Pre Prosthetic Surgery

Pre Prosthetic Surgery
Many conditions can exist in the mouth which can interfere with the
construction and successful use of the denture .
The methods to improve denture :
• Nonsurgical
• Surgical
• Combination
Nonsurgical methods:
• Rest of the supporting tissue

(out of the mouth, tissue conditioner, finger message)
• Occlusal correction of the old prostheses.

(old denture…wear occlusal surface, restore VD)
• Good nutrition
(vitamins ,minerals)
• Conditioning of of the pt. musculature.

(TMJ exercise)
Per prosthetic examination:
• No mental, physical condition exist….interfere with tret.

• Medical history
• Nutritional health.
• Intra oral examination….maybe only nonsurgical.
• TMJ examination
• Radiograph, blood test, dental model.
Surgical procedures.
Preprosthodontic surgical procedures may be described under :
• Procedures to improve the bony foundation.

• Procedures to improve soft tissue foundation.
• Procedures to improve ridge relationship
• Implant procedures
Procedures to improve the bony foundation:
• Retained dentition (un erupted, R.Root) associated with

pathology….
asymptomatic for years, may increase bone loss, impact upper third
molar…preserve tuberosity .
• Removal of pathogenic bony conditions

( cyst, tumors)
Cyst:…...enucleating or marsupialization
Tumor: ……Immediate attention.
Technique to deal with alveolar excess:
• Alveoloplasty
 Simple compression
 Cortical compression
 Intercortical alveoloplasty
• Alveolor repositioning
• Tuberosity reduction
Technique to deal with alveolar excess:
Alveoloplasty: surgical smoothing and shaping of the

alveolar ridge prior to denture placement.
Extensive alveoloplasty….bone resorption…keep it minimum.
Types:
_Simple compression……hand immediately after exo..for

healing.
_Cortical compression………if denture construction

urgent…..exo…crestal incision….. bone removed
….smoothed…suture if many exo.
_Intercortical alveoloplasty …… anterior ridge

prominent…undercuts….interradicular septa removed
…..rongeur …crushed…suture
Tuberosity reduction:
• Enlarge …interfere…..crestal incision….excess bone trimmed

(Tissue cut)….(rongeur,bur)…….smoothed…….suture.
(Complication…..maxillary sinus…..antibiotic…avoid blowing).

Knife edge or irregular ridge:
Painful denture
Incision not on ridge crest but slightly below the crest….sharp

edge removed rongeur …smoothed bone file….carful
Mylohyoid ridge reduction
Due to bone resorption.
Need surgery :
• Mucoperiosteum thin….irritation
• Undercuts
• Displace denture
crestal incision……………flap reflected………
muscle detached………….trim,smooth,…….reattach again ,…with
healing).
Genial tubercle reduction

Remove or not…act as shelf
Removal of tori:
Mandibular torus:
• Interfere full or partially with denture
• Ulceration
• Interfere with speech if too large
Crestal incision……..flap reflected
osteotome……malleted if clear or bur……stent needed
Palatal torus:
Small …ignore …relief
Same as mandibular indication
incisions:
Single midline palatal incision, Y, Horse shoe
Cut with fissure bur…..then use osteotome.. stent
Buccal exostoses:
• More maxilla in mandible.
• if interfere …surgery.
Cleaved with osteotome or removed with rongure, bur.
• Alveolar repositioning:
Better retention and stability if alveolar
bone aligned over basal bone.
This is done by separating part or all of

alveolar bone and realigning it over basal
bone.
Types:
• Anterior and posterior maxillary
osteotomies
• Le fort 1 osteotomy
• Mandibuler subapical osteotomy
The repositioned segments are fixed using

splints or denture held by wires.
Techniques to deal with alveolar atrophy:
A: Technique to reduce alveolar atrophy.

B: Technique to correct the condition.
C: Technique to compensate for alveolar atrophy.
A: technique to reduce alveolar atrophy.
if root left in alveolar …less resorption???
 Overlay denture:
over endodontically treated teeth. Modified. Less resoption.
 Submucous vital root retention:

root reduced 2 mm below crestal bone…closure of mucosa bone and
PDL will grow over
Denture after 6 weeks.

