pre-prosthetic surgery

Question 1

soft tissue procedures

re prosthodontics
3 categories

Answer 1

excisional
ridge extension
augmentation

Question 2

excisional soft tissue procedures

6 types

Answer 2

frenectomy or frenoplasty
papullary hyperplasia
flabby ridges
denture induced hyperplasia (epulis fissuratum)
maxillary tuberosity reduction
retromolar pad reduction

Question 3

frenoplasty

Answer 3

modify it not completely remove it - more common now

Question 4

indications for frenectomy or frenoplasty

Answer 4

frenum hindering OH, tongue tie etc

can be labial, buccal or lingual

Question 5

papillary hyperplasia is

Answer 5

overgrowth of soft tissue on palate

usually relating to denture and fungal infection

Question 6

most frequent cause for soft tissue ops

re prosthodontics

Answer 6

denture induced hyperplasia

Question 7

ridge extension procedures are

Answer 7

vestibuloplasty - deepening the sulcus, so extending the ridge

can be maxillary or mandubular

Question 8

soft tissue augmentation procedures are

Answer 8

soft tissue grafting

Question 9

hard tissue ops

4 categories

re prosthodontics

Answer 9

excisional
augmentation procedures
implants
inferior alveolar nerve relocations

Question 10

hard tissue excisional procedures

9 types

Answer 10

• 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

Question 11

4 types of hard tissue augmentation procedures

Answer 11

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

Question 12

inferior alveolar nerve relocation

Answer 12

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

Question 13

genial tubercle

Answer 13

mandible lingual side

at point of genioglossus and geniohyoid attachment

Question 14

genial tubercle and mylohyoid ridge
where

Answer 14

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

Question 15

mental foramen

Answer 15

mandible buccal side

can be on alveolar ridge if resorption occurs

Question 16

how to manage retained roots/teeth/pathology

Answer 16

clean incision with mesial relieving incision (2 sided flap)

flap elevated and tooth exposed

bone trimmed with Rongeurs

Canine extracted with upper root forceps

Question 17

what is this and management

Answer 17

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

Question 18

what is this and management

Answer 18

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)

Question 19

what is this and management

Answer 19

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

Question 20

possible ridge defects

2

Answer 20

knife edged ridge

retained certain teeth longer than others - uneven resorption occured

Question 21

what happened here and issue

Answer 21

Retained anterior more than posterior so post has resorbed more than anterior

interfere with denture retention

Question 22

what is this
and management

Answer 22

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

Question 23

what is mandibular torus

Answer 23

Can be bilateral or unilateral
Lower premolar region
Not usually symmetrical but can be

Not an issue until pt needs denture – lingual flange area

Question 24

mandibular torus managment

Answer 24

Surgical reduction of mandibular tori
1 sided flap – crestal incision
Raise flap and smooth bone

Question 25

palatal tori management

Answer 25

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

Question 26

prominent maxillary tuberosity can be

Answer 26

bony or fibrous tissue

Question 27

fibrous/soft tissue maxillary tuberosity management

Answer 27

* 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

Question 28

what is this and management

Answer 28

Bony exostosis (buccal side of maxilla) Interfere denture or cause pain Exposure of the exostosis and smooth down

Question 29

what is this issue causes caution in management

Answer 29

Prominent buccal frenum – at level of alveolar process (high) Break seal of lower denture often – whenever cheek move Close proximity to mental nerve

Question 30

what is this and management

Answer 30

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

Question 31

maxillary flabby ridge cause

Answer 31

combination syndrome lower natural teeth opposing full upper denture increase pressure from natural teeth cause excessive resorption of bone

Question 32

what is this how to dx issue that it causes

Answer 32

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

Question 33

common case for denture induced hyperplasia to occur

Answer 33

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

Question 34

vestibuloplasty

Answer 34

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

Question 35

NHS implant cases

Answer 35

hypodontia, major trauma, oral cancer Or a sponsored by implant companies

Question 36

implant retained overdenture

Answer 36

Really good for pt – particularly in mandible Implants ideally parallel to each other Clip denture in and out