Advanced Pre-prosthetic Oral Surgery Flashcards
Characteristics of the Ideal (3)
Broad Alveolar ridge
Adequate FOM
Deep Vestibular depth
With loss of teeth, there is significant resorption leading to bone atrophy in the jaws.
However, the — still remain in the same place
muscle attachments
Loss of Teeth - Long Term Consequences in the Mandible
More commonly done in mandible
(2)
Mandible resorbs more quickly (~4x)
Mandibular dentures more unstable
Muscles involved in mandible:
(3)
Mentalis (anteriorly), Buccinator (laterally) and Mylohyoid (lingually)
Maxilla: most commonly done near
hamular notches (as this area tends to resorb fairly
quickly)
- Palate provides large denture bearing area (Therefore, Maxillary dentures more stable)
What is Meant by Ridge Augmentation?
- It is a surgical procedure that aims at increasing the quantity and/or quality of bone or soft
tissues in edentulous area of the oral cavity
Ridge Augmentation Procedures
(2)
- Relative ridge augmentation
- Absolute ridge augmentation
Relative Ridge Augmentation
* Indicated for a
flat ridge with moderate resorption of the alveolar bone.
- Procedures that involve sulcus lengthening(Vestibuloplasty). In this procedure,
the
alveolar mucosa and muscle insertions can be repositioned apically.
Indication for Relative Ridge Augmentation in the Mandible
- If there is 2 cm or more bone present at the mid-body of the mandible.
Height will be increased in the symphysis and the mid- body regions.
Absolute Ridge Augmentation
Indicated for a —
Osteotomy and bone grafting are indicated to —
Subsequent — may be necessary to achieve desired results
flat ridge with extreme resorption of the alveolar bone.
augment the height of the ridge, actually increasing
the bone height.
muscle repositioning
Indication for Absolute Ridge Augmentation in the Mandible:
* Indicated when there is
* There is less than – bone at the mid-bodyof the mandible.
extreme resorption of the body of the mandible.
2cm
Advanced Pre- prosthetic Oral Surgery
(2)
Advanced Soft tissue pre-prosthetic Oral surgical procedures
Advanced Osseous pre-prosthetic Oral surgical procedures
Advanced Soft tissue Pre-prosthetic Oral surgical procedures
Relative Ridge Augmentation -
Vestibuloplasty
Vestibuloplasty is a soft tissue surgical procedure designed to increase:
(3)
- Surface area of fixed tissue for denture support
- Depth of vestibules for denture flange extension
- Used to prepare for either complete or partial dentures
Vestibuloplasty - Objectives
(2)
- To provide better anatomic condition for denture construction by deepening the sulcus
to provide healthy, firm soft tissue coverage of ridge thereby help in the denture
flange extension. - To provide adequate bony support for denture (decreasing dislodging forces by
muscles and soft tissues in denture bearing areas).
Vestibuloplasty is a soft tissue surgical procedure designed to
increase the relative height of the
alveolar ridge by apically repositioning the alveolar mucosa and the muscles attached to the buccal,
labial, and lingual aspects of the jaws.
Common Vestibuloplasty Techniques
(2)
- Secondary epithelization vestibuloplasty
- Grafting vestibuloplasty
- Palatal Mucosal graft / Split Thickness Skin graft
Vestibuloplasty followed by use of Palatal Surgical Splint and Screw
By using a splint and screw a controlled pressure equally distributed over the mucosa is achieved after the vestibuloplasty
procedure.
The splint fixed with screw on to the bone is more convenient for the patient and produces a better operative result.
Grafting vestibuloplasty
Vestibuloplasty with Palatal Mucosa / Skin Graft
* Following vestibuloplasty, the — is uncovered.
* If this vestibuloplasty wound is allowed to
granulate it usually results in relapse, especially
on the labial surface. Therefore, to prevent this, a
—
* The skin is removed from the outer surface of
the thigh, while the palatal mucosa is usually
taken from the —.
periosteum
skin or palatal mucosal graft is usually placed
over the periosteum.
palate
Grafting vestibuloplasty with Palatal Mucosal Graft/Skin
Important Considerations
(4)
- A supraperiosteal dissection is necessary.
- In order to prevent relapse of the muscles and vestibule, the harvested palatal mucosa
grafts /skin grafts are placed into a splint and placed onto the ridge. - Use the graft together with the splint for 10-14 days.
- The graft should “take” and gain a blood supply.
Mandibular Augmentation
Superior Border Graft of a Atrophic Mandible
Superior Border Graft of a Atrophic Mandible
Corticocancellous illiac crest contoured to adapt to
configuration of mandible
- Stabilized with —
rigid fixation screws
Iliac crest onlay bone reconstruction of maxilla
(4)
Atrophic maxilla
Three segment bone secured in place
Stabilization of onlay graft with screws
Small defects filled with cancellous bone
