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Oral Surgery > Pre-Prosthetic Oral Surgery > Flashcards

Pre-Prosthetic Oral Surgery Flashcards

1
Q

population that is edentulous

A

10% of american population

35% of those are above 65 years old

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2
Q

loss of dentition consequences

A

irregular alveolar ridge

undercuts

scarring

muscle interferes with denture stability

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3
Q

general goal of pre-prosthetic surgery

A

prepare the mouth to relieve a functional dental prosthesis

preserve hard and soft tissue

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4
Q

maxillary resorptionproblems

A

anteriorly - many times there is a concavity

posterior – problem with maxillary sinuse

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5
Q

mandibular resorption

A

knife edge ridge
- cortical bone - cant place implants there direcrtly without grafting

or grind down and place - but sacrifice knife edge

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6
Q

classification of edentulous jaws – general

A

I– VI

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7
Q

class I edentulous jaw description

A

dentate - still teeth

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8
Q

class II edentulous jaw description

A

immediately post-extraction

like good enough ridge to place something on right away

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9
Q

class III edentulous jaw description

A

convex ridge form, adequate in height and width

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10
Q

class IV edentulous jaw description

A

knife-edge form, adequate in height but INADEQUATE in width

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11
Q

class V edentulous jaw description

A

flat ridge form - inadequate height AND width

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12
Q

class VI edentulous jaw description

A

loss of basal bone which may be extensive but follows NO PREDICTABLE pattern

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13
Q

specific goals for pre-prosthetic intervention

A
  1. ridge should have adequate width, height, and U shape
  2. mucosa should have adequate UNIFORM thickness
  3. ridge without undercuts or sharpness
  4. no bony or soft tissue protruberence
  5. adequate buccal and lingual sulci depth
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14
Q

three broad overview of intra-oral examination

A

anatomical structures

  1. VISUAL
  2. PALPATE
  3. RADIOGRAPHIC EXAMINATION
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15
Q

visual inspection look at

A

ridge contour

undercuts

muscle atachment

soft tissue health

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16
Q

palpate?

A

denture bearing areas might reveal sharp bony areas

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17
Q

radiographic examination

A

need to rule out any bony pathologies

  • if decided to leave retained roots, should be notified to patietn
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18
Q

retained roots usually are noticeable to the patient?

A

NO – 73-84% of the retained root fragments are seen on radiographic examination of edentulous patients, and majority of theem are present WITH NO ASSOCIATED SYMPTOMS

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19
Q

prevelence of retained roots

A

11-37%

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20
Q

maxilla intra oral exam

A

evaluate for undercuts or bony protruberences

palatal tori

tuberosity

labial and buccal frenum

hyperpladstic tissue

inter arch distance

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21
Q

mandible intra oral exam

A

ridge form

contour

irregularities

buccal extoses

tori

muscle attachment

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22
Q

overclosure of the mandible?

A

might give the impression of a pseudo class III

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23
Q

normal resting position?

A

must evaluate patient in this as well to get the antero-posterior vertical relationship

also

  • assymetries
  • inter-arch distance
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24
Q

lateral ceph can

A

help determine anteroposteiror relation of the jaws

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25
Q

one of the most important determinants of success with complete dentures

A

soft tissue —health and quality

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26
Q

characterstics you want in soft tissue

A

healthy keratinized

firmly attached to the underlying bone

vestibule FREE of iflammation

muscle attachment low/ high to the alveolar crest

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27
Q

specific thing poited out that makes the denture base unstable?

A

hyperplastic tissue over the maxillary ridge — tissue will make the denture base unstable

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28
Q

implicationof labial frenum?

A

plasty

- reposition it if in way

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29
Q

treatment planning after?

