Ayoub Akgam B.D.S, MS.

Oral And Maxillofacial Surgery

Department

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 Any surgical procedure performed on a patient
aiming to optimize the existing anatomic
conditions of the maxillary or mandibular
alveolar ridges for successful prosthetic
rehabilitation”

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1- Provide adequate bony tissues for prosthesis
support(Ridge height and width)
2-Provide adequate soft tissue support
3-Eliminate pre-prosthetic bony deformities (Tori,
Exostosis)
4-Corrrection of maxillary and mandibular ridge
relation
5-Relocate abnormal frenum and muscle
Attachment
6- Relocate mental nerve
7- Establishing correct vestibular depth
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I- Hard tissue procedures:
1. Alveoloplasty
A-Simple alveoloplasty
B-Interadicular alveoloplasty or interseptal
alveoloplsty.

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is the surgical procedure performed to smooth or
recontour the alveolar bone.
- aiming to facilitate the healing procedure as well
as the successful placement of a future
prosthetic restoration.

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-The simplest form of alveoloplasty consists of the
compression of the lateral walls of the
extraction socket after simple tooth removal.

-Bony areas requiring recontouring should be

exposed using an envelope type of flap.

-Recontouring can be accomplished with a

rongeur, a bone file, or a bone bur in a hand
piece, alone or in combination.

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involving the removal of intraseptal bone and the
repositioning of the labial cortical bone
-a small rongeur can be used to remove the
intraseptal portion of the alveolar bone After
adequate bone removal has been accomplished.
- digital pressure should be sufficient to fracture
the labiocortical plate of the alveolar ridge
inward to approximate the palatal plate area
more closely

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A-Maxillary tori excision:
 localized at the center of the
hard palate
 exact causes remain
unknown.
 Clinically,
 asymptomatic bone
protuberances
 covered by normal mucosa .

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• Treatment:
 They usually do not require any special therapy, except
for edentulous patients in need of prosthetic rehabilitation.

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Linear incision in Bone
the center of tori remova
with vertical l with
releasing incision chisel

Sectioning Smoothenin
with bone g with
bur bone bur

Closure with
interrupted
suture 12
 -Bony protuberances on the lingual aspect of the
mandible that usually occur in the premolar area/
Bilaterally.
 After the removal of lower teeth and before the
construction of partial or complete dentures, it may be
necessary to remove mandibular tori to facilitate
denture construction.

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 Cristal Envelope
incision flap
reflection

Closure
Bone with An
removal interrupted
with bone or
bur continuous
suture
technique

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 Horizontal or vertical excess of the maxillary
tuberosity area may be a result of excess bone, an
increase in the thickness of soft tissue overlying
the bone, or both.

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 Closure
with An
Cristal interrupted
incision or
continuous
suture
technique

Bone
removal
Amount of Bone removal
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 One of the more common areas interfering with proper
denture construction in the mandible is the mylohyoid
ridge area.

 In addition to the actual bony ridge, with its easily

damaged thin covering of mucosa, the muscular
attachment to this area often is responsible for dislodging
the denture.

 When this ridge is extremely sharp, denture pressure

may produce significant pain in this area.

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• Immediate denture fitting to help relocate the
muscle
• Care to lingual nerve with posterior extension of
the incision.
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 A- Buccal Exostosis : Excessive bony protuberances and
resulting undercut areas are more common in the maxilla
than in the mandible.

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 The lateral aspect of the palatal vault may be
irregular because of the presence of lateral
palatal exostosis. This presents problems in
denture construction because of the undercut
created by the exostosis and the narrowing of the
palatal vault .

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Lateral Palatal Bony Exostosis

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 II. Soft Tissue Correction Procedures:
a.Frenectomy
-Labial Frenectomy

-Lingual Frenectomy -Buccal Frenectomy

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 Labial frenal attachments consist of thin bands of
fibrous tissue covered with mucosa, extending
from the lip and cheek to the alveolar
periosteum.
 Movement of the soft tissue adjacent to the
frenum may create discomfort and ulceration and
may interfere with the peripheral seal and
dislodge the denture.

