Mouth Preparation

For Complete
Dentures
Dr. Sweta V. Gandhi
Dr. Bhagyashri Bhalani
PG Student Part I
Dept. Of Prosthodontics & Crown & Bridge
K.M.Shah Dental college and Hospital
Introduction
The evolutionary cycle has selected a masticatory
system which is functionally efficient using
natural teeth and an omnivorous diet.
Dentures are subject to the physical laws
which form the realities of this oral
environment.
No denture, regardless of how well it is
constructed, can overcome the limitations
of the foundation on which it is placed.
- Heartwell CM. Syllabus of Complete Dentures 4/e: 143-
 Many conditions in the edentulous mouth should be corrected
or treated prior to the construction of complete dentures.
Often, patients are not aware that tissues in their mouth have
been damaged or deformed by the presence of old prosthesis.
Other conditions may have developed or be present which
must be altered to increase chances for success of new
dentures. The patient must be made
aware of these problems. A logical explanation by the dentist,
supplemented with
roentgenograms and diagnostic casts, usually will convince
the patient of the
necessity for the suggested treatment.

- Hickey J. Preparation of mouth for complete dentures. JPD 1964: 14(4)

- Bouchers Prosthodontic Treatment for Edentulous Patient 12/e
 A thorough examination of the mouth prior to
construction of dentures is necessary to identify
potential problem areas.
- Winkler S. Preparing the mouth for dentures. Essentials of
Complete Denture Prosthodontics 3/e; 2015: 80-110.

The patient must be made aware of these problems.

A logical explanation by the dentist, supplemented
with roentgenograms and diagnostic casts, usually
will convince the patient of the necessity for the
suggested treatment.
Goal
To modify the oral environment to render it free of

disease and to make its form and possibly its

function more compatible with the requirements
of complete denture wearing.
- Heartwell CM. Syllabus of Complete Dentures 4/e: 143-
188.
Methods of treatment

Non- surgical

Surgical

Combination
Non- surgical

Removal of Dentures / Rest for tissues

Occlusial and vertical dimension correction of old

prosthesis

Tissue conditioning

Good nutrition
Removal of Dentures / Rest for
tissues
All patients are required to leave their old
dentures out of the mouth for 24 to 48 hours to
allow the supporting tissue to recover its
normal form prior to making impressions for
new dentures.
This procedure is generally followed even after
the use of tissue treatment material or other
corrective methods.
-Hickey J. Preparation of mouth for complete dentures. JPD
1964: 14(4)
 Fig: The old denture base is in position on a cast
made of the patients mouth.

- Hickey J. Preparation of mouth for complete dentures.

JPD 1964: 14(4)
 Tissue has been severely
displaced by the posterior
border of the old denture.