Complication…dehiscence ..tension closure…pressure denture.
 Root cone implant:

Hydroxyapatite root cone implant after exo…less bone resorPtion
B: Technique to correct the condition:
1.Replacing the lost bone …augmentation.
2.Regeneration the lost bone.
Grafting (natural and synthetic)
• Rib graft augmentation of mandibular ridge.
• Rib graft augmentation of lower border of

mandible….extra oral incision bone
placed….denture immediately can be
worn…..scar….face shape change, nerve problem.
• Direct rib augmentation of atrophic
maxilla…graft lateral to ridge.
• Ridge augmentation with synthetic graft

(tunnel):
Bilateral vertical incision. Anterior to mental
foramen….use syringe inject material….molded by
finger.
• Labial undercut augmentation of anterior ridge

• Augmentation with pedicle and interpositional bone
grafts
 Horizontal osteotomy …sandwich

 Vertical osteotomy….split…sutured…nerve damage
 Combined vertical and horizontal
C: Technique to compensate for
alveolar atrophy:
• Vestibuloplasty:
• Prong dentures
• Zygomaticoplasty
• Tuberoplasty
• Lowering the mental foramen
C: Technique to compensate for alveolar
atrophy:
Vestibuloplasty:
a surgical procedure designed to restore alveolar ridge height by lowering
muscles attaching to the facial labial lingual aspects of the jaw.
Objectives:
• To extend denture bearing surface for retention and support.
• Reposition muscle attachment from crest of the ridge.
• Better functioning of the denture.
Classification:
- Secondary epithelialization:
Deepening of vestibule…portion left exposed….wound heals new mucosa
formed
• Reverse anterior sulcus slide

• Anterior sulcus slide
• Transpositional flap
two flap repositioned
- Submucosal resection
- Soft tissue graft
• Split thickness skin graft
• Mucosal grafts ( palatal, buccal)
Prong denture
• Aid retention of both maxillary and mandibular dentures…..now
more in maxilla
Procedure :
Involves the creation of two skin lines pockets in which acrylic prongs
are placed
• Provide lateral stability
• Prevent displacement
C: Technique to compensate for
alveolar atrophy:
• Vestibuloplasty:
• Prong dentures
• Zygomaticoplasty
• Tuberoplasty
• Lowering the mental foramen
• Zygomaticoplasty:
Using bur….cut….Providing height and lateral stability for denture
• Tuberoplasty:
Provide increased height on the distal aspect of
maxillary tuberosity …prevent anterior displacement.
• Lowering the mental foramen:

Nerve near crest…discomfort….expose nerve…

Procedures to improve the soft tissue foundation:
• Hypermobile tissue correction

 non surgical modify impression….W.O pressure
 Surgical
 injection of sclerosing solution…become firm
• Fibrous hyperplasia epulis fissuratum

Excision knife, scissors, electrosurgery
• Palatal hyperplasia
(poor hygiene, day and night)
(electrosuergery, scraped sharp bone file)
• Hyperplastic maxillary tuberosity
• Frenectomy
Hypertrophic labial frenum
Abnormal lingual frenum
high buccal frenum
• Soft tissue lesions. biopsied


procedures to improve ridge
relationship:
• Maxillary advancement procedures:

Le Fort 1 osteotomy with or W.O graft
• Maxillary retrusion procedure:

Le Fort 1 osteotomy maxillary repositioned superiorly and
posteriorly
• Mandibular advancement procedure:

Sagittal osteotomy
• Mandibular retrusion procedures:

Osteotomy of the body of mandibular on ramus

• Implant procedure:

Pre Prosthetic Surgery

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Pre Prosthetic Surgery

The methods to improve denture :

• Rest of the supporting tissue

• Occlusal correction of the old prostheses.

• Conditioning of of the pt. musculature.

• No mental, physical condition exist….interfere with tret.

Preprosthodontic surgical procedures may be described under :

• Procedures to improve the bony foundation.

• Retained dentition (un erupted, R.Root) associated with

• Removal of pathogenic bony conditions

Alveoloplasty: surgical smoothing and shaping of the

Extensive alveoloplasty….bone resorption…keep it minimum.

_Simple compression……hand immediately after exo..for

_Cortical compression………if denture construction

_Intercortical alveoloplasty …… anterior ridge

• Enlarge …interfere…..crestal incision….excess bone trimmed

(Complication…..maxillary sinus…..antibiotic…avoid blowing).

Incision not on ridge crest but slightly below the crest….sharp

Genial tubercle reduction

This is done by separating part or all of

The repositioned segments are fixed using

A: Technique to reduce alveolar atrophy.

 Submucous vital root retention:

Denture after 6 weeks.

 Root cone implant:

• Rib graft augmentation of mandibular ridge.

• Rib graft augmentation of lower border of

• Ridge augmentation with synthetic graft

• Labial undercut augmentation of anterior ridge

 Horizontal osteotomy …sandwich

• Reverse anterior sulcus slide

• Lowering the mental foramen:

Preprosthodontic surgical procedures may be described under :

• Procedures to improve the bony foundation.

• Hypermobile tissue correction

• Fibrous hyperplasia epulis fissuratum

• Hyperplastic maxillary tuberosity

• Soft tissue lesions. biopsied

Preprosthodontic surgical procedures may be described under :

• Procedures to improve the bony foundation.

• Maxillary advancement procedures:

• Maxillary retrusion procedure:

• Mandibular advancement procedure:

• Mandibular retrusion procedures:

Preprosthodontic surgical procedures may be described under :

• Procedures to improve the bony foundation.

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