Preprosthetic management of severe alveolar ridge atrophy

The preprosthetic management of individuals with denture instability caused by severe alveolar ridge atrophy is discussed with respect to augmentation by bone grafting or implantation of denture retention devices. Specific indications were made for the use of each surgical procedure and the clinical effectiveness of each was illustrated with a case presentation. In the maxilla and mandible, there is a range of functional alveolar ridge heights that results in unsatisfactory denture retention. If the alveolar morphology lends itself to a soft tissue procedure, a vestibuloplasty will often provide satisfactory improvement in stability. However, if the alveolar height is severely diminished, denture retention can be satisfactorily enhanced only by ridge augmentation procedures such as bone grafting or the placement of metal implants. Implantation of denture retention devices can improve denture stability on certain severely atrophic mandibular alveolar ridges. The staple is a precision appliance that must be placed during a surgical procedure under general anesthesia, requires close attention by patient and prosthodontist following placement, and is expensive. The ramus frame is a less expensive alternative that can be placed on an extremely atrophic mandible under local anesthesia with conscious sedation. The morbidity associated with harvesting autogenous iliac crest or rib for bone grafting, though it requires a general anesthetic, is relatively minimal in the healthy patient. Vigilant postoperative care and aggressive physical therapy lead to rapid rehabilitation of the individuals who must recover from the additional surgery.