Pre-prosthetic surgery in PTA
Introduction :
The PTA is based on:
- The mucosa must be of good quality and sufficiently extensive.
- The bone must be regular and of sufficiently marked relief.
These conditions are not always present, hence the need to resort to pre-prosthetic treatment including surgery before the prosthesis is made.
Definition :
Consists of removing or correcting anomalies or provisions unfavorable to the retention, stability, assembly and wearing of the prosthesis.
It is applied to the mucous membrane or to the bone.
Contraindications :
Absolute:
- Severe heart disease,
- Blood disease and clotting disorders,
- Cancer patients and irradiated ENT patients,
- Major neurological impairment,
- Tuberculosis in progress,
- Renal and hepatic insufficiency,
- AIDS,
- Certain ongoing treatment: MAOI – major antidepressants – chemotherapy.
Relatives:
Pre- and post-operative precautions must be taken.
RQ:
Before deciding on pre-prosthetic surgery, it is necessary to give importance to:
- The patient’s condition.
- Age of the patient.
- Nutritional status of the patient.
- Patient motivation and cooperation.
- Hospitalization in the event of major procedures.
Goals :
- Facilitate integration.
- Prevent painful manifestations.
- Correct the relationships between the upper and lower muco-osseous ridges.
- Correct the relationships between the upper and lower bone bases.
- Obtaining a more extensive attached fibromucosa.
- Increase the support surface.
- Obtaining rounded, high muco-osseous crests.
- Creation of the vestibule sufficiently deep.
- Achieving a lower mouth floor.
- Remove obstacles for mounting teeth.
Requirements:
- Must be justified and economical.
- Always supplemented by tissue conditioning.
- General and necessary examination.
- General treatment still in place.
- Anesthetic premedication will be prescribed.
- Transitional prosthesis will be constructed before surgery, inserted immediately.
- The stitches should never create a state of tension between the two flaps.
Pre-surgical clinical examination of the edentulous:
Before proceeding with surgery, examinations are necessary, namely:
- Careful local clinical examination (shape, volume, consistency of the element to be operated on).
- X-ray examination: panoramic, retroalveolar, tomography, etc.
- Biological examination.
- Review of models I and creation of a PEI for the design of the retention template and the temporary prosthesis.
- These techniques concern the underlying mucosal and bone tissue and even the bone bases.
Interventions on the mucosal level:
Subtraction:
Brakes:
Insertion is located near the alveolar rim and which prevents the creation of the peripheral seal.
Tuberosities:
These are hyperplasias in the vertical direction and when they exceed the occlusal plane they prevent correct assembly and prohibit the insertion of a PTA, hence the need for plastic surgery.
Mucosal hyperplasia:
It is a thick growth at the mucosal level generally caused by an erroneous prosthetic edge or rough intrados, it can be inflamed or painful to the touch responsible for prosthetic instability.
Floating ridges:
Their surgical removal is only indicated if the floating tissue alters prosthetic stability (impression is not satisfactory).
Vestibular deepening:
As a result of bone resorption, the muscles and the mucosal reflection line are located near the crest or on the crest itself, causing prosthetic instability.
Reduction in volume of the retromolar papillae: anterior hyperplasia in the vertical direction and when they exceed the occlusal plane prevent correct assembly and prohibit the insertion of a PTA, hence the need for plasty.
Mucosal hyperplasia:
Disinsertion of the mylohyoid muscle:
Cut and lower the mylohyoid muscle near the internal oblique line toward the basilar margin to create a depression on the internal face of the horizontal branches, increase the height of the internal table, and remove the repulsive forces of the floor of the mouth muscles.
Additives:
Restoration of the oral vestibule by grafts.
RQ:
Surgery must be sparing, sutures must be performed without any tension responsible for resorption.
The prosthesis filled with delayed-setting resin is inserted immediately to protect the wound and guide healing.
8 days later remove the stitches and renew the resin.
Pre-prosthetic surgery in PTA
Bone interventions:
Subtraction:
Undercut:
If it opposes an insertion and the obtaining of an effective peripheral seal.
Tori:
Higher if it interferes with speech or destabilizes the prosthesis, if it prevents the establishment of an effective peripheral seal.
Inferior which creates a counter-cut and opposes the establishment of the sublingual seal.
Ridge regularization:
The bony protrusions of the ridges, sometimes multiple, painful to digital pressure, likely to cause ulceration of the mucosa by compression or friction, they are the result of successive extractions spaced out over time which prevent the addition of a false gum, thickness leads to lip protraction and hinders lip movements.
Remodeling of the genial processes:
If they are located at a level higher than that of the alveolar rim.
Hard retention and stability ensured.
Painful to palpation.
Reshaping the internal oblique line:
If it is painful or prevents extension towards the niches, we proceed to regularize this edge.
Included tooth, forgotten apex, DDS in bad position:
Indicated when there is a breach of the bone table or the mucosa, when it is asymptomatic, it is necessary to abstain from controls.
Remodeling of a tuberosity:
Plastic: prevents easy insertion by forming an undercut.
Additives:
- Increase the height of the crests by placing bone grafts of iliac or costal origin or bone substitutes. In the presence of large losses of bone substances (cysts, cancer, etc.).
Bone bases:
- Treatment of overbite:
- The aggression of the lower incisor-canine block due to the absence of antagonists results in a bite of the palatine mucosa which opposes insertion.
- Compensate for the offset of the bone bases: Which prevents prosthetic stability if it is very significant.
- Restore the prosthetic space: The prosthetic space is reduced or absent due to the egression of teeth without antagonists, with a disturbed PO, the egressed segment is raised and the PO is corrected and the prosthetic space is restored.
Post-operative care:
Analgesic for pain
Anti-inflammatory drugs for edema
Antibiotic for infection.
Since the appearance of delayed-setting acrylic plastic resin, pre-prosthetic surgical treatment has seen the number of its indications significantly limited.
But remains the most effective and rapid way to correct certain causes of failure that are difficult to resolve by conditioning tissue and neuro-musculo-articular.
Pre-prosthetic surgery in PTA
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.