Minor Preprosthetic Oral Surgery Procedures

Question 1

Pre-prosthetic Surgery is the

Answer 1

surgical improvement of the denture bearing area and
surrounding tissues (Hard and Soft) to support the best possible prosthetic
replacement.

Question 2

The goal of pre-prosthetic surgery is to establish a

Answer 2

functional biologic platform for
supportive or retentive mechanisms that will maintain or support prosthetic
rehabilitation.

Question 3

Tooth Loss starts an immediate change in the —.

Answer 3

jaws

Question 4

— is the primary cause for this resorption

Answer 4

Lack of functional stress from teeth and periodontal ligament following extraction

Question 5

— begins to resorb after extraction and this process is unpredictable from one
patient to another

Answer 5

Bone

Question 6

n some patient’s, the bone loss stabilizes and in others it continues to include a
total loss of

Answer 6

alveolar and underlying basal bone.

Question 7

Resorption is accelerated by

Answer 7

denture wearing

Question 8

— denture wearers affected more than — denture wearers

Answer 8

Mandibular
maxillary

Question 9

Resorption affects the mandible more severely because
(2)

Answer 9

• Decreased surface area
• Less favorable distribution of forces

Question 10

Factors Responsible for Enhanced Bone Resorption
Systemic factors
(2)

Answer 10

– Nutritional abnormality e.g. Calcium and Vitamin D deficiency
– Systemic bone disease

Question 11

– Systemic bone disease
(3)

Answer 11

• Osteoporosis
• Endocrine dysfunction e.g. Diabetes, Hyperthyroidism, Hyperparathyroidism
• Other conditions that affect bone metabolism e.g. Osteomalacia, Renal Osteodystrophy

Question 12

Factors Responsible for Enhanced Bone Resorption
Local factors
(3)

Answer 12

• Surgery (Alveoloplasty, Some form of bone removal in the alveolar ridge)
• Denture wearing
• Low mandibular plane angle
  – Can generate greater bite force

Question 13

The Challenge of Edentulism
With loss of teeth, there is
significant resorption leading to
— in the jaws.
However, the —
still remain in the same place.

Answer 13

bone atrophy
muscle attachments

Question 14

Bone Loss following Dental Extractions
Long Term Results
(6)

Answer 14

• Loss of bony alveolar ridge
• Increase in intra-arch space
• Increase influence of surrounding soft tissue
  – Tongue expansion
• Decrease stability and retention of prosthesis
• Increased discomfort from improper prosthesis adaptation
• Severe resorption of the mandible can make the patient susceptible for a fracture

Question 15

Evaluation of Supporting Bone
(4)

Answer 15

• Inspection
• Palpation
• Radiographic Examination
• Models Evaluation

Question 16

Characteristics of the Ideal Alveolar Ridge
(4)

Answer 16

• Proper Jaw Relationship.
• Proper Configuration of the Alveolar Process (broad U-shaped ridge with Vertical components
  as Parallel as possible).
• No Bony or Soft tissue protuberances or undercuts.
• Adequate attached Keratinized mucosa in the primary denture bearing area.

Question 17

Characteristics of the Ideal Alveolar ridge
(6)

Answer 17

• Adequate Vestibular Depth (Buccal and Lingual sulcus)
• Adequate bone height and width
• “Fixed Tissue” under dentures
• Absence of redundant tissue
• No obstructing frena or scar bands
• No displacing muscle attachments

Question 18

Principles of Patient Evaluation and Treatment
Planning
(3)

Answer 18

• Understand clearly the desired design of final prosthesis.
• Develop a detailed treatment plan based on a thorough clinical examination.
• Define and outline the Problem. (Is it with the Soft tissue/ Hard Tissue OR Both

Question 19

AFTER THIS MAKE A DECISION FOR THE TYPE OF

Answer 19

PREPROSTHETIC
SURGICAL PROCEDURE

Question 20

Pre-prosthetic Surgical Procedures
(3)

Answer 20

• Pre-prosthetic surgical procedures span a spectrum from very simple to quite
  complex:
• Minor Pre-prosthetic Surgery
• Advanced Pre-prosthetic Surgery

Question 21

General Considerations for Minor Pre-prosthetic Surgery
(4)

Answer 21

• Most can be done with L.A.
• Advanced forms of pain control/ I.V sedation are helpful in Patients who are anxious
  and cases that need more elaborate pre-prosthetic surgery.
• Patients are often old, and require detailed workup and monitoring.
• Restorative phase in 4 – 8 weeks postop

Question 22

Minor Pre-prosthetic Surgical procedures
* Many Minor Modifications of the alveolar ridge and vestibular areas can
greatly improve

Answer 22

denture stability and retention.
* Hard Tissue(Osseous) surgery
* Soft Tissue Surgery

Question 23

Bony Recontouring of Alveolar Ridges
(4)

Answer 23

• Simple alveoloplasty (Multiple Teeth Extraction).
• Intraseptal alveoloplasty.
• Maxillary tuberosity reduction.
• Buccal exostosis and extensive undercuts.

