Research Article

Prevalence of (alveolar ridge defect) using Seibert’s

classification in fixed partial denture patient
Nor Syakirah Binti Shahroom1, Ashish R. Jain2*

ABSTRACT

Background: Alveolar ridge defect may occur due to injury, trauma, denture wears, and periodontitis. Based on Seibert’s
Classification, it can be classified into three classes: Class I (buccolingual loss of tissue), Class II (apicocoronal loss of tissue),
and Class III (both loss of tissue). It is important to close the ridge defect by replacing the tooth loss and to achieve good
esthetic, phonetic, and mastication. According to the classification, proper treatment plan and alternative can be determined
for successful outcomes. Aim: The aim of this study is to assess the prevalence of alveolar ridge defect using Siebert’s
classification in fixed partial denture patient among Indian population. Materials and Method: This study was conducted
in the Department of Prosthodontics, Saveetha Dental College. A total number of 55 of 60 patients with alveolar ridge defect
are selected. Based on the Siebert’s Classification (Class I, Class II, and Class III), the amount of destruction is analyzed to
determine the alveolar ridge defect using this classification. Therefore, the statistical analysis is performed using Chi-squared
test. Results: Based on the result, the prevalence of alveolar ridge defect due to trauma is 91.6% (55 of 60). According
to Siebert’s classification, the most common alveolar ridge destruction was Class  III defect which is both buccolingual
and apicocoronal loss of tissue of alveolar ridge, 24 (40.0%). This was followed by Class I defect which is buccolingual
loss of tissue of alveolar ridge with 20 (33.3%) number of patients. Class II defect was the least with 11 (18.3%) which is
apicocoronal loss of tissue of alveolar ridge. Conclusion: The prevalence of Siebert’s classification helps in suggestion of
various management techniques or treatment planning to the patient to ensure that the prognosis and treatment outcomes turn
out to successful.

KEY WORDS: Alveolar defect, Andrew’s bridge, Fixed partial denture, Ridge augmentation, Seibert’s classification

INTRODUCTION
In prosthetic dentistry, dentist may face challenges in
treating patient with alveolar ridge defect in edentulous
area. Localized alveolar ridge defect can be seen as a
volumetric deficit of limited extent of soft tissue and
bone within the alveolar process.[1] The edentulous
area may be due to tooth loss either due to trauma
during extraction or congenital defects which lead to
alveolar bone loss.[2] The alveolar bone defect causes
the soft tissue to collapse into the bone during healing
which creates contours.[3] These contours make it
difficult to produce an esthetical prosthesis. Besides,
it may also lead to food impaction and difficulty in
speech due to percolation of saliva.[4] As a dentist who
faces such cases, it is required for them to replace the
Access this article online
missing tooth and close the defect for the patient to
achieve esthetic, phonetic, and mastication.[2]
Besides, it is important to assess the factors such as type
and amount of destruction of the residual ridge, systemic
condition, and economic status of the patient for better
treatment planning, clinical outcome, and prognosis.[5]
Furthermore, it is also essential for the selection of pontic
for the patient and indication for the patient to undergo
surgical intervention to reshape the ridge.[1] Seibert has
classified residual ridges into three categories based on
the amount of destruction as shown in Figure 1a-d.[6,7]
Class I: Buccolingual loss of alveolar soft tissue with
normal apicocoronal height.
Class  II: Apicocoronal loss of alveolar tissue with
normal buccolingual width.

Website: jprsolutions.info ISSN: 0975-7619

Class III: Both buccolingual width and apicocoronal
height loss of tissue. Management of ridge defect
1
Graduate Student, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, Tamil Nadu, India,
2
Department of Prosthodontics, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai,
Tamil Nadu, India

*Corresponding author: Dr. Ashish R. Jain, Department of Prosthodontics, Saveetha Institute of Medical and Technical
Science, Saveetha, University, 162, Poonamalle High Road, Chennai - 600 077, Tamil Nadu, India. Phone: +91-9884233423.
E-mail: dr.ashishjain_r@yahoo.com

