What is Alveoloplasty in Dentistry

Alveoloplasty refers to the shaping of alveolar process using surgical methods. It is done if a person has bony projections, sharp crestal bones or undercuts.  

Alveoloplasty in Dentistry

Prior to the construction of any prosthetic appliance, attempts must be made to preserve the maximum possible amount of the alveolar bone. Primarily the alveolar ridge must be re-contoured for providing best tissue for denture support. This is done by maintaining and securing large amounts of the soft tissues and bone.

The final aim involves the patient’s rehabilitation, while also restoring best masticatory function, and further improving the facial as well as the dental esthetics. Alveoloplasty is referred for both single and the multiple teeth extractions.

There is a minimal initial procedure for this type of Alveoloplasty that just involves the smoothening of the sharp edges. Rather than opting for a surgical removal, the remaining bone must be permitted to remodel. An extensive Alveoloplasty is recommended in the cases that require an urgent denture construction.  

Prior to performing Alveoloplasty, it is always advisable to evaluate each patient individually for eliminating any future problems emanating at the time of extraction. Local anesthesia can be used for Alveoloplasty. 

Different types of Alveoloplasty Procedures

1.   Cortical Alveoloplasty 

 

2.   Single Tooth Extraction

This is recommended if certain alveolar bone’s prominent areas exist that will be of no interest in future construction of denture. 

Procedure is as follows:

  1. After giving anesthesia, there is an incision made along alveolar ridge’s crest and is extended across the site of extraction.
  2. There is a removal of the soft tissue from the socket’s distal and mesial sides.
  3. The projected bone is slowly removed using the surgical blur or ronguer. Further smoothening is done with the help of a bone file.
  4. There must not be any undercuts. 
  5. The additional bony fragments are also removed as the surgical site is thoroughly irrigated.
  6. 3-0 silk interrupted suture is used for approximating the wound margins.
  7. There is a removal of all the excessive fibrous areas. It is customary for the soft tissues to get adjusted to the alveolar process.

 

 

Simple Alveoloplasty eliminates buccal irregularities and undercut by removing labio cortical bone.

 

Extraction of Multiple Adjacent Teeth

This process is recommended for the extraction of the multiple adjacent teeth in just one sitting.
 
Procedure is as follows:

  1. An incision is made on the crest of alveolar ridge. For getting an adequate access, the incision made is either relaxing incision or envelope flap.
  2. Teeth are removed under direct vision. Surgical blur or rongeur is used for removing the sharp edges. Care must be taken to avoid any undercuts.
  3. Bone file is used for smoothening the area.
  4. 3-0 interruped or continuous silk sutures are used for closing the wound and for attaining a gingiva that is well adapted and attached.  

 Extraction of Multiple Adjacent Teeth
Site of crestal incision in maxillary anterior region for Alveoloplasty

 

Retraction of mucoperiosteal flap for Alveoloplast

sutures for Alveoloplasty

 Extraction of Teeth in the Entire Arch

This extraction proceeds in the same manner as that for single quadrant.

In the maxilla

1.   The incision is extended up till tuberosity’s back. 

2.   There is a reduction of the sharp alveolar margins and elongated alveolar process followed by removing the undercut areas.

3.   The wound is closed after the surgery. One must avoid the excessive elevation of the flap as it can result in some postoperative swelling and ecchymosis. It can also enhance further bone re-sorption.

Edentulous Patients

1.   There is an incision marked on the crest of the alveolar ridges in the areas of maxilla and mandible.

2.   Tuberosity must begin in maxilla.   
3.   Rongeur is used for removing the bony prominences. There is a retraction of the flap too.

3-0 continuous sutures for closing the wound.

 

Clinical appearance of max ridge after removal of teeth and before bony contouring for Alveoloplasty

 Properly contoured alveolar ridge free of irregularities and bony undercuts for Alveoloplasty 
 Properly contoured alveolar ridge free of irregularities and bony undercuts for Alveoloplasty

Intraseptal alveoloplasty - Dean’s Alveoloplasty with repositioning of labial  cortical bone

This procedure is employed for removing the gross maxillary overjet.

