A patient presenting for new complete dentures has a maxillary tuberosity that contacts the retromolar pad in centric relation. What should be done FIRST?

Correct answer: C. Surgically reduce the maxillary tuberosity

• A. ❌ The retromolar pad is the primary posterior stop and posterior seal for the mandibular denture — it must be COVERED, never removed.
• B. ❌ Impressions taken before the surgery capture anatomy that is about to change, so the prosthesis will not fit.
• C. ✅ CORRECT — There must be adequate interarch space for both denture bases plus the teeth. A hypertrophic tuberosity contacting the retromolar pad leaves none, so a TUBEROSITY REDUCTION is performed as a preprosthetic procedure, with healing before final impressions.
• D. ❌ Arbitrarily raising the vertical dimension to gain space causes soreness, instability, clicking teeth and TMJ discomfort. The VDO is dictated by the patient, not by a surgical shortcut.

Note: Sequence: preprosthetic surgery → healing (usually 4–6 weeks) → preliminary impression → custom tray → final impression.