pre-prosthodontics surgery

Question 1

types of soft tissue surgery pre-prosthetics

Answer 1

excisional
ridge extension procedures
augmentation procedures

Question 2

what reasons are there for soft tissue excision

Answer 2

frenectomy
papillary hyperplasia
flabby ridges
denture induced hyperplasia
maxillary tuberosity reduction
retromolar pad reduction

Question 3

what frenectomies/frenoplasty can be done

Answer 3

labial, buccal or lingual
could be causing a problem with OH, causing recession
lingual frenectomy often modified at birth if a tongue tie

Question 4

why are buccal frenectomies/frenoplasty risky on the lower

Answer 4

because mental nerve is situated there

Question 5

what is papillary hyperplasia usually in relation to

Answer 5

candida infection

Question 6

why are flabby ridges altered

Answer 6

interfering with retention and stability of denture

Question 7

why would you reduce maxillary reduction

Answer 7

sometimes too big to take impressions and make a good fitting denture
not as common now

Question 8

what is an example of a ridge extension procedure

Answer 8

vestibuloplasty = deepening the sulcus

Question 9

when is augmentation procedures done

Answer 9

quite unusual for prosthodontics, more so in perio

Question 10

what are reasons for hard tissue excisional proceudres

Answer 10

removal of retained teeth/roots/pathology
ridfe defect correction
maxillary/mandibular tori
maxillary tuberosity
exostoses
undercuts
genial tubercle reduction - uncommon
mylohyoid ridge reduction

Question 11

where does the mylohyoid muscle attach

Answer 11

along the mylohyoid ridge

Question 12

where is the genial tubercle

Answer 12

where genioglossus and geniohyoid muscles attach = tongue muscles

Question 13

where is the bone for augmentation procedures from

Answer 13

autografts = own bone from iliac crest, rib
allografts = from cadavers
xenografts = bio-oss
synthetic grafts = tricalcium phosphate

Question 14

where are xenografts usually from

Answer 14

usually cows, can be horses
all cellular content is removed and it is just the calcified part which is maintained = provides a framework to help bone regenerate

Question 15

what is the issue with synthetic grafts

Answer 15

no issue of transmission of disease/infections from other human/animals
can be less accepted in the body

Question 16

what is good about synthetic grafts

Answer 16

can be custom made to a desired shape/size

Question 17

other than excisional procedures for hard tissue, what else can be done

Answer 17

implants
inferior alveolar nerve relocation

Question 18

when would a IAN relocation be needed

Answer 18

when have severe resorption of alveolar process which leads to mental foramen coming to the surface and then can get the IAN being covered only by soft tissue and not by any bone

Question 19

how is a IAN relocation done

Answer 19

drill a channel deeper down in the body of the mandible and relocated the nerve to there
risky procedure

Question 20

how to remove retained roots/teeth/pathology

Answer 20

crestal incision with mesial receiving incision
flap elevated and tooth exposed
bone trimmed with ronguers (bone nibblers)
tooth extracted with forceps
sometimes need to section teeth to get them out

Question 21

what causes a ridge defect where there is a higher ridge anteriorly

Answer 21

patient retained lower anterior teeth for much longer than they retained their posterior so end up with this funny shape ridge where severe resorption posteriorly occurred but no anteriorly

Question 22

what is the problem with knife-edge ridge

Answer 22

its shape and when denture presses down on that edge it causes pain
don’t want to take too much away to lose retention, just enough to smooth out to stop pain

Question 23

when can mandibular tori be a problem

Answer 23

no an issue unless to has lost all teeth or is wanting a denture to fill the gap then it can be a problem

Question 24

how do mandibular tori usually present

Answer 24

often bilateral but not usually symmetrical

Question 25

what kind of flap is made for surgical excision of mandibular tori

Answer 25

one-sided flap, no relieving incision

Question 26

if had a palatal tori how could you adapt a denture design to prevent having to remove it

Answer 26

create a horseshoe design

Question 27

how to remove palatal tori

Answer 27

use very large bur and trim it down until flat enough or criss-cross pattern with a fissure but and cut off square bits of bone until it is flat enough

Question 28

what are the causes of prominent maxillary tuberosity

Answer 28

could be large because bone itself is big, or bone could be normal and have lots of fibrous tissue in the area

Question 29

surgical technique for removal of maxillary tuberosity

Answer 29

want to take away a bit of the bulk but still need to be able to get primary closure take a little bit of the underlying CT away as well then pull tissues together and suture

Question 30

what is a bony exostoses

Answer 30

projection of extra bone and can cause pain for a patient

Question 31

what flap is raised for bony exostoses

Answer 31

2-sided flap

Question 32

what syndrome is associated with flabby ridges

Answer 32

combination syndrome

Question 33

what is combination syndrome

Answer 33

lost all maxillary teeth and lose all lower teeth other than anteriors lower natural teeth are opposing full upper denture and the constant pressure can result in excessive resorption of the bone and end up with excess soft tissue

Question 34

what can denture induced hyperplasia/ulceratoin be mistaken for

Answer 34

looks like cancer small white lines is the beginning and get scarring and callous formation

Question 35

how can denture induced hyperplasia occur

Answer 35

people get an immediate denture and are told that it is only temporary and will need a new one but they never come back and then when they do they have lots of hyperplasia around the flanges where they have been digging into the soft tissue

Question 36

procedure for vestibuloplasty

Answer 36

numb pt up from tuberosity-tuberosity long crestal incision made (one sided flap_ dissect tissue maintaining periosteum = split thickness flap raised suture higher up in the sulcus leaving a big area of raw exposed periosteum fill edges of pts old denture with compound and place in pts mouth while still numb and do border moulding once got a good fit leave denture in as that is going to hold the soft tissue from coming back down while the new tissue over the periosteum granulates and forms new tissue pt needs to keep it in for about 1 month painful for pt

Question 37

why are vestibuloplasty done

Answer 37

to deepen the sulcus very rarely done now

Question 38

how do implant retained dentures work

Answer 38

implants placed parallel to each other usually in canine area pt able to clip denture in and out and retention is great life-changing for pts

Question 39

who can get implants on the NHS

Answer 39

hypodontia pts pts who have had cancer and lost teeth