A 58-year-old patient visited the clinic seeking treatment for removable dentures. An examination found she was missing teeth in the upper anterior region and had a protruding ridge that could cause discomfort. She also had a fused labial frenulum. The general dentist referred her to oral surgery for preprosthetic surgery. Her general health was normal with no systemic issues.

1. SCENARIO 2
Make a New Denture
a 58years old patient came to the RSGM with the aim of doing treatment for making
removable dentures. intra-oral examination showed on edentulous condition in the maxillary
anterior, but on the maxillary anterior ridge there was a protruding part, so it was feared that
during the treatment it would cause discomfort. in the examination also showed a frenulum
on the patient's anterior labial fused to thepalate area. the general dentist makes a referral to
the departement of oral surgery for preprostethic surgery. the general condition of the patient
were suspected has no abnormality and no systemic abnormalities.
Artinya :
seorang pasien berusia 58 tahun datang ke RSGM dengan tujuan melakukan perawatan
pembuatan gigi tiruan lepasan. Pemeriksaan intra oral menunjukkan kondisi edentulous pada
anterior rahang atas, namun pada ridge anterior rahang atas terdapat bagian yang menonjol,
sehingga dikhawatirkan selama perawatan akan menimbulkan rasa tidak nyaman. Pada
pemeriksaan juga didapatkan frenulum pada labial anterior pasien yang menyatu dengan
daerah palatum. dokter gigi umum membuat rujukan ke departemen bedah mulut untuk bedah
preprostetik. keadaan umum pasien diduga tidak ada kelainan dan tidak ada kelainan sistemik
Keywords: Dentures, Edentolous, Ridge, Frenulum, Surgery Preprosthetic
PREPOSTHETIC SURGERY
Definition:
Preprosthetic surgery is a part of oral and maxillofacial surgery that aims to form hard
tissue and soft tissue that is as optimal as possible as the basis of a prosthicion. Includes
simple retraction techniques and oral preparations for the manufacture of prosthics up to
bone grafting and alloplastic implants (Stephens, 1997). A dental implant is a biological or
alloplastic surgical biomaterial that is inserted into soft tissue and/or hard tissue in the oral
cavity for functional or cosmetic purposes.
Preprosthetic surgery is more intended for surgical modification of the alveolar bone
and surrounding tissue to facilitate the manufacture of good, comfortable and aesthetic
dental prothesa. When the original tooth tooth is lost, changes will occur in the alveolus and
surrounding soft tissues.Some of these changes willinterfere with the convenience of making
dentures. Intra oral evaluation of soft tissue that supports dentures systematically and liver
should be done before trying to rehabilitate the discharge with a mock geligi (Panchal et al,
2001).
PRE - PROTESTIC SURGICAL GOALS

2. Preprosetic Surgery (Matthew et al, 2001). The purpose of preprosthetic surgery
It is to prepare the soft tissues and hard tissues of the jaw for a comfortable prosasion that
will restore oral function, facial shape and aesthetic.
The purpose of preprosthetic surgery helps to:
 Restore jaw function (such as the function of sanctifying, speaking, swallowing)
 Maintaining or improving jaw structure
 Improve the patient's sense of comfort
 Improving the aesthetics of the face
 Reduce pain and discomfort arising from the installation of painful prosthans by
modifying surgery on areas that support the prose
 Restoring the area that supports the prose in patients where there is a lot of alveolar
bone loss.
Nonsurgical options should always be considered (such as denture remaking,
adjustment of occlusal muco height, expanding the periphery of the denture) before
preprosthetic surgery.
Perseden (1996), the purpose of alveolectomy:
1. Discarding the sharp, prominent ridge of alveolus
2. Removing a sore interceptal bone during a gingivektomy
3. To make bone contours that make it easier for patients to carry out effective plaque
control.
4. To form a bone contour that corresponds to the contours of the gingival tissue after
the splicing.
5. To facilitate the closure of the primary wound.
6. To open an additional clinical crown so that appropriate restoration can be carried
out.
INDICATIONS AND CONTRAINDICATIONS OF PRE-- PROTESTIC SURGERY
Indication
1. The presence of exostosis
A benign growth of bone tissue that comes out of the surface of the bone. Typically this
condition is characterized by the closure of the bulge by cartilage.
2. There is a torus
3. High frenulum
4. Acquire a good alveolar linggir state
5. There are no pathological conditions in intra oral and extra oral states.
6. Pain due to the installation of dentures
7. Because of repeated ulcers around dentures
8. Jaw atrophy due to physiological processes
9. Dysfunctions that are not reduced by conventional improvements, such as spastic
dysfunction, phonetic dysfunction, and temporo-mandibular joint dysfunction

