Residual ridge resorption in edentulous patients.

1. RESIDUAL RIDGE
RESORPTION
PRESENTED BY :
DR. ANNESHA K.
KONWAR

2. CONTENTS:
 DEFINITIONS
 CLASSIFICATIONS
 CONSEQUENCES
 MECHANISM
 PATHOGENESIS
 ETIOLOGY
 TREATMENT & MANAGEMENT
 SUMMARY AND CONCLUSION

3. DEFINITIONS :
• “Bone - a highly vascularized, living, constantly changing, mineralized
connective tissue”. [Gray’s anatomy-40th edition]
• “Alveolar process -- that part of the maxilla and mandible that forms and
supports the sockets of the teeth”. [Orban’s]

4. • “Alveolar bone is the bony portion of the maxilla and the mandible in which
roots of the teeth are held by fibers of periodontal ligament”. [GPT-8]

5. • “Residual alveolar ridge is the portion of the alveolar ridge and its soft
tissue covering which remains following the removal of or loss of teeth.
[GPT-8]

6. • The residual bony architecture of the maxilla and mandible undergoes a
life-long catabolic remodelling.
• The rate of reduction in size of the residual ridge is maximum in the first
3-6 months and then gradually tapers off.
• However, bone resorption activity continues throughout life at a slower
rate, resulting in loss of varying amount of jaw structure, ultimately
leaving the patient a ‘dental cripple’.

7. The mechanical aspect of bone remodeling is usually associated with
Wolff’s law of bone transformation which states that “Every Change In
Change In The Form And Function Of Bone , Or Of Their Function Alone,is

8. CLASSIFICATIONS

9. According to Atwood : (JPD 1971 vol.26)
• 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

10. SIEBART’S CLASSIFICATION
• Class I : defects – faciolingual loss of
tissue width with normal ridge height.
• Class ii : defects- loss of ridge height with
normal ridge width
• Class iii : defects-combination of loss in
both the directions

11. According to Wical and Swoope :
Class I : upto one third of the original vertical height lost.
Class ii : from one third to two thirds of the vertical height lost.
Class iii : two third or more of the mandibular height lost.

12. According to Niel’s classification
Class 1 : 0.5” space exists between mylohyoid ridge and
floor of the mouth
Class 2 : less than 0.5” space
Class 3 : mylohyoid muscle at the same level as
mylohyoid ridge

13. According to Misch’s classification
Bone Density
D1 dense cortical bone
D2 thick dense to porous cortical bone on
crest and cortical trabecular bone within
D3 thin porous cortical bone on crest and
fine trabecular bone within
D4 fine trabecular bone
D5 immature, non mineralized bone

14. According to the American College of Prosthodontists :
Mcgarry et al, J prosthodont 8(1):27-39, 1999
Based on bone height (mandible only)
Type I : residual bone height of 21 mm or greater measured at the least vertical
height of the mandible.
Type II : residual bone height of 16 - 20 mm measured at least vertical height of
the mandible.
Type III : residual alveolar bone height of 11 - 15 mm measured at the least
vertical height of the mandible.
Type IV : residual vertical bone height of 10 mm or less measured at the least
vertical height of the mandible.

15. BONE CELLS
1) Osteoblasts :
• Derived from osteoprogenitor cells
• Periosteum serves as important reservoir .
• Bone resorbing factors that act via the osteoblast
are parathyroid hormone, vitamin D3, interlukin -1
and tumor necrosis factor.

16. 2)OSTEOCYTES
Nerve cells
Sense the change in environment and send signals that affect
response of other cells involved in bone remodelling
Maintains balance between
resorption and remodelling
 Bone that forms more rapidly shows
more osteocytes.

17. 3) OSTEOCLASTS
- Bone destructing cells.

18. FORMATION OF OSTEOCLASTS

19. The organic components of the intercellular
substance are removed by proteolytic action
of the osteoclasts
Then, the Ca salts (inorganic) are dissolved
by a chelating action of the osteoclasts.
As resorption takes place, the osteocytes
released may revert to osteoblasts or
become osteoclasts, depending on the
physiologic and pathologic demands.
MECHANISM OF BONE RESORPTION
Histologically, bone apposition and resorption take place in close approximation, making
possible the bone balance of shape and size.

