pre-prosthodontics surgery Flashcards
types of soft tissue surgery pre-prosthetics
excisional
ridge extension procedures
augmentation procedures
what reasons are there for soft tissue excision
frenectomy
papillary hyperplasia
flabby ridges
denture induced hyperplasia
maxillary tuberosity reduction
retromolar pad reduction
what frenectomies/frenoplasty can be done
labial, buccal or lingual
could be causing a problem with OH, causing recession
lingual frenectomy often modified at birth if a tongue tie
why are buccal frenectomies/frenoplasty risky on the lower
because mental nerve is situated there
what is papillary hyperplasia usually in relation to
candida infection
why are flabby ridges altered
interfering with retention and stability of denture
why would you reduce maxillary reduction
sometimes too big to take impressions and make a good fitting denture
not as common now
what is an example of a ridge extension procedure
vestibuloplasty = deepening the sulcus
when is augmentation procedures done
quite unusual for prosthodontics, more so in perio
what are reasons for hard tissue excisional proceudres
removal of retained teeth/roots/pathology
ridfe defect correction
maxillary/mandibular tori
maxillary tuberosity
exostoses
undercuts
genial tubercle reduction - uncommon
mylohyoid ridge reduction
where does the mylohyoid muscle attach
along the mylohyoid ridge
where is the genial tubercle
where genioglossus and geniohyoid muscles attach = tongue muscles
where is the bone for augmentation procedures from
autografts = own bone from iliac crest, rib
allografts = from cadavers
xenografts = bio-oss
synthetic grafts = tricalcium phosphate
where are xenografts usually from
usually cows, can be horses
all cellular content is removed and it is just the calcified part which is maintained = provides a framework to help bone regenerate
what is the issue with synthetic grafts
no issue of transmission of disease/infections from other human/animals
can be less accepted in the body
what is good about synthetic grafts
can be custom made to a desired shape/size
other than excisional procedures for hard tissue, what else can be done
implants
inferior alveolar nerve relocation
when would a IAN relocation be needed
when have severe resorption of alveolar process which leads to mental foramen coming to the surface and then can get the IAN being covered only by soft tissue and not by any bone
how is a IAN relocation done
drill a channel deeper down in the body of the mandible and relocated the nerve to there
risky procedure
how to remove retained roots/teeth/pathology
crestal incision with mesial receiving incision
flap elevated and tooth exposed
bone trimmed with ronguers (bone nibblers)
tooth extracted with forceps
sometimes need to section teeth to get them out
what causes a ridge defect where there is a higher ridge anteriorly
patient retained lower anterior teeth for much longer than they retained their posterior so end up with this funny shape ridge where severe resorption posteriorly occurred but no anteriorly
what is the problem with knife-edge ridge
its shape and when denture presses down on that edge it causes pain
don’t want to take too much away to lose retention, just enough to smooth out to stop pain
when can mandibular tori be a problem
no an issue unless to has lost all teeth or is wanting a denture to fill the gap then it can be a problem
how do mandibular tori usually present
often bilateral but not usually symmetrical
what kind of flap is made for surgical excision of mandibular tori
one-sided flap, no relieving incision
if had a palatal tori how could you adapt a denture design to prevent having to remove it
create a horseshoe design
how to remove palatal tori
use very large bur and trim it down until flat enough or criss-cross pattern with a fissure but and cut off square bits of bone until it is flat enough
what are the causes of prominent maxillary tuberosity
could be large because bone itself is big, or bone could be normal and have lots of fibrous tissue in the area
surgical technique for removal of maxillary tuberosity
want to take away a bit of the bulk but still need to be able to get primary closure
take a little bit of the underlying CT away as well then pull tissues together and suture
what is a bony exostoses
projection of extra bone and can cause pain for a patient
what flap is raised for bony exostoses
2-sided flap
what syndrome is associated with flabby ridges
combination syndrome
what is combination syndrome
lost all maxillary teeth and lose all lower teeth other than anteriors
lower natural teeth are opposing full upper denture and the constant pressure can result in excessive resorption of the bone and end up with excess soft tissue
what can denture induced hyperplasia/ulceratoin be mistaken for
looks like cancer
small white lines is the beginning and get scarring and callous formation
how can denture induced hyperplasia occur
people get an immediate denture and are told that it is only temporary and will need a new one but they never come back and then when they do they have lots of hyperplasia around the flanges where they have been digging into the soft tissue
procedure for vestibuloplasty
numb pt up from tuberosity-tuberosity
long crestal incision made (one sided flap_
dissect tissue maintaining periosteum = split thickness flap raised
suture higher up in the sulcus leaving a big area of raw exposed periosteum
fill edges of pts old denture with compound and place in pts mouth while still numb and do border moulding
once got a good fit leave denture in as that is going to hold the soft tissue from coming back down while the new tissue over the periosteum granulates and forms new tissue
pt needs to keep it in for about 1 month
painful for pt
why are vestibuloplasty done
to deepen the sulcus
very rarely done now
how do implant retained dentures work
implants placed parallel to each other usually in canine area
pt able to clip denture in and out and retention is great
life-changing for pts
who can get implants on the NHS
hypodontia pts
pts who have had cancer and lost teeth
