At the established vertical dimension of occlusion, the maxillary tuberosity contacts the retromolar pad. What is the appropriate treatment?

Correct answer: C. Surgical reduction of the maxillary tuberosity

• A. The retromolar pad is soft, mobile, non-keratinised tissue overlying the pear-shaped pad of the mandible. It is a critical landmark for setting the occlusal plane and for posterior denture extension, and surgically removing it destroys that reference and the border seal.
• B. Failing to cover the tuberosity forfeits a key retentive area for the maxillary denture. The tuberosity contributes meaningfully to retention and stability and should be covered, not avoided.
• C. CORRECT. A fibrous or bony tuberosity that occupies the interarch space at the correct VDO leaves no room for the denture bases and teeth, and it is the tuberosity that must be reduced. Tuberosity reduction is a routine, well-tolerated pre-prosthetic procedure. Note the logic — you do NOT lower the vertical dimension to create space, because VDO is dictated by the patient's physiology, not by convenience.
• D. The retromolar pad must be COVERED by the mandibular denture — it is essential to the posterior border seal and to resisting distal displacement. Avoiding it undermines retention.

Note: Pre-prosthetic surgery targets whatever obstructs a properly extended denture at the correct VDO: tuberosity reduction, tori removal, frenectomy, alveoloplasty, and excision of flabby ridge or epulis fissuratum. Reducing VDO to make space is never the answer.