20. SEQUENCE OF RESORPTIVE EVENTS
Attachment of osteoclasts to mineralized surface of bone
Creation of a ruffled border and a sealed acidic environment
through action of the proton pump
Dissolution of the Hydroxyapatite
Fall in pH to 2.5-3 in the osteoclast resorption space
Digestion of the organic components of the matrix by proteolytic
enzymes

21. BONE RESORPTION
FACTORS
LOCAL SYSTEMIC
-Endotoxins from dental plaque
-Osteoclast activating factor(OAF)
-Prostaglandins
-Human gingival bone resorption
factor
-Trauma due to ill fitting dentures
which leads to increased or decreased
vascularity and changes in oxygen
tension.
-Correct amount of circulating
estrogen, thyroxine, growth
hormone, calcium,
phosphorus,
-vitamin D ,
-Osteoporosis
- Hypophosphetemia
- Parathormone
- Calcitonin

22. BONE RESORPTION AND CA HOMEOSTASIS:
The only sources of Ca for the body are
•Diet
•Bone reservoir.
Ca homeostasis is maintained by controlling Ca obtained from these 2
sources. This can occur by altering internal absorption mechanisms (income) or
tubular reabsorption (recycling) or by liberation of Ca from the skeleton via
resorption (savings).
There is a reciprocal relationship between Ca concentration and bone
resorption to maintain Ca homeostasis. As the level of serum calcium develops,
resorption is stimulated and factors that would inhibit resorption are
depressed.

23. Skeletal depletion of calcium occurs as a result of stimulation of
parathyroid gland and the alveolar bone is the first to be affected. This is due
to the function of parathyroid hormone in maintaining the blood calcium
level by mobilizing it from bones by osteoclastic activity.
Simultaneously , there is an increased renal excretion of phosphate,
which disturbs the blood calcium:phosphorous ratio by raising the blood
calcium level. This results in mobilization of phosphates from bones by
osteoclastic activity.
•Under these conditions , alveolar bone becomes susceptible to diseases like
osteoporosis.

24. In equilibrium the two antagonistic actions (of osteoblasts
and osteoclasts) are in balance. In growth, although resorption is
constantly taking place in the remodeling of bones as they grow,
increased osteoblastic activity more than makes up for the bone
destruction.
Whereas in osteoporosis, osteoblasts are hypoactive, and, in
the resorption related to hyperparathyroidism, increased osteoblastic
activity is unable to keep up with the increased osteoclastic activity.
The normal equilibrium may be upset and pathologic bone loss may
occur if either bone resorption is increased or bone formation is
decreased, or if both occur.

25. Since bone metabolism is dependent on cell metabolism, anything
that influences cell metabolism of osteoblasts and osteoclasts is important.
The thyroid hormone affects the rate of metabolism of cells in
general and hence the activity of both, the osteoblasts and osteoclasts.
Parathyroid hormone influences the excretion of phosphorous in
the kidney and also directly influences osteoclasts.

26. •The degree of absorption of Ca, P and proteins determines the amount
of building blocks available for the growth and maintenance of bone.
•Vit C aids in bone matrix formation.
•Vit D acts through its influence on the rate of absorption of calcium in
the intestines and on the citric acid content of bone.
•Various members of Vit B complex are necessary for bone cell
metabolism.

27. According to Reifenstein,
In the young person, there
is a relative predominance
of anabolic hormones
(estrogen and
testosterone) over the anti
anabolic hormones(
cortisone and
hydrocortisone) resulting
in continued growth of
skeleton.
As people get older, the
anabolic hormones are so
reduced that the
antianabolic hormones are
in relative excess with the
result that bone resorption
may take place faster than
bone formation and that
bone mass may be
reduced.

28. OSTEOPOROSIS
Osteoporosis is defined by the WHO as bone mineral density (BMD)
greater than 2.5 standard deviations below that of the young adult
BMD.
Osteoporosis is common in aging individuals, especially post
menopausal women when the estrogenic blood level is low.
 In elderly men and women, osteoporosis is caused by a variety of
factors such as calcium loss, calcium deficiency, hormonal deficiency,
change in protein nutrition and decreased physical activity.

29. osteoporosis
Primary
(no known cause)
Type 1
Post
menopausal
Type 2
Age related
secondary
Traceable
etiology

30. Normal Bone Osteoporosis

31. PATHOPHYSIOLOGY
• The most popular theory of how osteoporosis occur in females is
based on the central role of oestrogen in bone remodelling.

