Mandibular Ridge Resorption Research Articles

Comparative Evaluation of Mandibular Ridge Resorption in Post-menopausal Denture and Non-Denture-Wearing Females and Its Relation to Body Mass Index: An In-Vivo Study

Comparative Evaluation of Mandibular Ridge Resorption in Post-menopausal Denture and Non-Denture-Wearing Females and Its Relation to Body Mass Index: An In-Vivo Study

Four locator attachments of mandibular implant-retained overdentures with two different distributions: A 10-year retrospective preliminary study of residual alveolar ridge changes.

There is little information on the long-term function of the four Locator attachment of the mandibular implant retained overdenture (OD), particularly with different distributions. To compare the effect of different four inter-foraminal implant distributions retaining a mandibular OD after 10 years of function on posterior mandibular ridge resorption (PMandRR), anterior maxillary ridge resorption (AMaxRR), and the amount of marginal bone loss (MBL) around all four implants. Twenty-two participants with total edentulism who had worn mandibular OVDs retained by four inter-foraminal implants for 10 years of functional life were selected for this study. They were divided into two groups based on implant distribution: Group I with a quadrilateral distribution (QD) of implants and Group II with a linear distribution (LD) of implants. PMandRR, AMaxRR, and MBL around implants were measured. After 10 years of function, PMandRR was significantly higher in the LD group than in the QD group (p < 0.001*). There was no significant difference in AMaxRR between the QD and LD groups (p = 0.431). The QD group showed a significantly greater amount of MBL around dental implants when compared with the LD group (p = 0.002*). The LD of implants demonstrates more PMandRR compared with the QD. The QD of implants demonstrates a greater amount of MBL around dental implants compared with the LD. Both implant distributions demonstrate the same effect on the AMaxRR. MBL around implants remained within normal accepted values after 10 years of function.

Management of resorbed mandibular ridge resorption using the neutral zone technique - A case series.

Management of resorbed mandibular ridge resorption using the neutral zone technique - A case series.

A Randomised Clinical Study of the Effect of a Denture Soft Liner on Mandibular Ridge Resorption in Complete Denture Wearers After One and Two Years Of Denture Insertion

Abstract: Aim: The aim of this study was to assess the effect of soft denture liners on mandibular ridge resorption in complete denture wearers after two years of use. Methodology: The study included 32 patients ranging in age from 35 to 65 years old. Those patients were completely edentulous with well formed ridges, Class I relation and no medical problem. Thirty two selected patients were divided into two groups, namely Experimental group and Control group. Control group (n = 16, 8 males and 8 females) received conventional maxillary and mandibular complete dentures. Whereas in Experimental group, (n = 16, 8 males and 8 females) silicone lined lower complete denture were made. Three panoramic radiographs (orthopantomogram [OPG]) were taken for each participant to assess the amount of bone resorption; immediately, one year, and two years after denture insertion. For comparing two groups at three different time intervals, analysis of variance (ANOVA) two way with post-hoc tests was used. A statistically significant pvalue of less than 0.05 was considered. Results: After denture delivery, there was significant change in bone height in all patients ( p &lt; 0.001) . The comparison of bone height between the two groups in different regions at different time intervals revealed a significant difference in bone levels at baseline to one year and baseline to two years. However, Experimental group experienced 50% less bone loss than control group over a two-year period. Conclusion: Based on the findings of the current study, it can be inferred that use of soft liners helps in reducing residual ridge resorption significantly when compared with conventional denture material.

