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Preprosthetic management/ orthodontic seminars


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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

Published in: Education

Preprosthetic management/ orthodontic seminars

  1. 1. PREPROSTHETIC MANAGEMENT INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Contents Introduction Aims and objectives Phases of management Armamentarium Procedures Conclusion Bibligraphy
  3. 3. Introduction Thorough examination of the oral cavity prior to the construction of the prosthesis is a must to identify the Potential problems. This improves the treatment prognosis and reduce the Number of postinsertion adjustments.
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  5. 5. Rationale of pre prosthetic service Aim : Is to prepare the soft and hard tissues of jaws for a Comfortable prosthesis,that will restore oral function, Aesthetics and facial form.
  6. 6. Objectives • To restore functions of the jaws ( mastication,speech and swallowing ). • Preserve or improve jaw structure. • Improve aesthetics. Eliminating pain and discomfort arising from an ill fitting prosthesis by surgically modifying the denture bearing area. Improving the denture bearing area for patients in whom there has been extensive loss of alveolar bone.
  7. 7. Phases of management  Non surgical Surgical Combination of both
  8. 8. Non surgical methods Rest for denture supporting tissues. Occlusal correction for the existing prosthesis. Optimal vertical dimension of occlusionto the dentures currently worn by the patient with an interim resilient lining material. Good nutrition. Jaw exercises can permit relaxation of the muscles of mastication and strengthen their co- ordination.
  9. 9. Principles of surgery Sterilisation A- traumatic procedure Post operative care Supportive care
  10. 10. Surgical armamentarium Bard parker blade (no 15) Heamostat Molt periosteal elevator (no 4) Retractor Artery forceps Mosquito forceps Suturing materials
  11. 11. Surgical Methods  Broadly dividend into – 1. Correction of conditions that precluded optimal Prosthetic function. 2. Enlargements of denture bearing areas
  12. 12. Correction of conditions that precluded optimal Prosthetic function  Hyperplastic Ridge- mobile tissues that interfere optimal seating of denture  Epulis fissueratum – locailised enlargement of peripheral tissues may interfere peripheral seal of denture  Papillomatosis - Harbour micro organisms
  13. 13. 4. Unfavourable Frenular Attachments and Pendulous maxillary tuberosities. 5. Unfavourable Maxillary Tori. 6. Pressure on metal foramen
  14. 14. Enlargements of denture bearing areas – Vestibuloplasty Ridge augmentation Implants
  15. 15. Minor surgical procedures Alveoloplasty- To persue as much as alveolus possible without any bone irregularities Digital Compression of the socket is ideal Interseptal Alveoloplasty by O.T Dean  With adequate bone height, undercut on the buccal aspect of the jaw, repostioning of labial cortical bone is accomplished. Without raising the mucoperiosteal flap, interseptel bone is removed with a small rongour & buccal plate is infractured with digital pressure.
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  17. 17. Reduction of sharp spiny processes 1. Frequently associated with denture discomfort 2. Rapid resorption of labial / lingual plates results in knife edge ridge 3. 3 types of sharp ridges ( MEYER)  - Saw tooth  - Razor like  - Discrete spiny projections Labial & lingual flaps reflected, exposed bone recountoured strip of soft tissues reshaped & epithelium closed with sutures
  18. 18. Spiny Ridges
  19. 19. Bony Tuberosity reduction Classification- Clinical Histological Functional Pendulous Fibrous Mobile Bulbous Bony Immobile Con…
  20. 20. Clinical examination- lack of adequate clearance by placing a figure or mirror posterior to the tuberosity near the peripheral border Inability open widely when figure in place indicates reductions of excess tuberosity Care must be taken to avoid opening in to the sinus in those insantances in which the sinus dips down in to the pneumatized and elongated tuberosity it may be possible to collapse the sinus floor upwards- sinus lift procedure .
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  23. 23. Frenectomy  Frenum is a musculo-fibrous band attached to the alveolus and inserted into the muscles of the face Classification-(House) Class I Attachments are high in maxilla and low in mandible with respect to crest of the ridge Class II Medium Class III Freni encroach on the crest of the ridge and may interfere with the denture
  24. 24. Evaluations by visual examination Z- Plasty – more difficult , advised when frenum is broad and short to preserve sulcus depth V-Y advancement Technique – Concomitant decrease in nasal base width is required
  25. 25. Frenectomy
  26. 26. Tori  Tori are benign, slowly growing osseous projections of the maxilla and or mandible that attain maximum size by third decade.  Etiology- unknow Location:- – Maxilla Midline – Mandible Premolar region
  27. 27. Indication for the removal of maxillary tori – Extremly large tours that fills the Palatal vault and prevents the formation of a stable maxillary denture Under cut creating torus that traps foods debris causing the chronic inflammatory condition. Tori extending past the junction of the hard and soft palatals and prevents the development of an adequate posterior palatal seal Tori cuasing patient
  28. 28. Incisions for tori reduction
  29. 29. Tori reduction
  30. 30. Relocation of mental nerve Due to progressive ridge resorption,Mental foramen gets closer to the crest of te alveolar crest. Pressure from the denture flange causes discomfort to the patient. Relocating it apically by surgical exposure would be a satisfactory remedy
  31. 31. Relocating mental nerve
  32. 32. Exostosis
  33. 33. Abused tissues  Hyperplastic ridge  Epulis fissuratum  papillomatosis  Etiology  Faulty dentures  Poor oral hygiene  Systemic complications
  34. 34. Management of abused tissues Type I – rest, massage and topical anti- fungal agents. Type II – Tissue conditioners Type III- Surgical excision
  35. 35. Tissue conditioners Composition Polyethyl-methacrylate and an aromatic ester alcohol mixture. Plasticisers to improve flow. Classified as- Temporary (soft) Permanent (hard)
  36. 36. Uses of tissue conditioners Adjunctions in tissue conditioning Temporary obturators Stabilizers of base plates and surgical splints. Adjunct in impresson making procedure or as a final impression material
  37. 37. Advantages Hypertrophied, irritated,hyperemic tissues are rested without discontinuation of the denture. Improves stability,relives and equalizes pressure almost immediately thus preventin further damage. The dis-advantage are; Easily misused
  38. 38. Technique Powder liquid ratio- 1.75/1 ½ cc of plasticizer added to the monomer prior to mixing it with polymer. While the mixture is still creamy and runny pour it into denture. 1mm of even thickness or more in needed for effective conditioning of the tissues.
  39. 39. Surgical management Apart from conventional surgical techniques, Electrosurgery Lasers
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