GOOD MORNING

METHODS TO IMPROVE THE COMPLETE DENTURE FOUNDATION

ANISH AMIN

CONTENTS

CLASSIFICATION OF ALVEOLAR RIDGES

REFERENCES

INTRODUCTION

TYPES OF PREPROSTHETIC PROCEDURES

NONSURGICAL

SURGICAL

CONCLUSION

IDEAL REQUISITES OF DENTURE FOUNDATION

CHANGES DUE TO EDENTULISM

PROSTHODONTIC MANAGEMENT

INTRODUCTION

• In formulating a treatment plan for the edentulous patient, early decisions must be made regarding essential oral tissue rehabilitation

• It is essential that mouth is in an optimal state of health prior to commencing prosthetic treatment and failure to achieve this may produce an unsatisfactory treatment result which is therapeutically unacceptable and ethically questionable

• The goal of pre prosthetic mouth preparation is to modify the oral environmemt to render it free of disease and to restore its form and function near to normal which makes it compatible with the denture wearing

FEW BASIC TERMS... (GPT -8)

• RETENTION: that quality inherent in the dental prosthesis acting to resist the forces of dislodgment along the path of placement

• STABILITY: Resistance to horizontal displacement of a prosthesis

• SUPPORT: The foundation area on which a dental prosthesis rests. With respect to dental prostheses, the resistance to displacement away from the basal tissue or underlying structures

CHANGES DUE TO EDENTULISM

• The maxillomandibular relationship is altered in all spatial dimensions• Decrease in the Vertical dimension,and shortening of lower facial height• Loss of tone in the muscles• Progressive instability of the conventional soft tissues

CLASSIFICATION OF ALVEOLAR RIDGESAs given by ATWOOD (1963) CAWOOD &

HOWELL(1988)

• Class I –Pre extraction

• Class II - post extraction.

• Class III - rounded ridge, adequate height and

width

• Class IV - knife edge ridge, adequate height,

inadequate width.

• Class V - flat ridge, inadequate height and width.

• Class VI - depressed ridge with varying degrees of

basal bone loss, that may be extensive but follows

no predictable pattern.

CLASS A:Most of the alveolar bone is present

CLASS B:Moderate residual ridge resorption occurs

CLASS C:Advanced residual ridge resorption occurs

CLASS D:Moderate resorption of the residual bone

CLASS E:Extreme resorption of the basal bone

As given by BRANEMARK

ZELSTER’S CLASSIFICATIONGroup 1 : High muscle attachment &

minimal RRR

Group 2 : Severe residual ridge resorption with pain

Group 3 : Absence of residual ridge.

Group 4 : Severe resorption of basal bone

A) Anatomic factors:• Rate of vertical bone loss in a broad high

ridge is slower than that of a small ridge• Denser the bone, slower will be the rate of

resorption

C) Mechanical factors1)Functional factors:• Frequency, direction and strength of forces acting

on bone• Bruxism2)Prosthetic factors:• Type and fit of prosthesis• Occlusal disharmony

B)Metabolic factors :•Bone metabolism•Hormonal imbalance•Osteoporosis

•Many local and systemic factors are related with residual ridge resorption.

IDEAL REQUISITES OF A COMPLETE DENTURE FOUNDATION

• To provide a comfortable tissue foundation to support the denture

• To render proper jaw relationship in the antero-posterior, transverse and vertical dimensions

• Alveolar processes that are as large as possible and of the proper configuration

• No bony or soft tissue protuberances or undercuts

• Adequate attached keratinized mucosa in the primary denture-bearing area

• Adequate vestibular depth

• Adequate form and tissue coverage for possible implant placement

TYPES OF PREPROSTHETIC PROCEDURES

NON SURGICAL SURGICAL

Good nutrition

Conditioning of patients musculature

Occlusal correction of the old prosthesis

Rest for the denture supporting tissues

REST FOR THE DENTURE SUPPORTING TISSUES

• Removal of the dentures from the mouth for a

extended period of time

• Use of temporary soft liners inside the old dentures.

• Regular finger or toothbrush massage of the denture

bearing mucosa over the enlarged and edematous

regions is beneficial

• All of these procedures allow the deformed tissues

of the residual ridge to return to normal form

TISSUE ABUSE CAUSED DUE TO IMPROPER OCCLUSION CAN BE CORRECTED …..