SINGLE IMPLANT-RETAINED MANDIBULAR OVERDENTURE: A CASE REPORT

Edentulism is a public health problem, impacting the quality of life of many people worldwide. Factors related to the mandibular ridge minimal support may hinder the common use of complete dentures. The use of overdentures supported by a minimum of one implant can be considered as reliable approach in this situation. Aim: To present a case report of a single implant-supported overdenture in the mandibular symphysis fot public health policies. Case report: A 65-year-old edentulous patient complaining of discomfort in a mandibular denture was referred to the Universidade Federal Fluminense. On clinical examination, residual mandibular ridge resorption and soft tissue trauma were observed, which was in line with the reported discomfort. A mandibular overdenture retained by a single implant in the symphysis region was planned. A hex-type 4.0 mm in diameter and 11.0 mm in length implant was placed and a new set of complete dentures were made till the date of complete osseointegration. After four months, a second surgery exposed the implant platform to fit a ball attachment with a 32 N.cm torque. The denture was relieved on its tissue surface for the placement of a metal attachment matrix with a rubber O-ring inside, using a fast-curing resin, and the patient was locked into maximum intercuspidation during the acrylic polymerization process. Excessive resin was removed and the region was polished for daily use after the process. The patient reported an improvement in chewing condition and restorative esthetics. Conclusions: A minimum requirements protocol has achieved relevant results and may be feasible in public health policies. Maintenance visits are recommended to maintain retention quality and to decrease the risk of failures.

Characteristics of cases of severe mandibular ridge resorption with edentulous jaw and treatment method using suction denture

Characteristics of cases of severe mandibular ridge resorption with edentulous jaw and treatment method using suction denture

Stability is success: Rehabilitation of an atrophic mandibular ridge employing neutral zone technique - A case report

Mandibular ridge resorption is a biomechanical and a complex disease that brings about chronic, progressive, cumulative and irreversible changes in bone structure resulting in severe impairment in fit and function of prosthesis. Some common hormonal, neurological, metabolic disorders can affect the adaptability of denture which can be diagnosed by a trained prosthodontist with proper history taking and clinical examination. If a denture stays inside or outside of the neutral zone, it will be unstable during functional &amp; physiological activities such as talking, swallowing and mastication. Neutral zone technique is a long being used for the management of severely resorbed mandibular ridge. Various materials can used in recording neutral zone which have their own advantages and disadvantages. This technique serves as an alternative approach for the construction of mandibular complete denture. This technique is most effective for denture where there is a highly atrophic ridge, neuromuscular incoordination and history of denture instability. This clinical report describes in detail the fabrication of a complete denture in a patient with poorly formed mandibular ridge using neutral zone technique with addition of cast metal in mandibular denture for extra stability.

Management of cawood class V mandibular ridge using “Dynamic impression technique”: A case report

Residual ridge resorption is a chronic, progressive, irreversible and cumulative disease. Stability is defined as resistance to horizontal displacement of prosthesis. Providing a stable lower denture has been challenging for dentists. This article outlines the management of the mandibular ridge resorption with dynamic impression technique. Stability of complete lower dentures has challenged dentists and patients alike. Dynamic impression technique is clinically significant for management of resorbed mandibular ridge, as the range of action of the muscles and other structures that relate to the denture space is recorded by an impression so that the denture can be shaped accordingly.

The impact of relining bar-implant retained overdenture on alveolar bone resorption in posterior mandible: A 5-years retrospective study.

Purpose. The purpose of this study was to evaluate the effect of relining of mandibular implant retained overdenture with resilient liner on posterior mandibular ridge resorption. Material and methods. Twelve completely edentulous patients received 2 implants in the canine area of the mandible and connected with a Dolder bar. Patients were randomly divided in two groups: Group I (non-relined group), patients received bar/clip attachment and acrylic mandibular overdenture without relining. Group II (relined group), patient received bar attachment and acrylic mandibular overdenture totally relined with soft liner (around the bar and the distal extensions of the denture). Proportional measurements in terms of posterior area index (PAI) of the residual ridges were measured on panoramic images of Cone Beam computerized tomography taken after the overdenture insertion (base line, T0) and five years after the overdenture insertion (T5). Results. Group I demonstrated statistically significant higher mean change in PAI (bone loss) compared to group II. The amount of bone loss was 1.23mm (in group I) and .74mm (in group II) for each 1mm of the residual ridge length. Only group, mandibular bone height, and relining frequencies had a significant correlation with the change in PAI. No significant correlation between age or gender with change in PAI. Conclusions: Within the limitations of this study, it could be concluded that relined implant retained mandibular overdentures with silicon soft liner over bar attachments is preferred on long term as it reduced posterior mandibular ridge resorption compared to unrelined overdentures