3. Contraindications
1. Patients of advanced age due to bone resorbtion.
2. Psychological disorders: depressed, confused, and not ready to use dentures.
Other sources state indications and counter indications of pre-prosthetic surgery, namely:
Indications of Alveolectomy
1. Indications of an alveolectomy procedure are rare but usually performed in cases of
excess anterior projection on the alveolar ridge in the maxilla(Wray et al., 2003) or for
the reduction of elongation-experiencing alveolaris processus (Thoma, 1969). These
excess areas can cause problems in the aesthetics and stability of dentures. This
surgery is most widely performed in grade II maloclusion division I (Wray et al., 2003).
2. Alveolectomy is also done to remove pus from an abscess on the tooth.
3. Alveolectomy is also indicated for jaw preparation for prosthetic purposes, namely to
strengthen the stability and retention of dentures (Thoma, 1969).
4. Removes the pointed alveolar ridge that can cause: neuralgia, unstable prosas, sick
protests at the time of use.
5. Eliminating tuberosity to get a stable and comfortable prostrosity
6. For excision exostosis (Thoma, 1969).
7. Remove bonediseas interceptions.
8. Remove the undercut.
9. Get the spaceintermaksilaris thatisexpectedright.
10. For the purposes of orthodontic treatment, if the use of ortho tools is not maximal
then alveolectomy is carried out.
11. Severe periodontal disease that results in the loss of a small portion of its alveolar
bone.
12. extraction of traumatic teeth or due to external trauma.
Contraindications
1. Patients with systemic diseases
2. Periostitis (theimpact of inflammation of the tissue around the bones called periosteum)
3. Periodontitis
PRE-SURGICAL CLASSIFICATION – PROSTHETICS
The types of preprosthetic surgery include:
a. Alveolectomy is a radical surgical procedure to take the alveolaris processus so that
mucous aposition can be performed to prepare the lingir before radiation therapy.
This is done to remove unwanted contours, as wellas sharp to provide a more delicate
foundation that is comfortable for dentures. (Pedersen, 1997)
Alveolectomy is divided into several classifications:

4. - Simple alveolectomy. Done after multiple extraction, if there is a sharp bone
checked first then in the alveolectomy
- Radical alveolectomy. It is the formation of radix bone contours of the
alveolar bone thatisindicated due to the presence ofaveryprominentundercut.
b. Gingivoplasty. They are done to remove or reshape gum tissue to provide a more
acceptable surface for removable dentures. Sometimes excess or excessive soft tissue
requires removal (Fortin, 2000).
c. Torus removal is a surgical procedure performed to remove one or more extra bone
protrusions in both the upper jaw and lower jaw. Although segments such as
additional bone are harmless, the presence of these bones can be problematic for
patients who need some type of dental prosthancing, such as complete or partial
dentures. (Neville, et all., 2002)
d. A frenectomy is a surgical procedure performed to remove fibrous tissue (frenulum).
This soft tissue surgery aims to improve the comfort and stability of prosasity.
(Pedersen, 1997)
e. Vestibuloplasty is an act of deepening the sulcus vestibulum. The procedure of
deepening the sulcus for the upper or lower jaw is usuallyrequired by avery low sulcus
so that the prosthanity is unstable.
f. Implants are surgical procedures that aim to install artificial tooth roots that will be
used to remove dentures.
But some divide it into two groups, namely major preprosthetic surgery and minor
preprosthetic surgery.
a. Major preprosthetic surgery includes relative alveolaris augmentation
(vestibuloplasty), absolute alveolaris augmentation (osteotomy),and implants.
b. Minor preprosthetic surgery, including surgery on hard and softtissues.
PRE-PROSTHETIC SURGICAL PROCEDURES
Alveolectomy
Alveolectomy work procedures:
a. Disinfected with povidon iodine
b. Anaesthetist of the work area

5. c. Create a flap (triangular or trapezoidal)in the surgical area
d. Reduction of bone with bone bur, knabel tang (tocut a sharp part ofbone),and bone
file
e. Palpation of the mucosa, if there is still a sharp reduced again
f. Clean irrigation with saline solution (NaCl)
g. If you get excessive bone intake done free graft
h. Closed and sewn
i. Anti-inflammatory, antibiotic and analgesic administration
j. Patient instructions
Complications that arise after alveolectomy are infection, parastes,hematoma,
bonefracture, osteomyelitis, excessive bone resorbtion, swelling,and necrosis.
Frenectomy
Conventional frenectomytechniques:
1. Persiapan surgical equipment
2. Disinfect with Iod glycerin in the area to be under anesthesia. Anesthesia on sinistra
and dextra frenulum labialis superior to be excedied and palatal part expansion of
superior frenulum labialis.
3. Pinch the frenulum at vestibulum depth with hemostat and close to the mucosal
surface of the lips to avoid post-excision bleeding.
4. The excision of the superior frenulum labialis under the hemostat.with scalpel.
5. The basearea of the vestibulum and lip mucosa are sewn so that there is no expansion
of the iris area and excessive bleeding.
6. Excision of superior frenulum labialis expansion that dilates to palatal.
7. Do a curettage on the surface area of the bone. Clean all periosteum fibers so that
there is no meeting of coronal and apical fibers
8. Irrigation with saline, press 3-5 minutes
9. Installation of periodontal packs in the surgical area for optimal wound healing and
no attachment of the lips to the gingival during the gingival healing process.
10. Prescribing and instructions; Drugs used in the form of analgesics and antibiotics.
11. Control I (1 week postoperative): periodontal pack opening and stitch retrieval,
irrigation with antiseptic and instructions for home treatment.
12. Control II (2-3 weeks postoperative): 2 weeks of postoperative healing, irrigation and
treatment instructions.
Factors that affect the success of a frenectomy:
1. General health conditions
2. Nutrition and diet
3. Oral hygiene
4. Prescribing of drugs
Complications of a frenectomy procedure: Complications that may occur in frenulum surgery
are as follows (Kruger 1974):

