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

2. 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

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

4. 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.

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

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

7. 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

8. 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

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

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

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

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

13. 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

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

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

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

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

19. 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

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

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

22. 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

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

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

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

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

27. Alveoloplasty Cont.

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

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

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

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

32. Alveoloplasty Cont.
Debridement and wound closure

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

34. 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

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

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

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

38. Alveoloplasty Cont.
Debridement
Flaps approximation and closure

39. 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.

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

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

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