Week 3 Thomson- Surgical Prep for Prosthesis Flashcards
What are the 6 classification of alveolar ridge?
I – Dentate
II – Immediately Post-Extraction
III – Well-Rounded Ridge / Adequate Height & Width
IV – Knife-Edge / Adequate Height but Inadequate Width
V – Flat / Inadequate Height & Width
VI – Depressed / Basal; Bone Loss
What is the aim of preprosthetic surgery
To prepare Soft & Hard Tissues of the Jaws for a Comfortable Prosthesis that restores oral Function, Aesthetics & Facial Form
What are the objectives for pre-prosthetic surgery (4)?
Restore Mastication, Speech & Swallowing
Preserve or Improve Structure
Improve Patient’s Sense of Well Being (Quality of Life)
Improve Facial Aesthetics
What should you do before doing prosthetic surgery?
Consider remaking poor prosthesis, relining, adjusting occlusal face height, extending denture flanged to improve retention and stability
What are methods for preprosthetic surgery
- Preservation of alveolar bone
- Surgical preparation for tissue borne prosthesis
- Surgical prep for endosteal implant bone prosthesis
How can we preserve alveolar bone?
- Atraumatic exo
- Socket preservation
- Bone recontouring
How can we perform atruamatic exo?
- Careful Surgical Technique & Conservative Approach
- Preserve Alveolar Bone if attached to Mucoperiosteum
- Periotome to cut Periodontal Ligament
- Luxators to Widen Socket
- Elevators
- Forceps
- Trans-alveolar Approach
What are socket preservation techniques?
-
Placement of graft
- Autogenous bone
- Allogenous (cadaveric)
- Xenogenous (bovine)
- Allopastic (calcium hydroxyapatite)
- Biological membrane or mucosal graft cover
When can we perform bone recontouring?
- Minimal at time of exo
- Better to wait 3 months of healing and remodelling
- Common areas needing recontouring are jagged/irregular alveolar margins and septal bone
What are hard tissue irregularity for surgical preparations for tissue borne prosthesis?
- Torus
- Alveoplasty
- Knife edge ridge
- Genial tubercle
- Mylohyoid ridge reduction
What are soft tissue irregularities for surgical preparations for tissue borne prosthesis?
- Mobile ridges
- Tuberosity reduction
- Frenectomy
- Denture irritation hyperplasia
- Papillary hyperplasia
- Sulcus deepening
What are the grades for torus?
- Grade I < 3mm
- Grade II <6mm
- Grade II >6mm
What at issues with torus?
- Can enlarge and cause pain/functional problem
- In denture pt, may preclude denture placement and cause mucosal trauma and ulceration
How are md trous removed?
- Long gingival excision along alveolar crest
- Retract flap
- Make cross pattern with bone drill and chisel off
- Be careful of vessels in FOM (lingual a. and n, submandibular duct)
How are palatal tori removed
- Make palatal incision through middle of tori mucosa and retract flap each side
- Make cross work pattern on bone with bone drill and remove with chisel
What is issue with knife edge ridge?
Denture will be painful and may have ulceration
What is this?
Denture irritation hyperplasia/ Papillary hyperplasia
What are the steps of this implant placement?
- Keratinised Attached Gingiva + Ridge (a)
- 1st stage surgery (pilot osteotomy with custom made stent) (b)
- Osteotomy guided by direction indicator (c)
- Implant insertion (d)
- Cover screws placed + mucoperiosteal closure (e)
- 2nd stage surgery- healing abutments (f)
- Post healing locator abutments (g)
- Lower denture + male denture caps (h)
What is this?
Genial tubercles
