Introduction

Definitions
Classification
Pathophysiology
Pathogenesis
Etiology
Prosthetic factors
Consequences of RRR
Prevention and management
Conclusion
 INTRODUCTION

Umpteen research has been done on RRR & still whether is it

physiologic or pathologic state, is yet to be determined.

So, its necessary to discuss about the various aspects of RRR &
how it affects our day to day treatments in prosthodontics.
 Definitions
Resorption is defined as loss of tissue substance through
physiologic or pathologic process

RRR – ‘A term used for the diminishing quantity and quality of

the residual ridge after teeth are removed’.(G.P.T.-9)

Residual alveolar ridge – portion of the alveolar ridge and its

soft tissue covering which remains following the removal or loss
of teeth.
Parts of Residual Ridge

Crest

Body
Basal bone
 Normal bone physiology
• It depends upon the balance of activity among three cells :-

• Osteoblasts - to form bone

• Osteocyte - to maintain it
• Osteoclast - to resorb it

• Alveolar bone resorption occurs when the osteoblastic activity

cannot keep up with the pace of osteoclastic activity.
CLASSIFICATION OF RRR
• Atwood’s classification(1963)
Order 1 : pre-extraction
Order 2 : post-extraction
Order 3 : high, well rounded
Order 4 : knife edged
Order 5 : low, well rounded
Order 6 : depressed
Branemark et al (1985)

BONE QUANTITY

• Class A : Most of the alveolar bone present.

• Class B : Moderate RRR.
• Class C : Advanced RRR.
• Class D : Moderate resorption of basal bone.
• Class E : Extreme resorption of basal bone.
 Wical and Swoope (mandible)

• Class 1 : RRR is 1/3rd of original vertical height.

• Class 2 : 1/3rd to 2/3rd.
• Class 3 : 2/3rd or more.
 PATHOPHYSIOLOGY
Bone undergo constant remodeling throughout life.

Formation Resorption

Growth Formation>Resorption
Adult hood Formation=Resorption
Old age Formation<Resorption
Changes In The Maxilla
And The Mandible
 Changes in maxilla
• The bone of the maxilla resorb primarily from the occlusal
surface and from the buccal and labial surfaces as the outer
cortical plate is thinner than the inner cortical plate. maxillary
arch becomes narrower from side to side and shorter
anteroposteriorly.
Changes in the mandible

• The outer cortical plate is thicker than the inner cortical plate
except in the molar region. As a result the mandibular residual
bone appears to migrate inwards in the anterior region and
buccally in the posterior region

Consequently the mandibular arch appears wider than maxilla

with resorption.
• The surface of the arches may be resorbed out of
parallelism which can result in diminished stability of
dentures.

• Severe ridge resorption can also result in increased inter

arch space.
 ETIOLOGY of RRR
• Multifactorial
Anatomical

Prosthodontic Metabolic

Mechanical
 Anatomic factors
RRR α anatomic factors

- It includes following components-

• Size & Shape of ridges
• Type of bone removed
• Amount of bone
• Quality of bone
 Size And Shape Of Ridge

Favorable anatomy (for resorption)

• Order 2 residual ridge(post extraction) change to
order4(knife edge) in a scant 2 years.
• large ridges resorb more rapidly .

B. Unfavorable anatomy (for resorption)

• When low depressed ridge is in the same way for many
year, future RRR will probably be at a lower rate.
Amount Of Bone - Broad high ridges may have a greater
potential for bone loss however rate of vertical bone loss may
actually be slower than that a small ridge because there is more bone
to be resorbed per unit of time.

Quality of bone - Denser the bone slower the resorption.

 Metabolic factors
Bone Resorption factors
RRR ≈
Bone formation factors

Local bone resorbing factors

• Endotoxins from dental plaque.
• Osteoclast activating factor.
• Prostaglandins.
• Human gingival bone resorption stimulating factor.
 Systemic factors
Acc. to Baylink et al bone loss due to systemic causes occurs
in 3 ways :

• Bone loss due to decreased formation

• Bone loss due to increased resorption
• Bone loss due to unknown causes
 Bone loss due to decreased formation

Excess amount of glucocorticoid hormones which inhibit

bone formation. This may be seen in -
 Cushing’s syndrome

 Treatment of autoimmune diseases eg.

