PREPROSTHETIC SURGERY: ROLE IN PREPARATION OF AN IDEAL FOUNDATION FOR COMPLETE DENTURE

PREPROSTHETIC SURGERY: ROLE
IN PREPARATION OF AN IDEAL
FOUNDATION FOR COMPLETE
DENTURE
PRESENTED BY: DR. ARATI
S B Patil Dental College And Hospital

CONTENTS
• INTRODUCTION
• OBJECTIVES OF PREPROSTHETIC SURGERY
• PRINCIPLES OF PATIENT EVALUATION
• DEVELOPMENT OF TREATMENT PLAN
• CLASSIFICATION
• HARD TISSUE ABNORMALITIES
• SOFT TISSUE ABNORMALITIES
• VESTIBULOPLASTY
• RIDGE AUGMENTATION PROCEDURE
• CONCLUSION
• REFERENCES

• The goal of preposthetic surgery is to modify the
oral environment to render it free of disease and to
make its form and possibly it’s function more
compatible with the requirements of prosthesis.
DEFINITION
Preprosthetic surgery:
According to the Glossary of Prosthodontic Terms,
Surgical procedures designed to facilitate fabrication of
prosthesis or to improve the prognosis of prosthodontic care.
According to Bruce Donoff, preprosthetic surgery is that
part of the oral and maxillofacial surgery designed to
establish the best hard and soft tissue bases for prosthetic
appliances.

OBJECTIVES OF PREPROSTHETIC SURGERY
The objective of preprosthetic surgery is to create proper supporting
structures for subsequent placement of prosthetic appliances. The best
denture support has the following characteristics.
No evidence of intraoral or extraoral pathologic condition.
Proper interarch jaw relationship in anterior-posterior, transverse and
vertical dimension
Alveolar processes that are as large as possible and of the proper
configuration.
No bony or soft tissue protuberances or undercuts.

Adequate Attached Keratinized Mucosa in the primary
denture bearing area.
Adequate vestibular depth.
Adequate bony support and soft tissue covering.
Proper posterior tuberosity notching.

PRINCIPLES OF PATIENT EVALUATION
Before surgical intervention-thorough assessment of
general health.
Systemic diseases responsible for bony resorption ruled
out.
Intraoral and extraoral evaluation
 Evaluation of supporting bony tissue
 Evaluation of supporting soft tissue

EVALUATION OF SUPPORTING HARD TISSUE
Visual Inspection ,Palpation and
Radiographic Examination.
• Maxilla - Bony Ridge Form, undercuts,
palatal Vault, tori.
• Mandible - Ridge form contour, ridge
irregularities, tori, buccal exostosis.
• Interarch distance and relation.
• Radiographs - Impacted teeth, Retained
roots, Pathologic lesions, Cyst And
Tumors.

EVALUATION OF SUPPORTING SOFT TISSUE
• Soft tissue assessment for quality,
amount of keratinization, firmness of
mucosa to the underlying periosteum
• Vestibular areas should be free of
inflammatory changes such as
scarring, hyperplasia or ulceration
• Attachments of frenum and muscles
should be assessed.

DEVELOPMENT OF TREATMENT PLAN
• Patients oral problem identified.
• Long term maintenance of underlying bone and soft tissue, as
well as prosthetic appliances kept in mind all the times.
• Definite decision on bony augmentation must made before
considering soft tissue.
• Soft tissue surgery should delayed until hard tissue grafting
and appropriate healing have occurred.

CLASSIFICATION OF PRE-PROSTHETIC
SURGICAL PROCEDURES (MODIFIED FROM
PETERSON AND KRUGER)
1) Basic preprosthetic surgical procedures
A. Removal of Teeth
• Erupted
• Unerupted
• Partially erupted
• Root stumps
• Cysts
B. Bony Recontouring of alveolar ridges
• Simple alveoloplasty associated with removal of
multiple teeth.
• Intraseptal alveoloplasty

• Maxillary tuberosity reduction
• Buccal exostosis and excessive undercuts
• Lateral palatal exostosis
• Mylohyoid ridge reduction
• Genial tubercle reduction
C. Tori Removal
• Maxillary Tori
• Mandibular Tori
D. Soft Tissue Procedures
• Maxillary tuberosity reduction (soft tissue)
• Mandibular retromolar pad reduction

• Lateral palatal soft tissue excess
• Unsupported hypermobile tissue
• Inflammatory fibrous hyperplasia
• Inflammatory papillary hyperplasia of the palate.
• Labial frenectomy
• Lingual frenectomy
E. Immediate Dentures
F. Overdenture surgery.

