PREPROSTHTIC SURGERY In oral surgery and endo

DR.J.BALAJI
PROFESSOR
TNGDC
CHENNAI
M.D.S.,

➢ Introduction
➢ Definition
➢ Goals of Pre-prosthetic Surgery
➢ Objectives of Pre-Prosthetic Surgery
➢Classification of Pre-Prosthetic
Surgical Procedures
➢Description of clinical Pre-Prosthetic
Surgical Procedures
➢ Conclusion
➢ References

According to the glossary of Prosthodontic terms
(GPT-8). The surgical procedures designed to facilitate
fabrication of a prosthesis or to improve the prognosis of
prosthodontic care.
According to Bruce Donoff, preprosthetic surgery is
that part of the oral and maxillofacial surgery designed to
establish the best hard and soft tissue bases for prosthetic
appliances

➢ To modify the oral environment to render it free of
disease
➢Provide a broad and flat ridge form with vertical
height (minimum 5 mm)
➢ Provide a firm resilient mucosal covering
➢ Provide ideal interarch distance (minimum 16-18 mm)
➢Provide post tuberosity (hamular) notching to enhance
the posterior border seal and resistance of the denture to
anterior dislodging forces.

➢ Elimination of disease
➢ Conservation of oral structures
➢Provide residual tissue to withstand
masticatory forces
➢ Maintain function
➢ Esthetics

The best denture support has the following 11 characteristics:
1.No evidence of intraoral or extra oral pathologic
conditions
2.Proper interarch jaw relationship in the anteroposterior,
transverse, and vertical dimensions
3.Alveolar processes that are as large as possible and of the
proper configuration (The ideal shape of the alveolar process
is a broad U- shaped ridge, with the vertical
components as parallel as possible)

4.No bony or soft tissue protuberances or undercuts
5.Adequate palatal vault form
6.Proper posterior tuberosity
notching
7.Adequate attached keratinized mucosa in the
primary denture bearing area
8.Adequate vestibular depth for prosthesis extension

9.Added strength where mandibular fracture may
occur
10.Protection of the neurovascular bundle
11.Adequate bony support and attached soft
tissue
covering to facilitate implant placement when
necessary
Contemporary Oral and Maxillofacial Surgery,
Sixth Edition- Hupp, James R

9. Assessment of existing tooth; if any tooth is
remaining.
10.Amount and contour of the remaining bone.
11. Quality of soft tissue overlying the primary denture
bearing area.
12.Vestibular depth.
13.Location of muscle attachment.
14.Jaw relationship and presence of soft tissue or
bony pathologic condition.
15.Patient’s age.
16.Physical and mental health status.
17.Financial constraint.

Examination of inter-arch relationships in proper vertical
dimension often reveals lack of adequate space for prosthetic
reconstruction.
In this case, bony and fibrous tissue excess in tuberosity area must
be reduced to provide adequate space for partial denture construction

Radiograph demonstrating atrophic mandibular and
maxillary alveolar ridges. Pneumatization of maxillary sinus is
demonstrated.

Cephalometric radiograph illustrating cross-sectional
anatomy of the anterior mandible (patient is over closed,
giving the relative appearance of a Class III jaw
relationship

Palpation reveals hypermobile tissue that will not
provide adequate base in denture-bearing area.

I) Basic preprosthetic surgical procedures
A. Removal of Teeth
•Erupted
•Unerupted
•Partially erupted
•Root stumps
•Cysts

B. Bony Recontouring of alveolar ridges:
➢Simple alveoloplasty associated with
removal of multiple teeth.
➢ Intraseptal alveoloplasty
➢ Maxillary tuberosity reduction
➢ Buccal exostosis and excessive
undercuts
➢ Lateral palatal exostosis
➢ Mylohyoid ridge reduction
➢ Genial tubercle reduction

