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Case Report
Preprosthetic Surgery: An Adjunct to Complete Denture Therapy
Medha Vivek Bhuskute , Lt. Col Ravi GK Shet
Department of Pre-prosthetic surgery is an integral part of Complete denture Prosthodontics. The
Abstract
Prosthodontics, Bhabha
College of Dental Sciences,
ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental
Bhopal, Madhya Pradesh, prosthesis by redesigning and smoothening bony edges which would otherwise
India cause hindrance in restoration of optimum health and function. This case report
discusses how reduction of severe bony prominences and smoothening of irregular
ridges resulted in achieving a better denture foundation which if left untreated
otherwise would have resulted in sore spots and immense discomfort to the patient.
Received: April, 2019.
Accepted: May, 2019. Keywords: Alveoloplasty, bony prominences, preprosthetic surgery
Introduction Alveoloplasty [5]
The bony prominences are removed by means of
P reprosthetic surgery is done to provide a better
anatomic environment and to create proper
supporting structures for denture construction.[1] Lawson
alveolectomy and alveoloplasty.
“Alveoloplasty” is the term used to describe the
raised a question: “Why should it be assumed that a full trimming and removal of the labiobuccal alveolar bone
denture is the one type of dental restoration for which along with some interdental and interradicular bone and
the mouth is already perfectly designed?”[2] Significant is carried out at the time of extraction of teeth and after
extraction of teeth.
enhancements can often be achieved by surgical
preparation before denture construction. The main When surgery is planned on edentulous ridge, incision
functions of preprosthetic surgery are the elimination of should be made on the crest of alveolar ridge; usually, the
pathology in the denture bearing soft and hard tissues envelope flap would suffice, but releasing incision can be
made on the labial side to provide a broad base to the flap.
and ridge improvement.[3] To achieve this goal, the
maximum preservation of hard and soft tissues of the Removal of sharp ridge[2]
denture base is of utmost importance. Bony prominences, undercuts, and spiny ridges are
usually removed to avoid undercuts and to make possible
All denture bearing hard and soft tissues should be a border seal beyond them against the floor of the mouth.
evaluated with great care before denture construction.
Place an incision on the crest of the ridge and elevate
Surgical improvement of existing anatomy should
the mucoperiosteum as minimally as possible to
at least be considered in every patient for whom a maintain vestibular depth. Irregular and sharp bony
conventional prosthesis is planned.[4] edges are trimmed to a depth of 1–2 mm with the help
Objectives of preprosthodontic procedure [5]
Address for correspondence: Dr. Medha Vivek Bhuskute,
Correcting conditions that preclude optimal prosthetic FLAT NO.D-105, Coral Woods, Hoshangabad Road
function.[5] Bhopal ‑ 462 026, Madhya Pradesh, India.
E‑mail: medhabhuskute@gmail.com
1. Hyperplastic replacement of resorbed ridges
2. Unfavorably located frenular attachments
3. Bony prominences, undercuts. This is an open access journal, and articles are distributed under the terms of the
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Website: www.jicdro.org For reprints contact: reprints@medknow.com
How to cite this article: Bhuskute MV, Shet RG. Preprosthetic surgery:
DOI: 10.4103/jicdro.jicdro_6_19 An adjunct to complete denture therapy. J Int Clin Dent Res Organ
2019;11:49-51.
© 2019 Journal of the International Clinical Dental Research Organization | Published by Wolters Kluwer - Medknow 49
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Bhuskute and Shet: Preprosthetic surgery: Aan adjunct to complete denture therapy
of rongeurs, bone files, or burs, and the wound is closed
with silk sutures.
Case Report
An 81‑year‑old male patient reported 3 weeks after total
extraction of remaining natural teeth for construction of a
set of dentures. Intraoral examination revealed irregular,
bulbous bony ridges with corrugated appearance. On
palpation, the ridges were tender at some spots. The
patient was advised gingival massage with a gum
astringent, oral supplementation with multivitamins, and
a diet plan was advised, which would fulfill the caloric
requirements of the patient in the completely edentulous
phase. A recall was scheduled after 2 weeks. On recall,
not much improvement was found in the clinical Figure 1: preoperative image of maxillary and mandibular edentulous
picture [Figure 1] and quadrant wise surgical correction arches
of the irregular ridges and bony prominences was
discussed as the treatment option to achieve optimum
denture foundation with the patient.