• Correcting the occlusion of old prosthesis

• Use of tissue conditioning materials can provide

an interim cushioning stage and allow the tissues

to return to their unstressed shape

• Substituting properly made dentures.

Occlusal correction of old prostheses:• An attempt should first be made to restore an optimum vertical dimension of

occlusion to the dentures presently worn by the patient by using an interim

resilient lining material.

• Tissue treatment material permits movements of denture base to adjust according to

existing occlusion by allowing displaced tissues to recover their original form.

• Consequently, ridge relations are improved and also facilitates the occlusal

adjustments intraorally and extraorally, i.e., on an articulator.

Conditioning the patient's musculature

• The use of jaw exercises can permit relaxation of the muscles of mastication.

and strengthen their coordination as well as help prepare the patient

psychologically for the prosthetic service.

GOOD NUTRITION

• A good nutritional program must be emphasized

for each edentulous patient.

• This program is especially important for the

geriatric patient whose metabolic and masticatory

efficiency have decreased.

SURGICAL PROCEDURES

DEFINITION: GPT-8

“Surgical procedures designed to facilitate fabrication of prosthesis or to improve the prognosis of

prosthodontic care.”

EVALUATION OF HARD TISSUES PRIOR TO SURGICAL PROCEDURE

MAXILLA

• Bony ridge with no bony undercuts/gross bony

protuberances

• Palatal tori should be noted

• Adequate posterior tuberosity notching is must

for posterior denture stability and peripheral

seal

• Evaluate the Contour of palate

MANDIBLE

• Check for gross ridge irregularities, tori and

buccal exostosis

• Depression should be palpated between external

oblique line and mylohyoid ridge areas

• Location of mental foramen and mental

neurovascular bundle should be palpated. Note

any neurosensory distubances .

EVALUATION OF SOFT TISSUES• Palpate to disclose hypermobile fibrous tissue which are inadequate for stable denture base

• Vestibular areas should be :

Free of inflammatory changes / scarred / ulcerated areas – denture pressure

Tissue at depth should be supple without irregularities

Soft tissue attachments like frenum should not be tense

• Check for the keratinized and non keratinized tissue quality

• Lingual area should be evaluated

For the level of attachment of mylohyoid muscle to crest of mandibular ridge

And attachment of genioglossus

CLASSIFICATION OF SURGICAL PREPROSTHETIC PROCEDURES

A. Removal of Teeth : Erupted / Unerupted / Partially

erupted/ Root stumps / Cysts

C. INITIAL HARD TISSUE PROCEDURES

• Correction of prominent mylohyoid ridge,

ridge undercuts, sharp spiny spicules

• Removal of tori and exostoses

• Reduction of prominent genial tubercles

• Relieving mental foramen

B. INITIAL SOFT TISSUE PROCEDURES:

• Correction of hyperplastic ridge

tissue,epulis fissuratum,papilomatosis

• Management of frenular attachments

• Correction of pendulous maxillary

tuberosities

D) SECONDARY HARD TISSUE PROCEDURES

•Ridge augmentation procedures

•Ridge relation proceduresE) SECONDARY SOFT TISSUE PROCEDURES

Ridge extension/ vestibuloplasty

F)IMPLANT PROCEDURES

REMOVAL OF RETAINED TEETH

FACTORS TO BE CONSIDERED:•AGE

•GENERAL HEALTH

•STATUS OF THE TEETH TO BE

REMOVED

•All broken down root stumps have to be extracted before the

prosthetic rehabilitation

•If any root tip is situated deep within the trabecular bone and if

it requires removal of a considerable amount of bone itslef,

then it should be left undisturbed but should be frequently

monitored

•Unerupted tooth or retained roots should be removed

prophylactically so that there is no chance of any pathology

developing in the future.

