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Title: preprosthetic surgery (soft tissue surgery) .


1
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2
PREPROSTHETIC SURGERY
  • (SOFT TISSUE SURGERY)
  • ????????
  • ???. ???????? ???????? 4409040

3
PREPROSTHETIC SURGERY
  • ???????????????????????????????
  • ??? ?????????????????????????????????????????????
    ???????? ?????????????????????????????????????????
    ????????????????????????????????

4
PREPROSTHETIC SURGERY
  • ????????????????????????????????????
  • ?????????????
  • ??????????????? U
  • ?????????????????????
  • Soft tissue ????????????? ?????????
  • Buccal , lingual sulci ??????????
  • ????? muscle fiber ??? frenum ????????????????????
    ???
  • ?????????????????????????????????????????????

5
PREPROSTHETIC SURGERY
  • ????????
  • Osseous surgery
  • - Alveoloplasty
  • - Reduction of tori and exostoses
  • - Ridge augmentation

6
PREPROSTHETIC SURGERY
  • 2. Soft tissue surgery
  • - Frenum ( frenectomy , frenotomy )
  • - Vestibuloplasty
  • - Inflammatory papillary hyperplasia of the
    palate
  • - Fibrous hyperplasia of alveolar ridge
  • - Epulis fissuratum

7
Soft tissue surgery
8
FRENUM
9
FRENUM
  • INDICATIONS
  • ????? frenum ??????????,??????????????? crest ???
    alveolar ridge ???????????????????
  • ??????????????????????????????????????????????????
    ??
  • ??????? diastema ????????????? frenum ???????????
    ???????????????????????
  • ????? frenum ??????? attached gingiva
    ?????????????????? ????????????????????

10
FRENUM
  • Labial frenectomy
  • Simple labial frenectomy ( Diamond excision )
  • Z - plasty
  • V-Y plasty
  • V - Diamond plasty ( Modified V-Y plasty )
  • Buccal frenectomy
  • Lingual frenotomy

11
LABIAL FRENECTOMY
  • Simple labial frenectomy ???? Diamond excision
  • ???????? frenum ??????????????
  • ???? ???????
  • ????????????????????????

12
Simple labial frenectomy
  • ??? hemostat ???????? 2 ??? ??? frenum
    ???????????????????????????? frenum
  • ??? blade No. 15 ??? frenum ?????????????
    hemostat ?????????????????????????????????
  • undermind ??????
  • ??????????????????? vestibule ?????????????
    periosteum ????????????????????????? mucosa
    ????????
  • ??????????????????????????? secondary
    epitalization ???

13
Simple labial frenectomy
14
Simple labial frenectomy
  • ????????? labial frenum ???????? ?? origin ???
    depressor septi muscle ??????????? central
    incisor ??????????????? orbicularis oris muscle
  • ??? blade ???????????? interseptal osseous tissue
  • ?? vertical cut ??? depressor septi muscle
  • ????????? muscle ??????? labial sulcus
    ??????????? periosteum
  • ?????????? iodoform ??? raw surface 1 ??. ???????
    surgical dressing

15
Simple labial frenectomy
16
Z - Plasty
  • ???????? frenum ?????????? ????????
  • ????????????????? frenum ?????
  • ????????????????????????????????????

17
Z - Plasty
  • ?? vertical incision ???? submucosal incision
    ???? undermind ???? 2 ??????? incision
  • ?? lateral incision ???????incision ???? ????????
    60 ????
  • ????????????????????? flap ?????? submucosa
  • ??? tissue forceps ?????? flap ????????????????
    ???????????

18
Z - Plasty
19
V - Y Plasty
  • ????????????????????? frenum
  • ?? Incision ?????????????? frenum ??????? V
  • undermind ???? incision
  • ???????? V ?????????????????? Y

20
V - Y Plasty
21
V - Diamond Plasty ( Modified V - Y Plasty )
  • ???????? frenum ???????????????????????? palatal

22
V - Diamond Plasty ( Modified V - Y Plasty )
  • ??? lip ?????? ???????????? frenum
    ?????????????????? V ?????? interseptal bone
  • ???? frenum ???????????????? ???????????? diamond
    shape
  • undermind ?????????? lateral ???????????

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BUCCAL FRENECTOMY
  • Buccal frenum ????????????? premolar
    ?????????????
  • ??????? V - Y plasty ???? V -diamond plasty

25
LINGUAL FRENOTOMY
  • Lingual frenum ?????????????? alveolar process
  • ankyloglossia ???? tonguetie

26
LINGUAL FRENOTOMY
  • INDICATIONS
  • ????????????????????????????????? ??????????????
  • ???????????????????????

27
LINGUAL FRENOTOMY
  • ?????????
  • ?? lingual nerve block 2 ???? , local
    infiltration ???????
  • ?? traction suture ??????????????????? 2-0
    ?????????
  • ?? transverse incision ??????????????? ventral
    surface ?????????? sublingual caruncles
  • deeper dissection ?????? lateral
  • genioglossus muscle ????????????????
  • ?? dissection ??????????????????????????????
    ????????? diamond shape , undermind ?????????? 2
    ????
  • ???????? interupted suture , ????? sublingual
    vein

28
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29
LINGUAL FRENOTOMY
  • COMPLICATIONS
  • ???
  • ????????????????????????????????
  • ??????????????????????????????

