Pre-prosthetic Surgery

Question 1

What are the excisional soft tissue surgeries used in pre-prosthetic dental treatment?

Answer 1

Frenectomy/frenoplasty

Papillary hyperplasia (related to dentures/candida)

Flabby ridges

Denture induced hyperplasia (Epulis fissuratum)

Maxillary tuberosity reduction

Retromolar pad reduction

Question 2

What are the types of frenectomy/plasty?

Answer 2

Lingual- tongue tie (younger shortly after birth usually)

Labial- recession or issue with OH

Buccal- Risk of damaging mental nerve

Question 3

Why may maxillary tuborosity reduction be carried out?

Answer 3

If it hinders retention of denture or impression taking

Question 4

What is a vestibuloplasty?

Answer 4

ridge extending procedure- deepening of the sulcus

Question 5

What is an augmentative procedure that can be done in pre-prosthetic surgery?

Answer 5

Soft tissue grafting (more useful for perio)

Question 6

What are the excisional hard tissue surgeries used in pre-prosthetic dental treatment?

Answer 6

Removal of retained teeth/roots/pathology
Ridge defect correction (alveoplasty)
Mandibular/ Maxillary tori removal
Maxillary tuberosity reduction
Exostoses- bony lumps
Undercuts
Genial tubercle reduction
Mylohyoid ridge reduction- if denture rubbing

Question 7

When may genial tubercle reduction be required?

Answer 7

If the tubercle (attachment point of geniohyoid and genioglossus) comes closer to the denture bearing surface due to resorption of alveolus

Question 8

What are the types other hard tissue procedures in pre-prosthetic surgery?

Answer 8

Implants (can help retain denture)

IAN relocation

Augementive- bone grafts

Question 9

What are the different types of grafts?

Answer 9

Autografts- Iliac crest bone, rib

Allografts- bone from other humans

Xenografts- from animals (horses and cows), e.g. Bio-Oss

Synthetic grafts- β Tricalcium Phosphate

Question 10

What are xenografts used for?

Answer 10

Provide framework to help bone regenerate

Question 11

What are the advantages of synthetic grafts?

Answer 11

no issue with transfer of infection or cultural/religious belief

Question 12

Why may IAN relocation be required? How is it achieved?

Answer 12

If resorption is so great that mental foramen is at surface
-> Numbness and pain due to denture pressing on it

 Drill deeper channel in body of mandible and run nerve through

Question 13

Which teeth are commonly retained?

Answer 13

Canines, wisdom teeth, lower premolars

Question 14

How are retained teeth removed?

Answer 14

2 sided flap- expose and remove

-> might require bone removal (monguers)/elevation/sectioning

Question 15

What type of 2 sided flap is selected for retained tooth removal?

Answer 15

Crestal with mesial relieving incision

Question 16

When may retained roots need to be removed?

Answer 16

If it comes to surface and disturbs hygiene or denture retention

Question 17

What can be done as an alternative to retained root removal if ridge needs to be preserved?

Answer 17

Create root stub with GIC

Question 18

What is a corticated radiolucency in the mandible most likely to be?

Answer 18

Residual cyst from apical radicular cyst which formed due to infection of teeth

Question 19

What causes ridge defects to occur?

Answer 19

Patient retains teeth in different areas for longer amounts of time

Question 20

What can be done to treat knife edged ridges (serrated appearance)?

Answer 20

Take flap and reduce/round off
 Prevent denture pressing and causing pain

Question 21

Where are mandibular tori usually found?

Answer 21

premolar region (often not symmetrical)

-> can meet at midline

Question 22

What issues can mandibular tori cause with dentures?

Answer 22

Can cause issues fitting denture in lingual flange area in partially dentate patients (resorption)

Question 23

How are tori reduced?

Answer 23

Take one sided flap and smooth
-> use plenty of tissue to close flap

Question 24

What are the options when a palatal tori obstructs seating of a denture?

Answer 24

Produce horseshoe denture

OR

Remove to allow more standard denture (utilising whole palate for retention)

Question 25

What can cause an enlarge tuberosity?

Answer 25

Excess bone Excess fibrous tissue deposition

Question 26

What is done when tuberosity is enlarged as a result of excess soft tissue?

Answer 26

Remove some of mucosa and connective tissue but not all to allow closure (do not remove periosteum)

Question 27

What is the flap design for a buccal exotosis?

Answer 27

2 sided flap- then smooth

Question 28

How can a flabby ridge be identified?

Answer 28

Twists/moves on pressure -> Tends to happen in maxilla when patient still has lower natural teeth (combination syndrome)

Question 29

How are flabby ridges reduced?

Answer 29

Using a wedge incision (preserve ST)

Question 30

How can denture induced hyperplasia and ulceration appears?

Answer 30

White lines Ulcerations may look cancerous

Question 31

How is denture induced hyperplasia treated?

Answer 31

Remove denture and clean

Question 32

In what instances can immediate dentures cause hyperplasia?

Answer 32

If patient doesn't return for definitive treatment

Question 33

How are vestibuloplasties carried out?

Answer 33

Deepen sulcus- numb, do long crestal incision, dissect tissues while maintaining periosteum (half-thickness flap), suture tissue higher up in sulcus (leaving exposed area of raw periosteum) -> Use patients old denture and border mould with compound/greenstick- extend flanges (denture also keeps ST in place while recovering- may be screwed in for a month)

Question 34

When may implants be offered on the NHS?

Answer 34

Hypodontia Major trauma Oral cancer -> sometimes for overdentures (sponsored treatment)

Question 35

How do implant retained over dentures work?

Answer 35

2 implants are placed in parallel in canine region- they have studs on them which clips onto denture (fixes issues with retention)