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 hyperplastic and touches the lower ridge
when the patient closes.
Using diagrams, describe a surgical
procedure for tuberosity reduction.
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 which
fit 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 ___________________ ________________ ________________
Preprosthetic Surgery
The Dentition Function Curve
120
Function (%age)
100
80
60
40
20
0
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Dentate
Partially dentate
Edentulous
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
The Dentition Function Curve
The Dentition Function Curve
120
Function (%age)
100
A model
for
understanding
dental
function
over time
80
60
40
20
0
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Dentate
Partially dentate
Edentulous
The challenge of edentulism
Factors that impact on fit: anatomy
1.
2.
3.
4.
Bone quantity
Bone contour
Muscle attachments
Gingiva vs. mucosa
Factors that impact on fit: anatomy
1. Bone quantity
Factors that impact on fit: anatomy
2. Bone contour
3. Muscle attachements
4. Gingiva vs. mucosa
Factors that impact on fit: physiology
1. Gingiva vs. mucosa
2. Lip / tongue habits
3. Salivary function
4. TMJ / muscle function
Factors that impact on fit: physiology
1. Gingiva vs. mucosa
Factors that impact on fit: physiology
2. Lip / tongue habits
Factors that impact on fit: physiology
3. Salivary
function
4. TMJ/ muscle
function
Parotid
Submandibular
Factors that impact on fit: pathoses
1. Hard tissue
2. Soft tissue
Factors that impact on fit: pathoses
1. Hard tissue
a. Dental caries
b. Periodontal disease
c. Infection
d. Cysts and tumours
Factors that impact on fit: pathoses
1. Hard tissue
a. Dental caries
b. Periodontal disease
c. Infection
d. Cysts and tumours
Factors that impact on fit: pathoses
1. Soft tissue
a. Ulceration
b. Hyperplasia
c. Dysplasia
d. Carcinoma
a
d
b
c
Factors that impact on fit: atrophy
1. Atrophy
a. Decreasing bone
b. Increasing soft tissue
1
3
2
4
Factors that impact on fit: atrophy
1. Atrophy
a. Decreasing bone
b. Increasing soft tissue
Factors that impact on fit: atrophy
1. Atrophy
a. Decreasing bone
b. Increasing soft tissue
Factors that impact on fit: atrophy
1. Atrophy: accelerated by inflammation
a. Infection
b. Poorly fitting dentures … friction
c. Habits … clenching / bruxism
Factors that impact on fit: atrophy
The Dentition Function Curve
120
100
Function (%age)
1. Atrophy:
end result
… loss of
support &
retention
80
60
40
20
0
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Edentulous
Preprosthetic Surgery
An attempt to
reverse the
trend …
The Dentition Function Curve
120
Function (%age)
100
80
60
40
20
0
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Edentulous
Preprosthetic Surgery
Procedures designed to optimize the
retention, support, stability and comfort of
prostheses by the selective modification of
soft and hard tissues
Preprosthetic Surgery
Indications: compromized retention,
support, stability or comfort of prostheses
due to suboptimal hard or soft tissue
anatomy or pathoses
Preprosthetic Surgery
Procedures span a spectrum from very
simple to quite complex:
a. extractions and alveolar osteotomy
b. removal of pathoses
c. gingivoplasty and frenectomy
d. tuberosity reduction
e. alveoplasty and torus removal
f. vestibuloplasty with soft tissue graft
g. bone grafting???
h. orthognathic surgery
Preprosthetic Surgery
a. Extractions for caries, periodontal
disease, infection, etc.
Preprosthetic Surgery
a. Extractions…flap, bone removal, section
Preprosthetic Surgery
a. Extractions…flap, bone removal, section
Preprosthetic Surgery
a. Extractions and alveolar osteotomy …
removal of proclined incisors and
osteotomy of labial plate of bone
Preprosthetic Surgery
a. Extractions &
and alveolar
osteotomy …
removal of
proclined
incisors
and osteotomy
of labial plate of
bone
Preprosthetic Surgery
a. Extractions and alveolar osteotomy …
removal of proclined incisors and
osteotomy of labial plate of bone
Preprosthetic Surgery
b. Removal of pathoses…cystic, traumatic,
hyper-plastic, dysplastic, etc.
Preprosthetic Surgery
c. Gingivoplasty or frenectomy for flabby
ridge tissue or high frena that
interfere with support or retention
Gingivoplasty
Preprosthetic Surgery
c. Frenectomy
1
3
2
4
Preprosthetic Surgery
d. Tuberosity reduction
Canoe shaped wedge
Undermine
Close
Preprosthetic Surgery
d. Tuberosity reduction
1
4
2
3
Preprosthetic Surgery
e. Alveoplasty or torus reduction to
alleviate pain from point loading or
allow for path of insertion
Preprosthetic Surgery
e. Alveoplasty: flap…recontour…close
5
1
3
2
4
Preprosthetic Surgery
e. Alveoplasty: flap…recontour…close
1
5
4
2
3
Preprosthetic Surgery
e. Torus reduction: flap…recontour…close
5
1
4
2
3
Preprosthetic Surgery
f. Vestibuloplasty: ridge extension … move
muscle attachment and retain with
soft tissue graft
Preprosthetic Surgery
f. Vestibuloplasty: ridge extension … move
muscle attachment and retain with
soft tissue graft
Preprosthetic Surgery
f. Vestibuloplasty: move muscle attachment
and retain with soft tissue graft
5
1
4
2
3
Preprosthetic Surgery
f. Vestibuloplasty: Mandibular palatal graft
vestibuloplasty
6 months PO
6 months PO
Pre-op
12 months PO
12 months PO
Preprosthetic Surgery
f. Vestibuloplasty: Maxillary palatal graft
vestibuloplasty 6 months post-op
Preprosthetic Surgery
f. Vestibuloplasty: Mandibular split
thickness skin graft vestibuloplasty
12 months PO
Preprosthetic Surgery
f. Bone grafting: replacement of bone loss
to alveolar atrophy … benefit ???
Preprosthetic Surgery
f. Bone grafting: process … graft donor site
f. Bone grafting: process … graft site
Preprosthetic Surgery
f. Bone grafting: replacement of bone loss
to 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
upper partial. He had his posterior
teeth removed 22 years ago. The soft
tissue in the tuberosity area is hyperplastic and touches the lower ridge
when the patient closes.
Using diagrams, describe a surgical
procedure for tuberosity reduction.
Canoe shaped wedge
Close
Undermine
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 which
fit 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 ___________________ ________________ ________________
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
Preprosthetic Surgery
The Dentition Function Curve
120
Function (%age)
100
80
60
40
20
0
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Dentate
Partially dentate
Edentulous