30
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31
SOFT TISSUE SURGERY
  • VESTIBULOPLASTY
  • ??????? vestibule ????????????????????????????????
    ?????? ????????? retention ??? stability
    ??????????
  • ??????????????????????????????????????????????????
    ??????????????????????????????? 12-15 ??.
  • ???????????????????? mental nerve

32
VESTIBULOPLASTY
  • Mucosal advancement vestibuloplasty ( Submucosal
    vestibuloplasty , Obwegesers technique )
  • Secondary epithelization vestibuloplasty
  • Kazanjians technique
  • Obwegesers technique
  • Grafting vestibuloplasty
  • Mucosal graft
  • Skin graft

33
MUCOSAL ADVANCEMENT VESTIBULOPLASTY
  • ?????????
  • Local infiltration ??? vestibule
  • ?? vertical incision ??? midline ??? vestibule
    (???????? periosteum) ???????? mucogingival
    junction
  • ??? dissecting scissor ??? mucosa ??????
    submucosa ????????????????? ????? vertical
    incision ??????????? canine ???????????? ????
    premolar ??????????????
  • ??????? submucosa ??????????????????? periosteum

34
MUCOSAL ADVANCEMENT VESTIBULOPLASTY
  • ??????? submucosa ????????????????
    ??????????????????? vestibule
  • ?? mucosa ????????? periosteum ???? stent
    ??????????????????????????
  • ??????????
  • ?????? stent ????????????
    circumzygomatic wiring , screw ??? palate
  • ?????????????? circummandibular wiring
    ??????? 10-14 ???

35
MUCOSAL ADVANCEMENT VESTIBULOPLASTY
36
CIRCUMFERENTIAL WIRING
  • A Small skin puncture is made beneath the
    mandible
  • Obwegeser awl is passed upward into vestibular
    sulcus
  • A wire/heavy nylon suture is threaded
  • Withdraw awl wire , keeping instrument in
    contact to the bone
  • Awl wire are passed upward into lingual sulcus.
    Disengage the wire and withdraw the awl
  • The denture or splint is placed and secure with
    the wire

37
CIRCUMFERENTIAL WIRING
38
SECONDARY EPITHELIZATION VESTIBULOPLASTY
  • ???????????????????????????? vestibule
    ????????????????????????????? mucosal advancement
  • Kazanjians technique
  • Obwegesers technique

39
KAZANJIANS TECHNIQUE
  • ?????????
  • ?? incision ??? mucosa ??? lip ?????? ?? flap
    ?????????????? labial ??? vestibular mucosa
  • Flap ?????????????????????????? supraperiosteal
  • ??? flap ??????????????????? vestibule ??????????
    periosteum
  • ??? rubber catheter????????? vestibule????????????
    ?? flap ???????????? skin ??????? ( percutaneous
    suture ) ??????? 7 ???
  • raw surface ?????? Tincture of benzoin

40
KAZANJIANS TECHNIQUE
41
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42
OBWEGESERS TECHNIQUE
  • ?? incision ?????? mucogingival junction
    ?????????? submucosa
  • ?? supraperiosteal dissection ???????? over
    correction ??????????? flap ?????? periosteum
    ???????????????? vestibule
  • ??? rubber catheter ????????? vestibule
    ?????????????? flap ???????????? skin ??????? (
    percutaneous suture ) ??????? 7 ???
  • raw surface ?????? Tincture of benzoin
  • ??????????????????????? ??????????????????????????
  • ??????????????? vestibule ???????????

43
OBWEGESERS TECHNIQUE
44
GRAFTING VESTIBULOPLASTY
  • Advantages
  • ????????????????????
  • ????????????????????
  • ????????? vestibule ??????????????????????????????
    ???

45
GRAFTING VESTIBULOPLASTY
  • ?? 2 ????
  • 1. Mucosal graft - ??? mucosal tissue
    ????????????????????????????????
  • 2. Skin graft - ?????????????????????????????????
    ?

46
MUCOSAL GRAFT VESTIBULOPLASTY
  • ??????????? vestibule ??????? labial ???? buccal
    ?????????
  • ?????????????????????????????
  • mucosal graft ??????????????????????????????

47
MUCOSAL GRAFT VESTIBULOPLASTY
  • ?????????
  • local infiltration ?? incision ??????
    mucogingival junction
  • ???? flap ???? supraperiostal flap
    ??????????????????????? ???????? flap ??????
    periosteum ???????????????? vestibule ????
    horizontal mattress suture
  • ???? mucosal graft ?????? blade No. 15 ??? 12
    ???? mucotome
  • ????? connective tissue ????????????????
  • ??? graft ????????????????????? raw surface
    ???????????

