W3 - Surgical Prep for Prosthesis - Thomson

Question 1

What are the 6 classification of edentulous jaws?

Answer 1

I – Dentate
II – Immediately Post-Extraction
III – Well-Rounded Ridge / Adequate Height & Width
IV – Knife-Edge / Adequate Height but Inadequate Width
V – Flat / Inadequate Height & Width
VI – Depressed / Bone Loss

Question 2

What are the objectives for pre-prosthetic surgery (4)?

Answer 2

Restore Mastication, Speech & Swallowing
Preserve or Improve Structure
Improve Patient’s Sense of Well Being (Quality of Life)
Improve Facial Aesthetics

Question 3

What should you do before doing prosthetic surgery?

Answer 3

Consider remaking poor prosthesis

relining

Adjusting occlusal face height,

Extending denture flanged to improve retention and stability

Question 4

How can we preserve alveolar bone? (3)

Answer 4

• Atraumatic exo
• Socket preservation
• Bone recontouring

Question 5

How can we perform atraumatic exo?

Answer 5

• Careful Surgical Technique & Conservative Approach
• Preserve Alveolar Bone if attached to Mucoperiosteum
• Periotome to cut Periodontal Ligament
• Luxators to Widen Socket
• Elevators
• Forceps
• Trans-alveolar Approach

Question 6

How do we preserve the socket?

Answer 6

• Placement of graft
  
  • Autogenous bone
  • Allogenous (cadaveric)
  • Xenogenous (bovine)
  • Allopastic (calcium hydroxyapatite)
• Biological membrane or mucosal graft cover

Question 7

How can we perform bone recontouring?

Answer 7

• Minimal at time of exo
• Better to wait 3 months of healing and remodelling
• Common areas needing recontouring are jagged/irregular alveolar margins and septal bone

Question 8

What are hard tissue irregularity for surgical preparations for tissue borne prosthesis?

Answer 8

• Torus
• Alveoplasty
• Knife edge ridge
• Genial tubercle
• Mylohyoid ridge reduction

Question 9

What are soft tissue irregularities that require surgical preparation for tissue borne prosthesis?

Answer 9

• Mobile ridges
• Tuberosity reduction
• Frenectomy
• Denture irritation hyperplasia
• Papillary hyperplasia
• Sulcus deepening

Question 10

What are the grades for torus?

Answer 10

• Grade I < 3mm
• Grade II <6mm
• Grade II >6mm

Question 11

What at issues with torus?

Answer 11

• Can enlarge and cause pain/functional problem
• In denture pt, may cause mucosal trauma and ulceration

Question 12

How are md torus removed?

Answer 12

• Long gingival excision along alveolar crest
• Retract flap
• Make cross pattern with bone drill and chisel off
• Be careful of vessels in FOM (lingual a. and n, submandibular duct)

Question 13

How are palatal tori removed

Answer 13

• Make palatal incision through middle of tori mucosa and retract flap each side
• Make cross work pattern on bone with bone drill and remove with chisel

Question 14

What is issue with knife edge ridge?

Answer 14

Denture will be painful and may have ulceration

Question 15

How do you deal with knife edge ridge?

Answer 15

Remove some of sharp ridge (crestal incision, retract flap, use bone file/drill and smoothen knife edge)

Question 16

What is the issue with prominent genial tubercles?

Answer 16

Interfere with denture seating (can cut off tubercles)

Question 17

What is the issue with mobile, flabby, hyperplastic tuberosities and ridge?

Answer 17

Should cut the flabby part out →

Creates better uniform base for denture

Question 18

Why is frenectomy sometimes required?

(for dentures)

Answer 18

To avoid large areas of relief on denture that can compromise strength

Question 19

What is the best way to deal with denture irritation hyperplasia? (2)

Answer 19

Remove denture and hyperplastic regions resorb by itself.

However, pts are often uncompliant with this. Can remove with CO2 laser (good for haemostasis)

Question 20

What is this?

Answer 20

Denture irritation hyperplasia/ Papillary hyperplasia

Question 21

What is ridge extension/sulcus deepening used for? What are some of the methods

Answer 21

Increasing alveolar ridge height

• Submucosal vestibuloplasty
• Buccal inlay
• Lower labial vestibuloplasty
• Loweing of FOM + buccal vestibuloplasty

Question 22

What is surgical prep for endosteal implant borne prostheses?

Answer 22

• Implant inserted into bone
• Healing process of bone (osseointegration)
• Dental abutment is placed on dental implant

Question 23

How are implants placed (as preprosthetic) ?

Answer 23

1. 1st stage surgery (pilot osteotomy with custom made stent)
2. Osteotomy guided by direction indicator
3. Implant insertion
4. Cover screws placed + mucoperiosteal closure
5. 2nd stage surgery- healing abutments
6. Post-healing locator abutments
7. Denture provision

Question 24

What can be done when there is inadequate hard tissue height and volume? (5)

Answer 24

• Guided bone regeneration
• Ridge splitting
• Bone grafting
• Distraction osteogenesis
• Sinus lift

Question 25

How do you perform sinus lift?

Answer 25

1. Make Buccal window in alveolus
2. Carefully dissect sinus lining from bone
3. Place graft material
4. Allow to heal

Question 26

How can you improve unfavourable soft tissue?

Answer 26

• Recreate/improve papillae appearance
• Inc keratinised gingiva around implants
• Provide mucosal coverage of exposed implant threads

Question 27

Answer 27

Genial tubercles

Question 28

How may we preserve alveolar bone (3 ways)

Answer 28

Atraumatic Exo

Socket preservation

Bone Recontouring

Question 29

Methods of preprosthetic surgery (3)

Answer 29

1. Preserve alveolar bone
2. Surgical prep for tissue-borne pros (immediate)
3. Surgical prep for implant-borne pros

Question 30

What is the surgical prep needed for tissue-borne pros

Answer 30

Resolvement of hard tissue and soft tissue irregularities

(examples)