Eur. J. Prosthodont. Rest. Dent., Vol.19, No.

1, pp 21-24 © 2011 FDI World Dental Federation

Printed in Great Britain doi:10.1922/EJPRD_937Kathuria04

Flabby Alveolar Ridges: A Modified Technique to

Treat this Clinical Challenge.
Nidhi Kathuria*, Rahul Prasad* and Shreenivas Vasant Bhide*

Abstract - Flabby tissues are common clinical finding which poses no problem of pain and discomfort but adversely
affect the support, retention and stability of complete dentures. This paper presents a nonsurgical alternative to such
cases focusing on a modified impression technique to record the flabby tissue in its undisplaced form. The custom
tray was made in two parts, the first part of which contains a “lattice-work”, which strengthens the tray followed by
a second tray, which adequately supports the final impression. A standard neutral zone technique was additionally
employed for the mandibular ridge as it was severely resorbed.

KEY WORDS: Extensive flabby alveolar ridge, modified custom tray design, Neutral zone.

INTRODUCTION and complained that they were loose fitting. The intraoral
examination revealed the presence of extensive anterior
Flabby ridges are excessive tissue proliferation commonly and posterior flabby ridges. Since the patient wished to
seen in the maxillary and mandibular ridges, usually caused avoid surgical procedures, it was decided that a complete
as a response to chronic irritation1. There may be many denture would be given to the patient, paying special at-
causes for the development of flabby ridges, namely, tention to the impression technique for the flabby ridges.
unplanned or uncontrolled dental extractions2, constant
unbalanced forces under ill-fitting dentures3 and continued
traumatic bone resorption in cases with increased masti- Technique
catory stresses4. Flabby tissue in the anterior maxilla is a The step by step technique is described as follows:
feature of the so called “combination syndrome”, which is
seen when maxillary complete dentures oppose the natural 1. The Maxillary and mandibular preliminary impressions
mandibular anterior teeth2,5. Flabby ridges pose significant were made in perforated stock metal trays using irre-
problems for the provision of stable and retentive dental versible hydrocolloid and primary casts were obtained
prosthesis for the affected patients5. (Figure 1).

The most frequent problem arises during the act of con- 2. The maxillary and mandibular casts were surveyed for
ventional impression making, when the flabby tissue is soft tissue undercuts and were blocked, using model-
recorded in a compressed state, it will tend to recoil and ling wax.
dislodge the overlying prosthesis. The impression tech- 3. A wax spacer (0.6mm) thick was adapted on the basal
nique associated with such flabby ridges is therefore im- seat area of the primary cast. An extra sheet of spacer
portant and must record the denture bearing area without wax was adapted across the inter canine region, as
displacing the flabby tissues. it was more flabby than the other regions. This was
The purpose of this case report is to present a modified followed by making of the custom tray, using chemi-
impression technique that can be used to optimize the treat- cally activated acrylic resin tray material. Most of the
ment of edentulous patients with extensive flabby ridges basal surface of the first tray was removed, except for
and at the same time be conservative and makes use of a “lattice-work”, which provided strength to the tray
impression materials that are routinely available in practice. (Figure 2).
4. Using an acrylic trimmer, keys were placed on the first
trays in at least three places. The keys provided a guide
Case Report
for correctly orienting the second tray on the first tray,
A 57 year old edentulous male was referred to the Depart- during the final impression making process.
ment of Prosthodontics, Bharati Vidyapeeth Dental College, 5. The lattice framework of the first tray was covered
Pune, India for prosthodontic rehabilitation. The patient with single thickness of spacer wax, ensuring that the
reported that he had been wearing a complete denture “keyed” positions were kept free of the spacer wax
for 15 years. He was wearing his third set of dentures (Figure 3).
6. The second tray was adapted onto the first tray, ensur-
ing that it was 2 mm short of it and fitted well into the
keys (Figure 3).

* MDS
 N. Kathuria, R. Prasad and S.V. Bhide

Figure 1. Maxillary and mandibular primary impression and primary Casts.

Figure 2. Fabrication of maxillary and mandibular tray with lattice framework and keys.

Figure 3. Adaptation of spacer wax on first tray and fabrication of second tray.

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 Flabby Alveolar Ridges: A Modified Technique to Treat this Clinical Challenge.

Figure 4. Fabrication of palatal tissue stop and two step impression procedure.

Figure 5. Mandibular border molded custom tray and final impression followed by
neutral zone record.