6. a. Bleeding. This bleeding may occur during surgery (primary bleeding) or several hours
to a few days after surgery (secondary bleeding). This bleeding can occur by local or
systemic causes. Local causes usually include the release of a blood clot, an infected
wound, trauma to the wound or the release of stitches. Systemic causes can be blood
disorders. Countermeasures by cleaning the wound area and pressing with gauze
moistened with local vasoconstrictors, cold compresses and tailoring or giving
coagulation promoting agents such as gelatin sponge,thrombin, and others. If the
action can not overcome bleeding should be consuled to the internal disease.
b. Swelling. It usually occurs due to excessive trauma or due to infection. The
countermeasures can be controlled with cold compresses with ice bags or cold cloths.
c. Infection. To prevent infection it is recommended to maintain oral hygiene and given
antiseptic mouthwash. If an infection has occurred, local actions that need to be done
are irrigating the wound with warm physiological NaCl and antiseptic examination of
the edge of the wound, as well as antibiotic drugs.
d. Excessive pain. This condition usually arises due to the movement of the lips, cheeks,
or tongue when speaking or at the time of chewing. The countermeasures are given
analgetic drugs, a warm antiseptic mouthwash.
MaintenancePhase:
Maintenance phase is a maintenance phase that includes periodic visits and re-
examination. Things examined at the time of the patient's visit include:
1. Seeing the bleeding,
2. See if the stitches come off or not,
3. Are there any complaints of pain,
4. Whether or not there is swelling in the wound,
5. The wound is infected or not,
6. For aesthetic purposes, see if there are any scars
RELATIONSHIP OF PRE- PROSTHETIC SURGERY TREATMENT WITH GTL SUCCESS
With advances in technology enabling maintenance of dentures, prosthetic
restoration and rehabilitation of the immune systemare still needed in patients who are not
toothless or partially toothed. Objective preprosthetic surgery is to form a good support
network for the placement of dentures. Characteristics of a good support network for
dentures (Tucker, 1998):
1. There are no pathological conditions in intra oral and extra oral.
2. There is a good jaw relationship in the posterior antero, transverse and vertical
dimensions.
3. Good form of alveolar processus (an ideal form of an alveolar processus is a large U-
area shape, with parallel vertical components).
4. There are no bone protrusions or soft tissues or undercuts.
5. A good mucosa in the artificial tooth support area.
6. Sufficient vestibular depth.
7. Alveolar form and enough soft tissue for implant placement.

7. RELATIONSHIP OF PRE-PROSTHETIC SURGICAL TREATMENT WITH SYSTEMIC (CORONARY
HEART) DISEASE
Preprosthetic surgical relationship with patients with a history of heart disease is
a. The use of anaesthetes does not use adrenaline.
b. Prophylactic antibiotics
c. Anticoagulant drugs (aspirin, aspilet) are discontinued 5 to 7 days before surgery.
d. Asepsis tool to be used because it will cause endocarditis
e. In patients witha history of heart will be easily tiredso that surgery shouldnot be too
long.
ABNORMALITIES IN THE SHORT FRENULUM LINGUALIS
Ankyloglossia is a disorder with a network condition that connects the tongue to the
base of the mouth too short and thick so that it makes the movement or mobility of the
tongue very limited. Ankyloglossia can cause difficulty speaking (difficulty pronouncing
certain letters, e.g. R) due to limited tongue movement. Because limited movement of the
tongue can also cause difficulty swallowing.
Causes: Congenital abnormalities
Symptoms:
Signs and symptoms of ankyloglossia, among others:
1. The tissue that connects the tongue to the mouth (frenulum lingualis) istoo short
and thick.
2. Difficulty lifting the tongue to the upper teeth or moving the tongue from end to
end.
3. Difficulty sticking out the tongue more than 1 – 2 mm
4. Tongue that appears notched or heart-shaped when outsuming out
Treatment:
Mild ankyloglossia that is not very bothersome, does not require treatment. If
ankyloglossia is very bothersome, it can be treated with a frenotomy or frenectomy
procedure. A frenectomy or frenotomy is a surgical procedure that involves cutting or
removing frenulum tissue with local anaesthetic or local anesthesia.