Pre-Prosthetic Oral Surgery Flashcards
(120 cards)
1
Q
population that is edentulous
A
10% of american population
35% of those are above 65 years old
2
Q
loss of dentition consequences
A
irregular alveolar ridge
undercuts
scarring
muscle interferes with denture stability
3
Q
general goal of pre-prosthetic surgery
A
prepare the mouth to relieve a functional dental prosthesis
preserve hard and soft tissue
4
Q
maxillary resorptionproblems
A
anteriorly - many times there is a concavity
posterior – problem with maxillary sinuse
5
Q
mandibular resorption
A
knife edge ridge
- cortical bone - cant place implants there direcrtly without grafting
or grind down and place - but sacrifice knife edge
6
Q
classification of edentulous jaws – general
A
I– VI
7
Q
class I edentulous jaw description
A
dentate - still teeth
8
Q
class II edentulous jaw description
A
immediately post-extraction
like good enough ridge to place something on right away
9
Q
class III edentulous jaw description
A
convex ridge form, adequate in height and width
10
Q
class IV edentulous jaw description
A
knife-edge form, adequate in height but INADEQUATE in width
11
Q
class V edentulous jaw description
A
flat ridge form - inadequate height AND width
12
Q
class VI edentulous jaw description
A
loss of basal bone which may be extensive but follows NO PREDICTABLE pattern
13
Q
specific goals for pre-prosthetic intervention
A
- ridge should have adequate width, height, and U shape
- mucosa should have adequate UNIFORM thickness
- ridge without undercuts or sharpness
- no bony or soft tissue protruberence
- adequate buccal and lingual sulci depth
14
Q
three broad overview of intra-oral examination
A
anatomical structures
- VISUAL
- PALPATE
- RADIOGRAPHIC EXAMINATION
15
Q
visual inspection look at
A
ridge contour
undercuts
muscle atachment
soft tissue health
16
Q
palpate?
A
denture bearing areas might reveal sharp bony areas
17
Q
radiographic examination
A
need to rule out any bony pathologies
- if decided to leave retained roots, should be notified to patietn
18
Q
retained roots usually are noticeable to the patient?
A
NO – 73-84% of the retained root fragments are seen on radiographic examination of edentulous patients, and majority of theem are present WITH NO ASSOCIATED SYMPTOMS
19
Q
prevelence of retained roots
A
11-37%
20
Q
maxilla intra oral exam
A
evaluate for undercuts or bony protruberences
palatal tori
tuberosity
labial and buccal frenum
hyperpladstic tissue
inter arch distance
21
Q
mandible intra oral exam
A
ridge form
contour
irregularities
buccal extoses
tori
muscle attachment
22
Q
overclosure of the mandible?
A
might give the impression of a pseudo class III
23
Q
normal resting position?
A
must evaluate patient in this as well to get the antero-posterior vertical relationship
also
- assymetries
- inter-arch distance
24
Q
lateral ceph can
A
help determine anteroposteiror relation of the jaws
25
one of the most important determinants of success with complete dentures
soft tissue ---health and quality
26
characterstics you want in soft tissue
healthy keratinized
firmly attached to the underlying bone
vestibule FREE of iflammation
muscle attachment low/ high to the alveolar crest
27
specific thing poited out that makes the denture base unstable?
hyperplastic tissue over the maxillary ridge --- tissue will make the denture base unstable
28
implicationof labial frenum?
plasty
| - reposition it if in way
29
treatment planning after?
intra and extra oral exams
30
tx planning outline
1. medical and dx history
2. concerns of the patient
- benefits and possible complications
3. intra/extra oral exam
4. radiographi exam
5. alternative treatment
6. surgical procedures involving bone contouring or augmentatino should be addressed first, followed by soft tissue proceudres
31
surgical blades noted in armamentarium
15 and 11
bard parker scalpal handle and molt periosteal elevator
32
step 1 for immediate denture treatment
| w/ notes
prophylaxis PRIOR to extractions
to MINIMIZE BLEEDING AND INFECTION PROBABILITIES
33
Step 2 for immediate denture treatment
| w/ notes
complicated extractions
as bony changes may effect final impressions and denture fit
34
step 3 for immediate denture treatment
| w/ notes
extractions of maxillary and mandibular molars
after extractions -- allow 6 weeks for healing before making final impressoins
35
after extractions of molars wait?
