PREPROSTHETIC

MANAGEMENT
 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 seal
 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 concern

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