Preprosthetic Surgery Research Articles

ALVEOLOPLASTIA, CIRURGIA PRÉ-PROTÉTICA PARA REGULARIZAÇÃO DE REBORDO ALVEOLAR MANDIBULAR: RELATO DE CASO

Surgical interventions may be necessary for the adequate adaptation of prosthetic devices, for example, in cases of irregular alveolar ridges, which generally appear after tooth extractions. Such changes make it difficult or even prevent satisfactory oral rehabilitation. In this sense, the present work aims to carry out a literature review as well as describe a clinical case report on pre-prosthetic surgery, aiming to regularize the mandibular alveolar ridge, through alveoloplasty. In short, pre-prosthetic surgeries allow for good seating of the prostheses, providing comfort and harmony with the other orofacial components. Therefore, alveoloplasty is safe and effective, whose ridge leveling allows significant success in oral rehabilitation, as it provides a well-adapted, stable and retentive prosthesis, consequently restoring aesthetics, chewing function, phonetic readjustment, well-being and quality of life to patients.

Comparison of the analgesic efficacy of spray and tablet flurbiprofen for pain after soft tissue surgery.

The aim of this randomized clinical study was to assess the comparative efficacy of flurbiprofen in tablet and spray formulations for postoperative pain management in oral soft tissue wounds undergoing primary closure while investigating the feasibility of achieving optimal analgesia with reduced dosage and risk. Forty patients who underwent epulis fissuratum and frenulum excision for pre-prosthetic surgery were randomly assigned to receive either tablet or spray forms of flurbiprofen. The lesion dimensions were measured preoperatively, followed by excision and primary closure. The tablet group received oral tablets containing 100 mg of flurbiprofen twice daily, whereas the spray group received an oral spray containing 0.25% flurbiprofen, administered as two sprays thrice daily. Postoperative pain was assessed using the Numerical Rating Scale (NRS) until the 7th day. Lesion size, drug consumption, and rescue analgesic use were compared between the groups. There were no statistically significant differences in the lesion size between the groups. However, the mean NRS score in the spray group was significantly lower in the spray group compared to than that in the tablet group at 6th hour postoperatively (p = 0.037). Significant differences favoring the tablet group were observed in the first three doses of the drug (p = 0.001). No patients required rescue analgesics. The spray formulation of flurbiprofen demonstrated effective and safe pain relief in oral soft tissue wounds undergoing primary closure, with no reported adverse effects.

Ndërhyrjet kirurgjikale në zgavrën e gojës para trajtimit protetik

Introduction: Not all patients have the proper anatomy to provide the adequate support for tissue-supported pros- thesis. In these cases, we suggest pre-prosthetic surgery as the best option which helps to provide a suitable prosthet- ic field. Materials and Methods: The study aims to provide a panoramic overview -illustrated with 2 clinical cases- of pre-prosthetic surgical interventions in 79 patients carried out in the Oral Surgery Service at the University Dental Clinic (KSU) in Tirana, from January 2021 to May 2023. Results: 58% of the patients who underwent preprosthetic surgery were female and 42% were male, with a predomi- nance of the 50-60 years old age group (32%). 45% of these patients had no associated pathologies, with the most fre- quent intervention being alveoloplasty in the mandibular region. Conclusion: Pre-prosthetic surgical interventions in hard tissues ensure an adequate prosthetic field. Accurate diagnosis and selection of a correct surgical treatment plan are prerequisites for successful treatment.

Preprosthetic Surgery—Narrative Review and Current Debate

Preprosthetic Surgery—Narrative Review and Current Debate

Oral Rehabilitation of Marginal Maxillectomy Patient After Local Flap Reconstruction

The treatment of oral cancer can lead to various oral complications, including oral defects, tissue deformation, and trismus in patients who have undergone oral cancer surgery with resection of any part of the maxillary. Restoring the ability to chew, swallow, and maintain esthetics is essential and a significant challenge. The aim of this study was to report a successful clinical case of preprosthetic surgery and prosthetic rehabilitation of a 65-year-old man who had undergone marginal maxillectomy, resulting in tissue scarring and a significant reduction in maximal mouth opening. The oral rehabilitation was achieved using a conventional removable prosthesis. This case demonstrates that preprosthetic surgery combined with conventional removable prosthesis is an effective strategy for complex rehabilitations providing functional and esthetic improvement in the affected area for patients with marginal maxillectomies resulting from oral cancer.

LASERS IN PROSTHODONTICS

Laser treatment in periodontal and oral surgery and in other disciplines in dentistry has replaced many traditional electrosurgical and scalpel procedures and is beginning to replace the dental handpiece. The successful construction of removable full and partial dentures mainly depends on the preoperative evaluation of the supporting hard and soft tissue structures and their proper preparation. Lasers may now be used to perform most preprosthetic surgeries. These procedures include hard and soft tissue tuberosity reduction, torus removal, treatment of unsuitable residual ridges including undercut and irregularly resorbed ridges, treatment of unsupported soft tissues, and other hard and soft tissue abnormalities. Stability, retention, function, and esthetics of removable prostheses may be enhanced by proper laser manipulation of the soft tissues and underlying osseous structure.

