But this is highly impossible. Order 4 to order 5: more resorption Over this manipulated impression compound, a wash impression with zinc oxide and eugenol is made. The impressions were poured with dental stone and the displaceable tissues were identified on the cast. OVERDENTURES Any removable dental prosthesis that covers & rests on one or more remaining natural teeth, the roots of natural teeth, &/or implants. Class B- Moderate residual ridge resorption occurs. A cortical layer of bone is present over the crest of the ridge even during residual ridge resorption, which clearly shows the formation of new bone. Once set, the entire impression is removed. If the flabby tissue is compressed during conventional impression making it will later tend to recoil and dislodge the overlying denture . Class 2: Less than 0.5 inch space exists between mylohyoid ridge and the floor of the mouth. Non-anatomic teeth should be used for the setup. Keywords: Flabby ridge, hyperplastic soft tissue, McCord and Ahmad technique Flabby ridge is predominantly seen in the upper anterior region and is commonly associated with features of combination syndrome, as mentioned by Kelly . Order 3 to order 4: resorption on labial and lingual aspects Flat ridge management 11,538 views. The maxillary borders were recorded by selective pressure impression technique using green stick compound (Figure 13). In this paper, the authors have proposed a newer technique of impression making of the flabby tissues using a combination of readily available newer and older materials to ensure an accurate and easy impression of these tissues. 3. with the preservation of teeth for an overdenture, there is also the preservation of the periodontal membrane that surrounds these teeth. The best of all is to prevent the loss of natural teeth. Class 4- a thin layer of compact bone surrounds a core of low-density trabecular bone. Crawford et al. Of all these goals, preservation of the residual ridges is most important. Use of impression compound as a stopper for an edentulous mandibular impression also has its advantages as it avoids placing conventional stoppers in areas which are flabby. SUPERIOR BORDER AUGMENTATION Fingerprint identification, known as dactyloscopy, or hand print identification, is the process of comparing two instances of friction ridge skin impressions (see Minutiae), from human fingers or toes, or even the palm of the hand or sole of the foot, to determine whether these impressions could have come from the same individual. [6, 7] described a two-tray impression technique where two trays are fabricated and impression is recorded with two different materials and is then oriented intraorally. What are Teeth numbers and names – Tooth Numbering System? The design of the denture should aim at reducing the amount of force on the ridge, thereby reducing residual ridge resorption. A good impression plays an important role in the successful treatment in cases of resorbed mandibular ridges where there is inadequate tissue to fulfil the requirement of retention, stability and support . UNDERCUT RIDGES Retention will be reduced as denture will have to be trimmed, during fitting, in order that it may pass over the bulbous area of the ridge, thus causing loss of peripheral seal. Residual ridge resorption is multi factorial and biomechanical disease. SELECTIVE IMPRESSION TECHNIQUE. This technique helps in maintaining the contour and recording the details of the tissues without displacing the flabby tissues. Branemark classified residual ridge resorption depending on bone quality and quantity: Bone quantity Class A- Most utmost of the alveolar bone is present. Residual ridge resorption is a confined pathologic loss of bone that is not built back by removing the causative factors. Achieved using iliac crest bone grafts, tightened with rigid fixation Disadvantage: this technique does not correct the irregularities of denture bearing areas such as superior border changes or disclosed position of mental nerve which results from mandibular atrophy. Osborne  described the “window” impression technique with a custom tray made with a window over the flabby tissues. Each technique has its advantages and shortcomings. Watt and McGregor, recently revisited by Watson , described a technique where impression compound is applied to a modified custom tray. the Orchard Ridge Campus in Farmington Hills. Bone undergoes constant remodeling throughout life. The anterior canine-canine region in maxilla along with the maxillary tuberosity and the mandibular canine-canine region was flabby (Figures 1 and 2). Until this is determined, it is essential to analyze our patients in regard to the various possible factors to best of our ability, to seek consultation concerning possible metabolic factors, & to perform prosthodontic care of our patients within our best capabilities. Residual ridge resorption inversely proportional to damping effect So residual ridge resorption is related to the etiologic factors in the following manner: Anatomic factors + Residual ridge resorption is directly proportional to Bone resorption factors/bone formation factors + Force factors / damping effect factors + 1 / time. Earlier studies show that prevalence of flabby ridges vary in either arches, with edentulous maxillae prevalence being 24% and edentate mandibles 5% [2, 3]. 4. reducing the vertical dimension in such cases may be advantageous as this reduces the force applied during mastication. The impression technique plays the substantial role. Reduction of the lower facial height. Construction of complete dentures and its performance in function depend on accurate impression of the denture bearing and limiting areas. The thermoplastic properties of this material are then manipulated to simultaneously compress the “normal tissues,” while avoiding displacement of the “flabby tissues” using the same material and impression tray. Transpositional flap vestibuloplasty ( Lip Switch), Vestibule and floor of the mouth extension procedure. According to GPT-7, âresidual ridge resorption is a term used for the diminishing quantity and quality of the residual ridge after the teeth are removed.