1. Pre-prosthetic surgery modifies the oral anatomy to facilitate denture retention by creating proper supporting structures. 2. Objectives of pre-prosthetic surgery include eliminating pathologic conditions, achieving proper jaw relationships, and ensuring adequate bony support, keratinized tissue, and vestibular depth. 3. Common pre-prosthetic procedures described include exostosis removal, tori removal, tuberosity reduction, frenectomy, alveoloplasty, cyst enucleation and marsupialization, and various bone grafting techniques for ridge augmentation to enable dental implant placement.

1. DR.AISHA JAMIL

2. Introducton:
 Pre-prosthetic surgery refers to surgical procedure that can modify the oral
anatomy to facilitates the retention of conventional dentures .
Aisha jamil

3. Objectives of pre-prosthetic surgery
 Objectives is to create proper supporting structures for subsequent placement of prosthetic appliances.
 These are the following characteristics:
 1-no evidence of intra-oral or extra-oral pathologic conditions.
 2-proper inter-arch relationship in antero-posterior ,transverse etc.
3-there should be ideal shape of alveolar process i.e. broad u shaped ridge
4-no bony and soft tissue protuberance
 5-Adequate palatal vault form
 6-proper posterior tuberosity notch
 7-adequate attached keratinized mucosa in primary denture bearing area
 8-adequate vestibular depth
 9Added strenghth where mandibular fracture may occur
 10-protection of neurovascular bundle
 11-adequate bony support
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4. Lateral palatal exostosis removal:
 Problems by exostosis:
1-it creates undercuts
2-narrowing the palatal vault
3-mucosa covering the area become ulcerated.
4-Interference with the wearing of dentures
5- Problems eating
6-Problems speaking
- 4-Post – operative intraoral view:
Surgical site closed by 3-0 silk suture
3-Surgical removal of palatal bony exostosis
by chisel and mallet and
Bone file was used to smoothen the sharp
and rough edges of the bone and
2: -under L.A, Incision made, flap
raised and palatal bony exostosis
was exposed
1: - Intraoral view of the Palatal bony
exostosis
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5. Tori removal :
 Remove Tori with:
•Surgical drill / bur
•Osteotome and hammer
•A combination of both
 Insure a dry field and inspect
wound before closure
 Complications:
1-Oro-antral / nasal
communication / fistula
2-Arterial bleeding (from the
greater palatine artery)
3-Hæmatoma
4-necrosis of flap
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6. Maxillary tuberosity reduction:
 tuberosity is a rounded bony protrusion behind your last
molar in the upper jaw. It is covered by your gum.
 For proper inter-arch relationship and for making seal.
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7.  surgical procedure that
smoothes or re-contour the
jawbone
 An alveoplasty is done in
areas where teeth have been
removed or lost
alveoloplasty Advantages of deans
technique(interseptal
alveoplasty)
1-:labial prominence is
reduced without reducing
alveolar ridge height.
2-perioseal uder that removed
bone can also be maintained.
3-muscle attachment can be
left undisturbed.
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8. Labial frenectomy :
(thin bands of fibrous tissue covered with mucosa, extending from
the lip and cheek to he alveolar periosteum.)
 Types:
 1-simple excision
 2-z-plasty
 3-vestibulloplasty
 4-laser
Indications:
The frenum is characterized as pathogenic and is
indicated for removal when ::
• An aberrant frenal attachment is present, which causes a
midline diastema.
• A flattened papilla with the frenum closely attached to the
gingival margin is present, which causes a gingival
recession and a hindrance in maintaining the oral hygiene.
• An aberrant frenum with an inadequately attached
gingiva and a shallow vestibule is seen.
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9. Simple excision technique
[Table/Fig-1]: Pre-operative papilla
type of frenal attachment
[Table/Fig-2]: Frenum held with
hemostat
[Table/Fig-3]: Frenum excised
[Table/Fig-4]: Sutures placed
[Table/Fig-5]: One month post-
operative
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10. Z-plasty(decrease the amount of surgical ablation)
[Table/Fig-11]: Pre-operative attached
type of frenal attachment
[Table/Fig-12]: Incision given through
the frenum
[Table/Fig-13]: Incision given at both
ends of the frenum to obtain 2
triangular flaps
[Table/Fig-14]: Flaps transposed
across the midline sutured in the form
of Z
[Table/Fig-15]: 1 month post-operative
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11. Electro cautery(heal by primary intention, no need of sutures+fewer post
op. pain and swelling)
[Table/Fig-21]: Pre-operative attached type of frenal attachment
[Table/Fig-22]: Frenum held with hemostat and excised with a loop
electrode
[Table/Fig-23]: Excision of frenum completed with no requirement for
suture placement
[Table/Fig-24]: 1 month post operative
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12. Marsupialization:
 Cyst is opened and edges sutured,
forming an open pocket or pouch.
 The only portion of the cyst that is
removed is the piece removed to
produce the window. The remaining
cystic lining is left in situ.
 Advantages:
 process decreases intracystic pressure
and promotes shrinkage of the cyst
and bone fill.
 Marsupialization technique. A, Cyst
within maxilla. B, Incision through oral
mucosa and cystic wall into center of
cyst. C, Scissors used to complete
excision of window of mucosa and
cystic wall. D, Oral mucosa and
mucosa of cystic wall sutured
together around periphery of
opening
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13. Enucleation:
 Enucleation is the process by which the
total removal of a cystic lesion is
achieved
 remove the cyst in one piece without
fragmentation, and the patient is no
longer bothered by the cystic cavity.
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14. Cystic decompression:
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15. Lefort 1 osteotomy:
 the “Lefort 1 osteotomy”
that they ended up
performing refers to
surgical procedures in
which the tooth-bearing
part of the mid-face is
separated from the
supporting structures
and repositioned
upwards, downwards,
forwards or backwards.
 Anterior open bite
caused by a posterior
maxillary overgrowth
can be corrected.
Aisha jamil

