International Journal of Oral Health Sciences

CASE REPORT
Year
: 2018  |  Volume : 8  |  Issue : 2  |  Page : 104--108

Management of flabby ridge case: An arduous task in undergraduate practice


Jnanashree Chiplunkar, Masrie Tumbil, MD Chethan, DB Nandeeshwar, Disha Patel 
 Department of Prosthodontics and Crown and Bridge, Bapuji Dental College and Hospital, Davangere, Karnataka, India

Correspondence Address:
Disha Patel
Room No - 7, Department of Prosthodontics and Crown and Bridge, Bapuji Dental College and Hospital, Davangere, Karnataka
India

Abstract

A fibrous or flabby ridge is a superficial area of mobile soft tissue affecting the maxillary or mandibular alveolar ridges. It can develop when hyperplastic soft tissue replaces the alveolar bone and is a common finding particularly in the upper anterior region of long-term denture wearers. Masticatory forces can displace this mobile denture-bearing tissue, leading to altered denture positioning and loss of peripheral seal. Unless managed appropriately, such “flabby ridges” adversely affect the support, retention, and stability of complete dentures. Many impression techniques have been proposed to help overcome this difficulty. This paper presents case report for prosthodontic rehabilitation of a patient with flabby ridge with McCord and Ahmad impression technique.



How to cite this article:
Chiplunkar J, Tumbil M, Chethan M D, Nandeeshwar D B, Patel D. Management of flabby ridge case: An arduous task in undergraduate practice.Int J Oral Health Sci 2018;8:104-108


How to cite this URL:
Chiplunkar J, Tumbil M, Chethan M D, Nandeeshwar D B, Patel D. Management of flabby ridge case: An arduous task in undergraduate practice. Int J Oral Health Sci [serial online] 2018 [cited 2019 Aug 20 ];8:104-108
Available from: http://www.ijohsjournal.org/text.asp?2018/8/2/104/247807


Full Text



 Introduction



Complete denture prosthodontics will remain an important part of dental education and practice. The performance of a complete denture is often a reflection of its support and retention. A master impression for a complete denture should record the entire functional denture-bearing area to ensure maximum support, retention, and stability for the denture during use.[1] There are cases where it is difficult to restore the mouth with conventional technique. The flabby ridge or movable tissues are frequently seen in maxillary anterior ridge when the edentulous maxilla is opposed by natural teeth in the mandibular anterior region. The reported prevalence for this condition also varies among investigators, but it has been observed in up to 24% of the edentulous maxilla, in 5% of the edentulous mandible, and in both jaws most frequently in the anterior region.[2] Although the flabby ridge may provide poor retention for the denture, it may still be better than no ridge at all.[3] The conventional prosthodontic management of flabby ridges involves recording the flabby tissues in a minimally displaced form, while the rest of the tissues are recorded in functional form.[4] Therefore, this article tries to discuss impression technique for fabrication of a retentive and stabilized denture for the case of flabby maxillary anterior ridge through palliative approach.

 Case Report



A 58-year-old male patient reported to the Department of Prosthodontics and Crown and Bridge, Bapuji Dental College and Hospital, Davangere, Karnataka, India, with a complaint of looseness of the present dentures. The patient was wearing ill-fitting denture for the past 20 years. There was difficulty in eating and speaking with his old dentures. No relevant medical history was reported. On examination, it was found that there was an area of flabby tissue in the maxillary anterior region extending from the canine region from one side to the other and blanching of the tissues was seen when pressure was applied with the end of the mouth mirror.[Figure 1] and [Figure 2] The mandibular edentulous ridge was also resorbed. A treatment plan of fabricating a complete denture with the modification in the impression technique to achieve minimum displacement of the denture during function and maximum retention and stability was decided. It was decided to use the window impression technique for the maxilla.[5] Primary impressions were made with irreversible hydrocolloid (Zelgan, DENTSPLY, India) to record the tissues in a minimally displaced form. Custom trays were fabricated in autopolymerizing resin (Pyrax, India) with a spacer of modeling wax with 1-mm thickness. A spacer thickness of 2 mm is adapted in the area of flabby ridges (double spacer). Border molding was carried out using the sectional method for the maxillary arch with greenstick compound (DPI Pinnacle, Tracing Sticks Dental Products of India, Ltd.). The impression was made with zinc oxide eugenol paste. The displaceable tissue was marked intraorally with indelible pencil, and this marking was transferred on to the final impression [Figure 3] and [Figure 4]. A window was cut in the impression through the impression tray exactly corresponding to the area of the flabby tissues in the anterior maxilla [Figure 5] and [Figure 6]. The impression was placed in the mouth, and light body polyvinyl siloxane (3M ESPE™ II GARANT) was syringed on to the flabby tissues exposed through the window, and the maxillary impression was completed [Figure 7] and [Figure 8]. Now, this impression is beaded, boxed and poured properly. Complete denture is fabricated in conventional manner [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13].{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}{Figure 7}{Figure 8}{Figure 9}{Figure 10}{Figure 11}{Figure 12}{Figure 13}

