Improvised Neutral Zone Technique in a Completely Edentulous Patient with an Atrophic Mandibular Ridge and Neuromuscular Incoordination: A Clinical Tip.

Prathibha Saravanakumar,Umamaheswari Mani,Saravanan Thirumalai Thangarajan,Anand Kumar V

doi:10.7759/cureus.1189

Prathibha Saravanakumar, Umamaheswari Mani + Show 2 more

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https://doi.org/10.7759/cureus.1189

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Abstract

Resorption of mandibular ridges is a multifactorial and biomechanical disease that is chronic, progressive, irreversible, and cumulative leading to loss of sulcular depth, vertical dimension loss, and decreased lower facial height. Some common neurological, hormonal, and metabolic disorders affect the adaptability of dentures, and this can be diagnosed by a trained prosthodontist with proper history-taking and clinical examination.The denture becomes passive due to complex neuromuscular control and causes difficulties in impression-making, mastication, and swallowing, which in turn leads to loss of retention and stability in complete dentures. Hence, residual ridge resorption becomes a challenging scenario for a clinician during fabrication of complete dentures. The neutral zone concept plays a significant role in overcoming these challenges. The neutral zone is the area where the outward forces from the tongue are neutralized or nullified by the forces of the lips and cheeks acting inward during functional movements.The neutral zone technique is an alternative approach for the construction of lower complete dentures. It is most effective for dentures where there is a highly atrophic ridge and history of denture instability. The technique aims to construct a denture that is shaped by muscle function and is in harmony with the surrounding oral structures. The technique is by no means new, but it is a valuable one. It is rarely used because of the extra clinical step involved and its complexity. Complete and partial denture failures are often related to non-compliance with neutral zone factors. Thus, the evaluation of the neutral zone is an important factor. Increased retention and stability with reduced chairside time are the salient features of this new approach to any clinically challenging situation in complete dentures.This clinical report describes a modification of the conventional neutral zone technique using improvised procedures to minimize chairside visits for a patient with an atrophic mandibular ridge and neuromuscular incoordination.

Highlights

The principal concern for all patients is to retain all of their teeth comfortably throughout their lives through good oral health
The neutral zone technique is favorable for patients with multitudinous, unstable, unretentive mandibular complete dentures
In the neutral zone technique, the placement of teeth is dictated by the oral musculature that varies from one patient to another

Summary

Introduction

The principal concern for all patients is to retain all of their teeth comfortably throughout their lives through good oral health. The neutral zone technique is favorable for patients with multitudinous, unstable, unretentive mandibular complete dentures. The goal of this technique is to place the teeth such that the forces exerted by the tongue and the cheek muscles are nullified, and the teeth remain in a safe, protected zone. In the neutral zone technique, the placement of teeth is dictated by the oral musculature that varies from one patient to another Various materials such as impression compounds [5], tissue conditioners [6], waxes [7], and impression plaster [8] have been used for recording the neutral zone, and each material has its inherent advantages and disadvantages. This technique reduced the chairside time and the number of appointments or visits

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