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Lost salt technique for severely resorbed alveolar ridges: An innovative

approach
Himanshi Aggarwal, Sunit K. Jurel, Raghuwar D. Singh, Pooran Chand, Pradeep Kumar

Abstract
The success of a complete denture relies on the principles of retention, stability and support. The prosthodontist skill lies in applying
these principles efficiently in critical situations. Severely resorbed maxillary edentulous ridges that are narrow and constricted
with increased inter ridge space provide decreased support, retention and stability. The consequent weight of the processed
denture only compromises them further. This article describes a case report of an edentulous patient with resorbed ridges where
a simplified technique of fabricating a hollow maxillary complete denture using lost salt technique was used for preservation of
denture bearing areas. The hollowing of the denture reduces the weight of the denture, thereby enhancing stability and retention,
reducing the further resorption of the jaws.

Keywords: Hollow maxillary complete denture, inter‑ridge distance, residual ridge resorption, severely resorbed ridge

Introduction resin over the definitive cast and processing a minimal

thickness of acrylic resin around the teeth using a different
It is obvious that in large maxillofacial defects and in severe drag. Both portions of resin were attached using a heat
resorption of the edentulous ridges, there is a decreased polymerized resin.
denture bearing area for support, retention and stability.
Increased inter‑ridge space compounds this problem. O’Sullivan et al.[11] described a modified method for fabricating
To decrease the leverage, reduction in the weight of the a hollow maxillary denture. A clear matrix of the trial denture
prosthesis was recommended and was also found to be base was made. The trial denture base was then invested in
beneficial.[1,2] Various weight reduction approaches have been the conventional manner till the wax elimination. A 2 mm
achieved using a solid three‑dimensional spacer, including heat polymerized acrylic resin shim was made on the master
dental stone,[1‑6] cellophane wrapped asbestos,[7] silicone cast using a second flask. Silicone putty was placed over the
putty[8] or modeling clay[9] during laboratory processing to shim and its thickness was estimated using the clear template.
exclude denture base material from the planned hollow cavity The original flask with the teeth was then placed over the
of the prosthesis. putty and the shim and the processing was done. The putty
was later removed from the distal end of the denture and the
Holt et al.[8] processed a shim of indexed acrylic resin over the openings were sealed with auto‑polymerizing resin.
residual ridge and used a spacer which was then removed
and the two halves luted with auto polymerized acrylic resin. The technique was useful in estimation of the spacer
thickness, but removal of putty was found to be difficult
Fattore et al.[10] used a variation of the double flask technique especially from the anterior portion of the denture. Moreover,
for obturator fabrication by adding heat polymerizing acrylic the openings made from the distal end had to be sufficiently
large to retrieve the hard putty.
Department of prosthodontics,faculty of dental sciences(upgraded
In this case report, a 51‑year‑old edentulous female patient
KGMC),C.S.M.Medical University,Lucknow, Uttar pradesh,India
with severely resorbed ridges and increased inter‑ridge
Correspondence: Dr. Sunit Kumar Jurel, C/O Er. R. B. distance was treated with a hollow maxillary denture, using
Singh, 18 / 373, Indira Nagar, Lucknow, Uttar Pradesh, India. lost salt technique combined with neutral zone concept to
E‑mail: sonu.bhaiya@gmail.com improve the retention and stability of dentures.

Access this article online Case Report

Quick Response Code:
Website: A 51‑year‑old female patient reported to the department
www.contempclindent.org
of Prosthodontics, with a chief complaint of looseness of
both upper and lower dentures and desired the replacement
DOI: of the same. Her history revealed that, she had been
10.4103/0976-237X.103636 edentulous for 15 years and had been wearing dentures
for 14 years.

352 Contemporary Clinical Dentistry | Jul-Sep 2012 | Vol 3 | Issue 3

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Jurel, et al.: Hollow denture for resorbed ridges