C. Tori Removal:
➢ Maxillary tori
➢ Mandibular tori
D. Soft Tissue Procedures:
➢ Maxillary tuberosity reduction (soft tissue)
➢ Mandibular retromolar pad reduction
➢ Lateral palatal soft tissue excess
➢ Unsupported hypermobile tissue
➢ Inflammatory fibrous hyperplasia
➢ Inflammatory papillary hyperplasia of the palate.
➢ Labial frenectomy
➢ Lingual frenectomy

A)Maxillary Augmentation
•Onlay Bone Grafting
•Interpositional Bone Grafts
•Maxillary Hydroxyapatite Augmentation
•Tuberoplasty
B)Mandibular Augmentation:
•Superior Border Augmentation
•Inferior Border Augmentation
•Pedicled or Interpositional Grafts.
•Hydroxyapatite Augmentation of the mandible

C)Soft
tissue
mandible
surgery for ridge extension of
the
•Transpositional flap vestibuloplasty (Lip Switch)
•Vestibule and floor of the mouth extension procedure
•Relocation of the mental nerve
D)Soft tissue surgery for maxillary ridge extension
•Submucous vestibuloplasty
•Maxillary skin grafting vestibuloplasty

➢ The results of Talgren’s studies indicate that changes under the
denture base more often occurs in the mandible(4:1)
➢ The difference in resorption of the jaws increases within the first year
of denture wearing, which proves that the mandible cannot resist the
strong bite forces under the denture base
➢ According to Klemetti initially resorption starts on the alveolar part of
the mandible, and rest of the mandible remain unchanged
➢ Resorption is faster in the labial and buccal part of the alveolar ridge
(Resorptive changes of maxillary and mandibular bone structures;
Dubravka Knezovi et al, Acta Stomat Croat 2002; 261-265)

MODIFICATIONS
Class II-no wall
defect/buccal
wall/multiwall defect
Class IV marginal
resection / continuity
defect
Atrophy of the Residual Alveolar Ridge Following Tooth Loss in a Historical
Population; Reich, Karoline et al; Oral Diseases 17,1(2010)

PREPROSTHTIC SURGERY In oral surgery and endo

Surgical procedure which intends to re-contour the alveolar ridge
Alveolotomy: Partial removal of alveolar bone.
Alveolectomy : Complete removal of alveolar bone.
Alveoloplasty : Shaping of the alveolar bone.
INDICATIONS
1.Presence of sharp bony margins
2.Knife edge ridge
3.Sever undercuts
4.Maxillary protrusion alveoloplasty.
5.Reduction of Mylohyoid ridge and lingual alveolar crest.
6.Elimination of labial mandibular undercut

➢ Simple alveoloplasty
➢ Labial and buccal cortical alveoloplasty
➢ Dean’s interseptal or Thoma’s
intracorticular
➢ Obwegeser technique

➢ Easiest & quickest method
➢ Involves compression of cortical plates with fingers
➢ Reduction in socket width

Indications:
➢Reduction of
buccal/labial plate
➢Extraction of
single/multiple teeth
Technique:
➢ Single tooth
extraction
➢Multiple teeth
extraction
➢ Over erupted
teeth

Simple alveoloplasty eliminates buccal irregularities and
undercut areas by removing labiocortical bone

A, Clinical appearance of maxillary
ridge after removal of teeth.
B, Minimal flap reflection for
recontouring.
C, Proper alveolar ridge form free of
irregularities and bony undercuts
after recontouring

4)DEAN’S INTRASEPTAL
/INTERCORTICAL/CRUSH TECHNIQUE
PRINCIPLES
1.Reduction of labial /
alveolar prominences
2.Muscle attachments are
undisturbed
3.Intact periosteum
4.Preserve cortical bone
5.Less post-op resorption

In case of extreme protrusion both cortical Plates are
fractured inwards.

Indications
:
1. Reduced interridge distance
2.To prevent displacement of denture.
3.To reduce severe bilateral undercuts.
➢Incision placed on the lateral side rather on the
crest.
➢ In case of thick fibrous tissue - excised.
➢ Care should be taken not to perforate into the
sinus.

