The prosthodontist, the oral surgeon, and the denture-supporting tissues

Abstract

Misunderstandings between oral surgeons and prosthodontists are preventing many denture patients from getting the best that these disciplines have to offer. These misunderstandings have resulted from misconceptions on each side. The oral surgeons know that the removal of undercuts in the residual ridges is desirable, so they proceed to shape the edentulous mouth like a complete crown preparation—tapered in all directions. Prosthodontists want as much bony support as possible and ideally much of this at right angles to the forces that are placed upon the denture bases. This concept means that considerable undercut can exist. The tissue resiliency and a complex path of insertion permits the construction and placement of dentures with fully extended flanges. On the other hand, prosthodontists have prejudiced views on bone surgery that are not based on facts. Removal of the cortical layer of bone does not interfere with normal bone healing and restoration of the total bony architecture. We have confused removal of the cortical layer of bone with the removal of the labial plate. There have been shortcomings on both sides. The prosthodontists have not used the services of oral surgeons to best advantage, and the oral surgeons have often removed valuable bony support. Landa 14 expressed it well when he wrote: “It must be emphasized that many full dentures are failures for the sole reason that alevolectomy was not performed prior to the construction of these dentures. This provides no excuse, however, for excessive surgery. If the patient has lost his teeth, he needs his ridges and he needs them badly.”