Soft Tissue Abnormalities
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Transcript of Soft Tissue Abnormalities
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Soft Tissue abnormalities
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Soft Tissue Abnormalities
Maxillary Tuberosity reduction (soft Tissue)
Mandibular retromolar pad reduction
Unsupported Hypermobile tissue
Lateral Soft tissue excess
Inflammatory fibrous hyperplasia
Labial frenectomy
Lingual frenectomy
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Cross-section of the
Mandible
With age, loss of teeth,
the bone melts awayyet the muscle
attachments remain in
place
Most common cause of
unstable denture
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General considerations
When to commence impressions
Soft Tissue procedure3 to 4 weeks
Osseous procedures6 to 8 weeks
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Maxillary Tuberosity reduction (soft Tissue)
Aim: Provide adequate interarch space
Diagnostic aids:
Panoramic radiograph
sharp probe
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Technique
Incision
Elliptical
Width~ depth of tissue
Secondary undermining cuts
Allows tension free closure
Removes excessive tissue
Use digital pressure to approximate tissues
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Mandibular retromolar pad reduction
Rare
Elliptical incision
More tissue excised from the buccal/labialaspect
Avoid excising lingual tissue
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Unsupported Hypermobile tissue
Causes:
Resorption of underlying bone
Ill fitting dentures
Both
Diagnose the cause:
bony deficiency- Augment the underlying bone
adequate bone height exists-excise soft tissue
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Hypermobile tissue
Maxillary Anterior
Parallel horizontal incisions
Undermine
Excise
Mandibular Anterior
Simple scissor incision
Disadvantages Loss of vestibular height
eliminates keratinized mucosa
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Flabby Ridge
This occurs when you have natural teeth
occluding against denture teeth
Bone disappears and the body fills the space
with flabby tissue
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Inflammatory Papillary Hyperplasia
PAPILLARY HYPERPLASIA: the body attempts to make
the denture more stable
1. Epulis Fissuratum
2. Papillary Hyperplasia
As patients wear dentures for a long timethe bone
wears awaythe denture become looseit
wobblesthe bone resorbs morethe body fills
up the space with granulation tissue
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Epulis Fissuratum
Forms around the periphery ofthe denture
Soft, movable, poor base fordenture
Appearance
single or multiple fold of tissuethat grows in excess around thealveolar vestibule
The edge of the denture rests inbetween two of the folds
The excess tissue is firm andfibrous in nature
Ulcerations may be present
http://www.usc.edu/hsc/dental/PTHL312abc/Diseases/IMGs/15/014bb.html -
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Epulis fissuratum
Etiology- Ill fitting dentures
Problem
Underlying connective tissue hyperplasia and NOT
that of the epithelium
Small lesions
Tissue conditioner
Larger lesions
Surgical excision
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Total Excision/Secondary epithelialization
From crest of ridge to vestibular depth
Hyperplastic soft tissue is excised superficial to periosteum
from the alveolar ridge area
Unaffected mucosal margin is sutured to most superior
aspect of vestibular periosteum with interrupted sutures
Surgical stent with tissue conditioner/denture
Worn for 5-7days continuously
Epulis fissuratum
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Epulis fissuratum
Send tissue for biopsy
Disadvantages
Shrinkage of vestibule
Can be avoided by grafting
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Papillary Hyperplasia
Causes: Seen beneath ill-fitting dentures of long use
Overnight denture wearers
Clinical Presentation:
Combination of chronic, mild trauma and low-gradeinfection by bacteria or candida yeast.
Patients with high palatal vaults
Mouth breathers
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Papillary Hyperplasia -Treatment
Early stage
Tissue conditioning
Relining of dentures
Late stage
Surgical excision
Electrosurgical loop
Scalpel or loop blade
High speed diamond, acrylic or bone bur
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Papillary Hyperplasia
Complications of Deep excision
Bone necrosis
Atrophic, non elastic, fixed mucosa
Denture irritation ulcers
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Papillary Hyperplasia- Use of
Electrosurgery
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Labial Frenectomy
Anatomy
Level
Problems
Types of Techniques
The simple excision
Z-plasty
Localized vestibuloplasty with secondaryepithelization
Laser assisted frenectomy
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Simple Frenectomy
Indications : Narrow frenum
Local Anesthesia- Avoidexcessive infiltration
Incision- Narrow elliptical incision
Incision is made down to theperiosteum
Sharp dissection of
underlying periosteum
Dissect fibrous frenum
Suture placement
Advantages-reduceshematoma formation
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Z-plasty technique
Similar to simple frenectomy
Two oblique incision are made in a
Z fashion Undermine two pointed ends
Rotate to close vertical incision
Advantages
Less chances of Vestibular
obliteration
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Use of laser in frenectomy
No sutures
Fewer post operative complains
Less Swelling
Little or no pain
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Lingual Frenectomy
Anatomy-
Mucosa
Dense fibrous tissue
Superior fibers of genioglossus muscle
Binds tip of the tongue to posterior surface of
mandibular ridge
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Lingual Frenectomy
Affect Speech
Interfere with denture stability
Technique
Stabilize tongue with traction suture
Transverse incision of fibrous connective tissue at the base
o the tongue
Hemostat is placed across the frenal attachment at the
base of the tongue
Undermine tissues
Sutures placed parallel to midline of tongue
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Lingual Frenectomy
Structures to be careful of
Blood vessel
Whartons duct
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Lingual Frenectomy
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Localized vestibuloplasty with secondary
epithelialization
Indication: Base of the frenalattachment is extremely wideeg. Manibular anterior frenum
Local anesthesia: Infilterate the supraperiosteal
areas along the frenal attachments
Incision:
Mucosa, underlying submucosal
tissue SPARE the periostium
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Technique
Supraperiosteal dissection
Edge of the mucosal flap is sutured to the
periosteum at the maximal depth of the
vestibule
Exposed periosteum heals through secondary
epithelization
Surgical splint or denture with tissue liner is
very useful for initial healing period
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Immediate Dentures
Most commonly performed by GP(Prosthetics/surgery done by GP)
Surgery to be done by OMFS depending oncertain factors:
Complexity
Length of case
The older the patient, the more dense the bone, the longer ittakes to get the teeth out.
Anxiety level
To many women, this is a sign of aging which will cause them tobecome more anxious, thus requiring i.v. sedation
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Immediate Dentures
Preoperative stage Models- undercuts, tuberosity occluding with retromandibular pad
Mounted models are not required anymore
Operative stage
Phase1 1. Posterior extractions Phase2-
2. Anterior extractions
3.recontouring
4. surgical guide
5.suture
6.Insertion Postoperative stage (after 24hours)
Adjustments More adjustments on an immediate denture
The bone will remodel itself
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Immediate Dentures
Advantages:
Immediate psychologic & esthetic benefits
Functions as a splint
Improves tissue adaptation Vertical dimension can easily be reproduced
Disadvantages Frequent alterations
Cost
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Overdenture Surgery
Maintenance of Alveolar bone
An overdenture technique attempts to
maintain teeth in alveolus by transferring
force directly to the bone and improving
masticatory function with prosthetic
reconstruction Peterson
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Indications
Several teeth with adequate bone support
Good periodontal health
Teeth are restorable
Bilateral canines
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Overdenture
Advantages
Improves propriception during function
Improves Retention (retentive attachments)