Anaesthesia for Reconstruction Surgery Post Mandibulectomy in a Patient with a Predicted Difficult Airway: A Case Report

Introduction: Mandibular surgeries, edentulous mandible, use of dentures, and aging all predispose to residual mandibular ridge resorption and thinning. The edentulous state of the mandible makes the tongue occlude the upper airway. All these, contribute to difficulty in managing the airway. An adequate pre-operative review helped classify this index patient as high risk for difficult airway and adequate steps were taken to facilitate optimal airway management.Case report: We present a 53 years old woman with mandibular deformity, anterior neck mass and inadequate mouth opening who has had a segmental mandibulectomy and a soft tissue closure of reconstruction plate. She was scheduled for mandibular reconstruction.She was successfully intubated using a size 4.5 Intubating Laryngeal Mask Airway (ILMA) through which a size 6.0 ID classic endotracheal tube was introduced for ventilation. A gum elastic bougie was then inserted through the endotracheal tube, both the ILMA and classic endotracheal tube were withdrawn. An armored tube size 6.5 ID was then rail roaded.Conclusion: The successful anaesthetic management of this difficult airway patient was facilitated by a thorough pre-anaesthetic plan, concise and skilled anaesthetic management strategy with a well organized team work.

Effect of serum vitamin D, calcium, and phosphorus on mandibular residual ridge resorption in completely edentulous participants: A clinical study

Statement of problemPublished data regarding association between edentulous mandibular residual ridge resorption and nutritional status of geriatric patients is limited. PurposeThe purpose of this clinical study was to evaluate the degree of mandibular residual ridge resorption in completely edentulous participants and to investigate the role of dietary nutrients in the resorption process. Material and methodsThree hundred (55% men and 45% women; aged between 35 and 85 years) completely edentulous participants with specific inclusion and exclusion criteria were enrolled for the study. A standardized panoramic radiograph was made, measurements were made digitally, and the amount of resorption was calculated using the Wical and Swoope method. The blood plasma levels of vitamin D3 were analyzed by using the direct competitive chemiluminescence immunoassay (CLIA) method, whereas the total calcium and phosphorus were determined by using spectrophotometer method. Statistical data of serum nutrient levels (calcium, phosphorus, and vitamin D3), age, sex, and residual ridge resorption were subjected to the Mann-Whitney U test, the Spearman correlation test, and a stepwise multiple linear regression analysis (α=.05). ResultsCalcium (P=.003) and phosphorus (P<.001) levels were significantly increased in the female participants as compared with the male participants. Vitamin D3 levels were similar in all the participants. Moreover, metabolic levels of calcium (rho=-0.09), phosphorus (rho=-0.10), and vitamin D3 (rho=-0.02) were found to be reduced with increasing age. However, male participants had increased mandibular residual ridge resorption (P<.001) with positive correlation (rho=0.06) when compared with female participants. Mandibular ridge resorption was increased with a decrease in levels of serum nutrients. ConclusionsIncreased levels of mandibular residual ridge resorption were observed in participants with decreased levels of systemic biochemical parameters, including calcium, phosphorus, and vitamin D3. Moreover, male participants showed increased residual ridge resorption when compared with female participants, who showed a significantly higher level of serum nutrient levels. Serum nutrient levels decreased, whereas mandibular residual ridge resorption increased with age.