Surgeries were conducted sequentially in maxillary
left quadrant, maxillary right quadrant, followed by
alveoloplasty in mandibular canine to canine region and
lastly in mandibular left posterior region. A releasing
incision was given in maxillary left quadrant as the a b
envelope flap was not sufficient to gain access to the bony
prominence [Figure 2a and b]. It was crushed with bone
rongeur and smoothened using bone file [Figure 2c],
and sutures were placed [Figure 2d]. For maxillary
right quadrant an envelope flap was raised [Figure 3a],
smoothening of irregular ridges was carried out with c d
bone file and sutures placed [Figure 3b and c]. An
Figure 2: (a) sharp bony prominence seen clinically in maxillary left
envelope flap was used for mandibular canine to canine quadrant. (b) Releasing incision to expose bony prominence. (c) Bony
region [Figure 4a and b], and smoothening of ridge was prominence crushed with bone rongeur and smoothened using bone
file. (d) Sutures placed
carried out using rongeurs and bone file. A minimally
invasive incision was given in mandibular left posterior
region to expose a small bony prominence, smoothened,
and suture was placed [Figure 5].
Postoperative healing was satisfactory [Figure 6a and b].
Maxillary and mandibular conventional complete denture
prosthesis was then fabricated [Figure 7a and b].
a b c
Discussion Figure 3: (a) incision over crest of ridge, maxillary left quadrant
The preparation of the patient’s mouth before the (envelope flap). (b) Irregular residual ridge exposed. (c) Alveoloplasty
placement of a denture (or prosthesis) is referred to as done with bone file
preprosthetic surgery. Some patients require minor oral
surgical procedures before receiving a partial or complete of excess gum tissue.[6] Every effort should be made to
denture to ensure the maximum level of comfort.[1] A ensure that both the hard and soft tissues are developed
denture sits on the bone ridge, so it is very important in a form that will enhance the patient’s ability to wear
that the bone is the proper shape and size. One of several a denture. It is the responsibility of the practitioner to
procedures that might be needed to be performed to carefully evaluate and identify the need for any alteration
prepare the mouth for a denture include bone smoothing of the denture‑bearing areas and to educate the patient as
and reshaping, removal of excess bone, and/or removal to the importance of accomplishing this vital procedure.[7]
50 Journal of the International Clinical Dental Research Organization | Volume 11 | Issue 1 | January-June 2019
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Bhuskute and Shet: Preprosthetic surgery: Aan adjunct to complete denture therapy
a b
Figure 4: (a) envelope flap was used for mandibular canine to canine
region. (b) Smoothening of irregular ridge carried out with bone rongeur
and bone file
Figure 5: minimally invasive incision was given in mandibular left
posterior region to expose a small bony prominence
a b
Figure 6: (a) postoperative healing was satisfactory in maxillary arch,
high well‑rounded denture base foundation was ready. (b) Postoperative
healing was highly satisfactory in mandibular arch
The placement of an incision on the crest of the ridge
and elevating the mucoperiosteum as minimally as
possible to maintain the vestibular depth was the chief
concern in the mandibular anterior region.[5] Irregular
and sharp bony edges were trimmed to a depth of
1–2 mm with the help of rongeurs, bone files, or burs,
and the wound was closed with silk sutures. a b
Figure 7: (a) preoperative view of patient without prosthesis.
Postinsertion problems such as pain, discomfort, sore (b) Postoperative image after insertion of conventional complete denture
spots related to irregular ridges and bony prominences prosthesis
were minimized by well‑planned quadrant wise
alveoloplasty procedure that were carried out in this Financial support and sponsorship
case. Preprosthetic surgery thus served as an adjunct for Nil.
the development of a denture foundation that enabled Conflicts of interest
fabrication of a well‑fitting and comfortable prosthesis. There are no conflicts of interest.
Conclusion References
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