Preprosthetic surgery Flashcards
Structures that may require removal
- Tori
- Frenuli
- Mylohyoid ridges and alveolar crest
- Maxillary tuberosity reduction
- Epiludes on maxillary vestibule
- Alveoloplasty following tooth removal
- Exostosis
- Reduction of genial tubercles
- Removal of palatal papillary hyperplasia
Why preprosthetic surgery is undertaken
- Irregular soft tissue anatomy-impingement of flanges
- Health of overlying mucosa affected by bony irregularites
- Anatomy prevents seating of denture and dislodgement
- Pain and discomfort
Effect of tori on prosthesis
- Discomfort and prevent seating
Effect of frenuli on prosthesis
Interfere with seating and dislodgement
Effect of irregular mylohyoid ridges and alveolar crest
- Irritation and pain during occlusal loading
Effect of epiludes on maxillary vestibule
- Source of infection, irritation and pain
Why alveoloplasty is undertaken
- After extraction to preserve alveolar bone integrity
Procedure for alveoloplasty
- LA
- Incision(horizontal w/ two releasing incisions)
- Bone accessed and trimmed w/ ronguers, fine osteotome or bone file
- Closing of area
Exostosis
- Benign hypertrophic formations
- More common in maxilla
Treatment of exostosis
- LA
- Envelope flap w/ vertical releasing incision
- Bone resected and then smoothed with osteotome or bur
Genial tubercles
- Genioglossus muscle attaches to it at lingual aspect
- Mandibular resorption- more prominant tubercle
- Impairs wearing of denture and function
Treatment/removal of genial tubercle
- LA
- Crestal incision w/15 blade
- Subperiosteal access obtained until tubercles and muscle evident
- Sharp dissection of genioglossal muscle(electrocautery)
- Resection of tubercle w/ fissure bur
- Strict homeostasis before closure
Mylohoid ridge
- Extensive resorption of mandible= mylohyoid ridge prominence
- Denture displacement and muscle strain+pain
Procedure of reduction of mylohyoid ridge
- LA
- Crestal incision along posterior mandibular ridge
- Subperiosteal dissection to expose ridge and muscle
- Muscle attachment grasped w/ curved clamp and seperated w/ electrocautery
- Smoothing of ridge w/ bur
- Suturing
Palatal and lingual exostoses aka tori are
Benign osseous growth
Types of lingual tori
- Bilateral
- Singular
- Lobulated
- Multiple
Procedure for removal of lingual tori
- LA
- Horizontal crestal incision
- Removal w/ bur/ osteotome
- Gauze under tongue to prevent hematoma formation
Palatal tori
- Mostly in middle palatal vault
- Twice as common in women
- Broad, lobulated and nodular
Indications for palatal tori removal
- Large nodular and lobulated-interfere w/ seating of denture
- Traumatised mucosal surface
- Extend beyond palatal region
- Deep undercuts
- Complicates speaking
Types of incisions for palatal tori removal
- C or U shaped
- Open door technique(double Y-incision)
- Palatal flap technique
Depends on type and height of tori
Procedure for removal of palatal tori
- LA(makor palatal and nasopalatal nerves, labial infiltrations)
- Incision
- Subperiosteal flap elevated
- Removal of tori w/ round bur if small
- If large=> sectioned w/ fissure bur and removed w/ osteotome or egg shaped stainless steel bur
- Heavy irrigation w/ saline
- Suturing
Maxillary tuberosity potential issue
Enlarged tuberosity limits intermaxillary space
Maxillary tuberosity reduction procedure
- LA
- Incisions subperiosteally
- Excess submucosa removed
- Suturing
