Pre Prosthetic Surgery

Pre-Prosthetic Surgery Important Notes

1. Types Of Bone Grafts

2. Vestibular Procedures:

3. Lip Switch Procedure Or Transpositional Flap

• Transpositional Flap is a lingually-based flap
• First described by Kazanjian
• In this technique, an incision is made in the labial mucosa, and the thin mucosal flap is dissected from the underlying tissue
• Flap of labial mucosa is sutured to depth of vestibule
• Exposed labial tissue heals by secondary Intention

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

4. Submucous Vestibuloplasty:

• First described by Macintosh and Obwegeser
• Submucous Vestibuloplasty is a procedure of choice for the correction of soft tissue attachment on or near the crest of the alveolar ridge of the maxilla
• This technique is particularly useful when maxillary alveolar ridge resorption has occurred, but the residual bony maxilla is adequate for proper denture support

Pre-Prosthetic Surgery Short Essays

Question 1. Ridge augmentation procedure.
Answer:

Ridge Augmentation Procedure

• Superior Border Grafting:
  • Obtain 2 autogenous ribs
  • Contour it to the shape of the mandible
  • Fix one of it with the mandible with the help of wiring
  • Other rib is cut into small pieces & moulded around 1st rib
  • Closure of flap

• Inferior Border Grafting:
  • Supraclavicular incision given
  • Subplatysmal dissection given
  • Hollow out the mandible
  • It is filled with graft particles
  • Fixation done with sutures & wiring

 

• Interposition Bone Grafting:
  • Horizontal osteotomy done
  • Splitting of maxilla or mandible
  • Bone is grafted into the gap

Question 2. Indications & technique and Vestibuloplasty of sulcus extension procedure
Answer:

Indications:

• Inadequate depth of sulcus
• Inadequate retention for the denture
• Inadequate stability of the denture
• Difficulty in denture construction

Technique: Vestibuloplasty:

1. Labial Vestibuloplasty:

• Kazanjian’s Technique:
  • Submucosal dissection from inner aspect of lower lip
  • Supraperiosteal dissection given upto desired depth
  • Mucosal flap sutured at the desired depth

• Clarke’s Technique:
  • Incision given labial to the crest of alveolar ridge
  • Undermining of mucosal flap
  • Supraperiosteal dissection done
  • Mobilize the flap to the desired depth & suture

2. Lingual Vestibuloplasty:

• Trainer’s Technique:
  • Incision given over lingual side of alveolar ridge
  • Supraperiosteal dissection given
  • Separation of mylohyoid muscle
  • Fixation of incisal edge of mylohyoid muscle to the desired depth

Mental Nerve Transposition:

Question 3. Alveoloplasty. 
Answer:

Alveoloplasty

Alveoloplasty is surgical recontouring of the alveolar process

Purpose:

• Sharp bony margins
• Sharp crystal bone
• Undercuts

Types Of Alveoloplasty:

1. Simple Conservative Technique:

• Done when multiple extractions are done in a single sitting
• Immediately after extraction, buccal & palatal cortical plates are compressed together
• If any bony spicules are present they are trimmed with Rogue’s forces
• If excess redundant tissue is present it is trimmed with surgical scissors

2. Intra Septal Alveoloplasty:

• Intra Septal Alveoloplasty Indications:
  • In maxilla
  • To reduce gross maxillary overjet
  • To reduce the volume of cancellous bone Presence of undercut
  • In case of multiple extraction

Intra Septal Alveoloplasty Technique:

3. Obwegeser’s Modification:

• Cut the interseptal bone
• Widen the socket at the base
• Horizontal cuts made at the base of the socket
• Make vertical cuts distal to the canine extraction sockets
• Compress labial & palatal cortices
• Sutures

Question 4. Alveolectomy.
Answer:

Alveolectomy

• Alveolectomy is an alveolar ridge correction procedure
• Alveolectomy is a procedure of surgical removal or trimming of the alveolar process

Need Of Alveolectomy:

• After extraction, the presence of sharp bony margins
• This interferes with the fabrication of dentures

Technique Of Alveolectomy:

Question 5. Torus palatines.
Answer:

Torus Palatines

Torus Palatines is exostosis/ overgrowth of cortical corticocancellous bone

Technique For Excision Of Palatal Torus:

Question 6. Pre-prosthetic surgeries
Or
Enumerate pre prosthetic surgeries.
Answer:

Pre-Prosthetic Surgeries

1. Bony Surgeries:
   • Labial alveolectomy Primary alveoplasty Secondary alveoplasty
   • Excision of torus
   • Reduction of genial tubercle
   • Reduction of mylohyoid ridge
   • Maxillary tuberosity reduction
2.  Soft Tissues Surgeries
   • Removal of redundant crestal soft tissues
   • Frenectomy
   • Excision of epulis

Pre-Prosthetic Surgeries Aims:

• Provide adequate bony tissue support
• Provide adequate soft tissue support Elimination of bony interferances
• Elimination of soft tissues interferences
• Correction of maxillary and mandibular ridge relation
• Relocation of frenal/ muscle attachments
• Relocation of mental nerve
• Excision of epulis

Pre-Prosthetic Surgery Short Question And Answers

Question 1. Dean’s alveoloplasty.
Answer:

Indication Of Dean’s Alveoloplasty:

• Presence of adequate ridge contour & height
• Skeletal malalignment
• To correct the proclamation of interiors

Principles Of Dean’s Alveoloplasty:

• To facilitate the reception of dentures
• Muscle attachments are left to heal
• Periosteal attachment remains intact
• Preservation of cortical plate
• Minimizing post-operative resorption

The procedure Of Dean’s Alveoloplasty:

Question 2. Frenectomy.
Answer:

Frenectomy Indications:

• Frenum attachment upto alveolar crest
• Ulceration at frenal attachments

Labial Frenectomy:

Z –  Plasty:

Z –  Plasty Indications:

• Broad frenum
• Short vestibule
• Deepening of vestibule

V-Y Plasty:

Lingual Frenectomy: Aims Or Ankyloglossia:

• To correct speech
• Before denture construction
• To improve tongue mobility

Lingual Frenectomy Technique:

Question 3. Torus mandibular is.
Answer:

Torus mandibular Is

Torus mandibular is exostosis/overgrowth of cortical/corticocancellous bone

Technique For Excision Of Mandibular Torus:

Question 4. Enumerate ridge augmentation procedures.
Answer:

1. Mandibular Augmentation:
   • Superior border augmentation Inferior border augmentation
   • Interpositional augmentation
   • Visor osteotomy
   • Onlay grafting
2.  Maxillary Augmentation:
   • Onlay bone grafting
   • Interposition grafting
   • Sinus lift procedure
3. Combination Procedures:

Pre-Prosthetic Surgery Viva Voce

1. Z plastic or Y-V plasty procedure is done for labial frenectomy
2. Disadvantages of the use of autogenous bone include the need for donor-site surgery and extensive resorption after grafting
3. The two muscles which are present in the floor of the mouth are the genioglossus and mylohyoid
4. For removal of the bony tuberosity area, the incision is extended along the crest of the alveolar ridge distally to the superior extent of the tuberosity area
5. Interseptal valvuloplasty involves the removal of inter-septal bone and repositioning of the labial cortical bone
6. Alveolectomy for prosthetic reasons should be performed during the time of extraction of teeth
7. Pre-prosthetic surgery on the mandible requires the preservation of the genial tubercles
8. A skin graft vestibulopathy prevents relapse by physically maintaining the depth of the vestibule