2) Advanced pre-prosthetic surgical procedures
A. Mandibular Augmentation:
• Superior Border Augmentation
• Inferior Border Augmentation
• Interpositional bone Grafts.
• Onlay grafting
• Ridge split technique
B. Maxillary Augmentation
• Onlay Bone Grafting
• Interpositional Bone Grafts
• Ridge split technique
• Sinus lift procedure

C. Soft tissue surgery for ridge extension of the mandible
• Transpositional flap vestibuloplasty (Lip Switch)
• Vestibule and floor of the mouth extension procedure
• Relocation of the mental nerve and IAN
D. Soft tissue surgery for maxillary ridge extension
• Submucous vestibuloplasty
• Maxillary skin grafting vestibuloplasty
E. Correction of abnormal ridge relationships
• Segmental alveolar surgery in the partially edentulous
patient
• Correction of skeletal abnormalities in the totally
edentulous patient

3) Miscellaneous procedures
Ridge preservation procedures
• Submucosal vital root retention

HARD TISSUE ABNORMALITIES

RECONTOURING OF ALVEOLAR RIDGES
• ALVEOLOPLASTY-
Refers to surgical recontouring of the alveolar process. This
contouring is done with the purpose to take care of bony projections,
sharp crestal bone or the undercuts.
OBJECTIVES-
-To correct abnormalities and deformities of alveolar ridges
-To remove sharp or projecting ridges of alveolar process
-To remove diseased interseptal bone
-To reduce tuberosities to obtain clearance for denture base

TYPES OF ALVEOLOPLASTY
• Alveolar compression
• Simple alveoloplasty
• Intraseptal Alveoloplasty-Dean’s alveoloplasty
• Obswegeser’s alveoloplasty

ALVEOLAR COMPRESSION
• Easiest and quickest form of alveoloplasty
• Done by compressing the outer and inner cortical plates
between the fingers.
• Should be done following all extractions
• Prevents boney undercuts.

SIMPLE ALVEOLOPLASTY
WEDGE SHAPED INCISION
REMOVAL OF BONE MARGINS
PRE-OPERATIVE
SUTURES IN PLACE

Oblique view of alveolus showing undercut Sockets after extraction
Intraseptal bone removal with bur Fracturing labial wall of socket
DEAN’S ALVEOPLASTY

Compression of fractured wall
towards lingual wall to eliminate the
labial undercut
Sutures in place

OBSWEGESER’S TECHNIQUE
High inclination of incisor Longitudinal cuts in canine region

Approximation by compression
Sutures in place
Buccal and lingual walls
fractured
round disc used to weaken lingual plates

REDUCTION OF MYLOHYOID RIDGE
• Extreme alveolar ridge resorption sometimes
accentuates the mylohyoid ridge.
• It can cause-
• Ulcer over the ridge
• Boney undercut
• Sharp and painful margin

MAXILLARY TORI REMOVAL
• INDICATIONS
• They become so large as to interfere with speech.
• Mucosa becomes ulcerated and fails to heal because of it’s
poor vascularity.
• The torus interferes with design and construction of a
removable prosthesis.
• Deep bony undercut.
• Interfere with posterior palatal seal of the denture.
• Instability of the denture due to rocking; in such a case the
torus acts as a fulcrum.

PALATAL TORI
MEDIAN INCISION WITH
DIVERGING RELAXING INCISIONS
GROOVES IN THE TORUS SHARP CHIESEL TO REMOVE TORI IN PIECES

BUR USED TO
SMOOTHEN THE BONE
SUTURES IN PLACE
POST OPERATIVE

COMPLICATIONS-
• Bleeding-injury to greater palatine vessels.
• Hematoma formation.
• Perforation of nasal floor.
• Necrosis of palatal mucosa.

MANDIBULAR TORI REMOVAL
MANDIBULAR CRESTAL INCISION MUCOPERIOSTEAL FLAP ELEVATION
TORI REDUCTION WITH BUR SMOOTHENING OF ROUGH MARGINS

INTERRUPTED SUTUTRES IN PLACE
ASSESSMENT OF OPERATED SITE
 COMPLICATIONS
-HAEMORRAGE.
-INFECTION
-AIRWAY OBSTRUCTION
-SUB-MANDIBULAR DUCT
INJURY.

