Methods to improve com[lete denture foundation 2

METHODS TO IMPROVE THE COMPLETE
DENTURE FOUNDATION
ANISH AMIN

C
O
N
T
E
N
T
S
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
RIDGES
As 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 CLASSIFICATION
Group 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 factors
1)Functional factors:
• Frequency, direction and strength of forces acting on bone
• Bruxism
2)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.

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 procedures
E) 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
AUGMENTATION
Progressive 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

MANDIBULAR AUGMENTATION
PROCEDURE
ONLAY GRAFTING
VISOR OSTEOTOMY
SUPERIOR BORDER GRAFT
INFERIOR BORDER GRAFT
ONLAY 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

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 CONSIDERATIONS
Balanced occlusion
Lingualized occlusion
Monoplane occlusion
2)NEUTRAL ZONE CONCEPT
3)Use of magnets
4)Use of suction cups
5)MODIFYING IMPRESSION TECHNIQUES
6)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 tissues
William H Filler
Modified fluid wax impression
Splint method by Allan Mack
Hobkirk technique
Zafrulla Khan technique
Jone D Walter technique
• For severely resorbed ridge
Flange technique by Lott & Levine
Athur S Freese
Winkler technique
Modified 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

• 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

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.

• 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.

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 techniques

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 esthetics
IJDA, 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

REFERENCE
S
• 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 com[lete denture foundation 2

Methods to improve com[lete denture foundation 2

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