The ASH Impression Technique: A Game-Changer in the Prosthodontic Management of Mandibular Ridge Resorption
Dr. Arpit Sikri, Dr. Jyotsana Sikri
Abstract
Residual ridge resorption (RRR) is a chronic, progressive, and irreversible process characterized by the gradual loss of alveolar bone beneath the mucoperiosteum following the extraction of natural teeth. It is a multifactorial phenomenon influenced by anatomical, biomechanical, metabolic, and systemic factors. Among the two arches, the mandibular ridge typically undergoes more rapid and severe resorption than the maxillary counterpart, leading to a compromised denture-bearing foundation over time. This pronounced mandibular atrophy significantly impairs the stability, support, and retention of complete dentures, often resulting in functional limitations and reduced patient satisfaction. In prosthodontic practice, the rehabilitation of patients with severely resorbed mandibular ridges remains a formidable clinical challenge. The decreased surface area, altered ridge morphology, and loss of vertical height collectively contribute to poor denture base adaptation, reduced stability, and increased mucosal mobility. These issues are particularly pronounced in advanced stages of resorption as categorized by Atwood’s classification, where Order V denotes a low, well-rounded ridge and Order VI reflects a flat or depressed ridge form with minimal or no residual alveolar height. Such conditions severely compromise the effectiveness of conventional denture fabrication techniques and require careful modifications in clinical protocols. Among the many factors contributing to the long-term success of complete dentures, the stability of the mandibular denture often serves as a critical determinant. Lack of stability can trigger a cascade of issues such as soreness, ulcerations, masticatory inefficiency, and patient dissatisfaction. Additionally, poorly adapted dentures may exert uneven or excessive pressure on the underlying tissues, thereby accelerating the resorptive process. This clinical case report presents the prosthodontic management of a patient with a highly atrophic mandibular ridge (Atwood’s Order V) using a novel “cocktail impression technique.” Recognizing the limitations of a single impression philosophy, this hybrid approach integrates mucostatic, selective pressure, and functional techniques to enhance tissue adaptation, minimize displacement, and evenly distribute occlusal forces. The strategy is tailored to the patient's unique anatomy, promoting denture stability,