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.