Bony tuberosity
reduction.
A, Incision extended
along crest of alveolar
ridge distally to
superior extent of
tuberosity area.
B, Elevated
mucoperiosteal flap
provides adequate
exposure to all areas
of bony excess.
C, Rongeur used to
eliminate bony excess.
D, Tissue
reapproximated with
continuous suture
technique

➢ Common in the maxilla than the mandible.
➢Although large areas of bony exostosis
generally require removal.
➢Small undercut areas are often best treated by
filling with either autogenous or allogenic bone
material or with an alloplastic material such as
Hydroxyapatite (HA).

A, Gross irregularities of
buccal aspect of alveolar ridge. After
tooth removal, incision is
completed over crest of alveolar
ridge.
(Vertical-releasing incision in cuspid area
is demonstrated.)
B, Exposure and removal of
buccal exostosis with rongeur.
C, Soft tissue closure using continuous
suture technique

Lateral palatal exostosis present a problem in
denture construction because of the undercut
created by the exostosis and the narrowing of the
palatal vault.
Occasionally they are large enough that the mucosa
covering the area becomes ulcerated.
PRECAUTION : Avoid damage to the blood vessels as
they leave the palatine foramen and extend forwards
NO SURGICAL SPLINT OR PACK REQUIRED

Removal of palatal bony exostosis. A, Small palatal exostosis that interferes with proper
denture construction in this area. B, Crestal incision and mucoperiosteal flap reflection to
expose palatal exostosis. C, Use of bone file to remove bony excess. D, Soft tissue
closure.

The mylohyoid ridge is one of the more common
areas interfering with proper denture construction.
In addition to the actual bony ridge, which easily
damages thin covering of mucosa, the muscular
attachment to this area often is responsible for dislodging
the denture when this ridge is extremely sharp, denture
pressure may produce significant pain in this area.

Mylohyoid ridge reduction. A, Cross-sectional view of posterior aspect of mandible,
showing concave contour of the superior aspect of ridge from resorption. Mylohyoid
ridge and external oblique lines form highest portions of ridge. (This can
generally best be treated by alloplastic augmentation of mandible but, in rare cases,
may also require mylohyoid ridge reduction.)
B, Crestal incision and exposure of lingual aspect of mandible for removal of
sharp bone in mylohyoid ridge area. Rongeur or bur in rotating handpiece can be
used to remove bone.
C, Bone file used to complete recontouring of mylohyoid ridge

Genial tubercles are neither exostoses nor tori but are often
prominent following advanced alveolar ridge resorption in the
anterior area of the mandible.
They are covered by thin tissue
which will not bear the pressure of a denture flange
located in this area.

Grouped under exostosis
No pathological significance. Misdiagnosed as tumors.
No signs and symptoms Problem with Tori:
1.Denture failure because of rocking
2.Lead to ulceration, infection when impinged by prosthesis
3.Constant irritation may lead to malignant change.
4.Difficult in eating and speaking
Can occur in mandible - Torus mandibularis

Maxillary Tori : Seen in the midline of the palate with different
shapes.
a).Spindle shape b).Nodular c).Lobulated d).Flat e).Multiple
Maxillary Tori should not be excised enmass, to prevent entry into
the sinus.
Incisions : 1.Single midline incision.
2.Double ended ‘Y’ incision.
3.Elliptical incision.
Stent can be prepared prior to surgery to prevent
hematoma and to support the flap.

Removal of palatal torus.
A.Typical appearance of maxillary torus
B.Mucoperiosteal flaps retracted with silk sutures to improve
access to all areas of torus. Removal of palatal torus.

D &E, Sectioning of torus using fissure bur. F, Small osteotome used to remove sections of torus.
G& H, Large bone bur used to produce the final desired contour. I, Soft tissue closure

Mandibular Tori :
Lingual premolar area.
Bulbous or nodular
Incision:
Placed on the crest for edentulous and on gingival
margin for dentulous. Should not be placed on the Tori.
Complications:
Post operative hematoma
formation Wound dehiscence.