Received on: 21-02-2017; Revised on: 27-04-2018; Accepted on: 15-05-2018

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 Nor Syakirah Binti Shahroom and Ashish R. Jain

includes ridge augmentation which was proposed

by Langer, Kaldhal et al., and Calanga.[8,9] It can be
categorized under the soft tissue augmentation and
hard tissue augmentation procedure.[1] Soft tissue
augmentation procedure includes the roll technique
for Class I defects, interproximal graft technique for
Class  II and III defects, and free gingival graft.[10]
Ridge augmentation is preferably done for Class I ridge
defects. Besides, for Class II and Class III ridge defect,
bone augmentation technique by inlay and outlay
grafting with either autogenous grafts, allografts, or
xenografts is preferred.[11] Other procedures include
removable partial denture, fixed partial dentures Figure 1: (a) Normal apicocoronal alveolar ridge,
with pink ceramic, and Andrew’s bridge.[10] The ideal (b) buccolingual loss of alveolar ridge, (c) apicocoronal loss
ridge width and height allow placement of natural of alveolar ridge, (d) normal buccolingual alveoral ridge
appearance pontic and thus help in the maintenance of
plaque-free environment.[1,12]

Anterior ridge defect is the most difficult to treat well

esthetically. In such cases, the conventional option of
fixed partial denture or implant-supported fixed partial
denture is not enough to achieve esthetic results.[10]
Therefore, as an alternative, Andrew’s bridge is a good
option. It was introduced by Dr.  James Andrews of
Amite, Louisiana in 1975.[13] Andrew’s bridge consists
of two fixed retainer attached to their abutments and
connected by a rectangular bar that follows the curve
of the ridge under it.[14] The advantages of Andrew’s
bridge are that it has a flexibility and stabilizing
qualities of the fixed prosthesis.[12] It is indicated in
cases such as excessive residual ridge defect, jaw
defect, cleft palate, and patient with periodontal
problems.[15]
Few studies have done on the prevalence of alveolar
ridge defect using Siebert’s classification on fixed
partial denture patient. Many studies have presented
the case reports on various treatments of ridge defect
patient. Therefore, the purpose of this study is to assess
the prevalence of Siebert’s Classification among fixed
partial denture patient in Indian populations to achieve
a good treatment outcome for the most prevalence
ridge defect.
MATERIALS AND METHODS
Sample Collection
This study was approved by the Research
Committee of Saveetha Dental College, Saveetha
University, Chennai, India. This study was done in
the Department of Prosthodontics, Saveetha Dental
College. Patients who are completely edentulous
were excluded from this study. Meanwhile, single
partially edentulous site, multiple partial edentulous
site, excessive ridge defect, and anterior or posterior
ridge defect were included in this study. The
alveolar ridge of the patient was observed clinically
based on the Siebert’s Classification as shown in
Figure 2: (a) Clinical image of alveolar ridge defect with
Class I Siebert’s, (b) clinical image of alveolar ridge defect
with Class II Siebert’s, (c) clinical image of alveolar ridge
defect with Class III Siebert’s
Figure  2a-c. Therefore, the amount of destruction
of the alveolar ridge was analyzed to determine the
classification.
Sample Size
The sample size was determined using calculator
developed by Naing et al.[16] which can be downloaded
freely from http://www.kck.usm.my/ppsg/stats_
resources.htm. At least 32 patients with alveolar ridge
defect were required to determine the prevalence of
Siebert’s classification. Samples size was calculated
using 95% level of confidence (Z), prevalence of
91% (P), and the precision (d) of 0.05 with normal
approximation assumption.
Sample size
Z2 ×P(1-P)
n=
d2
Which n=Sample size
Z=Z statistic of level confidence
P=Expected prevalence of proportion
d=Precision.

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 Nor Syakirah Binti Shahroom and Ashish R. Jain

Sample size

0.952 × 0.9 (1 − 0.9)

n= = 32
0.052
Statistical Analysis
The data were collected, and statistical analysis was
performed using Microsoft Excel. The descriptive
statistic was computed. Mean and Chi-square test
were done. The Chi-square test was used to compare
the data and checked for the distributions at 0.05 level Figure 3: The bar graph of patient with alveolar ridge defect
of significance for effect statistical significance. depends on gender

RESULT
A total of 60  patients with partially edentulous
site were selected in this study. However, 55 of the
patients met the inclusion criteria which are single
or multiple partial edentulous site and defect in the
alveolar ridge. The remaining five patients were
excluded from this study due to the clinically normal
alveolar ridge. Therefore, this study population
composed of 55 partially edentulous patients with
alveolar ridge defect of whom 30  (54.5%) were
males and 25  (45.5%) were females as shown in
Figure  3. Based on the participants’ age, 3  (5.5%)
were in the range of 20–29 years old, 15 (27.3%) were Figure 4: The bar graph of the varying age of patients with
in the range of 30–39 years old, 28 (50.9%) were in alveolar ridge defect
the range of 40 to 49 years old, 7 (12.7%) were in the
range of 50–59  years old, and 2  (3.6%) were in the
range of 60–69 years old as shown in Figure 4. All the
patients (100%) came with the complaints of trauma
including tooth loss or decayed tooth.

