Preprosthetic

surgery
Preprosthetic
surgery: 1
Definition:
Preprosthetic surgery includes any surgical
procedure (minor or major), which should be
considered before the construction and
insertion of complete denture.
OBJECTIVES:

Mainly it aims to improve denture support,

stability, retention and comfort. In large number
of cases small or minor alteration on the denture
bearing area might benefit the patient or make
things a little easier for prosthodontist BUT even
the simplest or the most minor surgery is slightly
feared by most of the patients. Therefore, it
should never be underestimated. From the
prosthodontist point of view, preprosthetic
surgery is “an elective procedure “by means not
strictly necessarily! UNLESS you have been
convinced that the benefits outcome will outweigh
the risk and discomforts.
 GUIDE LINES FOR PREPROSTHETIC
SURGERY:
1) Full medical and dental history.
2) Radiographs.
3) Study cast especially before hard tissue
surgery.
4) The elimination of all other causes of
trouble with denture.
5) Respect for the patient’s wishes (It’s an
elective surgery).
Preprosthetic surgery could be
classified into:

1. SOFT TISSUE SURGERY

A. Non-surgical procedure.
B. Surgical procedure.
2. HARD TISSUE SURGERY
A. Major surgery.
B. Minor surgery.
PREPROSTHETIC
SURGERY
1) SOFT TISSUE SURGERY
A. NON-SURGICAL PROCEDURE

This is only applied to “denture wearers”, as

wearing dentures for long period may cause
biological adverse changes in the denture
bearing area. In most cases patients are not
aware that oral tissue “soft & hard tissue”
have been damaged or deformed by the
presence of the old dentures.
CAUSES: -

1. Prolong use of complete dentures >5 years.

2. Continuous use of ill-fitting denture.
3. The use of denture with faulty occlusion.
4. Wearing the denture day and night.
5. Relining the denture may times or using
commercial “denture adhesive” by patients
themselves {Do it your self-prosthodontist” OR
relining the denture by the patients or by dental
technician?
CONSEQUENCES:-

1. Hyperplasia or flabby ridges.

2. Granular or Papillary Hyperplasia.
3. Denture stomatitis.
4. Fibrous Hyperplasia (epulis or denture fissuratum).
 Steps for non-surgical methods
1.. Rest for the denture-supporting tissues: (applied for
the old denture wearers).

I. Removal of both dentures from the pt’s mouth for at least

“three days” to allow the soft tissues to recover from the
damaged caused the faulty or ill-fitting dentures to normal
healthy status.
II. Use tissue-conditioner soft lining “if you fail to take the
faulty dentures from the patient”. Soft →shock absorber →
cushion → to be changed every two weeks.
III. The patient should be encouraged to message the effected
area with a soft brush or finger, in addition to anti-fungal
medication.
IV. Remake a new denture after complete healing to the soft
tissue
Steps for non-surgical methods

2. Occlusal correction of old dentures: in

particular an old denture with worn acrylic teeth
↑ Occlusal \vertical dimension OVD.

Management:
A. Increase the OVD to tolerable level.
B. Occlusal pivoting or muscle deprogramming.
B. SOFT TISSUE REQUIRE
SURGERY
For better understanding, it may be classified
according to their sites in the upper and the
lower arch.

UPPER ARCH:
1. Hyperplastic flabby ridge or displaceable
tissues:
It is a common finding in the upper jaw in the
pre-maxilla area.
 CAUSES:

I. Ill-fitting old denture.

II. Sharpe underlying residual ridge.
III. Maxillary complete denture opposed by
lower natural standing teeth without
adequate restoration for the posterior
teeth which may be lead to increase of
bite force anteriorly and eventually
resorption of the underlying bone.
 Consequences:
A. Shifting of the incisive Papillae
B. Enlargement of the palatal rugae.
Management:

Careful diagnosis by probing or x-ray

(OPG) to determine the amount of
alveolar bone left after resorption.
a) In severe cases surgical removal.
b) Try first a special impression techniques.
c) Injection of sclorsing agents to reduce
the size of hyperplastic tissues.
 2. Papillary hyperplasia (more in
palate):

Causes:
I. Ill- fitting denture with bad oral hygiene.
II. Long standing chronic irritation.
III. Continues wearing of upper denture at night
(severe case of denture stomatitis).
 Management:

I. Try the non-surgical procedure.

II. If persist “Electrosurgery” to reduce the
post-operative pain and discomfort.
3. fibrous hyperplasia (Denture
epulis or denture fissuratum):
Causes:
Chronic irritation of an overextended poorly
fitted denture, which may be result in
fibrous tissues formation between the
denture periphery and the sulcus due to
bone resorption. Clinically it appears as a
single fold or multiple one.
 Management:

I. Try the non-surgical procedure

a. Trim or reduce the overextended
periphery of the denture.
b. Then follow the non -surgical procedures.
II. If persist surgical intervention
✔ Give L.A then surgical flap.
✔ Suture” in some cases you may end up
with shallow sulcus → Vestibuloplast
“deepening the sulcus”?? in elderly
patients you must think about it ??!!.
 4. Pendulous fibrous maxillary
tuberosity:
Bilateral or unilateral, it may be interfere with
denture construction due to the reduction in
the inter-arch space.
Causes:
I. Due to over eruption of the upper 3rd molar.
II. Expansion of the maxillary sinus.
Management:
Surgical removal when the inter-arch space
between the maxillary tuberosity and the
Retero-molar pad less than 10 mm.
 Diagnosis:
A. Place cotton roll between the two edentulous
ridges, if slightly flattened that means there is
enough space.
B. Mounted the two casts on articulator more
accurate to determine the height of Occlusal
plane.
C. Panoramic x-ray (OPG) to locate the position
of the maxillary sinus and to eliminate the
presence of un-erupted 3rd molar “V-shape
incision, suture”.
 5. High freni attachment in both
arches:
❖ Upper labial frenum more common. It may be large,
active or closely attached to the crest of the alveolar
ridge.
Management:
I. It may be interfere with peripheral seal of the
denture. Therefore, relieving the denture to
accommodate the freni may be weaken the denture
at that point “V-shape it cause stress concentrating
point, for more accuracy U-shape is preferable:.
II. If interfere with denture extension or stability, it
needs surgical removal “Frenectomy”.
III. Lingual frenum “tongue tie” if interfere with
denture stability or speech → Frenectomy.
 6. Vestibuloplasty or Deepening
the sulcus:
✔ Either labial or Buccal sulcus, as they should have
sufficient depth to permit a full extension to the
denture to achieve good peripheral seal.
✔ It is of a less value to deepen the sulcus to gain few
mm; as the cause is due to lack of bone??!!.
Management:
a. Mucosal advancement.
b. Epithelial grafting.
c. Dental implant has solve this problem by
retaining the denture in two ball attachment.