Epidemiology of Aging Preprosthetic Surgery

David L. Basi, DMD, PhD • Elderly is defined as persons over the age of 65. • Between 1900 and 1990 the elderly population increased from 3.1 million to 31.1 million. • Currently, one in eight Americans consists of the elderly population.

Epidemiology of Aging
• By 2030, one in five Americans will be elderly (approximately 23% of the pop.). • Considered on of the fastest growing age groups in the United States. (Some experts believe that this is the only segment of the population that is expected to grow significantly in the future.)

Edentulous US population
• 10% entire US population • 35% of the 65 and older population

Objective
• To create supporting oral structures for placement of partial or complete dentures

Ideal denture support:
1. 2. 3. 4. 5. 6. 7. 8. 9. Adequate bone height and width “Fixed Tissue” under dentures Adequate ridge relationships Adequate space between ridges Adequate buccal and lingual sulci Absence of redundant tissue No obstructing frena or scar bands No displacing muscle attachments Adequate saliva

knife edge Ridge height and width .Ideal Denture Support: Broad Alveolar ridge mucosa Adequate FOM Mylohyoid mm mandible Deep Vestibular depth Ideal vs atrophic mandible Lack of FOM or vestibular depth Resorption of Maxilla Atrophy of Edentulous Mandible Patient Evaluation • Evaluate maxilla and mandible for: – – – – – – Alveolar undercuts Palatal tori Mandibular exostosis Ridge relationship Ridge contour : broad vs.

Alveolar Undercut Evaluate for Exostoses Maxillary Tori Evaluate for soft tissue problems Evaluate Interarch Relationships Lingual fremum .

•Advanced forms of pain control are helpful •Patients are often old.A. infirm.Class III skeletal relationship Could be secondary to over closure of mandible (loss of VDO) Surgical Preparation of Mouth for Prostheses Surgical Preparation of Mouth for Prostheses •Alignment of jaws (Orthognathic Surgery) Osseous surgery •Minor alveoloplasty (sharp areas) •Adequate interarch distance •Eliminate opposing undercuts •Eliminate tori Soft tissue surgery •Release frena •Thin fibrous tuberosities •Preserve attached gingiva •Removal of teeth (and roots) Alveoloplasty/ Alveolectomy •Simple (sharp edges) -Primary -Secondary •Interradicular (interseptal) •Radical •Horizontal or vertical problems •Pre-radiation •Preserve Attached Gingiva! General Considerations for Preprosthetic Surgery •Most can be done w/ L. and require workup and monitoring •Restorative phase in 4 – 8 weeks postop .

Simple Alveoloplasty Simple Alveoloplasty Intraseptal Alveoloplasty Removal of Tori & Exostoses Indications •Chronic irritation •Inability to construct prosthesis •Opposing undercuts •Horizontal & vertical problems •Periosteal attachment is maintained •Alveolar height is preserved •Alveolar width is lost Removal of Tori & Exostoses Problems •Pneumatization of palatal torus •Thin mucosa over tori Removal of Tori Use LA to help “balloon” thin lingual tissue Raising the flap is the most tedious portion Remove Tori with: •Surgical drill and fissure bur •Osteotome and Mallet •A combination of both Assure a dry field and inspect wound before closure .

.Removal of Lingual Tori Removal of Palatal Tori Lingual Removal of Buccal Exostoses Maxillary Tuberosity Reduction Excess tissue in the maxillary tuberosity interferes with denture construction X-rays help delineate whether this excess tissue is soft or bony. X-rays also demonstrate pneumatization of the max sinus Models are often helpful.

Soft Tissue Surgery •Release of Freni •Thin Palatal Fibromatoses ALWAYS design flaps to preserve attached gingiva Frenectomy Frenectomy Z-plasty: More useful for the short vestibule .

Palatal papillary hyperplasia Secondary to chronic denture irritation Denture relief and oral antifungals can reduce the size of the lesion. .

Palatal papillary hyperplasia Treatment Options Large rotary bur Cryosurgery *Laser Ablation Post op splint or denture w/ liner is very helpful Epulis Fissuratum Epulis Fissuratum The Immediate Denture The denture can be considered a “temporary” Mandibular immediate dentures are difficult The Immediate Denture Remove all Max and Mand teeth except Max anterior The Immediate Denture Potential Problems Bone trim is difficult without a clear stent Perform necessary bone & soft tissue surgery Immediates work better when fewer teeth are extracted After adequate healing construct dentures Don’t forget about tori. exostoses. & freni Remove anterior teeth and insert dentures Reline after remodeling occurs (1 – 6 months) .

Class III skeletal relationship Needs orthognathic surgery to correct skeletal discrepancy Complex preprosthetic surgery .

.Vestibuloplasty Lowering the FOM Preprosthetic Surgery Complex “Preprosthetic Surgery” has been largely obviated by the osseointegrated implant.

Preprosthetic Surgery Many preprosthetic procedures are done today in support of the implant. Mucosal Grafts Partial Thickness palatal dissection “de-fat” the connective tissue side Supraperiosteal dissection on the mandible Sew graft mucosa side up Splints or a relieved denture can be helpful .

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