 Discussion



For patients with flabby ridges, when dentures are fabricated using the conventional impression techniques, the patient often complains of “looseness” of the dentures. This is because the flabby tissues recoil when recorded in a displaced form and dislodge the dentures. Prosthodontic management of a patient with a flabby maxillary ridge can be challenging problem and taking care to consider the influence of both the impression surface and occlusal surface detail in paramount. Standard mucocompressive impression techniques are likely to result in an unretentive and unstable denture as the denture constructed on a model of the flabby tissue in a distorted state. The use of selective pressure or minimally displaced impression techniques should help to overcome some of these limitations. Other treatment modalities for the scenario described in literature include surgical “debulking” or excision of the flabby tissues and the use of dental implants. Surgical “debulking” of flabby tissues is mainly a historical concept nowadays. The rationale behind its use was that removal of flabby tissues would result in a “normal” compressible denture-bearing area on which a mucocompressive impression technique could be used. Some of the difficulties caused by this approach include the fact that many complete denture patients are elderly or have complex medical histories, for which any form of surgery is contraindicated. One is reminded of the concept that prosthodontic therapy should be concerned with the “conservation of what remains, rather than the meticulous replacement of what has been lost.”[6] The current paper describes a simple technique to record flabby tissues in their undisplaced state using readily available clinical materials such as polyvinyl siloxanes in varying consistencies. The advantage of choosing light body polyvinyl siloxane impression material is that, due to the inherent nature of the material, different consistencies can be achieved by varying the pressure applied on the material during mixing.[7] McCord and Grant[8] and Ahmad (2008) described window technique which ensures peripheral molding resulting in peripheral seal because window, holes, or vents are prepared after the final impression is made. The suggested three methods eliminate the excessive displacement of the soft tissues at the secondary impression; thus, a physiologic and anatomic registration of the attached and the unattached tissue of the denture-bearing areas is attained. Most commonly used materials in such scenario are irreversible hydrocolloid, impression plaster and elastomeric impression material.[9],[10] The displaceable tissue is then recorded in minimally displaced position, and the peripheral seal is re-established which is lost due to the window prepared.[6]

 Conclusion



This paper has described an impression technique for the management of a denture-bearing area that contains flabby tissues. In this simple technique for making wash impression of highly displaceable maxillary anterior ridge with low-viscosity polyvinyl siloxane and zinc oxide eugenol, impression material is explained. The choice of impression materials and design of the custom tray used for making final impression to reduce the pressure on the displaceable tissue is very important. The materials used are readily available and used in contemporary general dental practice. The time required for the specialized impression technique is not excessive.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1The British Society for the Study of Prosthetic Dentistry. Guidelines in Prosthetic and Implant Dentistry. London: Quintessence; 1996.
2Xie Q, Närhi TO, Nevalainen JM, Wolf J, Ainamo A. Oral status and prosthetic factors related to residual ridge resorption in elderly subjects. Acta Odontol Scand 1997;55:306-13.
3Carlsson GE. Clinical morbidity and sequelae of treatment with complete dentures. J Prosthet Dent 1998;79:17-23.
4Crawford RW, Walmsley AD. A review of prosthodontic management of fibrous ridges. Br Dent J 2005;199:715-9.
5McCord JF, Grant AA. Impression making. Br Dent J 2000;188:484-92.
6Lynch CD, Allen PF. Management of the flabby ridge: Using contemporary materials to solve an old problem. Br Dent J 2006;200:258-61.
7Pai UY, Reddy VS, Hosi RN. A single step impression technique of flabby ridges using monophase polyvinylsiloxane material: A case report. Case Rep Dent 2014;2014:104541.
8Labban N. Management of the flabby ridge using a modified window technique and polyvinylsiloxane impression material. Saudi Dent J 2018;30:89.
9Sankeshwari B. Impression techniques for management of flabby ridges in complete dentures – A review. IDA J 2013;46:87-93.
10Bansal R, Kumar M, Garg R, Saini R, Kaushala S. Prosthodontic rehabilitation of patient with flabby ridges with different impression techniques. Indian J Dent 2014;5:110-3.