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Pre prosthetic surgery (nx power lite) /certified fixed orthodontic courses by Indian dental academy

Pre prosthetic surgery (nx power lite) /certified fixed orthodontic courses by Indian dental academy




The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call



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    Pre prosthetic surgery (nx power lite) /certified fixed orthodontic courses by Indian dental academy Pre prosthetic surgery (nx power lite) /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • Pre Prosthetic Surgery INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    • Definition ―Surgery performed to prepare the remaining oral tissues to best support a prosthesis‖ www.indiandentalacademy.com
    • Objectives • To provide a comfortable tissue foundation to support the denture • Proper jaw relationship in the anteroposterior, transverse and vertical dimensions. • Alveolar processes that are as large as possible and of the proper configuration. (The ideal shape of the alveolar process is a broad U-shaped ridge with the vertical components as parallel as possible. www.indiandentalacademy.com
    • Objectives • No bony or soft tissue protuberances or undercuts. • Adequate attached keratinized mucosa in the primary denture-bearing area. • Adequate vestibular depth. • Adequate form and tissue coverage for possible implant placement www.indiandentalacademy.com
    • Patient evaluation & treatment planning • History • Physical examination – Evaluation of supporting bony tissue Evaluation of supporting soft tissue www.indiandentalacademy.com
    • Classification • Corrective Procedures • Ridge extension procedure • Ridge augmentation www.indiandentalacademy.com
    • Corrective Procedures Soft tissue – Frenectomy – Excision of flabby ridges – Excision of denture induced granuloma – Reduction of fibrous tuberosity Hard tissue – Alveoloplasty – Removal of Tori – Tuberosity reduction – Myeloid hyoid ridge reduction – Genial tubercle reduction www.indiandentalacademy.com
    • Bony Recontouring of the alveolar ridges • Simple alveoloplasty associated with multiple removal of teeth • Compression of the lateral walls www.indiandentalacademy.com
    • Intraseptal alveoloplasty Deans technique • Involves removal of the intraseptal bone and repositioning of the labial cortical bone • Done immediately after tooth extraction or in the initial post operative healing period • Technique is best used when the ridges of regular contour and adequate height but presents an undercut to the depth of the labial vestibule www.indiandentalacademy.com
    • Advantages • Labial prominence of the ridge can be reduced without significantly reducing the height of the ridge www.indiandentalacademy.com
    • Intraseptal alveoloplasty • Periosteal attachment to the underlying bone,this reduces the post operative bone resorption and remodeling. • Muscle attachment to the alveolar ridge can be left undisturbed. www.indiandentalacademy.com
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    • Maxillary tuberosity reduction • Horizontal or vertical excess of the maxillary tuberosity area can be due to bone excess soft tissue both Pre operative evaluation • Clinical examination • Radiographic examination to locate the floor of the maxillary sinus www.indiandentalacademy.com
    • Objective Procedure for hard tissue • To provide adequate interarch space • A firm mucosal base of consistent thickness www.indiandentalacademy.com
    • Procedure for soft tissue www.indiandentalacademy.com
    • Mylohyoid ridge reduction www.indiandentalacademy.com
    • Genial tubercle • Reduction or augmentation www.indiandentalacademy.com
    • Maxillary Tori • Bony exostosis in the palate • Origin is unclear • Found twice as much in females than in males • Single smooth elevation to multiloculated pedunculated mass • Speech problems,ulcers,interferes with prosthesis • Usually present in the midline www.indiandentalacademy.com
    • Maxillary tori www.indiandentalacademy.com
    • Mandibular tori • Present on the lingual aspect • Usually premolar area • Gradually increase in size • May interfere with speech or tongue movement • Rarely requires surgical intervention when dentition is present www.indiandentalacademy.com
    • Mandibular tori www.indiandentalacademy.com
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    • Unsupported hyper mobile tissue • It is caused due to resorption of underlying bone or ill fitting denture • Treatment augmentation of bone soft tissue excision • Complication • obliteration of buccal vestibule due to undermining www.indiandentalacademy.com
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    • Inflammatory fibrous hyperplasia • Epulis fisuratum • Commonly caused by ill fitting denture • Treatment • initial stages– denture with a soft liner • significant fibrosis – excision of the hyperplastic tissue electro surgical surgical excision www.indiandentalacademy.com
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    • Inflammatory papillary hyperplasia of palate • Mechanical irritation, poor hygiene, fungal infection • Appears as multinodular projections in the palatal tissue • Treatment • initial stage – denture adjustment with tissue conditioner • Electro surgical excision • Abrade with a rotating hand piece www.indiandentalacademy.com
