Dental Science - Review Article

Pre-prosthetic surgery: Mandible

Veeramalai Naidu Devaki, Kandasamy Balu, Sadashiva Balakrishnapillai
Ramesh1, Ramraj Jayabalan Arvind2, Venkatesan2

Departments of ABSTRACT
Prosthodontics,
Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form.
1
Periodontics, and 2Oral
Surgery, Vivekanandha
This is concerned with surgical modification of the alveolar process and its surrounding structures to enable
Dental College, the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic
Thiruchengode, India surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges.

Address for correspondence:

Dr. Veeramalai Naidu Devaki
E-mail: drdevaki_2005@
gmail.com

Received : 01-12-11
Review completed : 02-01-12
Accepted : 26-01-12 KEY WORDS: Alveolectomy, alveoloplasty, denture retention, pre-prosthetic surgery, undercuts

P re-prosthetic surgery is done to provide a better anatomic

environment and to create proper supporting structures for
denture construction.[1] Ultimate goal should be rehabilitation
bone loss differs in maxilla from mandible. In maxilla, the
usual resorption is on the buccal and inferior portion of the
alveolar ridge. The pattern of edentulous bone loss results in
of the patient with restoration of the best possible masticatory upward and inward loss of structures. In the anterior maxilla,
function, combined with restoration or improvement of there is less horizontal bone loss and posterior drift of anterior
dental and facial esthetics. To achieve this goal, maximum rest is seen more than in edentulous mandible. In the posterior
preservation of hard and soft tissues of the denture base is of maxilla, there is invented drift of posterior rest. The width of
utmost importance. Wearing dentures for prolonged period
maxilla is reduced.
manifests adverse changes in the denture-bearing areas due to
change in the size of the jaw bones resulting in ill-fitting and
painful dentures.[2,3] Pattern of Resorption – Mandible

Since the end of World War II, through the development of The mandible resorbs downward and outward, causing rapid
better materials, improved accuracy of processing techniques, flattening of ridge with greatest loss occurring within 12–
and better understanding of oral physiology, dental prosthesis 18 months after extraction.
has made great strides in increasing the successful use of
prosthetic appliances in edentulous patients. The pattern of Gross anatomic studies[4,5] of dried jaw bones have shown a wide
variety of shapes and sizes of residual ridges. In order to provide
Access this article online
a simplified method for categorizing, the most common residual
Quick Response Code:
Website: ridge form has been described[5]: Order I, pre-extraction; Order II,
www.jpbsonline.org post-extraction; Order III, high, well-rounded; Order IV, knife
edge; Order V, low, well-rounded; and Order VI, depressed. This
DOI: self-descriptive system is useful clinically as well as for research
10.4103/0975-7406.100312 purposes and helps one to differentiate the various stages of
residual ridge resorption in the individual patient.

How to cite this article: Devaki VN, Balu K, Ramesh SB, Arvind RJ, Venkatesan. Pre-prosthetic surgery: Mandible.
J Pharm Bioall Sci 2012;4:414-6.

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 Devaki, et al.: Pre-prosthetic surgery 

Pre-prosthetic surgery is an integral part of oral and maxillofacial bony process. This causes the margins of the mental foramen
surgery and prosthodontics. It comprises both basic procedures to extend and have very sharp edges. Pressure from the denture
and sophisticated techniques of reconstructions and against the mental nerve will cause pain. If, however, constant
rehabilitation of oral and maxillofacial region. The treatment irritation develops as a result of soft tissue being pinched
planning, therefore, should involve coordination between the between the denture and the bone, the spicules and the knife-
prosthodontist and oral maxillofacial surgeon. As the goal of edged ridge most be reduced.
the prosthetic appliance construction is to improve functions
and esthetics, the requirements to achieve these goals should be Removal of Sharp Ridge (or) Knife Edge Ridge
discussed by the team members. Good shell had recommended
the following criteria for a healthy and edentulous ridge:[6] Bony prominences, undercuts, and spiny ridges[5,6] are usually
1. The bony ridge should have adequate width and height and removed to avoid undercuts and to make possible a border seal
should be U-shaped for a denture to be retentive and efficient. beyond them against the floor of the mouth.
2. The oral mucosa should have adequate uniform thickness.
3. The ridge should not have any undercut (or) sharp ridges. A sharp knife edge like edentulous ridge causes great
4. No bony (or) soft tissue protuberance should be present. denture irritation. It is usually found in the anterior part of
5. Should have adequate buccal and lingual sulci depth. mandible.

