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Journal club on Management of flabby ridges
1. MANAGEMENT OF FLABBY RIDGE – A
CASE REPORT
Agrawal B, Agrawal S, Mangal A. Management of Flabby Ridge-A
Case Report. Indian Journal of Dental Sciences. 2011 Jun 1;3(2).
PRESENTED BY:
Dr. ADITI SHREYA
1st year Post Graduate
GUIDED BY:
Dr. KHINNAVAR POONAM K
PROFESSOR
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Up to 24% of edentulous maxillae
In 5% of edentulous mandible
Prevalence
6
J Prosthet Dent 1998; 79: 17-23.
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• In a study conducted the flabby ridge was related
to the severity of resorption.
• Prevalence of flabby ridge was more in severely
resorbed maxilla than that of moderate or slight
resorption of maxilla.
• Maxilla > mandible
• Maxilla: in the anterior region
Review of prevalence:
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Acta Odontol Scand 1997 ;55: 306-13
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• The technique involves preparing the
customized, close-fitting tray with a
hole over the flabby ridge
Minimally displacive technique
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Lynch CD, Allen PF. Management of the flabby ridge: using
contemporary materials to solve an old problem. British Dental
Journal. 2006 Mar;200(5):258-61.
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Author demonstrated the impression of hyperplastic
tissue using the medium body and light body
vinylpolysiloxane.
Review of literature
21
British dental Journal 2000; 188: 484-92
33. Hobkirk
• Involves removal of acrylic from a complete special tray creating a
window over the displaceable area.
• Supported mucosa is recorded in medium-bodied silicone.
• Impression of the displaceable mucosa is then recorded by light-
bodied silicone
Eur j prosthodont rest dent 1997
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• Allen PF. Management of the Flabby Ridge in Complete
denture Construction. Dent Update;35:524-8
• Carlsson G E. Clinical morbidity and sequelae of treatment
with complete dentures. J Prosthet Dent 1998; 79: 17-23.
• Xie Q, Narhi T O, Nevalainen JM, Wolf J & Ainamo A. Acta
Odontol Scand 1997; 55 : 306-13
• Spicer G H. Impressions of ridges with hyperplastic tissue. J
prosthet dent 1953; 3 :163-4.
• McCord J F, Grant A A. Impression making. British dental 53
REFERENCES
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• Pai UY, Reddy VS, Hosi RN. A single step impression
technique of flabby ridges using monophase
polyvinylsiloxane material: a case report. Case reports
in dentistry. 2014 Apr 27;2014.
• Sajani R, Ranukumari A. Impression Techniques for
effective management of flabby ridge-An overview.
Journal of scientific dentistry. 2020 Jul 30;2(2):29-33.
• Laney WR, Gibilisco JH. Diagnosis and treatment in
prosthodontics.
• MacGregor A R. clinical dental prosthetics.
• Bouchers prosthodontic treatment for edentulous patients
54
55. 10/24/2023 55
• Crawford R W I and Walmsley A D. A review of prosthodontic
management of fibrous ridges. British Dental Journal 2005;199:715-9
• Lynch C D and Allen P F Management of the flabby ridge: using
contemporary materials to solve an old problem .British dental Journal
2006; 200 :258-61.
• Labban N. Management of the flabby ridge using a modified
window technique and polyvinylsiloxane impression material. The
Saudi Dental Journal. 2018 Jan 1;30(1):89-93.
• Bansal R, Kumar M, Garg R, Saini R, Kaushala S. Prosthodontic
rehabilitation of patient with flabby ridges with different impression
techniques. Indian journal of dentistry. 2014 Apr;5(2):110.
journal club presentation
INDIAN JOURNAL OF DENTAL SCIENCES 2011
Before going into the presentation proper lrt us quicky revise few things
Gpt 9 defines flabby rige as an excessive movable tissue.
Article Indian journal of dentistry : Is a superficial area of mobile soft tissues affectiong maxillary and mandibular ridges
Occurs when hyperplastic soft tissues replaces the underlying alveolar bone. As we know that the firm and resilient mucosa plays an importany role in the retention of a denture. So this movable flabby rige will affect the retention.. And retention stability and support are all interrelated ,, so, if not looked properly all of them will get compromised
From a clinical perspective, construction of a retentive maxillary denture for patients with a flabby maxillary ridge can be extremely challenging.
Acoording to various artciles compressibility of the alveolar ridge can be determines by using a t burnisher and displacibilty of the flabby rige can be detrmined using the handle of the mouth mirror.
Composed of mucosal hyperplasia and loosely arranged fibrous connective tissue as well as more dense collagenised connective tissue, which is considered to be the result of prolonged trauma from denture base and severe bone resorption.
The reported prevalence for this condition also varies among investigators, but it has been observed in… reason for prevalce in maxilla- as we know that the mandibular anterior teeth are last to exfoliate- so patient tend to wear maxillary complete denture opposing distal extension rpd.which tends to cause combination syndrome .