16. bilateral sagittal split osteotomy
procedure(bsso):
-osteotomy cut vertically extending down near he 1st molar and horizontally
extending posterioirly to the ramus
-3 bicortical screws on both side
Aisha jamil

17. surgically assisted rapid palatal
expansion(SARPE):
 Surgically assisted rapid palatal
expansion (S.A.R.P.E.) is a combined
orthodontic and surgical procedure
which facilitates an increase in
transverse maxillary width both in
children or adults. The procedure is
generally done because the upper
jaw generally does not expand during
development in order to
accommodate all its teeth in the
dental arch causing significant
crowding, malpositioned and
misaligned teeth.
Aisha jamil

18. Aisha jamil

19. Ridge Augmentation:
 Ridge Augmentation (also called bone grafting or bone regeneration)
can repair sites with inadequate bone structure due to previous
extractions, gum disease, or injuries to allow dental implant placement
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20. Grafts:
 Type:
 1-autogenoous (from anoher part of same body)
 2-isografts (between two twins)(monozygotic)
 3-allografts (one person o another)
 4-zengrafts (from animal to human)
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21. Vestibuloplasty : (lip swtich)-
mucosal flap from alveolar ridge is elevated from the underlying tissue and also from
inner side of lip and sutured to the depth of vestibule)
Disadvantage
1-scarring
2-relapse
Denuded periosteum heals
by secondary
epithelialization
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22. Maxiilay vestibuloplasty with issue
grafting:
 If denuded area is covered by tissue graft, it may helps in rapid healing
and long term maintenance of vestibular depth..
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23. Submucosal Vestibuloplasty (obwegeser)
1-Midline incision is made in anterior maxilla
2-Mucosa is separated from submucosa
3-Disssection of muscular and submucosal attachments form
Periosteum and repositioned superiorly
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24. Trans-mandibular implant:
dental implant a prosthetic tooth with an anchoring structure surgically
implanted beneath the mucosal or periosteal layer or in the bone.
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25. Nerve lateralization:
A pronounced atrophy of the alveolar process in the mandible may result in the bone height
over the root canal being too low to be able to insert implants.
`One possible therapy is to displace the nerve
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26. Aisha jamil