Implant-supported distal extension mandibular partial overdenture: comparison of two attachment types effect on mandibular posterior residual alveolar bone (five year retrospective study)

Purpose: This study aimed to compare effect of implant supported removable partial denture (IS RPD) with locator versus ball attachments on mandibular posterior residual alveolar ridge after 5 year period. Materials and Methods: From available data base of class I partially edentulous mandibular arches modified by bilateral distal implants in 2nd molar region against edentulous maxilla treated with IS RPDs against a maxillary denture. 18 patients were randomly selected and allocated in two equal groups, 9 patient each, as follows; G1, B&S Group, using a ball and socket attachment and G2, locator group, using locator attachment. The posterior mandibular ridge resorption was evaluated in the form of change in posterior area index (∆PAI) on digital panoramic radiographs over 5 year period. Also the relation of ∆PAI to implant marginal bone changes (MBC) and other patient's data as age, edentulous period, prosthesis use period, ridge length, initial ridge height number of relines and attachment maintenance. Results: locator significantly reduce the ∆PAI (0.032) compared to B&S (0.064) with non-significant difference in MBC of distal implants. Conclusion: The IS RPD using locator attachments offer better mandibular posterior ridge preservation versus the B&S attachment. Carful follow-up and proper post insertion service help to avoid any harmful effect on implant and/or residual ridge, maintaining the prosthesis/attachment/ tissue relation to assure proper functional load distribution.

Modified Impression Technique to Overcome Flabby Anterior Maxillary Ridge and Severe Residual Mandibular Ridge Resorption - A Case Report

Modified Impression Technique to Overcome Flabby Anterior Maxillary Ridge and Severe Residual Mandibular Ridge Resorption - A Case Report

Five-year Radiographic Changes of Residual Ridges under Maxillary Complete Denture and its Opposing Mandibular Two Implant-Retained Overdenture with Different Resilient Attachments

Aim: This study aimed to radiographically compare the effect of different resilient attachments on maxillary and mandibular residual ridge changes after 5 years of using mandibular 2-implant retained overdentures. Materials and methods: Eighteen completely edentulous male patients, with age ranging from 45 to 60 years, were included in the study. Maxillary complete dentures were constructed opposed to 2-implant retained mandibular overdentures. Patients were divided randomly into three equal groups according to type of attachment into; ball/socket (BOD) group, Locator attachment (LOD) group, and positioner attachment (POD) group. Maxillary and mandibular ridge resorption were determined by using the proportional area index method on the panoramic radiograph taken at time of overdenture insertion and at five years later.Results: The minimal rate of ridge resorption was recorded for posterior maxillary ridges (Max-PRRR) followed by that of posterior mandibular ones (Mand-PRRR), while the highest resorption rate was recorded for anterior maxillary ridges (Max-ARRR). The study did not reveal significant difference in ridge resorpion between the resilient attachment systems.Conclusion: Mandibular overdentures retained by two implants with the described attachment systems provide a similar and acceptable range of residual ridge resorption (RRR) after 5years of function. The reduced RRR with Locator attachments proved its ability to provide an equitable load on the implants and tissue bearing areas during function.

Cell therapy induced regeneration of severely atrophied mandibular bone in a clinical trial

BackgroundAutologous grafting, despite some disadvantages, is still considered the gold standard for reconstruction of maxillofacial bone defects. The aim of this study was to evaluate bone regeneration using bone marrow-derived mesenchymal stromal cells (MSCs) in a clinical trial, a less invasive approach than autologous bone grafting. This comprehensive clinical trial included subjects with severe mandibular ridge resorption.MethodsThe study included 11 subjects aged 52–79 years with severe mandibular ridge resorption. Bone marrow cells were aspirated from the posterior iliac crest and plastic adherent cells were expanded in culture medium containing human platelet lysate. The MSCs and biphasic calcium phosphate granules as scaffolds were inserted subperiosteally onto the resorbed alveolar ridge. After 4–6 months of healing, new bone formation was assessed clinically and radiographically, as were safety and feasibility. Bone at the implant site was biopsied for micro-computed topography and histological analyses and dental implants were placed in the newly regenerated bone. Functional outcomes and patient satisfaction were assessed after 12 months.ResultsThe bone marrow cells, expanded in vitro and inserted into the defect together with biphasic calcium phosphate granules, induced significant new bone formation. The regenerated bone volume was adequate for dental implant installation. Healing was uneventful, without adverse events. The patients were satisfied with the esthetic and functional outcomes. No side effects were observed.ConclusionsThe results of this comprehensive clinical trial in human subjects confirm that MSCs can successfully induce significant formation of new bone, with no untoward sequelae. Hence, this novel augmentation procedure warrants further investigation and may form the basis of a valid treatment protocol, challenging the current gold standard.Trial registrationEudraCT, 2012-003139-50. Registered on 21 August 2013. ClinicalTrials.gov, NCT 02751125. Registered on 26 April 2016.

