GUIDED BY:

DR. MANESH LAHORIPROFF & HEAD

DEPT. OF PROSTHODONTICS

KDDC, MATHURA

PRESENTED BY:

DR. PRATEEK AGRAWAL

M.D.S. IIIrd YEAR

CONTENTS

• INTRODUCTION• ETIOLOGY OF RIDGE RESORPTION • CLASSIFICATION OF RESIDUAL RIDGE • PREVENTION AND TREATMENT• SUMMARY• BIBLIOGRAPHY

INTRODUCTION

Residual ridge is a term used to describe the shape ofthe clinical alveolar ridge after healing of bone and softtissues after tooth extractions.

After tooth extraction, a cascade of inflammatoryreactions is immediately activated, and the extractionsocket is temporarily closed by the blood clot. Epithelialtissue begins its proliferation and migration within the firstweek and the disrupted tissue integrity is quickly restored.

The most striking feature of the extractionwound healing is that even after the healing ofwounds, the residual alveolar ridge bone undergoes alife-long catabolic remodeling. The size of the residualridge is reduced most rapidly in the first 6 months,but the bone resorption activity continues throughoutlife at a slower rate, resulting in removal of a largeamount of jaw structure.

This unique phenomena has been described asResidual Ridge Resorption (RRR).

Residual ridge resorption after loss ofteeth is a multifactorial oral problem.According to Atwood, the degree of mandibularloss of its alveolar portion is 3-4 times higherthan alveolar resorption in the maxilla. Therate of RRR is different among persons andeven at different sites in the same person.

Residual bone is considered to be the basewhich provides support for dentures and is anarea where forces created while biting andchewing foods are transmitted.

Loss of alveolar bone from the edentulousjaws is a serious and common clinical problem,especially among the elderly.

In particular, “flat lower ridge” is associatedwith difficulties in providing successful dentures.Stability of lower denture in such cases is usuallythe distinguishing factor between success andfailure.

ETIOLOGY OF RIDGE

RESORPTION

It is postulated that residual ridge resorptionis a multifactorial, biomechanical disease thatresults from a combination of:

• Anatomic factors• Metabolic factors• Mechanical factors• Prosthodontic factors

A. Anatomic factors:-Ridge resorption varies with-

Quantity and Quality of the bone.

Shape& Form of the ridges (Large, well-rounded ridgesand broad palates would seem to be favorable anatomicfactors)

Density of the ridge (density at any given moment doesnot signify the current, metabolic activity of the bone andbone can be resorbed by osteoclastic activity regardless of itsdegree of calcification)

B. Metabolic factors:-• Generally, body metabolism is the net sum of all the building

up (anabolism) and the tearing down (catabolism) going on itthe body.

RRR α bone resorption factorsbone formation factors

• In equilibrium the two antagonistic actions (of osteoblastsand osteoclasts) are in balance.

• In growth, although resorption is constantly taking place inthe remodeling of bones as they grow, increased osteoblasticactivity more than makes up for the bone destruction.

• Whereas in osteoporosis, osteoblasts are hypoactive,and, in the resorption related tohyperparathyroidism, increased osteoblastic activityis unable to keep up with the increased osteoclasticactivity.

• The normal equilibrium may be upset andpathologic bone loss may occur if either boneresorption is increased or bone formation isdecreased, or if both occur.

• Ridge resorption varies directly with some systemicor localized bone resorptive factors and inverselywith some bone formation factors.

• Some local biochemical factors in relation toperiodontal disease which affects the ridgeresorption-

Endotoxins from dental plaque on uncleardentures.

Osteoclast activating factor (OAF).Prostaglandins.Human gingival bone resorption stimulating

factors.Heparin acts as a cofactor in bone resorption

which is produced from mast cells

• Systemic factors influence the balance between thenormal bone formation and bone resorption. Thesefactors create a natural resistance to unfavorablelocal factors. They are-

Estrogen.Thyroxin.Growth hormone.Androgens.Calcium. Phosphorus.Vitamin D. Protein. Fluoride.

