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