The displaced tissue has

recovered dramatically
by simply leaving the
dentures out of the
mouth for 48 hours.
- Hickey J. Preparation of mouth for complete dentures.
JPD 1964: 14(4)
Occlusal correction
An attempt should be made to restore an
optimum vertical dimension of occlusion of
present dentures.
This enables us to prognosticate amount of
vertical facial support that patient can tolerate.
This also reduces traumatic force to supporting
tissues and joint.
Consequently, ridge relations are improved and
this facilitates dentists eventual relation
Tissue conditioning
Indicated for those who cannot leave their old
dentures out of mouth for sufficient length of
time.
Dynamic adaptive stress: the conditioning of
the mucosa by the continuous application of force
and motion to the basal-seat tissues through
occluding dentures utilizing a resilient flowing
treatment material.
Permits movement of denture base so that its
 They consist of a polymer powder (ethyl methacrylates
or copolymers) and aromatic esther ethnol mixture.
These components form a gel with the ethyl alcohol,
exhibiting considerable affinity for the polymer.
In the denture, the gel has sufficient viscosity to give it
body, yet it retains the resilience for 48 to 72 hrs to
permit movement of the tissues during masticatory
stress.
As the polymerization continues, the material stiffens,
loses its therapeutic value, and must be replaced.
 Some material formulations permit the
incorporation of an additional liquid plasticizer,
which obviates the need to replace the material
frequently and provides a smoothes, better-
tolerated surface.
Preparation of the denture :
Remove from the denture base all undercuts and
some of the area immediately in the ridge to a
depth of 1mm of more.
Retain the borders or flanges and the hard palatal
area in the maxillary denture as vertical stops in
seating or placing it on the ridge.
The dentures should be provided with room
for the conditioning material that is sufficient
to allow the displaced and traumatized tissue
to recover to a normal state.
Preparation and placement of a tissue
conditioner in the mouth :
For conditioning tissues: a ratio of 1 parts of
polymer to 1 part of monomer is recommended
with the addition of approx CC of the plasticizer
(flow-control).
This has been found to prevent the material from
getting rough and hard after 4 to 5 days in use. It
makes the material soft, smooth, glossy and it
prolongs its durability in use to approx 4 to 8 wks .
-Winkler S. Preventing and treating abused tissue. Essentials
of Complete Denture Prosthodontics 3/e; 2015: 111-119.
 Mix in a glass jar by slowly adding the powder to the
liquid and stirring continuously until the desired
amount of polymer is incorporated in the mixture.
Cover the entire area of the denture base.
When the material ceases to flow readily, insert the
denture in the patients mouth slowly but firmly.
Hold the dentures in the position of occlusal vertical
dimension for 3 to 7 min.
Following this, instruct the patient to move his or
her lips and cheeks to border mold the material.
 Pressure areas, where the pink color of the
denture base shows through are relieved.
Small amounts of the material are added where
necessary and the denture returned to the mouth
for contouring.
A thickness of at least 1 to 2mm is necessary to
achieve the desired flow-massaging effect.
New application is needed every 3-4 days till
tissue has recoverd.
Virtues and pitfalls :
The greatest virtue of tissue conditioners
lies in their versatility and easy of use.
Because the conditioner lined dentures
provide immediate relief and comfort, there
is a danger that the patient will wear them
too long and so cause trauma to the
supporting tissue.
Thereby producing the very situation that
their use is intended to prevent or correct.
Nutrition
Metabolic efficiency - decreased because of age
Masticatory efficiency - decreased because of the
loss of his natural teeth.
Vitamin C - helps combat capillary fragility and
Vitamin B - aids in tissue recovery.
An over-all diet that is low in carbohydrate and
fat and high in protein is recommended for these
patients.

- Hickey J. Preparation of mouth for complete dentures. JPD

Pre-prosthetic Surgery
Surgery performed to prepare the
remaining oral tissues to best support a
prosthesis

Surgical procedures designed to facilitate

fabrication of a prosthesis or to improve the
prognosis of prosthodontic care.
-GPT
Classification
I) Basic preprosthetic surgical procedures:
A. Removal of Teeth :-
. Erupted
. Unerupted
. Partially erupted
. Root stumps
. Cysts
B. Bony recontouring of alveolar ridges-
Simple alveoloplasty associated with removal of
multiple teeth.
Intraseptal alveoloplasty
Maxillary tuberosity reduction
Buccal exostosis and excessive undercuts
Lateral palatal exostosis
Mylohyoid ridge reduction
Genial tubercle reduction
C. Tori Removal :-

Maxillary tori

Mandibular tori

D. Soft Tissue Procedures :-

Maxillary tuberosity reduction (soft tissue)