Based on the result, the prevalence of alveolar ridge

defect due to trauma is 91.6% (55 of 60). According
to Siebert’s Classification, the most common alveolar
ridge destruction was Class  III defect which is both
buccolingual and apicocoronal loss of tissue of
alveolar ridge, 24  (40.0%). This was followed by
Class I defect which is buccolingual loss of tissue of
alveolar ridge with 20  (33.3%) number of patients.
Class II defect was the least with 11 (18.3%) which is
apicocoronal loss of tissue of alveolar ridge as shown Figure 5: The prevalence of alveolar ridge defect using
in Figure 5. Siebert’s classification

However, the results do not show any correlation of
age and the type of destruction of alveolar ridge based
on Siebert’s classification.
DISCUSSION
This study shows that the prevalence of alveolar ridge
defect according to Siebert’s Classification is high with
91.6%. According to Siebert, he classified the alveolar
ridge defect according to the presence of deficiencies
in form, function, and esthetics.[6,7] In these studies,
Class  III defects had the most number of incidence
which was 40.0% followed by Class I with 33.3% and
Class I with 18.3%. According to these studies also,
male gender has high prevalence in having alveolar
ridge deformities with 54.5% and also patients in the
age within 40–49 years old have a high incidence of
alveolar ridge defect with 50.9%. However, no study
has done on the correlation of alveolar ridge defect
with age and gender.
According to this classification, the quantification of
the magnitude of ridge deficiencies was not included
by Siebert. Therefore, modification of Siebert’s
classification was introduced by Allen et al.[17] in the
year 1985 which include the magnitude of the ridge