Question 24

Tori Removal
(2)

Answer 24

• Maxillary tori.
• Mandibular tori.

Question 25

Alveoloplasty

Answer 25

• Alveoloplasty is “ the recontouring or reduction of a portion of the alveolar
  process”

Question 26

Goals of alveoloplasty:
(3)

Answer 26

• Eliminate bony projections that result in undercuts
• Improve the path of insertion of the prosthesis
• Eliminate bony sources of irritation

Question 27

Types of Alveoloplasty
(3)

Answer 27

• Simple alveoloplasty
• Simple alveoloplasty with buccal or labial cortical reduction
• Intraseptal alveolectomy and cortical plate in-fracture

Question 28

Intraseptal Alveoloplasty and cortical plate in-fracture
(3)

Answer 28

*Periosteal attachment is maintained
*Alveolar height is preserved
*Alveolar width is lost

Question 29

Disadvantages of Alveoloplasty
(3)

Answer 29

1. Accelerates bone loss
2. Increased post-operative pain
3. Potential Complications:
   - Oral-antral communication(Maxilla)

Question 30

1. Accelerates bone loss
   (2)

Answer 30

• Buccal/labial cortical alveoloplasty (most long term loss)
• Intraseptal alveolectomy (significantly less)

Question 31

Maxillary Tuberosity (Osseous) Reduction
(4)

Answer 31

• Determine if it is excess bone /excess soft tissue or combination of two.
• Examine pre-op x-ray (Panoramic X-Ray necessary)
• Locate floor of the sinus
• Reasons for removal
  – Increase intra-arch space

Question 32

Surgical Removal of Palatal Tori
Clinical Examination:
(3)

Answer 32

• Size of the Torus (How large is it ?)
• How far has the palatal torus extended posteriorly?
• Is the overlying mucosa on the top of the torus
  traumatized?

Question 33

Indications for Removal
(5)

Answer 33

• Chronic irritation
• Inability to construct prosthesis
• Presence of deep undercuts
• Interference with normal speech
• The torus poses psychological problems (e.g., malignancy phobia)

Question 34

Surgical Removal of Tori & Exostoses
(3)

Answer 34

• Use L.A.
• Raising the thin flap is the most tedious portion of the surgery.
• Assure hemostasis before wound closure.

Question 35

• Remove Tori with:
  (3)

Answer 35

• Surgical drill and fissure bur
• Osteotome and Mallet
• A combination of both

Question 36

Minor Pre-prosthetic Soft Tissue Surgical Procedures
(4)

Answer 36

• Maxillary tuberosity reduction..
• Inflammatory Fibrous hyperplasia.
• Labial Frenectomy.
• Lingual Frenectomy

Question 37

Epulis fissuratum (Inflammatory Fibrous Hyperplasia)
* Etiology:

Answer 37

This is an inflammatory fibrous hyperplasia of oral mucosa caused by an over-extended
denture border.

Question 38

Epulis fissuratum (Inflammatory Fibrous Hyperplasia)
* Treatment:

Answer 38

Surgical excision of the lesion and reduction of the denture border

Question 39

Frenectomy
(3)

Answer 39

Labial frenectomy
* Buccal frenectomy
* Lingual frenotomy

Question 40

Labial frenectomy
(4)

Answer 40

– Simple labial frenectomy (Diamond Shaped)
– Z-plasty
– V-Y plasty
– V - Diamond plasty (Modified V-Y plasty)

Question 41

indications For Frenectomy
(2)

Answer 41

• When speech is impaired due to Ankyloglossia (Tongue tie) – Lingual Frenum
• To improve denture seating and stability

Question 42

Z-Plasty Technique For Maxillary Frenum
Main advantage of this method
is

Answer 42

Minimal Scar tissue formation

Question 43

V-Y plasty can be for

Answer 43

lengthening the
localized area