INITIAL SOFT TISSUE CORRECTIONS

HYPERPLASTIC RIDGE, EPULIS FISSURATUM, PAPILLOMATOSIS

• These tissues are not conducive to firm, healthy

foundations for complete dentures

• They should be rested, massaged, treated with

an antifungal agent before their surgical

excision

• In case patient doesn’t agree for surgery

impression technique and design can be

modified accordingly to accommodate these

tissues, with minimal distortion

HYPERPLASTIC RIDGE TISSUE

PAPILLOMATOSIS

EPULIS

FRENULAR ATTACHMENTS

• As a result of resorption, maxillary and mandibular labial and buccal

frenae can become attached too near to the crest of the ridge

• This makes it unfavourable to obtain an ideal extension and border of

the flange of the denture

• The notch of the denture is usually deepened and made round and

smooth to relieve the patient of acute discomfort but this may result in

loss of border seal when the frenum is broad or too near to the crest of

ridge

• If excessive relief is given it will weaken the denture base and makes

it more prone to midline fracture

• Therefore this frenae are surgically removed,before prosthodontic

treatment thereby exposing the amount of desired ridge height

PENDULOUS MAXILLARY TUBEROSITIES

• Unilateral / bilateral• May interfere with denture construction by

excessive encroachment or obliteration of the interarch space

• Surgical excision of this excess tissue is advised

• At times if tuberosities are enlarged laterally it might be due to bony enlargement.Such bone is surgically excised

Removal of prominent mylohyoid ridge, ridge undercuts, sharp spiny resIDual ridges ,

REMOVAL OF TORI AND EXOSTOSES

• Affects denture stability• If palatal torus is too large hampers posterior palatal seal

• Buccal side of maxillary posterior region

• Surgical excision

Palatal Torus Mandibular tori Exostoses

GENIAL TUBERCLE REDUCTION

• Sometimes, the genial tubercles are extremely prominent as a result of advanced ridge resorption in the

anterior part of the body of the mandible.

• If the activity of the genioglossus muscle has a tendency to displace the lower denture or if the tubercle

cannot tolerate the pressure or contact of the denture flange in this area, the genial tubercle is removed

and the genioglossus muscle detached.

• If it is clinically necessary to deepen the alveololingual sulcus in this area, the genioglossus muscle is

sutured to the geniohyoid muscle below it.

MENTAL FORAMEN RELIEF

• Bony margins of mental foramen are usually more dense and resistant to the resorption

• Therefore when there is resorption of the ridge,it causes the margins of the foramen to extend and have very sharp edges 2 to 3 mm higher than the surrounding bone

• Also the pressure from the denture against the mental nerve will cause pain

• Hence as a part of preprosthetic procedure it is necessary to smoothen the bony margin of foramen and increase the foramen diameter on its lower border, thereby relieving the nerve from excess pressure

ADVANCED PROCEDURES

•RIDGE AUGMENTATION PROCEDURES•RIDGE RELATION PROCEDURES•RIDGE EXTENSION/VESTIBULOPLASTY PROCEDURES

INDICATIONS FOR RIDGE AUGMENTATIONProgressive loss of denture stability and retention.

Loss of alveolar ridge height, width and decreased vestibular depth and denture bearing area.

Considerable basal bone resorption in the mandible, resulting in neurosensory disturbances.

Increased susceptibility to fracture of the atrophic jaws.

Replacement of necessary supportive bone.

Altered interarch relationship

MAXILLARY RIDGE AUGMENTATION

• ONLAY BONE GRAFTING

•ALLOPLASTIC BONE GRAFTING

•SINUS LIFT PROCEDURE

MANDIBULAR AUGMENTATION PROCEDURE

ONLAY GRAFTING

VISOR OSTEOTOMY

SUPERIOR BORDER GRAFT

INFERIOR BORDER GRAFTONLAY GRAFTING

INTERPOSITIONAL GRAFT

RESORPTION PATTERN AND SELECTION OF GRAFT MATERIAL

RIDGE RELATION PROCEDURES

• It pertains to the correction of discrepancies in arch size and

arch relationship to each other in space

• The prognathic patient frequently places considerable stress

and unfavorable leverages on the maxillary basal seat. This

may cause excessive resorption of the maxillary residual

ridge.

• It is better, when such malrelated jaws are evaluated and

surgically corrected before extracting any teeth

• Various surgical procedures like Le Fort I osteotomy,

sagittal osteotomy, subcondylar osteotomy etc can be

employed to correct the ridge relation

RIDGE EXTENSION PROCEDURES

VESTIBULOPLASTY

• Detaching the origin of muscles on either the labial or lingual or both, sides of the edentulous residual ridges , thereby increasing the vertical extension of denture flanges

Indications • In inadequate vestibular depth .• To increase the retention & stability of the denture.

Contraindications• In extreme alveolar bone atrophy .

