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Oral Surgery III > Minor Preprosthetic Surgery > Flashcards

Minor Preprosthetic Surgery Flashcards

1
Q

what is pre-prosthetic surgery

A

the surgical improvement of the denture bearing area and surrounding tissues (hard and soft) to support the best possible prosthetic replacement

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2
Q

what is the goal of pre prosthetic surgery

A

to establish a functional biologic platform for supportive or retentive mechanisms that will maintain or support prosthetic rehabilitation

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3
Q

what starts an immediate change in the jaws

A

tooth loss

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4
Q

what is the primary cause for resorption after tooth loss

A

lack of functional stress from teeth and periodontal ligament following extraction

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5
Q

when does bone begin to resorb

A

right after extraction

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6
Q

is the bone resorbing process the same across patients

A

no

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7
Q

what is the extent of bone loss in each patient

A

the bone loss stabilizes and in others it continues to include a total loss of alveolar and underlying basal bone

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8
Q

resorption is ______ by denture wearing

A

accelerated

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9
Q

mandibular denture wearers are affected _____ than maxillary denture wearers

A

more

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10
Q

why does resorption affect the mandible more severely

A
  • decreased surface area
  • less favorable distribution of forces
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11
Q

what are the systemic factors responsible for enhanced bone resorption

A
  • nutritional abnormality like calcium and vitamin D deficiency
  • systemic bone disease such as osteoporosis, endocrine dysfunction, and other conditions that affect bone metabolism
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12
Q

what endocrine dysfunction disorders enhance bone resorption

A

diabetes
- hyperthyroidism
- hyperparathyroidism

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13
Q

what are the other conditions that affect bone metabolism and enhance bone resorption

A

osteomalacia and renal osteodystrophy

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14
Q

what are the local factors that enhance bone resorption

A
  • surgery: alveoplasty, bone removal in the alveolar ridge
  • denture wearing
  • low mandibular plane angle
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15
Q

why can a low mandibular plane angle contribute to enhanced bone resorption

A

can generate greater bite force

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16
Q

with loss of teeth there is significant resorption leading to _____ in the jaws, however the muscle attachments:

A

bone atrophy; still remain in the same place

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17
Q

what are the long term results of bone loss following dental extractions

A
  • 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
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18
Q

what are the anatomical of an ideal alveolar ridge

A
  • adequate FOM
  • broad alveolar ridge
  • mylohyoid muscle
  • deep vestibular depth
  • mandible
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19
Q

what is evaluated in supporting bone

A
  • inspection
  • palpation
  • radiographic examination
  • models evaluation
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20
Q

what are the characteristics of the ideal alveolar ridge

A
  • 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
21
Q

what are the principles of patient evaluation and treatment planning

A
  • 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
22
Q

what are the general considerations for minor pre prosthetic surgery

A
  • 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
23
Q

what are the two types of minor pre prosthetic surgery

A
  • hard tissue (osseous) surgery
  • soft tissue surgery
24
Q

what are the types of bony recontouring of alveolar ridges

A
  • simple alveoplasty (multiple teeth extraction)
  • intraseptal alveoplasty
  • maxillary tuberosity reduction
  • buccal exostosis and extensive undercuts
25
Q

what are the types of tori removal

A

mandibular tori removal
maxillary tori removal

26
Q

what is alveoplasty

A

the recontouring or reduction of a portion of the alveolar process

27
Q

what are the goals of alveoplasty

A
  • eliminate bony projections that result in undercuts
  • improve the path of insertion of the prosthesis
  • eliminate bony sources of irritation
28
Q

what are the types of alveoplasty

A
  • simple alveoplasty
  • simple alveoplasty with buccal or labial cortical reduction
  • intraseptal alveolectomy and cortical plate in-fracture
29
Q

what happens in an intraseptal alveoplasty and cortical plate in-fracture

A
  • periosteal attachment is maintained
  • alveolar height is preserved
  • alveolar width is lost
30
Q

what are the disadvantages of alveoplasty

A
  • 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
31
Q

what are the considerations for maxillary tuberosity reduction

A
  • 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
32
Q

what are the steps in maxillary tuberosity reduction

A
  • incision
  • elevate flap- adequate exposure
  • use bone rongeurs or bur/surgical handpiece to remove bone
  • tissue re-approximation
33
Q

what are the steps in surgical removal of buccal exostoses

A
  • after tooth removal, raise a flap with vertical release
  • use of bone use of rongeurs
  • closure with continuous suture
34
Q

what does the clinical exam for surgical removal of palatal tori consist of

A
  • size of the torus
  • how far has the palatal torus extended posteriorly
  • is the overlying mucosa on the top of the torus traumatized
35
Q

what are the indications for tori removal

A
  • chronic irritation
  • inability to construct prosthesis
  • presence of deep undercuts
  • interference with normal speech
  • torus poses psychological problems- malignancy phobia
36
Q

what are the considerations for the surgical removal or tori and exostoses

A
  • 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
37
Q

what are the minor pre prosthetic soft tissue surgical procedures

A
  • maxillary tuberosity reduction
  • inflammatory fibrous hyperplasia
  • labial frenectomy
  • lingual frenectomy
38
Q

what are the steps in soft tissue tuberosity reduction

A
  • elliptical incision: incision is canoe shaped wedge
  • soft tissue excised
  • undermining buccal and palatal flaps for tension and free closure
  • final removal
  • closure
39
Q

what is the etiology for epulis fissuratum

A

this is an inflammatory fibrous hyperplasia of oral mucosa caused by an over extended denture border

40
Q

what is the tx for epulis fissuratum

A

surgical excision of the lesion and reduction of the denture border

41
Q

what are the types of frenectomy

A
  • labial frenectomy
  • buccal frenectomy
  • lingual frenectomy
42
Q

what are the types of labial frenectomy

A
  • simple labial frenectomy (diamond shaped)
  • Z-plasty
  • V-Y plasty
  • V-diamond plasty ( modified V-Y plasty)
43
Q

what are the indications for frenectomy

A
  • when speech is impaired due to anklyoglossue (tongue tie) from the lingual frenum
  • to improve denture seating and stability
44
Q

how is a simple labial frenectomy done

A
  • excision along lateral margins- tissue removed- periosteum exposed
  • placement of suture through mucosa and periosteum
  • closure
45
Q

what is the advantage of Z-plasty technique for maxillary frenum

A

minimal scar tissue formation

46
Q

what are the steps for a Z-plasty technique for elimination of labial frenum

A
  • a small elliptical excision of mucosa and underlying connective tissue
  • flaps are then undermined and rotated to desired position
  • wound closure with interrupted sutures
47
Q

what is V-Y plasty used for

A

lengthening the localized area

48
Q

what are the steps in the lingual frenectomy

A
  • 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
49
Q
A

Oral Surgery III (11 decks)

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