Mandibular retromolar pad reduction

Unsupported hypermobile tissue

Inflammatory fibrous hyperplasia

Inflammatory papillary hyperplasia of the palate

Labial frenectomy /Lingual frenectomy

II) Advanced pre-prosthetic surgical
procedures:
A. Mandibular Augmentation
B. Maxillary Augmentation
C. Soft tissue surgery for ridge extension of the
mandible
D. Soft tissue surgery for maxillary ridge
augmentation
E. Correction of abnormal ridge relationships
F. Oral Implantology
General considerations for surgery
Soft Tissue
Corrections
Hyperplastic Tissue
Cause: Excessive hypermobile tissue without
inflammation on the alveolar ridge is
generally the result of resorption of the
underlying bone, ill-fitting dentures or both.
 The denture has
settled as a result of
bone resorption in the
anterior region which
allows the denture
borders to rest on the
mucosa of the lip
instead of contacting
the mucosa of the
labial vestibule.
-Hickey J. Preparation of mouth for complete dentures. JPD 1964:
 Management:
1) Removal of dentures : Sufficient in most instances.
2) Surgery.
However, even when surgery is treatment of choice,
problem of haemmorhage are reduced by
discontinuing use of dentures.
3) Tissue conditioning material placed in denture
immediately after surgery.
4) Removing etiological factor: eg reducing incisal
edges of lower natural anterior teeth opposing
maxillary hyperplastic region.
-Hickey J. Preparation of mouth for complete dentures. JPD 1964:
Surgical technique
Two parallel full
thickness incisions are
made on the buccal
and lingual aspects of
the tissue to be
excised.

A periosteal elevator is
used to remove the
excessive soft tissue
from the underlying
bone.
Papillomatosis
Inflammatory papillary hyperplasia often occurs
in the region surrounding the median palatal
raphe.
Chronically inflamed tissues of palates may vary
from mild hyperplasias to conditions which could
be precancerous.
Since papillomatosis could be a precancerous
lesion, treatment is controlled in a different
manner from that for other soft tissue changes.
 Causes:
1) Faulty occlusion
2) Excessive palatal relief areas (particularly with
sharp margins),
3) Negative pressure from the pumping action
under excessively large palatal relief areas.
4) Unhygienic care of dentures
5) Allergy to chemicals in poorly processed
dentures,
6) Yeast infections
7) Viral infections.
 Management of Precancerous hyperplasia :-
 Management of Non - Precancerous hyperplasia :-

-Hickey J. Preparation of mouth for complete dentures. JPD 1964:

 The palatal part of the upper denture has been
removed so that the irritated Palatal tissue can be
exposed while the remainder of the denture is
worn.
-Hickey J. Preparation of mouth for complete dentures. JPD 1964:
 If removal is required, a mucosal excision
superficial to the periosteum is recommended.
Another technique is to use electrosurgical loops for
excision of the palatal mucosa maintaining a split
thickness excision so the palatal bone is not
cauterised.
Following tissue incision, insertion of a splint or
denture containing a soft tissue liner provides
improved patient comfort during the healing period.
Secondary epithelialization usually takes place in
approximately 4 weeks.
Frenectomy
Due to resorption, frenae appear near the crest of
the ridge.
Frenii interferes with border extension & exerts
dislodging forces.
Buccal frenum - seldom source of discomfort.
Relieved if irritation occurs.
Maxillary labial frenum:
Composed of a strong band of fibrous connective
tissue that may insert on the lingual side of the
crest of the residual ridge.
Excessive relief will weaken the denture & cause
loss of border seal.
If not relieved will cause dislodging forces on
denture.
Does not contain any muscle attachment so
frenectomy prior to construction of new dentures
can be performed.
Techniques Labial
Frenectomy
1) Simple excision (effective when mucosal and fibrous
tissue band is relatively narrow).
2) Z- plasty when the frenum is broad and the
vestibule is short, for eliminating the frenum, as well
as for deepening the vestibule to some extent)
3) Localized vestibuloplasty with secondary
epithelialization (preferred when the frenal
attachment has wide base).
 -Malik NA. Textbook of Oral & Maxillofacial Surgery 2/e: 417-
435.
- Kapur A et al. Pre prosthetic surgery ensuring success in
Prosthodontics A review. Journal of Dental Peers.
Lingual frenum surgery :-
Interfere with border extension & stability
Restrict tongue movements ???
Impairment of speech
Possible complications:-
Injury to superior lingual vessels
Haematoma in the floor of the mouth
Injury to Whartons duct/papilla.
Techniques Lingual
Frenectomy
The tip of the tongue is controlled by placing a
traction suture.
One haemostat can be placed at the anterior
attachment of the frenum to the tongue and
another haemostat be placed at the inferior
attachment to the ridge.
A cross-diamond incision along the edge of both
the haemostats is made.
 -Malik NA. Textbook of Oral & Maxillofacial Surgery 2/e: 417-
435.
Vestibular Corrections
Many dentists have attempted to enlarge the
mandibular denture bearing area by lowering
mandibular muscles and soft tissue attachments.
In most instances, the resulting scar tissue has
negated the improvement that may have been
gained by the increase in denture bearing
surface.
These procedures are seldom indicated.