The different vestibuloplasty techniques are• KAZANJHIAN• MODIFIED KAZANJHIAN• CLARK’S TECHNIQUE• OBWEGESER TECHNIQUE etc…

1

2

3

IMPLANTS

• This concept is used in cases with overdenture prosthesis• Implants can serve as substitutes for tooth or tooth roots and help provide support and retention for

overlying prosthesis• Implant overdenture treatment provides many benefits of conventional tooth borne over dentures while

negating some of the most troubling problems like decay or periodontal diseases

• Implant supported overdentures preserves the alveolar bone

• CRUM & ROONEY have found that reduction in the height of anterior part of the

mandible in those patients wearing complete upper and lower dentures amounted to 5.2mm

as compared with 0.6mm for the overdentures

• The anterior mandible bone under an implant overdenture may be resorbed as little as

0.5mm over a 5year period

• And long term resorption may remain at 0.1 mm annually

Journal of Contemporary Dentistry,January-April 2013;3(1)52:56

THE MCGILL CONSENSUS STATEMENT ON OVERDENTURES 

• On May 24-25, 2002, a Symposium was held at McGill University in

Montreal, Quebec, Canada during which fifteen scientists and expert

clinicians discussed the efficacy of overdentures for the treatment of

edentulous patients.

• Mandibular 2-implant overdentures have been shown to be significantly

superior to conventional dentures because they are more stable, ability to

chew various foods is better thereby improving the nutritional status

• In addition, they are more comfortable and easy while speaking

• Moreover, there is now evidence that oral implants may be placed in a single-

stage procedure, which reduces cost

• Overall it was concluded that Quality of life is significantly higher for patients

who receive 2-implant overdentures The Gerodontology Association 2002,Vol 19.No 1

PROSTHODONTIC MANAGEMENT

1)OCCLUSAL CONSIDERATIONSBalanced occlusionLingualized occlusionMonoplane occlusion2)NEUTRAL ZONE CONCEPT3)Use of magnets4)Use of suction cups5)MODIFYING IMPRESSION TECHNIQUES6)MODIFYING DENTURE FABRICAITON

BALANCED OCCLUSION

• It’s the bilateral, simultaneous, anterior and posterior occlusal contact of teeth in centric and eccentric position.

Indirect evidence that balanced occlusion may:• reduce ridge resorption (Maeda & Wood ,

1989)• allow for increased functional forces in

excursions (Miralles et al, 1989)

LINGUALIZED OCCLUSION

• Here the maxillary lingual cusps are the main functional occlusal elements• Mandibular teeth will have a cuspal inclination

of 00 or shallow 100

• Here the vertical forces are centralized on the mandibular teeth• Can be used in cases where complete denture

opposes a removable partial denture and there is severe ridge resorption

MONOPLANE OCCLUSION

• Cuspless teeth set on a flat plane with 1.5- 2 mm

overjet

• No cusp to fossa relationship

• No anterior contacts present in centric position

• No overbite

• It is advised in case of minimal ridges because it

reduces the horizontal forces

NEUTRAL ZONE CONCEPT

• The Neutral zone philosophy is based on the concept that

for each individual patient there exists a specific area with in

the denture where the function of the musculature will not

unseat the denture, and at the same time where the forces

generated by the tongue are neutralized by the forces

generated by the lips and cheeks.

• In this techinque teeth are arranged on the centre of the

ridges

• The neutral zone approach with low fusing compound is a

more practical and economically feasible treatment in the

general dental practice for patients with atrophic mandibular

ridge. Indian Journal of Dental Sciences.September 2012 Issue:3, Vol.:4

MULTIPLE CUP CHAMBER

• For patients with flat ridges, denture stability can be a challenge.

• Suction Cup Dentures utilizes a series of tiny suction cups made

from a soft silicone rubber that gently adhere to the oral tissue with

reportedly no irritation.

• They can be used for maxillary and mandibular replacements and

any existing denture can be easily converted into a SuctionCup

Denture.

Journal of Dental Sciences & Oral Rehabilitation 2013; April - June

MAGNETS• They are surgically embedded onto the edentulous ridge

• Following conventional denture construction, paired cobalt/samarium

magnets in a special configuration are cured into the denture base so

that with the denture inserted, the magnets grip the root elements with

a retentive force of approximately 300 g per root.

• The paired magnet arrangement eliminates any external magnetic field

and doubles the available retention.

• It offers simplicity, low cost, self-adjustment, inherent stress-

breaking, automatic repositioning after denture displacement,

comparative freedom of lateral denture movement, reduces trauma to

retained roots and eliminates the need for adjustment in service.J Interdiscip Dentistry [serial online] 2013 [cited 2014 Aug 5];3:43-6.

