Pre prosthetic surgery /certified fixed orthodontic courses by Indian dental academy


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Pre prosthetic surgery /certified fixed orthodontic courses by Indian dental academy

  1. 1. Pre Prosthetic Surgery INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Definition ―Surgery performed to prepare the remaining oral tissues to best support a prosthesis‖
  3. 3. 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.
  4. 4. 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
  5. 5. Patient evaluation & treatment planning • History • Physical examination – Evaluation of supporting bony tissue Evaluation of supporting soft tissue
  6. 6. Classification • Corrective Procedures • Ridge extension procedure • Ridge augmentation
  7. 7. 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
  8. 8. Bony Recontouring of the alveolar ridges • Simple alveoloplasty associated with multiple removal of teeth • Compression of the lateral walls
  9. 9. 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
  10. 10. Advantages • Labial prominence of the ridge can be reduced without significantly reducing the height of the ridge
  11. 11. 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.
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  13. 13. 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
  14. 14. Objective Procedure for hard tissue • To provide adequate interarch space • A firm mucosal base of consistent thickness
  15. 15. Procedure for soft tissue
  16. 16. Mylohyoid ridge reduction
  17. 17. Genial tubercle • Reduction or augmentation
  18. 18. 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
  19. 19. Maxillary tori
  20. 20. 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
  21. 21. Mandibular tori
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  23. 23. 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
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  25. 25. 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
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  27. 27. 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
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  29. 29. 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
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  34. 34. Augmentation procedures Maxillary augmentation • Onlay bone grafting • Interpositional bone graft • Maxillary hydroxyapetite augmentation • Sinus lift • Tuberocity augmentation
  35. 35. Mandibular augmentation • Superior border augmentation • Inferior border augmentation • Pedicle or interpositional augmentation • Hydroxyapetite augmentation
  36. 36. Superior border augmentation Indications • Inadequate height • Irregular contour • Potential risk of fracture • Neurosensory disturbance
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  42. 42. Advantages • Adds strength to the mandible • Increases height of the alveolus • Increases the width and recontours the mandible
  43. 43. Disadvantages • Donor site morbidity • Need for secondary soft tissue surgery • Avoid denture for 6-8 months • Resorption of the graft
  44. 44. 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
  45. 45. Inferior border augmentation Disadvantages • Extraoral scar • May worsen the facial appearance Procedure
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  47. 47. 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
  48. 48. 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
  49. 49. Procedure
  50. 50. 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
  51. 51. Procedure
  52. 52. 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 healing around the material
  53. 53. Procedure
  54. 54. 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
  55. 55. 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
  56. 56. 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.‘
  57. 57. Vestibuloplasty • Classification: – Maxilla • Submucosal • Secondary epithelization • Tissue graft – Mandible • Submucosal • Secondary epithelization – – – – Clerk‘s technique Kazanjian‘s technique Lip switch Lingual vestibulopasty
  58. 58. 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
  59. 59. 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
  60. 60. 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
  61. 61. Thank you