C. Mechanical factors:-Functional Factors-

When force within physiologic limits is applied tobone that force brings about the remodeling of bonethrough a combination of bone resorption and formation

• RRR directly proportional to Force:-– Amount, frequency, duration, direction, area over which force

is distributed (force/unit area) and damping effect of theunderlying tissue.

– Some postulate that it is because of disuse atrophy and others asabuse of bone.

– There is increased tendency for mandibular ridge to undergoresorption compared to maxilla.

Damping Effect/ Energy Absorption-Resorbing residual ridge is indirectly

proportional to damping effect. Dampeningeffect takes place in the mucoperiosteum, whichis a viscoelastic material. Maxillary bone (RR) isfrequently broader, flatter and more cancellousthan its mandibular counterpart.

So it is ideally constructed for the absorptionand dissipation of energy. Frost pointed out thatthe trabaculae in cancellous bone are arrangedparallel to direction of compressiondeformation.

D. Prosthodontic factors:-Clinical observations indicate that excessive

alveolar bone resorption can be caused byphysiologically intolerable forces produced byfunctioning complete dentures.

The inherent denture factors which may affect thesupporting structures include:– The occlusal forms of the teeth.– The alignment of the denture teeth / occlusal pattern.– Deformation of the denture bases.– Materials with which denture teeth are made and– The effects of the loss of proper occlusal vertical

dimension (over closure).

The occlusal forms-• The form of the occlusal surfaces of artificial teeth,

wether of the Anatomic, Non anatomic or 0 degreeconfiguration, must have some effect on chewingefficiency and on forces tending to distort thedenture bases.

• One of the earliest opponents of the anatomic toothform was French who coined the term “cusp trauma”as one of the most serious defects that had to beguarded against in complete denture construction.Soon after, Sear’s developed his non anatomic toothform which initiated the introduction of many newdesigns to denture teeth throughout the years.

Chewing efficiency-• Results of early studies on chewing efficiency with

various occlusal forms were contradictory.Thompson, Trapozzon and Lazzari found anatomicteeth to be more efficient than non anatomic teeth,whereas Soboik, Manly and Vinton found nostatistical difference between the efficiency of theanatomic and non-anatomic teeth.

• More recent studies have shown that there is nostatistical difference in the chewing performance indenture teeth with cuspal ranging from 0 to 30degree.

Denture base deformation –• Studies done by Askew and Hoyer showed that

when the mandible with denture was pulledinto lateral and protrusive more deformationwas caused under the denture with anatomictooth form than with non anatomic tooth formand same was with acrylic resin denture baseswhich resorbed the ridge more than the metalbase when used with anatomic teeth than withnon anatomic teeth.

Tooth material –• The material from which the denture teeth are made

may have some effect on the forces transmittedthrough the denture base material to the supportingridges.

• It is said that porcelain tooth when placed causesmore resorption of ridge than acrylic tooth.

Loss of occlusal vertical dimension (overclosure)-• The loss of proper occlusal vertical dimension after

the insertion of complete dentures results in thetriggering of a cyclic series of event detrimental to thehealth of the residual alveolar ridges.

CLASSIFICATION OF RESIDUAL

RIDGE

• The basic structural change in RRR is areduction in the size of the bony ridge underthe mucoperiosteum. It is primarily alocalized loss of bone structure. In somesituations, this loss of bone may leave theoverlying mucoperiosteum excessive andredundant.

• In order to provide a simplified method forcategorizing the most common residual ridgeconfigurations, Atwood (1963) described a system ofsix orders of residual ridge-

Order I – Pre extraction. Order II – Post extraction. Order III – High well rounded. Order IV – Knife edge. Order V – Low, well rounded. Order VII – Depressed.

