Removable

Prosthodontic
5

Dr. Tasnim Hamdan

Dr. Waseem Bahjat Mushtaha
BDS and Msc from University of
PhD in prosthodontics
Valencia, Spain
Unit 1 :Management of
Flabby Ridges

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 Definition
Edentulous ridges that are mobile or resilient with little evidence of
underlying supportive bone which occurs due to the replacement of bone
by fibrous tissue. A flabby ridge causes instability of the denture.
Prevalence is seen 24% in maxilla and 5% in mandible

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 Etiology
Multifactorial phenomenon
1) Long term denture wear without maintenance (relining or rebasing)

2) Loose ill-fitting dentures (main cause) as well wrong centric occluding

relation, occlusal disharmony and traumatic occlusion.

3) 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.

4) Complete maxillary denture opposing natural mandibular anterior teeth and

partial denture.

5) Not removing denture during night to allow the basal seat mucosa to regain its
resting form.

6) Unplanned extractions
 7) Combination
syndrome/Anterior
hyperfunction syndrome
Edentulous maxilla is opposed
by natural mandibular anterior
teeth
Loss of bone from the anterior
portion of the maxillary ridge
Overgrowth of the tuberosities
Papillary hyperplasia of the
hard palate’s 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
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 Location and forms
Single or multiple flaps
Localized, or generalized over the entire ridge crest.
Commonly found; maxillary anterior region associated with a maxillary
complete denture opposing natural mandibular anterior teeth without
posterior
Or mandibular partial denture is present but no longer provides for
posterior occlusal support due to tissue changes.

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 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 a recovery program
Irreversibility of flabby tissue: fibrous hyperplasia for the
mucosa and necessitates surgical removal.

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 Treatment steps
1) Removal of the cause:
Remove the denture from the patient’s mouth till the condition recover
Elimination of the cause without removing the denture
2) Detect any pressure area with indicating paste (PIP), i.e. Correction of pressure
areas and under-or overextended denture borders.
3) 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.

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4) Correction of occlusal disharmony by clinical remounting procedure.
5) Elimination of contact between natural anterior teeth and opposing
artificial teeth.
6) Restoring the lost occlusal vertical dimension (OVD): self curing acrylic
resin is applied to the palatal cusps of the second premolar and first molar
of the maxillary denture after vaseline application to the opposing
mandibular teeth (Sears and nelson occlusal pivots).

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 This will help to
Restore the correct vertical dimension.
Restore the correct position of the condyle.
Eliminate the load on the anterior segment.

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 Recovery program
Massage of the soft tissues 2-
3 times a day to stimulate the
blood supply and aid
recovery.
Instruct the patient to dissolve
one-half teaspoon of table salt
in a half glass of 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 24 hours.
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 If the condition persists after this recovery
program, than the treatment will be either:
Surgical removal of the hypertrophic tissues.
A modified impression making procedure can be
used to record these tissue under minimal pressure
without distortion as any distorted tissue tends to
rebound leading to denture instability.

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 Prosthetic management
1-Impression Techniques:
Sectional impression technique/windows technique (Two stage )
One part impression technique (selective perforation tray)
Controlled lateral pressure technique
Palatal splinting using a two-part tray system
Selective displacement technique/Selective composition flaming technique
Two part impression technique: Mucostatic and mucodisplacive
combination
2- The jaw relation is recorded using check bite technique.
3- Cross-linked cuspless acrylic teeth are used to decrease the lateral
component of force.
4- After denture insertion, the patient is instructed for periodic check-up of the
denture.

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 1.Sectional impression technique/windows
technique (Two stage )
Preliminary impression: alginate loaded in a stock tray.
Poured impression and a custom tray is constructed on 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

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 2.One part impression technique (selective
perforation tray)

If 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

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 3.Controlled 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 light 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 out. Since the green stick
extensions exert an even bilateral pressure on the fibrous ridge, it will assume a
resting central position

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 4.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 tray. An
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, backwards.

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 5. 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 customised 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 stable. If any instability occurs then the impression should be
reheated and re-taken.
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6.Two part impression technique: Mucostatic and
mucodisplacive combination

Preeliminar impression: alginate + convencional 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 light-bodied
silicone in displaceable mucosa with the secondary impression in place
Removed as one impression

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