Post on 19-Dec-2015
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Pre-Prosthetic Surgery Dr. Omnia Sultan
Asst. Prof of Oral & Maxillofacial Surgery
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Pre-Prosthetic surgery are procedures designed to optimize the
stability, retention, support and comfort of prosthetic devices
through selective surgical modifications of soft and hard
tissues.
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Objectives
∆ Elimination of disease∆ Conservation of oral structures∆ Provide residual tissue to withstand
masticatory forces∆ Maintain function∆ Esthetics
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The Criteria of an Ideal Ridge
Adequate bony support. Adequate soft tissue
coverage. Adequate buccal &
lingual sulci, (good vestibular depth).
No undercuts, sharp ridges or overhanging protuberances.
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Criteria Cont.
No muscle fibers or soft tissue folds to mobilize the periphery of the denture
Satisfactory maxillary/mandibular ridge relationship.
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Criteria Cont.
Soft tissue coverage should be free from redundancies or hypertrophies.
No evidence of pathosis or neoplasm.
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Treatment Planning
► Patient needs
► Medical condition
► Evaluation of Supporting Bony and Soft tissue (Visual, Palpation, Radiograph)
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Classification of Pre-Prosthetic surgeries
Preventive surgical procedures to reduce prosthetic difficulties:
1. Routine surgical measures at the time of extraction.
2. Alveoloplasty. Corrective surgical procedures to remove
abnormalities 1. Surgical bony correction2. Surgical soft tissue correction
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Classification continue..
Surgical correction of alveolar atrophy and flat ridges
1. Relative heightening procedure (Vestibuloplasty)
2. Absolute heightening procedure (Ridge augmentation)
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Preventative Procedures
1. Routine surgical measures at the time of extraction.
2. Alveoloplasty.
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Routine Surgical Measures
The aim of those procedures are to promote healing and preserve the
shape of the alveolar ridge.
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Routine Surgical Measures cont.
Atraumatic Extraction
Treatment of gingival Inflammation before extraction
Preservation of the alveolar bone and the adjacent soft tissues
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Routine Surgical Measures con.
Removal of fractured loose pieces of alveolar bone at the time of tooth extraction
Removal of projecting interseptal bone
Compression of the extraction socket
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Preventative Procedures
1. Routine surgical measures at the time of extraction.
2. Alveoloplasty.
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Alveoloplasty
it is surgical contouring or reshaping the alveolar process by removal of all sharp and rough bony projections.
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Alveoloplasty Cont.
Aim
► Correct irregularities of residual alveolar ridge
► Removal of unfavorable bony undercuts
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Alveoloplasty Cont.
► To provide the best possible tissue contour for prosthetic support while maintaining as much bone & soft tissue as possible
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Alveoloplasty Cont.
Types► Alveoloplasty with single tooth extraction
► Alveoloplasty with multiple teeth extraction (According to Degree of Labial undercut)Interseptal Simple Alveoloplasty Labial plate
► Recontouring of Edentulous Alveolar Ridge
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Alveoloplasty Cont.
► Alveoloplasty with single tooth extraction
contouring of bone surrounding isolated tooth after extraction through a gingival incision
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Alveoloplasty Cont.
Supra-erupted maxillary molar. Required surgical recontouring of alveolar bone after extraction of the tooth, to create adequate inter-arch space
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Alveoloplasty Cont.
Surgical technique AnesthesiaIncision at the crest of the gingiva or around the necks of teeth (gingival incision)Elevation of the mucoperiosteal flapTooth extraction
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Alveoloplasty Cont.
Ronguer is used to contour the bone and remove sharp prominent edges.
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Alveoloplasty Cont.
Smoothing of the alveolar ridg with surgical bur and bone file
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Alveoloplasty Cont.
DebridementThe flaps
approximated and sutured with interrupted
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Alveoloplasty Cont.
Alveoloplasty with multiple teeth extraction
Interseptal
No mucoperiosteal Flap, down fracture of the labial alveolar bone
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Alveoloplasty Cont.
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Alveoloplasty Cont.
Simple Alveoloplasty
If there are grossly irregular alveolar margins or if the alveolar ridge is high
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Alveoloplasty Cont.
part of the mucosa is removed with wedge-shaped incision mesial and distal to the extraction sockets
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Alveoloplasty Cont.
Reflection of the mucoperiosteum and removal of bone margins of the wound with a rongeur.
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Alveoloplasty Cont.
Smoothing of the bone surface with a bone bur
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Alveoloplasty Cont.
Debridement and wound closure
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Alveoloplasty Cont.
Labial plate
clinical and radiographic examination of the teeth to be extracted
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Alveoloplasty Cont.
Surgical technique AnesthesiaIncision at the crest of the gingiva or around the necks of teeth Elevation of the mucoperiosteal flapExtraction of teeth
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Alveoloplasty Cont.
Ronguer is used to contour the bone and remove sharp prominent edges
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Alveoloplasty Cont.
Smoothing of the alveolar ridg with surgical bur and bone file
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Alveoloplasty Cont.
Removal of excess soft tissues with soft tissue scissors
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Alveoloplasty Cont.
Debridement Flaps
approximation and closure
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Alveoloplasty Cont.
► Recontouring of Edentulous Alveolar Ridge
After tooth extractions and the wound has been healed for along time, the residual ridge may present irregularities at a certain point or even along the entire alveolar ridge.
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Alveoloplasty Cont.
Surgical technique AnesthesiaIncision along the alveolar ridge where the bone irregularity is located
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Alveoloplasty Cont.
Reflection of the mucoperiosteum
Smoothing of the alveolar ridge with a bone file
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Alveoloplasty Cont.
Removal of excess soft tissues with soft tissue scissors
Debridement & suturing
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