JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 49-51

Preprosthetic surgery: An adjunct to complete denture therapy


Department of Prosthodontics, Bhabha College of Dental Sciences, Bhopal, Madhya Pradesh, India

Date of Web Publication24-Jun-2019

Correspondence Address:
Dr. Medha Vivek Bhuskute
FLAT NO.D-105, Coral Woods, Hoshangabad Road Bhopal - 462 026, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_6_19

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   Abstract 


Pre-prosthetic surgery is an integral part of Complete denture Prosthodontics. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges which would otherwise cause hindrance in restoration of optimum health and function. This case report discusses how reduction of severe bony prominences and smoothening of irregular ridges resulted in achieving a better denture foundation which if left untreated otherwise would have resulted in sore spots and immense discomfort to the patient.

Keywords: Alveoloplasty, bony prominences, preprosthetic surgery


How to cite this article:
Bhuskute MV, K Shet RG. Preprosthetic surgery: An adjunct to complete denture therapy. J Int Clin Dent Res Organ 2019;11:49-51

How to cite this URL:
Bhuskute MV, K Shet RG. Preprosthetic surgery: An adjunct to complete denture therapy. J Int Clin Dent Res Organ [serial online] 2019 [cited 2019 Oct 22];11:49-51. Available from: http://www.jicdro.org/text.asp?2019/11/1/49/260953




   Introduction Top


Preprosthetic surgery is done to provide a better anatomic environment and to create proper supporting structures for denture construction.[1] Lawson raised a question: “Why should it be assumed that a full denture is the one type of dental restoration for which the mouth is already perfectly designed?”[2] Significant enhancements can often be achieved by surgical preparation before denture construction. The main functions of preprosthetic surgery are the elimination of pathology in the denture bearing soft and hard tissues and ridge improvement.[3] To achieve this goal, the maximum preservation of hard and soft tissues of the denture base is of utmost importance.

All denture bearing hard and soft tissues should be evaluated with great care before denture construction. Surgical improvement of existing anatomy should at least be considered in every patient for whom a conventional prosthesis is planned.[4]

Objectives of preprosthodontic procedure[5]

Correcting conditions that preclude optimal prosthetic function.[5]

  1. Hyperplastic replacement of resorbed ridges
  2. Unfavorably located frenular attachments
  3. Bony prominences, undercuts.


Alveoloplasty[5]

The bony prominences are removed by means of alveolectomy and alveoloplasty.

“Alveoloplasty” is the term used to describe the trimming and removal of the labiobuccal alveolar bone along with some interdental and interradicular bone and is carried out at the time of extraction of teeth and after extraction of teeth.

When surgery is planned on edentulous ridge, incision should be made on the crest of alveolar ridge; usually, the envelope flap would suffice, but releasing incision can be made on the labial side to provide a broad base to the flap.

Removal of sharp ridge[2]

Bony prominences, undercuts, and spiny ridges are usually removed to avoid undercuts and to make possible a border seal beyond them against the floor of the mouth.

Place an incision on the crest of the ridge and elevate the mucoperiosteum as minimally as possible to maintain vestibular depth. Irregular and sharp bony edges are trimmed to a depth of 1–2 mm with the help of rongeurs, bone files, or burs, and the wound is closed with silk sutures.


   Case Report Top


An 81-year-old male patient reported 3 weeks after total extraction of remaining natural teeth for construction of a set of dentures. Intraoral examination revealed irregular, bulbous bony ridges with corrugated appearance. On palpation, the ridges were tender at some spots. The patient was advised gingival massage with a gum astringent, oral supplementation with multivitamins, and a diet plan was advised, which would fulfill the caloric requirements of the patient in the completely edentulous phase. A recall was scheduled after 2 weeks. On recall, not much improvement was found in the clinical picture [Figure 1] and quadrant wise surgical correction of the irregular ridges and bony prominences was discussed as the treatment option to achieve optimum denture foundation with the patient.
Figure 1: preoperative image of maxillary and mandibular edentulous arches

