32.preprosthetic surgical procedures (n)

32. Preprosthetic Surgical Procedures ,[object Object],[object Object],[object Object],This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ideal Bearing Surfaces - Maxilla ,[object Object],[object Object],[object Object],[object Object]

Ideal Bearing Surfaces - Mandible ,[object Object],[object Object],[object Object],[object Object]

Mandibular Bearing Surfaces Common Problems ,[object Object],[object Object],[object Object],[object Object],[object Object]

Severe Resorption - Mandible ,[object Object],[object Object],a) Loss of the teeth b) Ill fitting dentures c) Hormonal influences? d) Wearing dentures at night e) Edentulous mandible opposing dentate maxilla

Severe Resorption - Mandible Prevention a) Retention of roots b) Well adapted dentures with a coordinated occlusion c) Leaving out dentures at night d) Use of osseointegrated implants e) Removing opposing dentition

Mandibular Arch – Common Problems ,[object Object],[object Object],[object Object],[object Object],Consequences: Length of lingual flange is minimized

Mandibular Arch – Common Problems ,[object Object],[object Object],[object Object],Note : Usually occurs coincident with moderate to severe resorption of the alveolar ridge

Mandibular Arch – Common Problems ,[object Object],[object Object],[object Object],[object Object]

Maxillary Arch – Common Problems ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Severe Resorption - Maxilla ,[object Object],[object Object],[object Object],[object Object],[object Object],Prevention:

Redundant tissues - Premaxilla The entire premaxillary segment is fibrous connective tissue in this patient. The underlying bone has resorbed. It is not advisable to remove this cushion of tissue, however, because the residual ridge crest beneath these soft tissues is likely to be knife edged.

Maxillary Arch – Common Problems ,[object Object],[object Object],[object Object],* Can be prevented during extraction by alveolar compression and primary closure (Obwegeser, 1966)

Maxillary Arch – Common Problems ,[object Object],Consequences: a) Seal b) Fracture of denture

Maxillary :Arch – Common Problems ,[object Object],Consequences: a) Prevents proper adaptation of the denture base compromising support

Preprosthetic Surgery ,[object Object],[object Object],a) Minor soft tissue procedures b) Minor osseous procedures c) Vestibuloplasty d) Bone augmentation e) Implants

Conventional Preprosthetic Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Epulis Fissuratum (Inflammatory Fibrous Hyperplasia) ,[object Object],[object Object],Treatment a) Surgical excision and primary closure* * These lesions are generally pedunculated and are easily removed with scissors.

Low Frenum Attachments ,[object Object],[object Object],[object Object],Treatment: Frenum are comprised of epithelium and fibrous connective tissue, not muscle, so surgical excision is quite effective.

Palatal Papillary Hyperplasia and Associated Candida Albicans Infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Early Advanced * Corner of mouth usually infected with fungus as well

Therapeutic Approaches – Palatal Papillary Hyperplasia**with Associated Candida Albicans ,[object Object],[object Object],[object Object],[object Object],[object Object],Surgical excision with electrosurgery (when antifungal therapy has reached an end point) * Nystatin rinse is generally ineffective. Nystatin oral or vaginal suppositories used as an oral lozenge are reserved for fungal infestations that extend beyond the denture bearing surfaces. **Is this a premalignant lesion? No!!!!

Case Report Note the chamber inscribed into the upper denture(A) and the corresponding tissue hyperplasia. Such chambers are ill advised.

Case Report – Palatal Papillary Hyperplasia A severe case of palatal papillary hyperplasia. A combination of antifungal therapy and surgical excision is recommended for this patient.

Palatal Papillary Hyperplasia – Surgical Removal The preferred method for surgical removal is with electrosurgery. Following removal, islands of epithelium remain which grow, expand and eventually coalesce.

[object Object],[object Object],[object Object],Enlarged or Hyperplastic Tuberosities

Hyperplastic Tuberosities When this patient assumes a protrusive position, the maxillary denture was tipped anteriorly leading to resorption of bone of the premaxilla and fibrous hyperplasia of the maxillary tuberosity

Enlarged Tuberosities – Criteria for Reduction ,[object Object],[object Object],[object Object],[object Object],Fibrous Hyperplasia

Conventional Preprosthetic Surgery – Boney Procedures ,[object Object],[object Object],[object Object],[object Object],[object Object]

Palatal Tori - Criteria for Removal ,[object Object],[object Object],The palatal torus on the left should be considered for removal while the small one on the right need not be removed.

Removal of Palatal Tori The torus is removed with a burr and chisel. Note that the mucosal flaps are supported by a palatal stent (arrow) so as to prevent formation of a hematoma.

Removal of Palatal Tori This torus was removed with a burr and chisel. The mucosal flaps should be supported by a palatal stent so as to prevent formation of a hematoma.

Mandibular Tori – Criteria for Removal ,[object Object],Removal is accomplished with burrs and chisels

Alveoloplasty ,[object Object],[object Object],[object Object],** Only half of the desired amount should be removed because of the resorption that follows reflection of the periosteum and the surgical removal of bone Study casts should be made to properly plan the procedure

Repositioning the Inferior Alveolar Nerve ,[object Object],Preferred solution: Placement of 4-5 implants anterior to the mental foramen and fabrication of a fixed edentulous bridge

32.preprosthetic surgical procedures (n)

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32.preprosthetic surgical procedures (n)