Pre prosthetic surgery /certified fixed orthodontic courses by Indian dental academy

PREPROSTHETIC SURGERY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


• Preprosthetic surgery is carried out to reform,
redsign soft/hard tissues,by eliminating biological hinderances to receive comfortable
and stable prosthesis.
• Goal should be rehabilitation of the patient with
restoration of best possible masticatory
function,
combined with restoration or improvement of
dental and facial esthetics.

Aims of Preprosthetic surgery
• Provide adequate bony tissue support for
the placement of RPD/CD(optimum ridge,
height,width & contour)
• Provide adequate soft tissue support
(optimum vestibular depth)
• Elimination of pre-existing deformities
(tori,prominent mylohyoid ridge,genial
tubercles)

• Correction of mandibular and maxillary ridge relationship.
• Elimination of pre-existing soft tissue
deformities (epulis,flabby,hyperplastic
tissues)
• Relocation of frenal /muscle
attachments.
• Relocation of mental nerve.
• Establishment of correct vestibulr
depth.

Preprosthetic
procedures
•
•
•
•
•
•

Alveoloplasty
Vestibuloplasty
Ridge augmentation
Frenectomy
Removal of palatal tori
Removal of exostoses

ALVEOLOPLASTY
•

Alveoloplasty: surgical recontouring
of the alveolar process.
Objectives & Principles:

1.

To provide optimal ridge contour
quickly,permitting early construction of
the well-fitting and comfortable denture.

2. Alveolar ridges should be left as broad
as possible for maximum distribution of
the masticatory load
3. Ridge need not be perfectly smooth but
sharp edges should be rounded and gross
irregularities should be reduced
4. Mucosa covering the ridge should be
uniform in thickness,density & compressibility for even distribution of forces.

5. In younger people less bone has to be
removed as it is more plastic and prone
for resorption than older patients.

6. Cancellous bone resorbs more rapidly
than the cortical bone,so it is desirable
to preserve as much of cortex as possbl
A denture should rest on the cortical
bone not on the medullary bone.

7. If the immediate reduction of the

undercuts will result in a narrow V
shaped ridge,alveoloplasty should be
delayed 4-6 weeks until new bone fills
the socket.

8. If pieces of bone are accidentally

removed with the teeth an attempt
should be made to return atleast some
of this bone(esp.medullary bone) to the
operative site.

TYPES OF ALVEOLOPLASTY
1. ALVEOLAR COMPRESSION
2. SIMPLE ALVEOLOPLASTY
3. LABIAL & BUCCAL CORTICAL A’PLASTY
4. DEANS INTRASEPTAL(INTERCORTICAL)
5. OBWEGESER’S A’PLASTY

ALVEOLAR COMPRESSION
-Easiest and quickest form of a’plasty.
-Compression of the inner and outer
plates between fingers is done
-Most effective in young patients
but it should be carried out in all the
cases

-compression reduces the width of the
socket and deliminates many otherwise
troublesome bony undercuts.
-sutures are used to maintain the
softtissue and bone in their desired
position.


Alveolar compression
diagram


SIMPLE ALVELOPLASTY
-It is done to reduce the labial or buccal cortical margin.
-Commonly envelope flap is given,also a
releasing incision if required.
- Flap should be reflected just beyond
the bony projection,avoiding excessive
apical reflection.

- With a rongeur bone-cutting forceps
held parallel with the bone margin of
the alveolar process,right amount of
bone can be removed.
- Overerupted teeth often have an
elongated alveolar process.
- Vertical reduction of these bone
margins of the socket is necessary.

- Maxillary sinus expands into the
maxillary tuberosity,making vertical
reduction of the residual ridge
difficult.
- In these cases care is taken to leave
some bone to form floor of the antrum


Simple alveoloplasty


LABIAL & BUCCAL CORTICAL
ALVELOPLASTY
• Incision is made on the crest of the
ridge and a full thickness mucoperi osteal flap is reflected.
• Flap is reflected atleast one tooth
distance on either side from the area
of surgery.

• Sharp side-cutting or a blumenthal
rongeur forceps is held with one beak
beneath the bony rim of the socket and
other in the crest of the ridge.
• Small pieces of bone can then be ‘`bitten
off’’ the ridge.
• The rongeur should be sharp so that bone
is removed cleanly rather than fractured
away in large pieces

• A bone file can then be used to
smoothen the bony contour
• The mucous membrane can then be
held with sutures that are placed
over the interradicular bony septa.
• This technique is one of the most
common procedure performed after
removal of the teeth.

Labial & buccal cortical a’plasty


DEAN’S INTRASEPTAL
ALVEOLOPLASTY
ADVANTAGES
• Prominence of the labial and buccal alveolar
margin is reduced to facilitate the reception
of dentures.
• Muscle attachments are undisturbed
• Periosteum remains intact
• Cortical plate is preserved as a viable onlay
bone graft with an intact blood supply.

• As cortical bone is spared the postop
resorption is less.
TECHNIQUE:
-After removal of the teeth,the interradicular bony septa should be removed
with a rongeur/burs/chisels.
-Dean used a chisel to make an inverted
‘V’ shaped excision of bone in the labial
cortex in the canine socket

-Thus three sides of the labial cortical
bony flap are freed.

-The labial cortex b’comes a freely
movable osteoperiosteal graft attached
to only the mucoperiosteum from which
it receives its blood supply


- At this point finger pressure usually is
sufficient to compress the labial cortex
- Sutures are placed to stabilize the
tissues.
- Dean used this tech.on posterior as well
as anterior ridges making a buccal-cortical
relief in the most posterior socket.

• Dean suggested removing most posterior
molar teeth first and the working
forward to preserve the tuberosity when
preparing the posterior ridge.
• Canines should be removed first before
incisors to avoid fracturing nd removing
the labial cortex attached to cuspid teeth.

DEAN’S INTRASEPTAL DIAGRAMS


OBWEGESER’S TECHNIQUE
• Obwegeser suggested further modifica tion of dean’s tech. for cases of extreme
premaxillary protrusion.
-Technique:
• Teeth are removed as usual.
• Sockets are connected and rongeurs /burs
are used to remove the medullary interradicular
bone.

• A large pear shaped/round bur is taken
and the sockets and their interconne cting trough is enlarged.
• Both labial and palatal plates are cut
with burs in the canine area to weaken
the bone and to form three sided bone
flaps in both cortical plates.


• A small mounted disk is inserted into
the sockets and trough,to
score/groove ,the labial nd palatal
plates ,horizontally weakening them.
• Since the labial cortex is very thin,
usually only the palatal cortex need to
be scored with the disk


• A pair of broad flat elevators is inser ted into the sockets nd their connecting trough and is used to # the labial plate
labially and palatal plate palatally.
• Finger pressure is used to mold the alveolar
process into the desired shape.
• Sutures are placed and a denture splint
is used to stabilize the alveolar process(46wks)

Thank you
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Pre prosthetic surgery /certified fixed orthodontic courses by Indian dental academy

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