Pre Prosthetic Surgery PDF

Pre-Prosthetic
surgery
PRE-PROSTHETIC SURGERY
(Essay)
Bony recontouring (9)
Procedures
a-Alveoloplasty
i-Primary
ii-Secondary
b- Intraseptal Alveoloplasty
c-Maxillary tuberosity reduction
d-Buccal exostosis exostosis & excessive undercuts
e-Lateral palatal exostosis
f-Mylohyoid ridge reduction
g-Genial tubercle reduction
h- Tori
i-Maxillary
ii-Mandibular
Pre-Prosthetic surgery Master Class -Vijayawada

(Essay) (9)
5-Mandibular augmentation
a-Superior border augmentation
b-Augmentation of the mand with alternative biologic materials
6-Maxillary augmentation
Onlay bone grafting
Interpositional bone graft
c-Sinus lift
d-Alveolar ridge destruction
e-Correction of abnormal ridge relationship.

(Essay) (9)
7-Soft time recontouring
a-Soft time Maxillary tuberosity reduction b-
Removal of reductant crestal soft tissue
c-Frenectomy
i- Labial
ii- Lingual
d-Palatal soft tissue excess
e-Unsupported hyper mobile tissue f-
Inflammatory fibrous hyperplasia

(Essay) (9)
8-For Ridge extension
a-Transpositionalflap Vestibuloplasty.
b-Vestibule & floor of the mouth extension process
c-Submucosal Vestibuloplasty

(Essay) (9)
REFERENCES
•Contemporary Oral and maxillofacial surgery, sixth edition –Hull, James R
•Peterson-contemporary oral and maxillofacial surgery second edition
•Boucher-prosthodontic treatment for edentulous patients, 13thedition
•Preprostheticsurgery: An adjunct to complete denture therapy
Medha Vivek Bhuskute,Ravi G K ShetDepartment of Prosthodontics, Bhabha College of Dental Sciences, Bhopal, Madhya
Pradesh, India
•HillerupS. Preprostheticsurgery in the elderly. J ProsthetDent
•EphrosH, Klein R, SallustioA. Preprostheticsurgery. Oral Maxillofac Surg Clin North Am
•ChoudhariS, RakshaganV, Jain AR. Evolution in preprostheticsurgery current trends: A review. Drug Invention Today

•Boucher-prosthodontic treatment for edentulous patients, 13thedition
•Preprostheticsurgery: An adjunct to complete denture therapy

ALVEOLOPLASTY (Short
Notes (4)
1-What is Alveoloplasty?
2-Aim of Alveoloplasty 3-
Preoperative evaluation
-Psychological evaluation
- Radiographs
-Benign soft tissue lesions

Notes (4)
4-Types of Alveoloplasty
-Simple Conservative Alveoloplasty with Multiple Extractions
-Dean’s Alveoloplasty
-Obwegeser’s Modification
-Alveoloplasty after Post extraction Healing

Notes (4)
5-Vestibuloplasty procedures
-Mucosal Advancement
-Obwegeser’s Submucous Vestibuloplasty
-Wallenius’ (Open-View) Technique
-Vestibuloplasty by Secondary Epithelization
-Kazanjian Technique
-Godwin Technique
-Cooley Technique
-Collett Technique
-Clark’s Technique
-Obwegeser Secondary Epithelization Vestibuloplasty -
Effects of Vestibuloplasty
-Mechanical Resistance to Displacement Forces
-Stable Denture Seating Area
-Skin as a Load Bearing Tissue

Notes (4)
REFERENCES
•Alveoloplasty withGraz,
facial Department, ridgeAustria
extension R. Trauner, A. EskiciUniversity Clinic and Maxillo-
•Lytle RB. Complete

underlying denture
soft tissues.J construction based on a study of deformation of the
ProsthetDent.
•Mercier P, LafontantR.
facial morphology.J Residual alveolar ridge atrophy: classification and influence of
ProsthetDent.
•GandevivalaAM, Kaul DD, Gupta AK. Premaxillary alveolar recontouring-A case report of
secondary Alveoloplasty. Universal Research Journal of Dentistry. 2011; 1(1): 46-48
•Hupp JR, Ellis E, Tucker MR. Contemporary oral and maxillofacial surgery. 5th Edition.
2009: 217-19.
•Peterson LJ. Peterson’s Principles of oral and maxillofacial surgery. 2nd Edition. 2004:
168-69. Pre-Prosthetic surgery Master Class -Vijayawada
RIDGE EXTENSION PROCEDURE
(Essay 07)
1-What is ridge extension procedure
2-Goals
3-Ridge extension procedure in MAXILLA
TYPES:-Mucosal advancement technique
*Definition & other name
*Types : Closed view
Open view
-Pocket inlay technique
-Grafting (Obwegeser’s skin graft technique)

