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Flabby ridge manage


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Flabby ridge manage

  1. 1. Flabby ridge management DU'. Muaiyed. Mallmoud. Buzayan, BDS MeäiuDent Maâaysia AF AAMP “SA
  2. 2. L” , Li 7 I? I ICii/ iy", I: L ___i". -)LJ L . L_. _›'; It is an excessive movable tissue a flabby ridge is one which becomes displaceable due to fibrous tissue deposition. Most frequently seen in the upper anterior region. Usually occurs when natural teeth oppose an edentulous ridge. A flabby ridge causes instability of the denture. There are a number of different methods to overcome this problem.
  3. 3. The lesion may be Iocalized, or generalized over the entire ridge crest. It can be caused by HYPERPLASIA or by HYPERTROPHY HYPERPLASIA It is the abnormal multiplication or increase in the number of normal cells in normal arrangement in tissue (irreversible). Single or multiple flaps or folds of fibrous tissue related to the border of a denture. HYPERTROPHY It is the bulk of tissue beyond normal caused by an increase in size but not in number of tissue elements (reversible).
  4. 4. I . EITIOLOGY Old loose dentures (chronic irritation). Or badly constructed dentures such as loose ill-fitting dentures as well as dentures with wrong centric occluding relation, occlusal disharmony and traumatic occlusion. Load concentration on the anterior segment of the ridge. Such as Anterior masticatory habits or anterior interference causes load concentration on the anterior segment of the ridge. And dentures constructed with anterior porcelain teeth and posterior resin teeth. Rapid ridge resorption on the lingual and labial on the lower alveolar ridge frequently results in a narrow knife-edge ridge. (COMBINATION SYNDROME) Complete maxillary denture opposing natural mandibular anterior teeth.
  5. 5. 5. Not removing the dentures during night to allow the basal seat mucosa to regain its resting form 6. Relived denture over wiry thin ridge. 7. Anterior over-erupted natural teeth against edentulous ridge. s. Denture instability due to under extended flange. EPULIS FISSURATUM: overgrowth of intraoral tissue resulting from chronic irritation. The primary cause of this condition is over extension of denture border which may be the result of sinking of the denture.
  6. 6. MANAGEMENT l. Conservative approach. (Recovery program) 2. Prosthetic approach. 3. Surgical. l- Conservative approach. lkecoveg Qrogrami l . Tissue rest. The dentures should be removed from the mouth for at least 8 hours every 24 hours for few days before making new impressions to allow the inflammation to subside. 2. Soft tissue massage. Massage of the soft tissues two or three times a day to stimulate the blood supply and aid recovery. Instruct the patient to rinse vigorously using proper mouth wash or even using the following (dissolve one-half teaspoon of table salt in a half glass of warm water)
  7. 7. 3. Modification of the denture by flange and occlusal adjustment. Detect and remove any pressure areas or sore spots using pressure-indicating paste (PIP). Correction of occlusal disharmonies by Clinical remounting and Restoring (VDO) the occlusal vertical dimension Elimination of any contact between natural anterior teeth and opposing artificial teeth. 4. Tissue Conditioning. Relining the old dentures with soft tissue Conditioning materials is to aid recovery before constructing new dentu res. For tissue Conditioning, the material is applied for a period of a few days to the Impression surface of a denture when the mucosa is traumatized and inflamed. The tissue Conditioner acts as a cushion absorbing the occlusal loads, improving their distribution to the supporting tissues and encouraging healing of the inflamed mucosa. It should be changed every 72 hours.
  8. 8. Prosthetic approach If the Condition persists then the prosthetic approach may be employed: i. Impression. 2. Centric Occluding record. 3. OCClusal form and posterior teeth arrangement Impression A particular problem Is encountered If a flabby ridge is present within an otherwise 'normal' denture bearing area. If the flabby tissue is Compressed during conventional Impression making, it will later tend to recoil and dislodge the resulting overlying denture. Clearly, an Impression technique is required which will Compress the non-flabby tissues to obtain optimal support, and, at the same time, will not displace the flabby tissues (SELECTIVE) .
  9. 9. Impression technique ether by i. Sectional Impression technique (window technique) Selective tech. 2. General selective Impression technique. lf the fibrous tissue is distorted during Impression taking, Elastic recoil of displaced tissue forces the denture downwards and eliminates retention. In addition Intermittent occlusion can traumatize the tissues.
  10. 10. SECTIONAL IMPRESSION TECHNI UE WINDOW TECHNIQUE). A primary Impression is taken in alginate loaded in a stock tray. The Impression is then poured and a special tray is constructed on the model. The special tray Is close fitting and has a hole or "window" over the area corresponding to the flabby ridge. An Impression is taken In Impression paste (mucodisplacive). Once this has set it Is left in place and Impression plaster (or any light body Impression material - mucostatic) Is painted over the flabby ridge and allowed to set and removed as one Impression. The Impression is removed as one, cast and the denture constructed on the resulting model.
  11. 11. SELECTIVE IMPRESSION TECHNIQUE. This technique aims to displace but not distort the flabby ridge as If In function. A primary Impression Is taken in a mucostatic Impression material (e. g. Impression plaster or alginate) and cast in stone. A spaced special tray for an Impression Compound Impression Is then constructed on this model. The tray Is loaded with Compound and an Impression taken of the model of the patient's mouth. This reduces the risk of displacing the flabby ridge. u Compound impression b, .
  12. 12. › The tray is then warmed and placed in the patient's mouth. It is adapted and border molded to the tissues, and should be quite retentive. The Impression Is removed and warmed all over apart from the flabby ridge area. The Impression is retaken, the flabby ridge Is Compressed but not distorted as the other portions of the Impression Compound sink Into the tissues. › The Impression Is removed Inspected and re-tried In the mouth to b Check that It Is stable. If any instability occurs then the Impression should be reheated and re-taken. A wash Impression may be taken in Impression paste to obtain maximum detail and retention and stability - Using a perforated Custom tray is another option.
  13. 13. 2- Centric Occluding record. The jaw relation Is recorded using the check bite technigue with the least possible displacement of the supporting structures. Centric relation should be recorded with least possible displacement of supporting tissue by applying minimal closing force on the tissue, so it should use wax wafer method with easily displaceable recording material as softened wax and silicon or plaster. 3- OCClusal form and posterior teeth arrangement > Posterior teeth are arranged In relation to neutral zone. > Reduce buCCo-lingual width of the teeth to decrease the pressure on the tissues : After denture Insertion the patient is instructed for periodic check-ups
  14. 14. Sur iCal Mana ement › This involves removal of the fibrous tissue to leave a firm ridge. However removing the shock absorbin flabb rid e may lead to trauma of the underlying bone (with the patient feeling soreness) and an increased bulk of denture material. There Is also the risk that the flabby ridge may recur. Removal of the fibrous material may also reduce the height of the ridge decreasing the chances of a stable denture. However, sometimes ridge augmentation would be indicated. “ Ridge augmentation by subperiosteal injection of hydroxyapatite
  15. 15. Thank You