6 weeks before final impressions
36
final impressions when
after the posterior extractions
37
step 5 for immediate denture treatment
| w/ notes
model surgery
remove the teeth that are visible above the gingiva, contour gingival tissue, and remove undercuts
38
step 6 for immediate denture treatment
| w/ notes
construction of clear surgical stent
will guide the surgeon during the preocedure for alveolar recontouring
- must make sure it is seated completely
39
post op instructions for immediate
antibiotics are usually UNNECESSARY
do NOT remove denture until follow-up with dentist (24 hours)
follow up with surgeon in 1 week
soft-tissue reline if needed
40
elliptical incision?
looked at the mandibular anterior
- raise a flap and eliminate tissue and bone
grind down with pinapple bur
41
be careful with pineapple bur?
yes -- around cancellous bone -- this is soft bone and this bur can remove too much if not careful
42
remove inter-proximal papilla?
is an option -- then can remove the bone in the inter-ridge areas and smooth down
43
remove mandibular lingual extoses
make incision in bone towards buccal
full flap
so not too worried about lingual nerve
because incisoin on bone towards buccal and full buccal periosteal flapp - so lingual nerve on the other side
44
most alveolopplasty are done
on the maxilla and anterior mandible
45
alveoplasty definiotn
contouring the alveolar ridge to remove irregularities and under-cuts
46
goals of alveoplasty
provide stable base for prosthesis
preserve alveolar bone
47
pitfalls of alveoplasty
poor evaluation of the patient
- does the patient need bone reduction or augmentation?
poor communication with the dentist
- dentists goals and expectaions met?
48
tip of elevator has to be?
POINTED EDGE CONTACTING BONE
could damage tissue and nerves in area if dont
49
surgical technique for alveoplasty with incision?
crestal incision over the area with VERTICAL RELEASE INCISION
- FULL thickness flap
- be careful with anatomical structures
50
periostal elevator?
MUST USE -- pointed edge of the elevator must be AGAINST BONE
51
reflect with?
a seldin or minnesota retractor
52
start reflection?
where the vertical and crestal incision join
53
contour bone with?
bone file, rongeurs and/ or round bur
| - ELIMINATE UNDERCUTS AND SHARP EDGES
54
eliminate the undercuts and sharp edges
bone file, rongeurs and round bur
55
irrigate with?
NNS and suture to original position
56
implication of lone standing tooth
the tooth super-erupts and brings bone with it - so if just remove the tooth - left with a bony protuberance
57
envelope flap has?
NO releasing incisions
58
isolated teeth in maxilla posterior make sure to check
x-ray
| dont use elevator -- maxillary sinus may come with the tooth
59
indication for maxillary tuberosity reduction
not enough space, vertically or horizontally for denture base
severe undercut
mobile tissue
60
radiograph with max tuberosity reduction?
panorex -- to determine the proximity of the maxillary sinus
helps to determien if it is fibrous or bony in nature
61
fibrous tuberosity technique?
wedge resection
62
wedge resection used in
fibrous tuberosity reduction on maxilla
63
surgical techniwue for wedge resection
incision type? with?
ELLIPTICAL INCISION
| - #15 BLADE
64
wedge resection incision starts?
elliptical incision
| STARTSON CREST or AT JUNCTION of the normal and fibrotic tissue
65
wedge resection incisoin extends?
POSTERIORLY towards hamular notch
66
submucous lateral resection?
yes used in the wedge resection technique with fibrous tuberosity reuction
uses #15 blade
67
make sure to preserve ___ with wedge resection
the vestibule and attached gingiva
68
suture with wedge resection
approximate flaps and suture with CONTINUOUS 3.0 suture
69
fibrous vs bony identified by?
x ray normally
70
bony tuberosity maxillary reduction incision?
we do 3 - corner flap - have to reflect more to work in the bone
single crestal incision
release incision ***
71
flap with bony tuberoisty
similar procedure to an alveloplasty
FULL THICKNESS with periosteal elevator
place seldin retractor - tip in bone
72
contour bone in bony tuberosity removal?
YES -- with rongeur, oval bur, bone file
73
suture in bony tuberosity?
suture 3.0
74
most tori...
do not need to be removed
- but if interfere - must remove
solid cortical bone
75
indications for removal of maxillary torus
constant trauma
prevent good post dam seal
large undercuts
speech impediment
psychological phobia
76
radiograph with max tori?
yes -- to evaluate and determine the proximity of nasal cavity and maxillary sinus
77
technique for max tori removal
maxillary impression
torus removed from the cast and clear stent is made
stent will protect the area andprevent hematom
78
stent can prevent
a hematoma
79
LA for max tori removal?
LA with VASOCONSTRICTOR for greater palatine and nasopalatine
#15 blade used to make an incision in the for of a Y
80
incision form for max tori removal?
| reflection?