-Hickey J. Preparation of mouth for complete dentures. JPD

 Whenever there is an inadequate vestibular depth
present to increase the retention and stability of
the denture, deepening of the vestibule is
considered.
To utilize this treatment option, sufficient amount of
height of the alveolar bone should be available.
In extreme atrophy cases, where resorption of the
basal bone has taken place, this option is out of
consideration.
- Malik NA. Textbook of Oral & Maxillofacial Surgery 2/e: 417-
435.
Kazanjian Technique (1924):
Oldest Technique
Uses mucosal flap from the inner aspect of the lower lip to
increase the depth of the anterior mandibular labial
vestibule.
Carried out in premolar to premolar region only.
Raw area is left on the lip side to heal by secondary
intention.
Periosteum on the bone is left intact.
Drawback
Severe scarring of the lip mucosa, may decrease the
flexibility of the lower lip (Poor long-term results).

- Malik NA. Textbook of Oral & Maxillofacial Surgery 2/e: 417-435.

Clarks Technique:
Supraperiosteal flap based on the inner aspect of
the lip.
Leaves raw surface on the bone, covering the
inner lip surface, thereby reducing bleeding,
postoperative pain and scarring.
Success rate is better than Kazanjian method.
Relocation of the mental nerve
Hypermobile edentulous ridges
The sclerosing procedure can be used in both the
maxillary and mandibular edentulous arches.
It is ideal for patients whose ridge contours are
satisfactory but whose ridge tissues are
excessively mobile.
The injection of 2 to 4 c.c. 5 per cent sodium
morrhuate as the sclerosing solution is used
depending upon the extent of the area involved.

- Laskin DM. A sclerosing procedure for hypermobile

edentulous ridges. JPD 1970; 23(3): 274-278.
 (A) Before the sclerosing (B) The soft tissue 3 years
procedure. Note the initial after treatment. Note the
gross mobility of the tissue resistance of the soft tissue
in a palatal direction. to displacement even with
firm pressure applied in a
posterior downward
- Laskin DM. A sclerosing procedure for hypermobile
direction.
edentulous ridges. JPD 1970; 23(3): 274-278.
 This technique has been successfully used in 58
patients, with the longest follow-up being 7 years.
It is apparent from re-examination of many of
these patients that the fibrous ridge remains firm
for a considerable number of years if the dentures
are correctly constructed and if the underlying
bone does not undergo appreciable change.
The sclerosing technique thus seems to offer a
relatively simple means for dealing with the
problem of hypermobile edentulous ridges.
- Laskin DM. A sclerosing procedure for hypermobile
edentulous ridges. JPD 1970; 23(3): 274-278.
Bony Corrections
Alveoloplasty
Surgical reshaping of alveolar ridge.

Alveolectomy
Surgical removal or trimming of the alveolar
process is termed as alveolectomy.
 The simplest form of alveoloplasty consists of the
compression of the lateral walls of the extraction
socket after simple tooth removal.
Minimum amount of alveolar bone resorption
occurs, if after simple extraction, digital
compression of the alveolar cortices is done
immediately.
-Malik NA. Textbook of Oral & Maxillofacial Surgery 2/e:
417-435.