After block, local anesthetic is
administered; ballooning of thin
mucoperiosteum over area of tori can
be accomplished by placing
bevel of local anesthetic needle against
torus and injecting local anesthetic
subperiosteally.

Use of bone bur and
bone file to
eliminate minor
irregularities.
Tissue closure

The amount of soft tissue available for reduction can often
be determine by evaluating a presurgical panoramic radiograph
If a radiograph is not necessary to determine soft tissue
thickness, this depth can be measured with a sharp probe after
local anesthesia is obtained at the time of surgery.

A.Elliptical incision around soft tissue to be excised
in tuberosity area.
B. Soft tissue area excised with initial incision.

Undermining of buccal and palatal flaps to provide adequate
soft tissue contour and tension-free closure.

An initial elliptical incision is
made over the tuberosity .
The medial and lateral margins of
the excision must be thinned out to
remove excess soft tissue
A tension free closure made with
Interrupted or continuous sutures

Rarely is it required to
perform this procedure. LA
infiltration in the area requiring
excision is sufficient.
An elliptical incision is made,
excising the greatest area of
tissue in the posterior
mandibular area.
Slight trimming of the
margins is carried out with the
majority of tissue reduction on
the facial aspect
RETROMOLAR PAD REDUCTION

Excess removal of tissue in the submucosal
area of the lingual flap may result in damage
to the lingual nerve and artery.
The tissue is approximated with interrupted
or continuous sutures.

LA infiltrated in the greater palatine area and anteriorto
the soft tissue mass is sufficient.
With a sharp scalpel blade in a tangential manner, the
superficial layers of mucosa and underlying fibrous tissue
can be removed to the extent necessary to eliminate
undercuts in soft tissue bulk.
Tangential
excision of excess
soft tissue
LATERAL PALATAL SOFT TISSUE EXCESS

Following removal of this tissue, a surgical splint lined
with a tissue conditioner (5-7 days) can be inserted to aid
healing.

Excessive hypermobile tissue on the alveolar ridge is generally the
result of resorption of the underlying bone, ill- fitting dentures or both.
Two parallel full thickness incisions are made on the buccal and
lingual aspects of the tissue to be excised.
UNSUPPORTED HYPERMOBILE TISSUE

A periosteal elevator is used to remove the excessive
soft tissue from the underlying bone
A possible complication of this procedure is the
obliteration of the buccal vestibule as a result of
tissue undermining necessary to obtain tissue closure.

In the early stages, when fibrosis is minimal
nonsurgical treatment with a denture in combination with
a soft liner is frequently sufficient for reduction or
elimination of this tissue.
When this condition has existed for some time,
significant fibrosis occurs and then this will not respond
to non surgical treatment and excision is the treatment of
choice.
If tissue mass minimal- Electrosurgical technique If
tissue mass extensive- Simple excision.
INFLAMMATORY FIBROUS HYPERPLASIA

Indication :
1. Frenum is close to crest of the ridge
2.Irritated by the flange of the ridge.
3.Diastema in the midline (in dentulous)
Method of Frenectomy :
1. Diamond type
2. Z plasty
3. V-Y plasty

➢ The V-Y type of incision can be used for lengthening localized
area.
➢Broad frenum in premolar molar area can be treated by taking
semilunar incision at the mucogingival junction and a
supraperiosteal dissection is done.
➢The superior edge of the incision is sutured at the depth of the
vestibule to the periosteum and the rest of the raw area is allowed
to heal by secondary epithelialization
➢ Use of prefabricated stent is necessary
Disadvantage
Excessive bulk of the tissue at the depth of the vestibule

Technique
2.The tip of the tongue is controlled by placing a traction suture.
3.The lingual frenum is released by incising the attachment of
the fibrous connective tissue at the base of the tongue in a
transverse fashion
4.A hemostat can be placed across the frenal attachment at the base
of the tongue for approximately 3 minutes providing
vasoconstiction and a nearlly bloodless field during the surgical
procedure.
5.Care must be taken not to excise the blood vessels at the inferior
aspect of the tongue and floor of the mouth region and to the
submandibular ducts openings – during incising and suturing.
LINGUAL FRENECTOMY

