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SHORT COMMUNICATION Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 1  |  Page : 129-131
Improving prosthetic prognosis by connective tissue ridge augmentation of alveolar ridge


1 Department of Prosthodontics, C.S.M. Medical University, Lucknow, U.P, India
2 Department of Periodontics, C.S.M. Medical University, Lucknow, U.P, India

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Date of Submission28-Mar-2009
Date of Decision10-Jun-2009
Date of Acceptance20-Oct-2009
Date of Web Publication27-Apr-2010
 

   Abstract 

The contour of edentulous ridge should be carefully evaluated before a fixed partial denture is undertaken. The ideal ridge height and width allows placement of a natural looking pontic which facilitates maintenance of plaque-free environment. The localized alveolar ridge defect refers to the volumetric deficit of the limited extent of bone and soft tissue within the alveolar process. Such type of ridge defects can be corrected by surgical ridge augmentation that can be accomplished by the addition of either soft or hard tissues. This article describes a procedure of surgical connective tissue augmentation of a localized deficient alveolar ridge in the maxilla, followed by fixed partial denture, enhancing the esthetics, function and health.

Keywords: Loss of ridge width and height, open gingival surfaces, connective tissue ridge augmentation

How to cite this article:
Mishra N, Singh BP, Rao J, Rastogi P. Improving prosthetic prognosis by connective tissue ridge augmentation of alveolar ridge. Indian J Dent Res 2010;21:129-31

How to cite this URL:
Mishra N, Singh BP, Rao J, Rastogi P. Improving prosthetic prognosis by connective tissue ridge augmentation of alveolar ridge. Indian J Dent Res [serial online] 2010 [cited 2014 Nov 1];21:129-31. Available from: http://www.ijdr.in/text.asp?2010/21/1/129/62799
The structural loss of the residual alveolar ridge can occur as a result of congenital defects, periodontal disease, tooth extraction or surgical procedures. During healing, the overlying soft tissue collapses into the bone defects, creating contours that make it difficult or impossible to make esthetic functional prostheses. [1]

The height and width of residual ridge allow placement of pontic that appears to emerge from the ridge and mimics the appearance of the neighboring teeth. Such residual ridge contour may lead to unesthetic open gingival surfaces ("black triangle"), food impaction and percolation of saliva during speech. [2]

Siebert [3] has classified residual ridge deformities into three categories:

Class 1 defect: Faciolingual loss of tissue width with normal ridge height

Class 2 defect: Loss of ridge height with normal ridge width

Class 3 defect: A combination of loss in both dimensions

There are high incidences of residual ridge deformity following anterior tooth loss; a majority of these are class 3 defects. [4] This clinical report describes, the soft-tissue ridge augmentation to correct alveolar ridge defect combined with fixed prosthodontics to achieve maximum esthetics and health.


   Case Report Top


A 32-year-old male patient visited the Department of Prosthodontics for replacement of the right central incisor [Figure 1]. The dental history revealed that his left maxillary central incisor was extracted following a road traffic accident one year back. A thorough clinical and radiographic examination revealed a Siebert's class 3 ridge defect in the edentulous region. In the presented case, the loss of faciopalatal ridge width was more pronounced with little loss of ridge height.

The patient was planned for connective tissue autogenous graft ridge augmentation for the correction of ridge defect followed by porcelain-fused-metal (PFM)-fixed partial denture to accomplish maximum esthetics and health.

The maxillary right central incisor and left lateral incisor were prepared for PFM-fixed partial denture. A provisional acrylic resin bridge was fabricated and placed over the abutment teeth. The provisional pontic contour will help identify patients who would benefit from surgery and simultaneously the size of the defect being repaired. The provisional pontic contour could not provide optimal esthetic as the loss of residual ridge contour led to unesthetic open gingival surfaces.

Surgical augmentation of the residual ridge was performed with subepithelial connective tissue graft to improve the ridge deformity. The roll technique was adopted for ridge augmentation that uses soft tissue from the palatal surface of the edentulous area. Epithelium of the donor site was removed. Incisions were made to allow the reflection of flap [Figure 2] and [Figure 3]. The flap was rolled back and placed into the defect under the base of the flap on the facial side of the ridge until the defect was filled [Figure 4]. The flap was sutured, stabilizing the donor material in position, and thereby enhancing the dimensions of the ridge defect [Figure 5]. The provisional bridge was cemented after surgery. Home care instructions were reviewed and patient was recalled after two months for the fabrication of permanent prosthesis. On recall appointment, examination of surgical site revealed that, the contour of the ridge was acceptable to place permanent prosthesis. Three-unit PFM-fixed partial denture was fabricated using the right central incisor and left lateral incisor as abutment to replace left central incisor with natural-looking esthetic pontic [Figure 6]. The fit of the restoration was confirmed and occlusal adjustments were performed prior to cementation. The prosthesis was cemented using resin cement.

Home care instructions were reviewed again and patient was scheduled for recall appointments after two weeks, three months and six months. There was no relapse of the augmented area and esthetics, function and health were satisfactory on recall appointments.


   Discussion Top


There are various other prosthetic and surgical options for improving esthetics in the patient with ridge deformities. Long pontic design or gingival (pink) ceramic in the cervical region can enhance esthetic in such cases. Surgical procedures using soft-tissue autogenous graft, various alloplastic materials, autogenous bone graft and guided tissue regeneration can correct such type of ridge defects.

In the presented case, the loss of ridge width was more evident with a little loss of ridge height; hence, an auto genous connective tissue graft was used to augment the ridge defect. Examination of the patient on 6-month recall appointment showed the clinical success of the procedure performed, restoring esthetic, function and health of the patient.

The type and amount of destruction of the alveolar ridge play a role in selecting the pontic to be used and also indicate the necessity for reshaping the ridge surgically. Such alveolar ridge deformities can be corrected by integrating connective tissue ridge augmentation with fixed prosthodontics, achieving maximum esthetics and health outcome.

 
   References Top

1.Shillingburg HT, Hobo S, Whitsett LD. Fundamentals of Fixed Prosthodontics. 3 rd ed; 1997. p. 491-6.   Back to cited text no. 1      
2.Rosenstiel SF, Land MF, Fujimoto J. Contemporary Fixed Prosthodontics. 3 rd ed; 2001. P. 513-5.  Back to cited text no. 2      
3.Seibert JS. Reconstruction of deformed, partially edentulous ridges, using full thickness onlay grafts. Part I. Technique and wound healing. Compend Contin Educ Dent 1983;4:437-53.  Back to cited text no. 3      
4.Abrams H, Kopczyk RA, Kaplan AL. Incidence of anterior ridge deformities in partially edentulous patients. J Prosthet Dent 1987;57:191.  Back to cited text no. 4      

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Correspondence Address:
Niraj Mishra
Department of Prosthodontics, C.S.M. Medical University, Lucknow, U.P
India
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DOI: 10.4103/0970-9290.62799

PMID: 20427923

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

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