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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prosthodontic rehabilitation of patient with flabby ridges with different impression techniques</title><author><name sortKey="Bansal, Rubina" sort="Bansal, Rubina" uniqKey="Bansal R" first="Rubina" last="Bansal">Rubina Bansal</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Kumar, Manjit" sort="Kumar, Manjit" uniqKey="Kumar M" first="Manjit" last="Kumar">Manjit Kumar</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Garg, Rashim" sort="Garg, Rashim" uniqKey="Garg R" first="Rashim" last="Garg">Rashim Garg</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Saini, Rishi" sort="Saini, Rishi" uniqKey="Saini R" first="Rishi" last="Saini">Rishi Saini</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Kaushala, Shaveta" sort="Kaushala, Shaveta" uniqKey="Kaushala S" first="Shaveta" last="Kaushala">Shaveta Kaushala</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25565737</idno><idno type="pmc">4184326</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184326</idno><idno type="RBID">PMC:4184326</idno><idno type="doi">10.4103/0975-962X.135296</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001C89</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001C89</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prosthodontic rehabilitation of patient with flabby ridges with different impression techniques</title><author><name sortKey="Bansal, Rubina" sort="Bansal, Rubina" uniqKey="Bansal R" first="Rubina" last="Bansal">Rubina Bansal</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Kumar, Manjit" sort="Kumar, Manjit" uniqKey="Kumar M" first="Manjit" last="Kumar">Manjit Kumar</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Garg, Rashim" sort="Garg, Rashim" uniqKey="Garg R" first="Rashim" last="Garg">Rashim Garg</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Saini, Rishi" sort="Saini, Rishi" uniqKey="Saini R" first="Rishi" last="Saini">Rishi Saini</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Kaushala, Shaveta" sort="Kaushala, Shaveta" uniqKey="Kaushala S" first="Shaveta" last="Kaushala">Shaveta Kaushala</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Indian Journal of Dentistry</title><idno type="ISSN">0975-962X</idno><idno type="eISSN">2213-3666</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>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. Forces exerted during the act of impression making can result in distortion of the mobile tissue. Unless managed appropriately by special impression techniques, such ‘flabby ridges’ adversely affect the support, retention and stability of complete dentures. This paper presents three case reports for prosthodontic rehabilitation of patient with flabby ridges with three different impression techniques.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Crawford, Rw" uniqKey="Crawford R">RW Crawford</name></author><author><name sortKey="Walmsley, Ad" uniqKey="Walmsley A">AD Walmsley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lynch, Cd" uniqKey="Lynch C">CD Lynch</name></author><author><name sortKey="Allen, Pf" uniqKey="Allen P">PF Allen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hobkirk, Ja" uniqKey="Hobkirk J">JA Hobkirk</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khan, Z" uniqKey="Khan Z">Z Khan</name></author><author><name sortKey="Jaggers, Jh" uniqKey="Jaggers J">JH Jaggers</name></author><author><name sortKey="Shay, Js" uniqKey="Shay J">JS Shay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kelly, E" uniqKey="Kelly E">E Kelly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Allen, F" uniqKey="Allen F">F Allen</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Dent</journal-id><journal-id journal-id-type="iso-abbrev">Indian J Dent</journal-id><journal-id journal-id-type="publisher-id">IJD</journal-id><journal-title-group><journal-title>Indian Journal of Dentistry</journal-title></journal-title-group><issn pub-type="ppub">0975-962X</issn><issn pub-type="epub">2213-3666</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25565737</article-id><article-id pub-id-type="pmc">4184326</article-id><article-id pub-id-type="publisher-id">IJD-5-110</article-id><article-id pub-id-type="doi">10.4103/0975-962X.135296</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Prosthodontic rehabilitation of patient with flabby ridges with different impression