However when multiple irregularities exist, more

extensive recontouring is carried out .
 Bony areas requiring recontouring should be
exposed using an envelope type of flap.
Recontouring can be accomplished with a
rongeur, bone file, bone bur in a handpiece or
combination.
Copious saline irrigations should be used
throughout the procedure.
The flap should be reapproximated using digital
pressure and the ridge palpated to ensure that all
irregularities have been removed.
 -Malik NA. Textbook of Oral & Maxillofacial Surgery 2/e: 417-
435.
Intraseptal alveoloplasty
Deans technique
Indication: an area where the ridge is of relatively
regular contour and adequate height but presents an
undercut to the depth of the labial vestibule because
of the configuration of the alveolar ridge.
Technique: The removal of intraseptal bone and
repositioning of the labial cortical bone, rather than
the removal of excessive or irregular areas of the
labial cortex.
 Incision on crest of the ridge Reflect a
mucoperiosteal flap.
Remove the intraseptal portion of the alveolar
bone using a small rongeur.
Using digital pressure, fracture the labial cortical
plate of the alveolar ridge inwards to approximate
the palatal plate area more closely.
Following positioning of the labial cortical plate,
any slight areas of bony irregularity can be
contoured with a bone file and the alveolar
mucosa reapproximated
Advantages
The labial prominence can be reduced without
significantly reducing the height of the ridge in
this area.
The periosteal attachment to the underlying bone
can also be maintained, thereby reducing
postoperative bone resorption and remodeling.
The muscle attachments to the area of the
alveolar ridge can be left undisturbed in this type
of procedure.
Sharp Spines or Spicules
Sharp projections of the alveolar process, that
remain following removal of teeth, press on the
mucosa from its inside surface and cause
discomfort to the patient.
Sometimes the stimulation from massage of the
finger will speed resorption of these projections.
When this procedure fails, they are removed
surgically with little operative or postoperative
difficulty.
Genial Spines
Severe resorption of the residual ridge may cause
the genial spines to become exceedingly sharp
and prominent in relation to the residual ridge.

-Hickey J. Preparation of mouth for complete dentures. JPD 1964:

 Management:
Rarely, these spines are reduced surgically as
such surgery can be complicated by the origin of
the genioglossus and geniohyoid muscles from
the genial spines.
In most instances no treatment is given and the
patient is informed of the limitations that these
structures will place on the completed dentures.

-Hickey J. Preparation of mouth for complete dentures. JPD 1964:

Maxillary tuberosity reduction
Indication:
Excessively large undercut / bilateral undercuts.
Inadequate interarch space between maxillary
tuberosity and retromolar pad.
Precaution:
Perforation of maxillary sinus.
A pre-operative radiograph is often useful to
determine the extent to which bone and soft
tissue contribute to this excess and to locate the
floor of the maxillary sinus.
 Unilateral undercut:
Many times the bony protuberance can be
left on one side and surgically corrected only
on the opposite side of the mouth.
Bony reductions in the anterior part of either
ridge should be performed only in extreme
situations as they decrease stability.
Diagnostic casts can be surveyed as a guide
to the amount of tissue that must be removed.
Interarch space corrections
When insufficient space exists between the
maxillary tuberosities and the retromolar pads,
the tuberosities should be surgically corrected to
permit the denture bases to cover all available
tissue and end on moveable tissue.

-Hickey J. Preparation of mouth for complete dentures. JPD 1964:

 Surgery is not performed on the retromolar pads
because of the anatomic structures contained
within the pad.
(temporal tendon, pterygomandibular raphe,
superior constructor and buccinator muscle fihers,
and mucous glands).
In addition to creating needed space, removal of
this tissue allows the occlusal plane of the upper
denture to be oriented in such a manner that
resultant forces are directed toward the ridge and
tend to seat the upper denture rather than
-Hickey J. Preparation
dislodge it. of mouth for complete dentures. JPD 1964:
 When health conditions, proximity of the
maxillary sinus, or other factors make surgical
intervention impractical, then metal sections can
be incorporated in both denture bases posteriorly
to utilize a small interarch space.
Should one denture need to be shortened beyond
its desired length, the posterior border of the
lower denture is reduced but still allowed to end
as far posteriorly on the retromolar pad as
possible.

