pre-prosthetic surgery Flashcards
soft tissue procedures
re prosthodontics
3 categories
excisional
ridge extension
augmentation
excisional soft tissue procedures
6 types
frenectomy or frenoplasty
papullary hyperplasia
flabby ridges
denture induced hyperplasia (epulis fissuratum)
maxillary tuberosity reduction
retromolar pad reduction
frenoplasty
modify it not completely remove it - more common now
indications for frenectomy or frenoplasty
frenum hindering OH, tongue tie etc
can be labial, buccal or lingual
papillary hyperplasia is
overgrowth of soft tissue on palate
usually relating to denture and fungal infection
most frequent cause for soft tissue ops
re prosthodontics
denture induced hyperplasia
ridge extension procedures are
vestibuloplasty - deepening the sulcus, so extending the ridge
can be maxillary or mandubular
soft tissue augmentation procedures are
soft tissue grafting
hard tissue ops
4 categories
re prosthodontics
excisional
augmentation procedures
implants
inferior alveolar nerve relocations
hard tissue excisional procedures
9 types
- Removal of retained teeth/roots/pathology
- Ridge defect correction (alveoplasty)
- Mandibular tori
- Maxillary tori
- Maxillary tuberosity
- Exostoses (bony lumps)
- Undercuts (excessive in size, so need reduced)
- Genial tubercle reduction
- Mylohyoid ridge reduction
4 types of hard tissue augmentation procedures
Autografts very popular
* e.g. Iliac crest bone, rib
Allografts
* Bone from other humans (cadaver)
Xenografts very popular
* From animals, e.g. Bio-Oss (cows usually, cells removed and only calcified part remained – framework for bone to regenerate in the area)
Synthetic grafts
* e.g. β Tricalcium Phosphate
no disease transmission risk
can be custom made – shape, size and porosity
can be rejected from body
inferior alveolar nerve relocation
v rare
make a lower bony cavity for the nerve, after resorption has occured (risky)
as IAN only covered by soft tissue and not in bony cavity due to resorption - pain, numbness when denture in situ
genial tubercle
mandible lingual side
at point of genioglossus and geniohyoid attachment
genial tubercle and mylohyoid ridge
where
mandible below teeth, lingual side
but if become edentulous for long time alveolar bone resorbs and they can come to the surface - problem as denture lingual flange rubs - sore
mental foramen
mandible buccal side
can be on alveolar ridge if resorption occurs
how to manage retained roots/teeth/pathology
clean incision with mesial relieving incision (2 sided flap)
flap elevated and tooth exposed
bone trimmed with Rongeurs
Canine extracted with upper root forceps
what is this and management
Retained lower premolars (5) not erupted
Only a problem when ridge resorbed when become edntulous, begins to communicate with surface and and get decayed, interfere with denture retention
Mental nerve in this area
what is this and management
Retained roots - # during XLA
Most don’t cause issues
But if come to surface can cause bother – OH and denture retention interference
Possible to become root stub (GI on top)
what is this and management
Well defined, corticated unilocular radiolucency on RHS of mandible
Likely residual cyst. Apical cyst developed prior in relation to tooth
Could be ameloblastoma etc
Need to biopsy to decide what to do
IAN in area
possible ridge defects
2
knife edged ridge
retained certain teeth longer than others - uneven resorption occured
what happened here and issue
Retained anterior more than posterior so post has resorbed more than anterior
interfere with denture retention
what is this
and management
Doesn’t look like much of an issue when soft tissue covering ridge but when flap raised can see sharp bone – pain when denture on top
Want to smooth to make comfortable for pt
Ridge smoothened – able to provide retention with less pain
what is mandibular torus
Can be bilateral or unilateral
Lower premolar region
Not usually symmetrical but can be
Not an issue until pt needs denture – lingual flange area
mandibular torus managment
Surgical reduction of mandibular tori
1 sided flap – crestal incision
Raise flap and smooth bone
palatal tori management
Issue again only when need denture (have option of horseshoe denture design still)
Large bur to smooth it down or criss cross and chip away
Often excess soft tissue so may need to excise before closure
prominent maxillary tuberosity can be
bony or fibrous tissue
fibrous/soft tissue maxillary tuberosity management
- want to take away a bit of bulk but also achieve good primary closure (don’t want exposed area of connective tissue)
- Take away bit of underlying connective tissue, maintain overlying mucosa and periosteum over bone
what is this and management
Bony exostosis (buccal side of maxilla)
Interfere denture or cause pain
Exposure of the exostosis and smooth down
what is this
issue causes
caution in management
Prominent buccal frenum – at level of alveolar process (high)
Break seal of lower denture often – whenever cheek move
Close proximity to mental nerve
what is this and management
flabby ridge
Missing bone so excess soft tissue – instrument can displace it
Can be designed around or remove
surgical reduction similar to tuberoisty reduction as soft tissue
maxillary flabby ridge cause
combination syndrome
lower natural teeth opposing full upper denture increase pressure from natural teeth cause excessive resorption of bone
what is this
how to dx
issue that it causes
Rogue margin, ulceration – looks like cancer
Confirm cause – remove denture and ulceration improves then remove hyperplastic parts
* due to excess flange, wearing denture too long etc
white lines is beginning of denture induced hyperplasia – early stage
Makes impression taking hard
common case for denture induced hyperplasia to occur
immediate denture,
told temporary as ridge will resorb so flanges be too excessive, but they like fit and appearance that they don’t come to get it changed and then when they eventually do get hyperplasia growing over denture
vestibuloplasty
Rare
Extend ridge without grafts – deepening sulcus, longer flange = more retention
Maxilla or mandible
- Long 1 sided flap on buccal – tuberosity to tuberosity
- Dissect tissue but maintain periosteum attached to bone (not full thickness), not exposed bone, suture it higher up
- Leave area of raw exposed periosteum – sore
Take old dentures, buccal edged extended with compound and border mould, line with green stick and adapt to pt to get fit, leave denture in to hold tissue up and act as a dressing whilst tissue granulate – need to wear all the time whilst healing (used to screw in), for about a month. Then make a new denture
NHS implant cases
hypodontia, major trauma, oral cancer
Or a sponsored by implant companies
implant retained overdenture
Really good for pt – particularly in mandible
Implants ideally parallel to each other
Clip denture in and out