SOFT TISSUE ABNORMALITIES

LABIAL FRENECTOMY
• Most common abnormality encountered
• Due to resorption frenum get attached too near to the crest
• Frenectomy accomplishes 2 things
1.Allows adequate border extensions
2.Releases a mobile band of tissue that is in contact with the
denture.

PRE-OPERATIVE PHOTOGRAPH
Tense frenum held
With hemostats
Incisions given both above and below
Hemostats to remove v shaped tissue,
The apex of v should be near
Inferior extent of frenum

The first suture is placed at the middle of the
wound to facilitate subsequent suturing

LINGUAL FRENECTOMY
lingual frenum
Elevation of the tongue with a suture
placed at the tip of the tongue
Undermining the wound margins
Excision of the frenum with converging
incisions towards the base of the tongue

Operation site after the placement of
sutures

PAPILLARY HYPERPLASIA OF THE PALATE
• Characterised by presence of red nodules and papillary growth.
• Sequelae of ill fitting denture.
• Excision performed with the instrument in constant contact with
the superficial mucosa (curettage with large surgical blade as far
as the periosteum).
• An electrosurgical loop may also be used, which is very effective
in such cases. The traumatized area is covered with a surgical
dressing.
• Healing is achieved by secondary intention.

Papillary hyperplasia of the palate
lesion in an edentulous patient.
Removal of the lesion with an electrosurgical loop

Surgical field after removal of the lesion
- Denture relined or acrylic stent used for wound protection

FIBROUS HYPERPLASTIC
TUBEROSITY
INDICATION
• Horizontal or vertical excess or both.
• Excess bone or excess soft tissue.
• Pre - operative assessment of floor of maxillary sinus.
In event of gross sinus perforation
antibiotics and sinus decongestants

Gradual excision of the lesion with a wedge-
shaped incision reaching as far as the bone.
Incision along marked area
Demarcated segment of hyperplastic
tissue to be removed
Fibrous hyperplastic retromolar tuberosity
of left maxilla

Operation site after placement of sutures
Postoperative clinical photograph
Reflection of tissues with periosteum, so
that wound margins can be re-
approximated and sutured

SURGICAL REPOSITIONING OF
MENTAL NERVE
• In patients with gross atrophy of the mandibular alveolar
process the mental foramen may be found at or near the
crest of the residual ridge.
• Pain due to this is similar to trigeminal neuralgia.
• Symptoms can be eliminated by relieving the denture to
avoid pressure on the mental foramen.
• But in some cases the mental foramina should be enlarged
and neurovascular bundles surgically repositioned

Nerve is secured in position by absorbable heamostatic gauze.

VESTIBULOPLASTY
DEFINITION
 Surgical procedure designed to increase the effective
residual ridge height by lowering muscle attachment to
the buccal, labial, and lingual aspects of the jaws.-GPT 9
OBJECTIVES:
• To increase the denture foundation area.
• Improve quality of tissue available for prosthesis
• When conservative procedure fails

CLASSIFICATION OF VESTIBULOPLASTY
PROCEDURES
Based on extent
 Full ridge vestibuloplasty
 Partial ridge vestibuloplasty
Based on dissection
 Open supraperiosteal vestibuloplasty
 Closed supraperiosteal vestibuloplasty
Based on healing
 Secondary re-epithelization vestibuloplasty
 Grafting vestibuloplasty

• Vestibuloplasty can be done in using one of the following
techniques
1. Mucosal advancement
2. Secondary epithelialization
3. Epithelial graft vestibuloplasty
4. Lip switch procedure (transitional flap vestibuloplasty)

MUCOSAL ADVANCEMENT /
SUBMUCOSAL VESTIBULOPLASTY
• Designed by Obwegeser, is used more frequently and
greater success is in the maxilla than the mandible
when adequate bone exists under an essentially healthy
mucosa.
Advantage
1. It preserves the vestibular mucosal fold without
scarring.
2. The adequacy of the existing bone may be assessed by
distending the labial or buccal vestibular tissue with a
finger or mouth mirror upward along the bony surface.

Indication:
• When adequate amount healthy mucosa is
available.
OBWEGESER’S SUBMUCOUS
VESTIBULOPLASTY
• A copious amount of saline or local
anaesthetic is injected in to submucosal area.
• A vertical incision is made in midline of
sulcus through mucosa only, extending in the
lip to a level corresponding to where
extension is required.

