Prosthodontics

P rosthodontics Dec. 2013

Modified Impression Techniques for

Flabby Ridge: Series of Case Reports

1
Department of Endodontics
Department of Prosthodotics
2,3

K.D Dental College & Hospital, Mathura UP, India

Dr. Satyendra Agarwal
1 2
Dr. Anupama Agarwal 3
Dr. Manjari
Reader Reader P.G. Student

INTRODUCTION
A so-called 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.
Watson discussed this phenomenon in 1970, and described an
impression technique for maxillary fibrous ridges. Further discussion
was reported by Kelly in 1972, when he described changes caused
by a mandibular removable partial denture opposing a maxillary
complete denture. He suggested the term Combination Syndrome
to describe the clinical features, including loss of bone from
the anterior maxilla with concurrent fibrous tissue hyperplasia;
overgrowth of the maxillary tuberosities; extrusion of lower anteriors
and papillary hyperplasia of hard palate.
Liddlelow 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 and eugenol) over the normal
tissues). Osborne described a technique whereby two separate
impression trays and materials are used to separately record the
flabby and normal tissues, and then related intra-orally.
Watson described the window impression technique where a
custom tray is made with a window or opening over the (usually
anterior) flabby tissues. A muco-compressive impression is first
made of the normal tissues using the custom tray with zinc-oxide
and eugenol. A low viscosity mix of plaster of Paris is then painted
onto the flabby tissues, through the window.
Considering impression techniques, it is important to realise that
all impressions for complete dentures could be categorised in three
ways:
XX The mucostatic technique (non-displacive),
Management of edentulous ridges with localized
hyperplastic tissue is challenging. Mobile fibrous
tissue offers inadequate support for the complete
denture and result in reduced stability and retention.
This condition is normally caused by localized loading
when the complete maxillary denture is opposed by
natural anterior teeth and an absence of posterior
natural or artificial teeth. The presence of displaceable
denture-bearing tissues often presents a difficulty
when making complete dentures. 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. The purpose of this
clinical report is to describe the various impression
techniques for the treatment of the completely
edentulous patients with localized hyperplastic
alveolar ridge.
XX The mucocompressive technique (displacive),
XX The selective pressure impression technique - where some denture
bearing tissues are displaced, and others are not.
A multitude of impression techniques have been suggested to
circumvent the difficulty of making a denture to rest on a flabby
ridge. The purpose of this article is to describe various impression
technique for making impressions of denture bearing areas
containing flabby ridges.

42 GUIDENT | Your Guide on the path of Dentistry

CASE REPORT-1
Dec. 2013
Prosthodontics
P
XX The
rosthodontics
custom tray was fabricated in the usual manner. On the day of
secondary impression, the flabby ridge area was marked in patients
A 60 yrs old male patient reported to the department of mouth and these marks were transferred to the custom tray, the tray
was then perforated over the areas representing the flabby tissue.
prosthodontics, K.D. Dental College & Hospital, to replace his teeth.
History revealed that he had complete denture for the past ten
XX After application of a suitable adhesive, medium bodied addition
years which was loose. On clinical examination, the patient was
polyvinyl-siloxane impression material was applied to the area of the
completely edentulous with an extensive area of flabby ridge on
custom tray associated with the normal tissues.
the maxillary and mandibular anterior region. Following discussion
with the patient regarding the available treatment options, it was
XX Once the material was set, tray was removed from the mouth.
decided to fabricate the new set of complete denture.
XX Using a scalpel, any material that had flowed into the area of the tray
PROCEDURE associated with flabby tissues was removed.

XX A primary impression of the maxillary denture bearing area was made
with an irreversible hydrocolloid material (Alginate), to ensure minimal
distortion of the displaceable (flabby) tissues. The impression was
poured in dental stone. The displaceable areas were identified on the
cast.
XX Three uniform thicknesses of dental wax were placed as a spacer
over the displaceable areas identified on the cast and one thickness
over the remaining non-displaceable areas.
XX Border molding was done with the heavy-body PVS impression
material.
XX Flabby tissue area was then recorded with the light- body PVS
impression material.
XX Denture fabrication was done in the conventional manner and regular
follow-up was maintained.

Completely edentulous maxilla and mandible with flabby ridge in anterior region Custom tray

Flabby ridge area marked in patients mouth Marks transferred to the custom tray Spacer removed from the flaby-ridge Spacer removed from the custom tray
area and perforations made associated with normal tissue

Normal tissue recorded with medium- Border molding done by heavy- Final impressions Post-operative
body PVS impression material body PVS impression material

| GUIDENT
Your Guide on the path of Dentistry 43
Prosthodontics
P rosthodontics
Case Report-2
Dec. 2013

Clinical examination revealed the completely edentulous upper and

lower ridge with an extensive area of flabby ridge on the maxillary
anterior region.

Procedure-
XX Preliminary impression was made in a stock tray with irreversible
hydrocolloid impression material.
Final impression
XX Spacer of 1mm thickness was adapted over the cast and custom tray
was fabricated in the conventional manner.
XX The border molding was done with softened greenstick compound.
XX A window was created in the custom tray in the flabby ridge area.
XX Secondary impression was made with zinc oxide eugenol impression
paste and light-body PVS impression material was injected over the
window corresponding to the flabby ridge area.
XX Once the material was set, impression was removed from the patients
mouth. Post-operative

Completely
edentulous maxilla
with flabby ridge

Case report-3
Clinical examination revealed the completely edentulous upper
and lower ridge with an extensive area of flabby tissue over the
mandibular anterior region.

Procedure-
XX Till
the secondary impression, steps are same as described in case
report-2.
XX A window was created in the custom tray corresponding to the flabby
ridge and secondary impression was made with ZOE paste.
XX After that alginate was mixed and loaded in the stock tray. Now this
stock tray was placed over the custom tray in the patients mouth.
XX Afterthe material was set, stock tray was removed along with the
custom tray.
XX Impression was poured and the denture fabrication was followed in
Custom tray the conventional manner.

Window created in custom tray Secondary impression made with ZOE

Edentulous lower ridge with flabby tissue
corresponding to flabby tissue paste

44 GUIDENT | Your Guide on the path of Dentistry

 Dec. 2013
Prosthodontics
P
Conclusion
rosthodontics
Modified impression techniques are required in a flabby ridge to
record the tissues in an undistorted position. The various techniques
described as well as the different impression materials used helped
in providing an accurately fitted as well as satisfactorily functioning
dentures for the patient with a flabby ridge.

References
Secondary impression made with ZOE paste
1. Management of flabby ridge: using contemporary materials to solve
an old problem
2. C. D. Lynch & P. f. Allen. BDJ 2005; 20 (5), 258-261
3. Minimally displacive impression technique: A clinical report
4. Rucha Kashyap, Zubeda Begum, Hilal Mohammed. IJCDS NOVEMBER
2011;2:1-3.
5. Management of flabby ridge in complete denture construction
6. Finbarr Allen. Dental update 2005;32:524-38.
7. Modified impression technique for a flabby maxilla-A clinical report
8. Muthukumar B et al. Volume 3, Issue 1, January - March 2012.

Final impression Post-operative

| GUIDENT
Your Guide on the path of Dentistry 45
Copyright of Guident is the property of Ivory India and its content may not be copied or
emailed to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use.