MODIFIED IMPRESSION TECHNIQUES

• For flabby tissuesWilliam H FillerModified fluid wax impressionSplint method by Allan MackHobkirk techniqueZafrulla Khan techniqueJone D Walter technique

• For severely resorbed ridgeFlange technique by Lott & LevineAthur S FreeseWinkler techniqueModified Fournet Tuller technique

The objective of these techniques is to maximize the supportive aspect of the available denture foundation by two approaches that is functional and anatomic

World Journal of Dentistry,January-March 2013;4(1) 67-71

MODIFIED FLUID WAX IMPRESSION TECHNIQUE

• Preliminary impression is made with an irreversible hydrocolloid impression material

• Border mould the tray with modelling plastic impression compound in segments

• Trim the tray over the crest of the ridge and create a window opening above the displaceable mandibular

ridge

World Journal of Dentistry,January-March 2013;4(1) 67-71

• Melt the impression wax in a water bath and apply onto the borders of the tray

• Apply adhesive on the tray surrounding the window opening

• Place the impression tray over the ridge and inject vinyl polysiloxane impression material over the

window opening

• This technique captures the primary and secondary load bearing areas without distortion

World Journal of Dentistry,January-March 2013;4(1) 67-71

Filler technique

•  Two trays are made

• First trays are then keyed to orientate the second tray in atleast three places. These keyed positions

correspond with an extension of the second tray and will insure proper seating of the second tray over the first

tray.

• Both the trays were painted with adhesive.

• Light body material was used in initial tray as a corrective wash impression material.

World Journal of Dentistry,January-March 2013;4(1) 67-71

• After it set the tray was removed from the mouth and all excess material was trimmed from the borders and

from the area where the second tray would come into contact with the first tray to key themselves.

• The second impression was made with plastogum used in corrective wash impression and plastogum was

painted over the entire vault and all available tissue surface not included in the first impression.

• The two trays were held lightly together until the impression material set and then the impression was

removed as a unit and the two trays were sealed together with sticky wax.

World Journal of Dentistry,January-March 2013;4(1) 67-71

FLANGE TECHNIQUE• Flange technique by Lott and Levin introduced in 1966 involves

making impressions of soft tissues of mouth adjacent to the buccal,

lingual, labial, palatal surface and incorporating the resulting

extensions or flange in the denture.

• Flange wax was rolled from the retromolar pad area to the

sublingual region, large enough to restore the diameter of estimated

resorption and patient is asked to forcefully perform functions of

swallowing etc to give border extensions which covers maximum

surface area (genial tubercles and sublingual gland).

• This modification increases the area of intimate contact of the

denture with the oral structures thus improving stability, function,

comfort and appearance of complete dentures over other techniquesWorld Journal of Dentistry,January-March 2013;4(1) 67-71

MODIFYING DENTURE FABRICATION

• Flange method

• Lost salt technique

FLANGE MEthOD• Used in cases with severe labial undercuts and surgery is

contraindicated or if the patient is not willing for surgical

correction

• Technique:After the impression techniques, baseplate was fabricated with the

autopolymerizing resin

For the maxillary rim the labial flange was trimmed and wax rims

were made

After recording jaw relations, and Try in procedures.. While

sealing the wax up, tin foil was incorporated in the area which had

to be left open in the final denture. The foil was folded and was

closely adapted to the cast.

IJDA, 2(2), April-June, 2010

• The denture was then invested and processed in

conventional manner. After deflasking the denture,

the tin foil was removed.

• A window was hence formed on the labial aspect of

the upper ridges in the area of prominence. At all

other places the denture covered the underlying tissue

similar to that by a conventional denture.

• In the area devoid of denture base the perioral tissues

came in direct contact with the mucosa reducing the

fullness and improving estheticsIJDA, 2(2), April-June, 2010

LOST SALT TECHNIQUE

• It is similar to the fabrication of conventional

denture.

• But a few special steps incorporated are:

While packing , half of the heat cure in

dough stage was positioned accurately over

the dewaxed mould and then salt crystals

were placed over it

Above that, the remaining heat cure resin

was packed and cured at 74 degree C for 7-8

hours

Contemp Clin Dent. 2012 Jul-Sep; 3(3): 352–355.

