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:
After giving anesthesia, there is an incision made along alveolar ridge’s crest and is extended across the site of extraction.
There is a removal of the soft tissue from the socket’s distal and mesial sides.
The projected bone is slowly removed using the surgical blur or ronguer. Further smoothening is done with the help of a bone file.
There must not be any undercuts.
The additional bony fragments are also removed as the surgical site is thoroughly irrigated.
3-0 silk interrupted suture is used for approximating the wound margins.
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:
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.
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.
Bone file is used for smoothening the area.
3-0 interruped or continuous silk sutures are used for closing the wound and for attaining a gingiva that is well adapted and attached.
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.
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
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:
The extraction is done in a way so as not to cause much trauma to the labial cortex.
Interdental papilla is removed following the extraction of the teeth.
Using rongeur or surgical bur, interseptal bone is removed from the canine region.
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.
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.
Labial and palatal plates will lie nearly next to each other.
All the sharp margins will be filled with the help of bone file.
3-0 continuous sutures are used for wound closure.
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
An inverted cone bur is used to widen the socket near the base, after the intraseptal bone is cut.
There are some horizontal cuts made, using a small disc, near the base of the extraction sockets in both labial and palatal cortices.
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.
Finally there is a compressing of the palatal and labial cortices.
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.
For such a condition, one incision is given near alveolar margin’s crest. Thus, there is an elevation of mucoperiosteal flap.
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.
Round bur or rongeur is used for removing the undercuts and also for trimming the bony processes.
Finally continuous sutures are used for closing the wound.
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.