• Several authors have affirmed the relationship of theforamen to the inferior border of the mandible remainsrelatively constant in spite of increasing age or resorptionof the alveolar process above the foramen. (JPD; 32 (1);1974; 7-12)

– CLASS I: Up to one third of the original vertical height lost.– CLASS II: From one third to two thirds of the vertical height

resorbed.– CLASS III : Two thirds or more of the mandibular height lost.

GUIDED BY:

DR. MANESH LAHORIPROFF & HEAD

DEPT. OF PROSTHODONTICS

KDDC, MATHURA

PRESENTED BY:

DR. PRATEEK AGRAWAL

M.D.S. IIIrd YEAR

CONTENTS

• INTRODUCTION• ETIOLOGY OF RIDGE RESORPTION • CLASSIFICATION OF RESIDUAL RIDGE • PREVENTION AND TREATMENT• SUMMARY• BIBLIOGRAPHY

TREATMENT AND PREVENTION

• SWENSON stated, “ The ideal ridge is one that is broadin its bearing surface and has practically parallelsides.”

• But in the degenerative denture ridges- undercutridges, V- shaped ridges, thin knife edge ridges, andflat or non- existent denture ridges may be seen.

• Prosthodontists must correct dentures on all of thesedegenerated ridges and should aim not only to replacethe lost structures and lost function but also topreserve the remaining ridge.

• The cause of the degenerative denture ridgewill determine the type of treatment.

• So a detailed examination must be performed.

• Complete mouth and panographicradiographs are essential.

• A comprehensive dental history including-

Previous prosthetic treatment

Number of old dentures made

Frequency of denture rebasing should beappreciated in order to estimate both theapparent rate of progression of RRR and thecapability of the individual to cope up withprevious denture.

• Intra-oral examination should determine theridge form and extent of resorption. Mucosalform on and surrounding the ridge should bechecked along with palpation to locate anytender areas of mucosa.

• The assessment of quantity, quality, viscosityof the saliva should be made. This may affectphysical retention of the denture associatedwith the cohesive and adhesive properties ofsaliva between the denture and mucosa.

• The tongue size and tongue movementsshould be assessed.

• Radiographs should also be taken which aidsin assessing ridge resorption, inadequate bonethickness (risk of spontaneous fracture). Theposition of the mental nerve and mandibularcanal can also be established.

• Diagnostic models may also be taken to allowcase evaluation in the absence of the patient.

• A dietary analysis can be obtained throughseveral means.

• Their ability to chew will frequently dictatetheir selection of food, and this will usuallygenerate a diet high in refined carbohydratesand low in proteins, vitamins and minerals-just the opposite of what is needed to helpstop the onslaught of bone destruction.

I. Prevention:– Best of all is to prevent the loss of teeth.– Prevention and/or the correct diagnosis and

management of all of the etiologic factors of thedisease.

– Any systemic illness that is contributing to thedegenerated bone condition must be corrected orstabilized. Any dental treatment should followonly after the condition is under control and thepatient is fit for treatment. In cases where limitedhelp can be given, the patient should be counseledabout its effect on dental health.

– Diet is one of the most neglected facets oftreatment in degenerate denture ridge patients.These patients need a diet high in protein,vitamin, and mineral content. So the dietaryproblems should be corrected.

– Correcting deficiency of various hormone,vitamin, mineral etc.

– Tissue treatment therapy to rejuvenate the tissuebearing area by the use of soft conditioningmaterial.

– Muscle strengthening exercises.

II. Prosthetic management:A. IMPRESSION MAKING-

• In patients with severely resorbed ridges, lack of idealamount of supporting structures decreases supportand the encroachment of the surrounding mobiletissues onto the denture border reduces both stabilityand retention.

• Thus the main aim of the impression procedure is togain maximum area of coverage. A broad areacoverage with maximal denture base extensiondecreases the force experienced per unit area of themucosa beneath the denture and the likelihood of itstrauma.

