Alveoloplasty

Alveoloplasty is a dental pre-prosthetic procedure performed to facilitate removal of teeth, and smoothen or reshape the jawbone after extractions to allow dentures to sit well. In this procedure, the bony edges of the alveolar ridge and its surrounding structures is made smooth, redesigned or recontoured so that a well-fitting, comfortable, and esthetic dental prosthesis may be fabricated. This pre-prosthetic surgery prepares the mouth to receive a dental prosthesis by improving the condition and quality of the supporting structures so they can provide support, better retention and stability to the prosthesis.

After tooth extraction, the residual crest irregularities, undercuts or bone spicules should be removed, because they may result in an obstruction in placing a prosthetic restorative appliance. Recontouring can be made at the time of extraction or at a later time.

History

In 1853: Willard described the procedure of contouring the alveolar bone and alveolar mucosa in order to achieve primary wound closure in preparation for future denture placement. His statement mentioned the purpose of this procedure is to allow bone and tissue of patient to heal faster.

In 1876: Beers described radical alveolectomy with cutting forceps. However, this technique has been classified as too aggressive due to great amount of bone loss after surgical procedure. Hence, nowadays, this particular procedure is not favourable.

In 1923: Dean claimed that his technique aim to preserve the labial cortex and countoured intraradicular bone. His technique does not include mucoperiosteal dissection and therefore, patient will experience less pain, swelling and bone resorption.

In 1976: Michael and Barsoum researched on patients who had immediate denture placement. They related the amount of bone resorption in relation with different surgical techniques. The above mentioned surgical techniques include extraction without alveoplasty, extraction with labial alveolectomy, and extraction with intraseptal alveoplasty as described by Dean in 1923. The result of their study showed labial alveoloplasty had the most bone resorption occurring at the procedure area.

Indications

The main purpose of alveoloploasty procedure is to recontour and restructure alveolar bone to provide a functional skeletal relationship.

Indications of alveoloplasty should nevertheless include recontouring or reshaping alveolar bone during tooth extraction surgery. For instance, if alveolar bone has sharp edges after tooth removal, it is necessary to smoothen the bone surfaces to facilitate tooth socket healing process and to avoid any procedural complications such as pain or long standing open wound.

The next indication for alveoloplasty involves a standalone procedure which is usually done prior to treatment planning of any prosthetic appliances such as placement of fixed or removable prosthetic appliances. In relation with the first point of indication of the procedure, the bone contouring after dental extractions also helps in preparation for prosthetic rehabilitation. This serves as an important procedure as any sharp bony projections under removable appliances such as dentures will cause discomfort and pain when patient perform masticatory functions.

The main essence of prosthetic rehabilitation in regard to alveoloplasty is maintaining the width and height of alveolar ridge so that it will provide stability and retention for prosthesis such as denture and even dental implants as the forces acting from the prostheses will be distributed evenly on the alveolar mucosa and alveolar ridge. In another point of view, alveoloplasty serves as debulking procedures for some pathologic conditions of the jaw bone as well.

Contraindications and Limitations

Alveoloplasty is contraindicated in situations whereby vital structures such as nerve bundle, blood vessel and/or vital tooth will be harmed during removal of bone structure. Nerve injury is unfavourable as there will be a risk of complications such as paraesthesia, neuropathic pain, allodynia and others. In addition to this, if there is existing diminished volume or atypical architecture of bone; alveoloplasty is not a recommended procedure as well.

Some important points to be included as contraindications of alveoloplasty comprise of individuals who have undergone head and neck radiation therapy or individuals with medical condition which will result in certain medical complications such as uncontrolled or excessive bleeding, poor healing response or immunocompromised. As a reference, patient who has underlying bleeding disorder or individuals who are currently on anticoagulant medications has risk of uncontrolled bleeding; whilst individuals with uncontrolled diabetes or infection has poor healing response after procedure.

Clinical procedure

The simplest form of alveoloplasty can be in the form of a digital compression on the lateral walls of bone after simple tooth extraction, provided that there are no gross bone irregularities. When more irregularities exist, other techniques can be adopted, such as the conservative technique, interseptal (Dean's) alveoloplasty, Obwegeser's modification of interseptal, alveoloplasty after post extraction and the alveoloplasty performed on edentulous ridges. In cases where there are severe undercuts, radical alveoloplasty is required. This involves the removal of the whole buccal or labial plate after extraction. In addition, secondary alveoloplasty sometimes occurs after the initial procedure to eliminate any gross bone irregularities.

A full thickness flap is usually elevated to a point apical to the desired area to be contoured, and according to the amount of bone needed to be removed, a bone file, or a bone rongeur, or a burr under copious irrigation can be used to provide the desired contour. Taking in consideration that lack of irrigation can lead to bone necrosis. When finished, the flap is repositioned and sutured. The alveolar mucosa covering bone should have uniform thickness, density and compressibility to evenly distribute the masticatory forces to the underlying bone.