Pre-prosthetic surgery aims to reform hard and soft tissues to facilitate comfortable and stable prosthetics. It involves procedures like alveoloplasty to reshape ridges, tori removal, tuberosity reduction, and frenectomy. The goals are to provide adequate bony support and keratinized soft tissue for dentures while correcting deformities. Careful evaluation of a patient's medical and dental history, intraoral examination, and radiographs guide the treatment plan. The procedures aim to improve function and aesthetics for prosthetic rehabilitation.

1. PRE-PROSTHETIC SURGERY

2. ▪ INTRODUCTION
▪ DEFINITION
▪ OBJECTIVES(GOALS– AIMS)
▪ PATIENT EVALUATION
▪ TREATMENT PLANNING
▪ IDEAL DENTURE BASE
▪ PREPROSTHETIC SURGICAL PROCEDURE
▪ ALVEOLAR RIDGE CORRECTIONPROCEDURES
▪ RIDGE EXTENSION PROCEDURES
▪ RIDGE AUGMENTATION PROCEDURES
▪ CONCLUSSION
▪ REFERENCE

4.  Pre-prosthetic surgery is carried out to reform/redesign soft/hard
tissues, by eliminating biological hindrances to receive
comfortable and stable prosthesis.
 Preprosthetic surgery is defined as surgical procedures designed
to facilitate fabrication of a prosthesis or to improve the prognosis
of prosthodontic care

5.  Objective of preprosthetic surgery to provide a better anatomic
enviroment and to create a proper supporting structures for
denture contruction.
 Ultimate goal should be rehabilitation with best possible
masticatory function, combined with restoration or improvement
of dental and facial esthetics

6.  To eliminate pre-existing bony & soft deformities
 To provide adequate bone support for prosthetic
 To provide adequate soft tissue support
 Correction of maxillary and mandibular ridge relationship
 Relocation of frenal / muscle attachments
 Relocation of mental nerve
 Correction of vestibular depth

7. 1. History
2. Intra oral and extra oral examination
3. Laboratory binvestigation
4. Radiographic examination

8. 1. History
• Pt. chief complaint.
• Pt. expectations of surgical and preprosthetic treatment.
• Esthetic and functional goal of the pt.
• Psychological factors and adaptability of the pt. to function with
P.D or C.D.dentures.
• Systemic diseases that may affect bone or soft tissue healing.

9. 2. Intra oral and extra oral examination
A. Evaluation of supporting hard bony tissue
B. Evaluation of supporting soft tissue to detect
C. Evaluation of interarch relationship
A. Evaluation of supporting hard tissues
This occur by visual inspection, palpation, radiographic examination
and evaluation of models.
I. Evaluation of denture bearing area of maxilla
• No bony undercuts or gross bony protuberance.
• Adequate post-tuberosity notching for denture stability and seal.

10. II- Evaluation of mandibular ridge
• Gross ridge irregularities, tori and buccal exostosis.
• Moderate to severe resorption of alveolar bone.
• Muscular and mucosal attachments near the crest of ridge.
• The location of mental nerve.

11. B-Evaluation of supporting soft tissue to detect
 Quality of tissue in denture bearing area.
 Degree of keratinization.
 Degree of tissue mobility.
 Presence of inflammation.
 Presence of irregularities at depth of vestibule.
 Inspection of lingual aspect of mandible by mirror to determine
level of mylohyoid and Geniohyoid.
 Depth of lingual vestibule through different tongue position.

12. C.Evaluation of interarch relationship
• This includes antro-posterior and vertical relationship and
skeletal asymmetries that may exist between maxilla,and
mandible.
• Proper radiographs like panoramic views and
cephalometric radiographare important for initial diagnosis
and treatment plan

13. Hb level
Serum(calcium level – phospate level )
Alkaline phosphate enzyme

14.  OPG – pathological lesion , impacted teeth, rermaining roots
 CT scan

16. CLASSIFICATION OF RIDGE ACCORDING TO RESORPTION
BEHAVIOR (LEVEL)
Class I: adequate height but inadequate width.
Class II: inadequate height and width.
Class III: at the level of basal bone.
Class IV: resorption of basal bone.