Cured denture was retrieved and 2 holes were made in the

thickest palatal area

All the residual salt crystals were removed by flushing water

with the high pressure syringe through the holes

After making sure that all the salt crystals have been removed,

the escape holes were closed with autopolymerizing resin

The hollow cavity seal was verified by immersing the denture

in water, if no air bubbles are evident, an adequate seal is

confirmed

The advantages of hollow dentures are reduction in the

excessive weight of the acrylic resin, resulting in the lighter

prosthesis, and decreased load on the residual alveolar ridges

thereby making the patient comfortable.

Contemp Clin Dent. 2012 Jul-Sep; 3(3): 352–355.

CONCLUSION

• The preprosthetic surgery attempts to create and oral environment that is conducive to a

functional, aesthetic, stable and retentive prosthesis that enhance patient comfort and

acceptance.

• Therefore, with proper preoperative evaluation, case selection, careful treatment planning and

judicious use of these procedures a prosthodontist can achieve desirable outcome.

REFERENCES• Zarb GA et al.2004 Prosthodontic treatment for edentulous patient.. 12th Edition. New Delhi:

Elsevier.

• Winkler S. 2004 Essentials of Complete Denture Prosthodontics.. 2nd Edition. New Delhi:AITBS

Publishers.

• Heartwell CM, Rahn AO.1984.Syllabus of Complete Dentures. 4th Edition. New Delhi:Varghese

Publishing House.

• Laskin DM.1989.Oral Maxillofacial Surgery-Vol 2.1st Edition. St Louis:Mosby.

• Fonseca RJ,Devis WH.Reconstructive Preprosthetic 1995. Oral Maxillofacial Surgery. 2nd

Edition. Philadelphia : Saunders publications.

• The Glossary of Prosthodontic Terms : J Prosthet Dent 2005; 94( 1): 10-92

REFERENCES

• Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg

1988: 17: 232–236

• Dubravka Knezovie-Zlatarie, Asja elebie , Biserka Lazie. Resorptive Changes of Maxillary and

Mandibular Bone Structures in Removable Denture Wearers Acta Stomat Croat 2002; 261-265

• J. Fanghänel, P. Proff1, S. Dietze, T. Bayerlein, F. Mack, T. Gedrange The morphological and

clinical relevance of mandibular and maxillary bone structures for implantation Folia Morphol.

Vol. 65, No. 1, pp. 49–53

• Alexandre MALACHIAS, Helena de Freitas Oliveira PARANHOS, Cláudia Helena Lovato da

SILVA, Valdir Antônio MUGLIA, Carla MORETO Modified Functional Impression Technique

for Complete Dentures Braz Dent J (2005) 16(2): 135-139

REFERENCES

• Swapnali Mhatre et al. Rehabilitation of an Edentulous patient with an implant supported overdenture

Journal of Contemporary Dentistry,January-April 2013;3(1)52:56

• Devendra Chopra,Vaibhav Gupta,Amrit Tandan . Enhancing the Retention of Mandibular Complete Denture

in a Severely Resorbed Mandibular Ridge by Incorporating Multi - Suction Chambers: A Case Report

Journal of Dental Sciences & Oral Rehabilitation 2013; April – June

• Neophytos Demetriades, Jong il Park, Constantinos Laskarides. Alternative Bone Expansion Technique for

Implant Placement in Atrophic Edentulous Maxilla and Mandible DOI:10.1563/AAID-JOI-D-10-00028

• Janya S, Gubrellay P, Purwar A, Khanna S. Magnet retained mandibular overdenture: A multidisciplinary

approach. J Interdiscip Dentistry [serial online] 2013 [cited 2014 Aug 5];3:43-6. Available

from: http://www.jidonline.com/text.asp?2013/3/1/43/120530

• Sandeep Garg, Sushant Garg, Mohit Mehta, Sangeeta Goyal The Neutral Zone

Concept: An Alternative Approach For Construction Of Mandibular Complete

Denture: A Clinical Case Report. Indian Journal of Dental Sciences. September 2012

Issue:3, Vol.:4

• Keni Nandita N1, Aras Meena A2, Chitre Vidya. Modified flange complete denture for

labially inclined premaxilla. IJDA, 2(2), April-June, 2010

• Himanshi Aggarwal, Sunit K. Jurel, and Pradeep Kumar Lost salt technique for

severely resorbed alveolar ridges: An innovative approach Contemp Clin Dent. 2012

Jul-Sep; 3(3): 352–355.

METHODS TO IMPROVE THE COMPLETE DENTURE FOUNDATION

ANISH AMIN