Download - Pre Prosthetics
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A 62 year old male presents for a new
upper partial. He had his posterior
teeth removed 22 years ago. The soft
tissue in the tuberosity area is hyper-
plastic and touches the lower ridgewhen the patient closes.
Using diagrams, describe a surgical
procedure for tuberosity reduction.
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A 54 year old female presents for the
fabrication of new complete dentures.
She has been edentulous for 30 years.
She is currently wearing her original
set of immediate dentures whichfit poorly. There is a I cm high by 1 cm wide by
5 cm long grooved soft tissue mass in the labial
vestibule. The denture fits into the groove. On
radiograph, the mandible is approx. 15 mm high
in the anterior.Note a 3 item differential diagnosis for the soft tissue mass.
3 ___________________ ________________ ________________
What factors may have contributed to the bone loss?
3 ___________________ ________________ ________________
What treatment will the soft tissue mass require?
2 ___________________ ________________
How will you address rehabilitation of the ridge?
3 ___________________ ________________ ________________
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Preprosthetic SurgeryThe Dentition Function Curve
0
20
40
60
80
100
120
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Function(%age)
Dentate Partially dentate Edentulous
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Preprosthetic Surgery
Objectives:
1. To understand the anatomy and physiology
of the edentulous milieu including alveolaratrophy and its associated pathoses
2. To diagnose conditions that can be improved
by preprosthetic surgical procedures
3. To treatment plan, design and execute
preprosthetic surgical procedures
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The Dentition Function Curve
0
20
40
60
80
100
120
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Function(%age)
Dentate Partially dentate Edentulous
A model
forunderstanding
dental
function
over time
The Dentition Function Curve
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The challenge ofedentulism
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Factors that impact on fit: anatomy
1. Bone quantity2. Bone contour
3. Muscle attachments
4. Gingiva vs. mucosa
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1. Bone quantity
Factors that impact on fit: anatomy
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2. Bone contour3. Muscle attachements
4. Gingiva vs. mucosa
Factors that impact on fit: anatomy
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Factors that impact on fit: physiology
1. Gingiva vs. mucosa2. Lip / tongue habits
3. Salivary function
4. TMJ / muscle function
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1. Gingiva vs. mucosa
Factors that impact on fit: physiology
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2. Lip / tongue habits
Factors that impact on fit: physiology
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3. Salivaryfunction
4. TMJ/ muscle
function
Factors that impact on fit: physiology
Parotid
Submandibular
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Factors that impact on fit: pathoses
1. Hard tissue2. Soft tissue
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1. Hard tissuea. Dental caries
b. Periodontal disease
c. Infectiond. Cysts and tumours
Factors that impact on fit: pathoses
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1. Hard tissuea. Dental caries
b. Periodontal disease
c. Infectiond. Cysts and tumours
Factors that impact on fit: pathoses
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1. Soft tissuea. Ulceration
b. Hyperplasia
c. Dysplasiad. Carcinoma
Factors that impact on fit: pathoses
a b c
d
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Factors that impact on fit: atrophy
1. Atrophya. Decreasing bone
b. Increasing soft tissue
1
2
3
4
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Factors that impact on fit: atrophy
1. Atrophya. Decreasing bone
b. Increasing soft tissue
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Factors that impact on fit: atrophy
1. Atrophya. Decreasing bone
b. Increasing soft tissue
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Factors that impact on fit: atrophy
1. Atrophy: accelerated by inflammationa. Infection
b. Poorly fitting dentures friction
c. Habits clenching / bruxism
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1. Atrophy:end result
loss of
support &retention
The Dentition Function Curve
0
20
40
60
80
100
120
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Function(%age)
Edentulous
Factors that impact on fit: atrophy
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An attempt toreverse the
trend
The Dentition Function Curve
0
20
40
60
80
100
120
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Function(%age)
Edentulous
Preprosthetic Surgery
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Procedures designed to optimize theretention, support, stability and comfort of
prostheses by the selective modification of
soft and hard tissues
Preprosthetic Surgery
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Indications: compromized retention,support, stability orcomfort of prostheses
due to suboptimal hard or soft tissue
anatomy or pathoses
Preprosthetic Surgery
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Preprosthetic Surgery
Procedures span a spectrum from verysimple to quite complex:
a. extractions and alveolar osteotomy
b. removal of pathoses
c. gingivoplasty and frenectomy
d. tuberosity reduction
e. alveoplasty and torus removalf. vestibuloplasty with soft tissue graft
g. bone grafting???
h. orthognathic surgery
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Preprosthetic Surgery
a. Extractions for caries, periodontaldisease, infection, etc.