• However, in resorbed ridge the extension ofthe base is critical to avoid interferences withthe movement of border structure.

• There are different impression techniques tofollow. The principles employed inimpression making should be maximalsupport, retention and stability.

• Special techniques, to determine accuratelythe denture border extension have beenevolved-

Fish recommended a technique where,sublingual fold space, extending frompremolar to premolar region on each side wasrecorded. This horizontal flange acted as‘tongue rest’ thereby increasing the stabilityand support.

Bernard Levin: Suggests making primaryimpression with alginate (25% less water).Special tray should be wider and heavier inthe buccal shelf area. While border moldingtongue should be allowed to extend fully.Patient should make only moderatemovements. Final impression should becompleted with Elastomeric impressionmaterial. Exaggerated tongue movementsshould be made.

Winkler technique involves the use of the tissueconditioning materials.• A preliminary impression is made to obtain a

generally overextended registration.• Using the resulting cast, a resin tray is made, and

an occlusal wax rim is added to simulate theheight and position of the anterior and posteriorteeth and then tried in the mouth.

• The borders are adjusted so that the lingualflange and sublingual crescent area are inharmony with the resting and active phases ofthe floor of the mouth.

• The buccal and labial extension of the acrylictray is adjusted to be deliberately short of thereflections of the cheek and lip.

• A stable, nonretentive tray should now beavailable.

• From this point on, an open- or closed mouthtechnique may be employed.

• In general, three applications of conditioning materialare used.

• Two applications of the more viscous material aremade, each application being allowed to remain in themouth for eight to ten minutes, removed, rinsed, andchecked.

• Pressure areas are corrected at the time of the firstapplication.

• The third and final wash is made with the relativelylight-bodied material.

• This results in an impression that has a tissue-placingeffect, very thick and conforming buccal borders, anda relatively thick lingual and sublingual crescent area.

• The overall denture is bulkier, with more surfacecontact area, than is found in the conventionaldenture.

• It can be thought of as a mandibular denturewith minimal bony contact in the alveolarridge area, suspended in a compatible softtissue hammock.

• This method results in improved retention ofthe mandibular denture, even with its built-ininstability, because of the conformity of theresidual alveolar ridge.

Dynamic Impression Method:• Its significance:– Avoids the dislocating effect of the muscles on improperly

formed denture border.– Complete utilization of the possibilities of active and

passive tissue fixation of the denture.– Dynamic impressions in contrast to non dynamic

impression records the tissues in an immobile condition,and

– Semi dynamic impressions in which the denture bordersare determined by partly passive and partly activemovements was described by Fournet and Tull.

Fabrication of the special tray is done.

A ridge of self curing resin is built up in the premolar molar region on each sideto support the thermoplastic material.

While the thermoplastic material is soft the tray is placed in position on thelower ridge in the mouth and the patient is asked to close the jaws slowly.

The upper residual ridge will form an impression in the soft thermoplasticmaterial at a height corresponding to the rest mandible. Tray is removed frommouth and cooled.

Lingually the mandibular rests should be concave to provide space for thetongue.

Sufficient amount of an irreversible hydrocolloid is mixed with 50%extra water material and is placed directly into the mouth to cover alltissues .

The tray is pressed through alginate by digital force until the stopsare firmly seated on the residual ridge.

Then, the patient is asked to close his mouth slowly until themandibular rests have obtained firm contact with the maxillae.

The patient should swallow three to four times at 10 seconds intervalwhile the final impression material is still in a moldable condition.

The action of the muscles that function in deglutition is accentuatedbecause the mandibular rests prevent the mandible from reaching thevertical, relation of occlusion and force it to remain in its rest position.

This procedure develops a registration of the denture space whichordinarily results in a proper extension of the lingual flanges of thefinished dentures.

Forceful protrusion of the lips brings the mentalis and orbicularis orismuscles into action and is responsible for forming the labial part of theimpression.

