minor preprosthetic surgery Flashcards
Pre-prosthetic Surgery defined
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?
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.
Bone Loss following Dental Extractions Facts
* Tooth Loss starts?
* Lack of functional stress from teeth and periodontal ligament following extraction is?
* Bone begins to resorb? predictable?
* In some patient’s, the bone loss? and in others it continues to include?
- Tooth Loss starts an immediate change in the jaws.
- Lack of functional stress from teeth and periodontal ligament following extraction is the primary cause for this resorption.
- Bone begins to resorb after extraction and this process is unpredictable from one patient to another.
- In some patient’s, the bone loss stabilizes and in others it continues to include a total loss of alveolar and underlying basal bone.
Alveolar Bone Resorption
Facts
* Resorption is accelerated by?
* more affected arch?
* why is one arch more affected?
- Resorption is accelerated by denture wearing
- Mandibular denture wearers affected more than maxillary denture wearers
- Resorption affects the mandible more severely because
- Decreased surface area
- Less favorable distribution of forces
systemic factors of enhanced resorbtion
– Nutritional abnormality e.g. Calcium and Vitamin D deficiency
– Systemic bone disease
* Osteoporosis
* Endocrine dysfunction e.g. Diabetes, Hyperthyroidism, Hyperparathyroidism
* Other conditions that affect bone metabolism e.g. Osteomalacia, Renal Osteodystrophy
local factors of enhanced resorb
- Surgery (Alveoloplasty, Some form of bone removal in the alveolar ridge)
- Denture wearing
- Low mandibular plane angle
– Can generate greater bite force
bone loss patterns of both arches
muscular attachments with edentualism
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
Bone Loss following Dental Extractions Long Term Results
- 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
components
- Inspection
- Palpation
- Radiographic Examination
- Models Evaluation
Characteristics of the Ideal Alveolar Ridge
Characteristics of the Ideal Alveolar Ridge
- Jaw Relationship?
- Configuration?
- protuberances or undercuts?
- preferred tissue type?
- 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
- Adequate ?
- bone height/width?
- Tissue under dentures?
- Absence of?
- No obstructing?
- No displacing?
Characteristics of the Ideal Alveolar ridge
- 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
* Understand clearly the?
* Develop a detailed treatment plan based on?
* Define and outline the?
AFTER THIS MAKE A?
Principles of Patient Evaluation and Treatment
Planning
* 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
General Considerations for Minor Pre-prosthetic Surgery
* Most can be done with?
* Advanced forms of pain control/ I.V sedation are helpful in Patients who are? and?
* Patients are often old, and require detailed?
* Restorative phase in ? weeks postop
- 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 Bony Recontouring of Alveolar Ridges
- Simple alveoloplasty (Multiple Teeth Extraction).
- Intraseptal alveoloplasty.
- Maxillary tuberosity reduction.
- Buccal exostosis and extensive undercut
tori removal
max and man tori removal
Alveoloplasty
- Alveoloplasty is “ the recontouring or reduction of a portion of the alveolar
process”
Goals of alveoloplasty:
- Eliminate bony projections that result in undercuts
- Improve the path of insertion of the prosthesis
- Eliminate bony sources of irritation
Types of Alveoloplasty
- Simple alveoloplasty
- Simple alveoloplasty with buccal or labial cortical reduction
- Intraseptal alveolectomy and cortical plate in-fracture
results of Intraseptal Alveoloplasty and cortical plate in-fracture
*Periosteal attachment is maintained
*Alveolar height is preserved
*Alveolar width is los
Disadvantages of Alveoloplasty
- Accelerates bone loss
- Buccal/labial cortical alveoloplasty (most long term loss)
- Intraseptal alveolectomy (significantly less) - Increased post-operative pain
- Potential Complications:
- Oral-antral communication(Maxilla)
Maxillary Tuberosity (Osseous) Reduction pre-op
* Determine if it is excess?
* Examine pre-op ?
* Locate?
* Reasons for removal?
- 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:
- Size ?
- How far?
- Is the overlying mucosa?
- 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 of tori
* Chronic?
* Inability to?
* Presence of ?
* Interference with?
* The torus poses?
- 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
* Use?
* most tedious portion of the surgery?
* Remove Tori with?
* Assure what before wound closure?
- Use L.A.
- Raising the thin flap is the most tedious portion of the surgery.
- Remove Tori with:
- Surgical drill and fissure bur
- Osteotome and Mallet
- A combination of both
- Assure hemostasis before wound closure
Minor Pre-prosthetic Soft Tissue Surgical Procedures
- Maxillary tuberosity reduction..
- Inflammatory Fibrous hyperplasia.
- Labial Frenectomy.
- Lingual Frenectomy
Epulis fissuratum (Inflammatory Fibrous Hyperplasia)
* Etiology:
* Treatment:
- Etiology: This is an inflammatory fibrous hyperplasia of oral mucosa caused by an over-extended
denture border. - Treatment: Surgical excision of the lesion and reduction of the denture border
Types of Frenectomy
- Labial frenectomy
– Simple labial frenectomy (Diamond Shaped)
– Z-plasty
– V-Y plasty
– V - Diamond plasty (Modified V-Y plasty) - Buccal frenectomy
- Lingual frenotomy
Indications For Frenectomy
* When speech is impaired due to?
* To improve ?
- When speech is impaired due to Ankyloglossia (Tongue tie) – Lingual Frenum
- To improve denture seating and stability
Simple Labial Frenectomy steps
- Excision along lateral margins –tissue removed – periosteum exposed
- Placement of suture through mucosa and periosteum
- Wound closure
Z-Plasty Technique For Maxillary Frenum Main advantage
Main advantage of this method
is Minimal Scar tissue formation
Labial Frenectomy - V - Y Plasty
V-Y plasty can be for?
Labial Frenectomy - V - Y Plasty
V-Y plasty can be for lengthening the
localized area
Lingual Frenectomy Procedure
- LA
- traction suture for tongue
- ncision made at superior portion of Frenal attachment
- vertical incision given through the mucosa alongside of the frenulum followed by blunt dissection to the floor of mouth
- Lateral wound margins are undermined with scissors to facilitate
primary closure of the wound - closure with sutures
