Minor pre-prosthetic surgery

Extraction of remaining teeth

Careful extraction, compress socket, remove only small unattached pieces of bone, cover any exposed area of bone with gingival flaps and surgically remove roots only when necessary.

Consider interseptal alveolotomy if ridge is prominent and heavily undercut. Prominent fraena should be simply excised.

 

Retained roots, bone sequestrae

Remove using standard transalveolar technique. Maxillary canines can be removed using an osteoplastic flap—raising bone on a mucoperiosteal hinge.

 

Small bony irregularities

Can be smoothed with a bur, but consider ridge augmentation if extensive.

 

Fibrous (flabby) ridges

Reduce by raising a flap of attached gingival to repair the defect, excise soft tissue ridge, and replace flap.

 

Fibrous bands and irritation hyperplasia

Excise. Palatal mucosa grafts can be used to repair the defect and minimise scarring.

 

Tori

Reduce using a bur under a local flap. Mandibular tori can be removed with a chisel.

 

Muscle attachments

Can be repositioned to aid sulcus depth. Dissect away muscle and reattach in desired position…

 

Ridge augmentation

The use of subperiosteally injected porous hydroxyapatite is a technique which can be carried out under LA. A subperiosteal tunnel is raised along the crest of the ridge and filled with a hydroxyapatite/ saline sludge. This technique works best with concave ridges.

 

Sulcus deepening

This depends on dissecting away non-attached mucosa to leave raw ‘new’ sulcus. This area can be lined with skin or mucosa and secured with a ‘stent’ - a denture or baseplate lined with tissue conditioner or impression compound. This is held in place by nylon sutures for 10—14 days, then replaced immediately by a new denture with a soft lining extending to the new sulcus and worn continually for the first 3 months.                                                                                              

Only use surgery when denture faults and psychogenic disorders have been excluded. Screen jaws with a DPT. Aim to preserve as much alveolar bone wherever possible.