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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.
The lesion may be Iocalized, or generalized over the entire
ridge crest. It can be caused by HYPERPLASIA or by
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.
It is the bulk of tissue beyond normal caused by an increase
in size but not in number of tissue elements (reversible).
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
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. 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
The primary cause of this
condition is over extension of
denture border which may be
the result of sinking of the
l. Conservative approach. (Recovery program)
2. Prosthetic approach.
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)
3. Modification of the denture by flange and occlusal adjustment.
Detect and remove any pressure areas or sore spots using pressure-indicating
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
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.
If the Condition persists then the prosthetic approach may be
2. Centric Occluding record.
3. OCClusal form and posterior teeth arrangement
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) .
Impression technique ether by
i. Sectional Impression technique (window technique)
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.
SECTIONAL IMPRESSION TECHNI UE WINDOW
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.
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.
› 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
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
- Using a perforated Custom tray is another option.
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
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
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
Ridge augmentation by subperiosteal
injection of hydroxyapatite