Minor Preprosthetic Oral Surgery Procedures Flashcards
Pre-prosthetic Surgery is the
surgical improvement of the denture bearing area and
surrounding tissues (Hard and Soft) to support the best possible prosthetic
replacement.
The goal of pre-prosthetic surgery is to establish a
functional biologic platform for
supportive or retentive mechanisms that will maintain or support prosthetic
rehabilitation.
Tooth Loss starts an immediate change in the —.
jaws
— is the primary cause for this resorption
Lack of functional stress from teeth and periodontal ligament following extraction
— begins to resorb after extraction and this process is unpredictable from one
patient to another
Bone
n some patient’s, the bone loss stabilizes and in others it continues to include a
total loss of
alveolar and underlying basal bone.
Resorption is accelerated by
denture wearing
— denture wearers affected more than — denture wearers
Mandibular
maxillary
Resorption affects the mandible more severely because
(2)
- Decreased surface area
- Less favorable distribution of forces
Factors Responsible for Enhanced Bone Resorption
Systemic factors
(2)
– Nutritional abnormality e.g. Calcium and Vitamin D deficiency
– Systemic bone disease
– Systemic bone disease
(3)
- Osteoporosis
- Endocrine dysfunction e.g. Diabetes, Hyperthyroidism, Hyperparathyroidism
- Other conditions that affect bone metabolism e.g. Osteomalacia, Renal Osteodystrophy
Factors Responsible for Enhanced Bone Resorption
Local factors
(3)
- Surgery (Alveoloplasty, Some form of bone removal in the alveolar ridge)
- Denture wearing
- Low mandibular plane angle
– Can generate greater bite force
The Challenge of Edentulism
With loss of teeth, there is
significant resorption leading to
— in the jaws.
However, the —
still remain in the same place.
bone atrophy
muscle attachments
Bone Loss following Dental Extractions
Long Term Results
(6)
- Loss of bony alveolar ridge
- Increase in intra-arch space
- Increase influence of surrounding soft tissue
– Tongue expansion - Decrease stability and retention of prosthesis
- Increased discomfort from improper prosthesis adaptation
- Severe resorption of the mandible can make the patient susceptible for a fracture
Evaluation of Supporting Bone
(4)
- Inspection
- Palpation
- Radiographic Examination
- Models Evaluation
Characteristics of the Ideal Alveolar Ridge
(4)
- Proper Jaw Relationship.
- Proper Configuration of the Alveolar Process (broad U-shaped ridge with Vertical components
as Parallel as possible). - No Bony or Soft tissue protuberances or undercuts.
- Adequate attached Keratinized mucosa in the primary denture bearing area.
Characteristics of the Ideal Alveolar ridge
(6)
- Adequate Vestibular Depth (Buccal and Lingual sulcus)
- Adequate bone height and width
- “Fixed Tissue” under dentures
- Absence of redundant tissue
- No obstructing frena or scar bands
- No displacing muscle attachments
Principles of Patient Evaluation and Treatment
Planning
(3)
- Understand clearly the desired design of final prosthesis.
- Develop a detailed treatment plan based on a thorough clinical examination.
- Define and outline the Problem. (Is it with the Soft tissue/ Hard Tissue OR Both
AFTER THIS MAKE A DECISION FOR THE TYPE OF
PREPROSTHETIC
SURGICAL PROCEDURE
Pre-prosthetic Surgical Procedures
(3)
- Pre-prosthetic surgical procedures span a spectrum from very simple to quite
complex: - Minor Pre-prosthetic Surgery
- Advanced Pre-prosthetic Surgery
General Considerations for Minor Pre-prosthetic Surgery
(4)
- Most can be done with L.A.
- Advanced forms of pain control/ I.V sedation are helpful in Patients who are anxious
and cases that need more elaborate pre-prosthetic surgery. - Patients are often old, and require detailed workup and monitoring.
- Restorative phase in 4 – 8 weeks postop
Minor Pre-prosthetic Surgical procedures
* Many Minor Modifications of the alveolar ridge and vestibular areas can
greatly improve
denture stability and retention.
* Hard Tissue(Osseous) surgery
* Soft Tissue Surgery
Bony Recontouring of Alveolar Ridges
(4)
- Simple alveoloplasty (Multiple Teeth Extraction).
- Intraseptal alveoloplasty.
- Maxillary tuberosity reduction.
- Buccal exostosis and extensive undercuts.
Tori Removal
(2)
- Maxillary tori.
- Mandibular tori.
Alveoloplasty
- Alveoloplasty is “ the recontouring or reduction of a portion of the alveolar
process”
Goals of alveoloplasty:
(3)
- Eliminate bony projections that result in undercuts
- Improve the path of insertion of the prosthesis
- Eliminate bony sources of irritation
Types of Alveoloplasty
(3)
- Simple alveoloplasty
- Simple alveoloplasty with buccal or labial cortical reduction
- Intraseptal alveolectomy and cortical plate in-fracture
Intraseptal Alveoloplasty and cortical plate in-fracture
(3)
*Periosteal attachment is maintained
*Alveolar height is preserved
*Alveolar width is lost
Disadvantages of Alveoloplasty
(3)
- Accelerates bone loss
- Increased post-operative pain
- Potential Complications:
- Oral-antral communication(Maxilla)
- Accelerates bone loss
(2)
- Buccal/labial cortical alveoloplasty (most long term loss)
- Intraseptal alveolectomy (significantly less)
Maxillary Tuberosity (Osseous) Reduction
(4)
- Determine if it is excess bone /excess soft tissue or combination of two.
- Examine pre-op x-ray (Panoramic X-Ray necessary)
- Locate floor of the sinus
- Reasons for removal
– Increase intra-arch space
Surgical Removal of Palatal Tori
Clinical Examination:
(3)
- Size of the Torus (How large is it ?)
- How far has the palatal torus extended posteriorly?
- Is the overlying mucosa on the top of the torus
traumatized?
Indications for Removal
(5)
- Chronic irritation
- Inability to construct prosthesis
- Presence of deep undercuts
- Interference with normal speech
- The torus poses psychological problems (e.g., malignancy phobia)
Surgical Removal of Tori & Exostoses
(3)
- Use L.A.
- Raising the thin flap is the most tedious portion of the surgery.
- Assure hemostasis before wound closure.
- Remove Tori with:
(3)
- Surgical drill and fissure bur
- Osteotome and Mallet
- A combination of both
Minor Pre-prosthetic Soft Tissue Surgical Procedures
(4)
- Maxillary tuberosity reduction..
- Inflammatory Fibrous hyperplasia.
- Labial Frenectomy.
- Lingual Frenectomy
Epulis fissuratum (Inflammatory Fibrous Hyperplasia)
* Etiology:
This is an inflammatory fibrous hyperplasia of oral mucosa caused by an over-extended
denture border.
Epulis fissuratum (Inflammatory Fibrous Hyperplasia)
* Treatment:
Surgical excision of the lesion and reduction of the denture border
Frenectomy
(3)
Labial frenectomy
* Buccal frenectomy
* Lingual frenotomy
Labial frenectomy
(4)
– Simple labial frenectomy (Diamond Shaped)
– Z-plasty
– V-Y plasty
– V - Diamond plasty (Modified V-Y plasty)
indications For Frenectomy
(2)
- When speech is impaired due to Ankyloglossia (Tongue tie) – Lingual Frenum
- To improve denture seating and stability
Z-Plasty Technique For Maxillary Frenum
Main advantage of this method
is
Minimal Scar tissue formation
V-Y plasty can be for
lengthening the
localized area