32. Decreased oestrogen levels leads
to increased pro-inflammatory
cytokine levels like IL1 and TNF
leading to increased osteoclast
formation and hence increased
bone loss.
Oestrogen acts through two
receptors: oestrogen receptor a
(ERa) and ERb, ERa appears to be
the primary mediator of the actions
of oestrogen on the skeleton.
Another line of action is the
decreased antagonistic action of
oestrogen on parathyroid leads to
more parathormone secretion and
consequently increased bone
resorption.

33. One
•loss and/or mobility of teeth
Two
•edentulism,
Three
•excessive residual ridge resorption
Four
•dentures which require repeated revision
or remakes
PROSTHODONTIC
IMPLICATIONS

34. PATHOGENESIS OF
RRR
Immediately
following the
extraction
(order II), any
sharp edges
remaining are
rounded off by
external
osteoclastic
resorption
leaving a high
well rounded
ridge (order III).
As resorption
continues from
the labial and
lingual aspects
,the crest of the
ridge becomes
increasingly
narrow,
ultimately
becoming knife
edged (order
iv).
As the process
continues, the
knife-edge
becomes shorter
and eventually
disappears
leaving a low
well-rounded or
flat ridge (order
v). Eventually
this too resorbs,
leaving a
depressed ridge
(order VI).

35. PHYSIOLOGY V/S
PATHOLOGY???
• Some clinicians feel that RRR is not a disease but a normal
physiological process.
• However there is wide variation in the rate of RRR in different
individuals- depending on multiple factors.
• The need to elucidate these major differences warrants labeling this
process a “ disease” or “pathology”

36. • The mechanism of the reduction of the mandibular residual ridge
actually represents a modified version of the enlow’s “V”
principle, showing external resorption accompanied by endosteal
deposition.
Principles of bone remodeling. By Donald H. Enlow

37. PATHOLOGY OF RRR
Gross Microscopic

38. The careful superimposition of
portions of tracings of lateral
cephalograms clearly shows the
gross reduction of bone in size and
shape that occurs on the labial,
crestal, and lingual aspects of the
residual ridge.

39. IN DRY
SPECIMENS
*External cortical surface of
maxilla and mandible are
uniformly smooth & crestal
area of residual ridge
shows porosities and
imperfections.
*Bones with more severe
RRR display gross
porosities of medullary
bone on the crest of ridge.

40. • Panoramic radiograph showing severe RRR in both maxilla and
mandible in contrast to dentulous area that support three
mandibular teeth.

41. MICROSCOPIC
PATHOLOGY
Osteoclastic activity occurs on the
external surface of crest of ridges .
Scalloped margins of howships lacunae
sometimes contain visible osteoclasts.
Frequently the scalloped external
surface seems inactive without bone
resorbing cells.

42. MEASUREMENT OF RRR
1. Serial examination of diagnostic
casts.
2. Lateral cephalometric
radiographs
• Most accurate
• Measures RRR over a period of time.
3. Panoramic radiographs.

43. ORIGINAL BONE HEIGHT
= THREE TIMES THE
DISTANCE FROM INFERIOR
BORDER OF MANDIBLE TO
THE LOWER EDGE OF
MENTAL FORAMEN.
{Kenneth E. Wical and Charles C. Swoope. Studies of residual ridge
resorption. Uses panaromic radiographs for evaluation and
classification of mandibular resorption. JPD;1974;32;7}

44. •To date, it appears that RRR world-wide, 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.
EPIDEMIOLOGY OF
RRR

45. AMOUNT AND RATE OF BONE
RESORPTION
• According to Boucher,
During the first year after tooth extraction, the reduction in residual
ridge height in the midsagittal plane is
 2-3 mm for maxilla
4-5 mm for mandible
Annual rate of reduction in height
0.1-0.2 mm for mandible
4 times less in the maxilla

46. DIRECTION OF BONE
RESORPTION
This progressive change of the edentulous mandible and maxilla
makes many patients appear prognathic.
Maxilla resorbs
upward and inward
to become
progressively smaller
The mandible
inclines outward
and becomes
progressively
wider.