1.   There is an elimination of the undercuts; and preservation of the stress bearing cortices.  
2.   It is usually done in the anterior region; and sometimes in the posterior region also.
3.   Mucoperiosteum remains intact, so that the outer cortex gets an adequate blood supply.   
4.   There can be a reduction in the buccal undercuts or labial prominence, without any reduction in the height of alveolar ridge.
5.   It essentially comprises of these two steps:
6.   Removing the intraseptal bone

7.   Repositioning the labial cortical bone.

Procedure is as follows:

  1. The extraction is done in a way so as not to cause much trauma to the labial cortex.
  2. Interdental papilla is removed following the extraction of the teeth.
  3. Using rongeur or surgical bur, interseptal bone is removed from the canine region.
  4. Then some vertical cuts are made in the labial cortex, near the distal ends of the sockets of the canine extraction, in a bilateral fashion.
  5. Periosteal elevator is bilaterally placed near the bottom of the canine sockets; and the labial cortex is fractured with the periosteal elevator.

There is compression of the labial cortex in the palatal direction.

  1. Labial and palatal plates will lie nearly next to each other.
  2. All the sharp margins will be filled with the help of bone file. 
  3. 3-0 continuous sutures are used for wound closure.

Intraseptal Alveoloplasty

 

Obsweger’s modification for Intraseptal Alveoloplasty

This procedure is employed in case of gross maxillary overjet along with an inward compression of just the labial cortex is insufficient for reducing the overjet.

Procedure is as follow

  1. An inverted cone bur is used to widen the socket near the base, after the intraseptal bone is cut. 
  2. There are some horizontal cuts made, using a small disc, near the base of the extraction sockets in both labial and palatal cortices.
  3. Vertical cuts are made in a bilateral fashion using a straight fissure bur. They are made in the palatal and labial cortices in the areas distal to canine sockets.
  4. Finally there is a compressing of the palatal and labial cortices.

 Obsweger’s Alveoloplasty
Obsweger’s Alveoloplasty

If there is an urgent requirement of denture delivery, clear acrylic is used to make the denture. This denture serves to be a template for detecting the pressure points. It can be judged by the blanching of the tissues and hence such areas should be properly trimmed before suturing. Finally, the doctors check the denture’s fit to avoid any rocking.

Alveoloplasty after Post Extraction Healing

Sometimes, irregular ridges are formed in cases the surgeon carries out multiple extractions at different times.

The ridge can appear in the form of knife edges, or be visible in the form of some sharp bony spicules that are painful when touched.

  1. For such a condition, one incision is given near alveolar margin’s crest. Thus, there is an elevation of mucoperiosteal flap.
  2. Adequate precautions must be taken so that the flap is not torn, owing to the difficulty in separation at the sharp points. One can make releasing incisions meant for further reducing the tension produced at the flap site.
  3. Round bur or rongeur is used for removing the undercuts and also for trimming the bony processes.
  4. Finally continuous sutures are used for closing the wound.

 
 Recontouring of knife edge ridge
Recontouring of knife edge ridge

A-  Lateral view of mandible with resoption resulting in knife edged ridge

B-  Crestal incision extends 1cm beyond each area to be recontoured

C-  Rongeur used to eliminate sharp bony projections

D-  Bone file used

E-  Continuous sutures given.

 

 

 User Comments on -  What is Alveoloplasty in Dentistry


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Posted By : Terri on 28-Jun-2014 02:01 PM
I just had mine done and wanted to leave this for people who are not aware as I was not I went to the dentist thinking I had to have a wisdom tooth removed in the back as my tooth which I thought was growing back in after having my wisdom teeth removed over 20 plus years. My tooth hurt so bad in the very back like I was teething or having a tooth coming back in. I was in agonizing pain which was headaches, earache and then it became painful eating my food as my tongue hurt me so bad and hard for me to swallow. This went on for about 2 weeks or better till my dentist finally saw me. When I went in I told him to remove my what I thought was back wisdom tooth. He stated he could not as it was no tooth it was alveoloplasty. I said, I had never heard of that..he said, when I had a tooth removed on bottom about 2 1/2 years ago it had left bone and had to be removed. I had to go to oral surgeon to have it removed they put me to sleep and removed and shaved and filed it down and sewed it back up. I am two days after the surgery and feel awesome!! I never felt better...all the pain that was in my gum and my tongue are gone and I was tired of living on medications to get rid of the agonizing pains from the bone under the gums. Lots of people don't realize you don't really have to be getting a denture to have this done. I still have most of my teeth and I needed this operation bad to just to be able to eat my food and live a normal life again. Good Luck to anyone going through this as this is some of the most painful dental experience I have ever been through. And I have had cavities and root canals and braces. After the surgery less pain than having that bone in my mouth stabbing and hurting me in the side of my head. Just wanted to share this information.
 


Posted By : Ps cakes on 30-May-2013 03:03 PM
I was riped off. 3560.00 for nine extractions I hate the so called "care givers" that take advantage of desperate hurting people. Over charged and under served.
 


