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CD02: Denture anatomy: Aging and Surgical procedures

Complete denture clinic - visit no.-1, Pre-clinical assessment
by

Dr LAYLA A. ABU-NABA'A

on 18 October 2015

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Transcript of CD02: Denture anatomy: Aging and Surgical procedures

DENTURES: Relevant Anatomy
Goal
Identify and locate anotomical landmarks of an edentulous mouth on study models, impressions and dentures.
Understand anatomical variations and how aging affects these structures
suggest surgical procedures for patients to optimize denture bearing areas for denture therapy.

Lips

Dentures have many surfaces
fitting surface
Polished surface
teeth surfaces
To get a successful denture , we need to examine and design the denture to contact the tissue correctly ;
Intra oral
We Also may look at hard tissues, soft tissues, & histology
Muscles
cross sections
Histology
Dentures need oral structures to be suitable
Thank you
basal seat areas
border limiting areas
Dr Layla Abu-Naba'a, PhD, BDS, MFDRCSI
Prosthodontist

At the End of This Presentation You Will be Able to:
Extra oral
http://dentistry.cu.edu.eg/Files/CDJ/2008/september/415-420-3.pdf
Basal Seat area (vs. denture fitting surface)
Border seal area (vs. denture border surface)
Other structures

Basal Seat area
(vs. denture fitting surface)

Is Divided by Support/Relief
Border area
(vs. denture border surface)
LYMPH NODE GROUPS
MUSCLES
AROUND THE MOUTH
Loss of muscle tone
drop of moduluos (corners)
drop of nose
retraction of upper lip
lip vermilion thins

Vermilion Border
Denture provides lip support
Affects vermilion border width

MOUTH AREA
Extra Oral structures
Intra -Oral Structures:
Support structures
Relief structures
IN FUNCTION

TMJ & Muscles
FACE PROFILE
AGING AND SURGICAL PROCEDURES
Creases of face
Accentuation of naso-labial and labio-mental folds


Loss of lower facial height
Advancement of the mandible in relation to the maxilla- Cl III



General age changes:
reduced vision, hearing and taste
reduced muscular coordination
reduced comprehension
bone density reduction


Bone surgeries
Reductions
Bone surgeries
Additions
Soft tissue Surgeries
Other Surgeries
these are the most critical in terms of denture contact , and they are not stable with aging
Thus may need surgery
Weakness of muscles
possibility of TMD
Not all cases are ready for denture therapy because of
basic anatomical variations,
developmental structures
aging
loss of tissue by trauma, surgery..... ect.
These may affect dentures' retention, stability and support.
or disease
of different patterns of resorption are
Alveolectomy
bone nippler
bone files
Remove irregular interseptal bone
More regualr and uniform residual ridge
after multiple extractions
Clearence of teeth
in the upper
also burs trim irregular bone
Prominent premaxilla reduction of labial undercuts
Removal of palatal Tori
Palate becomes regular with no undercuts of irregulalrities that prevent denture adaptation
Depends on
Removal of Exostosis
interferes with denture insertion
Enlarged tuberosity is examined to determine
bony enlargement
soft tissue enlargement
Mandibular tori interfering with denture borders
Can be done with alveolar compression:
squeezing labial and palatal bone plates closer by finger
Knife edge reduction:
filing sharp bone after opening tissue flaps
Relocating mental nerve away from denture area
Mylohyoid ridge reduction
sharp bony at muscle insertion is made smooth
continuous muscle pull make bone grow in the direction of the pull, interfering with denture borders
muscle attachemnt is located downward,
External oblique ridge reduction
Genial tubercle ridge reduction
Bone added to either mandible or maxilla
reduces the loss of facial height
bone added to maxilla
increase support area
improves denture stability
Bulk addition by a block of graft material
sharp thin residual ridge
small block of bone
fixed by screws
into new location
or can be added as bone graft HA powder
Sinus lift, HA powder graft
Addition of implants for support
Avoiding extensive bone or tissue surgeries
Adding connective tissue graft to areas with low attached gingiva
Continuous maxillary or mandibular resorption leave very thin attached gingiva on the slopes of the residual ridges,
this increases movement of tissue and unseating of denture borders
Excision of palatal papillary hyperplasia
by blade shaving
or burs
or electro surgeries
Excision of fibrous flabby ridge
redundant tissue
Frenectomy:
buccal
Lingual
Labial
Excision of redundant soft tissue lesions
epulis
Excision of fibrous maxillary tuberosity
enlargement
combination soft tissue grafts with bone grafts
Excision of Epulis fissuratum
For dentures to be stable and retentive,
there must be sufficient ridge clearance from frenum action

labial frenectormy
Lingual frenectomy
Combination frenectomy with alveoplasty
Lip switch: increases the length of the lower labial vestibule
Buccal frenectomy
Removal of labial undercut by adding
HA graft
Removal of knife edge ridge by adding grafts
Large tongue interferes with denture stability
Surgical reduction of tongue size
Excision of mucocele
Excision and biopsy of soft tissue lesions
vestibuplasty
vestibuplasty
Transposition
Ridge Augmentation
Major Age changes
stay the same
need careful examination
Full transcript