A

intra and extra oral exams

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30
Q

tx planning outline

A
  1. medical and dx history
  2. concerns of the patient
    - benefits and possible complications
  3. intra/extra oral exam
  4. radiographi exam
  5. alternative treatment
  6. surgical procedures involving bone contouring or augmentatino should be addressed first, followed by soft tissue proceudres
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31
Q

surgical blades noted in armamentarium

A

15 and 11

bard parker scalpal handle and molt periosteal elevator

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32
Q

step 1 for immediate denture treatment

w/ notes

A

prophylaxis PRIOR to extractions

to MINIMIZE BLEEDING AND INFECTION PROBABILITIES

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33
Q

Step 2 for immediate denture treatment

w/ notes

A

complicated extractions

as bony changes may effect final impressions and denture fit

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34
Q

step 3 for immediate denture treatment

w/ notes

A

extractions of maxillary and mandibular molars

after extractions – allow 6 weeks for healing before making final impressoins

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35
Q

after extractions of molars wait?

A

6 weeks before final impressions

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36
Q

final impressions when

A

after the posterior extractions

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37
Q

step 5 for immediate denture treatment

w/ notes

A

model surgery

remove the teeth that are visible above the gingiva, contour gingival tissue, and remove undercuts

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38
Q

step 6 for immediate denture treatment

w/ notes

A

construction of clear surgical stent

will guide the surgeon during the preocedure for alveolar recontouring
- must make sure it is seated completely

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39
Q

post op instructions for immediate

A

antibiotics are usually UNNECESSARY

do NOT remove denture until follow-up with dentist (24 hours)

follow up with surgeon in 1 week

soft-tissue reline if needed

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40
Q

elliptical incision?

A

looked at the mandibular anterior
- raise a flap and eliminate tissue and bone

grind down with pinapple bur

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41
Q

be careful with pineapple bur?

A

yes – around cancellous bone – this is soft bone and this bur can remove too much if not careful

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42
Q

remove inter-proximal papilla?

A

is an option – then can remove the bone in the inter-ridge areas and smooth down

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43
Q

remove mandibular lingual extoses

A

make incision in bone towards buccal

full flap

so not too worried about lingual nerve

because incisoin on bone towards buccal and full buccal periosteal flapp - so lingual nerve on the other side

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44
Q

most alveolopplasty are done

A

on the maxilla and anterior mandible

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45
Q

alveoplasty definiotn

A

contouring the alveolar ridge to remove irregularities and under-cuts

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46
Q

goals of alveoplasty

A

provide stable base for prosthesis

preserve alveolar bone

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47
Q

pitfalls of alveoplasty

A

poor evaluation of the patient
- does the patient need bone reduction or augmentation?

poor communication with the dentist
- dentists goals and expectaions met?

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48
Q

tip of elevator has to be?

A

POINTED EDGE CONTACTING BONE

could damage tissue and nerves in area if dont

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49
Q

surgical technique for alveoplasty with incision?

A

crestal incision over the area with VERTICAL RELEASE INCISION

  • FULL thickness flap
  • be careful with anatomical structures
50
Q

periostal elevator?

A

MUST USE – pointed edge of the elevator must be AGAINST BONE

51
Q

reflect with?

A

a seldin or minnesota retractor

52
Q

start reflection?

A

where the vertical and crestal incision join

53
Q

contour bone with?

A

bone file, rongeurs and/ or round bur

- ELIMINATE UNDERCUTS AND SHARP EDGES

54
Q

eliminate the undercuts and sharp edges

A

bone file, rongeurs and round bur

55
Q

irrigate with?

A

NNS and suture to original position

56
Q

implication of lone standing tooth

A

the tooth super-erupts and brings bone with it - so if just remove the tooth - left with a bony protuberance

57
Q

envelope flap has?

A

NO releasing incisions

58
Q

isolated teeth in maxilla posterior make sure to check

A

x-ray

dont use elevator – maxillary sinus may come with the tooth

59
Q

indication for maxillary tuberosity reduction

A

not enough space, vertically or horizontally for denture base

severe undercut

mobile tissue

60
Q

radiograph with max tuberosity reduction?