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    • Labial frenectomy • It is a thin band of fibrous tissue covered with mucosa extending from the lip and cheek to the alveolar periosteum. • Surgical techniques simple excision z plasty localised vestibuloplasty www.indiandentalacademy.com
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    • Augmentation procedures Maxillary augmentation • Onlay bone grafting • Interpositional bone graft • Maxillary hydroxyapetite augmentation • Sinus lift • Tuberocity augmentation www.indiandentalacademy.com
    • Mandibular augmentation • Superior border augmentation • Inferior border augmentation • Pedicle or interpositional augmentation • Hydroxyapetite augmentation www.indiandentalacademy.com
    • Superior border augmentation Indications • Inadequate height • Irregular contour • Potential risk of fracture • Neurosensory disturbance www.indiandentalacademy.com
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    • Advantages • Adds strength to the mandible • Increases height of the alveolus • Increases the width and recontours the mandible www.indiandentalacademy.com
    • Disadvantages • Donor site morbidity • Need for secondary soft tissue surgery • Avoid denture for 6-8 months • Resorption of the graft www.indiandentalacademy.com
    • Inferior border augmentation Indications • Improve the esthetic • Prevent fracture of the mandible Advantages • Does not obliterate the vestibule • Easier to do secondary vestibuloplasty • Denture can be worn immediately www.indiandentalacademy.com
    • Inferior border augmentation Disadvantages • Extraoral scar • May worsen the facial appearance Procedure www.indiandentalacademy.com
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    • Pedicle & Interpositional bone graft Horizontal osteotomy with interpositional bone graft is an ideal procedure when there is enough bone above the mandibular canal Advantages • Decreased bone resorption • Maintain stable height &contour • Avoids secondary vestibuloplasty • Can wear denture in 3—5 months www.indiandentalacademy.com
    • Pedicle & Interpositional bone graft Disadvantages • Need hospitalisation & GA • Donor site morbidity Concept: bone attached to its own blood supply will show less tendency to resorb and free grafted bone placed between 2 layers left undisturbed – permanent retention www.indiandentalacademy.com
    • Procedure www.indiandentalacademy.com
    • Visor or vertical osteotomy • Modification of horizontal osteotomy • Used when there is sufficient anterior bone to form the pedicle graft, but there is hardly any bone posteriorly above the mandibular canal Limitations: width of mandible is reduced to half, might damage the nerve www.indiandentalacademy.com
    • Procedure www.indiandentalacademy.com
    • Augmentation with synthetic materials Hydroxyapetite – It is a dense biocompatible material that can be produced synthetically or obtained from a biological source such as coral • Non resorbable ceramic bone substitute • Calcium phosphate material • Physical and chemical characteristic similar to enamel and cortical bone • Minimal foreign body reaction • Histological examination has shown normal bone www.indiandentalacademy.com healing around the material
    • Procedure www.indiandentalacademy.com
    • Advantages • Donor site surgery is eliminated • Can be done in an out patient setting • No post operative loss of graft • Vascular in-growth around the H.A. provides an adequate vascular bed for future soft tissue grafts www.indiandentalacademy.com
    • Disadvantages • Not effective as bone grafts in preventing fracture in a severely atrophic mandible • Sometimes difficulty is encountered in containing the material within the sub periosteal tunnel www.indiandentalacademy.com
    • Vestibuloplasty • Definition: ‗Vestibuloplasty is defined as a procedure to uncover the existing basal bone of the jaws surgically by re-positioning the overlying mucosa, muscle attachments to a lower position in the mandible/superior position in the maxilla.‘ www.indiandentalacademy.com
    • Vestibuloplasty • Classification: – Maxilla • Submucosal • Secondary epithelization • Tissue graft – Mandible • Submucosal • Secondary epithelization – – – – Clerk‘s technique Kazanjian‘s technique Lip switch Lingual vestibulopasty www.indiandentalacademy.com
    • Secondary epithelization • Procedure of choice for patients with extensive scarring/epulis fissuratum • Supra-periosteal dissection to raise a flap • Superior/inferior (maxilla/mandible) repositioning by suturing the flap to the periosteum • Exposed periosteum will granulate secondarily • Disadvantage: 50% relapse www.indiandentalacademy.com
    • Tissue graft vestibuloplasty • Modification of previous procedure where in tissue grafts are used to cover the exposed periosteum and hold the repositioned muscles in place • Reduces wound contracture • Palatal/buccal mucosa/skin/alloplastic materials www.indiandentalacademy.com
    • Expected Questions I. Short Notes a. Alveolectomy b. Torus palatinus c. Frenectomy II. Classify pre-prosthetic surgical procedures & your procedure to increase the depth of lingual sulcus III. Define pre prosthetic surgery. Write your technique for lingual sulcus extension www.indiandentalacademy.com
    • Thank you www.indiandentalacademy.com