RESIDUAL

RIDGE
RESORPTION

Residual ridge is a term used to describe

the shape of the alveolar ridge after healing

of bone and soft tissues after tooth
extractions.

- The size of the residual ridge is reduced

most rapidly in the first 6 months of extraction , but
the bone resorption activity continues throughout
life at a slower rate , resulting in removal of a large
amount of jaw structure.
- This unique phenomena has been described
as RESIDUAL RIDGE RESORPTION (RRR).

Consequences of RRR

Pathology of RRR

Gross pathology ::
Order 1

Pre extraction

Order 2

Post extraction

Order 3

High, well-rounded

Order 4

Knife edge

Order 5

Low, well-rounded

Order 6

Depressed

Pathophysiology of RRR

 It is a normal function of bone to undergo constant

remodeling throughout life through the process of
bone resorption and bone formation .

Growth : Bone formation .

Osteoporosis/localized periodontal disease: Bone

resorption .

Changes in the Maxilla

and the Mandible

Maxillary teeth are generally directed downward and

outward, so bone reduction generally is upward and
inward. Since the outer cortical
plate is thinner than the inner cortical
plate, resorption from the outer
cortex tends to be greater and more
rapid. As the maxilla becomes smaller in all
dimensions, the denture bearing area (basal seat)
decreases.

The anterior Mandibular teeth generally directed upward

and forward to the occlusal plane, whereas the posterior
teeth are either vertical or incline slightly lingually.

Because the mandible is wider at its

inferior border than at the residual
alveolar ridge, resorption moves the left and right ridges
progressively farther apart.

Epidemiology of RRR

To date, it would appear that RRR is world-wide ,

inevitable , occurs in males and females, young and old,
sickness and in health, with and without dentures and is
unrelated to the primary reason for the extraction of the
teeth (Caries / periodontal disease).
Rate of RRR is variable
-between persons.
-within the same person at different times.
-within the same person at different sites.

Etiology of RRR

 Anatomic.
Metabolic.
Functional.
Prosthetic factors.

ANATOMIC FACTORS :
RRR anatomic factors

1
RRR ------------------Density of the bone

METABOLIC FACTORS :

RRR bone resorption factors

bone formation factors

FUNCTIONAL FACTORS :

Forces within the physiological limits are beneficial

in their massaging effect .
Increased or sustained pressure produces bone
resorption .
Bone that is in disuse will tend to atrophy .

Disuse atrophy ::
It is directly proportional to the extent of disuse .
After the loss of natural teeth, bone cannot be
stimulated by a denture base as the teeth did
internally. The lack of internal stimuli contributes to
the disuse atrophy .

PROSTHETIC FACTORS :
Excessive stress resulting from artificial dentures .
Abuse of tissues from lack of rest .
Incorrect Centric relation record .
Faulty improper impressions employing compression
forces .

 Long continued use of ill fitting dentures

Under extended dentures .
Error in relating maxilla to the cranial landmarks
(orientation relation).
Lack of freeway space due to increased vertical
dimension of occlusion .

Faults in selection and placement of posterior teeth .

If occlusal corrections are not done .
Over closure .

Methods of evaluation of bone loss in RRR

Radiographs:
- Cephalometrics .
- Panoramic.
Porosimetry
Anatomic studies .

Management of RRR

Systemic evaluation

- Diet.
- Tissue Treatment Therapy.

- Pre-prosthetic surgery

Ridge Corrective surgery

Ridge extension
surgery/vestibuloplasty

Ridge Augmentation

Prosthetic management

- Impression technique .

Selection of denture base :

Methyl methacrylate resin denture bases

Cast metal bases
Processed resilient , lined denture bases

Teeth selection and arrangement

Implant supported prosthesis.

Prosthodontic classification of implants.

FP-1 : Fixed prosthesis replacing only crown.
FP-2 : Fixed prosthesis replacing crown and
portion of root.
FP-3 : Fixed prosthesis replacing missing crowns
and portion of the edentulous site.
RP-4 : Removable prosthesis : overdenture
supported by implants.
RP-5 : Removable prosthesis : overdenture
supported by both soft tissue and implant.

The success of implant

supported prosthesis, however, depends on the
technical knowledge and expertise of the
implantologist, and is directly related to the
selection of patient and implant, surgical
technique, follow up procedures and patient
acceptability.

Summary & Conclusion

Residual ridge resorption is a chronic,

progressive, irreversible, and disabling disease of
multi-factorial origin.
RRR requires a multiple approach for diagnosis
and treatment planning.
Construction of a stable functioning denture and
a regular follow up treatment can help in the
restoration of mastication , phonetics and esthetics.