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Epidemiology of Aging

• Elderly is defined as persons over the


age of 65.
Preprosthetic Surgery
• Between 1900 and 1990 the elderly
population increased from 3.1 million to
David L. Basi, DMD, PhD 31.1 million.
• Currently, one in eight Americans
consists of the elderly population.

Epidemiology of Aging Edentulous US population


• By 2030, one in five Americans will be elderly • 10% entire US population
(approximately 23% of the pop.).
• Considered on of the fastest growing age
• 35% of the 65 and older population
groups in the United States. (Some experts
believe that this is the only segment of the
population that is expected to grow
significantly in the future.)

Objective Ideal denture support:


1. Adequate bone height and width
• To create supporting oral structures for 2. “Fixed Tissue” under dentures
placement of partial or complete 3. Adequate ridge relationships
dentures 4. Adequate space between ridges
5. Adequate buccal and lingual sulci
6. Absence of redundant tissue
7. No obstructing frena or scar bands
8. No displacing muscle attachments
9. Adequate saliva

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Ideal vs atrophic
Ideal Denture Support: mandible
Broad Alveolar ridge

mucosa
Deep Lack of FOM or vestibular depth
Adequate FOM Vestibular depth

Mylohyoid mm

mandible

Resorption of Maxilla Atrophy of Edentulous Mandible

Patient Evaluation
• Evaluate maxilla and mandible for:
– Alveolar undercuts
– Palatal tori
– Mandibular exostosis
– Ridge relationship
– Ridge contour : broad vs. knife edge
– Ridge height and width

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Evaluate for Exostoses
Alveolar Undercut

Maxillary Tori

Evaluate for soft tissue problems


Evaluate Interarch
Relationships

Lingual fremum

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Class III
skeletal
relationship

Could be
secondary to over
closure of
mandible
(loss of VDO)

Surgical Preparation of Mouth for Prostheses Surgical Preparation of Mouth for Prostheses

Osseous surgery
•Alignment of jaws (Orthognathic Surgery) •Minor alveoloplasty (sharp areas)
•Adequate interarch distance
•Eliminate opposing undercuts
•Eliminate tori
•Removal of teeth (and roots)

Soft tissue surgery


•Release frena
•Thin fibrous tuberosities
•Preserve attached gingiva

Alveoloplasty/ Alveolectomy General Considerations for Preprosthetic


Surgery
•Simple (sharp edges)
-Primary
-Secondary •Most can be done w/ L.A.

•Interradicular (interseptal) •Advanced forms of pain control are helpful

•Radical •Patients are often old, infirm, and require workup and
•Horizontal or vertical problems monitoring
•Pre-radiation
•Restorative phase in 4 – 8 weeks postop
•Preserve Attached Gingiva!

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Simple Alveoloplasty Simple Alveoloplasty

Intraseptal Alveoloplasty Removal of Tori & Exostoses

Indications
•Chronic irritation
•Inability to construct prosthesis
•Periosteal attachment is
•Opposing undercuts
maintained
•Horizontal & vertical problems
•Alveolar height is preserved

•Alveolar width is lost

Removal of Tori & Exostoses Removal of Tori

Problems Use LA to help “balloon” thin lingual tissue


•Pneumatization of palatal torus
•Thin mucosa over tori Raising the flap is the most tedious portion

Remove Tori with:


•Surgical drill and fissure bur
•Osteotome and Mallet
•A combination of both

Assure a dry field and inspect wound before closure

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Removal of Lingual Tori Removal of Palatal Tori

Lingual

Removal of Buccal Exostoses Maxillary Tuberosity Reduction

Excess tissue in the maxillary tuberosity interferes with


denture construction

X-rays help delineate whether this excess tissue is soft or


bony.

X-rays also demonstrate pneumatization of the max sinus

Models are often helpful.

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Soft Tissue Surgery

•Release of Freni

•Thin Palatal Fibromatoses

ALWAYS design flaps to preserve attached gingiva

Frenectomy
Frenectomy

Z-plasty:

More useful for the


short vestibule

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Palatal papillary hyperplasia

Secondary to chronic denture irritation

Denture relief and oral antifungals can reduce the size


of the lesion.

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Palatal papillary hyperplasia Epulis Fissuratum

Treatment Options

Large rotary bur


Cryosurgery
*Laser Ablation

Post op splint or denture w/ liner is very helpful

Epulis Fissuratum The Immediate Denture

The denture can be considered a “temporary”

Mandibular immediate dentures are difficult

The Immediate Denture The Immediate Denture


Potential Problems
Remove all Max and Mand teeth except Max anterior
Bone trim is difficult without a clear stent
Perform necessary bone & soft tissue surgery
Immediates work better when fewer teeth are extracted
After adequate healing construct dentures
Don’t forget about tori, exostoses, & freni
Remove anterior teeth and insert dentures

Reline after remodeling occurs (1 – 6 months)

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Class III
skeletal
relationship
Needs
orthognathic
surgery to
correct skeletal
discrepancy

Complex preprosthetic
surgery

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Vestibuloplasty

Lowering the FOM

Preprosthetic Surgery

Complex “Preprosthetic Surgery” has been largely


obviated by the osseointegrated implant.

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Preprosthetic Surgery Mucosal Grafts

Many preprosthetic procedures are done today in support of


the implant.

Partial Thickness palatal dissection

“de-fat” the connective tissue side

Supraperiosteal dissection on the


mandible

Sew graft mucosa side up

Splints or a relieved denture can be


helpful

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