Pre-prosthetic Surgery Flashcards
What are the excisional soft tissue surgeries used in pre-prosthetic dental treatment?
Frenectomy/frenoplasty
Papillary hyperplasia (related to dentures/candida)
Flabby ridges
Denture induced hyperplasia (Epulis fissuratum)
Maxillary tuberosity reduction
Retromolar pad reduction
What are the types of frenectomy/plasty?
Lingual- tongue tie (younger shortly after birth usually)
Labial- recession or issue with OH
Buccal- Risk of damaging mental nerve
Why may maxillary tuborosity reduction be carried out?
If it hinders retention of denture or impression taking
What is a vestibuloplasty?
ridge extending procedure- deepening of the sulcus
What is an augmentative procedure that can be done in pre-prosthetic surgery?
Soft tissue grafting (more useful for perio)
What are the excisional hard tissue surgeries used in pre-prosthetic dental treatment?
Removal of retained teeth/roots/pathology
Ridge defect correction (alveoplasty)
Mandibular/ Maxillary tori removal
Maxillary tuberosity reduction
Exostoses- bony lumps
Undercuts
Genial tubercle reduction
Mylohyoid ridge reduction- if denture rubbing
When may genial tubercle reduction be required?
If the tubercle (attachment point of geniohyoid and genioglossus) comes closer to the denture bearing surface due to resorption of alveolus
What are the types other hard tissue procedures in pre-prosthetic surgery?
Implants (can help retain denture)
IAN relocation
Augementive- bone grafts
What are the different types of grafts?
Autografts- Iliac crest bone, rib
Allografts- bone from other humans
Xenografts- from animals (horses and cows), e.g. Bio-Oss
Synthetic grafts- β Tricalcium Phosphate
What are xenografts used for?
Provide framework to help bone regenerate
What are the advantages of synthetic grafts?
no issue with transfer of infection or cultural/religious belief
Why may IAN relocation be required? How is it achieved?
If resorption is so great that mental foramen is at surface
-> Numbness and pain due to denture pressing on it
Drill deeper channel in body of mandible and run nerve through
Which teeth are commonly retained?
Canines, wisdom teeth, lower premolars
How are retained teeth removed?
2 sided flap- expose and remove
-> might require bone removal (monguers)/elevation/sectioning
What type of 2 sided flap is selected for retained tooth removal?
Crestal with mesial relieving incision
When may retained roots need to be removed?
If it comes to surface and disturbs hygiene or denture retention
What can be done as an alternative to retained root removal if ridge needs to be preserved?
Create root stub with GIC
What is a corticated radiolucency in the mandible most likely to be?
Residual cyst from apical radicular cyst which formed due to infection of teeth
What causes ridge defects to occur?
Patient retains teeth in different areas for longer amounts of time
What can be done to treat knife edged ridges (serrated appearance)?
Take flap and reduce/round off
Prevent denture pressing and causing pain
Where are mandibular tori usually found?
premolar region (often not symmetrical)
-> can meet at midline
What issues can mandibular tori cause with dentures?
Can cause issues fitting denture in lingual flange area in partially dentate patients (resorption)
How are tori reduced?
Take one sided flap and smooth
-> use plenty of tissue to close flap
What are the options when a palatal tori obstructs seating of a denture?
Produce horseshoe denture
OR
Remove to allow more standard denture (utilising whole palate for retention)
What can cause an enlarge tuberosity?
Excess bone
Excess fibrous tissue deposition
What is done when tuberosity is enlarged as a result of excess soft tissue?
Remove some of mucosa and connective tissue but not all to allow closure (do not remove periosteum)
What is the flap design for a buccal exotosis?
2 sided flap- then smooth
How can a flabby ridge be identified?
Twists/moves on pressure
-> Tends to happen in maxilla when patient still has lower natural teeth (combination syndrome)
How are flabby ridges reduced?
Using a wedge incision (preserve ST)
How can denture induced hyperplasia and ulceration appears?
White lines
Ulcerations may look cancerous
How is denture induced hyperplasia treated?
Remove denture and clean
In what instances can immediate dentures cause hyperplasia?
If patient doesn’t return for definitive treatment
How are vestibuloplasties carried out?
Deepen sulcus- numb, do long crestal incision, dissect tissues while maintaining periosteum (half-thickness flap), suture tissue higher up in sulcus (leaving exposed area of raw periosteum)
-> Use patients old denture and border mould with compound/greenstick- extend flanges (denture also keeps ST in place while recovering- may be screwed in for a month)
When may implants be offered on the NHS?
Hypodontia
Major trauma
Oral cancer
-> sometimes for overdentures (sponsored treatment)
How do implant retained over dentures work?
2 implants are placed in parallel in canine region- they have studs on them which clips onto denture (fixes issues with retention)