In another method, an old denture can be used for adynamic impression when opposing natural orartificial teeth are present. Often the verticaldimension at occlusion is decreased hence steps areplaced at re-established height. The mandibular restsare built up include the inter-occlusal distance.

In still another method, denture is processed in aconventional manner. Then a correcting dynamicimpression is made in the denture base to reshapeand complete the final design and the denture isrelined. This procedure was originally indicated byMomme in 1872.

Klein in 1957, suggested three distinct typesof impression techniques for mandibulardentures depending on the type of foundation.

(J. Pros. Dent. September, 1957)

– First Condition-•When the mandibular ridge is almostcompletely resorbed with just a rib of softfibrous tissue along the crest. This rib oftissue is easily displaced and can be aconstant source of irritation, if theimpression is not recorded correctly.

After a routine modeling compound waxmandibular impression is made in the usualmanner, approximately 3mm of compound isrelieved over the crest of the ridge and a cast ispoured.

The clear acrylic resin tray processed on thepreliminary cast will not contact the ridge crest.

Three holes are drilled in the tray on each sidein the areas of the ridge crest to prevent abuilding up of undesired pressure.

The final impression is made inside the trayand the free flowing paste will allow the softtissue along the crest of the ridge to place itself.

– Second Condition-• In cases with almost complete resorptionand with a spiny ridge of dense bony tissuealong the crest of the residual ridge.

Compound impression is made as above. Inaddition to the crest of ridge, compound is scrapedaway along the crest of mylohyoid ridge andposterior lingual flange to a depth of 2mm.

Physiologic wax is added and primaryimpression completed. The cast is poured and thearea of the mylohyoid ridge is relieved with 0.001inch tin foil.

The clear acrylic resin tray is made and finalwash impression made. Master cast is poured.

The knife edged ridge crest is again relieved with0.001 inch tin foil. Thus forces of mastication willbe exerted along the sides of the ridge rather thanon the crest.

–Third Condition-• In cases where ridge is flat or concave.

The impression of lingual border is recordedaccurately with the impression wax.

This type of foundation should not require anyalteration or modification in the impressiontechnique, except where the mylohyoid ridgebecomes a disturbing factor. This situation ishandled as described previously. The coverage ofthe denture-bearing area will be the same as foran average foundation. The supporting structureshave changed, but the muscles of the borderregions still function normally and will mold theborders of the impression.

The technique is same as stated above.

B. SELECTION OF DENTURE BASE-

• For degenerative ridge patients there arethree types of denture bases:– Methyl methacrylate resin denture bases

– Cast metal bases

– Processed resilient , lined denture bases

Methyl methacrylate resin denture bases:• These are the standard bases normally used.• These bases are quickly and easily

processed.• Dimensionally stable.• But in a short time the base appears to

soften and change color, and is not strong.

Cast metal bases:• Main advantage is the great accuracy of fit to the

tissues by surface tension, than acrylic denturebases.

• They maybe of gold, chromium cobalt oraluminum.

• Advantages:Prevention of acrylic warpage,More strength,Increased accuracy,Less tissue change under the base,Less porosity and therefore easier to clean and

keep clean,Thermal conductivity,Less deformation in function.

Processed, Resilient, Lined Denture Bases• Its greatest advantages are its cushioning

effect upon the mucosa and its ability todistort and spring back.

• It is indicated in the cases of– Severely undercut ridges where surgery is

contraindicated– Patients with no ridge– Patients with a flat ridge and delicate tissues.– Spinous ridge, tori, the mental foramen, and the

genial tubercles

• The lining is best when there is a 2 mmthickness. So, it cannot be used in the casesof small inter-ridge distance.

• The biggest disadvantage is deterioration ofthe resilient liner in few months.

C. JAW RELATION-• Correct recording of vertical and horizontal

relations are equally important for thepreservation of residual bone resorption.

