Surgical management of the atrophic edentulous ridge--a prosthetic view

The vast majority of edentulous patients manage to wear complete dentures with relative ease. There are however a small group of patients described as "Denture Cripples" by Hopkins, Stafford and Gregory (1980), for whom the provision of complete dentures using conventional means has proved impossible. Clinical examination usually reveals marked atrophy of the alveolar ridge, the prominence of sharp bony ridges and an atrophic denture bearing mucosa. The patient complains of loose, painful dentures and an inability to masticate a normal diet. The patients can often be helped by correcting errors on their presenting dentures or by minor surgical procedures such as frenectomy or smoothing sharp bony ridges. Other patients present with such extreme ridge atrophy that major surgery may need to be considered. This paper reviews three types of surgery commonly used to help the prosthetist rehabilitate the patient, namely vestibuloplasties, ridge augmentations and implants.