SURGICAL AND NON-SURGICAL
PREPARATION OF THE MOUTH
FOR COMPLETE DENTURE SERVICE
INTRODUCTION
A thorough examination of the mouth prior to the
construction of complete dentures is necessary to
identify potential problem areas.
Since the support, retention, and stability of a
denture base depend on the quantity and quality of
the denture bearing area and border seal, every
effort is to be made to preserve the alveolar
bone.
A determination of whether surgery is necessary is
an essential part of that examination and plays an
important role in successful patient management.
 There is a risk in wearing dentures for prolonged
periods.
 This risk, manifests itself in a number of adverse
changes in the denture foundations.
 Consequently, several conditions in the edentulous
mouth should be corrected or treated before the
construction of complete dentures.
The methods of treatment to improve the patient’s
denture foundation and ridge relations are usually
either non-surgical or surgical in nature, or a
combination of both methods.
Surgical correction should be made only after alternate
non-surgical approaches have been considered and
evaluated.
A patient who presents with deformed, abused
pathologic tissues from an existing denture should first
undergo non-surgical approach.
Some of the characteristics of denture
bearing area for maximum support and
stability and minimum interference with
function are:
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Adequate bone support for dentures.
Bone covered by adequate soft tissue.
No undercuts or overhanging protuberances.
No sharp ridges.
Adequate buccal and lingual sulcus.
No scar bands to prevent normal seating of denture.
No muscle fibers or frenula to interfere with the
periphery of the prostheses.
Satisfactory ridge relationship between the maxilla and
the mandible.
No soft tissue folds or hypertrophies on the ridge or
sulci.
A ridge free of neoplastic disease.
NON-SURGICAL METHODS
Non-surgical methods of edentulous mouth preparation
include:
1.
Rest for denture supported tissues.
2. Occlusal and vertical dimension correction of old
prostheses.
3. Good nutrition
4. Conditioning of the patient’s musculature
1.
Rest for denture supporting tissues:
Rest can be achieved by;
 the removal of the dentures from the mouth for
an extended period or
 the use of temporary soft liners inside the old
dentures.
 Regular finger or toothbrush massage of denture
bearing mucosa, especially of those areas that
appear edematous and enlarged.
Tissue abuse caused by improper occlusion can
be made to disappear by,
 Withholding the faulty denture from the patient.
 Adjusting/correcting the occlusion and/or refitting
the denture by means of a tissue conditioner.
 Substituting properly made dentures.
2. Occlusal correction of old prostheses:
An attempt should first be made to restore an
optimum vertical dimension of occlusion to the
dentures presently worn by the patient by using
an interim resilient lining material.
Consequently, ridge relations are improved and also
facilitates the occlusal adjustments intraorally
and extraorally, i.e., on an articulator.
3. Good nutrition:
A good nutritional program must be emphasized
for each edentulous patient. This program is
especially important for the geriatric patient
whose metabolic and masticatory efficiency have
decreased.
4. Conditioning the patient's musculature:
The use of jaw exercises can permit relaxation of
the muscles of mastication. and strengthen their
coordination as well as help prepare the patient
psychologically for the prosthetic service.
SURGICAL METHODS
Non-surgical methods of edentulous mouth preparation
include:
 Correcting conditions that preclude optimal prosthetic
function.
 Correcting frenular attachments and pendulous
maxillary tuberosities.
 Correcting bony prominences, undercuts, spiny ridges,
and nonparallel bony ridges.
 Correcting discrepancies in jaw size.
 Correcting enlargement of denture bearing areas
(vestibuloplasty)
 Replacing tooth roots by osseointegrated dental
implants.
Correcting conditions that preclude optimal
prosthetic function
( Hyperplastic ridge, Epulis fissuratum,
Papillomatosis.)
 The mobile tissues (e.g., a hyperplastic ridge),
 The tissue that interfere with seating of dentures (eg;
epulis)
 The tissues that readily harbor microbes (
papillomatosis)
are not conducive to firm healthy foundations for
complete dentures.
Whenever possible, these tissues should be rested,
massaged, and / or treated with an antifungal agent
prior to their surgical excision.