Maxilla: in the anterior region ( max CD opposing mand RPD)
A displaceable or'flabby' anterior maxillary ridge is frequently seen when the edentate maxilla is opposed by natural teeth in the anterior mandible. This combination causes trauma to the anterior maxillary ridge as all occlusal forces are directed on to this area,and fibrous replacement of the bony ridge occurs (Figure 1). According to Kelly,5 the cause of this was related to lack of posterior seal and excessive bony resorption beneath the mandibular partial denture. When the anterior maxillary ridge is flabby, the main problem is poor support for the denture which becomes displaced during function, and retention and stability are compromised.so,The aim of treatment should be to reduce the potential for displacive forces during function by careful attention to impression surface detail and occlusal contacts with the mandibular dentition
Surgical removal of fibrous tissue prior to conventional prosthodontics
Implant retained prosthesis
Conventional prosthodontics without surgical intervention
Implant retained- long term maintainence, high cost general health.
health and general conditions of the patient should be kept in mind before planning a treatment- fit for surgery , bear the cost. Advantage – a firm denture bearing area is produced that enhances stability of denture. Disadv- loss of sulcular deoth so vestibuloplaty may be needed…if severe bone loss is present ridge augmentation procedure is needed… usually flabby ridge occure due to fibrous replacement of the underlying alveolar bone ..so surgical management may even worsen the situation. Carrison ij his article in 1998 published in jpd stated that it is better to have flabby ridge than no ridge at all.
SO THAT THE UNDERLYING AREAS ARE MINIMALLY displaced- low viscosity impression materilas
The'minimally displacive' technique is not called mucostatic now as a true mucostatic technique,as some of the denture-bearing tissues are compressed during the impression making process. ZAFARULLAH WALA Tray 2 mm short of the functional with adequate posterior extensions
Border moulding done with greenstick compound until the functional sulcus is recorded.
Impression made with ZOE. Trim the excess.
Reseat the impression and apply impression plaster using brush or wax knife over the exposed flabby tissue.
Remove the impression tray carefully when the impression plaster has set.
Separating agent to be applied on the plaster prior to casting impression.
Beading , boxing is done.
Using the same stages, medium and low viscosity polyvinylsiloxane impression materials can be used as alternatives to zinc oxide and eugenol paste and impression plaster, respectively.
2 mm short of the functional sulcus.The tray should extend just beyond
the vibrating line on the attached part of the soft palate.
Softened greenstick tracing compound (Kerr UK Ltd, Peterborough, UK) should be added gradually to the periphery of the tray and border moulded until the functional sulcus is recorded.
Apply zinc oxide and eugenol impression paste to the tray and record an impression. Trim back any impression material which has escaped through the hole in the
tray. Check that the remainder of the denture-bearing area has been recorded satisfactorily.
■ Reseat the impression and apply impression plaster over the exposed flabby tissue.This can be applied using a brush
or a wax knife.The material should be stiff enough to be applied with a brush, but not runny to the extent that it drips.
Remove the impression tray carefully when the impression plaster has set and check that it is satisfactory (Figure 3). Instruct the technician to put a separating agent on the plaster prior to casting impression.
Apply beading wax to the periphery to protect the periphery of the impression (Figure 4).
The'selective pressure' technique involves greater use of the mobile anterior tissue for denture support. Having made the primary impression,as described previously,a model is cast in dental stone.The stages unique to this technique then involve:
Recording an impression on the primary cast using greenstick impression compound.
Insert the impression tray containing greenstick compound into the mouth. Soften and border mould the periphery in the usual manner.
The compound should be softened in all the denture-bearing area except the mobile tissue. Reseat and exert digital pressure on the tray in the area distal to the anterior ridge.
Remove the impression, chill,and then re-insert the tray. Check that it is retentive and stable. If not, re-soften the greenstick material as before and repeat the procedure (Figure 5). Secondary impression made using zoe or impression plaster
This is not a selective pressure technique. The tissues are recorded in compressed state so after placing the denture they will tend to rebound..thus applying more force on the denture thus compromising retention .Applying more load on the movable tissues will make them more compressed leading to more resorbtion. Also the green sick is low fusing impression compound having increased flow.. So using a tray made up of green stick will be very difficult to handle against the gravity. So the use of this technique is questionable
READ ARTICLE
1. A preliminary impression in a fluid material such as alginate is cast producing a model of a relatively undistorted ridge.
2. A 3-4 mm spaced rigid special tray is constructed and used to take a composition impression of the primary cast .
3. The impression periphery is carefully softened and functionally trimmed. The fibrous part of the ridge can be outlined on the impression surface
. The composition overlying the firm denture bearing areas is softened with a flame before the tray is seated under heavy pressure, attempting to replicate functional force.
