Preprosthetic Surgery - Definition

• Rehabilitation of tissues
• Relieving biological interferences
• Repositioning of muscular attachments
• Restoration of alveolar ridge dimensions
• Re-establishing maxillomandibular relationships
• Satisfying aesthetics and function

Classification of Preprosthetic Procedures

I. RIDGE CORRECTION PROCEDURES

A. Hard Tissue (Osseous) Procedures

• Surgical reshaping/contouring of the alveolar ridge after tooth extraction
• Types:
  • Simple/Conservative alveoloplasty - smoothing sharp bony edges
  • Dean's alveoloplasty - removal of the interseptal bone with in-fracturing of cortical plates (most common technique)
  • Obwegeser's modification - interdental alveoloplasty preserving interproximal bone
  • Radical alveoloplasty - extensive reshaping in severe cases

• More extensive removal of alveolar bone
• Indicated when alveoloplasty is insufficient

• Genial tubercle reduction - mandibular genial tubercles that project into the denture-bearing area
• Mylohyoid ridge reduction - sharp mylohyoid ridge causing soft tissue ulceration
• Maxillary tuberosity reduction - bilateral maxillary tuberosities with fibrous/bony hyperplasia reducing interarch space

• Torus palatinus removal - midline palatal bony exostosis interfering with upper denture
• Torus mandibularis removal - lingual bony exostoses on the premolar region

• Removal of any other bony outgrowths on the facial/lingual aspect of the ridges

B. Soft Tissue Procedures

• Labial frenectomy (maxillary / mandibular) - removes/repositions a high labial frenum that impinges on the denture border
• Lingual frenectomy - releases a tight lingual frenum (ankyloglossia)

• Epulis fissuratum (denture granuloma) excision - fibrous hyperplasia caused by ill-fitting denture flanges
• Inflammatory fibrous hyperplasia removal
• Flabby/hyperplastic ridge reduction - excess mobile fibrous tissue on the crest of the ridge (commonly anterior maxilla)

• Surgical deepening of the vestibular sulcus to increase the height of the denture-bearing area
• Types:
  • Kazanjian's vestibuloplasty (lip-switch, submucous)
  • Clark's vestibuloplasty (secondary epithelialization technique)
  • Edlan-Mejchar vestibuloplasty (for the mandible)
  • Skin graft vestibuloplasty (using a split-thickness skin graft)
  • Transpositional flap vestibuloplasty

• Lowering of the floor of the mouth and repositioning of mentalis/buccinator muscle attachments
• Transpositional flap procedures

II. RIDGE AUGMENTATION PROCEDURES

• Adding bone to deficient ridges using autogenous, allograft, xenograft, or alloplastic material
• Commonly used sites: iliac crest, mandibular symphysis, calvarium, tibial plateau

• Splitting the atrophic ridge and placing bone graft within

• Alloplastic material placed subperiosteally to augment the ridge contour

• Gradual bone lengthening using a distraction device - used for severely atrophic ridges

• Lateral window (Caldwell-Luc) sinus augmentation
• Crestal (osteotome) sinus elevation
• Augments the posterior maxilla for implant placement

III. ENDOSSEOUS IMPLANT SURGERY

• Endosseous titanium implants (Branemark-type osseointegrated implants) as an alternative or adjunct to conventional prosthetics
• Immediate vs. delayed placement protocols

IV. SPECIAL SOFT TISSUE PROCEDURES

• Correction of inadequate zones of attached gingiva

• Cysts (dentigerous, residual, periapical)
• Retained root tips or foreign bodies

• Socket preservation / ridge preservation at the time of extraction (bone graft + membrane)
• Guided bone regeneration (GBR)

• For severe jaw discrepancies affecting prosthetic rehabilitation (e.g., mandibular osteotomy for severe atrophy - Obwegeser, Stoelinga modifications)

Summary Table

1. Alveoloplasty (Dean's technique - most common)
2. Torus palatinus / mandibularis removal
3. Frenectomy (labial/lingual)
4. Vestibuloplasty (Kazanjian's technique)
5. Maxillary tuberosity reduction
6. Epulis fissuratum excision
7. Sinus lift (for implant site preparation)