techniques</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bansal</surname><given-names>Rubina</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Kumar</surname><given-names>Manjit</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Garg</surname><given-names>Rashim</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Saini</surname><given-names>Rishi</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Kaushala</surname><given-names>Shaveta</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Prosthodontics and Crown and Bridge, Genesis Institute of Dental Sciences and Research, Moga Ferozepur Road, Ferozepur, Punjab, India</italic></aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Rubina Bansal, Department of Prosthodontics and Crown and Bridge, Genesis Institute of Dental Sciences and Research, Moga Ferozepur Road, Ferozepur, Punjab, India. E-mail: <email xlink:href="bansalrubina87@gmail.com">bansalrubina87@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Apr-Jun</season><year>2014</year></pub-date><volume>5</volume><issue>2</issue><fpage>110</fpage><lpage>113</lpage><permissions><copyright-statement>Copyright: © Indian Journal of Dentistry</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>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. Forces exerted during the act of impression making can result in distortion of the mobile tissue. Unless managed appropriately by special impression techniques, such ‘flabby ridges’ adversely affect the support, retention and stability of complete dentures. This paper presents three case reports for prosthodontic rehabilitation of patient with flabby ridges with three different impression techniques.</p></abstract><kwd-group><kwd>Flabby tissue</kwd><kwd>impressions</kwd><kwd>irreversible hydrocolloid</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>INTRODUCTION</title><p>A fibrous or flabby ridge is a superficial area of mobile soft tissue affecting maxillary or mandibular alveolar ridges. It develops when hyperplastic soft tissue replaces the alveolar bone and is a common finding particularly in the upper anterior region of long term denture wearers. The reported prevalence has varied, but has been demonstrated in upto 24% of edentulous maxillae and 5% edentulous mandibles. Masticatory forces can displace this mobile denture-bearing tissue leading to loss of peripheral seal. Forces exerted during impression making can result in distortion of the mobile tissue.[<xref rid="ref1" ref-type="bibr">1</xref>] Unless managed appropriately by special impression techniques, such ‘flabby ridges’ adversely affect support, retention and stability of complete dentures. Many impression techniques have been proposed to help overcome this difficulty.[<xref rid="ref2" ref-type="bibr">2</xref>]</p><p>This article presents case reports for prosthodontic rehabilitation of patient with flabby ridges with three different impression techniques.</p></sec><sec id="sec1-2"><title>CASE REPORT</title><sec id="sec2-1"><title>Case 1</title><p>A 60 year old female patient reported to the Department of Prosthodontics and Crown and Bridge with complaint of loose dentures. On examination, flabby tissue in the maxillary anterior region extending from canine to canine region was found. Tissue blanching was also noticed on pressure application [<xref ref-type="fig" rid="F1">Figure 1</xref>].</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Flabby tissue in the maxillary anterior region</p></caption><graphic xlink:href="IJD-5-110-g001"></graphic></fig><p>Fabrication of new complete dentures was planned for the patient with recording of flabby tissue in undisplaced condition using Hobkirk technique.[<xref rid="ref3" ref-type="bibr">3</xref>] The maxillary preliminary impression was made using irreversible hydrocolloid (Tulip Alginate Impression Material, Cavex Holland BV, Holland) in perforated edentulous tray and the primary cast was poured [Figures <xref ref-type="fig" rid="F2">2a</xref> and <xref ref-type="fig" rid="F2">b</xref>]. Special tray was fabricated using double spacer over the flabby tissue area and in the region of mid palatine raphe. After checking the proper tray extensions, border molding was done in conventional manner using green stick impression compound (DPI Pinnacle Tracing Sticks) [Figures <xref ref-type="fig" rid="F2">2c</xref> and <xref ref-type="fig" rid="F2">d</xref>].