Pre-Prosthetic Surgery Dr. Omnia Sultan Asst. Prof of Oral & Maxillofacial Surgery

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. O. Sultan

Objectives Elimination of disease Conservation of oral structures Provide residual tissue to withstand masticatory forces Maintain function Esthetics

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.

Criteria Cont. No muscle fibers or soft tissue folds to mobilize the periphery of the denture Satisfactory maxillary/mandibular ridge relationship.

Criteria Cont. Soft tissue coverage should be free from redundancies or hypertrophies. No evidence of pathosis or neoplasm.

Treatment Planning ► Patient needs ► Medical condition ► Evaluation of Supporting Bony and Soft tissue (Visual, Palpation, Radiograph) Patient needs (chief complain & expectations regarding function & esthetic –history of success or failure with previous prosthesis) Medical condition (many of the approaches require G.A, donor site surgery sequential surgery) O. Sultan

Classification of Pre-Prosthetic surgeries Preventive surgical procedures to reduce prosthetic difficulties: Routine surgical measures at the time of extraction. Alveoloplasty. Corrective surgical procedures to remove abnormalities Surgical bony correction Surgical soft tissue correction

Classification continue.. Surgical correction of alveolar atrophy and flat ridges Relative heightening procedure (Vestibuloplasty) Absolute heightening procedure (Ridge augmentation)

Preventative Procedures Routine surgical measures at the time of extraction. Alveoloplasty.

Routine Surgical Measures The aim of those procedures are to promote healing and preserve the shape of the alveolar ridge.

Routine Surgical Measures cont. Atraumatic Extraction Treatment of gingival Inflammation before extraction Preservation of the alveolar bone and the adjacent soft tissues

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

Preventative Procedures Routine surgical measures at the time of extraction. Alveoloplasty.

Alveoloplasty it is surgical contouring or reshaping the alveolar process by removal of all sharp and rough bony projections.

Alveoloplasty Cont. Aim ► Correct irregularities of residual alveolar ridge ► Removal of unfavorable bony undercuts

Alveoloplasty Cont. ► To provide the best possible tissue contour for prosthetic support while maintaining as much bone & soft tissue as possible

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

Alveoloplasty Cont. ► Alveoloplasty with single tooth extraction contouring of bone surrounding isolated tooth after extraction through a gingival incision

Alveoloplasty Cont. Supra-erupted maxillary molar. Required surgical recontouring of alveolar bone after extraction of the tooth, to create adequate inter-arch space

Alveoloplasty Cont. Surgical technique Anesthesia Incision at the crest of the gingiva or around the necks of teeth (gingival incision) Elevation of the mucoperiosteal flap Tooth extraction

Alveoloplasty Cont. Ronguer is used to contour the bone and remove sharp prominent edges.

Alveoloplasty Cont. Smoothing of the alveolar ridg with surgical bur and bone file

Alveoloplasty Cont. Debridement The flaps approximated and sutured with interrupted O. Sultan

Alveoloplasty Cont. Alveoloplasty with multiple teeth extraction Interseptal No mucoperiosteal Flap, down fracture of the labial alveolar bone

Alveoloplasty Cont.

Alveoloplasty Cont. Simple Alveoloplasty If there are grossly irregular alveolar margins or if the alveolar ridge is high

Alveoloplasty Cont. part of the mucosa is removed with wedge-shaped incision mesial and distal to the extraction sockets

Alveoloplasty Cont. Reflection of the mucoperiosteum and removal of bone margins of the wound with a rongeur.

Alveoloplasty Cont. Smoothing of the bone surface with a bone bur

Alveoloplasty Cont. Debridement and wound closure

Alveoloplasty Cont. Labial plate clinical and radiographic examination of the teeth to be extracted

Alveoloplasty Cont. Surgical technique Anesthesia Incision at the crest of the gingiva or around the necks of teeth Elevation of the mucoperiosteal flap Extraction of teeth

Alveoloplasty Cont. Ronguer is used to contour the bone and remove sharp prominent edges

Alveoloplasty Cont. Smoothing of the alveolar ridg with surgical bur and bone file

Alveoloplasty Cont. Removal of excess soft tissues with soft tissue scissors

Alveoloplasty Cont. Debridement Flaps approximation and closure

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.

Alveoloplasty Cont. Surgical technique Anesthesia Incision along the alveolar ridge where the bone irregularity is located

Alveoloplasty Cont. Reflection of the mucoperiosteum Smoothing of the alveolar ridge with a bone file

Alveoloplasty Cont. Removal of excess soft tissues with soft tissue scissors Debridement & suturing