Technique to Manage the Enlarged

Maxillary Tuberosity in Elderly

Edentulous Patients Requiring
Dentures

Mohammad Hosein Kalantar Motamedi, DDS,* and

Mojdeh Kalantar Motamedi

J Oral Maxillofac Surg

69:1283-1285, 2011
Enlarged Maxillary Tuberosity

= bony excess or a remaining third molar

impaction Tuberoplasty is 1 of the most

common >< problematic in elderly people

and those with rarefaction or osteoporosis

Treatment removing the maxillary cortical
bone
Effect elderly patients, especially those
with osteoporosis: exposure of the
rarified bone marrow, irregularities
under the mucosa, pain under the
denture, irregular postsurgical bone
resorption, alveolar deformity, and
loss of denture retention
The technique:a composite osteoplastic flap
the thin overlying bone

Surgical Technique
BONY EXCESS
Large edentulous bony maxillary
tuberosities can be reduced in width with
little or no reflection of the bone flap and
without exposing the buccal aspect of
the tuberosity
 local anesthesia
a paracrestal palatally placed incision is
made from behind the tuberosity that
extends anteriorly past the undercut
requiring treatment
access is obtained for the removal of a
wedge of crestal bone between the
buccal and palatal cortices using a
piezoelectric device
a triangular wedge of crestal bone is
removed
...
After the bone is cut vertically, the buccal
cortex is in-fractured manually
Several sutures are placed (2-0 or 3-0 silk
are sufficient to hold the flap in place).
Sutures are removed 7 to 10 days
postoperatively.
FIGURE 1. Schematic representation of the technique used for
reduction tuberoplasty of a large bony tuberosity.
Axial view (top), coronal view (bottom).
(Motamedi and Motamedi. Managing Enlarged Maxillary Tuberosity in Elderly
Edentulous Patients. J Oral Maxillofac Surg 2010)
IMPACTED TEETH IN THE EDENTULOUS
MAXILLARY TUBEROSITY
accessed via a soft tissue incision started
5 to 8 mm away from the surgical site on
the alveolar crest
The vertical incision is extended anteriorly
to run along the alveolar crest beyond the
impaction
After the soft tissues are reflected 5 to 8
mm, the buccal cortical bone is cut
vertically
...
Cut to the necessary depth using burs,
microscillating blades, or osteotomes and
then split open
The bone flap is reflected outward just
enough to gain access to the tooth using a
periosteal elevator
After removal of the tooth or root (with or
without sectioning), the bone flap is
manually adapted and pressed into place
and the mucosa is sutured
FIGURE 2. Schematic representation of the osteoplastic flap
procedure used for removal of impacted teeth or remaining
roots in an edentulous maxillary tuberosity. Axial view (top),
coronal view (bottom).
(Motamedi and Motamedi. Managing Enlarged Maxillary Tuberosity in
Elderly Edentulous Patients. J Oral Maxillofac Surg 2010.)
Discussion
Dentists and prosthodontists are
commonly confronted with edentulous
patients requiring full dentures that often
require preprosthetic surgery
Surgery is required mainly in the area of
the distobuccal prominence of the maxillar
tuberosity to accommodate the buccal
flange of the prosthesis
 Via flap reflection lead to a large defect
with irregularities under the
mucoperiosteal flap, can be painful under
a denture, leads to bone resorption,
denture retention is also compromised
The osteoplastic flap may be indicated to
prevent these complications was first
described by Wilhelm Wagner (1889),
demonstrated by Ward (1956), who used
this flap for removal of impacted teeth
with the intent to preserve the alveolar
ridge
 The osteoplastic flap is a simple way for the
clinician to preserve the buccal bone and
the existing alveolar ridge height, as well as
vestibular depth
In elderly patients requiring osseous
tuberoplasty, the quality of bone is usually
poor, low in substance, and osteoporotic,
especially in postmenopausal women. The
cortical bone is also very thin, rarefied bone
with large marrow spaces, which are
irregular and which break off in spicules
when rasped and are impossible to smooth
out
 use a bone flap to allow removal of the
intercortical marrow instead of the buccal
cortex, thereby decreasing the possibility
of postoperative resorption and
irregularities of the rarefied bone while
obviating the undercuts and decreasing
the bulk and width of the tuberosity
Added advantage: maintaining the
vestibular depth, because the
mucogingival junction is untouched and
buccinator muscle insertions are
untouched
 Application of this technique to large
edentulous tuberosities or those encasing
impactions allows for preservation of the
height and width of the alveolar bone,
enhances retention of dentures, and
facilitates the future placement of
implants
THANK YOU