Segmental Alveolar Surgery in the Partially Edentulous Patient
Supraeruption of teeth and bony segments into an.opposing edentulous area may decrease interarch space and preclude the construction of an adequate fixed or removableprosthetic appli.mr« in this area. ‘1Ill’ Ims of teeth in one 0arch may increase till’ difficulty of (JiJtaining a functional
and esthetic prosthetic appliance with prosthetic teeth located properly over the underlying ridge. Several altema- .tives exist to restore the dentition in these patients, including extraction of teeth in the mal positioned segment or repositioning-of these teeth with segmental surgery.
Preoperative considerations should include facial esthetic quality, an intraoral occlusal examination, panoramic and cephalometric radiographs, and modelsproperly mounted on an articulator. If segmental surgery is to be considered, the models can .be cut and teeth . repositioned in’ their desired location. The dentist responsible for final prosthetic restoration of the patient must ‘make the final determination of the placement of the segments on the articulated models. Presurgical .orthodontic preparation may be necessary to align teeth properly and allow proper segmental ‘positioning. After model surgery, a splint is fabricated to locate placement
of segments precisely at tbe time of surgery and to pro-
vide stability during the postoperative healing period. When possible the splint should be stabilized by contacting other teeth rather than resting on soft tissue. Palatal and lingual flanges on the splint should be avoided,
because pressure from the splint may interfere with blood supply important for the viability of the bone and teeth that were repositioned with segmental surgery. In construction of the splint must include contact
on the alveolar ridge tissue of the opposing arch to maintain the interridge distance. The patient’s deformity and the surgeon’s preference and experience dictate the specific surgical procedure performed. Segmental procedures for correction of abnormalities in the maxilla and the mandible are described in Chapter 25 and in other textbooks _(Fig. 13_43).35 A final fixed and removable prosthetic rehabilitation follows the surgical procedure and an adequate postoperative healing period