(Essay
4-Ridge 07)procedure in
extension
MANDIBLE
types of approach:
labial approach:
-Kazanjian technique
-Godwin’s technique
-Lipswitch technique
-Clarks technique
Lingual approach:
-Trauner’s technique
-Caldwell’s technique
Combination of buccal &lingual
Obwegeser’s technique
(Essay 07)OF ALVEOLAR SOFT TISSUE PRIOR TO DENTURE
IMPROVEMENT
PLACEMENT 1-Definition of alveolar ridge correction
2-objectives
3-types:
1.Alveoloplasty
- Definition
- goals
-types: primary Alveoloplasty
-definition
-indications
-technique (Dean’s intraseptal technique)
Secondary Alveoloplasty

(Essay 07)
2.Tori removal
-definition of tori
-types:
Maxillary torus-Indications, techniques, complications
Mandibular torus-Indications, technique, precaution
3.Mylohyoid ridge reduction
-techniques
-indications

(Essaytubercles
4.Genial 07) reduction
-techniques and its importance
5.Maxillary tuberosity reduction
-causes of enlarges tuberosity
-technique
1.crestal approach
2.lateral approach
6.Tuberoplasty
-indications
-technique

(Essay
REFERENCES
07)
•House
Osseous,MM.Nichols, IG:Tissue
Muscular, and Prosthetic Dentistry.Vol.
Conditions 2. St.Louis:
of Edentulous CVpp.
Mouths; Mosby Co.; Classification of
90–91.
•StarshakT, Sanders B. St Louis, MO: Mosby; 1980. Preprostheticoral and maxillofacial surgery.
•Shelton DW.Current Advances in Oral Surgery.Vol II. St Louis, MO: Mosby; 1977. Critical review
of preprostheticsurgery, in Irby WB; p. 362.
•Kazanjian VH. Surgery as an aid to more efficient service with prosthetic dentures.J Am Dent
Assoc.1935;22(4):566–81.
•Godwin
86. JG. Submucous surgery for better denture service.J Am Dent Assoc.1947;34(10):678–
•TraunerR.
problem of Alveoloplasty
a lower dental with ridge extension
prosthesis.Oral Surg on lingual
Oral side of
Med Oral the lower jaw to solve the
Pathol.1952;5(4):340–46
•Clark HB. Deepening the labial sulcus by mucosal flap advancement: Report of a case.J Oral Surg.
1953;11(2):165–68.
LABIAL VESTIBULOPLASTY
(SN-05)
1.What is Vestibuloplasty
2.Goals of Vestibuloplasty
3.Types:
LabiobuccalVestibuloplasty of MAXILLA:
1.Mucosal advancement Vestibuloplasty
-Definition
-Other name
-Types:
Closed view submucous Vestibuloplasty
Open view submucous Vestibuloplasty

(SN-05)
2.Pocket inlay Vestibuloplasty
3.Grafting Vestibuloplasty
Labial
Types: approach for Mandibular Vestibuloplasty
-Kazanjian’s technique
-Godwin’s technique
-Lipswitch technique
-Clark’s technique

