Journal of Positive School Psychology http://journalppw.

com
2022, Vol. 6, No. 3, 3752 –3755

Preprosthetic Surgery And Its Cureent Trends : A Review

Dr. Balakrishnan 1, Dr. G.Sumathi 1*,Dr.Vijay ebenezer2

1) Research scholar, BIHER, SBDCH

Professor, Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital,
Bharath University, Chennai- 600100, Tamil Nadu, India.

1*)Supervisor ,Department of Anatomy, Sree Balaji Dental College and Hospital, Bharath University,
Chennai- 600100, Tamil Nadu, India.

2)Head of the department & prof , , Department of Oral and Maxillofacial Surgery, Sree Balaji Dental
College and Hospital, Bharath University, Chennai- 600100, Tamil Nadu, India.

ABSTRACT: -

The aim of pre-prosthetic surgery is to prepare the hard and soft tissues for a befitting
prosthesis[1]. This will help in restoring the function of the jaws, preserve and improve jaw
structure and improves the esthetic outcome. Pre-prosthetic surgery must begin with
thorough history and examination of the patient[2], since there are many contraindications
in patient with systemic diseases. Attention should be given to the laboratory tests to
determine the degree of bone resorption. Every attention should be taken in restoring
the hard and soft tissues of denture bearing areas[2]. The procedures include smoothening
and reshaping, removal of excess bones and gums in denture bearing area. The prime
determining factor for the success of pre-prosthetic surgery is the condition of denture
bearing tissues[3]. It should be noted that the hard and soft tissue should be in a state that
the patient can wear denture without any hindrance[3]. This article deals about the various
pre-prosthetic procedures and its recent advances.

Key Words: Pre prosthetic, Alveoloplasty , Ridge augmentation, Vestibuloplasty

INTRODUCTION: - Increase in inter-arch distance,

Pre prosthetic surgery is defined as the surgical Prognathic mandible profile and
procedure designed to facilitate prosthesis
Progressive resorption results in wider
fabrication or to improve denture retention,
mandible and narrow maxilla.
stability and support[2]. This aims at eliminating
the certain lesions and abnormalities of hard DISCUSSION:-
and soft tissue for successful denture
placement. The denture bearing bone should be CLASSIFICATION OF
in a uniform shape and size[1]. However , at PREPROSTHETIC SURGERY:-
times the alveolar bone gets resorbed soon due Respective
to prolonged use of an ill-fitting denture,
leading to poor retention of denture. Recontouring

Differences in shape of upper and lower Augmentation

alveolar ridge results in following:- INVOLVED AREAS
Reduction in height of residual ridges, Osseous tissues

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Dr. Balakrishnan, et. al. 3753

Soft tissues Soft tissue excision

CATEGORY OF PATIENT Soft tissue repositioning

Completely edentulous Soft tissue grafting

Partially edentulous OBJECTIVES :-

ALTERATION OF ALVEOLAR BONE 1. Ridges that are broad and flat with
vertical height are parallel and non-
Removing undesirable contours
undercut bony walls.
Bone reductions 2. A firm, resilient mucosal covering
with nicely shaped buccal and lingual
Bone repositioning sulci , un-interrupted by scars, frena
Bone reshaping/recontouring or redundant tissue folds.
3. Inter-arch distance of 16-18 mm
Bone grafting which allows room for optimal
SOFT TISSUE MODIFICATIONS:- denture placement.

Soft tissue reduction

ALVEOLOPLASTY:- INTRASEPTAL
ALVEOLOPLASTY:-
An alveoloplasty [syn. Alveoplasty] is a
An alternative to the removal of
surgical procedure which involves
alveolar ridge irregularities by simple
smoothening and reshaping the patient’s
alveoloplasty is the Dean’s intraseptal
jawbone, where teeth has been extracted or
alveoplasty, thereby removing the
shed off[1].
intraseptal bone and respositioning of
The purpose of the procedure is two fold:- labial cortical bone rather than removal
of it.
1. When performed before denture
construction, it is used to optimize the REDUCTION OF GENIAL
shape of patient’s jaw bone to avoid TUBERCLE:-
complications during insertion, The genial tubercle is prominent in
stability and retention. case of advanced ridge reduction in
2. If performed in association with tooth anterior mandible[1]. If genioglossus
extractions, it forms a jawbone shape displaces the denture , the involved
thereby facilitating healing process. tubercle should be removed and
3. Helps in successful placement of muscle should be detached. The
future prosthetic restoration. tubercles are visible superiorly as a
result of extreme resorption of the
Faster healing is important in cancer ridge. If augmentation is suggested,
patients , who are receiving more provision should be given for the
radiation, which leads to xerosis of placement of graft[2]. Local infilrtration
salivary glands , reducing the blood and bilateral lingual nerve block
flow leading to osteoradionecrosis. provide adequate anaesthesia. Using
Radiation therapy cannot be bur, chisels and roengeurs, the tubercle
commenced until the extraction is reduced and smoothened using bone
sockets are healed[1]. file[1].