48
MUCOSAL GRAFT VESTIBULOPLASTY
  • ??graft ??????????????????????????????? raw
    surface ???????????? ???????? interupted suture
    ?????? silk 4.0 ??????? 5-0 polyglycolic acid
    suture
  • ?? graft ?????????????????????? 5 ???? ???????
    stent ?????????????????? circumferential wiring
  • ?????? donor site ???????????????????????????????
    ????????????????????????? oxidised cellulose
    ?????? stent
  • ???????????????????? reline stent ??? 2 ???????

49
SKIN GRAFT VESTIBULOPLASTY
  • PRINCIPLE
  • Skin graft ?????????????????????????????
  • Graft ??????????????????? graft ??????
    ??????????????????
  • recipient ( host ) area ??????????????????????????
    ???????? infection
  • ???????????????? recipient ( host ) area
    ???????????? graft
  • Graft ????????? periosteum
  • Graft ???????? raw surface ???????????????????????
    healing ?????????????????

50
SKIN GRAFT VESTIBULOPLASTY
  • ?????????
  • ?? split thickness skin graft ??? 0.0125 - 0.0150
    ???? ?????? dermatome ( ?????????????????? )
  • ????????????????? local infiltration??????
    submucosal incision ????? buccal
    ????????????????????????????????????
  • ??? supraperiosteal flap ??????????????
    periosteum???????????????? vestibule ??????
    percutaneous suture
  • ?? stent ???????????????????????? compound
    impression material

51
SKIN GRAFT VESTIBULOPLASTY
  • ?? skin graft ????? inner surface ??? stent
    ?????? Tincture of benzoin ???? dermatome cement
    ?????????????????????? ??????? circumferential
    wiring ??????? 1 ???????
  • ??? donor site ?????????????????? antibiotic
    dressing ??????? 10-14 ???

52
GRAFTING VESTIBULOPLASTY
53
INFLAMMATORY PAPILLARY HYPERPLASIA
  • Inflammatory hyperplasia of the palate , Palate
    papillomatosis , verrucous papillomatosis
  • ????????????????????? oral mucous membrane
    ?????????????
  • ??????? pt. ?????? complete maxillary denture

54
INFLAMMATORY PAPILLARY HYPERPLASIA
  • ???????????????
  • ???????????????? oral mucosa
  • painless
  • ????????????????? ?????????????, mucous ???
    bacterial debris
  • ??????????? velvetlike
  • dyskeratosis , premalignant
  • lesion

55
INFLAMMATORY PAPILLARY HYPERPLASIA
  • ??????
  • ????????????????????
  • ?????????????????????
  • Oral hygiene ?????
  • ???????????? palatal relief

56
INFLAMMATORY PAPILLARY HYPERPLASIA
  • ????????
  • ????????????? ???????????????????????? 1 - 2
    ???????
  • ?????????? ???????????????? submucosa ??????
    periodontal curette ???? electrosurgery
  • reline denture ???????? tissue conditioner
    ??????? stent ?????? 1 ??????? ???????????????????
    ????????????

57
FIBROUS HYPERPLASIA OF ALVEOLAR RIDGE
  • ???? dense connective tissue
  • maxilla - ???????? tuberosity
  • mandible - ???????? retromolar pad
  • ?????????????????? ??????????????

58
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59
FIBROUS HYPERPLASIA OF ALVEOLAR RIDGE
  • ?????????
  • ?? incision ??????? eliptical wedge ???? blade
    No. 15
  • ??? submucosal fibrous tissue ??????????? palatal
    ??? buccal ????? incision ????????????????
    ????????????
  • ??????????? interupted suture
  • ?????????????????????????????????????
    ??????????????????????????????

60
EPULIS FISSURATUM
  • ??????
  • Soft tissue ??????????????????????????????????????
  • ???? imflammatory hyperplasia ???
  • vestibular mucosa
  • ?????????????? ????????

61
EPULIS FISSURATUM
  • ?????????
  • local infiltration ?????????????
  • ??? tissue forceps ???? Allis forceps ??? ???
    blade ????????????????????? ??????? fold ?????
    ??????????????
  • ?????????????????????? 1 - 2 ???????
    ???????????????? ??? reline ????
  • ????????????????? ????????????????

62
REFERENCES
  • ?. ??????? ???????? ????????????????????????
    ??????????????????????????????? ( Preprosthetic
    surgery ) ,2546.
  • Starshak, T.J. Preprosthetic oral surgery,
    St.Louis. The C.V. Mosby Company 1971.
  • Waite, D.E. Textbook of practical oral surgery,
    Philadelphia. Lea Febiger 1978.
  • Archer, H.W. Oral and maxillofacial surgery
    volume 1, Philadelphia. W.B. Saunders Company
    1975.

63
???????????
  • ?. ??????? ????????

64
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