17. ❖ Factors affect ridge resorpation General factors:
Systemic bone diseases.
Osteoporosis
Endocrine dysfunction.
❖ Local factors:
Alveoloplasty.
Surgical removal of teeth.

18. 1. Adequatebony support:
No irregularities.
No sharp edge.
No undercuts.
No exostosis.
2. Bone covered by adequateattached keratinized mucosa:
Not flabby.
Adequate vestibular depth.
No hypertrophy.
No ulceration.
3. Freedom from pathologicor neoplasticdisease.
4. Satisfactoryrelationship of the maxillaryand mandibularalveolar ridge.

21. • Labial frenectomy.
• Lingual frenectomy.
• Denture fissuratum.
• Flabby ridge.
• Maxillary tuberosity soft tissue
reduction.
• Inflammatory papillary
hyperplasia of the palate

22. Indication for removal:
 A highly attached frenum interfering with the peripheral
seals of the denture and dislodge the denture.

25. It is a congenital condition.
The patient is unable to protrude the tongue.
Indications for removal
• Speech difficulty.
• Prevents seating and retention of the mandibular denture
during speech or mastication.

27.  INTRA OPERATIVE COMPLICATION
Injury to the superior lingual vessels
Injury to wharton’s duct
POST OPERATIVE COMPLICATION
Hematoma in the floor of the mouth
Pain , restricted tongue movement
Partial dysphasia

28. Seen in palatal region or vestibular depth, obliterating the
sulcus or in lingual aspect of the lower denture
Tissue is inflammed , fibrous and hyperplastic
 Etiology
ill fitting denture

29. Treatment
1. Early stages
• The lesion may shrink and even disappear if the offending denture
is either not worn for a period.
• New denture should then be constructed.
2. Late stages
• The lesion should be excised before new dentures are constructed.
• Challenge: Great care and skill are required to preserve the
shallow sulcus that remains after their excision.

31.  By definition it is a pendulous gingival
ridge with lack of bony support.
Etiology
• Excessive occlusal trauma due to lack of
posterior support, which causes bone
resorption.

32.  Causes:
• Chronic irritation by a denture.
• Poor oral hygiene
• Fungal infection.
Clinically:
• This condition usually appears as multiple nodular projections
in the palatal tissue.
Treatment
Antifungal agents can be prescribed prior to the excision

34. I. Alveolar ridges recontouring (Alveoloplasty)
• Alveolar compression.
• Simple Alveoloplasty.
• Intra septal Alveoloplasty.
Dean’s alveoloplasty, Obwegeser’s modification.
II. Tori removal:
• Maxillary tori.
• Mandibular tori.
III. Maxillary tuberosity reduction:
IV. Buccal exostosis
V. Mylohyoid palatal reduction

37. I. Alveolar ridges
recontouring
(Alveoloplasty)
II.Tori removal:
III. Maxillary tuberosity
reduction:
IV.Buccal exostosis
V.Mylohyoid palatal
reduction

38. Defined as surgical recontouring of alveolar process
History:
• Willard(1853) –removal of interdental papilla ,permitting edge to
edge closure
• Beers(1876): radical alveolectomy
• De van(1930): trend towards conservatism had begun
• Molt(1923):use of study casts in planning alveolectomy
• Dean(1936):interseptal alveoloplasty
• Obwegesser(1966):modification of dean’s technique
• Michael & Barsoum(1976): study on post operative resorption

39.  Principles
1. Optimal ridge contour
2. Permit early construction of dentures
3. Preservation of alveolar bone
4. Broad alveolar ridges
5. Reduction of irregularities
6. Rounding off sharp ridges
7. Preserve cortical bone as much as possible
8. Defer surgery 4-6 weeks in case of severe periodontitis

40. Obwegess
ser’s techq
Dean’s
interseptal
Labial &
buccal
cortical
Simple
alveoloplasty
Alveolar
compression

41. Alveolar compression
• Easiest & quickest method
• Involves compression of cortical plates with fingers
• Reduction in socket width

42. SIMPLE ALVEOLOPLASTY
• It is simply reshaping the alveolar process by removal of all sharp
and rough bony projections.
Indications:
• Facilitate removal of teeth.
• Correct irregularities of the residual alveolar ridge following
removal of teeth.
• Removal of undercuts for denture reconstruction.
• Removal of excessive ridge height to ↓ inter- maxillary space.