The intra‑ oral examination revealed a narrow and 12. Cured denture was retrieved [Figure 3a] and 2 holes
constricted U‑shaped flat palatal vault and severely resorbed were made in the thickest palatal area [Figure 3b].
maxillary and mandibular ridges [Figure 1]. The treatment 13. All the residual salt crystals were removed by flushing
plan decided for the patient was the fabrication of a water with the high pressure syringe through the holes.
hollow maxillary complete denture combined with neutral 14. After making sure that all the salt crystals have
zone concept to enhance the retention and stability of been removed, the escape holes were closed with
dentures. Because of severely resorbed ridges and increased autopolymerizing resin (Trevalon, Dentsply India Pvt.
inter‑ridge distance, fabrication of hollow maxillary Ltd., Gurgaon, India) [Figure 3c].
complete denture with utilization of neutral zone concept 15. The hollow cavity seal was verified by immersing the
was planned for better stability and retention. denture in water, if no air bubbles are evident, an
adequate seal is confirmed.
Technique 16. The dentures were inserted in the patient’s mouth
1. Maxillary and mandibular impression was made [Figure 4] and instructions regarding care, hygiene and
followed by border molding with green‑stick (DPI maintainance were given. On 3-month follow up, the
Pinnacle tracing sticks, The Bombay Burmah Trading patient reported that she was quite comfortable with
Corporation Ltd.,) and final impression with zinc oxide the dentures and she had encountered no problems.
eugenol impression paste (DPI Impression paste, The
Bombay Burmah Trading Corporation Ltd.,). Discussion
2. Compound occlusal rims were fabricated by using
modeling compound (DPI Pinnacle Impression The method described has advantages over the previously
Compound, The Bombay Burmah Trading Corporation described techniques. The salt crystals being heat labile
Ltd.) mixed with greenstick (DPI Pinnacle Tracing sticks, melt during the curing procedure and thorough flushing
The Bombay Burmah Trading Corporation Ltd.) in ratio after curing results in no crystals remaining in the denture
of 3:7 i.e.  3 parts impression compound +7 parts thereby maintaining the integrity of the denture, avoiding
greenstick compound) as per McCord’s technique for the tedious effort to remove the spacer material from the
making a neutral zone record by having the patient denture. This technique of lost salt technique is simple
perform various Orofacial movements. to execute and utilizes a very cheap and easily available
3. Then index of this record was then made with plaster spacer material.
of Paris and rims were duplicated in wax.
4. The maxilla‑mandibular relationship was recorded using Extreme resorption of the ridge whether maxilla or mandible
wax occlusal rims and transferred to the articulator and will lead to a reduced denture bearing area which in turn will
the artificial teeth were arranged. affect retention, stability and support for the complete denture.
5. Try in procedure was done and then, all the wax Problems that are likely to be faced may be due to narrower and
excluding the wax surrounding the teeth was removed more constricted residual ridge as the resorption progresses,
and replaced with light body elastomeric impression causing reduced supporting tissue with larger restorative space
material (Aquasil Ultra LV Dentsply Caulk, Milford, USA). between maxillary and mandibular residual ridges.[11]
6. Trial denture bases were reinserted into the patient’s
mouth and she was instructed to perform various
In general a heavy denture, whether maxillary or mandibular,
Orofacial movements so as to record the polished
is likely to cause poor denture bearing ability. Even though
surface of the denture in harmony with the Orofacial
it is suggested that gravity and the additional weight to the
musculature.
mandibular complete denture may aid in prosthetic retention,
7. After the try in procedure, wax up was done and
it is not a universally accepted one.
dentures were made ready for processing.
8. The mandibular denture was processed using the
Extensive volume of the denture base material in prosthesis
conventional procedures.
provided to patients with large maxillofacial defects or severe
The Special Steps Taken for the Fabrication of Hollow residual ridge resorption is always a challenge to prosthodontist.
Maxillary Complete Denture were as Follows: To increase the retention and stability of heavy prosthesis, many
9. The maxillary trial denture was flasked [Figure 2a]and methods have been tried like utilizing the undercuts, modifying
dewaxed in the conventional manner [Figure 2b]. the impression technique, use of magnets, use of implants, etc.
10. Half of the heat cure PMMA (Trevalon, Dentsply India
Pvt. Ltd., Gurgaon, India) in dough stage was positioned Apart from this, when we look into the history of bulkier
accurately over the dewaxed mould and then salt prosthesis reduction in prosthesis weight also have been tried by
crystals were placed over it [Figure 2c]. making the denture hollow. Such weight reduction approaches
11. Above that, the remaining heat cure resin was packed have been achieved using a solid 3‑dimensional spacer including
and cured at 74 degree C for 7‑8 hours [Figure 2d]. dental stone, cellophane wrapped asbestos, silicone putty or

Contemporary Clinical Dentistry | Jul-Sep 2012 | Vol 3 | Issue 3 353

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Jurel, et al.: Hollow denture for resorbed ridges

a b
Figure 1: (a) Intra oral view of the maxillary arch (b) Intra oral view of the mandibular arch

a b

c d
Figure 2: (a) Invested maxillary denture (b) Dewaxed mould (c) Salt crystals placed over first layer of dough (d) Second layer
of dough placed over the salt crystals

a b c
Figure 3: (a) Incorporated salt crystals seen inside the maxillary denture (b) Escape holes for salt crystals (c) Floating hollow
maxillary denture

354 Contemporary Clinical Dentistry | Jul-Sep 2012 | Vol 3 | Issue 3

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Jurel, et al.: Hollow denture for resorbed ridges

Hence, the best way is to rehabilitate them with conventional

complete dentures. Apart, from modifying the impression
technique to get maximum denture bearing area, modifying the
type of denture also may be better accepted by patients. Hence,
less denture weight provides for healthy and comfortable living.

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Rehabilitation of severely resorbed ridges is a challenge to

the prosthodontist. Even though, the choice of rehabilitation How to cite this article: Aggarwal H, Jurel SK, Singh RD, Chand P,
can be overdentures, implant retained over‑dentures, ridge Kumar P. Lost salt technique for severely resorbed alveolar ridges: An
innovative approach. Contemp Clin Dent 2012;3:352-5.
augmentation, etc., many a times the patients who comes with
Source of Support: Nil. Conflict of Interest: None declared.
such a problem are geriatric patients with many systemic illness.

Contemporary Clinical Dentistry | Jul-Sep 2012 | Vol 3 | Issue 3 355