Advanced Pre-prosthetic Oral Surgery

Question 1

Characteristics of the Ideal (3)

Answer 1

Broad Alveolar ridge
Adequate FOM
Deep Vestibular depth

Question 2

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

Answer 2

muscle attachments

Question 3

Loss of Teeth - Long Term Consequences in the Mandible
More commonly done in mandible
(2)

Answer 3

Mandible resorbs more quickly (~4x)
Mandibular dentures more unstable

Question 4

Muscles involved in mandible:
(3)

Answer 4

Mentalis (anteriorly), Buccinator (laterally) and Mylohyoid (lingually)

Question 5

Maxilla: most commonly done near

Answer 5

hamular notches (as this area tends to resorb fairly
quickly)
- Palate provides large denture bearing area (Therefore, Maxillary dentures more stable)

Question 6

What is Meant by Ridge Augmentation?

Answer 6

• It is a surgical procedure that aims at increasing the quantity and/or quality of bone or soft
  tissues in edentulous area of the oral cavity

Question 7

Ridge Augmentation Procedures
(2)

Answer 7

• Relative ridge augmentation
• Absolute ridge augmentation

Question 8

Relative Ridge Augmentation
* Indicated for a

Answer 8

flat ridge with moderate resorption of the alveolar bone.

Question 9

• Procedures that involve sulcus lengthening(Vestibuloplasty). In this procedure,

Answer 9

the
alveolar mucosa and muscle insertions can be repositioned apically.

Question 10

Indication for Relative Ridge Augmentation in the Mandible

Answer 10

• If there is 2 cm or more bone present at the mid-body of the mandible.
  Height will be increased in the symphysis and the mid- body regions.

Question 11

Absolute Ridge Augmentation
Indicated for a —
Osteotomy and bone grafting are indicated to —
Subsequent — may be necessary to achieve desired results

Answer 11

flat ridge with extreme resorption of the alveolar bone.
augment the height of the ridge, actually increasing
the bone height.
muscle repositioning

Question 12

Indication for Absolute Ridge Augmentation in the Mandible:
* Indicated when there is
* There is less than – bone at the mid-bodyof the mandible.

Answer 12

extreme resorption of the body of the mandible.
2cm

Question 13

Advanced Pre- prosthetic Oral Surgery
(2)

Answer 13

Advanced Soft tissue pre-prosthetic Oral surgical procedures
Advanced Osseous pre-prosthetic Oral surgical procedures

Question 14

Advanced Soft tissue Pre-prosthetic Oral surgical procedures
Relative Ridge Augmentation -

Answer 14

Vestibuloplasty

Question 15

Vestibuloplasty is a soft tissue surgical procedure designed to increase:
(3)

Answer 15

• Surface area of fixed tissue for denture support
• Depth of vestibules for denture flange extension
• Used to prepare for either complete or partial dentures

Question 16

Vestibuloplasty - Objectives
(2)

Answer 16

• To provide better anatomic condition for denture construction by deepening the sulcus
  to provide healthy, firm soft tissue coverage of ridge thereby help in the denture
  flange extension.
• To provide adequate bony support for denture (decreasing dislodging forces by
  muscles and soft tissues in denture bearing areas).

Question 17

Vestibuloplasty is a soft tissue surgical procedure designed to

Answer 17

increase the relative height of the
alveolar ridge by apically repositioning the alveolar mucosa and the muscles attached to the buccal,
labial, and lingual aspects of the jaws.

Question 18

Common Vestibuloplasty Techniques
(2)

Answer 18

• Secondary epithelization vestibuloplasty
• Grafting vestibuloplasty
• Palatal Mucosal graft / Split Thickness Skin graft

Question 19

Vestibuloplasty followed by use of Palatal Surgical Splint and Screw

Answer 19

By using a splint and screw a controlled pressure equally distributed over the mucosa is achieved after the vestibuloplasty
procedure.
The splint fixed with screw on to the bone is more convenient for the patient and produces a better operative result.

Question 20

Grafting vestibuloplasty
Vestibuloplasty with Palatal Mucosa / Skin Graft
* Following vestibuloplasty, the — is uncovered.
* If this vestibuloplasty wound is allowed to
granulate it usually results in relapse, especially
on the labial surface. Therefore, to prevent this, a
—
* The skin is removed from the outer surface of
the thigh, while the palatal mucosa is usually
taken from the —.

Answer 20

periosteum
skin or palatal mucosal graft is usually placed
over the periosteum.
palate

Question 21

Grafting vestibuloplasty with Palatal Mucosal Graft/Skin
Important Considerations
(4)

Answer 21

• A supraperiosteal dissection is necessary.
• In order to prevent relapse of the muscles and vestibule, the harvested palatal mucosa
  grafts /skin grafts are placed into a splint and placed onto the ridge.
• Use the graft together with the splint for 10-14 days.
• The graft should “take” and gain a blood supply.

Question 22

Mandibular Augmentation
Superior Border Graft of a Atrophic Mandible
Superior Border Graft of a Atrophic Mandible
Corticocancellous illiac crest contoured to adapt to
configuration of mandible
- Stabilized with —

Answer 22

rigid fixation screws

Question 23

Iliac crest onlay bone reconstruction of maxilla
(4)

Answer 23

Atrophic maxilla
Three segment bone secured in place
Stabilization of onlay graft with screws
Small defects filled with cancellous bone