(SN-05)
REFERENCES
•StellingsmaC, VissinkA,
severely resorbed Meijer
edentulous HJ, Kuiper C, RaghoebarGM. Implantology and the
mandible.
•KonstantinovaD, DjongovaE,
of a modified method ArnautskaH, GeorgievT,
of vestibuloplastywith PeevS, DimovaM.
an early prosthetic loading. JPresentation
of IMAB. 2015
•SikkerimathBC, DandagiS,
in vestibuloplastyusing GudiSS,
standard JayapalanD.
Clark’s technique Comparison of vestibular
with and without amnion assulcus
graftdepth
material. Ann Maxillofac Surg. 2012
•Kazanjian VH. Surgery as an Aid to More Efficient Service with Prosthetic Dentures.
•KethleyJL Jr, Gamble
Vestibuloplasty. JW. The Lipswitch: a modification of Kazanjian’s labial
J Oral Surg.
•Edlan, A, MejcharB. Plastic surgery of the vestibulum in periodontal therapy. Int Dent J.
REHABILITATION OF COMPLETELY
EDENTULOUS PATIENT WITH COMPLETE
BONE LOSS
Pattern of bone loss (Essay 01)
Classification of atrophy stages in maxilla and mandible
Procedures
Maxillary ridge augmentation
1.Onlay bone grafting
Indications, advantages and disadvantages
2.Interpositional bone graft
Indications, procedures, advantages and disadvantages
3.Maxillary hydroxyapatite augmentation
Procedures
4.Tuberoplasty

BONE LOSS
Mandibular (Essay 01)
ridge augmentation
1. Superior border augmentation
indications, disadvantages
2. Inferior border augmentation
indications, disadvantages
3. Pedicled or Interpositionalgrafts(Sandwich technique)
indications
4. Hydroxyapatite augmentation of mandible
5. Visor and modified Visor osteotomy

BONE LOSS (Essay 01)
SOFT AND HARD TISSUE FACTORS IN PREPARING THE
JAWS TO RECEIVE ARTIFICIAL PROSTHESIS
Pre prosthetic surgical procedure

-Definition
- Classification
Basic procedures
Advanced procedures

BONE
HARD LOSS
TISSUE (Essay 01)
FACTORS
cysts) 1) Removal of teeth (erupted, unerupted, partially erupted, root stumps,
2)Bony recontouring ofassociated

-simple Alveoloplasty alveolar ridges
with removal of multiple teeth
-intraseptal Alveoloplasty
-maxillary tuberosity reduction
-buccal exostosis
-lateral palatal and excessive undercuts
exostosis
-mylohyoid ridgereduction
-genial tubercle reduction

3)Tori Removal
-Maxillary and Mandibular tori
4)Maxillary and Mandibular ridge augmentation procedures
-Onlay bone grafting
-Interpositional bone grafts
- Tuberoplasty
-Superior and inferior border augmentation,
-Visor osteotomy

BONE LOSS (Essay
SOFT TISSUE FACTORS
01)
-Maxillary tuberosity reduction (soft tissue)
-Mandibular retromolar pad reduction
-Lateral palatal soft tissue excess
-Unsupported hypermobile tissue
-Inflammatory fibrous hyperplasia
-Inflammatory papillary hyperplasia of palate
-Labial frenectomy
-Lingual frenectomy

Soft tissue surgery for maxillary and mandibular ridge extension
•Submucous Vestibuloplasty
•Maxillary skin grafting Vestibuloplasty
•Transpositional flap Vestibuloplasty
•Vestibule and floor of the mouth extension procedure
•Relocation of mental nerve

REFERENCES
•SadowskyJS. The implant-supported prosthesis for the edentulous arch: Design considerations. J ProsthetDent 1997;78
•Henry JP. A review of guidelines for implant rehabilitation of the edentulous maxilla. J ProsthetDent 2002;87:281-8
•EmamiE., de Souza R. F., KabawatM., FeineJ. S. The impact of edentulism on oral and general health.International Journal of
Dentistry.2013;2013:7. doi: 10.1155/2013/498305.498305
•Atkinson P. J., Woodhead C. Structural changes in the ageing mandible.Proceedings of the Royal Society of Medicine.1972;65(8):p.
675.
•Mercier P., BellavanceF. Effect of artificial tooth material on mandibular residual ridge resorption.Journal of the Canadian Dental
Association. 2002;68(6):346–350.
•PietrokovskiJ., KaffeI., ArensburgB. Retromolar ridge in edentulous patients: clinical considerations.Journal of Prosthodontics.
•KovacićI., CelebićA., ZlatarićD. K., et al. Decreasing of residual alveolar ridge height in complete denture wearers. A five year
follow up study.

