advanced preprosthetic sx

Question 1

Loss of Teeth - Long Term Consequences: bone and mm attatchements

Answer 1

With loss of teeth, there is significant resorption leading to bone atrophy in the jaws.
However, the muscle attachments still remain in the same place.

Question 2

Muscles involved in mandible:

Answer 2

Mentalis (anteriorly), Buccinator (laterally) Mylohyoid (lingually)

Question 3

Loss of Teeth - Long Term Consequences in the Maxilla

Answer 3

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)

Question 4

What is Meant by Ridge Augmentation?

Answer 4

• 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.

Question 5

forms of ridge augmentation

Answer 5

absolute and relative

Question 6

Relative Ridge Augmentation
* Indicated for?
* Procedures that involve?

Answer 6

• Indicated for a flat ridge with moderate resorption (>2cm bone left) of the alveolar bone.
• Procedures that involve sulcus lengthening(Vestibuloplasty). In this procedure, the alveolar mucosa and muscle insertions can be repositioned apically.

Question 7

Indication for Relative Ridge Augmentation in the Mandible

Answer 7

• 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.

Question 8

Absolute Ridge Augmentation
Indicated for?
Osteotomy and bone grafting?
mm?

Answer 8

Indicated for a flat ridge with extreme resorption of the alveolar bone.
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 9

Indication for Absolute Ridge Augmentation in the Mandible:

Answer 9

• Indicated when there is extreme resorption of the body of the mandible.
• There is less than 2cm bone at the mid-bodyof the mandible

Question 10

Vestibuloplasty is a soft tissue surgical procedure designed to increase:

Answer 10

• 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 11

Vestibuloplasty - Objectives
* To provide?
* bony support?

Answer 11

• 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).

Question 12

Vestibuloplasty Procedure

Answer 12

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.

Question 13

Common Vestibuloplasty Techniques

Answer 13

• Secondary epithelization vestibuloplasty
• Grafting vestibuloplasty
• Palatal Mucosal graft / Split Thickness Skin graft

Question 14

Grafting vestibuloplasty
Vestibuloplasty with Palatal Mucosa / Skin Graft
* Following vestibuloplasty?
* If this vestibuloplasty wound is allowed to granulate in?
* The skin is removed from? while the palatal mucosa is usually taken from?

Answer 14

• 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 15

Grafting vestibuloplasty with Palatal Mucosal Graft/Skin
Important Considerations
* what dissection is necessary?
* In order to prevent relapse of the muscles and vestibule, the harvested palatal mucosa grafts /skin grafts are placed into? and?
* Use the graft together with the splint for ? days.
* blood supply?

Answer 15

• 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.

Question 16

Mandibular Augmentation
Superior Border Graft of a Atrophic Mandible

Answer 16

Corticocancellous illiac crest contoured to adapt to
configuration of mandible
- Stabilized with rigid fixation screws

Question 17

Maxillary Augmentation
Onlay Bone Grafting (Iliac Bone graft)

Answer 17

Question 18

Iliac crest onlay bone reconstruction of maxilla

Answer 18

1. Atrophic maxilla
2. Three segment bone secured in place
3. Stabilization of onlay graft with screws
4. Small defects filled with cancellous bone

Question 19

Maxillary Augmentation Interpositional Bone Grafting
(With Le Fort-I Ostetomy)

Answer 19

Question 20

Alveolar Distraction Osteogenesis

Answer 20

Gradual Bone Lenghtening
Procedure

Question 21

Segmental Maxillary Osteotomy

Answer 21