• A scissor is inserted through this incision
to perform submucosal dissection up to
mental foramens in mandible and
zygomatic buttresses in maxilla.
• Now the incision is deepened down to
bone and connective tissue is separated
from the periosteum.
• The wedge shape connective tissue is
removed from in between
• The denture with overextended borders is
kept in place for one week.

VESTIBULOPLASTY BY SECONDARY EPITHELIALISATION
• Used when inadequate ridge is combined with a poor
mucosal covering.
This technique is especially good when only small areas
are involved.
Labial approach
In this technique, a subperiosteal flap is dissected till the
predetermined depth and repositioned, leaving the exposed
periosteum to cover by secondary growth of epithelial
tissue from the wound margins.

1.KAZANJIAN’S TECHNIQUE (1924)
• Incision is made in the mucosa of the lip and a large
flap of labial and vestibular mucosa is retracted.
• Mentalis muscle is detached from the periosteum to
required depth, and the vestibule is deepened via
supraperiosteal dissection.

• A flap of the mucosa is turned downwards from the
attachment of the alveolar ridge and is placed directly
against the periosteum to which it is sutured.
• Rubber catheter stent can be placed in the deepened sulcus
and secured with percutaneous sutures.

Advantages
• Simple
• Doesn't require hospitalization
• No donor site surgery
• No prolonged period without denture
Disadvantages
• Unpredictability of amount of relapse of vestibular depth
• Scarring in the depth of vestibule
• Problem with the adaptation of the peripheral flange of
denture to depth of vestibule

2. CLARK’S TECHNIQUE
• The procedure is reverse of that explained by kazanjian.
• Clark’s four principles:-
1. Raw surfaces on connective tissue contract, whereas the same
surfaces undergo minimal contraction when covered with
epithelium.
2. Raw surfaces overlying bone cannot contract
3. Epithelial flaps must be undermined sufficiently to permit
repositioning and fixation without tension.
4. Soft tissues undergoing plastic revision have a tendency to return
to their former position so overcorrection and firm fixation
without tension.

Technique
• Flap is pediceled of the lip rather than the alveolar process
leaving a raw surface on the bone instead of on the lip.
• Incision is made slightly labial to the crest of the ridge.
• Dissection is carried out supraperiosteally till the desired depth
of the sulcus.

• The lip mucosa is undermined up to the vermilion border so that
free edge of the mucosal flap is secured to the periosteum deep
in the sulcus.
• The raw surface on the bone heals by granulation tissue
formation and epithelialization without contracture.
• Initially the depth of the sulcus is maintained for a long time.

EPITHELIAL GRAFT VESTIBULOPLASTY
Indications
when the available bone is inadequate to compensate for
relapse of the vestibuloplasty.
When a bone graft has been previously placed in the surgical
site.
When a large surgical defect is present.

TRANSPOSITIONAL FLAP (LIP-SWITCH)
VESTIBULOPLASTY.
KETHLEY AND GAMBLE-1961
Periosteum is incised at the crest of the
alveolar ridge and a subperiosteal
dissection is completed on the anterior
aspect of the mandible.
The periosteum is then sutured to the
anterior aspect of the labial vestibule,
and the mucosal flap is sutured to the
vestibular depth at the area of the
periosteal attachment.

TRAUNER’S TECHNQUE
Dissection of mylohyoid muscle Nylon suture passed through mucosa,
muscle and skin
Suture kept in place with buttons
Graft in place

CALDWELL’S PROCEDURE

RIDGE
AUGMENTATION
PROCEDURES

CLASSIFICATON
MANDIBULAR AUGMENTATION PROCEDURES
A. Superior border augmentation
A. Bone Grafts-iliac crest
B. Cartilage Grafts-rib
C. Alloplastic Grafts-hydroxyapatite
B. Inferior border augmentation
A. Bone Grafts
B. Cartilage Grafts
C. Interpositional or Sandwich bone grafts
A. Bone Grafts
B. Cartilage Grafts
C. Hydroxyapatite blocks
D. Visor osteotomy

E. Onlay grafting
F. Pedicled augmentation-horizontal osteotomy
G. Ridge split technique for implant placement

MAXILLARY AUGMENTATION
PROCEDURES
A. Onlay Bone Grafting- autogenous/ allogenous materials
B. Interpositional or Sandwich Grafts
C. Sinus lift procedures

OBJECTIVES
• Functional Biological Platform
• Support Prosthetic Rehabilitation
• Without further bone or tissue loss

MANDIBULAR AUGMENTATION
Indications :
1. Severely atrophic mandible with inadequate bone width of less
than 8mm and bone length less than 5mm.
2. Poor bone quality of mandible due to previous bone insult such
as radiation, infection or fractures etc.
3. Localized severe alveolar ridge defects following surgery.
4. Young patient with severe jaw atrophy.

