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Pre-Prosthetic Surgery Dr. Omnia Sultan
Asst. Prof of Oral & Maxillofacial Surgery
O. Sultan
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
O. Sultan
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.
O. Sultan
Criteria Cont.
No muscle fibers or soft tissue folds to mobilize the periphery of the denture
Satisfactory maxillary/mandibular ridge relationship.
O. Sultan
Criteria Cont.
Soft tissue coverage should be free from redundancies or hypertrophies.
No evidence of pathosis or neoplasm.
O. Sultan
Treatment Planning
► Patient needs
► Medical condition
► Evaluation of Supporting Bony and Soft tissue (Visual, Palpation, Radiograph)
O. Sultan
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
O. Sultan
Classification continue..
Surgical correction of alveolar atrophy and flat ridges
1. Relative heightening procedure (Vestibuloplasty)
2. Absolute heightening procedure (Ridge augmentation)
O. Sultan
Preventative Procedures
1. Routine surgical measures at the time of extraction.
2. Alveoloplasty.
O. Sultan
Routine Surgical Measures
The aim of those procedures are to promote healing and preserve the
shape of the alveolar ridge.
O. Sultan
Routine Surgical Measures cont.
Atraumatic Extraction
Treatment of gingival Inflammation before extraction
Preservation of the alveolar bone and the adjacent soft tissues
O. Sultan
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
O. Sultan
O. Sultan
Preventative Procedures
1. Routine surgical measures at the time of extraction.
2. Alveoloplasty.
O. Sultan
Alveoloplasty
it is surgical contouring or reshaping the alveolar process by removal of all sharp and rough bony projections.
O. Sultan
Alveoloplasty Cont.
Aim
► Correct irregularities of residual alveolar ridge
► Removal of unfavorable bony undercuts
O. Sultan
Alveoloplasty Cont.
► To provide the best possible tissue contour for prosthetic support while maintaining as much bone & soft tissue as possible
O. Sultan
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
O. Sultan
Alveoloplasty Cont.
► Alveoloplasty with single tooth extraction
contouring of bone surrounding isolated tooth after extraction through a gingival incision
O. Sultan
Alveoloplasty Cont.
Supra-erupted maxillary molar. Required surgical recontouring of alveolar bone after extraction of the tooth, to create adequate inter-arch space
O. Sultan
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
O. Sultan
Alveoloplasty Cont.
Ronguer is used to contour the bone and remove sharp prominent edges.
O. Sultan
Alveoloplasty Cont.
Smoothing of the alveolar ridg with surgical bur and bone file
O. Sultan
Alveoloplasty Cont.
DebridementThe 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
O. Sultan
Alveoloplasty Cont.
O. Sultan
Alveoloplasty Cont.
Simple Alveoloplasty
If there are grossly irregular alveolar margins or if the alveolar ridge is high
O. Sultan
Alveoloplasty Cont.
part of the mucosa is removed with wedge-shaped incision mesial and distal to the extraction sockets
O. Sultan
Alveoloplasty Cont.
Reflection of the mucoperiosteum and removal of bone margins of the wound with a rongeur.
O. Sultan
Alveoloplasty Cont.
Smoothing of the bone surface with a bone bur
O. Sultan
Alveoloplasty Cont.
Debridement and wound closure
O. Sultan
Alveoloplasty Cont.
Labial plate
clinical and radiographic examination of the teeth to be extracted
O. Sultan
Alveoloplasty Cont.
Surgical technique AnesthesiaIncision at the crest of the gingiva or around the necks of teeth Elevation of the mucoperiosteal flapExtraction of teeth
O. Sultan
Alveoloplasty Cont.
Ronguer is used to contour the bone and remove sharp prominent edges
O. Sultan
Alveoloplasty Cont.
Smoothing of the alveolar ridg with surgical bur and bone file
O. Sultan
Alveoloplasty Cont.
Removal of excess soft tissues with soft tissue scissors
O. Sultan
Alveoloplasty Cont.
Debridement Flaps
approximation and closure
O. Sultan
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.
O. Sultan
Alveoloplasty Cont.
Surgical technique AnesthesiaIncision along the alveolar ridge where the bone irregularity is located
O. Sultan
Alveoloplasty Cont.
Reflection of the mucoperiosteum
Smoothing of the alveolar ridge with a bone file
O. Sultan
Alveoloplasty Cont.
Removal of excess soft tissues with soft tissue scissors
Debridement & suturing
O. Sultan