Preprosthetic surgery

PREPROSTHETIC SURGERYDR. SALWAN AL-HAMDANIB.D.S.MSC.PROSTH

Preprosthetic Surgery
Objectives:

1. To understand the anatomy and physiology

of the edentulous status including alveolar
atrophy and its associated pathoses

2. To diagnose conditions that can be improved

by preprosthetic surgical procedures

3. To treatment plan, design and execute

preprosthetic surgical procedures





Factors that impact on fit: anatomy
1. Bone quantity
2. Bone contour
3. Muscle attachments
4. Gingiva (mucosa)

1. Bone quantity

2. Bone contour

3. Muscle attachments
4. Gingiva (mucosa)

Factors that impact on fit: physiology

1. Gingiva (mucosa)
2. Lip / tongue habits
3. Salivary function
4. TMJ / muscle function

1. Gingiva,. mucosa

2. Lip / tongue habits

3. Salivary function
4. TMJ/ muscle
function

Parotid

Submandibular

Factors that impact on fit: pathoses

1. Hard tissue
2. Soft tissue

1. Hard tissue

a. Dental caries
b. Periodontal disease
c. Infection
d. Cysts and tumours














1. Soft tissue
a. Ulceration
b. Hyperplasia
c. Dysplasia
d. Carcinoma








a
b
c
d

Factors that impact on fit: atrophy

• Atrophy
• a. Decreasing bone
b. Increasing soft tissue

Factors that impact on fit: atrophy

1. Atrophy
a. Decreasing bone
b. Increasing soft tissue

Factors that impact on fit: atrophy

1. Atrophy: accelerated by inflammation
a. Infection
b. Poorly fitting dentures … friction
c. Habits … clenching / bruxism






Procedures designed to optimize the retention, support, stability and comfort of prostheses by the selective modification of soft and hard tissues
Preprosthetic Surgery



Indications: compromized retention, support, stability or comfort of prostheses due to suboptimal hard or soft tissue anatomy or pathoses
Preprosthetic Surgery

Preprosthetic Surgery

Procedures span a spectrum from very
simple to quite complex:

a. extractions and alveolar osteotomy

b. removal of pathoses
c. gingivoplasty and frenectomy
d. tuberosity reduction
e. alveoplasty and torus removal
f. vestibuloplasty with soft tissue graft
g. bone grafting???
h. orthognathic surgery


Preprosthetic Surgery
a. Extractions for caries, periodontal disease, infection, etc.
a. Extractions…flap, bone removal, section

a. Extractions and alveolar osteotomy …

removal of proclined incisors and
osteotomy of labial plate of bone
Preprosthetic Surgery







a. Extractions &
and alveolar
osteotomy …
removal of
proclined incisors
and osteotomy
of labial plate of
bone

Preprosthetic Surgery

b. Removal of pathoses…cystic, traumatic, hyper-plastic, dysplastic, etc.

Preprosthetic Surgery
c. Gingivoplasty or frenectomy for flabby ridge tissue or high frena that interfere with support or retention

Gingivoplasty

Preprosthetic Surgery

c. Frenectomy



1
2




4
3

Preprosthetic Surgery

d. Tuberosity reduction

Preprosthetic Surgery

d. Tuberosity reduction

Preprosthetic Surgery

e. Alveoplasty: flap…recontour…close

Preprosthetic Surgery

e. Alveoplasty: flap…recontour…close

Preprosthetic Surgery

e. Torus reduction: flap…recontour…close

Preprosthetic Surgery

f. Vestibuloplasty: ridge extension … move muscle attachment and retain with soft tissue graft

Preprosthetic Surgery

f. Vestibuloplasty: move muscle attachment and retain with soft tissue graft

Preprosthetic Surgery

f. Vestibuloplasty: Maxillary palatal graft vestibuloplasty

f. Bone grafting:

f. Bone grafting: replacement of bone loss alveolar atrophy … benefit ??? … typically ALL of the newly grafted bone is gone within 5 years … unless … supported by implants









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