Some clinical factors related to rate of resorption of residual ridges
Douglas Allen Atwood, AB, MD, DMD Boston, Mass.
R esorption of residual ridges is a complex bio-
physical process. Sometimes a simile is made between by thick or thin mucoperiosteum? Have there been any recent extractions? bone and ice. If a measured weight is placed on a mea- Tracings of cephalometric roentgenograms of the sured piece of ice for a given length of time at a given 18 complete denture patients showed considerable temperature and atmospheric pressure, a predictable variation in shape and size of the residual ridges degree of melting of the ice occurs. This is a physical (Fig. 1). However, all patients had reasonably favor- process subject to certain physical laws. However, if a able ridges at the beginning of the study. Tracings of measured force is applied on alveolar bone, either 2 (patients 59 and 118) show that, if everything else through natural teeth or through a denture, different is equal, there is a potential for more bone loss in effects are observed in different patients. The force in patient 59 than in patient 118—simply because there this second situation is subject to the same physical is more bone available to be lost. In other words, laws, but in addition, the response of the bone is gov- clinical joy over big ridges must be tempered with erned by certain physiologic laws. the sober realization of the greater potential bone Bone resorption of residual ridges is a common loss over the years of future edentulousness. occurrence after the extraction of teeth. In a study pre- Although the broad, high ridge may have a greater viously reported,1 vertical resorption of the anterior potential bone loss, the rate of vertical bone loss may residual ridges was measurable in 30 or 32 patients actually be slower than that of a small ridge because studied cephalometrically after the extraction of there is more bone to be resorbed per unit of time and remaining teeth. Both the total amount of bone loss because the rate of resorption also depends on the and the rate of resorption varied among different density of the bone. patients. In addition, the rate of resorption varied for Quality of Bone.—Clinically, intraoral roentgenograms a given patient at different times. are made to check the density of the residual ridges. In In seeking the causes of such variations, it is helpful evaluating such roentgenograms, a three dimensional if the clinical factors are organized into four major cat- object is portrayed on two dimensional film. Two egories: (1) Anatomic: How much and what kind of roentgenograms of apparently equal density may represent bone does the dentist have to work with? (2) either a wide, poorly calcified bone, a narrow, highly calci- Metabolic: What is the physiologic capability of this fied bone, or even different roentgenographic techniques. bone to respond to treatment? (3) Functional: What Therefore, meaningful evaluation of roentgenograms for functional forces will be placed on this bone? (4) bone density requires a specialized technique with rigid Prosthetic: What technical details are incorporated controls over equipment and development, as well as con- into the prosthesis? sideration of the thickness of the soft and hard tissues In discussing these various factors,1 I will refer to examined. 18 complete denture patients studied cephalometrical- McLean and Urist2 state that a loss of 24 to 30 per ly after the extraction of remaining teeth. These cent of the bone salt is necessary to produce an appre- patients will be used to illustrate basic principles. No ciable change in roentgenograms of bone. In fact, the attempt is made or should be made to use this mater- diagnosis of osteoporosis3-5 is made more on the basis ial for proof of theories, because the number of of gross pathologic changes in the spine than on crite- patients is too small for statistical significance. ria of decreased radiodensity of bone. Moreover, the value of a given treatment of osteoporosis4-6 is based ANATOMIC FACTORS more on the decrease in symptoms and the cessation of Amount of Bone.—Clinically, when examining resid- the progressive decrease in body height than on any ual ridges, the dentist asks: Are the ridges high or low, increase in radiodensity of bone. In other words, many broad or narrow, rounded or spiny, or are they covered dental patients may have a degree of generalized osteoporosis and no one knows it. Read before the American Prosthodontic Society in Philadelphia, Pa. A standardized study of bone density was not done Reprinted with permission from J Prosthet Dent 1962;441-50. in the 18 patients studied. In retrospect, probably doi:10.1067/mpr.2001.117609 none of the patients had frank osteoporosis. On theo-
AUGUST 2001 THE JOURNAL OF PROSTHETIC DENTISTRY 119