• The difficulty in obtaining good jaw-relationrecords is complicated by the frequentlyimpaired masticatory apparatus.

• Perhaps the most important factor inarticulation is that centric occlusion beharmonious with the centric relation.

• In horizontal relations unless centric relation isestablished properly, the mandibular teeth will notocclude properly with those on the maxillary arch,thus proper occlusion is essential to the health ofbony support.

• Otherwise during eccentric movement it causespressure on bone due to failure of the stability factor.Hence cause resorption of bone.

D. SELECTION OF TEETH AND OCCLUSION-

Neutrocentric occlusion:• The neutrocentric concept was developed by

DeVan.• DeVan has suggested embodying the two key

objectives of his occlusal scheme– Neutralization of inclines,– Centralization of forces.

• The neutralization of inclines and centralization ofocclusal forces aids in stability without interferingwith speech, appearance and chewing capacity.

• The five elements of this scheme are:• Position: the position of posterior teeth should be

centralized over the residual ridge so that the forces areperpendicular to the support areas. This avoids tensile andshearing forces.

• Proportion: DeVan reduced the teeth width by 40%. Thisreduced the vertical stress on the ridge. Horizontal forcesare reduced because friction between opposing surfaces isdecreased. The forces are thus centralized withoutencroaching on the tongue.

• Pitch: This is the inclination or tilt of the occlusal plane. Itis oriented parallel to the underlying ridge and midwaybetween them. This directs the forces perpendicular to themean osseous foundation plane.

• Form: Flat teeth with no deflective inclines wereused so that there is no interference withmandibular movements.

• Number: The number of posterior teeth wasreduced from eight to six. This reduced themagnitude of occlusal force and centralized it tosecond premolar and first molar.

Linear occlusion:• William H. Goddard introduced the concept

of linear occlusion.• Frush described occlusion in geometric terms

as one dimensional (linear), two dimensional(flat) and three dimensional (cusped).

• Groans and Stout explained how anatomicand non anatomic occlusal schemes transmitlateral forces to the denture and reducestability and suggested that the linear occlusalscheme has the potential for creating thesmallest lateral force component.

• Linear occlusion consists of the following basicParameters:– Zero degree teeth (flat teeth) are opposed by bladed

(line contact) teeth in which the blade is a straightline over the crest of the ridge.

– The arch which requires the greatest stability receivesthe bladed teeth (the mandible most often requiresgreater stability and receives bladed teeth).

– There is no anterior interference to protrusive orlateral movements.

– This non-interceptive occlusion provides a consistentvertical seating force in both centric and eccentric;hence transverse vectors are eliminated.

E. OVERDENTURES:• Overdentures are designed to distribute the

masticatory load between the edentulous ridge andthe abutments.

• The overdenture transfers occlusal forces to thealveolar bone through the periodontal ligament ofthe retained tooth roots.

• Proprioceptive feedback, from the periodontalligament to the muscles of mastication, may act toprevent occlusal overload and thereby prevent boneresorption because of excessive forces.

• The short term and long-term preservation ofalveolar bone has been documented not onlyadjacent to the overdenture abutments but alsoadjacent to the edentulous ridges.

• A comparison of immediate conventionaldentures and immediate overdentures foundhalf as much bone loss (0.9mm compared with1.8 mm) in the anterior mandible over the firstyear in the overdenture group, surprisingly, thebone loss was also slowed in the posteriormandible.

• The increased stability that resulted from theuse of overdentures may limit lateral forcesplaced on residual bone.

F. SUBMERGENCE OF ROOTS (VITAL ORNON-VITAL).

• Studies have shown that the roots that weresubmerged remained asymptomatic andhelp to preserve residual ridge and it maybe an alternate method to conventional overdenture.

III. SURGICAL MANAGEMENT:A. IMPLANTS-• The various problems associated with RRR

and stability of removable soft tissue bornedentures have aroused interest in dentalimplantology to provide stable mechanicalsupport to the dental prosthesis. This isbecause of the following advantagesoffered by implant supported prosthesis.