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Surgeries were conducted sequentially in maxillary left quadrant, maxillary right quadrant, followed by alveoloplasty in mandibular canine to canine region and lastly in mandibular left posterior region. A releasing incision was given in maxillary left quadrant as the envelope flap was not sufficient to gain access to the bony prominence [Figure 2]a and [Figure 2]b. It was crushed with bone rongeur and smoothened using bone file [Figure 2]c, and sutures were placed [Figure 2]d. For maxillary right quadrant an envelope flap was raised [Figure 3]a, smoothening of irregular ridges was carried out with bone file and sutures placed [Figure 3]b and [Figure 3]c. An envelope flap was used for mandibular canine to canine region [Figure 4]a and [Figure 4]b, and smoothening of ridge was carried out using rongeurs and bone file. A minimally invasive incision was given in mandibular left posterior region to expose a small bony prominence, smoothened, and suture was placed [Figure 5].
Figure 2: (a) sharp bony prominence seen clinically in maxillary left quadrant. (b) Releasing incision to expose bony prominence. (c) Bony prominence crushed with bone rongeur and smoothened using bone file. (d) Sutures placed

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Figure 3: (a) incision over crest of ridge, maxillary left quadrant (envelope flap). (b) Irregular residual ridge exposed. (c) Alveoloplasty done with bone file

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Figure 4: (a) envelope flap was used for mandibular canine to canine region. (b) Smoothening of irregular ridge carried out with bone rongeur and bone file

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Figure 5: minimally invasive incision was given in mandibular left posterior region to expose a small bony prominence

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Postoperative healing was satisfactory [Figure 6]a and [Figure 6]b. Maxillary and mandibular conventional complete denture prosthesis was then fabricated [Figure 7]a and [Figure 7]b.
Figure 6: (a) postoperative healing was satisfactory in maxillary arch, high well-rounded denture base foundation was ready. (b) Postoperative healing was highly satisfactory in mandibular arch

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Figure 7: (a) preoperative view of patient without prosthesis. (b) Postoperative image after insertion of conventional complete denture prosthesis

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   Discussion Top


The preparation of the patient's mouth before the placement of a denture (or prosthesis) is referred to as preprosthetic surgery. Some patients require minor oral surgical procedures before receiving a partial or complete denture to ensure the maximum level of comfort.[1] A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. One of several procedures that might be needed to be performed to prepare the mouth for a denture include bone smoothing and reshaping, removal of excess bone, and/or removal of excess gum tissue.[6] Every effort should be made to ensure that both the hard and soft tissues are developed in a form that will enhance the patient's ability to wear a denture. It is the responsibility of the practitioner to carefully evaluate and identify the need for any alteration of the denture-bearing areas and to educate the patient as to the importance of accomplishing this vital procedure.[7]

The placement of an incision on the crest of the ridge and elevating the mucoperiosteum as minimally as possible to maintain the vestibular depth was the chief concern in the mandibular anterior region.[5] Irregular and sharp bony edges were trimmed to a depth of 1–2 mm with the help of rongeurs, bone files, or burs, and the wound was closed with silk sutures.

Postinsertion problems such as pain, discomfort, sore spots related to irregular ridges and bony prominences were minimized by well-planned quadrant wise alveoloplasty procedure that were carried out in this case. Preprosthetic surgery thus served as an adjunct for the development of a denture foundation that enabled fabrication of a well-fitting and comfortable prosthesis.


   Conclusion Top


Proper diagnosis of the condition of edentulous ridges, discussing problems associated about the same with patient and proper treatment planning are the key determinants for successful fabrication of complete dentures. Minor oral surgical procedures (alveoloplasty) carried out in four steps served as an effective aid for the fabrication of well-fitting and comfortable prosthesis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Taylor RL. A chronological review–1960-1985 of the changing concepts related to modifications, treatment, preservation and augmentation of the complete denture basal seat. Aust Prosthodont Soc Bull 1986;16:17-39.  Back to cited text no. 1
    
2.
Lawson WA. Objectives of pre-prosthetic surgery. Br J Oral Surg 1972;10:175-88.  Back to cited text no. 2
    
3.
Hillerup S. Preprosthetic surgery in the elderly. J Prosthet Dent 1994;72:551-8.  Back to cited text no. 3
    
4.
Ephros H, Klein R, Sallustio A. Preprosthetic surgery. Oral Maxillofac Surg Clin North Am 2015;27:459-72.  Back to cited text no. 4
    
5.
Devaki VN, Balu K, Ramesh SB, Arvind RJ, Venkatesan. Pre-prosthetic surgery: Mandible. J Pharm Bioallied Sci 2012;4:S414-6.  Back to cited text no. 5
    
6.
Choudhari S, Rakshagan V, Jain AR. Evolution in preprosthetic surgery current trends: A review. Drug Invention Today 2018;10:2010-6.  Back to cited text no. 6
    
7.
Chari H, Shaik KV. Pre-prosthetic surgery: Review of literature. JSS Case Reports Rev 2016;3:9-16.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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