-Hickey J. Preparation of mouth for complete dentures. JPD 1964:

Reduction of Fibrous
Tuberosity:
Wedge Resection 1/3rdof the bulbous mass will be
removed from the centre and remaining two sides
undermined submucosally, compressed and then
sutured.

- Kapur A et al. Pre prosthetic surgery ensuring success in

Prosthodontics A review. Journal of Dental Peers.
Reduction of Bony
tuberosity:
A crestal incision in made starting from behind the

tuberosity to approximately 10 mm beyond intended area

of bony reduction.

A periosteal elevator is used to raise a buccal flap to

expose entire aspect of bony tuberosity.

Bone may be removed using a side cutting rongeur or a

large oval acrylic bur if rotary instruments are preferred.

- Kapur A et al. Pre prosthetic surgery ensuring success in

Prosthodontics A review. Journal of Dental Peers.
 -Malik NA. Textbook of Oral & Maxillofacial Surgery 2/e: 417-
435.
Exostosis
Excess bone formation may occur from unknown
causes in various parts of the residual ridge.
These projections of bone are surgically removed
if they interfere in any way with denture
construction.

-Hickey J. Preparation of mouth for complete dentures. JPD

1964: 14(4)
Lateral Palatal Exostosis
Undercut created by
the exostosis.
Narrowing of the
palatal vault.
Bony reduction is
similar.
Special attention to
avoid damage to the
http://www.exodontia.info/Tubero
blood vessels sityReduction.html
Tori
Bony hypertosis seen in maxilla & mandible.
Large tori compromise the fabrication & function of
dentures. Usually require surgical recontouring or
removal.
Smaller tori necessitate removal when they are irregular,
extremely undercut or in the area where a posterior
palatal seal is expected.
Maxillary tori should be removed if-
Interferes with speech.
Extends posteriorly which affect the
seal.
Denture instability due to fulcrum
effect.

Mandibular tori are almost always

removed as
the tissue covering is thin and
extend into the region of the border
seal of the lower denture.
 Technique
one or both ends.
Section the tori into
multiple fragments.
Careful attention must
be paid to avoid
perforation of the floor
of the nose

