Advanced Pre Prosthetic Surgery Flashcards
what are the long term consequences in the mandible
- mandible resorbs more quickly ~4x
- mandibular dentures more unstable
what are the muscles involved in the mandible
- mentalis (anteriorly)
- buccinator ( laterally)
- mylohyoid (lingually)
what are the long term consequences of tooth loss in the maxilla
most commonly done near hamular notches as this resorbs quickly
- palate provides large denture beating area so maxillary dentures are more stable
what is ridge augmentation
a surgical procedure that aims at increasing the quantity and/or quality of bone or soft tissues in edentulous area of the oral cavity
what are the ridge augmentation procedures
- relative ridge augmentation
- absolute ridge augmentation
what is relative ridge augmentation indicated for
- a flat ridge with moderate resorption of the alveolar bone
- procedures that involve sulcus lengthening (vestibuloplasty)
what happens in a vestibuloplasty
the alveolar mucosa and muscle insertions can be repositioned apically
what are the indications for relative ridge augmentation in the mandible
- if there is 2 cm or more bone present at the mid bony of the mandible
- height will be increased in the symphysis and the mid bony regions
what is absolute ridge augmentation indicated for
a flat ridge with extreme resorption of the alveolar bone
what is done in absolute ridge augmentation
- osteotomy and bone grafting are indicated to augment the height of the ridge, actually increasing the bone height
- subsequent muscle repositioning may be necessary to achieve desired results
what are the indications for absolute ridge augmentation in the mandible
- indicated when there is extreme resorption of the body of the mandible
- there is less than 2cm bone at the mid bony of the mandible
what are the advanced pre-prosthetic procedures
- advanced soft tissue pre-prosthetic oral surgical procedures
- advanced osseous pre-prosthetic oral surgical procedures
what are the advanced soft tissue pre prosthetic oral surgical procedures
relative ridge augmentation - vestibuloplasty
vestibuloplasty is a soft tissue surgical procedure designed to increase:
- surface area of fixed tissue for denture support
- depth of vestibules for denture flange extension
- used to prepare for either complete or partial dentures
what are the goals of vestibuloplasty
- 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 (decrease dislodging forces by muscles and soft tissues in denture bearing areas)
describe the vestibuloplasty procedure
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
what are the common vestibuloplasty techniques
- secondary epithelization vestibuloplasty
- grafting vestibuloplasty: palatal mucosal graft/ split thickness skin graft
what are the steps in secondary epithelization vestibuloplasty
- horizontal incision with electrocautery
- supra periosteal dissection used to reposition the overlying alveolar mucosa and muscles in an apical position
- 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
describe the grafting vestibuloplasty with palatal mucosa/skin graft
- following vestibuloplasty, the periosteum 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 skin or palatal mucosal graft is usually placed over the periosteum
- the skin is removed from the outer surface of the thigh while the palatal mucosa is usually taken from the palate
what are the important considerations for grafting vestibuloplasty with palatal mucosal graft/skin
- 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 on to the ridge
- use the graft with the splint for 10-14 days
- the graft should take and gain a blood supply
how is a superior border graft of an atrophic mandible done
- corticocancellous illiac crest contoured to adapt to configuration of mandible
- stabilized with rigid fixation screws
what bone is used in maxillary augmentation
iliac
how is iliac crest onlay bone reconstruction of maxilla done
- atrophic maxilla
- three segment bone secured in place
- stabilization of onlay graft with screws
- small defects filled in with cancellous bone
what is another name for gradual bone lenghtening
alveolar distraction osteogenesis
what procedure is done for improving interarch space for implants or partial
segmental maxillary osteotomy