Superior border augmentation
Indications
➢When severe resorption of the mandible results in
inadequate height and contour and potential risk of
fracture.
➢ Neurosensory disturbances from the location of the
mental foramen
Disadvantages
➢ High morbidity associated with removal of ribs.
➢ Need for soft tissue surgery at a later date.
➢Necessity of the patient to forego denture wearing to
allow 6 - 8 months of healing after
surgery.
➢Possibility of significant postoperative resorption of

Indications
➢ Atrophy of the alveolar ridge area.(less than 5-8mm)
➢ Prevention and management of fractures of the atrophic mandible.
Disadvantages
Does not address abnormalities of the denture bearing areas
such as 1.increased inter – arch distance
2.superior border irregularities
3.exposed position of the mental nerve which result in
mandibular atrophy.
These disadvantages combined with the morbidity of rib harvesting
make this a seldom used technique.
INFERIOR BORDER AUGMENTATION

A pedicle graft is designed to minimize resorption after
healing by maintaining a vascular supply to the augmented bony
area through an attached soft tissue pedicle.
A horizontal osteotomy is performed , splitting the
residual mandible and bone is grafted into the osteotomy
gap.
Indication:
Significant mandibular atrophy with absence of adequate
bone in the denture bearing area and a bucco lingual width of
the mandible of approximately 15mm.
Mainly used for augmentation of anterior mandible.
PEDICLED OR INTER POSITIONAL
GRAFTS (SANDWICH TECHNIQUE)

•Because of the viability of the repositioned segment, and the
immediate vestibuloplasty performed at the time of surgery,
denture construction can usually take place within 3-5 months.

Goal:
To increase the height of the mandibular ridge for
denture support.
➢Visor osteotomy consists of central splitting of
mandible in buccolingual dimension.
➢The lingual segment is raised along a greater length of
the mandibular body and free chips of bone are added to
the lateral aspect of the raised bony segment.

A.Intraoperative view of the chin region, with the
incision line.
B.The visor osteotomy is performed.
C-D. The bone fragment is mobilized and fixed in
correct position.

➢ The combination of the ‘visor’ and ‘sandwich’ techniques was designed to over
come the disadvantages in bone grafting.
➢ A modification of the visor osteotomy has been recommended for patients with
at least 8 mm of bone height as measured at mental nerve region.
➢ Frost and colleagues used a sagittal cut in the body region of the mandible, but
changed to horizontal cut anteriorly.
Disadvantages:
Nerve parasthesia and dysaethesia Need for hospitalization
Donor site morbidity
Inability to wear dentures for 3-5 months post surgery.

ONLAY BONE GRAFTING
Indications:
➢Severe resorption of the maxillary alveolar resulting in the absence of a clinical
alveolar ridge and loss of adequate palatal vault form.
Advantages:
➢Development of increased height and form of the alveolar ridge and the
palatal vault area.
➢ The anteroposterior position of the maxilla can be corrected.
Disadvantages
➢ Need for a secondary donor site.
➢ Extensive post operative resorption.
➢ Postoperative secondary soft tissue procedures.
➢ Delay in wearing dentures for 6-8 months

Indications
➢In a bony deficient maxilla where there is adequate form to the palatal
vault but insufficient ridge height, particularly in the zygomatic buttress
and posterior tuberosity areas.
Advantages
➢Stable and predictable results by changing maxillary position in the
vertical, anteroposterior and transverse directions.
➢ May eliminate the need for secondary soft tissue procedures.
Disadvantages
➢ Need to harvest bone from the iliac bone crest
➢ Possible secondary soft tissue surgery

The lateral maxillary and lateral nasal walls and pterygoid maxillary suture
area separated using surgical saws and osteotome and the maxilla is down
fractured.
Bone grafts obtained from the iliac crest are shaped and wired in place in the
lateral maxilllary areas.
This technique effectively increases the ridge height from
the lateral maxillary area to the crest of the ridge.