</p><fig id="F2" position="float"><label>Figure 2</label><caption><p>(a) Preliminary impression, (b) Primary cast, (c) Special tray, (d) Border molding</p></caption><graphic xlink:href="IJD-5-110-g002"></graphic></fig><p>Spacer wax was removed and impression was made with medium body elastomeric impression material (Elite Glass medium body, Zhermack, Germany). The tray was then removed from the mouth and impression material was removed in the region of flabby tissue using a scalpel. Relief holes were made and tray was loaded in this region with light body elastomeric impression material (Elite HD+ light body, Zhermack, Germany) to record flabby tissue. Beading and boxing of the final impression was done using plaster pumice method and master cast was poured [Figures <xref ref-type="fig" rid="F3">3a</xref>–<xref ref-type="fig" rid="F3">c</xref>]. The denture was fabricated and it had good retention and stability with proper recording of flabby tissue [Figures <xref ref-type="fig" rid="F3">3d</xref>, <xref ref-type="fig" rid="F4">4a</xref> and <xref ref-type="fig" rid="F4">b</xref>].</p><fig id="F3" position="float"><label>Figure 3</label><caption><p>(a and b) Secondary impression,(c) Master cast,(d) Maxillary denture</p></caption><graphic xlink:href="IJD-5-110-g003"></graphic></fig><fig id="F4" position="float"><label>Figure 4</label><caption><p>(a) Preoperative, (b) Postoperative</p></caption><graphic xlink:href="IJD-5-110-g004"></graphic></fig></sec><sec id="sec2-2"><title>Case 2</title><p>A female patient aged 56 years reported to the Department of Prosthodontics and Crown and Bridge with complaint of ill fitting dentures. On examination, an area of flabby tissue in the maxillary anterior region was found [<xref ref-type="fig" rid="F5">Figure 5</xref>].</p><fig id="F5" position="float"><label>Figure 5</label><caption><p>Flabby tissue in the maxillary anterior region</p></caption><graphic xlink:href="IJD-5-110-g005"></graphic></fig><p>Zafarullah Khan technique[<xref rid="ref4" ref-type="bibr">4</xref>] for impression making was planned for this patient. The maxillary preliminary impression was made using irreversible hydrocolloid (Tulip Alginate Impression Material, Cavex Holland BV, Holland) in perforated edentulous tray and primary cast was poured. Spacer was adapted over the primary cast except in the region of flabby tissue. Special tray was fabricated providing a window in the region of flabby tissue. Border molding was done using green stick compound [Figure <xref ref-type="fig" rid="F6">6a</xref>–<xref ref-type="fig" rid="F6">d</xref>]. Spacer wax was removed and impression was made with zinc oxide eugenol impression material. With the zinc oxide eugenol impression (DPI Impression Paste) in the mouth, flabby tissue was painted with impression plaster. Impression plaster was allowed to set and tray was removed from the mouth [Figures <xref ref-type="fig" rid="F7">7a</xref> and <xref ref-type="fig" rid="F7">b</xref>]. Master cast was poured after applying soap solution as separator over impression plaster [Figures <xref ref-type="fig" rid="F8">8a</xref> and <xref ref-type="fig" rid="F8">b</xref>]. The denture was fabricated in which flabby tissue was properly recorded and given adequate relief [Figures <xref ref-type="fig" rid="F9">9a</xref> and <xref ref-type="fig" rid="F9">b</xref>].</p><fig id="F6" position="float"><label>Figure 6</label><caption><p>(a) Preliminary impression, (b and c) Special tray with window, (d) Border molding</p></caption><graphic xlink:href="IJD-5-110-g006"></graphic></fig><fig id="F7" position="float"><label>Figure 7</label><caption><p>(a) Painted impression plaster (b) Secondary impression</p></caption><graphic xlink:href="IJD-5-110-g007"></graphic></fig><fig id="F8" position="float"><label>Figure 8</label><caption><p>(a) Beading boxing (b) Master cast</p></caption><graphic xlink:href="IJD-5-110-g008"></graphic></fig><fig id="F9" position="float"><label>Figure 9</label><caption><p>(a) Preoperative (b) Postoperative</p></caption><graphic xlink:href="IJD-5-110-g009"></graphic></fig></sec><sec id="sec2-3"><title>Case 3</title><p>A 65 year old male patient reported to the Department of Prosthodontics and Crown and Bridge with history of wearing maxillary complete denture opposing mandibular removable partial denture for 2 years. He got his mandibular anteriors extracted 6 months back. There was flabby tissue in the maxillary anterior region. Window technique was used for this patient also. Instead of impression plaster, over impression of the flabby tissues was made with irreversible hydrocolloid (Tulip Alginate Impression Material, Cavex Holland BV, Holland) [Figures <xref ref-type="fig" rid="F10">10a</xref> and <xref ref-type="fig" rid="F10">b</xref>].</p><fig id="F10" position="float"><label>Figure 10</label><caption><p>(a) Flabby tissue (b) Secondary impression</p></caption><graphic xlink:href="IJD-5-110-g010"></graphic></fig></sec></sec><sec sec-type="discussion" id="sec1-3"><title>DISCUSSION</title><p>In 1972, Kelly and his colleagues first described ‘combination syndrome’ caused by the presence of opposing natural teeth to an edentulous area. His observations included alveolar bone resorption in the anterior maxilla, enlargement of the tuberosities and bone resorption underneath the mandibular denture bases.