Denture Complications: Flabby and Flat Ridge Management

Flabby Etiology and Treatment

Etiology of Flabby Tissue:

1. Old, loose dentures.
2. Anterior interference determining Vertical Dimension of Occlusion (VDO).
3. Rapid ridge resorption leading to a knife-edge ridge.
4. Complete maxillary denture opposing natural mandibular teeth.
5. Loose, ill-fitting dentures.
6. Dentures with anterior porcelain teeth and posterior resin teeth.
7. Over-eruption of opposing natural teeth.
8. Failure to remove dentures at night.
9. Overextended denture border causing epulis fissuratum.

Treatment for Flabby Tissue:

A) Removal of Cause:

• Remove pressure areas.
• Relining old dentures with soft tissue conditioning.
• Correction of occlusal disharmonies.
• Restoration of lost VDO.

B) Remove Denture: (For acute inflammation).

C) Recovery Program:

1. Massage soft tissues.
2. Warm, salty water rinses.
3. Remove old dentures temporarily.

Prosthetic Approach for Flabby Tissue:

1. Preliminary Impression: Use a stock tray with low-viscosity alginate.
2. Secondary Final Impression:
   • A) Selective Pressure Technique.
   • B) Sectional Impression Technique (2-part): Use a close-fitting cold cure acrylic tray with the flabby area left uncovered.
     • Step 1: Border molding and impression of firm tissues.
     • Step 2: Record the flabby area separately using light body material applied by brush.

Jaw Relation:

Use the check bite technique with a wax wafer and cross-linked cuspless teeth.

Flat Ridge Etiology and Impression Techniques

Etiology of Flat Ridge:

A) Anatomic Factors:

1. Bone type: Cancellous.
2. Size and shape: Thin, narrow, V-shaped ridge.

B) Biologic Factors:

1. Age.
2. Sex: Females often affected.
3. Nutritional deficiencies: Calcium deficiency, Vitamin C deficiency.
4. Systemic health issues: Blood disorders, diabetes, radiation effects, hormonal imbalances.

C) Prosthodontic Factors:

1. Long-term wearing of dentures.
2. Improperly constructed dentures.
3. Porcelain and anatomic teeth with high cusps.

D) Functional Factors: Bruxing, grinding, tapping.

Clinical Problems Associated with Flat Ridges:

1. Instability (lack of ridge height).
2. Mental foramen impingement (paresthesia of the lower lip).
3. Dehiscence of the mandibular canal.
4. Sandwiched mucosa.
5. Prominent genial tubercles.
6. Sublingual gland projection.
7. Prominent mylohyoid ridge.

Flat Ridge Impression Techniques:

A) Preliminary Impression: Use high-viscosity alginate or putty rubber base.

B) Definitive Second Impression:

1) Muco-Compressive Technique:

Closed mouth technique, high viscosity material, non-perforated tray with no spacer. Use occlusal blocks to establish proper VDO.

2) Butterfly Technique (for prominent sublingual salivary glands):

Preliminary impression: Low-viscosity alginate in a stock tray with the lingual flange opened. Secondary impression: Closed mouth, using occlusal blocks for proper VDO. Apply tissue conditioning material three times.

3) Dynamic Technique:

Records the ridge and a wide range of muscle action. Involves active border molding, occlusal stops for proper VDO, and positioning the tongue rests. Ask the patient to swallow three times, smile, and protrude the mouth. Preliminary impression: high viscosity; Secondary impression: low viscosity.

4) Conventional Technique:

Materials used: Alginate, Zinc Oxide Eugenol, or Rubber base.

Jaw Relation:

Use the check bite technique with a wax wafer.

Single Denture Problems

Problems often arise when one arch has a complete denture and the opposing arch has natural teeth or a removable partial denture (RPD).

1. Lack of firmness and rigidity in the opposing arch.
2. Uneven occlusal plane.
3. Single Denture Syndrome: Displacement of the maxillary denture due to an unfavorable occlusal relationship, leading to mucosal irritation.
4. Abrasion of artificial acrylic teeth against natural porcelain teeth.
5. Fixed positions of mandibular anterior teeth affecting esthetics and phonetics.
6. Combination Syndrome (Kelly’s Syndrome): Occurs when a complete maxillary denture opposes a distal extension removable partial denture over a long period, causing:
   • A) Loss of bone beneath the complete denture.
   • B) Loss of bone beneath the removable partial denture.
   • C) Downward growth of maxillary tuberosities.
   • D) Papillary hyperplasia of the hard palate.
   • E) Extrusion of lower anterior teeth.