AHUy
dGr
oMx
yEa
pNa
tTi
tAe gTr
aIfOt
i
nNg has become the
primary method of maxillary augmentation.
Procedure
•A single midline incision is usually sufficient. When inadequate,
bilateral vertical maxillary incisions in the canine promolar area can
be used.
•Subperiosteal tunnels are created over the crest of the alveolar ridge
and preloaded syringes are inserted into the most posterior aspect of
these tunnels.
•HA particles are injected and molded to the desired height and
contour, and the incision are closed with a horizontal mattress suture.
MAXILLARY HYDROXYAPATITE

The tuberosity – hamular notch area prevents denture
displacement and aids the peripheral seal of the maxillary denture.
Tuberosplasty is performed through a transverse incision,
approximately 5mm posterior to the hamular area exposing the
pterygomaxillary junction.
A curved osteotome inserted into the depth of the notch
fractures and displaces the pterygoid plate area from the posterior
aspect of the maxilla.
Exposed bone in the tuberosity pterygoid plate area is allowed
to heal by secondary intention.
Brisk heamorrhage may be encountered when the
pterygoid plates are fractured.
TUBEROPLASTY

Vestibuloplasty :
Vestibuloplasty has become most
popular
method
for
improving denture-retention and stabilizing capabilities of
alveolar ridge. The technique makes no attempt to ‘cure’ alveolar
atrophy; rather it attempts to expose and make available for
denture construction that bone which is still present. Procedure to
increase the depth of sulcus. Done when sufficient height of the
ridge is present.
AIM:
To uncover the existing basal of
the jaws by the repositioning the overlying
mucosa, muscle attachment.

Indication:
1.Obliteration of the sulcus with high muscle
attachment.
2.Extensive mandibular bone atrophy with mental
nerve emerging at the crest
RIDGE EXTENSION PROCEDURE

adequate vestibular depth on
•Presence of
an the lingual aspect of the mandible.
TRANSPOSITIONAL FLAP VESTIBULOPLASTY
(LIP SWITCH)
▪A lingually based flap vestibuloplasty was first described
by Kazanjian.
▪In this procedure, a mucosal flap pedicled from the alveolar ridge is
elevated from the underlying tissue and sutured to the depth of the
vestibule.
▪The inner portion of the lip is allowed to heal by secondary intention
/ epithelialization.
Indications
•Adequate anterior mandibular height (min. 15mm)
•Inadequate facial vestibular depth from mucosal
and muscular attachments in the anterior mandible.

A, Incision is made in the labial mucosa, and a thin mucosal flap is dissected from underlying
tissue. B, The flap of the labial mucosa is sutured to the depth of the vestibule.
C, Modification of technique by incising periosteum at crest of alveolar ridge and suturing
free periosteal edge to denuded area of labial mucosa
. D, The mucosal flap is then sutured over denuded bone to the periosteal junction at the depth
of the vestibule

Advantages
•Provides adequate results in many cases.
•And generally does not require hospitalization
•Donor site surgery or
•Prolonged periods without a dentures.
Disadvantages
•Unpredictable relapse to vestibular depth
•Scarring in the depth of the vestibule
•Occasional problems with
adaptation
of
the
peripheral flange area of the denture to the depth of
the vestibule
•Accelerated bone resorption of the alveolar crest.

Labial vestibuloplasty, floor-of-mouth lowering procedure, and skin
grafting (i.e., Obwegeser’s technique). A, Preoperative muscle and
soft tissue attachments near crest of remaining mandible. B, A
crestal
incision is made. Buccal and lingual flaps are created by a supraperiosteal
dissection. C, Sutures are passed under the inferior border of the
mandible tethering the labial and lingual flaps near the inferior border of
the mandible

D, Graft held over the supraperiosteal dissection with a stent
stabilized with circum-mandibular wires.
E, Postoperative view of newly created vestibular depth and
floor-of-mouth area.

