Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form. This is concerned with surgical modification of the alveolar process and its surrounding structures to enable the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges.

1. Pre Prosthetic
Surgery
Abdullah al mamun Tusher

2. HISTORY OF
ORAL SURGERY
The famous Greek physician
HIPPOCRATES,describe
manually reducing dislocation
of mandible,indicating the
long history of this discipline

3. FATHER OF
ORAL SURGERY
JAMES EDMUND GARRETSON
 He stablished oral surgery as a
branch of medicine and dentistry
though distinct from both.

4. INTRODUCTION
Pre prosthetic surgery refers to the surgical procedures that can modify
the oral anatomy to facilitate the retention of conventional denture.
Surgery performed to prepare the remaining oral tissues to best support
a prosthesis

5. objective
To provide a comfortable tissue
foundation to support the denture.
Proper jaw relationship in
anteroposterior & transverse and
vertical dimension.
Alveolar process that are as large
as possible and of the proper
configuration.

6. objective
No bony or soft tissue
protuberances or undercuts.
Adequate attached keratinized
mucosa in the primary denture-
bearing area.
Adequate vestibular depth.
Adequate form and tissue coverage

7. Classification
Correctiveprocedures
Soft tissue
• Frenectomy
• Excision of flabby ridge
• Excision of denture induced granuloma
• Reduction of fibrous tuberosity
Hard tissue
• Alveoloplasty
• Removal of tori
• Tuberosity reduction
• Genial tubercle reduction
• Mylohyoid ridge reduction

8. Classification
Ridge extension
• Vestibuloplasty
Ridge augmentation
• Maxillary
• Mandibular

9. Patient evaluation and treatment
planning
 Preprosthetic surgical treatment must begin with a proper
case history and physical examination.
 Special attention should be given to systemic diseases that
may be responsible for the severe degree of bone resorption.
 Esthetic and functional goals of the patient must be assessed
carefully.
 Long term maintenance of the underlying tissues as well as
prosthetic appliances should be kept in mind.

10. Labial frenectomy
 It is a thin band of fibrous
tissue covered with mucosa
extending from the lip and
cheek to the alveolar
periosteum
 Surgical techniques
• Simple excision
• Z plasty
• Localised Vestibuloplasty

11. Alveoloplasty
Defined as surgical
recontouring of
alveolar process
Indication
• Patient with prominent and dense
alveolar bone undergoing extraction.
• Prior to construction of an immediate
denture.

12. Maxillary tuberosity reduction
 Excess tissue in the region of the
maxillary tuberosity may become so
large that it:
• Bone excess ,soft tissue.
• Impinge upon the mandible during mastication.
• Interfere with denture construction ,insertion
and seating.
 Complication:
• Expanded tuberosity in .

13. Mandibular tori
 Present on the lingual aspect of
the mandible.
 Present in 8% of population,male
female frequency equal.
 Common in premolar area.
 Gradually increase in size.
 May interfere with speech or
tongue movement.
 Etiology:unknown.

14. Maxillary Tori
 Bony exostosis in the palate.
 Origin is unclear.
 Found twice as much in female then
males.
 Single smooth elevation to multiloculated
pedunculated mass.
 Speech problems,ulcers,interferes with
prosthesis.
 Usually present in the midline.

15. Removal maxillary tori

16. Ridge augmentation
 The augmentation of the bone is achieved by building up the
atrophied jaw bone using autogenous bone,allogenic bone
or alloplastic material.
 Progressive loss of denture stability and retention.
 Loss of alveolar ridge height,width and decrease vestibular depth.
 Protection of the neurovascular bundle.
 Increased susceptibility to fracture of the atrophic jaw.
 Altered interarch relationship.
 Improve the patient comfort for wearing the denture
indication

17. Augmentation procedure
 Onlay bone grafting
 Interpositional bone grafting
 Maxillary hydroxyapetite
augmentation
 Sinus lift
 Tuberocity augmentation
 Superior border augmentation
 Inferior border augmentation
 Interpositional augmentation
 Hydroxyapetite augmentation
Maxillary augmentation Mandibular augmentation

18. Superior border augmentation
 Inadequate height
 Irregular contour
 Potential risk of fracture
 Neurosensory disturbance
 Add strength to the mandible
 Increase height of the alveolus
 Increase the width
indications
advantage

19. Inferior border augmentation
 Improve the esthetic
 Prevent fracture of the mandible
 Advantage
 Does not obliterate the vestibule
 Easier to do secondary vestibuloplasty
 Denture can be worn immediately
indication
advantage

20. conclusion
Accurate diagnosis of the problem areas during denture
construction and determination of the necessity of surgery is
accomplished by careful evaluation of the information
systematically obtained from the patient.
As conservation is the philosophy of surgical patient as much
as oral structure s as possible.
Proper knowledge of the available surgical procedures helps
in achieving the best results.

21. references
 Textbook of oral & maxillofacial surgery-
Neelima,Anil,Malik
 Textbook of oral & maxillofacial surgery -killey and
kay
 Textbook of oral & maxillofacial surgery -kruger
 Bone grafing in oral implantology:alfaro