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

2 Objectives: Preprosthetic Surgery1. 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: anatomy1. Bone quantity 2. Bone contour 3. Muscle attachments 4. Gingiva (mucosa)

4 1. Bone quantity

6 Factors that impact on fit: physiology1. Gingiva (mucosa) 2. Lip / tongue habits 3. Salivary function 4. TMJ / muscle function

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

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

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

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

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

19 Preprosthetic SurgeryProcedures 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 Surgerya. Extractions for caries, periodontal disease, infection, etc. a. Extractions…flap, bone removal, section

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

25 Preprosthetic Surgeryc. Frenectomy 1 3 2 4

26 Preprosthetic Surgeryd. Tuberosity reduction

28 Preprosthetic Surgerye. Alveoplasty: flap…recontour…close

30 Preprosthetic Surgerye. Torus reduction: flap…recontour…close

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

35 f. Bone grafting: replacement of bone loss alveolar atrophy … benefitf. 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 + =