Before any surgical intervention, a treatment plan addressing the patient’s identified oral problems should be formulated. The dentist responsible for prosthesis construction should assume responsibility for seeking surgical
consultation when necessary. Long-term maintenance of the underlying bone and soft tissue, as well as of the prosthetic appliances, should be kept in mind at all times. When severe bony atrophy exists, treatment must be
directed at correction of the bony deficiency and alteration of the associated soft tissue. When adequate bony tissue remains despite alveolar atrophy, improvement of the denture-bearing area may be accomplished either by directly treating the bony deficiency or by compensating for it with soft tissue surgery. The most appropriate treatment plan should consider ridge height, width, and contour. Several other factors should also be considered: In an older patient in whom moderate bony resorption’ has
taken place, soft tissue surgery alone may be sufficient for improved prosthesis function. In an extremely young patient who has undergone the same degree of atrophy, bony augmentation procedures may be indicated. The role of implants may alter the need for surgical modification of bone or soft tissue. Hasty treatment planning, without consideration for long-term results, can often .result in unnecessary loss of bone or soft tissue and
improper functioning of the prosthetic appliance. For example, when there appears to be a soft tissue excess over the alveolar ridge area, the most appropriate Iong-term treatment plan may involve grafting bone
an alloplastic material, such as hydroxyapatite (HA), to improve the contour of the alveolar ridge or support endosteal implants. Maintenance of the redundant soft tissue may be found necessary to improve the results of
the grafting procedure. If this tissue were removed with out any onsideration of the possible long-term benefits of a grafting procedure, both the opportunity for. improved immediate function and the opportunity for long-term maintenance of pony tissue and soft tissue –
would be lost. This is especially true for conservation of gingiva and keratinized soft tissues, which provide a better implant environment.
Preprosthetic surgical preparation of the denturesupportingareas begins early in the treatment ‘sequence
It may be desirable to delay definitive soft tissue procedures until underlying bony problems have been adequately resolved. ‘ A deftriite decision-en the need’ for bony augmentation must be made before cOnsidering soft tissue surgery. If bony or alloplastic augmentation is indicated, maximal augmentation frequently depends on availability of adjacent soft tissue to provide tension-free coverage of th e graft. Soft tiss_
uesurgery should be delayed until hard tissue grafting and appropriate healing have occurred. However, when bone or alloplastic grafting or other, more complex treatment of bony abnormalities is not required, both bony and soft tissue preparation can be completed simultaneously. The patient’s health status must be carefully evaluated, because the surgery may require hospitalization, general anesthesia, donor-site, surgery, and more than one oral surgical procedure. The patient’s ability and willi,Dgness to undergo these surgical procedures, including possible long periods without dentures during healing phases should be considered.