Minnor preprosthetic surgery

MINOR PREPROSTHETIC SURGERY
Overview
When teeth are extracted alveolar bone resorbs, therefore should aim to preserve alveolar bone
whenever possible, either by not extracting teeth or by using a minimally traumatic technique.
At time of extraction of remaining teeth Extract carefully, compress the sockets, remove only small
unattached pieces of bone, cover any exposed areas of bone with gingival flaps, and surgically
remove roots only when necessary (infected, loose, ?1/3 root length). Consider interseptal
alveolotomy if ridge is prominent and heavily undercut (e.g. Class II). This consists of creating a
labial osteomucosal flap by dividing the septae and extending bone cut at the 3 region through the
buccal plate and collapsing-in the bone flap. Prominent fraena should simply be excised. Attempts
at decreasing the rate of ridge resorption have been made by leaving roots under mucosal flaps and
by implanting hydroxyapatite or biocoral cones into extraction sockets.

Problems in denture wearers

Only use surgery when denture faults and psychogenic disorders have been excluded. Screen
jaws with DPT.
Retained roots and bone sequestrae are removed using standard transalveolar technique, except in
the maxilla where buried canines may be removed using an osteoplastic flap (where bone is raised
on a mucoperiosteal hinge).
Small bony irregularities can be smoothed with a bur but consider ridge augmentation if extensive.
Fibrous (flabby) ridges ? by raising a flap of attached gingiva to repair the defect, excise remaining
soft tissue ridge, and repair with flap raised first. Fibrous tuberosities can be dealt with similarly.
Fibrous bands and irritation hyperplasia should be excised. Results are improved if palatal mucosal
grafts are used to repair the defects and minimize scarring.
Tori can be reduced with a bur under a local flap. Or resected with a combination of bur and chisel.
Muscle attachments to the mylohyoid ridge or genial tubercles can be displaced by resecting the
bone from the mandible with a chisel and dissecting away the muscles. Genioglossus and
geniohyoid should be reattached to the labial sulcus.
Ridge augmentation The use of subperiosteally injected porous hydroxyapatite as an
outpatient procedure under LA is useful in a very limited number of cases, mainly due to ridge type.
In this technique, a subperiosteal tunnel is raised along the crest of the ridge and filled with a
hydroxyapatite/saline sludge. It is very dependent on the shape of the ridge, and works best with
concave ridges as opposed to the more often seen feather-edge ridge. Problems : migration of
particles after periosteal elevation. Biocoral is replacing particulate hydroxyapatite for this purpose.
Sulcus deepening When adequate vertical and horizontal basal bone exists but there is a
shortage of ridge and/or attached gingiva, these procedures can help. Depends on: (a) dissecting
away non-attached mucosa to leave a raw new sulcus; (b) lining this new sulcus with skin or
mucosa; (c) securing the new depth with a stent ??a denture or baseplate lined with tissue
conditioner or impression compound, which is held in place by nylon sutures for 10-14 days, then
replaced immediately by a new denture with a soft lining extended to the new sulcus and worn

continually for the first 3 months.