Preprosthetic surgery

The core problem in dental prosthetics is tooth loss. This may seem self-evident but in relation to preprosthetic surgery, it is the progressive loss of the residual alveolar bone (the bone that exists only to retain teeth) at the rate of 0.5 to 1.0 mm / year following tooth loss that generates difficulties. This results in a progressive loss of bone stock and secondary soft tissue support for any prosthesis. In order to compensate for this loss of soft tissue support and to maintain the occlusal vertical dimension (the distance the jaws should remain apart with the teeth lightly in contact) there is an increase in bulk of the dentures leading to further instability. After dental extractions, the initial healing of the extraction socket by secondary intention with the formation of myofibroblasts within the organising blood clot will also hasten this loss of bone stock. Finally, the pathological processes that have led to the initial loss of teeth may continue and so leading to the progressive loss of remaining teeth and / or supporting bone. The jaw without functioning teeth is trying to vanish back to the foetal jaw structure, a thin continuity of bone from jaw joint to jaw joint referred to as basal bone.

Taking the above observations into account, surgery for prosthodontics begins with the extraction of teeth and the removal of retained roots and unerupted teeth. The need to preserve alveolar bone is paramount and best achieved by a technique known as atraumatic exodontias including socket compression. Socket compression reduces any expansion of the buccal plate and reduces the residual blood clot within the socket.

The following pages summarise atraumatic exodontia and interventions in preparation for conventional prosthodontics and discuss some more specialised procedures in more detail.

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