If the patient's health precludes surgical intervention,
the impression technique and design of the denture
base have to be modified.
Frenular attachments and pendulous maxillary
tuberosities.
If the frenum is close to the crest of the bony ridge, it may be
difficult to obtain the ideal extension and border of the
flange of the denture.
The frenectomy can be carried out before prosthetic
treatment is begun, or it can be done at the time of
denture insertion when the new denture can act as a
surgical template.
Pendulous fibrous maxillary tuberosities are frequently
encountered and may interfere with denture construction by
excessive encroachment on or obliteration of the interarch
space.
Surgical excision is the treatment of choice, but occasionally
maxillary bone must be removed.
Care must be used to avoid opening into the maxillary sinus.
Bony prominences, undercuts, spiny ridges, and
nonparallel bony ridges.
Tori are usually removed to avoid undercuts and to make possible a
border seal beyond them against the floor of the mouth.
The indications for the removal of maxillary tori
are as follows:
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An extremely large torus that prevents the
formation of an adequately extended and stable
maxillary denture.
An under cut torus that traps food debris, causing a
chronic inflammatory condition.
A torus that extends past the junction of the hard
and soft palates and prevents an adequate posterior
palatal seal.
One that causes the patient concern (because of a
cancerphobia)
Bony exostoses may occur on both jaws but are more
frequent on the buccal sides of the posterior maxillary
segments.
They may create discomfort if covered by a denture and
usually are excised.
Sometimes, the genial tubercles are prominent interfering
with genioglossus muscle, then they are excised.
Residual alveolar ridge undercuts are rarely excised
as a routine part of improving a patient's denture
foundations. Usually, a path of insertion and withdrawal
of the prosthesis can be determined together with
careful adjustment of a denture flange, which enable the
dentist to use the undercuts for extra stability.
Discrepancies in jaw size.
Impressive advances in surgical techniques of
mandibular and maxillary osteotomy have enabled
the oral surgeon to create optimal jaw relations for
prosthetic patients who have discrepancies in jaw
size.
Usually an adjunctive face-lifting procedure in this
type of patient produces impressive results.
Pressure on the mental foramen.
If bone resorption in the mandible has been extreme, the
mental foramen may open near or directly at the crest
of the residual bony process. This causes the margins of
the mental foramen to extend and have very sharp
edges 2 to 3 mm higher than the surrounding
mandibular bone. Pressure from the denture against
the mental nerve exiting the foramen and over this
sharp bony edge will cause pain.
The most suitable way of managing this is to alter the
denture so pressure does not exist. However, in rare
instances it may be necessary to trim the bone to
relieve the mental nerve of pressure.
ENLARGEMENT OF DENTURE BEARING
AREAS (VESTIBULOPLASTY)
The anterior part of the body of the mandible is the
sight most frequently involved: the labial sulcus is
virtually obliterated and the mentalis muscle
attachment appear to migrate to the crest of the
residual ridge.
When the absent sulcus is accompanied by little or no
attached alveolar mucosa in this area, it is virtually
impossible for a lower denture to be retained.
Sulcus deepening is carried out in an attempt to improve
denture retention.
This enables the prosthodontist to increase the vertical
extensions of the denture flanges.
Ridge augmentation.
For many years surgeons have attempted to restore
mandibular bulk by placing onlay bone grafts from an iliac
or rib source above or below the mandible.
However, it is a formidable undertaking for elderly patients.
REPLACING TOOTH ROOTS BY OSSEOINTEGRATED
DENTAL IMPLANTS.
Complete dentures are not the only method available for
treating edentulous patients.
In implant technique, a number of cylindrically shaped
screws, made of specific materials are buried inside the
selected host bone sites and
They are left to heal in situ for 4 to 6 months while
osseointegration occurs. The screws or tooth root analogues
are uncovered at a second surgical procedure, when an
elective removable fixed bridge is attached to the implants.
The technique also improves the scope for use of supporting
over dentures and is widely regarded as having completely
eclipsed the previously mentioned pre prosthetic surgical
methods.
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