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3754 Journal of Positive School Psychology

TORI REMOVAL:- form of 2 folds, namely one inner and

Torus palatinus is a benign, slow another at the outer and ulceration
growing, bony projection of palatine noted in between the sulcus.
process of maxilla and occasionally at
horizontal plate of palatine bones. PAPILLARY HYPERPLASIA:-
Heredity, superficial trauma and This occurs as a result of ill fitting
malocclusion are responsible factors of denture, a low grade infection due to
tori[2]. It is composed of cortical bone, candida or due to palatal relief in the
some may also have cancellous bone. denture[2]. Appears as intensely red soft
The tori is classified into four types, polyploid masses of multiple papillary
namely flat, spindle, nodular and projection. It will resolve on its own,
lobular tori respectively based on their failing to heal, will be removed by
appearance.[1] surgical means like electrocautery,
The surgical removal of palatine torus laser, sharp excision and curettage with
indicated in traumatized overlying large rotary burs.
mucosa, speech and tongue
interferences, prosthodontic VESTIBULOPLASTY:-
reconstruction. Large , lobulated tori It is a procedure designed to restore the
with undercuts should be treated , ridge heights by lowering muscle
where dentists recommend smooth, attachment on buccal, labial and
broad based tori as insignificant[3]. lingual aspects of residual ridge[2]. It is
done to widen the denture bearing area.
SOFT TISSUE PROCEDURES:- There are different types of
HYPER MOBILE RIDGE:- vestibuloplasty , they are:-
This results from extensive ridge
resorption under ill- fitting denture KAZANJIAN
with unbalanced occlusion[2]. Seen in VESTIBULOPLASTY:-
anterior part as knife edged mandibular A mucosal flap pedicled from alveolar
ridge. Results from anterior ridge is elevated from the underlying
hyperocclusion of maxillary complete tissue and sutured to depth of vestibule.
denture against mandibular natural The exposed tissue is allowed to heal
teeth or class 1 removal partial denture. by secondary epithelization[1].
Bony augmentation should be done
before excision. The tissues should be CLARK’S VESTIBULOPLASTY:-
preserved[2]. Reflection of the In this, the flap was harvested from the
mucoperiosteal flap should be as lip. Horizontal incision is performed
minimal as possible to reduce bone from canine to canine between
resorption post-operatively[2]. If there immobile and mobile gingiva[1]. The
is excess of soft tissue in upper molar mucosa is sutured to the depth of
region ,at the tuberosity, removal is vestibule. The denued periosteum heals
facilitated using electrosurgery or by secondary epithelization. Healing is
sharp dissection. very fast.

EPULIS FISSURATUM:-
It is a hyperplasia of the sulcular
epithelium due to chronic irritation
from an ill- fitting denture[2] or due to CORN VESTIBULOPLASTY:-
resorption. The hyperplasia is in the

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Dr. Balakrishnan, et. al. 3755

It is similar to Clarke’s
[1]
vestibuloplasty . Horizontal incision
through soft tissue mucosa and
periosteum/mucoperiosteal flap is
exposed. It is not used much due to pain
and long duration of procedure.

SUBMUCOSAL
VESTIBULOPLASTY:-
It was first described by Obwegeser as
a method of choice of soft tissue
attachment on or near the alveolar crest
of maxilla. This is useful, when the
entire ridge is resorbed , but residual
bony maxilla is adequate for proper
denture support[3].

CONCLUSION:-
Preprosthetic surgery is a rapidly
changing area in dentistry[2].
Knowledge of the procedure, the
structures involved is essential for
receiving proper denture insertion.
When principles of case selection and
treatment plan is properly followed,
excellent results and patient
[3]
satisfaction are attained .

REFERENCES:-
1. Evolution of preprosthetic surgery
current trends: A review
Sahil Choudari, V Rakshagan,
Ashish R Jain
2. Preprosthetic surgery: A review of
literature
Haripriya Chari, Khadar Vali
Shaik
3. Preprosthetic surgery: A review of
literature
Prachi Madan Rohilla, Manish
Kumar, Ulfat Majeed, Akansha
Singh

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