S2 - surgical preparation of mouth for prostheses

Question 1

Aim and objective of pre-prosthetic surgery

Answer 1

Aim: to prepare soft and hard tissues of jaw for comfortable prosthesis that restores oral function, aesthetic and facial form/aesthetics

Objectives:
- preserve or improve structure
- improve pt sense of wellbeing
- improve facial aesthetics

Question 2

What should be considered before surgical intervention

Answer 2

Non-Surgical Options Always Considered First
i.e. re-making technically poor prosthesis, relining, adjusting occlusal height, extending flanges to improve retention & rtability

Question 3

Methods of surgical preparation of mouth for prosthesis

Answer 3

• preservation of alveolar bone
• surgical preparation for tissue-borne prosthesis and
• for endosteal implant-borne prosthesis

Question 4

How may you preserve alveolar bone?

Answer 4

• atraumatic extraction
• socket preservation
• bone recontouring

Question 5

How do you perform an atraumatic extraction? (6)

Answer 5

• careful surgical technique and conservative approach
• preserve alveolar bone if attached to mucoperiosteum
• peritome to cut PDL
• luxators to widen socket
• elevators, forceps
• trans-alveolar approach if appropriate

Question 6

Methods for socket preservation? (2)

Answer 6

• bone grafting
• biological membrane or mucosal graft cover

Question 7

How long to wait after exo to do bone recontouring and why

Answer 7

3m, to allow for healing and bone remodelling

Question 8

What are some hard tissue irregularities which may indicate pre-prosthetic surgery?

Answer 8

• torus
• irregular alveolar ridge
• knife-edge ridge
• genial tubercles
• mylohyoid ridge

Question 9

What are some soft tissue irregularities which may indicate pre-prosthetic surgery?

Answer 9

• mobile/flabby ridges
• prominent tuberosity
• frenum irregularities
• denture irritation hyperplasia or papillary hyperplasia
• shallow sulcus

Question 10

Grading system for tori size

Answer 10

Grade I <3mm

Grade II <6mm

Grade III >6mm

Question 11

What kind of issues would tori cause for a dentate and edentulous pt (particularly if they have dentures)

Answer 11

dentate - pain, functional problems
edentulous - may impede denture placement, mucosal trauma/ulceration

Question 12

What can tori be useful for?

Answer 12

potential donor site for autogenous bone graft

Question 13

What is this and why may it be an issue. How to fix?

Answer 13

knife edged ridge - problem with dentures,will cause pt discomfort

can do surgery - use bone chisel or cutting bur to round it off

Question 14

What natural landmarks in the mandible may be an issue if enlarged/larger than normal? (2)

Answer 14

mylohyoid ridge
genial tubercle

Question 15

Soft tissue irregularities that may cause issues with prosthesis? (4)

Answer 15

• flabby/mobile ridges/tuberosity (issue for denture stability)
• high frenal attachment (treat with fraenectomy)
• shallow vestibule
• denture irritation hyperplasia/papillary hyperplasia

Question 16

What are these. What is a method to remove

Answer 16

1. denture irritation hyperplasia
2. Papillary hyperplasia

CO2 laser excision/ablation

Question 17

Alternative tx instead of surgery to alter soft/hard tissues for pre-prosthetic preparation

Answer 17

surgical preparation for endosteal implant borne prosthesis

Question 18

What are some methods to alter hard tissues if there is inadequate heigh and/or volume for prosthesis?

Answer 18

• GBR
• ridge splitting/dilation
• bone grafting
• distraction osteogenesis
• sinus lift

Question 19

What are some methods to alter unfavourable soft tissues to make them favourable for prosthesis?

Answer 19

• recreate/improve papillae appearance
• increase keratinised gingiva around implants
• provide mucosal coverage of exposed implant threads