48. Thus RRR is centripetal in maxilla and centrifugal in mandible.

49. ETIOLOGY OF RRR :
According to Atwood :
RRR is a multifactorial biomechanical disease caused by a combination
of :
Some clinical factors related to rate of resorption of residual ridges JPD vol 12,issue 3,
pages 441-450

50. ANATOMIC FACTORS
• It is postulated that RRR varies with the quantity and quality of the bone of
residual ridges..
The more bone there is, the more rrr will ultimately be.
But this cannot be considered a good prognostic factor, because in
some cases large ridges resorb rapidly and some knife-edge ridges may
remain with little change for long periods of time.
RRR α Anatomic factors

51. • We should always try to evaluate the present status of the residual
ridge to determine what has gone on before.
• If a ridge has existed as high and well rounded (order iii) for several
years, it will likely to continue to do so.
• But if a ridge has gone from an order ii to order iv in just two years it
will probably continue to resorb rapidly.

52. MECHANICAL
FACTORS
• Disuse atrophy vs. Abuse resorption.
• Duration of functional forces do not exceed 15 mins. /Day
(brewer)
• 3500 – 4200 lbs loading force by 1500 empty swallows.
RRR ≈ force

53. • Projected maxillary denture bearing area – 4.2 in.2 , mandibular
denture bearing area – 2.3 in.2 ( ratio 1.8:1)
• Thus biting force of 50 lbs translates to 12lb/in2 on maxilla and
21lb/in2 on mandible
Rrr ≈ 1
Damping effect
• Damping effect or energy absorption by
• Viscoelastic mucoperiosteum
• Bone

54. RRR ≈ Anatomic factors + Bone resorption factors
Bone formation factors
+ Force factors
Damping effect factors
+ 1
Time

55. METABOLIC FACTORS
• RRR varies directly with certain systemic or localized bone
resorptive factors and inversely with certain bone formation
factors.
RRR  BONE RESORPTION FACTORS
BONE FORMATION FACTORS

56.  Excessive stress resulting from artificial environment.
 Abuse of tissues from lack of rest-
Bone is moldable. It can tolerate masticatory forces within the limits of
physiologic tolerance.
But exceeding that it causes damaging forces which will result in resorption
of the
alveolar bone.
PROSTHETIC FACTORS

57.  Long continued use of ill fitting dentures:
May be due to long use, loss of bone, Incorrect occlusion, Incorrect jaw
relation.
 Lack of freeway space due to increased vertical dimension of
occlusion:
Freeway space is present in the teeth in the physiologic rest position. It
is normally around 2mm.
At times, due to lack of freeway space the bone resorbs because of
increased vertical height in an attempt to create the space.

58.  Incorrect Centric relation record
If the Centric relation is not recorded properly, the mandibular teeth will not
occlude properly with those on the maxillary arch. This proper occlusion is
essential to the health of bony support.
Otherwise, during eccentric movement, it causes pressure on bone due to
failure of denture stability. Hence resorption of base occurs.
 Error in relating maxilla to the cranial landmarks (orientation relation):
The plane of the maxilla should be oriented to the facial reference line
(Camper’s plane or ala tragus line). If not, may cause instability of denture
leading to resorption.

59.  If occlusal corrections are not done:
• These errors which may be caused due to processing techniques if not
corrected causes premature contacts resulting in increased stress.
• Selective grinding should be done to minimize lateral stress and resulting
tissue trauma.

60. CONSEQUENCES OF RRR :
• Apparent loss of sulcus width and
depth.
• Displacement of muscle attachment close
to the ridge.
• Loss of vertical dimension of occlusion.
• Reduction of the lower face height.
• Increase in relative prognathia

61. • Changes in inter alveolar relationship.
• Morphological changes of the alveolar bone such as sharp, spiny
uneven residual ridges.
• Location of mental foramina close to the ridge crest.

62. MANAGEMENT OF RRR

63. Prosthetic
manageme
nt
Systemic
evaluatio
n.
Tissue
treatmen
t therapy
Pre
prosthe
tic
surgery
Diet

64. Pre-prosthetic surgery
It aims at providing a good healthy surface for the insertion
of the dentures.
It includes all the surgical procedures by virtue of which an
ideal smooth, healthy U shaped ridge , without any
unfavourable undercuts or bony growths and with sufficient
vestibular depth is achieved.

65. It includes the following surgical procedures:
•Ridge correction.
•Ridge extension/vestibuloplasty.
•Ridge augmentation
•Surgical correction of maxillomandibular relation.