ALVEOLOPLA
STY
Alveoloplasty is the surgical procedure performed to smooth or
recontour the alveolar bone, aiming to facilitate the healing
procedure as well as the successful placement of a future prosthetic
restoration

ALVEOLOPLA
STY

ALVEOLOPLASTY AFTER
EXTRACTION OF SINGLE TOOTH

ALVEOLOPLASTY AFTER

ALVEOLOPLASTY AFTER

ALVEOLOPLASTY AFTER

ALVEOLOPLASTY USING BONE
RONGEUR AND BONE BUR




FILE AND RONGEUR

FILE AND RONGEUR

FILE AND RONGEUR

ALVEOLOPLASTY AFTER
MULTIPLE EXTRACTIONS

ALVEOLOPLASTY AFTER

ALVEOLOPLASTY AFTER

ALVEOLOPLASTY AFTER

ALVEOLOPLASTY AFTER

ALVEOLOPLASTY AFTER

RECONTOURING OF EDENTULOUS
AREA OF ALVEOLAR RIDGE



RECONTOURING OF ENTIRE
ALVEOLAR RIDGE

ALVEOLAR RIDGE

ALVEOLAR RIDGE

ALVEOLAR RIDGE

ALVEOLAR RIDGE

DEAN’S
ALVEOLOPLASTY

EXOSTOS
ES
Exostoses are bony protuberances, which develop in
various areas of the jaw
Not considered real neoplasms, but dysplastic exophytic
lesions

MAXILLARY TUBEROSITY
REDUCTION
Excesses in the maxillary tuberosity may consist of soft tissue, bone, or
both. Sounding, which is performed with a needle, can differentiate
between the causes with a local anesthetic needle or by panoramic
radiograph.
Access to the tuberosity area can be obtained easily using a crestal incision
beginning in the area of the posterior tuberosity and progressing forward to
the edge of the defect using a no. 12 scalpel blade.

Periosteal dissection then ensues exposing the underlying
bony anatomy. Excesses in bony anatomy are removed using a
side cutting rongeur.
Sharp undermining of the overlying soft tissue may be

performed in a wedge-shaped fashion beginning at the edge of
a crestal incision to thin the overall soft tissue bulk overlying
the bony tuberosity. Excess overlying soft tissue may be
trimmed in an elliptic fashion from edges of the crestal
incision to allow a tension-free passive closure
EXOSTOS
ES
The etiology of these lesions remains unknown, even though evidence
suggests that genetic and environmental factors determine their
development.
Exostoses are classified into three types:

(1) torus palatinus
(2) torus mandibularis

(3)multiple exostoses.

BUCCAL
EXOSTOSIS
• A buccal exostosis is an exostosis (bone prominence) on the

buccal surface (cheek side) of the alveolar ridge of the maxilla or
mandible. More commonly seen in the maxilla than the
mandible.
• It creates problem in denture construction because of the

undercut created by the exostosis.

LOCALIZED MANDIBULAR BUCCAL
EXOSTOSIS

EXOSTOSIS

EXOSTOSIS

EXOSTOSIS

EXOSTOSIS

EXOSTOSIS

MYLOHYOID RIDGE
REDUCTION

GENIAL TUBERCLE
REDUCTION

TORUS
PALATINUS

TORUS
PALATINUS

TORUS
PALATINUS

TORUS
PALATINUS

TORUS
PALATINUS

TORUS
PALATINUS

TORUS
PALATINUS

TORUS
PALATINUS

TORUS
MANDIBULARIS

TORUS
MANDIBULARIS

TORUS
MANDIBULARIS

TORUS
MANDIBULARIS

MULTIPLE
EXOSTOSES

MULTIPLE
EXOSTOSES

MULTIPLE
EXOSTOSES

MULTIPLE
EXOSTOSES
Mandibular augmentation
a-Superior border augmentation
b-Augmentation of the mandible with alternative biologic materials
Maxillary augmentation
a.Onlay bone grafting
b.Interpositional bone graft
c-Sinus lift
d-Alveolar ridge destruction
e-Correction of abnormal ridge relationship

