Pre-prosthetic Surgery Flashcards Preview

Oral Surgery Final > Pre-prosthetic Surgery > Flashcards

Flashcards in Pre-prosthetic Surgery Deck (32):
1

Preprosthetic Surgery - Bony surgery

Alveoloplasty
Torus Reduction
Tuberosity Reduction

2

Preprosthetic Surgery - Soft tissue surgery

Inflammatory papillary Hyperplasia

Inflammatory fibrous hyperplasia

Frenal attachments/release

3

Edentulism Long term results

Loss of bony alveolar ridge

Increased inter-arch space

Increase influence of surrounding soft tissue

Decreased stability and retention of prosthesis

Increased discomfort from improper prosthesis adapation

Increased risk of spontaneous mandibular fracture

4

Preprosthetic surgery

Surgical preparation in anticipation of removable prosthesis

Tissue supported hypothesis

5

Evolution of preprosthetic surgery

Implant supported prosthesis

Implant is integrated w/ osseous tissue = anchorage for fixed or removal prosthesis

6

Tissue-supported hypothesis optimal results

Good height, width and contour of denture base

No Retentive undercuts

No undercuts impeding path of insertion

Evenly distributed masticatory forces

Adequate vestibular base

7

Anatomical Factors

Ridge form

Osseous Prominences

Tuberosity Form

Vestibular Depth

Adjacent Vital Structures

Inter-arch distancce

8

Anatomical Factors - Ridge form

Height

Width

Contour

9

Anatomical Factors - Osseous Prominences

Tori
Exostosis

10

Anatomical Factors - Vestibular Depth

Frenum and muscle attachments

11

Anatomical Factors - Adjacent Vital Structures

Mental Nerve

Sinus

12

Anatomical Factors - Interarch Distance

Material volume of prosthesis

13

Preprosthetic Surgery Instrumentation

Rongeur - workhorse, clips bone to desirable height

Bone file - smooths bone

Burs - rotatory, reduce large boney prominences

Chisel/osteotome - really large piece removal

14

Preprosthetic Surgery begins with?

Extraction (surgical or non-surgical)

Preserve buccal plates especially for maxillary molars and canine eminences

Retain maximum bone height

15

Alveoloplasty

Recontouring/removing alveolar bone irregularities

Provides best possible tissue contour for prosthesis, retain as much tissue as possible

16

Timing of alveoloplasty

Goal is to do it immediately at time of extraction.

Or

Delay after bony healing of sockets (6-10 weeks). Makes contouring easier but requires additional surgery

17

Types of Alveoloplasty

Digital compression - Compressing socket site

Intraseptal - get rid of intraseptal bone (if loose or fractured)

Surgical

18

Surgical Alveoplasty

1. Full thickness mucoperiosteal flap (good exposure, releasing incisions)
2. Expose osseous structure
3. Reduction/recontouring (burs, rongeur, bone file)
4. Reposition flap, palpate, recontour
5. Close with running stitch

19

Exostosis

Overgrowth of bone on buccal surface of maxilla or mandible

Technique same as alveoloplasty

20

Reduction of exostosis - Buccal

Less common than maxillary or mandibular torus.

Usually at maxillary molar areas

Reduce when interferes with stability/retention of denture or chronic traumatic ulceration

21

Mandibular Torus

Bony protuberances on lingual aspect of mandible

May prohibit denture fabrication

More difficult to remove then buccal exostosis

22

Mandibular Tori Removal Technique

1. Lingual mucoperiosteal flap reflection (crestal?)
2. Undermine the tori with fissure bur.
3. Remove tori with chisel
4. Use bone file as needed
5. Soft tissue closure

23

Maxillary Torus

Bony protuberances of palate

May interfere with fabrication or fit of RPD or CD

Very thin soft tissue

Carefully elevate and dissect soft tissue flap

Naso-palatal fistula may occur if using chisel

24

Maxillary Torus Excision Technique

1. Expose edges of tori
2. May reduce by fissure bur and chisel or acrylic bur
3. Close up

Consider protective post-op stent.

Y incision

25

Maxillary Tuberosity Reduction

Horizontal and/or vertical excess interference w/ denture

Result of excess soft tissue and/or bone - remove

At least 2-3 mm of vertial sulcus height distal to tuberosity = denture stability

26

Inflammatory Papillary Hyperplasia causes

Caused by: mechanical irritation, ill-fitting dentures, poor oral hygiene, fungal infections

27

Inflammatory Papillary Hyperplasia Treatment

Non-surgical: proper denture adjustment, antifungals (usual)

Surgical excision (rare)

Abrasion of superficial layer of palatal mucosa (rare)

28

Inflammatory Fibrous Hyperplasia (Epulis Fissuratum) Cause

Denture irratation from bad fitting.

Allergic or chemical to denture material

29

Inflammatory Fibrous Hyperplasia Treatment

Correction of denture

Electrocautery (if small)

Surgery (if big)

Submit excised tissue for histology!

30

Inflammatory Fibrous Hyperplasia Post-Op

Denture w/ adequate flange extension or stent.

Reline w/ soft liner

Maintain in place for 7 days, where denture after

31

Abnormal Labial/lingual frenum problems

Diastema, speech problem, edentulous denture displacement

32

Abnormal Labial/lingual frenum Treatment

Simple excision, Z-plasty