[<xref rid="ref5" ref-type="bibr">5</xref>] Liddlelow[<xref rid="ref2" ref-type="bibr">2</xref>] in 1964 described a technique whereby two separate impression materials were used in a custom tray (using ‘plaster of Paris’ over the flabby tissues and zinc oxide eugenol over the normal tissues). In 1964, Osborne[<xref rid="ref2" ref-type="bibr">2</xref>] described a technique where two separate impression trays and materials were used to separately record the ‘flabby’ and ‘normal’ tissues and then related intra-orally. Watt and McGregor[<xref rid="ref2" ref-type="bibr">2</xref>] in 1986 described a technique where impression compound was applied to a modified custom tray and a wash impression with zinc-oxide and eugenol is made.</p><p>Impression making plays critical role in complete denture fabrication. A particular problem is encountered if a flabby ridge is present within an otherwise ‘normal’ denture bearing area. 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.</p></sec><sec sec-type="conclusion" id="sec1-4"><title>CONCLUSION</title><p>Managing a patient with flabby maxillary ridge can be a challenging problem. Standard mucocompressive impression techniques are likely to result in an unretentive and unstable denture as the denture will be constructed on a model of the flabby tissue in a distorted state. Mucostatic techniques may not make the best use of the available tissue support and movement of the denture base relative to the support tissues may be a problem. The use of selective pressure or minimally displacive impression techniques should help to overcome some of these limitations. With modified impression techniques, these ridges can be managed effectively without any additional clinical visits as compared to patients with normal edentulous ridges.[<xref rid="ref6" ref-type="bibr">6</xref>]</p></sec></body><back><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> Nil.</p></fn><fn fn-type="conflict"><p><bold>Conflict of Interest:</bold> None declared.</p></fn></fn-group><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Crawford</surname><given-names>RW</given-names></name><name><surname>Walmsley</surname><given-names>AD</given-names></name></person-group><article-title>A review of prosthodontic management of fibrous ridges</article-title><source>Br Dent J</source><year>2005</year><volume>199</volume><fpage>715</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">16341179</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lynch</surname><given-names>CD</given-names></name><name><surname>Allen</surname><given-names>PF</given-names></name></person-group><article-title>Management of the flabby ridge: Using contemporary materials to solve an old problem</article-title><source>Br Dent J</source><year>2006</year><volume>200</volume><fpage>258</fpage><lpage>61</lpage><pub-id pub-id-type="pmid">16528326</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Hobkirk</surname><given-names>JA</given-names></name></person-group><article-title>Complete Denturesda Dental Practitioner Hand book</article-title><year>1986</year><publisher-loc>Bristol</publisher-loc><publisher-name>Wright</publisher-name><fpage>44</fpage><lpage>5</lpage></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Khan</surname><given-names>Z</given-names></name><name><surname>Jaggers</surname><given-names>JH</given-names></name><name><surname>Shay</surname><given-names>JS</given-names></name></person-group><article-title>Impression of unsupported movable tissues</article-title><source>J Am Dent Assoc</source><year>1981</year><volume>103</volume><fpage>590</fpage><lpage>2</lpage><pub-id pub-id-type="pmid">7026644</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kelly</surname><given-names>E</given-names></name></person-group><article-title>Changes caused by a mandibular removable partial denture opposing a maxillary complete denture</article-title><source>J Prosthet Dent</source><year>1972</year><volume>27</volume><fpage>140</fpage><lpage>50</lpage><pub-id pub-id-type="pmid">4500509</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Allen</surname><given-names>F</given-names></name></person-group><article-title>Management of the flabby ridge in complete denture construction</article-title><source>Dent Update</source><year>2005</year><volume>32</volume><fpage>524</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">16317885</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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