â Aim: This article described a physiological impression technique to design denture surfaces by the action of the surrounding musculature during functional movements based on "neutral zone concept" in patients with severely atrophied mandibular ridge. Microscopic studies show the presence of osteoclasts on the external surface of the crest of residual ridges. impression technique: The impression procedure thickness of wax spacers were adapted on the palatal for this technique was carried out following the aspect of the flabby ridge and extending to the crest. Its limitations include chances of decrease in vestibular height requiring an additional surgery of vestibuloplasty. These prosthetic factors include broad coverage area, decreased number of dental units, decreased buccolingual width of the teeth, improved tooth form, avoidance of inclined planes, centralization of occlusal contacts, adequate interocclusal distance during rest jaw relation. Flat (Atrophic) Mandibular Ridge covered with Atrophic Mucosa (Admix Impression Technique) Atrophic mandibular ridge Definitive Impression with admix of 3 parts by weight of (red) impression compound to 7 parts by weight of greenstick Denture Space (Neutral zone) Impression A primary impression of the upper and lower arches was taken with alginate (Neocolloid; Zhermack) in the edentulous trays. Clear acrylic resin was preferred for tray fabrication as tissue blanching underneath the tray could be easily evaluated, thereby making it easier for the operator to relieve pressure spots on the tray. MAXILLARY HYDROXYAPATITE AUGMENTATION Eliminates the need for donor site surgery & is easily placed in an outpatient setting It can be used to contour or eliminate minor ridge irregularities & undercut areas in the maxilla. My best wishes, Alda. Order 1——order 2——order 3——-order 4——-order 5——order 6, Order 1 to order 2: after extraction 4). This preserves proprioceptive impulses supplied by the periodontal membrane. Typically these “flabby ridges” are composed of mucosal hyperplasia and loosely arranged fibrous connective as well as more dense collagenised connective tissues. However, resorption of the posterior residual ridge was increased when compared with similar sites in the patients treated with implant-supported fixed prostheses. A variety of impression techniques have been suggested for flabby ridge cases, such as using two materials on a single custom impression tray, a two-tray impression with different impression materials incorporated together intraorally, a window impression, and using impression compound on a custom tray with a wash impression material application. Another reason for flabby tissue is unplanned and uncontrolled dental extraction . Prosthodontic literature has documented various impression techniques for overcoming the problem of the flabby ridge. Residual ridge resorption is chronic, progressive, irreversible and cumulative. The presence of impression compound also helps in orienting the tray thereby ensuring proper seating during border moulding and secondary impression procedures. This article presents a technique to overcome the difficulties encountered in impressing the severely resorbed mandibular ridge using elastomeric impression materials and a modified special custom tray. The 1,270 ppi reader is able to better capture the minute details present on a childâs ï¬nger (e.g. A primary Impression Is taken in a mucostatic Impression material (e. g. Impression plaster or alginate) and cast in stone. and functional moments were done till the impression material hardens.13 The technique proposed by Dr. Chandrasekaran Nair Irreversible hydrocolloid is used for mandibular primary impression. A Single Step Impression Technique of Flabby Ridges Using Monophase Polyvinylsiloxane Material: A Case Report, Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Mangalore, Karnataka 575001, India, Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore-575018, India. If endosteal bone growth fails to keep pace with external osteoclastic activity, then medullary bone would be exposed resulting in defects on the crest of the ridge. Peripheral borders are thicker, and peripheral seal should be maintained in the maxillary arch. The upper tray is kept properly seated in position by the operatorâs thumb and index fingers. In this paper, the authors have proposed a newer technique of impression making of the flabby tissues using a combination of readily available newer and older materials to ensure an accurate and easy impression of these tissues. Treatment: 1. an alveolectomy to reduce undercut. deformation model based on ridge curves yields better matching performance compared to minutiae points. Class E- Extreme resorption of the basal bone occurs. A maxillary custom tray was fabricated using clear autopolymerising acrylic resin (RR self-cure acrylic resin, Dentsply, India) covering the tissues except the area that was flabby (Figure 6). The current paper describes a simple technique to record flabby tissues in their undisplaced state using readily available clinical materials like polyvinylsiloxanes in varying consistencies. The remaining borders of impression were recorded by selective pressure technique using green stick compound (Pinnacle tracing stick, DPI, Mumbai, India) (Figure 10). But this is labeled as a disease because of the wide variation in the rate of residual ridge resorption. Elsey HJ. This gives the patient a denture that has far more support than any conventional appliance. It seems, therefore, prudent to suggest that younger edentulous patients would benefit from fixed prostheses supported by implants, whereas overdentures should be recommended for elderly edentulous patients. A good impression plays an important role in the successful treatment in cases of resorbed mandibular ridges where there is inadequate tissue to fulfil the requirement of retention, stability and support. 7 out of 10 completely edentulous patients have resorbed mandibular ridge. FLAT PALATE WITH SHALLOW RIDGES the denture may easily be displaced during mastication through lack of ridge support, the shallow sulci adversely influence peripheral seal Treatment: an impression technique incorporating careful peripheral adaptation, the use of cuspless teeth, to reduce the lateral drag from cuspal interference. Fig.5: Impression with border molding completed. Stability of lower denture in such cases is usually becomes the determining factor between success and failure. 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