Pre-prosthetic Surgery Flashcards
Preprosthetic Surgery - Bony surgery
Alveoloplasty
Torus Reduction
Tuberosity Reduction
Preprosthetic Surgery - Soft tissue surgery
Inflammatory papillary Hyperplasia
Inflammatory fibrous hyperplasia
Frenal attachments/release
Edentulism Long term results
Loss of bony alveolar ridge
Increased inter-arch space
Increase influence of surrounding soft tissue
Decreased stability and retention of prosthesis
Increased discomfort from improper prosthesis adapation
Increased risk of spontaneous mandibular fracture
Preprosthetic surgery
Surgical preparation in anticipation of removable prosthesis
Tissue supported hypothesis
Evolution of preprosthetic surgery
Implant supported prosthesis
Implant is integrated w/ osseous tissue = anchorage for fixed or removal prosthesis
Tissue-supported hypothesis optimal results
Good height, width and contour of denture base
No Retentive undercuts
No undercuts impeding path of insertion
Evenly distributed masticatory forces
Adequate vestibular base
Anatomical Factors
Ridge form
Osseous Prominences
Tuberosity Form
Vestibular Depth
Adjacent Vital Structures
Inter-arch distancce
Anatomical Factors - Ridge form
Height
Width
Contour
Anatomical Factors - Osseous Prominences
Tori
Exostosis
Anatomical Factors - Vestibular Depth
Frenum and muscle attachments
Anatomical Factors - Adjacent Vital Structures
Mental Nerve
Sinus
Anatomical Factors - Interarch Distance
Material volume of prosthesis
Preprosthetic Surgery Instrumentation
Rongeur - workhorse, clips bone to desirable height
Bone file - smooths bone
Burs - rotatory, reduce large boney prominences
Chisel/osteotome - really large piece removal
Preprosthetic Surgery begins with?
Extraction (surgical or non-surgical)
Preserve buccal plates especially for maxillary molars and canine eminences
Retain maximum bone height
Alveoloplasty
Recontouring/removing alveolar bone irregularities
Provides best possible tissue contour for prosthesis, retain as much tissue as possible
Timing of alveoloplasty
Goal is to do it immediately at time of extraction.
Or
Delay after bony healing of sockets (6-10 weeks). Makes contouring easier but requires additional surgery
Types of Alveoloplasty
Digital compression - Compressing socket site
Intraseptal - get rid of intraseptal bone (if loose or fractured)
Surgical
Surgical Alveoplasty
- Full thickness mucoperiosteal flap (good exposure, releasing incisions)
- Expose osseous structure
- Reduction/recontouring (burs, rongeur, bone file)
- Reposition flap, palpate, recontour
- Close with running stitch
Exostosis
Overgrowth of bone on buccal surface of maxilla or mandible
Technique same as alveoloplasty
Reduction of exostosis - Buccal
Less common than maxillary or mandibular torus.
Usually at maxillary molar areas
Reduce when interferes with stability/retention of denture or chronic traumatic ulceration
Mandibular Torus
Bony protuberances on lingual aspect of mandible
May prohibit denture fabrication
More difficult to remove then buccal exostosis
Mandibular Tori Removal Technique
- Lingual mucoperiosteal flap reflection (crestal?)
- Undermine the tori with fissure bur.
- Remove tori with chisel
- Use bone file as needed
- Soft tissue closure
Maxillary Torus
Bony protuberances of palate
May interfere with fabrication or fit of RPD or CD
Very thin soft tissue
Carefully elevate and dissect soft tissue flap
Naso-palatal fistula may occur if using chisel
Maxillary Torus Excision Technique
- Expose edges of tori
- May reduce by fissure bur and chisel or acrylic bur
- Close up
Consider protective post-op stent.
Y incision
Maxillary Tuberosity Reduction
Horizontal and/or vertical excess interference w/ denture
Result of excess soft tissue and/or bone - remove
At least 2-3 mm of vertial sulcus height distal to tuberosity = denture stability
Inflammatory Papillary Hyperplasia causes
Caused by: mechanical irritation, ill-fitting dentures, poor oral hygiene, fungal infections
Inflammatory Papillary Hyperplasia Treatment
Non-surgical: proper denture adjustment, antifungals (usual)
Surgical excision (rare)
Abrasion of superficial layer of palatal mucosa (rare)
Inflammatory Fibrous Hyperplasia (Epulis Fissuratum) Cause
Denture irratation from bad fitting.
Allergic or chemical to denture material
Inflammatory Fibrous Hyperplasia Treatment
Correction of denture
Electrocautery (if small)
Surgery (if big)
Submit excised tissue for histology!
Inflammatory Fibrous Hyperplasia Post-Op
Denture w/ adequate flange extension or stent.
Reline w/ soft liner
Maintain in place for 7 days, where denture after
Abnormal Labial/lingual frenum problems
Diastema, speech problem, edentulous denture displacement
Abnormal Labial/lingual frenum Treatment
Simple excision, Z-plasty
