How can you improve a deepened jaw

The operative improvement of the prosthesis bed in the upper and / or lower jaw is called preprosthetic surgery.

Loss of teeth and lack of stress on the alveolar bone (jawbone) lead to atrophy (decline) of the bone. The flexible mucous membrane often reaches close to the alveolar ridge. The hold of prostheses is often unsatisfactory because the low bone height and the adjacent movable ginigva (gums) mean that the prosthesis is poorly seated and loosens quickly.

Deeply inserting ligaments in the area of ​​the vestibule (oral vestibule) or the frenulum of the tongue can also negatively affect the hold of prostheses.

Indications (areas of application)

Pre-prosthetic surgery serves to improve the prosthetic bed.
A well-fitting prosthesis makes a significant contribution to maintaining quality of life by restoring language, function and aesthetics.

The surgical procedures

Different methods are used to improve the hold of the prosthesis, depending on the situation at hand.

Disturbing tapes Lips, cheeks or tongue are surgically corrected so that they do not interfere with the prosthesis when moving and there are no painful pressure points.

If there is one Schlotterkamm (connective tissue transformation of the alveolar bone) or the presence of Flap fibroids (Irritant fibroids, edge hyperplasia of the prosthesis due to poorly fitting prostheses) is also the indication for surgical improvement of the prosthesis bed. In both cases, the removal of the excess tissue is usually combined with a vestibuloplasty (oral atrial plasty).

Corrections to the bone are necessary when sharp bone edges, exostoses (protruding bones), e.g. B. in the form of the torus palatinus (bone protrusion in the middle of the palate) or a strongly pronounced linea obliqua (bone edge on the outside of the lower jaw) disturb the prosthesis fit and lead to painful pressure points.

The Vestibuloplasty in the upper jaw is a surgical procedure to deepen the oral vestibule. This indirectly increases the alveolar ridge and improves the hold of the prosthesis. One distinguishes the open vestibuloplasty, in which the tissue is detached via a circular incision in the mucous membrane and sewn again cranially (above) from the closed method according to Obwegeser.

The disadvantage of the open method is the subsequently exposed periosteum (periosteum), which is left to the open granulation (healing wound). This can lead to more scarring and thus to a renewed loss of alveolar process height. Alternatively, these bodies can also go through free mucosal grafts, for example from the palate, to avoid this.

With the closed method according to Obwegeser, the mucous membrane is tunneled and the underlying soft tissue and muscles are shifted cranially (above).

In the lower jaw, in addition to the vestibuloplasty, the floor of the mouth often has to be loweredto improve the prosthesis fit over the long term. The floor of the mouth, the mylohyoid muscle and the vestibule are shifted caudally (below). Here it is extremely important to pay attention to the course of the mental nerve (lower jaw nerve).

If the floor of the mouth is to be deepened, especially in the rear area, a retromolar lowering of the floor of the mouth can be carried out. The mucous membrane of the floor of the mouth and the insertion of the mylohyoid muscle are shifted caudally (below).

Following the above-mentioned methods of vestibuloplasty or lowering the floor of the mouth, either the previously extended (lengthened) prosthesis or a bandage plate is used until the situation has healed enough for a new prosthesis to be made.

Further information on vestibuloplasty

  • The procedure is an important therapy option in implantology. It serves to widen the so-called "attached gingiva" (attached gingiva; attached gums) or the fixed mucosa (oral mucous membrane) in the area of ​​the implant and thus offers lasting protection against peri-implantitis (inflammation of the bony bed of a dental implant with peri-implant bone loss ) [3].

literature

  1. Koeck B (Hrsg): Total dentures: Praxis der Zahnheilkunde Volume 7. 4th edition Urban & Fischer Verlag / Elsevier GmbH 2005
  2. Gutwald R, Gellrich NC, Schmelzeisen R: Introduction to Dental Surgery. 1st edition Urban & Fischer Verlag / Elsevier GmbH 2003
  3. Raff A: Vestibulumplastik, an independent service The free dentist Edition 3/2021 Print ISSN: 0340-1766 Electronic ISSN: 2190-3824 doi: https://doi.org/10.1007/s12614-021-0039-2

     
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