Surgical Excision of an Inverted-Y Frenum

Frenula of the oral cavity consist of the labial, buccal, or lingual frenum. They are folds of mucous membrane enclosing connective tissue. Clinically, an abnormal/aberrant frenum can pull the gingival margins causing recession, plaque accumulation, pocket formation, or midline diastema. Furthermore, in edentulous ridges, high frenal attachment can interfere with the denture margins affecting its stability. Frenotomy and frenectomy are common surgical approaches for such conditions. This case report highlights the frenectomy of inverted-Y frenula with a wide base as a means of preprosthetic surgery.

Mandibulanın Anatomisi, Embriyolojisi ve Mandibular Foramen’in Klinik Önemi

Sagittal split ramus osteotomisi, mandibular travma, benign ve malign lezyonların çıkartılmaları, preprotetik cerrahi, nervus alveolaris inferior’un lokal anestezisinde sinir hasarı ve olası diğer komplikasyonları önlemek için mandibulanın anatomisi, mandibular foramen’in lokalizasyonu ve anatomik varyasyonlarının bilinmesi oldukça önemlidir. Bu derlemenin amacı mandibulanın anatomisi, embriyolojisi ve mandibular foramenin lokalizasyonun klinik önemini ortaya koyabilmektir.

Navigation in oral surgery: a systematic review

Introduction: Dynamic navigation is a fast-growing technology in the field of head and neck surgery, which is now taking its place in oral surgery. The aim of this review was to present and describe all the uses of navigation in oral surgery. Materials and methods: A systematic review was conducted using all clinical trial/cases reports (Embase/PubMed) in which navigation is used during oral surgery, published over the last 5 yr. A total of 32 clinical trial/cases reports were analyzed. Results: Dynamic navigation was used in 7 different indications: implantology (55%), foreign body removal (15%), dental avulsion (12%), bone augmentation (9%), cellulitis (3%), benign tumour (3%), pre-prosthetic surgery (3%). A total of 335 patients were treated, 631 implants, 8 foreign bodies, 1 benign tumour, 24 dental avulsions, 3 bone augmentations, 1 cellulitis, and 1 pre-prosthetic surgery were found. In implantology, there were 500 standard implants, 75 zygomatic implants, 31 pterygoid implants, 1 short implant and 24 angulated implants. Conclusion: This review showed the recent development of dynamic navigation in oral surgery. The most common indication is dental implantology and few others indications seemed promising. This technique broadened its scope and might become an indispensable tool that can be used in many situations, increasing safety and predictability of a lot of procedure.

Opioid Prescribing Patterns of Oral and Maxillofacial Surgeons at a Single Academic Institution in Southern California - A 10-year Retrospective Study

According to the Centers for Disease Control and Prevention (CDC), nearly 500,000 people died from an opioid drug overdose from 1999 to 2019.1 CDC coined the term “opioid epidemic” and declared it a public health emergency in 2011. The American Dental Association (ADA) recommended NSAIDs as a first-line dental pain medication.2 Despite efforts from the ADA, JAMA Internal Medicine published an article that cited opioid prescriptions following dental procedures as a major contributor to the opioid epidemic in 2019.3 In this study, we investigated if opioid prescribing patterns by oral and maxillofacial surgeons after dentoalveolar surgery have changed over the last 10 years. We included a total of 4,149 patients who underwent dentoalveolar procedures with either IV general anesthesia or IV sedation from January 1, 2011, through December 31, 2021, at the Loma Linda Oral and Maxillofacial Surgery Clinic. There were 1,591 patients for wisdom teeth extraction, 2,195 patients for multiple teeth extraction (teeth number ≥ 2), 154 patients for implant placement, and 179 patients for preprosthetic surgery with or without other dentoalveolar procedures. The prescribed opioid pain medications per patient were converted to morphine milligram equivalent (MME). The changes in MME between 2011 to 2016 and 2017 to 2021 were evaluated using one-way ANOVA, χ2 testing, and linear regression analysis; age, gender, and ethnicity were considered. The mean MME in 2017 to 2021 (vs 2011 to 2016) was significantly decreased in 4 treatment groups (wisdom teeth extraction: 20.5 vs 7.9, P < 0.001; multiple teeth extraction: 21.6 vs 8.9, P < 0.001; implant placement: 22.5 vs 12.9, P = 0.001; preprosthetic surgery: 28.0 vs 11.2, P = 0.037). Linear regression of outcomes of MMEs in treatment groups of wisdom teeth extraction, multiple teeth extraction, and implant placement were shown to be statistically significantly decreased in 2017 to 2021 compared to that of 2011 to 2016 (unstandardized coefficient: -12.6, -12.6, and -9.77, respectively, all P < 0.001). This trend toward decrease in MME was maintained also in preprosthetic surgery (unstandardized coefficient: -14.8), but was not statistically significant (P = 0.059). Our study has demonstrated that oral and maxillofacial surgeons are appropriately responding to the recommendations set by both federal and state government.

