This document discusses preprosthetic management prior to dental prosthesis construction. It covers examining the oral cavity to identify potential problems, improving treatment outcomes. Non-surgical methods include tissue rest, occlusal adjustments, and nutrition/jaw exercises. Surgical methods include correcting conditions limiting prosthesis function and enlarging denture bearing areas through procedures like vestibuloplasty and ridge augmentation. Specific procedures covered are alveoloplasty, tuberosity reduction, frenectomy, tori removal, and managing irritated tissues with conditioners. The goal is preparing tissues for a comfortable, functional prosthesis.
3. Introduction
Thorough examination of the oral cavity prior to the
construction of the prosthesis is a must to identify the
Potential problems.
This improves the treatment prognosis and reduce the
Number of postinsertion adjustments.
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5. Rationale of pre prosthetic service
Aim :
Is to prepare the soft and hard tissues of jaws for a
Comfortable prosthesis,that will restore oral function,
Aesthetics and facial form.
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6. Objectives
• To restore functions of the jaws
( mastication,speech and swallowing ).
• Preserve or improve jaw structure.
• Improve aesthetics.
Eliminating pain and discomfort arising from an ill
fitting prosthesis by surgically modifying the denture
bearing area.
Improving the denture bearing area for patients in
whom there has been extensive loss of alveolar bone.
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7. Phases of management
Non surgical
Surgical
Combination of both
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8. Non surgical methods
Rest for denture supporting tissues.
Occlusal correction for the existing prosthesis.
Optimal vertical dimension of occlusionto the
dentures currently worn by the patient with an
interim resilient lining material.
Good nutrition.
Jaw exercises can permit relaxation of the
muscles of mastication and strengthen their co-
ordination.
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10. Surgical armamentarium
Bard parker blade (no 15)
Heamostat
Molt periosteal elevator (no 4)
Retractor
Artery forceps
Mosquito forceps
Suturing materials
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11. Surgical Methods
Broadly dividend into –
1. Correction of conditions that precluded optimal
Prosthetic function.
2. Enlargements of denture bearing areas
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12. Correction of conditions that precluded
optimal Prosthetic function
Hyperplastic Ridge- mobile tissues that
interfere optimal seating of denture
Epulis fissueratum – locailised
enlargement of peripheral tissues may
interfere peripheral seal of denture
Papillomatosis - Harbour micro
organisms
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13. 4. Unfavourable Frenular Attachments and Pendulous
maxillary tuberosities.
5. Unfavourable Maxillary Tori.
6. Pressure on metal foramen
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14. Enlargements of denture bearing areas –
Vestibuloplasty
Ridge augmentation
Implants
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15. Minor surgical procedures
Alveoloplasty- To persue as much as alveolus
possible without any bone irregularities
Digital Compression of the socket is ideal
Interseptal Alveoloplasty by O.T Dean
With adequate bone height, undercut on the
buccal aspect of the jaw, repostioning of labial
cortical bone is accomplished. Without raising
the mucoperiosteal flap, interseptel bone is
removed with a small rongour & buccal plate is
infractured with digital pressure.
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20. Clinical examination- lack of adequate clearance
by placing a figure or mirror posterior to the
tuberosity near the peripheral border
Inability open widely when figure in place
indicates reductions of excess tuberosity
Care must be taken to avoid opening in to the
sinus in those insantances in which the sinus dips
down in to the pneumatized and elongated
tuberosity it may be possible to collapse the sinus
floor upwards- sinus lift procedure .
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23. Frenectomy
Frenum is a musculo-fibrous band attached
to the alveolus and inserted into the muscles of
the face
Classification-(House)
Class I Attachments are high in maxilla and low
in mandible with respect to crest of the ridge
Class II Medium
Class III Freni encroach on the crest of the ridge
and may interfere with the denture sealwww.indiandentalacademy.com
24. Evaluations by visual examination
Z- Plasty – more difficult , advised when frenum
is broad and short to preserve sulcus depth
V-Y advancement Technique – Concomitant
decrease in nasal base width is required
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26. Tori
Tori are benign, slowly growing osseous
projections of the maxilla and or mandible
that attain maximum size by third decade.
Etiology- unknow
Location:-
– Maxilla Midline
– Mandible Premolar region
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27. Indication for the removal of maxillary tori –
Extremly large tours that fills the Palatal vault
and prevents the formation of a stable maxillary
denture
Under cut creating torus that traps foods debris
causing the chronic inflammatory condition.
Tori extending past the junction of the hard and
soft palatals and prevents the development of an
adequate posterior palatal seal
Tori cuasing patient concernwww.indiandentalacademy.com
30. Relocation of mental nerve
Due to progressive ridge resorption,Mental
foramen gets closer to the crest of te
alveolar crest.
Pressure from the denture flange causes
discomfort to the patient.
Relocating it apically by surgical exposure
would be a satisfactory remedy
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36. Uses of tissue conditioners
Adjunctions in tissue conditioning
Temporary obturators
Stabilizers of base plates and surgical
splints.
Adjunct in impresson making procedure or
as a final impression material
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37. Advantages
Hypertrophied, irritated,hyperemic tissues
are rested without discontinuation of the
denture.
Improves stability,relives and equalizes
pressure almost immediately thus
preventin further damage.
The dis-advantage are;
Easily misused
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38. Technique
Powder liquid ratio- 1.75/1
½ cc of plasticizer added to the monomer
prior to mixing it with polymer.
While the mixture is still creamy and runny
pour it into denture.
1mm of even thickness or more in needed
for effective conditioning of the tissues.
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