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 Nor Syakirah Binti Shahroom and Ashish R. Jain
defect. This classification was meant to aid in the
treatment planning and prognosis of the patient with
alveolar ridge defect. The main problem occurs with
the incidence of anterior tooth loss with alveolar ridge
defect which is very difficult to treat properly due to
esthetic factor.[10] Besides, other problems might also be
encountered such as lack of emergence profile, lack of
root eminence, lack of marginal gingiva, and presence
of black triangles in interdental papillae area which is
esthetic disturbance.[18] Black triangle can be described
as dark appearance of alveolar tissue above the pontic
in comparison to the adjacent gingival tissue.[19] The
main reason of alveolar ridge deformities is due to
trauma to the alveolar process during extraction. After
extraction, the process of healing of the bone and soft
tissue took place. However, due to the trauma, the soft
tissue will collapse into the bone defects which create
contours which make esthetic functional prosthesis
would be difficult.[3] Therefore, the management of
alveolar ridge defect can be classified into hard tissue
augmentation and soft tissue augmentation.[1] There
are various treatment options to treat alveolar ridge
defect such as the roll technique for Class I defect and
interproximal graft technique for Class II and Class III
defect, free gingival graft, bone grafting using both
inlay and onlay grating technique either autogenous
grafts, allografts, or xenografts, ridge augmentation
using bone graft followed by implant placement,
removal partial denture, fixed partial denture with
pink ceramic, and Andrew’s bridge.[10] To achieve an
esthetically successful pontic, all criteria including
replication of the form, contours, incisal edge,
gingival and incisal embrasures, and color of adjacent
teeth should be met.[19]
Besides, the study of prevalence in Siebert’s
classification was intended to give a clear image on
the treatment choices and alternatives to achieve a
successful outcomes. As the primary goal of closing,
the defect and replacing the tooth are to restore the
loss of function, esthetic, and natural appearance, but
the goal can only be achieved if the final prosthesis
is modified according to the prevalent situation.[19]
In a study done by Abrams et al.,[20] they reported
that the prevalence of anterior ridge deformities of
partially edentulous patient was 91% similar to the
current study which is 91.6%. Class III defects were
the highest with 55.8% followed by Class  I defects
with 32.8% and Class  II defects with 2.9%. In a
study done by John et al.,[21] bone defects in posterior
mandibular tooth region show a maximum defect with
33.8% followed by maxillary posterior with 19.9%.
Since the prevalence of Class III defect is the highest
compared to Class I and Class II, many articles have
described the treatment outcome for Class III defects
patients in their case report article.[2,5,10,22] In Class III
defect, Andrew’s bridge is the best option due to
the challenging situation with esthetics and severe
756
alveolar ridge defect. Andrew’s bridge was introduced
by Dr. James Andrew of Amite Louisiana in the year
1975.[13] It is a combination of a fixed dental prosthesis
and a removable dental prosthesis and commonly
used for anterior edentulous area.[22] It replaced the
teeth within the bar area which incorporated with
the fixed dental prosthesis. The removable dental
prosthesis received retention from the vertical wall
of the bar. The advantages of Andrew’s bridge system
are the advantages of fixed and removable partial
dentures with better esthetics, hygiene along with
better adaptability, and phonetics.[10] Besides, it is
economical and comfortable for the patient. Other
advantages of this technique process are the flexibility
and stabilizing quantities of the prosthesis.[10]
In a study done by Snehal and Amberkar[7] the clinical
case report suggests that soft tissue augmentation with
subepithelial connective tissue graft is a promising
treatment in a condition with Class I defect. The study
was done by harvesting the connective tissue graft
from the palate along with metal ceramic restoration.
The advantages of this technique are maintenance
of adequate blood supply, and the use of stents or
hemostatic agent can be avoided and healing by first
intention which provides greatest comfort to the patient
postoperatively.[7] Apart from that, the disadvantages
of this technique are the limited volume of graft which
depends on the size of the graft and increases prone to
necrosis in case of large grafts.[23]
In a study done by Tanaka et al.,[24] a segmental
osteotomy procedure with an interpositional graft
is done on a patient with Class  II alveolar ridge
defect. Most of the studies shown that this technique
is practical and a predictable procedure with low
incidence of complications and a high probability of
successful treatment outcomes.[25-28] Apart from that,
alveolar osteotomy associated with interpositional
grafting is another alternative in increasing vertical
bone height. It is known as sandwich bone graft because
of the interposing bone graft between osteotomized
bony segments, which acts as a “sandwich.”[25-28]
The advantage of this technique is that it offers good
vasculature to the segment and graft which helps in
reducing bone resorption. Lack of alveolar bone
height (apicocoronally) condition can be overcome
using various vertical guide bone regeneration
procedures, alveolar distraction osteogenesis, titanium
mesh, or only bone graft.[29-31] There is a possibility
of increase in ridge height depending on the material
used. However, in such cases with excessive alveolar
ridge defect, implant placement is totally avoided as
it is difficult and impossible for support due to lack
of bone. Several studies show that short implants can
be an alternative to avoid problems associated with
vertical augmentation.[32-34] Besides, this placement
demonstrated high success rate and predictable
Drug Invention Today | Vol 10 • Issue 5 • 2018
 Nor Syakirah Binti Shahroom and Ashish R. Jain
clinical outcomes.
In another study done by Parikh et al.,[18] roll flap
technique is suggested to be the most predictable and
simplest method for the management in patient with
alveolar ridge defect. This technique was introduced
by Abrams.[35] The advantages of this technique are
utilization of pedicle flap, increase probability of
success, lesser chance of tissue loss and shrinkage,
simple technique, easy to perform, stabilize the graft,
maintenance of the color and texture, and single
surgical wound.[18,36,37] The disadvantages include it
depends on the thickness of the adjacent palatal tissue,
moderate volume gain, and very difficult for adjusting
addition mucogingival problems simultaneously.[18]
Besides, as designed by Abrams, the ovate pontics was
selected for fixed prosthesis.[35] This type of pontic
automatically created interdental papilla which fills
in the embrasure and removes the unesthetic black
interdental triangles.[18]
CONCLUSION
It is important to assess the alveolar ridge deficiencies
among patient who came to the hospital with a
complaint of trauma or tooth loss. According to the
amount of destruction, it can be classified into three
classes based on Siebert’s classification. Through
this, various management techniques or treatment
planning can be suggested to the patient to ensure
that the prognosis and treatment outcomes turn out to
successful. In summary, the suggestive treatment for
Class I is soft tissue augmentation, Class II is alveolar
osteotomy with interpositional grafting, and Class III
is Andrew’s bridge.
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Source of support: Nil; Conflict of interest: None Declared
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