7. Numerous perforations were made in the second tray 10. The impression of the flabby ridge was made with eug-
with a No. 8 round bur to provide escape holes to enol free impression paste. The impression paste was
reduce excessive pressure during placement of the injected over the flabby ridge surface using a syringe
impression material loaded tray and also to aid in and the preloaded second tray was gently vibrated into
mechanical retention (Figure 3). position until keyed parts of the tray were in contact.
Two trays were held together until the impression
8. In order to ensure stability and equalization of pressure
material set, followed by which the impression was
during impression making, a tissue stop was placed in
removed as a single unit (Figure 4).
the maxillary custom tray in the region of the palatal
vault. The central portion of the maxillary custom tray 11. The mandibular custom trays were fabricated in a man-
was removed and a circular opening was created. ner similar to the maxillary custom trays and the final
Petroleum jelly was applied on the palatal mucosa to impression was made as described above (Figure 5).
prevent thermal injury. The first tray was seated with
12. Along with the presence of flabby tissue, the mandibular
minimum pressure and autopolymerizing resin was
ridge was extremely resorbed and therefore a standard
place on a tongue depressor and was gently placed in
neutral zone technique was employed9. Tentative jaw
the opening of the tray. The set resin formed a tissue
relations were recorded and face-bow transfer was
stop on the firm and stable palate (Figure 4).
undertaken on a semi-adjustable articulator followed
9. Maxillary border molding was undertaken with green- by teeth arrangement with balanced occlusion scheme.
stick compound, using the palatal resin stop to ensure
13. Try-in was undertaken and dentures were cured and
the stability of the tray. The spacer wax was removed
denture placement appointment was completed.
and final impression was made using light body elas-
tomeric impression material. After setting, the tray was
removed and excess impression material was trimmed
from the open lattice regions (Figure 4).

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 N. Kathuria, R. Prasad and S.V. Bhide

DISCUSSION MANUFACTURERS’ DETAILS

A relatively common finding in most edentulous cases Cavex outline eugenol free impression paste distributed
is presence of a ridge that is displaceable and hence by Cavex Holland BV, Netherland; Imprint alginate im-
called as ‘flabby ridge’. It is often seen in cases where pression material (DPI, India), Heat activated acrylic resin
the natural lower anterior teeth have occluded against a distributed by (DPI, India); Express VPS light body by
maxillary complete denture without adequate restoration 3M ESPE; Kaldent Dental plaster and Kalstone (Kalabhai,
of the posterior occlusion10. Consequently, the excessive India); Chemically activated acrylic resin tray material (MP
anterior load causes bony resorption which is followed by Sai Enterprise Mumbai, India), Beading wax, Boxing wax,
forward movement of the anterior mucosa, causing flabby Modelling wax and Spacer wax (Hindustan, India)
tissue development. In many cases the flabby tissue may
extend to the posterior ridges and may even involve the
tuberosities10. Surgical excision of the flabby tissue may be Address for correspondence
the most viable option, however accompanying medical Dr. Nidhi Kathuria, Senior Lecturer, Dept. of Prosthodontics,
conditions or medical treatment of such elderly patients Address: Dept. of Prosthodontics, P.D.M Dental College
may contraindicate any surgical procedure2. This makes & Research Institute, Bahadurgarh, Dist. Jhajjar, Haryana-
the impression procedure of such cases imperative and India. E-mail id: nidhi_niki2006@yahoo.com
technique sensitive. The impression must not only include
the denture bearing area but also ensure that the flabby
tissues are captured in an undisplaced form. REFERENCES
Keeping the above facts in mind, a modified impression 1. Lynch CD, Allen .lPF. Management of the flabby ridge: using
tray design and corresponding technique has been de- contemporary materials to solve an old problem. Br Dent J
scribed which is mainly indicated when alveolar ridge is 2006;200: 258-268.
extremely flabby and involves both anterior and posterior 2. Winkler S. Essentials of complete denture Prosthodontics. Second
Edition. St. Louis: Ishiyaku EuroAmerica, Inc. U.S.A.
residual alveolar ridges. 3. Lello GE, Makek M. Submucosal nodular chondrometaplasia in
The technique used involves a two part custom tray de- denture wearers. J Prosthet Dent 1985;54:237-40.
4. Allen PF. Management of the flabby ridges in complete denture
signed with a lattice (first tray) to strengthen the tray and
construction. Dent Update2005;32:524-28.
also providing sufficient support (second tray) for the im- 5. Filler WH. Modified impression technique for hyperplastic al-
pression, so as not to damage or distort it during removal. veolar ridges. J Prosthet Dent 1971;25:609-612.
6. Lynch CD, Allen PF. Case Report: Management of the Flabby
The impression technique also uses materials with which ridge: Re-visiting the principles of complete denture construc-
dental practitioners are already familiar with and are dimen- tion. Eur. J. Prosthodont. Rest.Dent2003;11:15-18.
sionally stable. Injecting eugenol free impression material 7. Khan Z, Jaggers JH. Impressions of unsupported movable tissues.
over the flabby ridges with a syringe and the open lattice JADA 1981;103:590-592
design of the tray ensures that the flabby tissues are not 8. Alfano SG, Leupold RJ. Using the neutral zone to obtain maxil-
lomandibular relationship records for complete denture patients.
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a pressure free, well supported final impression. 9. MacGregor AR. Fenn, Liddelow and Gimsons’ Clinical dental
prosthetics. Third Edition. Wright Publ Co,1989; 69-70.
However, this technique does require expertise in custom
tray fabrication and accurately fitting trays for error free
impressions.

CONCLUSION
This paper describes an impression technique for manage-
ment of denture bearing areas with extensive flabby tis-
sues. The materials used are readily available and used in
contemporary general dental practice. The two part custom
tray design, when fabricated accurately, can provide the
practitioner with an undisplaced flabby ridge impression
that can successfully be used in managing such cases,
without surgical intervention.

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