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BDS4 Oral Surgery > Pre-Prosthetic Surgery > Flashcards

Pre-Prosthetic Surgery Flashcards

1
Q

Provide examples of when excisional soft tissue procedures may be performed for pre-prosthetic surgery

A
  • frenectomy/frenoplasty
    • labia
    • buccal
    • lingual
  • papillary hyperplasia
  • flabby ridges
  • denture induced hyperplasia
    • epulis fissuratum
  • maxillary tuberosity reduction
  • retromolar pad reduction
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2
Q

Where might a frenoplasty be carried out and why?

A
  • labial
    • issues with oral hygiene
  • buccal
    • risky in mandible
      • mental nerve
  • lingual
    • tongue tie
      • usually done in children
      • can be released when older
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3
Q

What is papillary hyperplasia?

A
  • overgrowth of soft tissue in the palate
    • candida
    • poorly fitted denture
      • may resolve once replaced
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4
Q

Provide examples of when excisional hard tissue procedures may be performed for pre-prosthetic surgery

A
  • removal of retained teeth/roots/pathology
  • ridge defect correction
    • alveoplasty
      • modification fo alveolar ridge
  • tori
    • maxillary and mandibular
      • most commonly mandibular
    • excess bone
  • maxillary tuberosity
  • exostoses
    • bony lumps in the mouth
  • modification of undercuts
    • if excessive
  • genial tubercle reduction
    • rare
  • mylohyoid ridge reduction
    • very rare
    • interfered with denture fit
      • flanges rub on ridge
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5
Q

Why might mylohyoid ridge reduction be carried out?

A

if alveolar process resorbs the mylohyoid ridge is closer to the surface and wearing a denture can pinch and rub the gum
- muscle attachment filed down
- rarely carried out

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6
Q

What types of augmentation procedures may be carried out?

A
  • grafting
    • autografts
    • allografts
    • xenografts
    • synthetic grafts
  • implants
  • inferior alveolar nerve relocation
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7
Q

What are autografts?

A
  • grafts using bone from the patient
    • mouth
    • iliac crest bone
    • rib
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8
Q

What are allografts?

A
  • grafts using bone from other humans
    • cadaveric bone
      • sterilised
      • cellular content removed, calcified
    • common for implant placement
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9
Q

What are xenografts?

A
  • graft using bone from animals
    • most common after autograft
    • usually cows, can be horses
    • cellular content removed, calcified
    • framework provided for bone regeneration
    • Bio-Oss
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10
Q

What are synthetic grafts?

A
  • graft using synthetic bone
    • beta tricalcium phosphate
    • no risk of disease transmission
    • no cultural issues
    • less accepted by body
    • can be custom made
      • correct shape and porosity
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11
Q

What is inferior alveolar nerve relocation and when may it be carried out?

A
  • repositioning of the inferior alveolar nerve
    • mandible opened
    • cannel drilled to reposition nerve
    • rarely done as risky
  • severe cases of resorption
    • mental foramen more superficial
      • surface of ridge
      • below soft tissue
    • denture causes pain and numbness
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12
Q

What kind of flap may be cut for exposure of upper retained roots?

A
  • 2 sided flap
    • crestal incision
    • mesial relieving incision
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13
Q

How might unerupted teeth cause problems for edentulous patients?

A
  • ridge resorbs and tooth communicates
    • impaired denture retention
    • compromised oral hygiene
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14
Q

How can ridge defects arise?

A
  • some teeth retained much longer
    • varied resorption
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15
Q

What is a knife edge ridge?

A
  • bone does not smooth out after extraction
    • sharp areas remain
    • can have serrated appearance
  • application of denture causes pain
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16
Q

How can a knife edge ridge be managed surgically?

A
  • raise a flap over knife edge ridge
  • smooth down and round with bur
  • leave enough bone for retention
17
Q

When might mandibular tori be managed and how is this done?

A
  • only challenge is lower denture
    • no problems in dentate patients
  • surgically reduced
    • one sided flap
      • crestal incision
    • bone smoothed down
    • ridge sutured and allowed to heal
    • denture constructed
18
Q

When might a palatine torus be managed and how is this done?

A
  • only a challenge for upper denture
    • can consider a horseshoe
    • not a problem for dentate patients
  • surgically reduced
    • flap opened on palate
    • trimmed with bur
      • trimmed entirely
      • x cut and chip bone away
    • palate sutured closed
      • lots of soft tissue
      • sometimes have to excise some
19
Q

How might a prominent maxillary tuberosity cause problems?

A
  • can be challenging to make a denture fit
    • large undercuts
20
Q

How is a prominent maxillary tuberosity be managed?

A
  • surgical reduction
    • bone or fibrous tissue
  • bulk of tuberosity removed
    • mostly underlying connective tissue
    • overlying mucosa and periosteum remain
  • requires primary closure
21
Q

What are bony exostosis and why might they cause problems?

A
  • bony prominence in unusual location
    • buccal of tuberosity
  • can interfere with denture construction
22
Q

How can bony exostosis be managed?

A
  • surgical reduction
    • 2 sided flap raised
    • bony prominence smoothed
23
Q

How might a prominent buccal frenum cause problems?

A
  • attached at level of alveolar process
    • due to resorption
  • seal of lower denture easily broken
    • every time cheek moves
24
Q

How can a prominent buccal frenum be managed?

A
  • frenoplasty
    • must be cautious of mental nerve
25
Q

How does a flabby ridge form?

A
  • combination syndrome
    • retained lower anteriors
    • complete upper denture
    • excessive resorption of bone in upper
    • formation of fibrous tissue
26
Q

How can a flabby ridge be managed?

A
  • construct denture around ridge
  • surgical removal of flabby ridge
    • wedge excision
    • primary closure should be achieved
27
Q

How should denture-induced hyperplasia be managed?

A
  • remove denture
    • extensively trim in area of hyperplasia
  • ulceration should subside
    • monitor as can have suspicious appearance
  • tissue remains enlarged
28
Q

What are the early clinical signs of denture-induced hyperplasia?

A
  • white lines under denture
    • essentially callous formation
29
Q

How can immediate dentures lead to denture-induced hyperplasia?

A
  • patient likes immediate denture
    • happy with fit and appearance
    • does not attend for new denture
  • ridge resorbs and flanges are too large
    • digs into sulcus
    • tissue becomes hyper plastic
  • patient returns on noticing hyperplasia
    • can grow over denture
    • patient must be informed of this
30
Q

What is a vestibuloplasty?

A
  • extension of ridge without augmentation
    • deepens sulcus
  • flap raised leaving periosteum attached
    • tissue places higher into sulcus
    • raw area of periosteum left
    • denture worn while healing
  • works initially but no longevity
    • rarely carried out now

BDS4 Oral Surgery (2 decks)

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