- Kapur A et al. Pre prosthetic surgery ensuring success in Prosthodontics A

review. Journal of Dental Peers
To prevent hematoma formation, some form of
pressure dressing must be placed over the area
of the palatal vault:-
Vaseline gauze formed into a pack and adapted
to the palate can be sutured in place
A temporary denture or prefabricated splint
relieved in the center of the palate to prevent
pressure necrosis with a soft liner can also be
used to support the thin mucosa and prevent
hematoma formation.
Technique Mandibular
Tori
Lingual sulcus incision, without releasing
incision(prevents damage to the lingual nerve).
Mucoperiosteal flap is raised on the lingual aspect
of the mandible.
Make a groove with the bur on the medial aspect
of the torus.
Osteotome placed in the groove.
Gentle tapping to excise the entire torus.
http://www.surgical-dentistry.info/RemovalofTori.html
Potential Complications- Mandibular (Lingual) Tori:-
Lingual plate fracture
Lingual nerve damage
Injury to submandibular salivary gland duct.
Laceration of the mylohyoid muscle.
Life-threatening haemorrhage in the floor of the
mouthinfectionairway obstruction.
Mylohyoid ridge reduction
The mylohyoid ridge is one of the more common
areas interfering with proper denture construction.
Easily damaged thin covering of mucosa,
The muscular attachment to this area often is
responsible for dislodging the denture when this
ridge is extremely sharp
Denture pressure may produce significant pain in
this area.
 A full thickness mucoperiosteal flap is reflected,
exposing the mylohyoid ridge area and mylohyoid
muscle attachments.
The mylohyoid muscle fibers are removed from
the ridge by sharply incising the muscle
attachments at the area of bony origin.
After reflection of the muscle, a rotary instrument
or bone file can be used to remove the sharp
prominence of the mylohyoid ridge.
Knife Edge Ridges
Sharp ridges must be palpated well before
enthusiastically launching into a surgical program.
The anatomic nature of the knife edge ridge is often
such that surgery offers only temporary relief and
another sharp narrow ridge may become prominent
in a few months.
The only available treatment for this kind of ridge is
often adequate provisions for relief in the impression
and completed dentures.
-Hickey J. Preparation of mouth for complete dentures. JPD 1964:
14(4)
Alveolar Ridge Deficiency
When the alveolar ridge resorption is so extreme, that in
maxilla, the height has been reduced to the point that a
nearly flat surface exists between the vestibule and
palate,
And in the mandible, the mental nerve positioned almost
at the crest and very thin mandibular alveolar ridge
exists, which can end up in fracture easily,
Vestibuloplasty is out of consideration in such cases, until
the replacement of necessary supportive bone is done.
Superior Border
Augmentation
Autogenous rib grafts.
Iliac crest grafting to the superior border also can
be used.
Disadvantages
Donor site morbidity.
Second surgical site necessary.
Continued resorption of the grafted sites.
Soft tissue dehiscence or limitation.
Inferior border grafting
A freeze-dried allogenic cadaver mandible is hollowed
out and multiple perforations made into it to allow for
revascularization of the packed cancellous bone graft.
Advantages
Since no surgery is done intraorally, patients old
dentures can be used as transitional dentures
Increased bone height to accommodate implants
Also lower one-third of the facial height is increased
Esthetically better results.
Hydroxypatite
Augmentation of Mandible
Granular or particle form is most commonly used
for augmenting alveolar ridge contour defects.
When placed in subperiosteal environment
adjacent to bone, it bounds physically and
chemically to bone.
A subperiosteal tunnel technique is used which
exposes entire aspect of mandible in area to be
augmented but avoiding neurovascular bundle.
 Preloaded beveled syringe containing
Hydroxyapatite is inserted into most posterior
aspect of tunnel.
Then hydroxyapatite in injected until desired
contour of mandible is obtained.
A splint is useful for healing post operatively.

- Kapur A et al. Pre prosthetic surgery ensuring success in Prosthodontics A

review. Journal of Dental Peers.
Pathological condition
Odontogenic cyst- Denture construction delayed
till mucous membrane is well epithelized.
Non-odontogenic cyst- small-enucleation
- large-marsupialization
Large cyst are packed open to heal by secondary
intention. As granulation progresses, dressings
are reduced in size.
Pathological condition
Tumors: histological diagnosis is required as
radiographic finding are not conclusive.
All lesions require medical management before
denture construction.
Recent Advances - Laser
Conventional surgical techniques include the use of
scalpels to incise the soft tissue to obtain access to the
underlying structures.
Ronguers, bone files, and round burs in high-speed
handpieces have been the treatment of choice to remove
sharp bony projections and to smooth the residual ridge.
Today, soft tissue laser surgery to expose the bone may
be performed with any number of soft tissue wavelengths
(CO2, diode, Nd:YAG).
Hard tissue surgery may be performed with the erbium
family of wavelengths.
Conclusion
Consideration of pre-prosthetic surgery is one of
numerous methods by which a patients clinical
presentation may be advantageously altered.
As a general "rule of thumb" the best procedure to
consider is the least invasive process that will produce
clinical success.
This may mean that it could be a disservice to the
patient to perform surgery when a non-surgical
method could be used.
It is likewise a disservice to fail to consider and
perform surgery when a non-surgical approach will
Refrences
1) Hickey J. Preparation of mouth for complete dentures. JPD
1964: 14(4)
2) Bouchers Prosthodontic Treatment for Edentulous Patient
12/e
3) Winkler S. Preparing the mouth for dentures. Essentials of
Complete Denture Prosthodontics 3/e; 2015: 80-110.
4) Heartwell CM. Syllabus of Complete Dentures 4/e: 143-188.
5) Malik NA. Textbook of Oral & Maxillofacial Surgery 2/e: 417-
435.
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