PRE PROSTHETIC SURGERY

1. PRE PROSTHETIC SURGERY – I
PROCEDURES TO IMPROVE THE
ALVEOLAR SOFT TISSUES
Dr. Rahul Tiwari
2nd
Yr. Post Graduate,
Dept. of Oral & Maxillofacial Surgery,
SIBAR Institute of Dental Sciences.

2. CONTENTS
• INTRODUCTION
• SOFT TISSUE DEFORMITIES
1. Labial frenectomy.
2. Lingual frenectomy.
3. High frenal attachments.
4. Alveolar muco-periosteal hyperplasia.
5. Inflammatory fibrous hyperplasia.
6. Fibrous hyperplasia of maxillary tuberosity.
7. Fibromatous enlargement of retromolar area
8. Papillary palatal hyperplasia.
9. Gingival fibromatosis.
10. Double lip.
11. vestibuloplasty
12. Other Procedures
• CONCLUSION
• REFERENCES
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3. INTRODUCTION
• An understanding of the anatomy & physiology of the jaws & their
associated structures & especially of the denture bearing tissues
(basal seats) is essential to any detailed study of pre prosthetic
surgery.
• Hard tissues and soft tissues both are equally important in
maintaining form function and esthetics.
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4. INTRODUCTION
• It is aimed at providing a good healthy surface for the insertion of dentures.
• It also involves the surgical procedures aimed at making the best use of
residual tissues in terms of restoration of function and aesthetics.
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5. According to the Glossary of Prosthodontic
Terms Preprosthetic surgery is defined as surgical
procedures designed to facilitate fabrication or to
improve the prognosis of prosthodontic care.
According to Brucc 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.
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6. HISTORY
• Pre prosthetic surgery was born around 18th
century.
• Willard(1853) advocated the reduction of interdental
gingival papillae & alveolar margins after dental
extractions; the procedure permitted the earlier
construction of artificial dentures.
• Beers(1876)- excision of alveolus after extraction of
teeth.
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7. • For many years pre prosthetic surgery consisted of the removal of
teeth & the reduction of humps, bumps & sharp edges.
• Pre prosthetic surgery emerged from a “Ridge-trimming” service
to a truly reconstructive service when Kazanjian(1924,1935)
reported on the prototype of labiobuccal vestibuloplasty
procedures.
• His technique was modified by Godwin(1947),
clark(1953) & others.
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8. Some of the characteristics of this ideal form which
provide for maximum support and stability and
minimum interference with function are:
1. Adequate bone support for dentures.
2. Bone covered by adequate soft tissue.
3. No undercuts or overhanging protuberances.
4. No sharp ridges.
5. Adequate buccal and lingual sulcus.
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9. 6. No scar bands to prevent normal seating of
denture.
7. No muscle fibers or frenula to interfere
with the periphery of the prostheses.
8. Satisfactory ridge relationship between the
maxilla and the mandible.
9. No soft tissue folds or hypertrophies on
the ridge or sulci.
10. A ridge free of neoplastic disease.
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10. The Dentition Function Curve
0
20
40
60
80
100
120
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Function(%age)
Dentate Partially dentate Edentulous
A model For Understanding Dental function over time
The Dentition Function Curve
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11. NON-SURGICAL METHODS
Non-surgical methods of edentulous mouth preparation
include:
1. Rest for denture supported tissues.
2. Occlusal and vertical dimension correction
of old prostheses.
3. Good nutrition.
4. Conditioning of the patient’s musculature 09/19/16
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12. TYPES OF SURGERY
PROCEDURES TO IMPROVE THE ALVEOLAR SOFT TISSUES
PROCEDURES TO IMPROVE THE ALVEOLAR HARD TISSUES
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13. 1. LABIAL FRENECTOMY
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14. 2. LINGUAL FRENECTOMY
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15. 3. FRENECTOMY FOR DIASTEMA/ HIGH FRENAL ATTACHMENT
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16. REPOSITIONING (DEPRESSOR SEPTI MUSCLE)
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17. 4. ALVEOLAR MUCO-PERIOSTEAL HYPERPLASIA.
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18. 5. INFLAMMATORY FIBROUS HYPERPLASIA
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6. FIBROUS HYPERPLASTIC MAXILLARY TUBEROSITY

20. 7. FIBROMATOUS ENLARGEMENT OF RETROMOLAR AREA
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21. 8. PAPILLARY PALATAL HYPERPLASIA
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22. SURGICAL REDUCTION OF BILATERAL FIBROMATOSIS OF PALATE
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23. 9. GINGIVAL FIBROMATOSIS
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24. DOUBLE LIP
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25. PALATAL EXOSTOSIS
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26. MUCOSAL ADVANCEMENT (submucous) VESTIBULOPLASTY
• CLOSED SUBMUCOUS VESTIBULOPLASTY.
• OPEN VIEW SUBMUCOUS VESTIBULOPLASTY.
• SECONDARY EPITHELIZATION(RE-EPITHELIZATION)
VESTIBULOPLASTY.
1. KAZANJIAN’S TECHNIQUE.
2. GODWIN’S TECHNIQUE.
3. LIPSWITCH VESTIBULOPLASTY.
4. CLARK’S TECHNIQUE.
5. OBWEGESER’S SECONDARY EPITHELIZATION PROCEDURE.
6. PERIOSTEAL FENESTRATION.
7. LABIAL-PALATAL ADVANCEMENT VESTIBULOPLASTY.
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27. MAXILLARY MUCOSAL ADVANCEMENT (closed submucous)
VESTIBULOPLASTY. OBWEGESER 1959
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28. MANDIBULAR MUCOSAL ADVANCEMENT (closed submucous)
VESTIBULOPLASTY
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29. SECONDARY EPITHELIZATION VESTIBULOPLASTY
(kazanjian’s technique) 1935
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LABIAL PEDICAL FLAP

