Pre-Prosthetic Surgeries

1. PRE-PROSTHETIC SURGERY
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. Outline
• Objectives of Pre-Prosthetic Surgery
• Evaluation of patients undergoing Pre-Prosthetic surgeries
• Types of Pre-Prosthetic Surgeries
• References

3. Which resorbs faster? Maxilla or Mandible

4. Objectives of Pre-Prosthetic Surgery
•To create proper supporting structures for
subsequent placement of prosthetic
appliances

5. Best Denture Support Characteristics
1. No evidence of intraoral or extra-oral pathologic conditions
2. Proper inter-arch jaw relationship in the anteroposterior, transverse, and vertical dimensions
3. Alveolar processes that are as large as possible and of the proper configuration
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

6. Evaluation of Patients undergoing Pre-Prosthetic
Surgeries
• Supporting BonyTissues: Inspection, Palpation, Radiographs, and evaluation of
models.
• Supporting SoftTissues: Adequate Keratinized Mucosa, Free of inflammation and
the level of attachment of the mylohyoid muscle in relation to the crest of the
mandibular ridge and the attachment of the genioglossus muscle in the anterior
mandible.

7. Types of Pre-Prosthetic Surgeries
• Many classifications
• Maxillary vs. Mandibular procedures
• Hard vs. Soft tissue procedures

8. RecontouringAlveolar Ridge
• Simple Alveoloplasty
• Intra-septal Alveoloplasty
• Reduction of Knife-Edge Ridge

9. Simple Alveoloplasty
• Simplest form: Digital Compression
• Degree of irregularity
• Bone file or Bur and hand-piece

10. Dean’s IntraseptalAlveoloplasty
• Intraseptal bone removal
• Undercut with adequate height and width.
• Advantages: 1.The labial prominence of the alveolar
ridge can be reduced without significantly reducing
the height of the ridge in this area. 2.The periosteal
attachment to the underlying bone can be
maintained thereby reducing postoperative bone
resorption and remodeling. 3.The muscle
attachments to the area of the alveolar ridge can be
left undisturbed
• Disadvantage: Decrease in ridge thickness

11. Recontouring Knife-Edged Ridge
• Crestal incision.
• Rongeur and Bone file.
• Augmentation?

12. MaxillaryTuberosity Reduction
• Hard vs. Soft tissue enlargement
• X-Ray and Pre-Operative probing
• Crestal Incision
• Sinus injury?

13. Soft MaxillaryTuberosity
Reduction

14. Exostosis and Undercuts
• Maxilla > Mandible
• Crestal incision
• Bone file, Rongeur bur and handpiece

15. Tori Removal
• Maxilla 20% of females
• Different configurations
• Frequent traumas
• Extremely large tori interfere with normal speech or tongue function.
• Y-Incision

18. SoftTissue Abnormalities
• Unsupported Hypermobile tissue:
• Resorption and/ or Ill-Fitting Denture
• Augmentation vs. Removal

19. Frenectomy
• Multiple surgical techniques:
• The simple excision technique
• The Z-plasty technique
• Localized vestibuloplasty with secondary epithelialization
• The laser-assisted frenectomy.

23. References
•Chapter 13: Pre-Prosthetic Surgeries

24. THANKYOU