Preprosthetic

surgery: 2
2. HARD TISSUES REQUIRE
SURGERY
1. Routine dental procedure:

i. Buried roots.
ii. Un-erupted teeth.
iii. Dental cysts.
 2. Ridge Irregularities (Minor surgery):

i. Feather-ridge.
ii. Knife-edge ridge.
iii. Torus mandibularis or palatinus.
iv. Undercut areas.
v. Prominent Mylohyoid ridges.
vi. Pressure on the mental foramina.
 3. Discrepancies in jaw size (Major surgery):

i. Skeletal class II Div. II & I.

ii. Skeletal class III.

The first three conditions should be removed if they caused

any symptoms or associated with pathological changes
or when they are in continuity with the oral cavity
(sinuses) before denture construction.

DIAGNOSIS:- probing, X-rays (periapical or OPG)

A. Conditions Require Minor Surgery

Ridge irregularities
It is the prosthodontist decision and it is like other oral
surgical procedures. Therefore, the following
points should be noted:
A. Proper diagnostic aids such as radiographs or
models.
B. Proper instrument, malt, bone rongures or burs
and bone files.
C. Asepsis filed.
D. The fundamental steps in oral surgery. L.A,
proper incision, reflection of flap, suturing and
post-operative instructions.
 1. Feather-ridge:
Classical features after an immediate
dentures and following multiple extraction
in patients with chronic periodontal
diseases due to irregular bone resorption.
Diagnosis and Management: -
Painful in palpation, X-ray shows radiolucent
cancellous bone. Reshaping and
recontouring by cutting these irregularities
followed by bone filing.
ii.Knife-edge ridge:
More in the mandible, painful to pressure,
it appears thin but smooth ridge.
Management:
Try to relieve the fitting surface if
discomfort persists with recurrent sores or
ulcer. Surgery by means of roundation and
smoothing.
 iii.Tori:
TORUS PALATINUS: Bony existosis or
overgrowth of bone lies on the centre of the
hard palate. It may be single or multiple
covered by thin firm mucosa.
Management:
If it is a small one relieve the fitting surface of
the denture at that site, but if it is extremely
large by means acting as a fulcrum which may
be lead to denture instability (rocking) or if it
extended too far posteriorly as it may interfere
with speech or patient concern (cancer
phobia). Surgery by burs or chisel. (Greater
palatine nerve??!!!)
TORUS MANDIBULARIS:
Again overgrowth of bony structure usually
bilateral on the lingual side of the mandible
between the premolars.

Management:
Relieve if small, surgery if large.
iv. Prominent Mylohyoid ridge:

Structure which can not be resorped through

out the life, and because of resorption
around them they become sharp and it may
cause pain and discomfort to patients.

Management:
Diagnosed by palpation. First try to relieve the
denture, if symptoms persist surgical removal
(Lingual nerve?)
V. Pressure on the mental foramen:
OPG, relieve or implant Overdenture.

Vi. Undercuts: More common sites the

labial side of the pre-maxilla, labial or
lingual of the lower anterior region, and
the buccal side of the maxillary tuberosity.
Difficulty in insertion and removing the
denture (traumatic ulcer??).
Management of undercuts:

Try to relieve the denture at these area but if

they are too deep and large surgical excision.
1. Not recommended in the mandible.
2. Two posterior L/R remove one.
3. Three one anterior two posterior.
Remove the two posteriors.
2.
B. Conditions require major
surgery
Jaws discrepancy: Such as in class II and III
these need major surgery under G.A.
(Orthognathic surgery).
Management:
Try the conventional methods of changing the setting of
the teeth to fit both aesthetic and function. If severe
and young patients (Osteotomy).
▪ Cephalometric X-ray.
▪ Diagnostic cast semi-adjustable articulator with
proper measurement.