Maxillary Complete Denture with a Flabby Anterior Ridge and Severe Resorption
A 72-year-old woman presents for a new maxillary complete denture. She has worn her current denture for 14 years. Examination shows a severely resorbed anterior maxilla with a mobile, fibrous (flabby) ridge in the premaxilla, a prominent labial frenum, and a shallow vault. The mandibular arch has a stable, well-maintained complete denture that she is happy with. She reports that her current denture 'floats' when she speaks and that food collects under the anterior border. She is medically stable, takes a calcium channel blocker, and has no history of radiation. She is edentulous and does not want implants.
1. Describe how you would manage the flabby anterior ridge in the impression sequence and the definitive prosthesis design, and explain the reasoning.
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The flabby ridge is displaceable soft tissue over resorbed bone; if it is compressed during impressioning, the denture will be built on a distorted cast and will rebound, causing instability and soreness.
Management:
- Selective pressure / mucostatic impression of the flabby area - use a window or a low-viscosity material over the mobile tissue so it is recorded in its undisplaced state, while the firm posterior ridge is recorded with functional border molding. A two-stage technique (custom tray with relief over the flabby area, then a wash) is standard.
- Border molding - functional molding of the labial frenum and anterior border to eliminate the food trap and the 'floating' complaint.
- Design - extend the denture base to cover the flabby area fully (do not leave it uncovered), keep the polished surface convex and well-contoured, and ensure the posterior palatal seal is adequate. Consider a metal or reinforced base if fracture risk is high.
- Occlusion - balanced occlusion to distribute load and reduce tipping.
If the flabby tissue is very large and mobile, surgical reduction may be considered, but in a 72-year-old with a stable mandibular denture and no implants, a well-made conventional denture with a selective-pressure impression is the conservative first choice.
2. The patient's calcium channel blocker is relevant. How does this change your assessment and what would you check before finalizing the plan?
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Calcium channel blockers (e.g., amlodipine, nifedipine) are associated with gingival overgrowth, but in an edentulous patient the relevance is different: they can contribute to mucosal changes and, more importantly, they are a marker of hypertension and possible cardiovascular disease.
Before finalizing:
- Confirm the drug and indication with the patient and, if needed, her physician - is blood pressure controlled? Is there any bleeding risk or need for antibiotic prophylaxis (generally not required for routine denture work)?
- Check for drug-induced xerostomia - many antihypertensives cause dry mouth, which affects denture retention, comfort, and caries/soft-tissue health. Ask about dryness and consider saliva substitutes or a humidifying regimen.
- Soft-tissue examination - look for medication-related mucosal changes, candidiasis, or hyperplasia under the existing denture.
The drug itself does not contraindicate a complete denture; it prompts a medical review and a dry-mouth management plan, which directly affects the prognosis of the new prosthesis.