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ManagementOfKnifeEdgeRidgeACaseReport

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VishalKatna 1,Dr.VijayChopra 2,AmarjitSinghChadda 3,AnkitaGaur 4

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1SeniorLecturer,Dept.ofProsthodonticsHDC,Sundernagar(H.P)
2ReaderDepttofPedodontics,HimachalDentalCollegeSundernagar

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3P.G.Student,DepartmentofProsthodonticsHDC,Sundernagar(H.P)
4SeniorLecturer,DepartmentofPedodonticsHDC,Sundernagar(H.P)

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Dr.VishalKatna,SeniorLecturer,
DepartmentofProsthodontics,
HimachalDentalCollege&Hospital,Sundernagar(H.P)

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Abstract
Knife edge ridge most commonly occurs in the edentulous mandible. Patient complains of pain while chewing the food
becausetheoverlyingmucosaispinchedbetweenthedentureandthebone.Acasewithknifeedgeridgeismanagedby
usingtheDifferentialpressureimpressiontechniqueisdiscussed.

Currentissue

Keywords
knifeedgeridge,differentialpressureimpressiontechnique.

FullText

Introduction:
Asharpbonyridgeisafrequentproblemamongtheedentulouspatientsandcommonlyoccurinthemandibleintheedentulouspatient.If
presentshouldbeidentifiedduringtheinitialassessmentbypalpationofresidualedentulousridges.Whenitisconventionallyloaded,the
overlyingmucosaispinchedbetweenthedenturebaseandthebonewhichleadstopainovertheridge.1Effectintheunderlyingbony
structureoftheresidualridgemaybethecauseofchronicpainunderdenturesespeciallyduringmastication.
Knifeedgeridgeisformedduetorapidresorptionoflabialandlingualsideoftheloweranteriorridge.Gingivaoverlyingitbecomesrolled
andsofttissueproliferatesleavinghypermobileridgecresttissue.2

March2016|Vol.8Issue1

LatestNews

Acc.toMeyerthreetypesofsharpridgesare:2
1)Sawtoothridge
2)Razorlikeridgeand

Vol.2Issue1January2010

3)Thosewithdiscretespinyprojections.However,thisclassificationisacademicbecauseallofthesetypecanproducepainunderdenture

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Knifeedgeridgesarethin,bucccolinguallysharpbutsmoothandlikeafeatheredgetheyarepainfulunderpressureandthistypeofridge
seenonlyinmandible2
Xrayphotographsshowathinridgewithaclearlydefinedoutline,thecancellousbonebeingcoveredwithacorticallayer3.

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Immediatedenturesareoftenanultimatecauseofsharpridges.Localdestructionofthebonebytheperiodontaldiseasebeforetooth
extraction,impropersurgicalproceduresofalveolarboneatthetimeofextractionofteeth,orlackoffollowupandpropercorrectionof
changingtissueconditionsmaybecontributingfactors.4
Acombinationoffactorscontributestoboneresorption,withtheamountofresorptionandtherelativeimportanceofeachfactorsvarying
withthepatients.45

Theetiologicagentsbelievedtobeofsignificanceinclude,
1)nutritionalinadequacyofthediet
2)endocrinefunctions
3)tissueresistancetostress
4)traumaticfactors(denturesetc)
5)systemicdiseaseand
6)disuse.

Theinfluenceofgeneticfactorsappearsnottohavebeeninvestigated.
Inadequatedenturesdonotnecessarilycauseresidualridgechangesinotherwisehealthyindividuals.6

Alternativetreatmentsforknifeedgedridges:

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IndianJournalOfDentalSciences(www.ijds.in):FreefulltextarticlesfromIndianJournalOfDentalSciences(ijds)
a)Provisionofsoftliningsoftliningwasnotusedbecauseofhygieneandmaintenanceproblemsassociatedwiththesematerials.
b)Acontrolledpressureimpressiontechniquewoulddecreaseocclusalloadingovertheaffectedareaanddistributeforcesmoretothe
primarysupportareaslikebuccalself2
c)Preprostheticsurgeryhasbeenwidelyadvocatedfordealingwithsharpbonyridges.Itwasnotchosenhereforthetwindisadvantageof
surgicaltraumatothepatientanddestructionofpotentiallystabilizingbone.
d)Differentialpressureimpressiontechnique.Differentialpressuretechniquewaschosenasitenablesaconservativepreservationofridge
heightforstabilitywithoutoverloadingthecrestoftheridge.

Method
Techniquewhichwilldistributeloadingontoalternativeareasovertheridgeandrelivethemucosaoverthesharpbonyridgeproducing
differentialpressure,secondaryimpressionofthemandibulararchwithasharpbonyridge
Theaimofthistechniqueistoproduceloadingontoalternativeareas(buccalshelfarea)andrelievethemucosaoverthesharpbonyridge
fromtheload.
Theareasthatarecapableofbearingtheloadshouldbepreferentiallyloaded.Thoseareasthatareincapableofloadbearingshouldhave
theirloadsreduced1.