• Advantages:Maintenance of alveolar boneRestoration & maintenance of occlusal vertical

dimension.Maintain facial esthetics.Improved phoneticsImproved occlusionImproved psychological health.Regained proprioception.Increased stability, retention

Improved masticatory performance.Immune to caries.Increased trabeculation and density of bone.Overall volume of bone is maintained.Efficiency to take up stress and strain.There is 20 fold decrease in the loss of structure

with implants when compared with resorption thatoccurs with removable prosthesis.

B. VESTIBULAR EXTENSION PROCEDURE-• Indicated when there is high muscular and

mucosal attachments.• The reduction of alveolar ridge size is frequently

accompanied by an apparent encroachment ofmuscle attachments on the crest of the ridge.These serve to reduce the available denturebearing area and undermine denture stability.

• Soft tissue vestibuloplasties including localizedmucosal flap to a full-skin graft vestibuloplastymay be performed to increases the relativeheight and extent of the denture foundation.

C. RIDGE AUGMENTATION-These are the procedures designed to

enlarge or increase the size, extent, or qualityof deformed residual ridge.

• Aims– Restoration of optimum/near optimum ridge

height & width, ridge form, vestibular depth andoptimum denture bearing area

– Protection of neurovascular bundle– Establishment of proper inter arch relationship– Improvement of retention and stability of

denture– Improve the patient comfort for wearing the

denture.

Mandibular augmentation-• Superior border augmentation

– Bone grafts – Cartilage grafts – Alloplastic grafts.

• Inferior border augmentation – Bone grafts (autogenous or allogenic freeze dried

cadaveric mandible) – Cartilage grafts.

• Interpositional or Sandwitch bone grafts – Bone grafts – Cartilage grafts – Hydroxyapatite blocks.

Maxillary augmentation-• Onlay bone grafting - autogenous /

allogenic grafts. • Onlay grafting by alloplastic material. • Interpositional or Sandwich grafts.• Sinus lift procedure.

SUMMARY

Residual ridge resorption is a chronic,progressive, irreversible, and disabling disease ,of multifactorial origin. Much is known aboutits pathology and pathophysiology, but a lotremains to know about its pathogenesis,epidemiology and etiology.

Resorbed ridge requires a multipleapproach for diagnosis and treatment planning.The cause must be detected, by the aid of aphysician, and then eliminated or stabilizedbefore dentures are constructed.

Although challenging, the severelyresorbed ridges can be resorted to a certainlevel of mastication with the help ofimproved impression techniques, properselection of occlusion schemes, the use ofspecialized dentures techniques and aregular follow up.

More recently, implant supportedoverdentures are playing tremendous role inthe treatment of the severely resorbed ridges.

As prosthodontists, we need to performthe most meticulous and intelligentprosthodontic care of the patient within ourcapabilities for the restoration of the physicaland mental vitality of the patient.

…and then , it would not seem a nebuloushope that some day there will be control overresidual ridge resorption.

BIBLIOGRAPHy• Essentials of Complete Denture Prosthodontics, 2nd Edition, By Sheldon

Winkler• Prosthodontic Treatment for Edentulous patients, 11th Edition, By Boucher.• Impression for Complete Denture, by Bernard Levin• Misch implant dentistry• The management of gross alveolar resorption : (JPD 1973, vol. 29, Pg.

397).• The degenerative denture ridge-Care and treatment. (JPD 1974, vol. 32,

477-492).• Reduction of residual ridges: A maior oral disease entity (JPD 1971, vol.

26, 266-279).• Lamie G.A. : The reduction of the edentulous ridge. J. Prosthet. Dent. 10 :

605-611, 1960.• Conservative prosthodontic procedures to improve mandibular denture

stability in an atrophic mandibular ridge. JIPS December 2008, Vol 8,Issue 4.