Pre-Prosthetic Surgery Flashcards
Provide examples of when excisional soft tissue procedures may be performed for pre-prosthetic surgery
- frenectomy/frenoplasty
- labia
- buccal
- lingual
- papillary hyperplasia
- flabby ridges
- denture induced hyperplasia
- epulis fissuratum
- maxillary tuberosity reduction
- retromolar pad reduction
Where might a frenoplasty be carried out and why?
- labial
- issues with oral hygiene
- buccal
- risky in mandible
- mental nerve
- risky in mandible
- lingual
- tongue tie
- usually done in children
- can be released when older
- tongue tie
What is papillary hyperplasia?
- overgrowth of soft tissue in the palate
- candida
- poorly fitted denture
- may resolve once replaced
Provide examples of when excisional hard tissue procedures may be performed for pre-prosthetic surgery
- removal of retained teeth/roots/pathology
- ridge defect correction
- alveoplasty
- modification fo alveolar ridge
- alveoplasty
- tori
- maxillary and mandibular
- most commonly mandibular
- excess bone
- maxillary and mandibular
- 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
Why might mylohyoid ridge reduction be carried out?
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
What types of augmentation procedures may be carried out?
- grafting
- autografts
- allografts
- xenografts
- synthetic grafts
- implants
- inferior alveolar nerve relocation
What are autografts?
- grafts using bone from the patient
- mouth
- iliac crest bone
- rib
What are allografts?
- grafts using bone from other humans
- cadaveric bone
- sterilised
- cellular content removed, calcified
- common for implant placement
- cadaveric bone
What are xenografts?
- 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
What are synthetic grafts?
- 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
What is inferior alveolar nerve relocation and when may it be carried out?
- 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
- mental foramen more superficial
What kind of flap may be cut for exposure of upper retained roots?
- 2 sided flap
- crestal incision
- mesial relieving incision
How might unerupted teeth cause problems for edentulous patients?
- ridge resorbs and tooth communicates
- impaired denture retention
- compromised oral hygiene
How can ridge defects arise?
- some teeth retained much longer
- varied resorption
What is a knife edge ridge?
- bone does not smooth out after extraction
- sharp areas remain
- can have serrated appearance
- application of denture causes pain
How can a knife edge ridge be managed surgically?
- raise a flap over knife edge ridge
- smooth down and round with bur
- leave enough bone for retention
When might mandibular tori be managed and how is this done?
- 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
- one sided flap
When might a palatine torus be managed and how is this done?
- 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
How might a prominent maxillary tuberosity cause problems?
- can be challenging to make a denture fit
- large undercuts
How is a prominent maxillary tuberosity be managed?
- surgical reduction
- bone or fibrous tissue
- bulk of tuberosity removed
- mostly underlying connective tissue
- overlying mucosa and periosteum remain
- requires primary closure
What are bony exostosis and why might they cause problems?
- bony prominence in unusual location
- buccal of tuberosity
- can interfere with denture construction
How can bony exostosis be managed?
- surgical reduction
- 2 sided flap raised
- bony prominence smoothed
How might a prominent buccal frenum cause problems?
- attached at level of alveolar process
- due to resorption
- seal of lower denture easily broken
- every time cheek moves
How can a prominent buccal frenum be managed?
- frenoplasty
- must be cautious of mental nerve
How does a flabby ridge form?
- combination syndrome
- retained lower anteriors
- complete upper denture
- excessive resorption of bone in upper
- formation of fibrous tissue
How can a flabby ridge be managed?
- construct denture around ridge
- surgical removal of flabby ridge
- wedge excision
- primary closure should be achieved
How should denture-induced hyperplasia be managed?
- remove denture
- extensively trim in area of hyperplasia
- ulceration should subside
- monitor as can have suspicious appearance
- tissue remains enlarged
What are the early clinical signs of denture-induced hyperplasia?
- white lines under denture
- essentially callous formation
How can immediate dentures lead to denture-induced hyperplasia?
- 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
What is a vestibuloplasty?
- 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
