1. PREPROSTHETIC SURGERY DR. SALWAN AL-HAMDANI B.D.S.MSC.PROSTH

2. Objectives: Preprosthetic Surgery
1. To understand the anatomy and physiology
of the edentulous status 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

3. Factors that impact on fit: anatomy
1. Bone quantity
2. Bone contour
3. Muscle attachments
4. Gingiva (mucosa)

4. 1. Bone quantity

5. 2. Bone contour
3. Muscle attachments
4. Gingiva (mucosa)

6. Factors that impact on fit: physiology
1. Gingiva (mucosa)
2. Lip / tongue habits
3. Salivary function
4. TMJ / muscle function

7. 1. Gingiva,. mucosa

8. 2. Lip / tongue habits

9. 3. Salivary function
4. TMJ/ muscle
function
Parotid
Submandibular

10. Factors that impact on fit: pathoses
1. Hard tissue
2. Soft tissue

11. 1. Hard tissue
a. Dental caries
b. Periodontal disease
c. Infection
d. Cysts and tumours

13. 1. Soft tissue a. Ulceration b. Hyperplasia c. Dysplasia d. Carcinoma

14. Factors that impact on fit: atrophy
a. Decreasing bone
b. Increasing soft tissue

15. Factors that impact on fit: atrophy
a. Decreasing bone
b. Increasing soft tissue

16. Factors that impact on fit: atrophy
1. Atrophy: accelerated by inflammation
a. Infection
b. Poorly fitting dentures … friction
c. Habits … clenching / bruxism

17. Preprosthetic Surgery
Procedures designed to optimize the retention, support, stability and comfort of prostheses by the selective modification of soft and hard tissues

18. Preprosthetic Surgery
Indications: compromized retention, support, stability or comfort of prostheses due to suboptimal hard or soft tissue anatomy or pathoses

19. 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

20. Preprosthetic Surgery
a. Extractions for caries, periodontal disease, infection, etc.
a. Extractions…flap, bone removal, section

21. Preprosthetic Surgery
a. Extractions and alveolar osteotomy …
removal of proclined incisors and
osteotomy of labial plate of bone

22. a. Extractions &
and alveolar
osteotomy …
removal of
proclined incisors
and osteotomy
of labial plate of
bone

23. Preprosthetic Surgery
b. Removal of pathoses…cystic, traumatic, hyper-plastic, dysplastic, etc.

24. Preprosthetic Surgery
c. Gingivoplasty or frenectomy for flabby ridge tissue or high frena that interfere with support or retention
Gingivoplasty

25. Preprosthetic Surgery
c. Frenectomy 1 3 2 4

26. Preprosthetic Surgery
d. Tuberosity reduction

27. Preprosthetic Surgery
d. Tuberosity reduction

28. Preprosthetic Surgery
e. Alveoplasty: flap…recontour…close

29. Preprosthetic Surgery
e. Alveoplasty: flap…recontour…close

30. Preprosthetic Surgery
e. Torus reduction: flap…recontour…close

31. Preprosthetic Surgery
f. Vestibuloplasty: ridge extension … move muscle attachment and retain with soft tissue graft

32. Preprosthetic Surgery
f. Vestibuloplasty: move muscle attachment and retain with soft tissue graft

33. Preprosthetic Surgery
f. Vestibuloplasty: Maxillary palatal graft vestibuloplasty

34. f. Bone grafting:

35. f. Bone grafting: replacement of bone loss alveolar atrophy … benefit
f. Bone grafting: replacement of bone loss alveolar atrophy … benefit ??? … typically ALL of the newly grafted bone is gone within 5 years … unless … supported by implants + =