Y shape
and reflect with a periosteal elevator
81
score?
score the torus with a FISSURE BUR
82
fissure bur?
used to score the torus on the maxilla
83
technique for removal of max torus?
score torus with fisure bur
chisel and mallet or round bur
smooth with large oval burr with copious irrigation
suture with chromic 3.0
84
suture with max tosi removal?
with chromic 3.0
85
mandibular tori location?
usually bilateral and located on the lingual aspect
86
mandibular tori can interefere?
yes with the mandibualr partial or complete denture
87
LA technique for mandibular tori removal
IAN blocks
88
incision for mandibular tori
incision alongt he crest of the ridge extended equivalent of 2 teeth beyond torus
release incisions usually NOT needed
89
release incisions in mandibular tori?
usually NOT needed
90
flap in mandibular tori removal
| detailed with anatomy included
FULL thickness flap
be careful because mucosa is THIN
the lingual ARTERY and NERVE are close to the surgical area
flap extended BELOW the torus and protected with selding retractor
91
groove in mandibular tori removal?
yes use a groove with fissure burr on the SUPERIOR MARGIN
- depth should not be more than halfway through the vertical dimension
92
monobevel chisel?
used to be placed into the groove created with fissure bur when removing a mandibular tori
93
mandibular tori removal
| implication with chin?
needs to be supported when removing
- so support manually and then monobevel chisel in the groove
- tap with a mallet
- a bur could also be used
94
mandibular tori suture?
SILK 3.0
vs. maxillary tori was chromic 3.0
95
vestibuloplasty goal
remove unwanted muscle insertions into the alveolar ridge that prevents denture flange from extending adequate stability and retention
96
vestibuloplasty requires adequate?
HEIGHT OF ALVEOLAR BONE
97
vestibuloplasty surgical technique
LA
incision
- placed at the JUNCTION of attached and unatteched mucosa with a #15 blade
partial thickness flap is raised with the blade or deans scissors preserving the periosteum
periosteal has to be left
so PARTIAL THICKNESS FLAP
98
vestibuloplasty incision
incision
| - placed at the JUNCTION of attached and unatteched mucosa with #15
99
flap in vestibuloplasty
partial thickness flap is raised with the blade or deans scissors preserving the periosteum
100
suture in vestibuloplasty
the mucosal edge is sutured to the bottom of dissected area
101
resulting denuded periosteum can be handled in different ways... name the two
1. heal by SECONDARY INTENTION (50% will relapse)
2. GRAFT the area
- palatal graft
- collagen membrane
- cadaveric mucoslal membrane
102
perforate graft?
YES -- graft should be perforated with a #11 blade after suturing to prevent blood clots forming between the graft and periosteum
103
protect the graft?
yes -- use patients denture or soft clear splint with soft tissue relining material to protect the graft
104
denture / splint removal after vestibuloplasty
should NOT be removed for a WEEK
105
removal of the splint after grafting?
graft will look WHITE - this is NORMAL
106
angiogensis and healing with graft?
angiogenesis occurs within 48 hours and healing takes up to 5-6 weeks
107
labial frenectomy
frenum consists of thin bands of connective tissue attached to the bone
can interfere with the extension of the denture flange if not altered
108
simple excision used in? effective when?
labial frenectomy
| *EFFECTIVE WHEN MUCOSAL AND FIBROUS BAND IS RELATIVE NARROW
109
labial frenectomy surgical technique with incision?
simple incision is made
ELLIPTICAL
- is done around the frenum down to the periosteum
RHOMBOID IN SHAPE AROUND IT
110
incision margins undermined with___ in labial frenectomy
deans scissors
111
Z plasty?
technique to remove labial frenum
112
z plasty effetive when
when mucosal and fibrous band is relatively narrow
113
incisoin with z plasty
with #15 blade -- do incision ALONG the frenum
at edge of the incisions - two small incisions are made in a Z fashion
114
flaps in labial frenectomy with z plasty technique
flaps are undermined with deans scissors and rotated to close the original vertical incision in a horizontal manner
you actually lengthen the frenum
- do not see secondary intention healing
115
labial frenectomy when frenal attachment has a wide base with secondary epithelialization
incision?
flap?
suture?
healing?
SEMI-LUNAR SUPRA-periosteal incision is made at the JUNCTION free and attached gingiva
flap
- undermined
suture
- to the periosteum at the depth of the vestibule
helaing
- takes place by secondary epitheliazatoin
116
lingual frenectomy aka
need for TONGUE-TIE OR ANKYLOGLOSIA
can cause difficulty in denture contriction
117
surgical technique for lingual frenectomy
| suture?
TRACTION SUTURE - at the tip of the tongue to retract the tongue SUPERIORLY
118
lingual frenectomy use of hemostat?
yes -- clamp the hemostat at the BASE of the frenum at the same time you RETRACT the tongue
119
watch out for___ in lingual frenectomy?
SUBMANDIBULAR DUCTS
120
have to what in lingual frenectomy with tissue
have to UNDERMINE the tissue