MANDIBULAR BONE
AUGMENTATION
Augmentation grafting adds strength to an extremely deficient mandible and
improves the height and contour of the available bone for implant placement on
denture-bearing areas.
Sources of graft material include autogenous or allogeneic bone and alloplastic

materials.
The use ofshown

has been allogeneic
to bebone eliminates
useful the need
in augmenting forareas
small a second surgical site
of deficiency and
in the
mandible.
The increased popularity of implants has renewed enthusiasm for use of

autogenous bone grafts alone or in combination with other biologic materials
for bony augmentation.
SUPERIOR BORDER
AUGMENTATION

SANDWICH VISOR
OSTEOTOMY

MAXILLARY
AUGMENTATION
Severe resorption of the maxillary alveolar ridge presents a Significant challenge to
prosthetic reconstruction of the dentition.
When moderate to severe maxillary resorption does occur, the larger denture-bearing area of
the
maxilla may allow prosthetic rehabilitation without bony augmentation.

In certain cases a severe increase in interarch space, loss of palatal vault, interference from the
zygomatic buttress area, and absence of posterior tuberosity notching may prevent
construction
of proper dentures, and augmentation must be considered.

SOFT TISSUE SURGERY FOR
EXTENSION OF MANDIBLE

Soft time recontouring
a-Soft time Maxillary tuberosity reduction
b-Removal of reductant crestal soft tissue
c-Frenectomy
i- Labial
ii- Lingual
d-Palatal soft tissue excess
e-Unsupported hyper mobile tissue
f-Inflammatory fibrous hyperplasia
For Ridge extension
a-Transpositional flap Vestibuloplasty.
b-Vestibule & floor of the mouth extension process
c-Submucosal Vestibuloplasty

SOFT TISSUE LESIONS OR
ABNORMALITIES
Lesions or abnormalities associated with soft tissue and which require
•
alteration are also classified into two categories:
•
Congenital abnormalities, such as a hypertrophic frenum, etc.
•
Abnormalities created after the use of dentures (e.g., fibrous
hyperplasia of the mucosa)

Improvement of Alveolar Soft Tissue Prior to Denture Placement

• Excessive fibrous or hypermobile tissue
• Fibrous hyperplasia pf the vestibule
• Inflammatory Papillary hyperplasia of the palate
• Abnormal muscular and frenal attachments
• Loss of tooth necessitates prosthetic reconstruction

• Long Term Treatment planning before any soft tissue is mandatory
• Soft
futureTissue
ridgethat initially appears
augmentation to beprocedures
or grafting flabby and are
excessive may be useful if
necessary.
Oral Mucosa is difficult to replace once tissue is removed.

•

MAXILLARY TUBEROSITY
REDUCTION SOFT TISSUE

MANDIBULAR RETROMOLAR PAD
•
REDUCTION
Rarely indicated procedure
• An elliptical incision is made to excise the greatest area of tissue thickness in

the posterior mandibular area.
• Slight thinning of the adjacent areas is carried out with the majority of the tissue
reduction on the labial aspect.
• Excess removal of tissue in the submucosal area of the lingual flap may result in
damage to the lingual nerve and artery.
• The tissue is approximated with continuous or interrupted sutures.

INFLAMMATORY FIBROUS
HYPERPLASIA
Also called as epulis fissurataor denture fibrosis is a generalizedhyper plastic
enlargement of mucosa and fibrous tissue in the alveolar ridge .
When
within the
the condition has tissue
hyper plastic been present
. for some time significant fibrosis exists

Best
Wishes

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Pre-Prosthetic

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

•Peterson-contemporary oral and maxillofacial surgery second edition

•Preprostheticsurgery: An adjunct to complete denture therapy

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

•Lytle RB. Complete

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

5. Visor and modified Visor osteotomy

Pre-Prosthetic surgery Master Class -Vijayawada

Pre prosthetic surgical procedure

Pre-Prosthetic surgery Master Class -Vijayawada

2)Bony recontouring ofassociated

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

recontour the alveolar bone, aiming to facilitate the healing

procedure as well as the successful placement of a future prosthetic

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

Pre-Prosthetic surgery Master Class -Vijayawada

various areas of the jaw

Not considered real neoplasms, but dysplastic exophytic

Pre-Prosthetic surgery Master Class -Vijayawada