pre prosthetics

8/22/2019 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.


2/55

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)


A model

forunderstanding

dental

function

over time



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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



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2. Bone contour3. Muscle attachements




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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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2. Lip / tongue habits



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3. Salivaryfunction

4. TMJ/ muscle

function


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



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1. Hard tissuea. Dental caries

b. Periodontal disease

c. Infectiond. Cysts and tumours



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1. Soft tissuea. Ulceration

b. Hyperplasia

c. Dysplasiad. Carcinoma


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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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


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



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An attempt toreverse the

trend


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



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Procedures designed to optimize theretention, support, stability and comfort of

prostheses by the selective modification of

soft and hard tissues



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Indications: compromized retention,support, stability orcomfort of prostheses

due to suboptimal hard or soft tissue

anatomy or pathoses



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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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a. Extractions for caries, periodontaldisease, infection, etc.


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a. Extractionsflap, bone removal, section


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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



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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



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b. Removal of pathosescystic, traumatic,hyper-plastic, dysplastic, etc.


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c. Gingivoplasty orfrenectomy for flabbyridge tissue or high frena that

interfere with support or retention

Gingivoplasty


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c. Frenectomy

1

2 4

3


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d. Tuberosity reduction

Canoe shaped wedge

Undermine

Close


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3

4

d. Tuberosity reduction

2

1


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e. Alveoplasty ortorus reduction toalleviate pain from point loading or

allow for path of insertion


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e. Alveoplasty: flaprecontourclose

1

3

2

4

5


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e. Alveoplasty: flaprecontourclose

2

1

3

4

5


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e. Torus reduction: flaprecontourclose

2

1

4

5

3


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f. Vestibuloplasty: ridge extension movemuscle attachment and retain with

soft tissue graft


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f. Vestibuloplasty: ridge extension movemuscle attachment and retain with

soft tissue graft


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1

4

5

3

2

f. Vestibuloplasty: move muscle attachmentand retain with soft tissue graft


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Pre-op

6 months PO

12 months PO

f. Vestibuloplasty: Mandibular palatal graftvestibuloplasty

6 months PO

12 months PO


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f. Vestibuloplasty: Maxillary palatal graftvestibuloplasty 6 months post-op


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f. Vestibuloplasty: Mandibular splitthickness skin graft vestibuloplasty

12 months PO


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f. Bone grafting: replacement of bone lossto alveolar atrophy benefit ???


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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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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



52/55


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



53/55


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 ___________________ ________________ ________________


54/55


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


55/55

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)


pre prosthetics

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