Preprosthetic Surgery & Tori Removal

1. Preprosthetic Surgery & Tori Removal May 2, 2008 Alex Isom

2. Cuspid Removal • In order to preserve the canine eminence, an alveolectomy is required • Selective removal of the buccal plate • Remove 1/3 of the buccal plate • This will remove the support and give a better crown: root ratio

3. High Frenum Attachment

4. Frenectomy • The diamond technique • Using two hemostats, secure the frenum adjacent to the gingiva and adjacent to the vestibule • Cut on the outside of the hemostats to avoid leaving crushed tissue in place • The key to healing is to open up the submucosal tissue

5. Frenectomy • If you close the wound in its present state, a scar will form, and you will lose what you have attempted to accomplish • Undermine the wound to prevent scar formation • This will ensure a tension-free wound

6. Frenectomy • You can use a laser as well

7. Fibrous Tuberosity Reduction • Key- Undermine the wounds • Make an elliptical incision (similar to a biopsy), with an undermining of the wound margins • It is narrower than a biopsy • Keep it narrow otherwise it won’t approximate

8. Fibrous Tuberosity Reduction • There are two approaches to reducing the tuberosity • 1. Cut straight down to bone and then filet either side of the wound Or • 2. Incise at a 45° angle, thinning the tissue at the same time

9. Papillary Hyperplasia • A supraperiosteal excision • Methods of removal include: • Antral curette • Instrument used to clean out the maxillary sinus of polyps, but works adequately here • 15 Blade • The most common method • Laser • This is less bloody and heals quicker • Electrosurgery • The patient should have less pain and discomfort

10. Epulis Fissuratum • Yet another attempt by the body to stabilize the denture • Whatever you remove, should be biopsied just to be sure

11. Vestibuloplasty with Secondary Epithelization • We must worry about relapse • After exposing the vestibule, send the excess tissue out for biopsy • To prevent relapse: • Tack it down with sutures • Take the old denture, reline it with Lynal and extend the flanges to secure it in place • Let it heal for 10-14 days in place

12. Secondary Epithelization • This procedure simply removes the redundant tissue • The vestibule is already present, however it is filled up with gar-bawje • Yet another supraperiosteal dissection • Let it heal with the denture in place for 10-14 days to act as a Band-Aid

13. Maxillary Tori Removal • NBDE II • Be aware of the midline anatomy • If during removal of palatal torus and you perforate into a cavity, you are in the NASAL CAVITY • The maxillary sinus lies over the teeth • It’s pretty bad to remove a maxillary torus and see an instrument in nose

14. Incision • Linear • Make an incision directly over the torus • Linear with a release at each end • If the torus is larger, make releases at each end and don’t suture the releases afterwards

15. Removal • Mallet and Chisel • Monobevel • Surgical bur • You can use these to make depth cuts like in Crown and Bridge • Patients generally don’t like this because it causes their whole head to vibrate

16. Post Op: Splint to Prevent • Infection • Necrosis of the flap • Gravity will pull the flap down and remove the blood supply • Hematoma Formation • The body will attempt to fill in the space creating a hematoma and a great place for bacteria to invade

17. Post Op: Splint to Prevent • In the dentate patient, the splint should have retention features built in • In the edentulous ridge, drill holes in the splint and suture the splint in place • Make sure the lab leaves a space one base-plate thick to allow for post-op swelling