Collapsed edentulous ridges present esthetical challenges especially in the anterior areas. Sometimes the ridge defect is in the bucco-lingual direction (horizontal), sometimes in corono-apical direction (vertical) and sometimes in combination of both directions (combination of horizontal and vertical). When implants are planned, hard tissue grafting is necessary to make an implant placement possible. However, when a fixed partial denture (bridge) is planned, a pontic needs to be made a little longer than esthetically acceptable. There is a way to augment the deficient ridge to allow an FPD that is esthetic.
- ridge defect under pontic #10
- Provisional FPD
In the above case, a defect (mostly horizontal) is seen under the pontic of a provisional FPD. This type of defect creates a dark shadow under the pontic and most patients prefer to have a more fuller ridge that mimics the natural ridge contour that shows the bulge of a root.
Unless an implant is planned, a predictable soft tissue augmentation can be done. It is a variation of the root coverage technique using subepithelial connective tissue graft. First the recipient site is prepared. In this case, a simple pouch is made at the crest extending into the buccal area. Subepithelial CT graft is harvested from the palate and prepared. The graft is placed into the pouch and stabilized with sutures. With vertical ridge deficiencies, a variation of the pouch technique or soft tissue onlay can be done. Following images show how this case was treated.
- CT graft harvested
- graft sutured
- provisional FPD recemented after surgery
- after healing 1 week
The grafted site looks fuller than the adjacent area initially, but will blend in with the adjacent area with time. Once healing as completed, the grafted area becomes stable and will provide a good frame for the permanent FPD, a work of art done by you.
Hard tissue (bone) grafting should be done instead if implants are planned for the deficient ridge area.