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Preprosthetic surgery /certified fixed orthodontic courses by Indian dental academy


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Preprosthetic surgery /certified fixed orthodontic courses by Indian dental academy

  1. 1. PREPROSTHETIC SURGERY INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. • Preprosthetic surgery is carried out to reform, redsign soft/hard tissues,by eliminating biological hinderances to receive comfortable and stable prosthesis. • Goal should be rehabilitation of the patient with restoration of best possible masticatory function, combined with restoration or improvement of dental and facial esthetics.
  3. 3. Aims of Preprosthetic surgery • Provide adequate bony tissue support for the placement of RPD/CD(optimum ridge, height,width & contour) • Provide adequate soft tissue support (optimum vestibular depth) • Elimination of pre-existing deformities (tori,prominent mylohyoid ridge,genial tubercles)
  4. 4. • Correction of mandibular and maxillary ridge relationship. • Elimination of pre-existing soft tissue deformities (epulis,flabby,hyperplastic tissues) • Relocation of frenal /muscle attachments. • Relocation of mental nerve. • Establishment of correct vestibulr depth.
  5. 5. Preprosthetic procedures • • • • • • Alveoloplasty Vestibuloplasty Ridge augmentation Frenectomy Removal of palatal tori Removal of exostoses
  6. 6. ALVEOLOPLASTY • Alveoloplasty: surgical recontouring of the alveolar process. Objectives & Principles: 1. To provide optimal ridge contour quickly,permitting early construction of the well-fitting and comfortable denture.
  7. 7. 2. Alveolar ridges should be left as broad as possible for maximum distribution of the masticatory load 3. Ridge need not be perfectly smooth but sharp edges should be rounded and gross irregularities should be reduced 4. Mucosa covering the ridge should be uniform in thickness,density & compressibility for even distribution of forces.
  8. 8. 5. In younger people less bone has to be removed as it is more plastic and prone for resorption than older patients. 6. Cancellous bone resorbs more rapidly than the cortical bone,so it is desirable to preserve as much of cortex as possbl A denture should rest on the cortical bone not on the medullary bone.
  9. 9. 7. If the immediate reduction of the undercuts will result in a narrow V shaped ridge,alveoloplasty should be delayed 4-6 weeks until new bone fills the socket. 8. If pieces of bone are accidentally removed with the teeth an attempt should be made to return atleast some of this bone(esp.medullary bone) to the operative site.
  11. 11. ALVEOLAR COMPRESSION -Easiest and quickest form of a’plasty. -Compression of the inner and outer plates between fingers is done -Most effective in young patients but it should be carried out in all the cases
  12. 12. -compression reduces the width of the socket and deliminates many otherwise troublesome bony undercuts. -sutures are used to maintain the softtissue and bone in their desired position.
  13. 13. Alveolar compression diagram
  14. 14. SIMPLE ALVELOPLASTY -It is done to reduce the labial or buccal cortical margin. -Commonly envelope flap is given,also a releasing incision if required. - Flap should be reflected just beyond the bony projection,avoiding excessive apical reflection.
  15. 15. - With a rongeur bone-cutting forceps held parallel with the bone margin of the alveolar process,right amount of bone can be removed. - Overerupted teeth often have an elongated alveolar process. - Vertical reduction of these bone margins of the socket is necessary.
  16. 16. - Maxillary sinus expands into the maxillary tuberosity,making vertical reduction of the residual ridge difficult. - In these cases care is taken to leave some bone to form floor of the antrum
  17. 17. Simple alveoloplasty
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  19. 19. LABIAL & BUCCAL CORTICAL ALVELOPLASTY • Incision is made on the crest of the ridge and a full thickness mucoperi osteal flap is reflected. • Flap is reflected atleast one tooth distance on either side from the area of surgery.
  20. 20. • Sharp side-cutting or a blumenthal rongeur forceps is held with one beak beneath the bony rim of the socket and other in the crest of the ridge. • Small pieces of bone can then be ‘`bitten off’’ the ridge. • The rongeur should be sharp so that bone is removed cleanly rather than fractured away in large pieces
  21. 21. • A bone file can then be used to smoothen the bony contour • The mucous membrane can then be held with sutures that are placed over the interradicular bony septa. • This technique is one of the most common procedure performed after removal of the teeth.
  22. 22. Labial & buccal cortical a’plasty
  23. 23. DEAN’S INTRASEPTAL ALVEOLOPLASTY ADVANTAGES • Prominence of the labial and buccal alveolar margin is reduced to facilitate the reception of dentures. • Muscle attachments are undisturbed • Periosteum remains intact • Cortical plate is preserved as a viable onlay bone graft with an intact blood supply.
  24. 24. • As cortical bone is spared the postop resorption is less. TECHNIQUE: -After removal of the teeth,the interradicular bony septa should be removed with a rongeur/burs/chisels. -Dean used a chisel to make an inverted ‘V’ shaped excision of bone in the labial cortex in the canine socket
  25. 25. -Thus three sides of the labial cortical bony flap are freed. -The labial cortex b’comes a freely movable osteoperiosteal graft attached to only the mucoperiosteum from which it receives its blood supply
  26. 26. - At this point finger pressure usually is sufficient to compress the labial cortex - Sutures are placed to stabilize the tissues. - Dean used this tech.on posterior as well as anterior ridges making a buccal-cortical relief in the most posterior socket.
  27. 27. • Dean suggested removing most posterior molar teeth first and the working forward to preserve the tuberosity when preparing the posterior ridge. • Canines should be removed first before incisors to avoid fracturing nd removing the labial cortex attached to cuspid teeth.
  29. 29. OBWEGESER’S TECHNIQUE • Obwegeser suggested further modifica tion of dean’s tech. for cases of extreme premaxillary protrusion. -Technique: • Teeth are removed as usual. • Sockets are connected and rongeurs /burs are used to remove the medullary interradicular bone.
  30. 30. • A large pear shaped/round bur is taken and the sockets and their interconne cting trough is enlarged. • Both labial and palatal plates are cut with burs in the canine area to weaken the bone and to form three sided bone flaps in both cortical plates.
  31. 31. • A small mounted disk is inserted into the sockets and trough,to score/groove ,the labial nd palatal plates ,horizontally weakening them. • Since the labial cortex is very thin, usually only the palatal cortex need to be scored with the disk
  32. 32. • A pair of broad flat elevators is inser ted into the sockets nd their connecting trough and is used to # the labial plate labially and palatal plate palatally. • Finger pressure is used to mold the alveolar process into the desired shape. • Sutures are placed and a denture splint is used to stabilize the alveolar process(46wks)
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  34. 34. Thank you Leader in continuing dental education