Is Denture Surgery Right For You?

About 20 percent of Americans have no teeth by age 60. All told, that equals about 30 million people. Dentures are the most common treatment for these people; however, it’s important to prevent them from rubbing on sharp areas of bone. That’s why it’s important to know about pre-prosthetic surgery, or surgery that happens before you get your dentures.

Types of Pre-prosthetic Surgery

1. Edentulation: This is when all the teeth in a given arch need to be removed. The extractions are done, and the sockets are cleaned out of any abscesses or debris.
2. Alveoloplasty: This is when the bone around the extracted teeth is smoothed so there will be no sharp ledges or bony projections that can poke through the gum causing denture sores and pain.
3. Alveolectomy: This is a procedure where part of the alveolar process or bone of the jaw is removed and smoothed to allow the denture to sit smoothly on the remaining bone. This involves more bone removal than the alveoloplasty.
4. Tuberosity reduction: This is when the bone in the upper jaw is too big for the denture and it must be reduced in size so the denture can fit over the back area of the upper jaw.
5. Tori removal: There can be bony projections in the roof of the mouth (torus palatinus) or inside the lower jaw (torus mandibularis). These often need to be removed since the denture can’t fit around these big knots of bone.
6. Soft tissue removal: When excess flabby tissue is present along the ridge, it must be removed. This can be called a gingivectemy, or excision of hyperplastic tissue. If people have worn ill-fitting dentures for long periods of time, the resulting flap or “epulis” is removed so the new denture has a smooth base to sit upon.

Here are some frequently asked questions about pre-denture surgery:

My denture makes me gag. Does that mean I should have had some surgery prior to the dentures?

Usually this means the denture was extended too far and needs to be trimmed. Soft palate surgery is rarely part of pre-prosthetic surgery.

I have sores constantly and feel big bumps of bone in the back that are raw. What can be done?

In the back of the upper jaw, the tuberosity is a large bump of bone. The denture constantly slides over this thin tissue, and if the bone is too prominent, it may need to be trimmed. Then the denture can be relined. The dentist will try to adjust the denture before performing the surgery. But if the denture is too thin (less than two mm), the bone should have been reduced prior to surgery.

I am tongue-tied; will this interfere with wearing dentures?

Having a piece of tissue that is prominent may not interfere with denture wear. But it may interfere with proper speech. To correct this, a frenectemy, or tissue trimming, can be done.

What might be causing the sharp pain under my denture on the bottom when I chew?

When people lose extensive amounts of bone in the lower jaw, the mental nerves can be exposed. This can lead to “zingers,” or sharp pain. The dentures can be adjusted and soft liners can be tried in the denture. This is not an indication for surgery.

My dentures keep falling out because I have very little bone and it’s really flat. What can I do?

There are two possible options. Pre-prosthetic surgery could be done to the tissues, sliding them back and up to expose more bone. The moving of tissue is called a vestibuloplasty; it may not be successful, but is an attempt to expose more bone for the denture to grab on to.

The second, more frequent option, is ridge augmentation to build up the bone so the denture has more to grab on to. This augmentation can be done with a person’s own bone, or with donated bone, soft tissue or a different grafting media. This may help to prevent the denture from sliding and may add to the retention of the dentures.

I had my dentures made, but my smile is too gummy and embarrasses me! What can I do?

When teeth are removed and the underlying bone is not trimmed, the dentures may not look good. Dentures must be at least two millimeters in width, and they sit on the bone. If healthy teeth are removed, the remaining bone is healthy. Placing two millimeters or more of acrylic over the remaining bone can lead to the denture teeth being placed too far above the ridge with an ensuing “gummy smile.” While maintaining this bone is wonderful for eventual implant placement, it can lead to cosmetic failure and embarrassment for the patient. This bone must be trimmed and new dentures made if the cosmetics are poor. If you have a “horsey” or gummy smile and your dentist cannot satisfy you, you are a likely candidate for pre-prosthetic surgery.