A

panorex – to determine the proximity of the maxillary sinus

helps to determien if it is fibrous or bony in nature

61
Q

fibrous tuberosity technique?

A

wedge resection

62
Q

wedge resection used in

A

fibrous tuberosity reduction on maxilla

63
Q

surgical techniwue for wedge resection

incision type? with?

A

ELLIPTICAL INCISION

- #15 BLADE

64
Q

wedge resection incision starts?

A

elliptical incision

STARTSON CREST or AT JUNCTION of the normal and fibrotic tissue

65
Q

wedge resection incisoin extends?

A

POSTERIORLY towards hamular notch

66
Q

submucous lateral resection?

A

yes used in the wedge resection technique with fibrous tuberosity reuction

uses #15 blade

67
Q

make sure to preserve ___ with wedge resection

A

the vestibule and attached gingiva

68
Q

suture with wedge resection

A

approximate flaps and suture with CONTINUOUS 3.0 suture

69
Q

fibrous vs bony identified by?

A

x ray normally

70
Q

bony tuberosity maxillary reduction incision?

A

we do 3 - corner flap - have to reflect more to work in the bone

single crestal incision
release incision ***

71
Q

flap with bony tuberoisty

A

similar procedure to an alveloplasty

FULL THICKNESS with periosteal elevator

place seldin retractor - tip in bone

72
Q

contour bone in bony tuberosity removal?

A

YES – with rongeur, oval bur, bone file

73
Q

suture in bony tuberosity?

A

suture 3.0

74
Q

most tori…

A

do not need to be removed
- but if interfere - must remove

solid cortical bone

75
Q

indications for removal of maxillary torus

A

constant trauma

prevent good post dam seal

large undercuts

speech impediment

psychological phobia

76
Q

radiograph with max tori?

A

yes – to evaluate and determine the proximity of nasal cavity and maxillary sinus

77
Q

technique for max tori removal

A

maxillary impression

torus removed from the cast and clear stent is made

stent will protect the area andprevent hematom

78
Q

stent can prevent

A

a hematoma

79
Q

LA for max tori removal?

A

15 blade used to make an incision in the for of a Y

LA with VASOCONSTRICTOR for greater palatine and nasopalatine

80
Q

incision form for max tori removal?

reflection?

A

Y shape

and reflect with a periosteal elevator

81
Q

score?

A

score the torus with a FISSURE BUR

82
Q

fissure bur?

A

used to score the torus on the maxilla

83
Q

technique for removal of max torus?

A

score torus with fisure bur

chisel and mallet or round bur

smooth with large oval burr with copious irrigation

suture with chromic 3.0

84
Q

suture with max tosi removal?

A

with chromic 3.0

85
Q

mandibular tori location?

A

usually bilateral and located on the lingual aspect

86
Q

mandibular tori can interefere?

A

yes with the mandibualr partial or complete denture

87
Q

LA technique for mandibular tori removal

A

IAN blocks

88
Q

incision for mandibular tori

A

incision alongt he crest of the ridge extended equivalent of 2 teeth beyond torus

release incisions usually NOT needed

89
Q

release incisions in mandibular tori?

A

usually NOT needed

90
Q

flap in mandibular tori removal

detailed with anatomy included

A

FULL thickness flap

be careful because mucosa is THIN

the lingual ARTERY and NERVE are close to the surgical area

flap extended BELOW the torus and protected with selding retractor

91
Q

groove in mandibular tori removal?

A

yes use a groove with fissure burr on the SUPERIOR MARGIN

  • depth should not be more than halfway through the vertical dimension
92
Q

monobevel chisel?

A

used to be placed into the groove created with fissure bur when removing a mandibular tori

93
Q

mandibular tori removal

implication with chin?

A

needs to be supported when removing

  • so support manually and then monobevel chisel in the groove
  • tap with a mallet
  • a bur could also be used
94
Q

mandibular tori suture?