CONTRA-INDICATIONS
1. Physical condition of the patient.
2. Short lip length.
3. Nutritional deficiencies.
4. Insufficient inter-arch space
5. Recent radiation therapy.

AUGMENTATION OF SUPERIOR BORDER OF MANDIBLE.
RIB ONLAY GRAFT :
• Two rib segments about 16cm long are taken any where from 5th –
9th rib.
• The rib is contoured by vertical scoring of the internal surface of one
rib to allow bending to ridge shape.
• The second rib is cut in pieces of 2 X 3 mm, later to be packed
against the solid rib.
• At the recipient site, incision is placed from right retromolar region
to left retromolar region.
• Flap is elevated and the graft material is placed on the bone and in
posterior region a wire is passed through mylohyoid ridge and the
inferior part of the rib.
• In anterior part the wires are passed through rib and lingual crest.

• Corticocancellous bone chips are used to fill the voids in
between the graft material and bone.
• Surgical closure is accomplished by horizontal mattress
sutures placement.
DISADVANTAGES:-
1. Donor site morbidity
2. Second surgical site is necessary
3. Continued resorption at graft site
4. Soft tissue dehiscence

INFERIOR BORDER AUGMENTATION
SANDER & COX (1976)
• A continuous submandibular incision is placed
from angle to angle of mandible 3-4mm below
inferior border of mandible.
• Cadaveric mandible involves relieving the
condyles and superior rami and with uniform
thickness of bone is used as a tray to
incorporate the autogenous bone graft.
• The fit of cadaveric mandible is verified by
repeated try-ins.
• The entire specimen with autogenous bone and
bone morphogenetic protein is screwed in
place.

INTERPOSITIONAL GRAFTS
• The idea of using pedicle and Interpositional bone grafts is based
on the concepts that bone attached to its blood supply.
• Procedure of choice for mandibular augmentation.
• Due to maintained blood supply of bone, resorption is less than
onlay graft.
• Chance of permanent retention are more
• A horizontal or vertical osteotomy with Interpositional graft can be
performed
• Horizontal osteotomy with Interpositional bone graft is the
procedure of choice.
• In case of insufficient height of the mandible, a vertical or visor
osteotomy may be performed if the width of the mandible is more
than 15mm.

MODIFIED INTERPOSITIONAL
TECHNIQUE :
• Lekkas and Wes (1981) osteotomy is performed through a
combined intraoral and extraoral approach, and the inferior
segment is lowered rather than the superior portion being raised.
• Advantage : Used in mandible <  6mm ; To avoid mandibular
canal – Lip anesthesia or paresthesia.
• Disadvantage : Extra oral scar

VERTICAL OR VISOR OSTEOTOMY WITH GRAFT
SUPPLEMENT :
(HARLE AND MODIFIED BY PETERSON & SLADE)
•Mandible is vertically split from one external oblique ridge , lingual
segment of the bone is pushed up to increase mandibular
height…..the space between two segments is filled with
corticocancellous bone…Transosteal wire holds segment in place
for 3-4 months.
•Disadvantage - unavoidable nerve trauma

COMBINED VERTICALAND HORIZONTAL
WITH GRAFT SUPPLEMENTATION
• Vertical osteotomy cut in posterior region to divide the
segment bucco-lingually
• Horizontal osteotomy cut- anterior mandible divide anterior
segment superiorly and inferiorly
• In anterior segment bone struts placed- space filled with
cortico-cancellous chips

MAXILLARY ONLAY GRAFT
• Incision above the mucogingival
junction.
• Subperiosteal dissection to expose the
lateral piriform aperture, anterior floor
of the nose.
• Minimum reflection of palatal
mucoperiosteum.
• Cotricocancellous blocks of iliac crest bone blocks can
be secured to maxilla with small screws, eliminating
mobility ,decreasing resorption.
• Interrupted and continuous mattress
sutures.
• Antibiotic coverage 2wk postoperatively

SINUS LIFT AND ANTRAL
INLAY GRAFTING PROCEDURE
• A crestal incision is made from tuberosity
to canine region with relieving incision in
buccal sulcus.
• Semilunar bone cut is made at the level of
antero inferior edge of antrum without
touching the antral lining
• Corticocancellous bone graft is placed
between bone and mucosal lining of
antrum.
• Wound is closed with GTR memberane
and vertical matress sutures
• Allow to heal for 4-5 months.