CaseReport1
A 60 yr old female patient reported to the Department of Prosthodontics with complains of replacement of her missing teeth. On
examinationithasbeenfoundthatpatienthasverythin(knifeedge)ridgepresentinrelationtomandibulararch(fig:1)thuscomplete
denturehasbeenadvisedwithdifferentialpressureimpressiontechnique.

Fig1

Primaryimpressionwasmadeforbothupperandlowerarchusingimpressioncompoundandspecialtrayfabricatedontheprimarycast.A
mediumbodiedsiliconeimpressionwasusedtomakeafullymuscletrimmedsecondaryimpression.(fig:2).

Fig2

Theimpressionproduceddisplacementofthemucosaoverthesharpbonyridge.Ifitisusedtoconstructthefinaldentureprosthesis,there
isapotentialforthedenturetocausetraumaticpaininthisregion.Theareaoftheimpressionoverthesharpridgeiscutawayusinga
scalpelblade.Thetrayisperforatedoverthesharpridge.(fig:3)

Fig3

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IndianJournalOfDentalSciences(www.ijds.in):FreefulltextarticlesfromIndianJournalOfDentalSciences(ijds)
It is important to place numerous large perforations in order to ensure low pressure for the next stage of the impression. Complete
impressionwasmadeusinglightbodiedimpressionmaterial(fig:4).Jawrelationrecordedandtryingwasdone.

Fig4

CaseNo2
A56yearoldmalecomplainedofsorenessunderhisdenture.Hisdenturehadbeenmade5yearback.Thetissueonthemandibularridge
werehyperplastic,mobileandtendertopalpation.Radiographrevealedmultiplebonyspinesprotrudingfromthemandibularridgecrest.
Thehyperplasticsofttissueandsharpbonewereremovedsurgically.Duringhealingperiodthelowerdenturewaswornwithasoftreline
material.newdentureweremade.Thepatientreportedcomfort,retention,andrenewedpleasureineating.

CaseNo3
A54yearoldfemalepatientreportedwithcomplainedofpainwhilechewingfood.Onexaminationitwasfoundthatshehadsharpedge
ridgeinthemandibulararch.Shewasdenturewearer.ItwasdecidedthatfabricateanewdentureforthispatientwithDifferentialpressure
impressiontechnique.Aftergivingthedenturetothepatient,shereportedoneweekafterandnowshedon'thaveanypainontheridge
whilechewingthefood.

Discussion
The complete denture fabricated by this technique has proved successful for this patient. The successful treatment depended on the
accuratediagnosisofthecauseofthepatient'ssymptoms.
BolenderandSwensonhavereportedasuccessfulvestibularextensionprocedures.Thissurgicaltechniquemightbeusedforpatientswho
lackadequateridgesafterremovalofsharpprojectionstorecreateridgeconditionsfavorabletodenturestabilityandretention.7
Theuseofthepressurereliefareasisasuccessfulformoftreatment.Howeverredistributionoftheloadbytheimpressiontechnique,as
presentedhere,islikelytocreateamorecontrolledloadingofthemucosa.Preprostheticsurgerycanalsobeadvocatedtodealingwiththe
sharpbonyridge.Butitisnotchosenherebecauseitmayleadtotraumatothepatientanddestructionofthepotentiallystabilizingbone.
Sharpbonyridgecannotbearloadbuttheheightoftheridgedoesprovideresistancetohorizontalforce(stability).Differentialpressure
impression technique is a conservative preservation of the ridge height for stability without overloading the underling mucosa1.Thus
selectionoftheappropriateimpressiontechniqueisessentialforthesuccessofourprosthesis.

References
1.TPHyde"acasereportdifferientialpressureimpressionforcompletedenture:EurJProsthodontRestroDent,2003mar11(1)58.
2.SheldomWinkler,essentialofcompletedentureprosthodontics.A.I.T.B.S.Publishersanddistributors2ndedition2000.
3.H.R.B.Fenn,K.P.Liddelow,A.P.Gimson,clinicaldentalprosthetics,CBSPublisher1stedition1986.
4.RogerA.MeyerManagementofdenturepatientswithsharpresidualridges.jpros.Dentmayjune,196616(3)43137.
5.ClintonF.Sobolikalveolarboneresorption.j.prosdent.1960julyaugust10(4)61219
6.Atwood,D.A.someclinicalfactorsrelatedtorateofresorptionofresidualridges.j.pros.Dent.196212:44150.
7.Bolender,C.L.,Swenson,R.D:cephalometricevaluationofalabialvestibularextensionprocedure.jpros.Dent.196313:41631

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