Objective of Pre-prosthodontic Procedure Place an incision on the crest of the ridge and elevate
the mucoperiosteum as minimally as possible in order to
Correcting conditions that preclude optimal prosthetic maintain the vestiblular depth. Irregular and sharp bony
edges are trimmed to a depth of 1–2 mm with the help of
function
rongeurs, bone files, or burs, and the wound is closed with
silk sutures.
1. Hyperplastic replacement of resorbed ridges
2. Unfavorably located frenular attachments
3. Bony prominences, undercuts Reduction of Genial Tubercle

The genial tubercles are extremely prominent as a result of

Enlargement of denture bearing areas
advanced ridge reduction in the anterior part of the body of
mandible. If the activity of the genioglossus muscle has a
1. Vestibuloplasty
tendency to displace the lower denture, the genial tubercle is
2. Ridge augmentation
removed and the genioglossus muscle detached.

Placement of tooth root analogues by means of implants Genial tubercles are the bony projections located on the lingual
aspect of the mandible, two on either side of the midline,
Treatment Plan which gives attachment to the genial muscles. The two genial
tubercles located superiorly are more prominent than the
The prognathic patient frequently places considerable stress and inferior ones due to the gross resorption of the mandibular
unfavorable leverages on maxillary basal seat. This may cause ridge. This may elevate the ridge lingually, giving a shelf-like
extensive reduction of maxillary residual ridge. A mandibular appearance and making the anterior lingual seal impossible.
osteotomy of these cases can create a more favorable arch Genial tubercles are exposed by blunt dissection. Using bur,
alignment and improve cosmetics as well. chisel, or rongeurs, the tubercle is removed, and the rough bony
margins are smoothened using file.
Alveoloplasty
Ridge extension procedure
The bony prominences are removed by means of alveolectomy
and alveloplasty. Alveoloplasty is the term used to describe the Vestibuloplasty[7-9] is a surgical procedure wherein oral vestibule is
trimming and removal of the labiobuccal alveolar bone along deepened by changing the soft tissue attachments. Vestibuloplasty
with some interdental and interradicular bone and is carried out can be done either on the labial or on the lingual side.
at the time of extraction of teeth and after extraction of teeth.
Kazanjian’s technique
When surgery is planned on the edentulous ridge, incision
should be made on the crest of alveolar ridge; usually the An incision is made in the mucosa of the lip and a large flap of
envelope flap would suffice, but releasing incision can be labial and vestibular mucosa is retracted. The mentalis muscle
made on the labial side to provide broad base to the flap. Bony is detached from the periosteum to the required depth and the
contouring is accomplished with bone files, rongeurs, or burs. vestibule is deepened by supraperiosteal dissection. A flap of
Digital palpation can be used to determine the uniformity of the the mucosa is turned downward from the attachment of the
ridge. If bone resorption in the mandible has been extreme, the alveolar ridge and is placed directly against the periosteum to
mental foramen may open directly at the crest of the residual which it is sutured. A rubber catheter stent can be placed in

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 Devaki, et al.: Pre-prosthetic surgery

the deepened sulcus and secured with percutaneous sutures. supply is maintained. In this procedure, mandible is divided
This catheter helps to hold the flap in its new position and buccolingually by a vertical osteotomy from external oblique
maintains the depth of the vestibule. It is removed after 7 ridge of one side of the mandible to the other side. The
days. The labial donor site is coated with tincture of benzoin osteotomized lingual segment is pushed superiorly and fixed
compound, and the surface heals by granulation and secondary with the buccal segment using stainless steel wire in the lower
epithelialization. Contracture of the wound margins take border of the lingual segment.
place.
References
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resorption of free onlay bone graft. This technique is followed Source of Support: Nil, Conflict of Interest: None declared.
where the muscle insertion to the mandible and nutrient

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