Professional Documents
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Maxilla –
Maxillary alveolar ridge,
labial & buccal vestibular area
& palatal vault .
Frenal / muscle attachments,
tuberosity area
Mandible –
Mandibular alveolar ridge ,
vestibule , retromolar area ,
mylohyoid ridge and
frenal /muscle attachments .
PATHOPHYSIOLOGY OF
EDENTULOUS BONE LOSS-
•Alveolar atrophy-
It is the regression of teeth supporting
crescent shaped osseous part of upper and lower jaw,
after the loss of teeth.
Residual bone –
“That component of maxillary or mandibular bone, once
used to support the roots of the teeth that remains after
the teeth are lost.”
Residual ridge – “The portion of the residual bone and
its soft tissue covering that remains after the removal of
teeth .’’
Order – I II III IV V VI
Patterns of bone loss
Examination includes –
Advanced
Basic
surgery
procedures
procedures
Basic procedures
A. Bony surgeries
- Labial alvectomy
- Primary alveoplasty
- Secondary alveoplasty
- Excision of tori- mandibular ,palatal
- Reduction of genial tubercle
- Reducton of mylohyoid ridge
- Maxillary tuberosity reduction
- Removal of undecuts in maxilla & mandible
B. Soft tissue surgeries
- Removal of flabby soft tissue
- Frenectomy – Labial & lingual
- Excision of –
Epulis fissuratum
Palatal papillary hyperplasia
Denture hyperplasia
Advanced surgery procedures
Irregular alveolar
ridge post extraction
Ridge undercuts –
- Small undercuts & undercut only in anterior labial do not require
any surgical intervention
- If undercuts present both anteriorly & posteriorly , reduction of
posterior undercuts is preferred
- bilateral undercuts need correction at least in one side
Prominent mylohyoid ridge
- It damages the mucosa covering , the muscular attachment in this
area dislodges the denture .
- Requires surgical recontouring along with detachment of posterior
muscle insertion of mylohyoid muscle.
Sharp , spiny residual ridges –
- Knife – edged ridges commonly occur in lower anterior region
- Leads to hypermobile tissue that gets trapped between the
denture & sharp bony ridge.
- 3 types of sharp ridges given by Meyer –
1. Saw- tooth
2. Razor - like
3. Discrete spiny projection
- Surgical treatment requires reshaping of bone & soft tissue & closure
of epithelium with sutures.
- If surgery is contraindicated –
selective pressure impression technique
permanent resilient liners
Reduction of occlusal table with maximum denture base extension
Tori & exostoses
- Relatively common , benign , slowly growing bony projections of
maxilla & mandible .
- When it occurs midline palate it is called as ‘torus palatinus’
- When it occurs in the lingual aspect of mandible called as ‘torus
manibularis’
- Covering mucosa is thin
Maxillary tuberosity interfernce
- pendulous tuberosity with undercuts .
- unilaterally or bilterally
- Interfernce with interarch space , denture insertion & extension ,
mandibular movements .
Soft tissue abnormalities
Hypertrophic frenum –
- Fibrous bands of tissue frequently attached to superficial muscle
attachments in maxilla & mandible
- -Hypertrophic lingual frenum interfering with denture extension &
denture stability .
Hypertrophic maxillary labial frenum prevents
ideal extension of denture borders & peripheral
seal .
Providing relief in the labial notch of the
denture will decrease the incidence of midline
fracture of denture.
Treatment – frenectomies
Alveolar ridge correction
1. submucosal vestibuloplasty
2. Secondary epithelization procedure –
Trauner’s technique
Caldwell’s technique
Obegser’s technique
3. Tissue/ alloplastic grafts vestibuloplasty
Ridge augmentation procedures
C. Augmentation in
combination with
orthognathic surgery –
1. Mandibular osteotomy procedure
2. Maxillary osteotomy procedure
3. Combination procedure
D. Distraction osteogenesis –
Vertical
anterioposterior vector ( recent)
SURGICAL
INTERVENTIONS
ALVEOLOPLASTY
Simple
(Conservative)
Intraseptal
Simple Alveoloplasty
Osteoplasty
(flame shaped bur or using a bone file)
Reduction Of Mylohyoid Ridge
Crestal incision with oblique release incision in posterior
ridge region
INDICATIONS
• Deep bony undercuts
• Ulcerations/ Traumatization/ hyperkeratinization of mucosa
• Interference in function
Maxillary
Tori
Surgical Technique
Possible Complications
Intraoperative :
1) Bleeding- Injury to greater palatine vessels.
2) Fracture of palatal shelf
3) Oronasal/ oroantral perforation
Postoperative :
1) Hematoma formation
2) Sloughing or Necrosis of palatal mucosa
3) Gaping/ Nonhealing wound
4) Oronasal/ oroantral fistula
Mandibular
Tori
Possible Complications
Intraoperative :
1) Injury to the submandibular salivary gland structures
2) Excessive bleeding
3) Laceration of the mylohyoid muscle
4) Tearing of the flap
Postoperative :
1) Life threatening hemorrhage in the floor of the mouth
2) Airway obstruction due to infection
Maxillary Tuberosity And
Exostosis removal
Enlarged tuberosities due to bony overgrowth interfere
with denture construction.
Indications :
1) High frenal attachments
2) Fibrous bands attached near the alveolar crest which
often displace the dentures during function.
Techniques
Maxillary Labial Frenectomy
Z-Plasty
Technique :
1) 2 releasing incisions creating a Z shape precede
undermining of the flap.
2) The two flaps are eventually undermined and rotated to
close the initial vertical incision horizontally.
Lingual Frenectomy
Intraoperative ;
1) Injury to superior lingual vessels
2) Injury to Warthin’s duct/papilla
Postoperative:
1) Hematoma in the floor of the mouth
2) Pain
3) Restricted tongue movements
Why Correction ?
Decreased
Inadequate Deepening of
retention and
vestibular depth vestibule considered
stability of denture
Vestibuloplasty
KAZANJIAN TECHNIQUE (1924)
Supraperiosteal dissection
Suturing done
RAW AREA on the BONE
OBWEGESER’S TECHNIQUE
Godwin’s Technique
Lipswitch Technique
Lingual Vestibuloplasty
TRAUNER’S TECHNIQUE
Suturing extraorally
Placement of skin graft or stent.
CALDWELL’S TECHNIQUE
Indications
When the width of alveolar ridge inadequate
Oldest technique by Obwegeser
Advantage
improved ridge height and width
uniform ridge is created
VISOR OSTEOTOMY
Indication
Method
closure done
Advantage
Disadvantage
1) Nerve paraesthesia
2) Donor site morbidity
3) Need for hospitalization
4) Inability to wear dentures for 3-5 months
Distraction Osteogenesis