Posted By : Dr. Rtiz on 21-Apr-2013 07:32 AM
Rebecca, If the bony areas are interfering with denture then you have to get alveloplasty done otherwise your dentist can relieve them in the dentures. If your bones are too soft then you have consult your physician. There definite suggestions can be given only after clinical examination.
 


Posted By : rebecca d. on 20-Apr-2013 05:08 AM
i have osteoporosis, and i take Reclast IV once a year.. i had 5 teeth removed and i have an upper denture that is made like a bottom denture.. i have an upper tori and that is why i have a denture made that way. i have several bony areas that need to have alveoloplasty, my dentist did some, but was worried about my bones being to soft. do you have any suggests. thanks
 


Posted By : Dr.Ritz on 12-Sep-2012 11:10 PM

Hi B.K. GHOSH,Alveoloplasty means that the bone of the ridges is shaved and contoured. Sometimes this is a radical removal of bone. Bone is vital for successfully wearing dentures.This procedure should not be done immediately after extractions so that we can see how much shrinking and bone loss has occurred. For many people,alveoloplasty is NOT a necessary procedure.But,in case if you need an immediate denture,alveoloplasty is necessary.Your dentist would be the best person to decide your need for alveoloplasty after clinical examination.Hope it helps.If you still have any doubts,leave another comment.Good luck!

 


Posted By : B.K.Ghosh on 12-Sep-2012 09:25 AM
I have recently extracted all my tooths and want to have full denture.The doctor advised to get Alveoloplasty done beforehand.Is it neccesary?Pl advise
 


Posted By : Dr.Melissa on 25-Jul-2012 11:50 PM
yvonne,actually alveoloplasty means to remove any sharp bony margins or any bone spicules present after the extraction around the socket.The alveloplasty is performed only in those cases where the bony spicules are present and causing discomfort as they are either causing pain or swelling or it is injuring the tongue. Usually this procedure has to be done only in few cases of extraction so dentists might not charge anything but this occur in only a few cases but these days the dentist do charge for this procedure and it is considered to be a separate chargeable procedure.You can go to ur dentist and ask him about this as some dentists do it for free also.
 


Posted By : yvonne on 25-Jul-2012 11:17 AM
IS THIS A SEPERATE BILLABLE SERVICE OR IS IT PART OF EXTRACTIONS CUZ CODED 7311 STATES IT IS SEPERATE BUT CODE D7310 DOES NOT STATE THAT CDT BOOK 2008
 


Posted By : Dr.Ritz on 07-May-2012 12:09 AM
NANNETTE C. GARCIA, treatment cost varies from dentist to dentist and is as per specialization. Your dentist might have taken and studied well your Xrays before deciding the treatment modality. If you feel that you are being over charged than you can feel free to discuss with your dentist and also get the treatment done under NHS scheme. Also you can visit a dental school, where though the treatment is done by students but extreme cases are taken up by specialists. The cost there is very less as compared to private practitioners..
 


Posted By : Nannette C. Garcia on 06-May-2012 09:04 PM
I have 20 broken teeth that need to be removed. The Periodontist wants to make this two procedures since I am going to have to have alvioplasty done in order for the dentures to sit well. I have more than adequate bone strength in the upper and lower mandibles. I just think that he wants to charge me more than he needs to. He wants $150 per tooth in addition to the alveoplasty. Is this reasonable. I do not have that kind of money. Thank you.
 


Posted By : Dr Ritz on 07-Mar-2012 11:10 AM
Terry, if implant site has bony spikes then Alveoloplasty has to be done to make it smooth and if the dentist feels that bone thickness is less then may be bone grating is needed.
 


Posted By : Terry on 06-Mar-2012 10:17 PM
I am told that my iimplant extraction site is dehiscence . It's wide opened you can see right down into the hole !!its hurts. I'm told I need an alveoplasty needs to be done. So will bone be implanted? There are little spikes coming out my gums from other implants too. So confused. Help!
 


Posted By : Deanna Franklin on 30-Jan-2012 10:16 PM
I had all my teeth taken out 5 days ago and had alveoplasty done. My tongue is swollen is this normal for this type of surgery? 23 teeth removed. I have taken Advil only no other medicines. This is scary cause it makes it thick to swallow. How long before this swelling should go down?
 


Posted By : sharon on 27-Jul-2011 05:03 AM
I had this done three days ago. I was wondering how long does it take for the sutures to come out.
 

 
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