43. Types
1. Alveoloplasty after Extraction of Single Tooth.
2. Alveoloplasty after Extraction of Two or Three Teeth or multiple
extractions.
3. Recontouring of Edentulous Alveolar Ridge.

44. 1.Alveoloplasty after Extraction of Single Tooth.

45. 2. Alveoloplasty after Extraction of Two or Three Teeth or
multiple extractions

46. 3. Recontouring of Edentulous Alveolar Ridge

47. Labial and buccal cortical alveoloplasty

48. Dean’s interseptal alveoloplasty
• Only done in maxillary anterior region to reduce gross maxillary
overjet.
• Mostly done immediately after extraction of anterior teeth.
Indication
Immediate denture
Quadrant extraction

49.  Principle
Reduction of labial/alveolar prominences
Muscle attachmentsare undisturbed
Intact periosteum
Preserve cortical bone
Less post-op resorption

51. Obwegeser’s modification
In this both the labial and palatal cortices are repositioned.
This is done when the anterior overjet is too gross that cannot be
reduced by labial plate repositioning.
Indication
Premaxillary protrusion
Procedure:
• Procedure is same as dean’s alveoloplasty but the only addition is
that,here palatal plate is fractured too at its base and
repositioned with labial plate in palatal direction.

53. 1.Maxillary tori
2.Mandibular tori

54. • It is a congenital exostosis usually situated in the midline of the
palate.
Indication for removal:
• An extremely large torus, filling the palatal vault.
• Ulceration/traumatization/hyperkeratinization of the overlying
mucosa.
• Deep bony undercuts.
• Interference with the function—speech-deglutition.
• Psychological consideration—malignancy/cancer phobia.
• Food lodgment under the folds and projection of the tori.

56. Complications of maxillary tori removal:
Intra-operative complication
• Fracture of the palatal process and nasal floor
• Injury to the greater palatine nerve.
• Oronasal/ oroantral bleeding.
Post-operative complication
• Necrosis of the palatal mucosa.
• Hematoma formation.
• Oronasal/ oroantral fistula.

57. 
 It is a congenital exostosis situated on the lingual surface of the
mandible in the canine - premolars area, and is usually bilateral.
Indication for removal:
• If they cause pain, ulceration or difficulty to denture wearers.

59.  Possible complication
1. Intra-operative complication:
• Injury to the submandibular salivary gland duct.
• Excessive bleeding.
• Laceration of the mylohyoid ridge.
• Tearing of the flap complication.
2. post-operative complication:
• Life threatening hemorrhage in the floor of the mouth.
• Infection.
• airway obstruction.

60.  Horizontal and/or vertical excess of the maxillary tuberosity
area may be the result of excess bone, excess thickness of
the soft tissue overlying bone or both.

62. Complications:
Perforation in the floor of the sinus:
• No specific treatment is required.
• Tension free water tight seal closure over the area for 10- 14
days.
• Postoperative antibiotics and decongestants should be given
for 7 - 10 days postoperatively.
• Ask pt. to avoid creation of excessive sinus pressure such as
nose blowing for 10 - 14 days.

63. • Buccal exostoses are more common in maxilla than in
mandible.
• Buccal exostosis presents problems in denture construction
because of the undercut created by exostosis.

65.  It is a prominent internal oblique ridge and it is also called
lingual balcony.
• These bilateral ridges result from advanced resorption of the
alveolar process.
Indications for removal
• pain when the lingual flange of the denture compresses the
intervening soft tissue against it.
• Affecting the stability of the denture.