A

SILK 3.0

vs. maxillary tori was chromic 3.0

95
Q

vestibuloplasty goal

A

remove unwanted muscle insertions into the alveolar ridge that prevents denture flange from extending adequate stability and retention

96
Q

vestibuloplasty requires adequate?

A

HEIGHT OF ALVEOLAR BONE

97
Q

vestibuloplasty surgical technique

A

LA
incision
- placed at the JUNCTION of attached and unatteched mucosa with a #15 blade

partial thickness flap is raised with the blade or deans scissors preserving the periosteum

periosteal has to be left
so PARTIAL THICKNESS FLAP

98
Q

vestibuloplasty incision

A

incision

- placed at the JUNCTION of attached and unatteched mucosa with #15

99
Q

flap in vestibuloplasty

A

partial thickness flap is raised with the blade or deans scissors preserving the periosteum

100
Q

suture in vestibuloplasty

A

the mucosal edge is sutured to the bottom of dissected area

101
Q

resulting denuded periosteum can be handled in different ways… name the two

A
  1. heal by SECONDARY INTENTION (50% will relapse)
  2. GRAFT the area
    - palatal graft
    - collagen membrane
    - cadaveric mucoslal membrane
102
Q

perforate graft?

A

YES – graft should be perforated with a #11 blade after suturing to prevent blood clots forming between the graft and periosteum

103
Q

protect the graft?

A

yes – use patients denture or soft clear splint with soft tissue relining material to protect the graft

104
Q

denture / splint removal after vestibuloplasty

A

should NOT be removed for a WEEK

105
Q

removal of the splint after grafting?

A

graft will look WHITE - this is NORMAL

106
Q

angiogensis and healing with graft?

A

angiogenesis occurs within 48 hours and healing takes up to 5-6 weeks

107
Q

labial frenectomy

A

frenum consists of thin bands of connective tissue attached to the bone

can interfere with the extension of the denture flange if not altered

108
Q

simple excision used in? effective when?

A

labial frenectomy

*EFFECTIVE WHEN MUCOSAL AND FIBROUS BAND IS RELATIVE NARROW

109
Q

labial frenectomy surgical technique with incision?

A

simple incision is made
ELLIPTICAL
- is done around the frenum down to the periosteum

RHOMBOID IN SHAPE AROUND IT

110
Q

incision margins undermined with___ in labial frenectomy

A

deans scissors

111
Q

Z plasty?

A

technique to remove labial frenum

112
Q

z plasty effetive when

A

when mucosal and fibrous band is relatively narrow

113
Q

incisoin with z plasty

A

with #15 blade – do incision ALONG the frenum

at edge of the incisions - two small incisions are made in a Z fashion

114
Q

flaps in labial frenectomy with z plasty technique

A

flaps are undermined with deans scissors and rotated to close the original vertical incision in a horizontal manner

you actually lengthen the frenum
- do not see secondary intention healing

115
Q

labial frenectomy when frenal attachment has a wide base with secondary epithelialization

incision?
flap?
suture?
healing?

A

SEMI-LUNAR SUPRA-periosteal incision is made at the JUNCTION free and attached gingiva

flap
- undermined

suture
- to the periosteum at the depth of the vestibule

helaing
- takes place by secondary epitheliazatoin

116
Q

lingual frenectomy aka

A

need for TONGUE-TIE OR ANKYLOGLOSIA

can cause difficulty in denture contriction

117
Q

surgical technique for lingual frenectomy

suture?

A

TRACTION SUTURE - at the tip of the tongue to retract the tongue SUPERIORLY

118
Q

lingual frenectomy use of hemostat?

A

yes – clamp the hemostat at the BASE of the frenum at the same time you RETRACT the tongue

119
Q

watch out for___ in lingual frenectomy?

A

SUBMANDIBULAR DUCTS

120
Q

have to what in lingual frenectomy with tissue

A

have to UNDERMINE the tissue

Oral Surgery (26 decks)

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