COMPLETE MUCOSTATIC

IMPRESSION: A NEW ATTEMPT

 Bindhoo YA, J Prosthodont. 2012 Apr;21(3):209-14

 CONTENTS
 INTRODUCTION
 ETIOLOGY OF FLABBY RIDGE
 TREATMENT OPTIONS
 CLINICAL REPORT
 TREATMENT PLAN
 TREATMENT PROCEDURE
- Self retained tray technique
 DISCUSSION
 CONCLUSION
 INTRODUCTION

Hypermobile ridges or Flabby edentulous

ridges are a common occurrence in edentulous patients.This
presentation is a clinical report of a patient with a
generalized flabby maxillary edentulous ridge opposing a
partially edentulous mandibular arch.
 FLABBY RIDGE

 Flabby tissue is defined as excessive movable

tissue
(GPT 9 )

 Flabby ridge (a mobile or extremely resilient

alveolar ridge) is due to replacement of bone by
fibrous tissue.
 ETIOLOGY

Unbalanced occlusal forces

Excessive load on residual ridge

Resorption of underlying bone

Marked fibrosis and inflammation

 TREATMENT
1. Tissue rest
2. Denture correction

3. Surgical reduction  If tissue is still freely displaceable,

pendulous, fissured and some
or
underlying alveolar bone remains
Mucostatic impression technique  If inflammation subsides, shrinkage
occurs and mobility decreases
or

Implant retained prosthesis

 Various Methods Used In Making
Mucostatic Impression
1. Window technique
2. Using detachable trays
3. Employing spacers or perforations in
impression trays
4. Scraping of Impression trays
 CLINICAL REPORT

 73 yr Old Male Patient

 Wanted a new maxillary complete denture due to fracture of the
existing denture
 Previous denture was made 10 yrs back
 History of continuous wearing of denture without tissue rest
 Patient was hypertensive and diabetic
 CLINICAL EXAMINATION

 Class IV complete edentulism-maxillary

ridge
 Class III partial edentulism –mandibular
ridge with missing central incisors
according to American college of
Prosthodontists and Prosthodontic diagnostic
index ( ACP PDI )
 Maxillary ridge mucosa was hyperplastic
with varying degrees of displaceability
 TREATMENT PLAN

1) Scaling and root planing of the remaining mandibular teeth;

(2) Management of flabby ridge,
(i) surgical or
(ii) prosthodontic;
(3) Maxillary removable complete denture and mandibular removable
partial denture (RPD).
 TREATMENT PROCEDURE
 Diagnostic impression for edentulous maxillary arch made
with irreversible hydrocolloid
 Diagnostic cast prepared with type II gypsum product
 Custom tray was constructed with magnets for its
stabilization during impression making
 Construction Of Magnetically Retained
Custom Tray

 Diagnostic cast with denture bearing areas divided into

1. region A – palatal vault
2. Region 2 – ridge portion
 Fabrication Of Tray A

 Spacer – single thickness modelling wax

 Tray A prepared with autopolymerizing resin
 Covered region A and extended around the hamular notch region
 One anterior depression and two posterior lateral depressions were made
 6mm diameter Ferrite magnetic discs (0.35 magnetic field) placed in the depressions
 Fabrication Of Tray B

 Spacer – 2 layers of modelling wax

 Tray fabricated with autopolymerizing resin covering the hyperplastic ridge
 3 horizontal resin extensions to engage the depressions in tray A
 3 ferrite magnets placed in the extensions and secured with autopolymerizing resin
 TRAY ASSEMBLY

 Uniform clearance of 1 to 2 mm between trays A and B all around,

except in the areas where the magnets engaged each other
 IMPRESSION MAKING WITH SELF-
RETAINING CUSTOM TRAY
BORDER MOLDING:
 Heavy body elastomer (Express,3M ESPE, Seefeld, Germany) was
used on the borders of tray B and on the posterior palatal seal region
of tray A for functional border molding
 The tray was stabilized with finger support over the tray A region
TWO STAGES OF IMPRESSION MAKING

 The placement and orientation of trays A and B in stages were

rehearsed many times
 (A) First stage—Impression making of region A with tray A;
 (B) Second stage - Application of impression material for
impression making of region B with Tray B.
The amount of close adaptation to the tissues was
appreciable in the details recorded

The master cast was prepared with type III gypsum

product
 The denture base showed uniform adaptation to the
tissues, and there was no evidence of tissue blanching
or tissue rebound

• static method of jaw relation using bite registration material was done
• Acrylic teeth modified to have minimal or zero degree cusp
• Wax try-in for the maxillary complete denture and mandibular RPD was
carried out
• dentures were processed with heat-polymerizing denture base resin
DENTURE TRY-IN

• Mandibular partial denture maxillary

complete denture were inserted
• Signs of tissue rebound assessed
• Disclosing paste was used to check localized
areas of tissue loading
• Occlusal discrepancies were eliminated
• The denture exhibited satisfactory retention
and stability.
• The necessity of the patient’s role in denture
care was explained
 DISCUSSION

 Flabby ridges can be managed by prosthodontic management alone

or in combination with surgical treatment depending on the degree
of displaceability.
 Pressure on hyperplastic mucosa alters normal tissue balance as per
the law of hydrostatics.
 The concept of mucostatics says that the soft tissues, especially
flabby tissue, should be registered in an unstrained position for the
reason that any other position will compel the tissues to regain their
rest position, dislodging the denture.
 This technique enabled a satisfactory recording of generalized ridge
hyperplasia.
 The magnetic retention ruled out finger pressure and provided an
easy and stable orientation of special trays. The magnets also acted
as tissue stops, avoiding overcompression of displaceable tissues of
crest.
 Tissue displacement limited only to 2- 3 hrs during mastication.
 This passive denture adaptation will not interfere with the
viscoelasticity or the vascularity of the hyperplastic tissue, thereby
maintaining the tissue health.
 CONCLUSION

A self-retained tray technique aims to record the

tissues in their complete passive form, as finger pressure is ruled out. It
is a simpler and less-extensive prosthodontic alternative for patients
with generalised hyperplastic edentulous ridges, where surgical
management is not an option.
REFERENCES:

 Boucher’s Prosthodontic Treatment for Edentulous Patients- 10th edition

 Winkler’s Essentials of Complete Denture Prosthodontics- 2nd edition
 Philip’s Science of Dental Materials – 9th edition
 Prosthodontic Treatment for Edentulous Patients-Zarb-Bolender 12th edition
 McGarry TJ, Nimmo A, Skiba JF, et al: Classification system for the completely dentate patient.
J Prosthodont 2004;13:73-82
 McGarry TJ, Nimmo A, Skiba JF, et al: Classification system for partial edentulism. J
Prosthodont 2002;11:181-193
 A review of Prosthodontic management of fibrous ridges ,R.W.I.Crawford;British dental journal
2005;199:715-719