Preprosthetic Surgery

objectives
Understand the types of procedures utilized
to facilitate prosthetic reconstruction
Understand the purpose of the surgical
procedure
Understand the potential pitfalls and risks of

the procedures

General Considerations for Preprosthetic

The Ideal Edentulous Mouth

Surgery
Most can be done w/ L.A.
Patients are typically older, and may have significant
medical issues

Typically; restorative phase in 4 8 weeks postop

Prosthetic plan should dictate the surgical plan

Adequate bone height and width

Fixed, keratinized gingiva under dentures
Adequate ridge relationships
Adequate space between ridges
Adequate buccal and lingual sulci
Absence of redundant tissue
No obstructing frena or scar bands
No displacing muscle attachments
Adequate saliva (amount and consistency)

Implant reconstruction: effect on preprosthetic surgery

Alveoloplasty

Simple Alveoloplasty

Al veolo = al veolus
P lasty= recontouring
Goals
Smo oth ridges to pre vent irritatio n from
pro sthesis

Remove un dercuts for path o f draw

M aintai n ideal ridge co nto ur and
relationship

Simple Alveoloplasty

Intraseptal Alveoloplasty

Periosteal attachment is
mainta ined

Alveolar height is preserved

Undercut is removed, but labial
plate is preserved

Radical Alveolectomy

Removal of Tori & Exostoses

Indications
Chronic irritation
Inability to construct prosthesis
Opposing undercuts
Horizonta l & vertical problems

Radical Alveolectomy

Removal of Tori & Exostoses

Potential pitfa lls/Problems

Pneumatization of palata l torus
Thin mucosa over tori

Postoperative redundant tissue

Other anatomic issues (floor of mouth contents ,
greater palatine artery, etc.)

Removal of Tori

Removal of Lingual Tori

Use LA to help balloon thin tissue

tumescent technique
Reflecting the flap is the most tedious portion
tissue is thin and is easily torn
It is easier to remove tori when ridge is edentulous
Remove Tori with:
Surgical drill

Osteotome and Mallet

A combination of both
Assure a dry field and inspect wound before closure

Lingua l

Removal of Palatal Tori

Tori/exostosis removal
Potential complications
Lingual tori
Lingua l plate fracture
Lingua l nerve damage
Hematoma
Damage to floor of mouth structures
Postop dehiscence

Maxillary Tuberosity Reduction

Tori/exostosis removal
Potential complications:
P alatal
Oro-nasal communication/fistula
Arterial bleeding
Hematoma
Dehiscence

Excess tissue/bone in the maxillary tuberos ity interferes with

denture construction at area between tuberosity and

retromolar pad
Radiographs help delineate whether this excess tissue is soft
tissue or bony.
Radiographs also demonstrate pneumatization of the
maxillary s inus
Mounted models/surgical guide recommended

Maxillary tuberosity reduction

Surgery can consist of
1. So ft tissue component of tubero sity
2. Bo ny compo nent of tuberosity
3. Bo th

Frenectomy

Soft Tissue Surgery

Diamond

Frenectomy
Vestibuloplasty
Papillary hyperplas ia
Epulis fissuratum

Frenectomy

vestibuloplasty
Z-plasty :

Goals
More useful for the
short vestibule

To deepen labial, buccal o r ling ual vestibule to

preve nt dislo dgement of denture
Repositio n muscle attachments (eg:mylohyo id)
P reserve/create keratinized m ucosa if possible

Partial Thickness palatal dissection

vestibuloplasty

de-fat the connective tissue side

Types

Supraperiosteal dissection on the

mandible

Supraperiosteal
Subm ucosal

Sew graft mucosa side up

Laser abl atio n

Splints or a relieved denture can be

M ucosal grafting/skin gr afting

helpful

Floor of the mo uth lowering

Palatal papillary hyperplasia

Palatal papillary hyperplasia

Secondary to chronic denture irritation

Treatment Options

Denture relief and oral antifunga ls can reduce the size

Large rotary bur

of the lesion.

Cryosurgery
Laser Ablation
Post op splint or denture w/ liner is very helpful

Epulis Fissuratum

Epulis Fissuratum

Epulis Fissuratum

Preprosthetic Surgery
Complex Preprosthetic Surgery has been largely obviated
by the osseointegrated implant.

Preprosthetic surgery for implant

reconstruction

Preprosthetic Surgery
Many preprosthetic procedures are done today in support of
the implant.

Qu i c kT i m e a n d a
T IFF (U n c o m p re s s e d ) d e c o m p re s s o r
a re n e e d e d to s e e th i s p i c tu re .

Sinus augmentation
Ridge augmentation
Soft tissue augmentation/grafting
Orthognathic surgery
QuickT ime and a
T IFF (Uncompressed) decompressor
are needed to see this picture.

QuickT ime and a

T IFF (Uncompressed) decompressor
are needed to see this picture.

QuickT ime and a

T IFF (Uncompressed) decompressor
are needed to see this picture.

QuickT ime and a

T IFF (Uncompressed) decompressor
are needed to see this picture.

QuickTime and a
TIFF (Uncompressed) decompressor
are needed to see this picture.

QuickT ime and a

T IFF (Uncompressed) decompressor
are needed to see this picture.

QuickT ime and a

T IFF (Uncompressed) decompressor
are needed to see this picture.

QuickT ime and a

T IFF (Uncompressed) decompressor
are needed to see this picture.