient, not the “average”
patient.
CHANGES IN MAXILLA AND MANDIBLE

• In maxilla , bone reduction takes place mostly in upward and inward direction.

• Since the outer cortical plate is thinner than the inner cortical plate, resorption from
outer cortex tends to be greater.

• The bone of maxilla resorbs primarily from the occlusal surface and from the buccal
and labial surfaces.

• Thus the ridge looses height and becomes narrower from side to side and shorter
anteroposteriorly.
• In mandible, bone reduction takes
place in outward and downward
direction.

• The mandibular arch resorbs in a

labial and lingual direction resulting in
widening of the arch posteriorly.
EPIDEMIOLOGY OF RRR
• Till date there have been no large scale studies of RRR in man.

• To date it would appear that RRR is worldwide-

- In males and females
- In young and old
- In sickness and in health
- with and without dentures
- unrelated to the primary reason for the extraction of teeth.

• Rate of RRR is variable-

- between persons.
- within the same person at different times.
- within the same person at different sites.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

ETIOLOGY
• It is postulated that RRR is a multifactorial, biomechanical disease that results from
combination of one or more factors which may be called co-factors.
• The factors can be divided into 4 categories-
ANATOMIC, METABOLIC, MECHANICAL/FUNCTIONAL, PROSTHETIC

• For further convenience, since the functional factors must function through the prosthetic
factors, they may be grouped together as mechanical factors

ANATOMIC METABOLIC

MECHANICAL

Some clinical factors related to rate of resorption of residual ridges . J Prosthet Dent. 1962; 441-50
ANATOMIC FACTORS

It is postulated that RRR varies with quantity and quality of bone of the residual
ridges.

RRR Anatomic factors

Quantity of Bone Quality of Bone

It is not a good It depends on the

prognosticator of the density of ridge. Dense
rate of RRR because at compact bone has
times large ridges decreased resorption.
resorb rapidly and knife But density of ridge
edges may undergo does not at any
only little changes. moment signify the
current metabolic
activity of bone.
Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.
METABOLIC FACTORS

bone resorption factors

RRR
bone formation factors

RRR varies directly with certain systemic or localized bone resorptive

factors and inversely with bone forming factors

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

BONE RESORPTION FACTORS BONE FORMING FACTORS
- Endotoxins (from dental plaque) - Circulating estrogen

-Osteoclast Activating - Thyroxine

Factor(OAF)
- Growth hormone
- Prostaglandins
-Androgens
-Human gingival bone- resorption
factor -Calcium

- Heparin -Phosphorus

- Trauma -Vitamin D

- Protein

- Fluoride

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

There has been evidences of osteoporosis on mandible. Therfore it is a reasonable
working hypothesis that Osteoporosis contributes to RRR

• Osteoporosis is a common metabolic disorder characterised by low bone mass

and microarchitectural deterioration of bone tissue, leading to higher bone
fragility and increased fracture risk.

• It has 2 forms-

a. Type I ( post menopausal)- most prevalent upto a decade in females.

b. Type II(senile or idiopathic)- attacks males and females at any age.

• RRR is mostly a manifestation of Type I Osteoporosis.

Singhal S, Chand P, Singh BP, Singh SV, Rao J, Shankar R, et al. The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers. Gerodontology.
2012 Jan 9;29(2):e1059–66.
MECHANICAL FACTORS
Bone that is “used” by regular physical activity will tend to strengthen with certain
limits, while bone that is in “disuse” will tend to atrophy.

Wollf’s law states that “ change in form follows change in function and that its change is
due to alteration of its internal architecture and external conformation, in accordance
with mathematical laws.”

Others postulates that RRR is an “abuse” bone resorption due to excessive forces
transmitted by dentures. Perhaps both the postulates are true.

The fact is that with or without dentures some patients have little or no RRR whereas
some have severe RRR.

Ortman harold r . Factors of bone resorption of the residual ridge. journal of prosthetic dentistry [Internet]. 1962 May;12(3):429–40.
 RRR FORCE

Bone is directly influenced by Force.

But while considering force one must consider-

a. Amount of force

b. Frequency of force

c. Duration of force

d. Direction of force

e. Distribution of force per unit area

f. Damping effect of underlying tissue

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

• When a force of 50lbs was given while biting then it was seen that
pressure under maxillary denture is 12 lb/in2 whereas under mandibular
denture is 21lb/ in2 . So chances of RRR is more in mandible than
maxilla.

• Frequency and duration of the force exerted on denture during normal

functional mastication and swallowing is <15 mins per waking day.
3500lbs- 4200 lbs of loading per day including 1500 empty swallows.

• The direction of force is determined by the angulation of bone which in

turn is determined by angulation of teeth. Maxillary posterior teeth are
buccaly tilted, so when force is directed resorption of bone is inward and
upward . Whereas mandibular molar are lingually tilted , so by the same
reasoning the direction of resorption is downward and outward.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

 1
RRR

Damping
effect
• The amount of force applied to the bone may be affected inversely by the
“damping effect,” or energy absorption.