TITANIUM MESH FOR
AUGMENTATION
• Ti mesh + grafting of particulate marrow and cancellous bone
(PMCB) can be employed to reconstruct atrophic maxilla.
• Ti mesh maintains an appropriate contour for desired osseous
restoration of maxilla and submucosal support for bone graft.

Titanium mesh with the porous bone mineral and the PMCB graft. The porous bone
mineral is mixed in a 50-50 proportion in the center portion of the graft. The
peripheral portion directly underneath the titanium mesh is entirely PMCB
autograft. Porous bone mineral alone is placed immediately next to the host bone.

Ridge defect due
to accident
vestibular incision Mesh tried for fit
A mixture of irradiated cancellous bone
and platelet-rich protein was used to
build up the defective ridge.
Absorbable collagen
membrane covered
the titanium mesh.
Excellent tissue
healing evident 3
months after the
initial surgery.
After removal of the
titanium mesh 3.5
months after
grafting, shows
ample restoration of
width and height.
Healed tissue 2
weeks after the
mesh removed
from the newly
augmented ridge

RIDGE AUGMENTATION WITH SYNTHETIC
GRAFT MATERIALS :
Hydroxylapatite:
Nonresorbable ceramic bone substitutes – Calcium phosphate,
radioopque, sterilized
HA – Bone mixture (1:1) Loaded in a syringe to facilitate
its placement in graft site

Surgical Technique for Minor Deficiencies
(Class I & II)
•For complete augmentation --Ridge crest or single midline
vertical incision
•For only posterior aspects --ridge crest or bilateral vertical
incision in cuspid areas
•Periosteum is elevated only in the area of augmentation
•Traction sutures
•Filling of HA from posterior ends bilaterally to these incision
•Denture or Splint

HA being injected through
the tunnel
Vertical incision in mental nerve
Subperiosteal tunnels developed
Augmentation with synthetic graft material
Proposed by Kent (1983)

Denture can be placed at one month, in cases augmented with
HA only and in six to eight weeks, in cases with HA-
Bone
Postoperative complications
1. Dehiscence with extrusion of particles
2. Abrasion through the mucosa
3. Infection
4. Abnormal colour
5. Mental nerve neuropathy

Advantages
• Simple surgery
• No donor site
• Bio-compatable, non resorbable
• Composite grafting – severe class III and IV cases
• Local augumentation possible
• Metallic implant system through HA augumentation
ridge is possible.

CONCLUSION
• Prosthodontists previously were limited in providing satisfactory
artificial dentures for the patient with defective and malaligned jaws.
• As a result of advances in preprosthetic surgery, they now can provide
well fitting , esthetic dentures for these patients.
• Major anatomic structures that previously interfered with the
construction of artificial dentures now can be changed.
• The recent advances in implants has made the prognosis of a denture
even better.
• With proper diagnosis of problem and treatment planning along with
multi disciplinary team efforts a good and favourable prosthesis can be
delivered to the patient.

LIST OF REFERENCES
• Peterson ellis, Contemporory oral and maxillofacial surgery 7th edition.
• Daniel laskin, Oral and maxillofacial surgery, vol 2.
• Thomas j starshak, bruce sanders , Preprosthetic oral and maxillofacial surgery
• Carl O Boucher, Prosthdontic treatment for edentulous patients 12th edition.
• Sheldon Wrinkler’s. Essentials of complete denture Prosthodontics 3rd edition.
• Dr Neelima anil malik, textbook of oral and maxillofacial surgery, 4th edition.
• Ephros H, Klein R, Sallustio A. Preprosthetic surgery. Oral and Maxillofacial Surgery
Clinics. 2015 Aug 1;27(3):459-72.
• Chari H, Shaik KV. Preprosthetic surgery: review of literature. IJSS. 2016
Sep;3(4):10.
• McLaurin WS, Krishnan D. Preprosthetic Dentoalveolar Surgery. Oral and
maxillofacial surgery clinics of North America. 2020 Nov;32(4):583-91.

PREPROSTHETIC SURGERY: ROLE IN PREPARATION OF AN IDEAL FOUNDATION FOR COMPLETE DENTURE

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PREPROSTHETIC SURGERY: ROLE IN PREPARATION OF AN IDEAL FOUNDATION FOR COMPLETE DENTURE