66. Ridge Corrective surgery
Soft tissue deformities
•Labial frenectomy.
•Lingual frenectomy.
•High buccal frenal attachments.
•Hyperplasia of soft tissues.

67. Bony deformities
•Sharp irregular ridge.
•Alveoloplasty.
•Alveolectomy.
•Excision of tori and genial tubercles.

68. RIDGE EXTENSION SURGERY/VESTIBULOPLASTY:
•Labial.
•Lingual.
•High mental foramen.
•Zygomaticoplasty.
•Tuberoplasty.

69. RIDGE AUGMENTATION
It is aimed at :
•Increase in the ridge height and width providing a large denture
bearing area ,
•Protection of neuro vascular bundles
•Restoration of proper maxillomandibular arch relationship.

70. Impression techniques. Denture base selection.
Teeth selection and
arrangement
Implant supported
prosthesis.
Prosthetic
manageme
nt

71. 1) IMPRESSION TECHNIQUE
The main aim of the impression procedure is to gain maximum area of
coverage. For e.g., in mandibular ridge, obtaining a fairly long
retromylohyoid flange helps to achieve a better border seal and retention.
Selection of proper trays and the correct impression procedure is very
essential for an accurate impression.

72. Selective pressure technique
This technique is most widely advocated to manage RRR.
It makes it possible to confine the forces acting on the denture to the stress
bearing areas .
This helps in better withstanding the mechanical forces induced by
denture wearing.
Miller used mouth-temperature waxes instead of tissue conditioners.

73. Mucodynamic technique
It is intended to integrate the changes in the shape of the vestibules when
functional movements are made.
A highly viscous thermoplastic reversible impression material is placed in
the custom tray, then carefully adapted to the residual ridge and held with
light and uniform pressure while the functional movements are made.
As soon as the entire surface is smooth and the buccal and lingual borders
are molded to the outer circumference without any folds, the impression is
complete.

74. 2) Selection of denture base
For degenerative ridge patients there are three types of denture bases:
•Methyl methacrylate resin denture bases
•Cast metal bases
•Processed resilient , lined denture bases

75. 3) TEETH SELECTION AND ARRANGEMENT
Teeth can be selected acc. to their form and size.
The following requirements have to be met during teeth arrangement:
•Stability of occlusion in centric relation.
•Balanced occlusion for eccentric contacts.
•Unlocking of the cusps mesio distally to accommodate the settling of
denture bases.

76.  Control of horizontal force by buccolingual cusp height reduction acc. to
residual ridge shape and inter arch space.
 Functional balance by favorable tooth to ridge crest position.
 Cutting and shearing efficiency.
 Anterior clearance of teeth during mastication.
 Minimal occlusal stop areas for reduced pressure during function.
 Teeth should be placed in neutral zone to create co ordination between
the primary and secondary masticatory organs.

77. Relative to each other, the maxillary and mandibular residual
ridges are known to be in a favorable position for normal arrangement of
posterior teeth if the connecting line between the midridge line of the max.
and mand. residual ridges are at an angle of more than 80 degrees.
An angle less than 80 degrees necessitates a cross bite or reverse
occlusion arrangement of posterior teeth.
A prognathic mandible necessitates the arrangement of anterior
teeth in a reverse occlusion.

79. •Non anatomic teeth have known to cause fewer denture sore spots
and lesser ridge resorption.
•Anatomic posterior teeth cause more denture soreness and ridge
resorption
•Few studies state that anatomic posterior occlusion favors lower
dentures and non anatomic posterior teeth favor upper denture.

80. 4) IMPLANT SUPPORTED PROSTHESIS
The various problems associated with RRR and stability of removable
soft tissue borne dentures have aroused interest in dental implantology to
provide stable mechanical support to the dental prosthesis.
This is because of the following advantages offered by implant supported
prosthesis:
 Maintenance of alveolar bone.
 Maintenance of occlusal vertical dimension.
 Height of alveolar bone is found to be maintained as long as the implant
remains healthy.

81.  Regained proprioception.
 Increased stability, retention and phonetics.
 Maintenance of structure and function of muscles of mastication and
facial expression.
 Immune to caries.
 Increased trabeculation and density of bone.

82. •Overall volume of bone is maintained.
•Efficiency to take up stress and strain.
•There is 20 fold decrease in the loss of structure with implants when
compared with resorption that occurs with removable prosthesis.
•Preventive implant is given following extraction to retard ridge
resorption.