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Preprosthetic Surgery
a. Extractionsflap, bone removal, section
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Preprosthetic Surgery
a. Extractionsflap, bone removal, section
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a. Extractions and alveolar osteotomy removal of proclined incisors and
osteotomy of labial plate of bone
Preprosthetic Surgery
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Preprosthetic Surgery
a. Extractions &and alveolar
osteotomy
removal ofproclined
incisors
and osteotomy
of labial plate of
bone
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a. Extractions and alveolar osteotomy removal of proclined incisors and
osteotomy of labial plate of bone
Preprosthetic Surgery
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Preprosthetic Surgery
b. Removal of pathosescystic, traumatic,hyper-plastic, dysplastic, etc.
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Preprosthetic Surgery
c. Gingivoplasty orfrenectomy for flabbyridge tissue or high frena that
interfere with support or retention
Gingivoplasty
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Preprosthetic Surgery
c. Frenectomy
1
2 4
3
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Preprosthetic Surgery
d. Tuberosity reduction
Canoe shaped wedge
Undermine
Close
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Preprosthetic Surgery
3
4
d. Tuberosity reduction
2
1
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Preprosthetic Surgery
e. Alveoplasty ortorus reduction toalleviate pain from point loading or
allow for path of insertion
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Preprosthetic Surgery
e. Alveoplasty: flaprecontourclose
1
3
2
4
5
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Preprosthetic Surgery
e. Alveoplasty: flaprecontourclose
2
1
3
4
5
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Preprosthetic Surgery
e. Torus reduction: flaprecontourclose
2
1
4
5
3
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Preprosthetic Surgery
f. Vestibuloplasty: ridge extension movemuscle attachment and retain with
soft tissue graft
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Preprosthetic Surgery
f. Vestibuloplasty: ridge extension movemuscle attachment and retain with
soft tissue graft
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Preprosthetic Surgery
1
4
5
3
2
f. Vestibuloplasty: move muscle attachmentand retain with soft tissue graft
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Preprosthetic Surgery
Pre-op
6 months PO
12 months PO
f. Vestibuloplasty: Mandibular palatal graftvestibuloplasty
6 months PO
12 months PO
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Preprosthetic Surgery
f. Vestibuloplasty: Maxillary palatal graftvestibuloplasty 6 months post-op
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Preprosthetic Surgery
f. Vestibuloplasty: Mandibular splitthickness skin graft vestibuloplasty
12 months PO
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Preprosthetic Surgery
f. Bone grafting: replacement of bone lossto alveolar atrophy benefit ???
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Preprosthetic Surgery
f. Bone grafting: process graft donor site
f B fti ft it
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f. Bone grafting: process graft site
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Preprosthetic Surgery
f. Bone grafting: replacement of bone lossto alveolar atrophy benefit ???
typically ALL of the newly grafted bone
is gone within 5 years
unless
supported by implants
+ =
Details to follow
A 62 year old male presents for a new
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A 62 year old male presents for a new
upper partial. He had his posterior
teeth removed 22 years ago. The soft
tissue in the tuberosity area is hyper-
plastic and touches the lower ridgewhen the patient closes.
Using diagrams, describe a surgical
procedure for tuberosity reduction.
Canoe shaped wedge
Undermine
Close
A 54 year old female presents for the
-
8/22/2019 Pre Prosthetics
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A 54 year old female presents for the
fabrication of new complete dentures.
She has been edentulous for 30 years.
She is currently wearing her original
set of immediate dentures whichfit poorly. There is a I cm high by 1 cm wide by
5 cm long grooved soft tissue mass in the labial
vestibule. The denture fits into the groove. On
radiograph, the mandible is approx. 15 mm high
in the anterior.Note a 3 item differential diagnosis for the soft tissue mass.
3 ___________________ ________________ ________________
What factors may have contributed to the bone loss?
3 ___________________ ________________ ________________
What treatment will the soft tissue mass require?
2 ___________________ ________________
How will you address rehabilitation of the ridge?
3 ___________________ ________________ ________________
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Preprosthetic Surgery
Objectives:
1. To understand the anatomy and physiology
of the edentulous milieu including alveolar
atrophy and its associated pathoses
2. To diagnose conditions that can be improved
by preprosthetic surgical procedures
3. To treatment plan, design and execute
preprosthetic surgical procedures
P th ti S
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Preprosthetic SurgeryThe Dentition Function Curve
0
20
40
60
80
100
120
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Function(%age)
Dentate Partially dentate Edentulous