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Multiple surgical techniques are effective in
removal of frenal attachments:
1- the simple excision technique
2- the Z-plasty technique
3- localized vestibuloplasty with secondary
epithelialization
4- the laser-assisted frenectomy.
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narrow elliptical incision
around the frenal area down
to the periosteum

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The edge of the mucosal flap is
sutured to the periosteum at the
maximal depth of the vestibule
and the exposed periosteum is
allowed to heal by secondary
epithelialization 27
 The excision of frenum attachments can also be
accomplished through a laser. The tendinous frenum
attachment is ablated with the laser and often does not
require suture reapproximation of the tissue because
re-epithelialization occurs from the wound margins.
Frenectomies completed with the laser often respond
well with fewer postoperative complaints of swelling
and pain. 28
An abnormal lingual frenal attachment usually consists of
mucosa, dense fibrous connective tissue, and, occasionally,
superior fibers of the genioglossus muscle.
-This attachment binds the tip of the tongue to the posterior
surface of the mandibular alveolar ridge. Even when no
prosthesis is required, such attachments can affect speech.
-After loss of teeth, this frenal attachment interferes with
denture stability, Surgical techniques –with hemostat or
without hemostat.
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 Retraction of the tongue with
Traction suture

With use of two hemostats across the

frenal attachment

Transverse cut though

the frenum followed by
undermining the tissue
and closure parallel to
the midline of the
tongue 30
 Inflammatory fibrous hyperplasia, also
called epulis fissurata or denture fibrosis , is a
generalized hyperplastic enlargement of
mucosa and fibrous tissue in the alveolar
ridge and vestibular area, which most
often results from ill-fitting dentures.

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preservation of the socket using a variety of
bone materials can aid in the maintenance of
alveolar height and width.
The graft material is placed into the
extraction site and compressed to the
level of the alveolar crest

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 Transpositional Flap Vestibuloplasty (Lip
Switch)
Kazanjian technique

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  Indications:
1. Adequate anterior mandibular height (at least
15 mm).
2. Inadequate facial vestibular depth from
mucosal and muscular attachments in the
anterior mandible.
3. The presence of an adequate vestibular depth
on the lingual aspect of the mandible.

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  Adventages:
 adequate results in many cases and generally
do not require hospitalization, donor site
surgery, or prolonged periods without
dentures.
 Disadvantages:
1. unpredictability of the amount of relapse of the
vestibular depth
2. scarring in the depth of the vestibule
3. problems with adaptation of the peripheral
flange area of the denture to the depth of the
vestibule 42
 Labial vestibuloplasty, floor-of-mouth
lowering procedure, and skin grafting

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 Advantages:
 Early covering of the exposed periosteal bed,
which improves patient comfort and allows
earlier denture construction.
 Disadvantages:
 The need for hospitalization and donor site
surgery combined with the moderate swelling
and discomfort experienced by the patient
postoperatively.

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Obwegeser’s technique.

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III. Ridge Reconstruction or Augmentation
Procedure
I- Ridge reconstruction with non- resorbable
hydroxyapetite (onlay graft).
After instituting proper local anesthesia a midline
incision for maxilla or bilateral vertical
mucoperiosteal incision for mandible is done, on
the ridge and a subperiosteal tunnel is made.
Hydroxyapetite graft material is inserted and held in
position by sutures followed by splint.

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II-Ridge augmentation with iliac crest bone or rib
bone graft
-Superior border grafting technique of atrophic
mandible held by plates and screws.
-inferior border grafting technique done and held
by plates and screws.

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1. Maintains the blood supply to the repositioned
portion of the maxilla.
2. Less extensive resorption postoperatively
3. Correction of both anteroposterior and
transverse discrepancies.
4. No need for secondary soft tissue procedure.

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- In this technique, an opening is made in the lateral
aspect of the maxillary wall and the sinus lining is
carefully elevated from the bony floor of the sinus
.
 Allogeneic, autogenous, xenogeneic bone,
BMP(bone morphognic protein), or a combination
of these materials can be used as a graft source.

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-Supraeruption of teeth and bony segments into an
opposing edentulous area may decrease interarch
space.
-repositioning of these teeth with segmental surgery
can solve the problem and help in fabricating
adequetly positioned prosthesis.

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 The procedure is done with osteotomy in the
deformed bone and fixing a device
(distractor)which allow gradual lengthening of
the osteomatized bone so distracting both bone
(osteogensis) and soft tissue(histogensis).
 used to correct most of bone deformities.

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