30. OTHER MODIFICATIONS
• GODWIN 1947- STRIPPED PERIOSTEUM
• COLLETT 1954- NO SUTURES
DISADVANTAGE- All had scar contractures on the labial side.
• CLARK 1953- PEDICLED FLAP FROM LIP NOT FROM ALVEOLAR PROCESS.
• HOWE 1966 & KETHLEY GAMBLE 1978- LIP SWITCH PROCEDURE.
• OBWEGESER 1959- SUBMUCOSAL DISSECTION
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31. CLARK 1953- PEDICLED FLAP FROM LIP NOT FROM
ALVEOLAR PROCESS.
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32. HOWE 1966 & KETHLEY GAMBLE 1978- LIP SWITCH
PROCEDURE/MOD. KAZANJIAN.
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33. DEEPENING THE MANDIBULAR SULCUS
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34. EXCISION OF MENTALIS MUSCLE & DEEPENING OF ANTERIOR
MANDIBULAR SULCUS
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35. MAXILLARY SECONDARY
EPITHELIZATION VESTIBULOPLASTY
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36. MAXILLARY SECONDARY EPITHELIZATION
VESTIBULOPLASTY WITH EXCISION OF FLABBY GINGIVAL
CREST
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37. MANDIBULAR SEC. EPI. VESTIBULOPLASTY
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38. MAXILLARY LABIAL-PALATAL ADVANCEMENT
VESTIBULOPLASTY (double flap technique)
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39. GRAFTING VESTIBULOPLASTY
• SKIN GRAFT VESTIBULOPLASTY- MOSCOWIZ & ESSER 1917
1. MAX. SKIN GRAFT VESTIBULOPLASTY.
2. MAN. SKIN GRAFT VESTIBULOPLASTY.
• DERMAL GRAFTING- SMILER ET AL 1977
• MUCOSA GRAFT VESTIBULOPLASTY – BONDREAU STARSHAK 1975
1. PALATAL MUCOSA GRAFT VESTIBULOPLASTY- HALL & O STEEN 1970
2. BUCCAL MUCOSA GRAFT VESTIBULOPLASTY- EVASKUS, HEZOG 1980
3. IMMEDIATE VESTIBULOPLASTY WITH FREE MUCOSAL GRAFT AFTER
DENTAL EXTRACTIONS
• VESIBULOPLASTY WITH XENOGRAFTS.
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TRAUNER,SCHUDARTZ,
OBWEGESER 1953

40. MAX. VESTIBULOPLASTY WITH MUCOSA OR SKIN
GRAFTING
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41. MAN. VESTIBULOPLASTY WITH MUCOSA OR SKIN
GRAFTING
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42. MAN. VESTIBULOPLASTY WITH PALATAL MUCOSA
GRAFT
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43. MUCOSAL GRAFT SUTURED IN PLACE ON
SUPRAPERIOSTEAL DISSECTION
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44. REPOSITIONING OF THE GENIOGLOSSUS MUSCLE TO
DEEPEN THE ANT. LINGUAL SULCUS
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45. MYLOHYOID MUSCLE ATTACHMENT LEVEL
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46. LINGUAL SULCOPLASTY(Caldwell’s Technique 1955)
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47. LINGUAL SULCOPLASTY AND LOWERING OF FLOOR OF
THE MOUTH (Trauner’s Technique 1955)
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48. TECHNIQUE OF CIRCUMMANDIBULAR SUTURING
CLARK & OBWEGESER 1963
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49. COMBINED VESTIBULOPLASTY & LINGUAL SULCOPLASTY
WITH SKIN GRAFTING (Obwegeser’s Technique)
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50. REPOSITIONING OF MENTAL NERVE
MATHIS & COOLEY 1952
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51. CONCLUSION
A thorough examination of the mouth prior to construction
of complete dentures is necessary to identify potential
problem areas.
To determine whether surgery is necessary or not is an
essential part of examination and plays an important role
in successful patient management.
Many conditions should be corrected prior to denture
construction to improve the treatment prognosis and
reduce the number of post-insertion adjustments.
In general, bony abnormalities should be managed first.
Associated soft tissue corrections can be delayed if required.
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52. REFERENCES
• Preprosthetic oral & maxillofacial surgery by Thomas J. Starshak.
• Oral & maxillofacial surgery by Daniel M Laskin.
• Oral & maxillofacial surgery by Archer.
• Oral & maxillofacial surgery by Fragiskos and Fragiskos.
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53. • 1. Tallgren A: The continuing reduction of residual alveolar ridges in
complete denture wearers: mixed longitudinal study covering 25 years, J
Prosthet Dent 27:120-132, 1972.
• 2. Weintraub JA, Burt BA: Oral health status in the United States: tooth loss
and edentulism, J Dent Educ 49:368-378, 1985.
• 3. Bays RA: The pathophysiology and anatomy of edentulous bone loss. In
Fonseca R, Davis W, editors: Reconstructive pre- prosthetic oral and
maxillofacial surgery, Philadelphia, 1985, WB Saunders.
• 4. Starshak TJ: Oral anatomy and physiology. In Starshak TJ, Sanders B,
editors: Preprosthetic oral and maxillofacial surgery, St Louis, 1980, Mosby.
• 5. Starshak TJ: Corrective soft tissue surgery. In Starshak TJ, Sanders B,
editors: Preprosthetic oral and maxillofacial surgery, St Louis, 1980, Mosby
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54. THANK YOU
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