• The “damping effect” may take place in the mucoperiosteum, which can be
considered a viscoelastic material.

• Frost stated that bones that are subjected largely to compression loads and
experience no significant bending loads, are composed largely of cancellous
bone, which is ideally constructed for the absorption and absorption of energy.

• He also pointed out that trabeculae in such bones are oriented parrallel to the
direction of compression allowing for maximal resistance to deformation.

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

• The traditional design of dentures includes many features whose goal is to reduce the
amount of force to the ridge and thereby to reduce RRR .

• These prosthetic factors include

- broad-area coverage (to reduce the force per unit area)

- decreased number of dental units

- decreased buccolingual width of teeth

- improved tooth form (to decrease the amount of force required to penetrate a bolus of
food)

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers;

2021.
- avoidance of inclined planes (to minimize dislodgement of dentures and shear forces)

- centralization of occlusal contacts (to increase stability of dentures and to maximize

compressive forces)

- provision of adequate tongue room (to improve stability of denture in speech and
mastication)

- adequate interocclusal distance during rest jaw relation (to decrease the frequency and
duration of tooth-contacts)

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

Hence RRR can be co-related to the major co-factors in the form of a formula as follows-

RRR Anatomic factors + Bone resorption factors + Force factors

Bone formation factors Damping effect factors

In addition to the three major categories of factors (anatomic, metabolic, and mechanical), the
importance of the time since extraction to the bone-loss curves, described in the section on the
pathogenesis of RRR , should be emphasized by adding an inverse relation

RRR 1
time

So the combined formula is as -:

RRR Anatomic factors + Bone resorption factors + Force factors + 1

Bone formation factors Damping effect factors Time

Winkler S. Essentials of complete denture prosthodontics. Delhi: Aitbs Publishers; 2021.

MANAGEMENT OF RRR

1. Physical health evaluation

2. Diet

3. Tissue treatment therapy

4. Pre prosthetic surgery

5. Prosthetic management
- Impression techniques
- Denture base selection
- Teeth selection and arrangement
- Implant supported prosthesis

Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
1. PHYSICAL HEALTH EVALUATION

• Systemic conditions that can contribute to the degenerartion of

the bone condition should be corrected and stabilized, for eg-
osteoporosis, hyperparathyroidism, diabetes mellitus.

• Any dental treatment should follow only after the condition has
been treated and patient is fit.

Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
2. DIET

• These patients need a diet high in protein, vitamin, and

mineral content.

• They should totally eliminate refined carbohydrates, white

flour, and white sugar or, specifically, sucrose and glucose.

• In all dietary prescriptions, the consistency of food

prescribed must take into account the patient’s ability to
masticate.

Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
3. TISSUE TREATMENT THERAPY

• The use of soft conditioning material to

rejuvenate the tissue-bearing area has been well
established.

• Many tissues, such as hypertrophied tissue,

treated previously by surgery, can now be
reconditioned by the judicious use of this
material.

Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
4. PRE PROSTHETIC SURGERY
• Oral surgery is often necessary and can be of great benefit to
a degenerate denture ridge. Particularly, it can help eliminate
the undesirable undercuts or reduce the bony spines in a
knife-edge ridge.

• Some surgical procedures include-

- Ridge correction
- Ridge extension/ vestibuloplasty
- Ridge augmentation
- Surgical correction of maxillo- mandibular realtion

Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
5. PROSTHETIC MANAGEMENT
a. IMPRESSION TECHNIQUES

In patients with severly resorbed ridges , lack of ideal ammount of

supporting structures, decreases support and the encroachment of the
surrounding mobile tissues onto the denture border reduces both
stability and retention .

Thus ,the main aim of impression procedure is to gain maximum area of

coverage

Yadav B, Jayna M, Yadav H, Suri S, Phogat S, Madan R. Comparison of Different Final Impression Techniques for Management of Resorbed Mandibular Ridge: A Case Report. Case Reports in Dentistry [Internet]. 2014;2014:1–6.
 -Mc- Cord and Tyson’s admixed technique

• Impression compound and green tracing stick compound are mixed

in the ratio of 3:7 by weight and placed in a bowl of water at 60 C
and kneaded into a homogeneous mass that provides a working
time of 90 secs.

• Wax spacer is removed , this homogeneous mass is loaded and

patient is made to various tongue movements

Yadav B, Jayna M, Yadav H, Suri S, Phogat S, Madan R. Comparison of Different Final Impression Techniques for Management of Resorbed Mandibular Ridge: A Case Report. Case Reports in Dentistry [Internet]. 2014;2014:1–6.
 - All Green technique
• Green stick compound is
kneaded into a homogeneous
mass and is loaded on the
special tray and border
movements are done.
• Final impression is made using
zinc oxide eugenol paste.

