4/28/06

-PREPOSTHETIC SURGER
-WOUND: UNDERMINE TO PREVENT RELAPSE
-open wound, tear CT underneath so no TENSION when close wound
-If dont undermine hard to bring otgher white around margins cuz pulling scarring
relapse BAD
-High frenum att near ridge (dont undermine denture so get rid of it
-Same technique: 2 HEMOSTATS
-Dont cut inside cuz will get necrosis, cut on OUTSIDE!
-Little wound undermine so no tension
-notice difference in size:WHEN PUT STICTH NO TENSIOn!
-Best treatment for frenum: LASER (bloodless, less scarring\
-Tuberosity reduction: if tuberosity occlude with retromolar pad
-genreally FIBROUS NOT BONY **BOARDS**
-PANO so get accurate view of sinus to bone to tissue (not very much bone, all
FIBROUS TISSUE)
-miss tuberosity on exam so have MODELS
-Treatment: if tubersoity occluding with retromolar pad, do something to make
space ELLIPTICAL INCISION (similar to biopsy): undermining of wound margins
-Only difference from biopsy is that its NARROWER than for biopsy
-2 options: straight down, remove wedge, open up area to thin margin or
when make incision angle blade so thinning margin at same time cuz have to THIN
MARGINS ON EITHER SIDE
-Instead of straight down, 45 degree angle on both sides THINNING
MARGINS
-Periosteal elevator, pick up, filet on either side
-Either way:THIN THE FLAPS!
-Flaps thinned can bring it together (if have exposed bone pain)
-**BOARDS**: if taken away and still occlude with retromolar pad
remove retromolar being careful for LINGUAL NERVE (elliptical insion but watch for
lingual nerve)
-key: make incison straight down and strip off bone and filet or when make initial
incision make 45 degree angle to get rid of bulk on either side
1. straight down filet
-PAPILLARY HYPERPLASIA: bodys attempt to make denture more stable
1. Epulis Fissuratum
2. Papillary Hyperplasia
-as patient wear denture for long tim e bone wear away loose wobble
boen resorb more body fill up space with granulation tissue
-anytime TAKE ANYTHING OUT BIOPSY (PATHOLOGIST)

SUPRAPERIOSTEAL: so epithelium can reepithelize the palate (cobble stone

appearnc ein palate, movable, absolute solid stable tissue
-How get in to take out?
-Antral curette: triangle of metal to get up into palate to remove papillary palate
-Methods: antral currete, 15 blade, laser, electrosurgery
-GRANULATION TISSUE: LOTS OF BV; bleed more than normal
-Electrosurgery: loop that sends electricity through to supraperiosteally remove tissue;
-After supraperiosteal dissection reline with lynol or any soft bandage (doesnt hurt)
-RE-EPITHELIAZE: 10-12 DAYS
-Nice solid base for denture fabrication
-Epulis Fissuratum: granulation tissue biopsy
-around PERIPHERY to try to make denture stable
-remove and biopsy
-aka DENTURE GRANULOMA
-fibrous or RED (bleed like crazy) how long been there is only difference
-Get rid of all movable granulation tissue before dentures
-If fibrotic: wont bleed a lot (its beent here for LONG TIME)
-Vestibuloplasty with Secondary Epithelization:
-Denture against natural lower dentiotn pound maxilla (endentulous) - garbage
(need to create ridge + vestibule)
-take everything off, but leave periosteum for BLOOD SUPPLY
-SUPRAPERIOSTEAL DISSECTION
-suture where made cut and separated everything , put high in max vestibule
prevent relapse
-extendn border mold to where have flap suture, reline prevent relapse (
-Vestibuloplasty with secondary epithelization: clean everything out, let denture be
bandage, and let epithelize; not complicated, no bone graft
-natural teeth oudnign against upper denture lose bone body lay granulation tissue
in this space (no vestibule problem, but can move flabby tissue, so fte rid of garbage and
get nice oslid base : SUPRAPERIOSTEAL DISSECTION -> PATHOLOGIST
**BOARDS**: IF TAKING OUT TORUS IN MIDLINE OF MAXILLA AND
PERFORATE INTO HOLE YOU ARE IN NASAL CAVITY
-SINUS OVER TEETH , BUT IN MIDLINE IN NOSE; bad to remove maxillary torus
and see instrument in nose
-Some tori removed cuz so large when eat traumatize and constantly irritated
-Could be food trap
-2 incisions to remove torus:
1. Mandibular
2. Maxillary: OVER TORUS (MIDLINE); if large and need more room, add Y on
each end acts like releasing
-how take out? Mallet and chisel or surgical bur
-pts dont like you to use acrylic bur cuz whole head vibrates
-Post Op: gravity not our friend in maxilla so when take out torus gravity pull tissue
down
-Post OP: splint to prevent: infection, necrosis of flap, hematoma formation
-blood fill can cuase infection I palate or if flap pull away from palate necrose

-If no denture, have lab make SPLINT (allow for swelling or flap necrose from splint