W3 - Surgical Prep for Prosthesis - Thomson Flashcards
What are the 6 classification of edentulous jaws?
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
What are the objectives for pre-prosthetic surgery (4)?
Restore Mastication, Speech & Swallowing
Preserve or Improve Structure
Improve Patient’s Sense of Well Being (Quality of Life)
Improve Facial Aesthetics
What should you do before doing prosthetic surgery?
Consider remaking poor prosthesis
relining
Adjusting occlusal face height,
Extending denture flanged to improve retention and stability
How can we preserve alveolar bone? (3)
- Atraumatic exo
- Socket preservation
- Bone recontouring
How can we perform atraumatic exo?
- 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
How do we preserve the socket?
-
Placement of graft
- Autogenous bone
- Allogenous (cadaveric)
- Xenogenous (bovine)
- Allopastic (calcium hydroxyapatite)
- Biological membrane or mucosal graft cover
How can we perform bone recontouring?
- 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
What are hard tissue irregularity for surgical preparations for tissue borne prosthesis?
- Torus
- Alveoplasty
- Knife edge ridge
- Genial tubercle
- Mylohyoid ridge reduction
What are soft tissue irregularities that require surgical preparation for tissue borne prosthesis?
- Mobile ridges
- Tuberosity reduction
- Frenectomy
- Denture irritation hyperplasia
- Papillary hyperplasia
- Sulcus deepening
What are the grades for torus?
- Grade I < 3mm
- Grade II <6mm
- Grade II >6mm
What at issues with torus?
- Can enlarge and cause pain/functional problem
- In denture pt, may cause mucosal trauma and ulceration
How are md torus removed?
- 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)
How are palatal tori removed
- 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
What is issue with knife edge ridge?
Denture will be painful and may have ulceration
How do you deal with knife edge ridge?
Remove some of sharp ridge (crestal incision, retract flap, use bone file/drill and smoothen knife edge)
What is the issue with prominent genial tubercles?
Interfere with denture seating (can cut off tubercles)
What is the issue with mobile, flabby, hyperplastic tuberosities and ridge?
Should cut the flabby part out →
Creates better uniform base for denture
Why is frenectomy sometimes required?
(for dentures)
To avoid large areas of relief on denture that can compromise strength
What is the best way to deal with denture irritation hyperplasia? (2)
Remove denture and hyperplastic regions resorb by itself.
However, pts are often uncompliant with this. Can remove with CO2 laser (good for haemostasis)
What is this?
Denture irritation hyperplasia/ Papillary hyperplasia
What is ridge extension/sulcus deepening used for? What are some of the methods
Increasing alveolar ridge height
- Submucosal vestibuloplasty
- Buccal inlay
- Lower labial vestibuloplasty
- Loweing of FOM + buccal vestibuloplasty
What is surgical prep for endosteal implant borne prostheses?
- Implant inserted into bone
- Healing process of bone (osseointegration)
- Dental abutment is placed on dental implant
How are implants placed (as preprosthetic) ?
- 1st stage surgery (pilot osteotomy with custom made stent)
- Osteotomy guided by direction indicator
- Implant insertion
- Cover screws placed + mucoperiosteal closure
- 2nd stage surgery- healing abutments
- Post-healing locator abutments
- Denture provision
What can be done when there is inadequate hard tissue height and volume? (5)
- Guided bone regeneration
- Ridge splitting
- Bone grafting
- Distraction osteogenesis
- Sinus lift
How do you perform sinus lift?
- Make Buccal window in alveolus
- Carefully dissect sinus lining from bone
- Place graft material
- Allow to heal
How can you improve unfavourable soft tissue?
- Recreate/improve papillae appearance
- Inc keratinised gingiva around implants
- Provide mucosal coverage of exposed implant threads
Genial tubercles
How may we preserve alveolar bone (3 ways)
Atraumatic Exo
Socket preservation
Bone Recontouring
Methods of preprosthetic surgery (3)
- Preserve alveolar bone
- Surgical prep for tissue-borne pros (immediate)
- Surgical prep for implant-borne pros
What is the surgical prep needed for tissue-borne pros
Resolvement of hard tissue and soft tissue irregularities
(examples)