Yadav B, Jayna M, Yadav H, Suri S, Phogat S, Madan R. Comparison of Different Final Impression Techniques for Management of Resorbed Mandibular Ridge: A Case Report. Case Reports in Dentistry [Internet]. 2014;2014:1–6.
 - Winkler’s technique( closed
mouth functional impression)
• Denture base with occlusal rim
are fabricated on primary cast.
• Jaw relations are done to
record appropriate horizontal
and vertical dimensions.
• Three applications of tissue
conditioner material are done
at an interval of 8- 10 mins
and functional movements are
made by the patient.

Yadav B, Jayna M, Yadav H, Suri S, Phogat S, Madan R. Comparison of Different Final Impression Techniques for Management of Resorbed Mandibular Ridge: A Case Report. Case Reports in Dentistry [Internet]. 2014;2014:1–6.
• Tissue conditioning material is applied on the tissue surface of
mandibular denture base and the patient is asked to close the
mouth in pre recorded vertical dimensions and do various
functional movements such as puffing, blowing, whistling and
smiling.

• Final impression is made with light body addition silicon material

using closed mouth technique.
-Elastomeric Technique

• Tray adhesive is applied over the border , internal and external surface of the
acrylic custom tray to facilitate the retention of the silicon border molding material

• An addition silicon putty with an extended working time is loaded along the
borders of the special tray

• The special tray is placed in the mouth and its border is molded , the patient is
asked to move the tongue according to standard impression procedures

• The tray is removed from the mouth and the impression is examined.

• Light-body addition of silicon impression material is loaded in the impression and

inserted in the mouth .

Yadav B, Jayna M, Yadav H, Suri S, Phogat S, Madan R. Comparison of Different Final Impression Techniques for Management of Resorbed Mandibular Ridge: A Case Report. Case Reports in Dentistry [Internet]. 2014;2014:1–6.
 • The patient is instructed to
repeat the tongue movements
more vigourously , while the
light-body impression material
is border molded along the
buccal and labial flange
areas .
• After the material has set , the
impression is removed from
the mouth and examined for
any discrepency

Yadav B, Jayna M, Yadav H, Suri S, Phogat S, Madan R. Comparison of Different Final Impression Techniques for Management of Resorbed Mandibular Ridge: A Case Report. Case Reports in Dentistry [Internet]. 2014;2014:1–6.
b. Selection of denture base

- There are three types of denture bases that are selected

- methyl methacrylate resin denture bases

- cast metal bases
- processed resilient lined denture bases

Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
• Methyl methacrylate resin
denture bases

- They are the standard bases

used.
- These bases are quickly and
easily processed.
- Dimensionally stable.
- In a short time,the base
appears to soften, change
colour and is not strong .

Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
• Cast metal bases

- They provide greater

accuracy of fit to the tissues
by surface tension than
acrylic denture bases

- They maybe of gold ,

chromium cobalt or
aluminium .

Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
• Processed resilient, lined
denture bases

- Its greatest advantage is its

cushioning effect on the mucosa and its
ability to distort and spring back .

- Indications :-
1. Patients with severly undercut
ridges , for whom surgery is
contraindicated .

2. Patients with parafunctional

mandibular movement habits

3. Patients with flat ridge and delicate

tissues
Wendt DC. The degenerative denture ridge—Care and treatment. Journal of Prosthetic Dentistry. 1974 Nov 1;32(5):477–92.
c. Teeth Selection and Arrangement

- Teeth can be selected according to their form and size

1. Anatomical or cuspal teeth

2. Semi anatomic teeth

3. Non anatomic or zero degree teeth

d. Implant Supported Prosthesis

The various problems associated with RRR and stability of removable

soft tissue born dentures have aroused interest in dental implantology
to provide stable mechanical support to the dental prosthesis

Implant Support Dentures [Internet]. [Link]. [cited 2023 Dec 16].

This is because of the following
advantages offered by implant supported
prosthesis

- Maintenance of alveolar bone.

- Maintenance of occlusal vertical

dimension .

- Height of alveolar bone is found to be

maintained as long as the implant
remains healthy.
- Improved psychologial health.

- Overall volume of bone is maintained.

- Efficiancy to take up stress and strain.

CONCLUSION

• RRR is a major unresolved oral disease which cause physical, psychological, and
economic problems.
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• It is a chronic, progressive, irreversible and disabling disease that is multifactorial
in origin.

• Patient should be educated regarding the type of treatment plan that is ideal for
them, the prognosis of the treatment outcomes and the various types of
removable and fixed prosthesis that are available.

• More research in RRR should be done to provide better treatment approaches to

millions of edentulous patients.

• The motto of research in this field is to provide better methods of prevention and
control of this disease.
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2. The Glossary of Prosthodontic Terms [Link] of Prosthetic Dentistry, Volume 130, Issue 4, e7 - e126

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