PREPROSTHETIC MANAGEMENT GUIDE

PREPROSTHETIC
MANAGEMENT
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Contents
Introduction
Aims and objectives
Phases of management
Armamentarium
Procedures
Conclusion
Bibligraphy

Introduction
Thorough examination of the oral cavity prior to the
construction of the prosthesis is a must to identify the
Potential problems.
This improves the treatment prognosis and reduce the
Number of postinsertion adjustments.

Rationale of pre prosthetic service
Aim :
Is to prepare the soft and hard tissues of jaws for a
Comfortable prosthesis,that will restore oral function,
Aesthetics and facial form.

Objectives
• To restore functions of the jaws
( mastication,speech and swallowing ).
• Preserve or improve jaw structure.
• Improve aesthetics.
Eliminating pain and discomfort arising from an ill
fitting prosthesis by surgically modifying the denture
bearing area.
Improving the denture bearing area for patients in
whom there has been extensive loss of alveolar bone.

Phases of management
 Non surgical
Surgical
Combination of both

Non surgical methods
Rest for denture supporting tissues.
Occlusal correction for the existing prosthesis.
Optimal vertical dimension of occlusionto the
dentures currently worn by the patient with an
interim resilient lining material.
Good nutrition.
Jaw exercises can permit relaxation of the
muscles of mastication and strengthen their co-
ordination.

Principles of surgery
Sterilisation
A- traumatic procedure
Post operative care
Supportive care

Surgical armamentarium
Bard parker blade (no 15)
Heamostat
Molt periosteal elevator (no 4)
Retractor
Artery forceps
Mosquito forceps
Suturing materials

Surgical Methods
 Broadly dividend into –
1. Correction of conditions that precluded optimal
Prosthetic function.
2. Enlargements of denture bearing areas

Correction of conditions that precluded
optimal Prosthetic function
 Hyperplastic Ridge- mobile tissues that
interfere optimal seating of denture
 Epulis fissueratum – locailised
enlargement of peripheral tissues may
interfere peripheral seal of denture
 Papillomatosis - Harbour micro
organisms

4. Unfavourable Frenular Attachments and Pendulous
maxillary tuberosities.
5. Unfavourable Maxillary Tori.
6. Pressure on metal foramen

Enlargements of denture bearing areas –
Vestibuloplasty
Ridge augmentation
Implants

Minor surgical procedures
Alveoloplasty- To persue as much as alveolus
possible without any bone irregularities
Digital Compression of the socket is ideal
Interseptal Alveoloplasty by O.T Dean
 With adequate bone height, undercut on the
buccal aspect of the jaw, repostioning of labial
cortical bone is accomplished. Without raising
the mucoperiosteal flap, interseptel bone is
removed with a small rongour & buccal plate is
infractured with digital pressure.

Reduction of sharp spiny processes
1. Frequently associated with denture discomfort
2. Rapid resorption of labial / lingual plates
results in knife edge ridge
3. 3 types of sharp ridges ( MEYER)
 - Saw tooth
 - Razor like
 - Discrete spiny projections
Labial & lingual flaps reflected, exposed bone
recountoured strip of soft tissues reshaped &
epithelium closed with sutures

Spiny Ridges

Bony Tuberosity reduction
Classification-
Clinical Histological Functional
Pendulous Fibrous Mobile
Bulbous Bony
Immobile
Con…

Clinical examination- lack of adequate clearance
by placing a figure or mirror posterior to the
tuberosity near the peripheral border
Inability open widely when figure in place
indicates reductions of excess tuberosity
Care must be taken to avoid opening in to the
sinus in those insantances in which the sinus dips
down in to the pneumatized and elongated
tuberosity it may be possible to collapse the sinus
floor upwards- sinus lift procedure .

Frenectomy
 Frenum is a musculo-fibrous band attached
to the alveolus and inserted into the muscles of
the face
Classification-(House)
Class I Attachments are high in maxilla and low
in mandible with respect to crest of the ridge
Class II Medium
Class III Freni encroach on the crest of the ridge
and may interfere with the denture sealwww.indiandentalacademy.com

Evaluations by visual examination
Z- Plasty – more difficult , advised when frenum
is broad and short to preserve sulcus depth
V-Y advancement Technique – Concomitant
decrease in nasal base width is required

Frenectomy

Tori
 Tori are benign, slowly growing osseous
projections of the maxilla and or mandible
that attain maximum size by third decade.
 Etiology- unknow
Location:-
– Maxilla Midline
– Mandible Premolar region

Indication for the removal of maxillary tori –
Extremly large tours that fills the Palatal vault
and prevents the formation of a stable maxillary
denture
Under cut creating torus that traps foods debris
causing the chronic inflammatory condition.
Tori extending past the junction of the hard and
soft palatals and prevents the development of an
adequate posterior palatal seal
Tori cuasing patient concernwww.indiandentalacademy.com

Incisions for tori reduction

Tori reduction

Relocation of mental nerve
Due to progressive ridge resorption,Mental
foramen gets closer to the crest of te
alveolar crest.
Pressure from the denture flange causes
discomfort to the patient.
Relocating it apically by surgical exposure
would be a satisfactory remedy

Relocating mental nerve

Exostosis

Abused tissues
 Hyperplastic ridge
 Epulis fissuratum
 papillomatosis
 Etiology
 Faulty dentures
 Poor oral hygiene
 Systemic complications

Management of abused tissues
Type I – rest, massage and topical anti-
fungal agents.
Type II – Tissue conditioners
Type III- Surgical excision

Tissue conditioners
Composition
Polyethyl-methacrylate and an aromatic
ester alcohol mixture.
Plasticisers to improve flow.
Classified as-
Temporary (soft)
Permanent (hard)

Uses of tissue conditioners
Adjunctions in tissue conditioning
Temporary obturators
Stabilizers of base plates and surgical
splints.
Adjunct in impresson making procedure or
as a final impression material

Advantages
Hypertrophied, irritated,hyperemic tissues
are rested without discontinuation of the
denture.
Improves stability,relives and equalizes
pressure almost immediately thus
preventin further damage.
The dis-advantage are;
Easily misused

Technique
Powder liquid ratio- 1.75/1
½ cc of plasticizer added to the monomer
prior to mixing it with polymer.
While the mixture is still creamy and runny
pour it into denture.
1mm of even thickness or more in needed
for effective conditioning of the tissues.

Surgical management
Apart from conventional surgical
techniques,
Electrosurgery
Lasers

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PREPROSTHETIC MANAGEMENT GUIDE