Vestibuloplasty, floor of the mouth lowering, and palatal soft
tissue grafting.
A, Preoperative photograph showing lack of facial
and lingual vestibular depth and absent keratinized tissue
adjacent to implant abutments.
B, Improved vestibular depth with sound attached tissue over
the alveolar ridge

In cases of severe atrophy of the alveolar bone and
superior aspect of underlying basal bone, the mental
neurovascular bundle may occupy a position at the
superior aspect of the mandible resulting in pain as a
result of trauma from the denture on the superior portion
of the remaining alveolar ridge.

•The cortical bone and underlying medullary bone can
be more
removed with curettes and the NV bundle relocated to a
inferior position.
•After the bone is exposed inferior to the mental foramen, a
groove is cut with a bur through the lateral cortex inferior to the
mental foramen area.
•Resorbable material, such as Gel foam, can be packed around
the bundle to help stabilize it at the inferior portion of the newly
created groove.
•Soft tissue closure with interrupted or continuous suturing
technique completes the procedure.

Procedure of choice for correction of soft tissue attachment on
or near the crest of the alveolar ridge of the maxilla, particularly
useful when maxillary alveolar ridge resorption has occurred but the
residual bony maxilla is adequate for proper denture support.
Underlying mucosal tissue is either excised or repositioned ,
allowing for direct apposition of the labial vestibular mucosa to the
periosteum of the remaining maxilla.
To provide adequate vestibular depth without producing
an
abnormal appearance of the upper lip, adequate mucosal length
must be available in this area
.
SUBMUCOUS VESTIBULOPLASTY

An anterior vertical incision is used to create a submucosal tunnel Excision of
submucosal soft tissue layer.
Splint in place holding mucosa against periosteum at depth of vestibule until healing
occurs

•This technique provides a
predictable
increase in
mucosa over the
vestibular depth and attachment
of denture bearing area.
•A properly relined denture can be worn immediately after
the surgery or after removal of the splint.
•Impressions for final denture relining or construction can
be completed 2-3 weeks after surgery.

“ Pre-prosthetic surgery is carried out to reform and
redesign soft and hard tissues by eliminating biological
hindrances to receive comfortable & stable prosthesis”
➢Sufficient alveolar bone volume and favorable
architecture of the alveolar ridges are essential to
achieve ideal functional and esthetic and prosthetic
rehabilitation

Pre-prosthetic surgery starts with the extraction of the
teeth & indicating the need for the socket preservation
and it doesn't end even after the prosthetic
rehabilitation, as alveolar ridge resorption is a
“continuous process” throughout life
Even the recent rehabilitation procedures like implant
requires the optimal alveolar bone for esthetic and
functional rehabilitation. Therefore alveolar ridge
preservation becomes the prime important criteria for
rehabilitation

➢Contemporary Oral and Maxillofacial Surgery,
Sixth Edition- Hupp, James R
➢ Peterson– Contemporary oral and maxillofacial surgery.
2nd edition.
➢ Syllabus of Complete Dentures., C. M. Heartwell, 4th
edition.
➢Boucher–Prosthodontic treatment for edentulous patients.
13th edition.
➢ Sheldon Winkler– Essentials of complete denture
prosthodontics.
2nd edition.

Pre-Prosthetic surgery
1.Elaborate on pros and cons of vestibuloplasty procedure.
2. Ridge augmentation procedure. (REPEAT)
3.Classify pre prosthetic surgery. Write in brief various soft and hard tissue
modalities.
4. Pre prosthetic surgery.
5.Classify pre prosthetic surgery. Write in detail about various ridge
augmentation procedures.
6. Discuss the indication and techniques of ridge augmentation
procedures.
7. Ridge extension procedure.
8.Discuss on hard and soft tissue factors in preparing the jaws to receive
artificial prosthesis.
9. Visor osteotomy and modified Visor osteotomy.

PREPROSTHTIC SURGERY In oral surgery and endo

More Related Content

What's hot (20)

Similar to PREPROSTHTIC SURGERY In oral surgery and endo (20)

Recently uploaded (20)

PREPROSTHTIC SURGERY In oral surgery and endo