Posterior Mandibular Ridge Resorption Associated with Different Retentive Systems for Overdentures: A 7-Year Retrospective Preliminary Study.

This retrospective study compared posterior mandibular residual ridge resorption with two different retentive mechanisms for overdentures after 7 years. A convenience sample of 18 edentulous men was assigned to one of two equal groups. Two implants were placed in the mandibular canine areas for each patient using the conventional two-stage surgical protocol, and the implants were splinted with a round bar 3 months later. New mandibular overdentures were then connected to the bars with clips (clip-retained overdentures, CR group) or resilient liners (resilient liner-retained overdentures, RR group). Posterior mandibular ridge resorption (PMRR) was recorded using proportional measurements and posterior area index (PAI) on panoramic radiographs taken immediately after overdenture insertion (T0) and 7 years later (T7). A linear regression model was used to verify the relationship between PAI and the following considerations: attachment type, age, initial mandibular ridge height, period of mandibular edentulism, number of previously worn dentures, and relining events. After 7 years, the RR group demonstrated a significantly (P = .014) higher change in PAI (0.11 ± 0.02) than the CR group (0.06 ± 0.04). The average PMRR for each mm of posterior mandibular ridge was 0.79 mm (0.11 mm/year) in the CR group and 1.4 mm (0.2 mm/year) in the RR group. Attachment type, initial mandibular ridge height, and relining times were significantly correlated with change in the PAI (P = .004, P = .035, and P = .045, respectively). Within the limitations of this preliminary study's design, it was observed that following a 7-year period of use, resilient liner attachments for bar/implant-retained overdentures appear to be associated with greater posterior mandibular ridge resorption when compared to clip attachments.

Effect of denture soft liner on mandibular ridge resorption in complete denture wearers after 6 and 12 months of denture insertion: A prospective randomized clinical study.

Purpose:Soft liners act as a cushion between the denture base and the residual ridge. Hence, it is important to study their effect on resorption of mandibular denture bearing area. Therefore, the purpose of this study was to evaluate the influence of soft denture liner on mandibular ridge resorption after 1 year in completely denture wearers.Materials and Methods:Twenty-eight completely edentulous patients having age between 45 and 60 years with well-formed ridges in class I jaw relations were selected as per the inclusion and exclusion criterion. Randomization chart was used to enroll participants in experimental and control groups who were given mandibular dentures with and without soft denture liner, respectively. Vertical measurements were made on orthopantomograph and analyzed using Adobe Photoshop 7.0 software at five points, i.e., one at central incisor and two points at right and left first premolars and two in each first molar region.Results:On application of repeated measures analysis of variance, both groups showed a significant change in bone height after denture delivery (P < 0.05). Intergroup comparison (Wilcoxon rank sum test) of bone height in different regions at various time intervals showed statistically significant difference in bone levels (P < 0.05) from baseline to 6 months and baseline to 12months (P < 0.01), while the difference was statistically not significant during 6 and 12 months’ period.Conclusion:The use of soft denture liner significantly reduces the residual ridge resorption in complete denture wearers as compared to conventional denture wearers (without denture liner) over a period of 1 year.