Surgical and prosthetic rehabilitation of siblings with Witkop tooth and nail syndrome using zygomatic implants: a familial case series of 3 patients with up to 15-year follow-up.

Witkop tooth and nail syndrome is a rare, autosomal dominant type of ectodermal dysplasia that can have significant effects on dentition, including hypoplastic and malformed dentition and significantly atrophic maxillas. Endosseous implants have become one possible solution to replace missing teeth, although their use in areas where bone is sparse becomes challenging. Due to the severe atrophy of the maxillary alveolus, extensive preprosthetic surgeries including orthognathic surgery, extensive bone grafting, and sinus floor augmentations have been recommended prior to placement of endosseous dental implants. Although this treatment has shown favorable outcomes, it requires multiple surgical procedures, contributing to a prolonged treatment course and increased morbidity. An alternative treatment of atrophic maxillas in patients with ectodermal dysplasia includes the use of zygomatic implants. This familial case series discusses 3 siblings, all previously diagnosed with Witkop Syndrome, who underwent comprehensive preprosthetic surgery and prosthetic rehabilitation using zygomatic implants with a follow-up period up to 15years.

Z-frenuloplasty: A Versatile and Effective Technique

There are various cases where Z-frenuloplasty, a specific Z-plasty technique, can be used, including prior to mucogingival surgery, to manage localized recession defects, pre-prosthetic surgery, post-orthodontic treatment, oral hygiene and ankyloglossia, to name a few. This case series demonstrates the versatility of the Z-plasty technique in oral surgery/periodontal procedures for a variety of indications, as well as describing the technique in detail. The frenectomy technique using Z-plasty for the removal of the abnormal labial frenum attachment is reliable, easy to perform, and provides excellent aesthetic results for a range of indications. CPD/Clinical Relevance: An appreciation of the Z-plasty technique will allow for tissue healing by primary intention, reduces risk of tissue contractures, improves recovery time, and improves aesthetic results.

Awareness and Preference of General Dental Practitioners towards Pre-Prosthetic Surgery as an Adjunctive to Complete Denture Therapy

Awareness and Preference of General Dental Practitioners towards Pre-Prosthetic Surgery as an Adjunctive to Complete Denture Therapy

Application of allogeneic grafts for augmentation of the width of attached gingiva in pre-prosthetic surgery. A literature review

Introduction: Pre-prosthetic surgical procedures are intended to eliminate or improve any poor soft- and hard-tissue conditions in preparation of the prosthetic field. Vestibuloplasty continues to be regarded as a predictable and affordable procedure for increase of the prosthetic field, particularly in patients with removable dentures. With the introduction of dental implants, the need for pre-prosthetic surgical preparation of jaws has been considerably reduced, yet certain manipulations are still to be performed, such as increasing of the width of attached gingiva as well as correction of alveolar ridge defects using grafts. Aim: The aim of the present paper is to discuss some of the allogeneic grafts used in soft-tissue augmentation for the purposes of pre-prosthetic surgery, as well as their advantages and disadvantages. Materials and Methods: The present study relied on dental literature data, concerning the application of various allogeneic grafts for enlarging the width of attached gingiva in pre-prosthetic surgery, found in PubMed and Google Scholar, from 1910 to 2021, published in the English language. Results: The publications addressed in this review provide information on the clinical features of allogeneic grafts as a substitute for autogenous grafts, especially in cases where larger size grafts are required or where their harvesting may be limited by various factors. Conclusion: The application of autogenous grafts is supported by good clinical outcomes in the augmentation of the amount of attached keratinized gingiva. However, there are limitations associated with their harvesting. This necessitates the search for substitutes such as allogeneic or xenogeneic grafts, which could deliver similar clinical results.

Application of subepithelial connective tissue grafts in pre-prosthetic surgery and graft harvesting techniques. A literature review

Application of subepithelial connective tissue grafts in pre-prosthetic surgery and graft harvesting techniques. A literature review

Title:Preprosthetic Surgeries and its Protocol for Complete Dentures: A Review

Title:Preprosthetic Surgeries and its Protocol for Complete Dentures: A Review

Dermal Regeneration Templates in Maxillo-Facial District: A Multipurpose Aid.