83. IMMEDIATE DENTURES:
Some authors claim that extraction followed by immediate dentures
reduces the ridge resorption.

84. OVERDENTURES
 Tooth supported over dentures help in
improved
stress distribution there by maintaining the
integrity of residual ridge.
 The occlusal and parafunctional stresses are
distributed through the abutment teeth.
A study was conducted with overdentures supported by canines and it was seen
that, the bone loss was 0.6mm where as 5mm in conventional complete dentures.

85. THE ADVANTAGES OF THE OVERDENTURE
OVER THE CONVENTIONAL DENTURE ARE:
1. The denture bearing mucosa of the residual ridges are spared abuse.
2. Maintenance of the alveolar bone.
3. Sensory feedback.
4. Tactile sensitivity discrimination.
5. Masticatory performance.
6. Reduction of psychological trauma.

86. JOURNAL REVIEW

87. • MARKOVIC D ET AL., “ CURRENT KNOWLEDGE
ON RESORPTION OF THE EDENTULOUS
ALVEOLAR RIDGE”
(1967)
He proved that there is direct relation between the pressure
under the mobile denture and the residual ridge resorption level
on the other side. It seems that the frontal areas of the edentulous
are more susceptible to resorption. Orthopantomography is the
most acceptable method in level measuring of the RRR.

88. • MORRIS ET AL HAVE CONDUCTED STUDIES ON THE
RESIDUAL RIDGE RESORPTION IN FIVE YEARS AFTER
IMPLANT PLACEMENT
The rate of resorption decreases significantly from that seen in
conventional mandibular dentures
• -XIE Q, ET AL., “ORAL STATUS & PROSTHETIC FACTORS
RELATED TO RESIDUAL RIDGE RESORPTION IN ELDERLY
SUBJECTS” -1997
He concluded that the local factors related to RRR more
often in the maxilla than in the mandible,thus suggesting that
severe resorption in the mandible is influenced more by systemic
factors

89. • WYATT CC “THE EFFECT OF PROSTHODONTIC TREATMENT ON
ALVEOLAR BONE LOSS”
Concluded that an implant-supported fixed Prosthesis to restore missing
teeth in partially or completely edentulous jaws seems to be the best
means
of preserving residual alveolar bone.
• KLEMETTI E ET AL., “ FLUORIDATED DRINKING
WATER,OESTROGEN THERAPY AND RESIDUAL RIDGE
RESORPTION.”
J ORAL REHABIL 1997 JAN:24(1):47-51
Artificially fluoridated water may also reduce the degree of residual
ridge
resorption

90. • AINAMO A ET AL., “ ASSOCIATION OF RESIDUAL RIDGE
RESORPTION WITH SYSTEMIC FACTORS IN HOME-LIVING
ELDERLY SUBJECTS” -1997
Concluded that asthma due to corticosteroid treatment is to be
considered a risk indicator for severe resorption of the edentulous
mandible, alcohol intake in the elderly may be related to a lesser
degree of resorption of the edentulous maxilla.

91. PROSTHODONTIC MANAGEMENT OF A SIEBERT
CLASS III DEFECT IN MANDIBULAR ANTERIOR
REGION WITH A MODIFIED ANDREW’S BRIDGE .
MANJUSHA PALEPU, DEVIPRASAD NOOJI, PRANAV MODY, SUHAS

94. SUMMARY AND CONCLUSION
• The ultimate aim of a successful prosthesis is stability in function and
excellent esthetics.
• The expectations of edentulous patients are highly variable therefore the
outcome of patient treatment varies significantly.
• Patients should be educated regarding the type and extent of treatment
that is ideal for them, the prognosis of the treatment outcomes with
various types of removable or fixed prostheses and the alternatives that
are available.

95. •Ortman HR: Factors of bone resorption of the residual ridge. J Prosthet
Dent 1962;12,3:429-440.
•Wendt DC: The degenerative denture ridge – Care and treatment. J
Prosthet Dent 1974;32,5:477-492.
REFERENCES

96. •Winkler S : Essentials of complete denture prosthodontics. 2nd
edition,2000.
•Boucher CO : Prosthodontic treatment for edentulous patients. 12th
edition,2004.
•Misch CE : Contemporary implant dentistry. 2nd edition,1999.

97. THANK YOU