Prognoses of new complete dentures from the patient's denture assessment of existing dentures.

The aim was to determine prognostic factors affecting frequent post-delivery adjustments of new complete dentures using patients' assessments of existing complete dentures. A total of 125 edentulous participants (56 men, 69 women; mean age, 76.4years) who required new complete dentures evaluated existing dentures using the patient's denture assessment (PDA), a questionnaire regarding the self-assessment of dentures composed of 22 question items and containing six subscales: "function," "lower denture," "upper denture," "expectation," "esthetics and speech," and "importance." Moreover, the numbers of post-delivery adjustments of new dentures were recorded. A multiple logistic regression analysis was performed to identify significant factors for frequent adjustments of new dentures with five subscales of the PDA (excluding "importance"), level of mandibular ridge resorption, and age as independent variables. The analysis showed that "function," "esthetics and speech," and level of mandibular ridge resorption were significant variables for a frequent number of post-delivery adjustments of new complete dentures. The results suggested that patients' assessments of existing dentures using the PDA might allow a prediction of prognosis for complete denture treatments. Additionally, low "function" scores and high "esthetics and speech" scores for existing dentures and high levels of mandibular ridge resorption were significant prognostic factors affecting frequent post-delivery adjustments of new complete dentures. It may be difficult for edentulous persons to adapt to new complete dentures, especially those who have complaints about mastication and swallowing with existing dentures and poor mandibular ridges, but are satisfied with esthetics and speech.

A comparative study on complete and implant retained denture treatments – A biomechanics perspective

Although implant-retained overdenture allows edentulous patients to take higher occlusal forces than the conventional complete dentures, the biomechanical influences have not been explored yet. Clinically, there is limited knowledge and means for predicting localized bone remodelling after denture treatment with and without implant support. By using finite element (FE) analysis, this article provides an in-silico approach to exploring the treatment effects on the oral mucosa and potential resorption of residual ridge under three different denture configurations in a patient-specific manner. Based on cone beam computerized tomography (CBCT) scans, a 3D heterogeneous FE model was created; and the supportive tissue, mucosa, was characterized as a hyperelastic material. A measured occlusal load (63N) was applied onto three virtual models, namely complete denture, two and four implant-retained overdentures. Clinically, the bone resorption was measured after one year in the two implant-retained overdenture treatment. Despite the improved stability and enhanced masticatory function, the implant-retained overdentures demonstrated higher hydrostatic stress in mucosa (43.6kPa and 39.9kPa for two and four implants) at the posterior ends of the mandible due to the cantilever effect, than the complete denture (33.4kPa). Hydrostatic pressure in the mucosa signifies a critical indicator and can be correlated with clinically measured bone resorption, pointing to severer mandibular ridge resorption posteriorly with implant-retained overdentures. This study provides a biomechanical basis for denture treatment planning to improve long-term outcomes with minimal residual ridge resorption.

Rehabilitation of an edentulous mouth with severe mandibular ridge resorption using neutral zone impression technique: a case report

Alveolar ridge atrophy poses a clinical challenge towards the fabrication of a successful prosthesis. Resorption of denture bearing areas results in an unstable non-retentive dentures associated with pain and discomfort. Prosthetic Rehabilitation of a patient with severely resorbed ridge is the most challenging therapy a prosthodontist can undertake. For a favourable prognosis of the denture therapy, impression technique selected should be based on the present state of the basal tissue support. This article presents rehabilitation of a patient with severely resorbed mandibular ridge with the application of neutral zone concept being incorporated into impression making in an effort to achieve successful complete denture therapy. Finally, patient had more stable, retentive and functionally efficient complete denture. In conclusion, neutral zone impression technique proved to be a quite effective method for prosthetic rehabilitation of patient with severe mandibular ridge resorption. DOI: http://dx.doi.org/10.3329/bjms.v13i4.15605 Bangladesh Journal of Medical Science Vol.13(4) 2014 p.477-480