Managing edentulous patients with PDI Class IV ridge resorption presents considerable clinical difficulties due to the severe loss of alveolar support and accompanying functional impairments [10]. In such scenarios, conventional dentures often underperform, as their retention depends heavily on the residual ridge anatomy. This commonly results in diminished chewing ability, unclear speech, and overall patient dissatisfaction.

In this case, a conservative strategy was chosen, employing the suction-effective mandibular denture technique introduced by Dr. Jiro Abe. This method involves dynamic impression-taking to capture functional muscle movements, allowing for an optimal peripheral seal that facilitates negative intraoral pressure, thereby enhancing denture retention [7]. This technique proves especially beneficial in mandibular arches with narrow ridges, high muscle activity, or challenging tongue posture [11]. By guiding the borders of the denture through functional movement, the flange conforms closely to the oral musculature during daily functions, such as swallowing or speaking, eliminating the need for adhesives or implants [6].

Occlusion also plays a pivotal role in denture success, particularly in cases with compromised ridges. In this case, a lingualized occlusal scheme was used, which channels occlusal forces more centrally along the ridge, limits lateral stresses, and contributes to denture stability during function [12]. Furthermore, this occlusion style offers bilateral contact, enhancing comfort and reducing dislodgment during mandibular motion [13].

To further improve prosthesis function, the neutral zone technique was integrated. This method identifies the area of balance between tongue forces and the opposing pressures of lips and cheeks, allowing for precise tooth placement and flange extension within this zone [14]. In patients with resorbed ridges, this muscle-guided approach is essential, as it compensates for the loss of anatomical landmarks and enhances prosthesis control during speech and mastication [15].

By combining the suction-effective impression method, lingualized occlusion, and neutral zone principles, this case demonstrated a stable, adhesive-free mandibular denture with excellent functional outcomes. The patient reported marked improvement in comfort, speech, and chewing, with no evidence of sore spots or instability during follow-up, suggesting proper load distribution and favorable tissue response.

This case underscores how advanced yet non-invasive prosthodontic strategies can produce successful rehabilitations in patients with severe ridge resorption. It also highlights the importance of respecting oral dynamics and applying occlusal concepts that suit the biomechanical challenges of edentulous conditions. Nonetheless, more longitudinal research is needed to validate the long-term reliability of these techniques across larger patient cohorts.