Advanced Pre Prosthetic Surgery

Question 1

what are the long term consequences in the mandible

Answer 1

• mandible resorbs more quickly ~4x
• mandibular dentures more unstable

Question 2

what are the muscles involved in the mandible

Answer 2

• mentalis (anteriorly)
• buccinator ( laterally)
• mylohyoid (lingually)

Question 3

what are the long term consequences of tooth loss in the maxilla

Answer 3

most commonly done near hamular notches as this resorbs quickly
- palate provides large denture beating area so maxillary dentures are more stable

Question 4

what is ridge augmentation

Answer 4

a surgical procedure that aims at increasing the quantity and/or quality of bone or soft tissues in edentulous area of the oral cavity

Question 5

what are the ridge augmentation procedures

Answer 5

• relative ridge augmentation
• absolute ridge augmentation

Question 6

what is relative ridge augmentation indicated for

Answer 6

• a flat ridge with moderate resorption of the alveolar bone
• procedures that involve sulcus lengthening (vestibuloplasty)

Question 7

what happens in a vestibuloplasty

Answer 7

the alveolar mucosa and muscle insertions can be repositioned apically

Question 8

what are the indications for relative ridge augmentation in the mandible

Answer 8

• 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

Question 9

what is absolute ridge augmentation indicated for

Answer 9

a flat ridge with extreme resorption of the alveolar bone

Question 10

what is done in absolute ridge augmentation

Answer 10

• 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

Question 11

what are the indications for absolute ridge augmentation in the mandible

Answer 11

• 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

Question 12

what are the advanced pre-prosthetic procedures

Answer 12

• advanced soft tissue pre-prosthetic oral surgical procedures
• advanced osseous pre-prosthetic oral surgical procedures

Question 13

what are the advanced soft tissue pre prosthetic oral surgical procedures

Answer 13

relative ridge augmentation - vestibuloplasty

Question 14

vestibuloplasty is a soft tissue surgical procedure designed to increase:

Answer 14

• surface area of fixed tissue for denture support
• depth of vestibules for denture flange extension
• used to prepare for either complete or partial dentures

Question 15

what are the goals of vestibuloplasty

Answer 15

• 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)

Question 16

describe the vestibuloplasty procedure

Answer 16

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

Question 17

what are the common vestibuloplasty techniques

Answer 17

• secondary epithelization vestibuloplasty
• grafting vestibuloplasty: palatal mucosal graft/ split thickness skin graft

Question 18

what are the steps in secondary epithelization vestibuloplasty

Answer 18

• 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

Question 19

describe the grafting vestibuloplasty with palatal mucosa/skin graft

Answer 19

• 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

Question 20

what are the important considerations for grafting vestibuloplasty with palatal mucosal graft/skin

Answer 20

• 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

Question 21

how is a superior border graft of an atrophic mandible done

Answer 21

• corticocancellous illiac crest contoured to adapt to configuration of mandible
• stabilized with rigid fixation screws

Question 22

what bone is used in maxillary augmentation

Answer 22

iliac

Question 23

how is iliac crest onlay bone reconstruction of maxilla done

Answer 23

• atrophic maxilla
• three segment bone secured in place
• stabilization of onlay graft with screws
• small defects filled in with cancellous bone

Question 24

what is another name for gradual bone lenghtening

Answer 24

alveolar distraction osteogenesis

Question 25

what procedure is done for improving interarch space for implants or partial

Answer 25

segmental maxillary osteotomy