Since 1980s, the use of dermal regeneration templates (DRT) for reconstructive purposes has been described in Literature.1 The authors present their experience of 13 patients treated with integra dermal regeneration template and a single-stage surgery for different indications like oncologic reconstruction, trauma injuries, and preprosthetic surgery in the maxillo-facial district.The authors retrospectively reviewed a total of 13 patients treated with DRT at Maxillo-Facial Department of S. Maria Hospital in Terni.Inclusion criteria included the presence of a defect nonapproachable primarily or by secondary intention with an easy locoregional flap reconstruction, a complete clinical record, and a minimum 6 months follow-up.A total of 12 patients underwent surgical reconstruction with DRT at the S. Maria Hospital from June 2018 to February 2020.During follow-up, all patients in which intraoral reconstruction was performed showed first signs of re-mucosization and neovascularization after 10 days.Only in 1 patient (8%) a seroma underneath the silicon sheet was observed. Afterward, the patient healed correctly with no other complications.Dermal regeneration template represents an option that should be considered in the head and neck district reconstruction, especially for intraoral defects where, thanks to its long-term functional results and limited alternatives, should represent a relevant choice.

Piezosurgery in periodontics: A new paradigm for traditional approaches: A review

Piezosurgery is a new method that uses piezoelectric ultrasonic vibrations to perform precise and safe osteotomies. It was first discovered by Tomaso Vercelotti to overcome the limitations of traditional instruments in oral bone surgery. Its use was first introduced in the field of preprosthetic surgery alveolar crest expansion and sinus grafting procedures. It is a favorable, scrupulous, and soft tissue sparing system for bone cutting based on low frequency ultrasonic microvibrations. The absence of macrovibration makes the instrument more feasible and allows greater intraoperative control with increase in cutting safety in the more difficult anatomical cutting zone. This article focuses on the broad range of applications of this novel technique in periodontology.

Comparison of Vestibular Depth Relapse and Wound Healing After Reconstructive Preprosthetic Surgery Using Cryopreserved Amniotic Membrane and Acellular Dermal Matrix - A Comparative Study.

Introduction:The significance of membranes as wound dressing in oral surgeries has been reported by previous studies. The aim of the present split-mouth randomized clinical study was to assess and compare the wound dressing properties of acellular dermal matrix (ADM) and cryopreserved human amniotic membrane (AM) after reconstructive preprosthetic oral surgery.Materials and Methods:Twenty-eight patients with complete mandibular edentulism and resorbed alveolar bone were included. After taking mandibular impression, a clear acrylic splint with increased labial flange height was created. In each participant, labial vestibular depth was elevated using the Clark's technique. Subsequently, half of the exposed periosteum was covered with ADM while the other half was covered with cryopreserved human AM. Vestibule depth and relapse in the two sides were measured immediately after vestibuloplasty and at the end of the 1st week, 2nd week, 1st month, and 3rd months with graduations of 0.1 mm. Furthermore, after 3 and 7 days, samples were collected from graft material, and the macrophage population was analyzed by flow cytometry.Results:There was no significant difference in the relapse of vestibule depth between the two grafts at different time intervals. However, the frequency of wound-infiltrating macrophages (CD68+ cells) was significantly higher in areas covered by ADM after 3 and 7 days.Discussion:ADM is as effective as cryopreserved AM in terms of maintaining the postoperative vestibular depth. On the other hand, our results suggested that the onset of healing phase in ADM-covered areas occurs faster compared to the periosteum covered with cryopreserved human AM. This clinical trial showed significantly faster postoperative healing onset when ADM was used than when cryopreserved human AM was applied on the periosteum.

Alveoloplasty: A Case Report of Recontouring The Alveolar Process

Alveoloplasty is one of the common pre-prosthetic surgical procedure carried out in dental surgical practice setups. A. T. Willard in 1853 advocated reduction of the alveolar ridge to bring about the complete proximity of soft tissues over the alveolus. Sir O. T. Dean first proposed “Intra-septal alveoloplasty” in the American Dental Association journal in 1936 so, named as Dean's alveoloplasty. The objective of Pre-prosthetic surgeries provide adequate bony tissue support for the placement of complete dentures. the characteristics of ideal denture base are adequate bony support with proper soft tissue coverage, no undercuts, no sharp ridges. Preprosthetic surgical treatment must begin with a thorough history and physical examination of the patient. The aim of the alveoloplasty procedure is used for recontouring of bony irregularities at the time of extractions or after initial healing. This case report illustrates case of a 71 year old healthy male. On examination who revealed irregular bony spicules on the edentulous ridge. After complete evaluation, alveoloplasty procedure was performed to smoothen the ridge. Proper diagnosis of the condition of edentulous ridges are important for successful fabrication of complete dentures. Every effort should be made to ensure that both the hard and soft tissues are developed in a form that will enhance the patient's ability to wear a denture.