Minor Preprosthetic Surgery Flashcards
what is pre-prosthetic surgery
the surgical improvement of the denture bearing area and surrounding tissues (hard and soft) to support the best possible prosthetic replacement
what is the goal of pre prosthetic surgery
to establish a functional biologic platform for supportive or retentive mechanisms that will maintain or support prosthetic rehabilitation
what starts an immediate change in the jaws
tooth loss
what is the primary cause for resorption after tooth loss
lack of functional stress from teeth and periodontal ligament following extraction
when does bone begin to resorb
right after extraction
is the bone resorbing process the same across patients
no
what is the extent of bone loss in each patient
the bone loss stabilizes and in others it continues to include a total loss of alveolar and underlying basal bone
resorption is ______ by denture wearing
accelerated
mandibular denture wearers are affected _____ than maxillary denture wearers
more
why does resorption affect the mandible more severely
- decreased surface area
- less favorable distribution of forces
what are the systemic factors responsible for enhanced bone resorption
- nutritional abnormality like calcium and vitamin D deficiency
- systemic bone disease such as osteoporosis, endocrine dysfunction, and other conditions that affect bone metabolism
what endocrine dysfunction disorders enhance bone resorption
diabetes
- hyperthyroidism
- hyperparathyroidism
what are the other conditions that affect bone metabolism and enhance bone resorption
osteomalacia and renal osteodystrophy
what are the local factors that enhance bone resorption
- surgery: alveoplasty, bone removal in the alveolar ridge
- denture wearing
- low mandibular plane angle
why can a low mandibular plane angle contribute to enhanced bone resorption
can generate greater bite force
with loss of teeth there is significant resorption leading to _____ in the jaws, however the muscle attachments:
bone atrophy; still remain in the same place
what are the long term results of bone loss following dental extractions
- 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 to fracture
what are the anatomical of an ideal alveolar ridge
- adequate FOM
- broad alveolar ridge
- mylohyoid muscle
- deep vestibular depth
- mandible
what is evaluated in supporting bone
- inspection
- palpation
- radiographic examination
- models evaluation
what are the characteristics of the ideal alveolar ridge
- proper jaw relationship
- proper configuration of the alveolar process (broad U-shaped 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
- 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
what are the 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 exam
- define and outline the problem - soft tissue or hard tissue issues
- after this make a decision for the type of preprosthetic surgical procedure
what are the general considerations for minor pre prosthetic surgery
- most can be done with LA
- advanced forms of pain control/IV 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
what are the two types of minor pre prosthetic surgery
- hard tissue (osseous) surgery
- soft tissue surgery
what are the types of bony recontouring of alveolar ridges
- simple alveoplasty (multiple teeth extraction)
- intraseptal alveoplasty
- maxillary tuberosity reduction
- buccal exostosis and extensive undercuts
what are the types of tori removal
mandibular tori removal
maxillary tori removal
what is alveoplasty
the recontouring or reduction of a portion of the alveolar process
what are the goals of alveoplasty
- eliminate bony projections that result in undercuts
- improve the path of insertion of the prosthesis
- eliminate bony sources of irritation
what are the types of alveoplasty
- simple alveoplasty
- simple alveoplasty with buccal or labial cortical reduction
- intraseptal alveolectomy and cortical plate in-fracture
what happens in an intraseptal alveoplasty and cortical plate in-fracture
- periosteal attachment is maintained
- alveolar height is preserved
- alveolar width is lost
what are the disadvantages of alveoplasty
- accelerates bone loss: buccal/labial cortical alveoplasty (most long term loss) and intraseptal alveolectomy (significantly less)
- increased post operative pain
- potential complications: oral antral communication in the maxilla
what are the considerations for maxillary tuberosity reduction
- determine if it is excess soft tissue or bone or combo of the two
- examine pre-op xray: pano is necessary
- locate the floor of the sinus
- reasons for removal: increase intra arch space
what are the steps in maxillary tuberosity reduction
- incision
- elevate flap- adequate exposure
- use bone rongeurs or bur/surgical handpiece to remove bone
- tissue re-approximation
what are the steps in surgical removal of buccal exostoses
- after tooth removal, raise a flap with vertical release
- use of bone use of rongeurs
- closure with continuous suture
what does the clinical exam for surgical removal of palatal tori consist of
- size of the torus
- how far has the palatal torus extended posteriorly
- is the overlying mucosa on the top of the torus traumatized
what are the indications for tori removal
- chronic irritation
- inability to construct prosthesis
- presence of deep undercuts
- interference with normal speech
- torus poses psychological problems- malignancy phobia
what are the considerations for the surgical removal or tori and exostoses
- use LA
- raising the thin flap is the most tedious portion of the surgery
- remove tori with surgical drill and fissure bur, osteotome and mallet, a combo of both
- assure hemostasis before wound closure
what are the minor pre prosthetic soft tissue surgical procedures
- maxillary tuberosity reduction
- inflammatory fibrous hyperplasia
- labial frenectomy
- lingual frenectomy
what are the steps in soft tissue tuberosity reduction
- elliptical incision: incision is canoe shaped wedge
- soft tissue excised
- undermining buccal and palatal flaps for tension and free closure
- final removal
- closure
what is the etiology for epulis fissuratum
this is an inflammatory fibrous hyperplasia of oral mucosa caused by an over extended denture border
what is the tx for epulis fissuratum
surgical excision of the lesion and reduction of the denture border
what are the types of frenectomy
- labial frenectomy
- buccal frenectomy
- lingual frenectomy
what are the types of labial frenectomy
- simple labial frenectomy (diamond shaped)
- Z-plasty
- V-Y plasty
- V-diamond plasty ( modified V-Y plasty)
what are the indications for frenectomy
- when speech is impaired due to anklyoglossue (tongue tie) from the lingual frenum
- to improve denture seating and stability
how is a simple labial frenectomy done
- excision along lateral margins- tissue removed- periosteum exposed
- placement of suture through mucosa and periosteum
- closure
what is the advantage of Z-plasty technique for maxillary frenum
minimal scar tissue formation
what are the steps for a Z-plasty technique for elimination of labial frenum
- a small elliptical excision of mucosa and underlying connective tissue
- flaps are then undermined and rotated to desired position
- wound closure with interrupted sutures
what is V-Y plasty used for
lengthening the localized area
what are the steps in the lingual frenectomy
- administer LA 2% lido with 1:100,000 epi on either side of lingual frenum for local pain control and hemostasis
- application of traction suture on the tongue with 3-0 silk suture will help to manipulate the tongue during surgery with minimal use of tissue forceps and hence decrease the trauma to the tongue
- assistant holds the traction suture to stabilize the tongue while the operator proceeds to remove the lingual frenum
- incision made at superior portion of frenal attachment
- a vertical incision given through the mucosa alongside the frenulum followed by blunt dissection to the floor of the mouth
- during the lingual frenectomy procedure care must be exercised not to damage the Wharton’s duct lying on either side of the lingual frenum
- after the excision of the linugal frenum, the alteral wound margins are undermined with scissors to facilitate primary closure of the wound
- close wound with interrupted sutures
