Pre-prosthetic surgical procedures - Prosthetic dentistry
Pre-prosthetic surgical procedures
Before a (new) prosthesis is made, established dental abnormalities must be remedied by the surgeon or dentist.
X-rays may show root residues, impacted elements or foreign bodies such as amalgam residues. In addition, referral can take place for the investigation or treatment of pathological processes in the jaw bone or abnormalities of the jaw bone or gums that make it difficult or impossible to make the new prosthesis. A patient can also be referred for a relative or absolute increase in the jaw.
We will then briefly discuss the gum and jaw bone corrections that can be performed by the surgeon.
Irritation fibroid. Prolonged irritation due to sharp or too long edges can give a tissue reaction in the form of a fibroma. A fibroma is a benign tumor of the connective tissue, located directly below the gums. These swellings often disappear completely or partially after the cause has been removed. If this is not the case, they must be cut off at the base (see images below).
Fiber due to too long a prosthetic edge.
Fibroma. a Too long prosthetic edge can lead to irritation fibroids. b The therapy consists of cutting the fibroid and shortening the prosthetic edge.
Flabby ridgeof Schlotterkamm. Sometimes a loose gum comb remains after shrinking the jaw bone. We often see this occur in a toothless upper jaw with a natural residual tract in the lower front. The elements in the lateral parts of the lower jaw are absent. All the chewing force is transmitted by the much stronger lower front elements to the jaw wall in the upper front. Here we see extensively shrunken bone. Only a mobile gum comb remains. This is not a solid basis for a prosthesis. The flabby ridge needs to be corrected in such a way that the mucous membrane is tight again (see pictures below).
Flabby ridge. a Wedge-shaped excision. b The mucosa lies tightly over the jaw bone and is again a solid basis for a prosthesis.
Removal of a flabby ridge.
Bone corrections. Sometimes the shape of a jaw is such that making a prosthesis is difficult or impossible. This mainly has the following causes:
- Exostoses, bulges of the jawbone and sharp bone projections. Sometimes well-rounded thickening of bone occurs on the lingual side of the lower jaw and on the palatum to the left and right of the midline. These thickenings can be flattened and removed by an MKA surgeon with the aid of a technical angle piece and cutter.
- Bone combs.
- Bone undercuts. It may be that (usually) the upper jaw has undercuts that the prosthesis cannot be placed over. A better shape can be obtained by removing a little jaw bone in certain places.