By performing the impression in this way, the original relatively undistorted shape of the fibrous tissues is retained while the tissues more capable of functional denture support are recorded in a displaced state
The author said that by performing the impression this way, the original undistorted shape of the fibrous tissue is retained , while the tissues more capable of functional support are recorded in displaced state.
denture thus compromising retention .Applying more load on the movable tissues will make them more compressed leading to more resorbtion. Also the impression compound having LOW flow flow increases at very high temp which can cause tisse burns.. And as we know impression compound is mucocompressive , so there will be continuous forces applied on the denture causing resorbtion of the underlying bone
Author describes the use of impression plaster for the impressions of hyperplastic tissue. After the ZOE impression the slot is created in the region of hyperplastic tissue . A thin mix of Plastogum is painted on the exposed hyperplastic tissue.
Author describes series of techniques of making impression for flabby ridges.
Author said that the pressure to the underlying mucosa can be reduced by creating multiple holes in the special tray. As it will cause the secondary impression to squuez out (bleed)
Placing window is better because in this case we generate minimum pressure over the underlying flabby ridge as paint on technique is used .
DIAGRAM :Pressure on the unsupported, displaceable soft tissue can be minimised further by the use of perforations in the tray overlying these areas.
Osbrone described this technique in 1964,
Aim of this technique was to maintain the contour of the easily displacable tissue while rest of the denture bearing tissue are recorded.
Stop modification by devin in 1985 oblique inclined so that the second impression tray is guided oblique upward and backward direction to envelope the palatal tray.
A primary model is constructed using the fitting surface contour of a previous denture. From this a palatal tray is fabricated with wax being used to create space on the palatal aspect of the mobile area and extending to the ridge crest around the arch
In this acrylic resin palatal tray, a low viscosity zinc oxide paste impression is taken of the palate. An upward force is maintained until it is apparent that the mobile ridge is just beginning to have pressure applied to it. Once this has set, a second special tray impression is made completely encompassing the first tray. It should be inserted from in front, backwards, and the presence of the supporting zinc oxide should prevent backward displacement of the mobile ridge..
The palatal tray accurately locates the second part special tray using a stop, thereby allowing for a pre-planned even thickness of impression material.
First described by Osborne in 1964 for use in the mandible, this is a popular technique described by many authors as it ensures that pressure exerted by the tray does not cause distortion of the mobile tissues
1. The preliminary impressions are taken and cast. The displaceable tissue can be marked on the impression and transferred to the primary cast.
2. A close fitting cold-cured or light-cured acrylic base is constructed so that the flabby ridge area is left uncovered
3. Appropriate border correction is then carried out before an impression of the firm, supported mucosa is recorded in zinc oxide-eugenol or medium-bodied silicone
. An impression of the displaceable mucosa is then recorded by applying or syringing a thin mix of impression plaster or light-bodied silicone .The latter having preferential use in cases involving undercut.
cons- no bordermoulding was done in this article. As as we know border moulding plays an important role in recording the function of the tissues.
62 year old visited to the clinic with complain of loose denture fabricated few days back. This was her second denture. Intra oral examination –complete edentulous maxilla opoosing partially dentate mandible with teeth present anteriorly. Anxious to undergo surgical procedure so conventional prostho
Primary impression with alginate…followed by custom tray with 3 spacers present in the flabby anterior area.
Spacers removed and perforations made. Medium bodied addition siloxane placed over the ‘normal” tissue.
After application of a suitable adhesive, heavy bodied addition-curing polyvinylsiloxane was applied to the area of the custom tray associated with the ‘normal’ tissues.
Once set, it was removed from the mouth.
Using a scalpel, any material that had flowed into the area of the tray associated with ‘flabby’ tissues was removed.
Heavy bodied impression material was then applied to the periphery of the custom tray. This was placed in the mouth, and the heavy bodied polyvinyl siloxane was border-moulded in the usual manner. Once this had set, the tray was removed from the mouth
The area of the custom tray associated with the ‘flabby’ tissues was then filled with light bodied polyvinylsiloxane impression material. A wash of light-bodied polyvinylsiloxane impression material was also placed over the heavy bodied material that had compressed the ‘normal’ tissues. This tray was placed in the mouth and allowed to set.
Cons – since border moulding was not done earlier , the proper peripheral seal during impression is questionable
SPECIAL TRAY WITH WINDOW OPENING
THEN BORDER MOULDING
THEN ZOE
THEN PLASTER
ARTICLE PUBLISHED IN 2022
in resorbed mand ridges with flabby ridge
Both primary and secondary impression made in one step
Mcolds technique –viscous admix r3 parts impression compound+1 part green stick
Make primary ..same primary relief the flabby area and make secondary using light bodied polyvinyl siloxane.
A heated instrument is then used to remove the greenstick related to the fibrous crestal tissues and the tray is perforated in this region
Perforated tray in the region: figure
Light bodied silicone impression material is then syringed onto the buccal and lingual aspects of the greenstick and the impression gently inserted. The excess material is extruded through the perforations.
tell abou denture base –heat cured clear acrylic.To conclude there are various techniques present to record the flabby ridge. The most easy and most commonly used is the zafrulla khan. In order to make a proper impression we must know the propertits of a material.. A light bodied also if loaded late may lead to increase in viscosity and thus may not act as minimally compressive .. A proper management of flabby ridge may help in better denture delivery and thus more patient satisfaction .
