Soft Tissue Abnormalities

5/28/2018 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)

Documents

Soft Tissue Abnormalities