Rheumatoid arthritis
 Bone loss due to increased resorption
• Hypophosphatemia –
…enhances synth. of dihydroxycholecalciferol
… seen in duodenal ulcer pts
… In renal impairment

• Estrogen & Androgen deficiency-

….estrogen antagonizes effect of PTH

• Calcitonin deficiency-
….Increase bone resorption
 MECHANICAL FACTORS

Force
• Amount
• Frequency
• Duration
• Direction
Damping effect/ energy absorption
• viscoelasticity of mucoperiosteum
• Quality of bone
RRR α ANATOMIC FACTOR
+
BONE RESORPTION FACTORS

BONE FORMATIONFACTOR

+
FORCE FACTOR

DAMPING EFFECT
1
+
TIME
 PROSTHETIC FACTORS FOR RRR:

1. Excessive stress resulting from artificial dentures.

2. Lack of rest/relief to underlying bone from denture.
3. Long continued use of ill fitting dentures.
4. Lack of freeway space due to increased vertical dimension of occlusion
5. Incorrect Centric relation record
6. Faulty selection and placement of posterior teeth

Other prosthetic factors which reduces RRR are:-

broad coverage area by denture base, decrease bucco lingual width of

teeth, balanced occlusion, proper vertical dimension
 Consequences of RRR

• Loss of sulcus width and

depth.
• Muscle attachments placed
close to ridge crest.
• Loss of vertical dimension of
occlusion.
• Reduction of lower facial.
Height.
• Relative prognathism of
mandible.
Consequences of residual ridge resorption

-Sharp Spiny Residual Ridge

-Sharp Mylohyoid Ridge
-Position Of Mental Foramen
-Paraesthesia From
dehiscent Mandibular Canal
-Prominent Genial Tubercles
 Prevention & Management

• Preventive measures

• Diet

• Tissue treatment therapy

• Pre prosthetic surgery

• Prosthetic management:
-Impression techniques.
-Denture base selection.
-Teeth selection and arrangement.
-Implant supported prosthesis
 1 Preventive measures
1
• Preventing loss of teeth

2
• Rest/relief for denture supporting tissues

3
• Socket preservation

• Finger massage of denture bearing mucosa

4

5
• Use temporary soft liners

6 • Good nutrition for (geriatric patients)

 3 Dietary guidelines for patients at risk of losing
bone
 Maintain a high daily calcium intake
 Take calcium supplements if dietary intake is
low

 Obtain 4000 I.U of Vitamin D daily

 Spend 15 minutes in the sun 3 times a week
 Choose a multivitamin or calcium supplement
that contains 4000 I.U of Vitamin D
 4 Tissue Treatment Therapy
• A recent edentulous ridge which may have bony spicules from
extraction site with thin mucosal covering

• Soft conditioning materials can be used to rejuvenate the tissue-

bearing area.
 5 Pre-prosthetic surgery
AIM-Providing a good healthy surface for the insertion of the
dentures
SURGICAL PROCEDURES:
Ridge correction.
Soft tissue surgeries
Hard tissue surgeries
Ridge extension/vestibuloplasty.
Ridge augmentation
Bone transplants
Autogenous and homogenous cartilage
Surgical correction of maxillomandibular relation
 PROSTHETIC MANAGEMENT

 Impression technique

 Selection of denture base

 Teeth selection and arrangement

 Immediate dentures
 Impression technique
Selective pressure technique
• This technique is most widely advocated.
• It confines the forces acting on the denture to the
stress bearing areas .

Winkler used tissue conditioners

• Primary impression of alginate is made.
• Borders are recorded with tissue conditioners.
• Final wash impression is made with a light bodied
material.
 REQUIREMENTS HAVE TO BE MET DURING TEETH ARRANGEMENT

• Stability of occlusion in centric relation.

• Balanced occlusion is preferred.

• Posterior buccolingual cusp width reduction to decrease forces

• Teeth placed in neutral zone

• Non anatomic teeth have known to cause lesser ridge resorption so prefered in
severely resorbed teeth.

• Proper maxillomandibular relation

THANK YOU
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