Alveoloplasty (Alveoplasty) -
What is it?
An alveoloplasty (also referred to as alveoplasty) is a surgical procedure used to smooth and reshape a patient's jawbone in areas where teeth have been extracted or otherwise lost.
Why is an alveoloplasty performed?
The purpose of this procedure can be twofold:
- When performed prior to (partial or complete) denture construction, it's used to optimize the shape of the patient's jawbone (ridge) so to avoid complications with appliance insertion, comfort, stability and/or retention.
- When performed in association with tooth extractions, it also establishes a jawbone shape that helps to facilitate the healing process that follows.
When is an alveoplasty performed?
As suggested above, an alveoloplasty can be performed as a part of the tooth extraction process, or as its own stand-alone procedure.
a) In conjunction with the extraction process.
It's routine that after a tooth has been removed, but before its extraction site has been "closed," the treating dentist will evaluate the contours of the bone tissue in the immediate area. The purpose for this is as follows:
- Leaving a smooth, rounded bone surface (whether or not a gum tissue flap has been raised during the procedure) helps to insure that the healing process that follows will occur as uneventfully as possible.
- When any tooth is removed, a dentist must always plan for how that tooth will be (might be) replaced. And an important part of this planing involves the contours of the jawbone in the immediate area (see below).
Multiple extraction cases.
Alveoloplasty is more likely to comprise a substantial portion of a patient's extraction process when multiple consecutive teeth have been removed.
That's because with these longer expanses, it's easier for the dentist to identify ridge irregularities and potential problems and have the needed access to substantially improve them.
Avoidance of a second surgery.
By planning ahead now and taking the extra moments it takes to include alveoloplasty as part of the patient's extraction process, the dentist may prevent their necessity of having a separate, possibly extensive, surgical procedure at a later date.
b) Alveoplasty as a separate procedure.
It's commonplace that at the time of initial denture construction, a dentist may identify jawbone ridge irregularities that are likely to interfere with (partial or complete) denture insertion, comfort, stability and/or retention. If so, plans will need to be made to perform an alveoloplasty as a stand-alone procedure.
Some of the types of problems that may exist include:
- It may be that the surface of the patient's jawbone is not smooth and even. Any portion of the ridge that is sharp or protrudes may become irritated by the denture surface that lies over it.
- A denture (typically a hard, non-flexible object) must be able to slip over the jawbone for which it's made.
If the jaw ridge has "undercuts" (regions where the ridge is excessively concave, or areas that have a divergent form as compared to other aspects of the jawbone) they must be corrected so it's possible to insert and wear the appliance.
The need for a stand-alone alveoloplasty may have been unavoidable.
As a patient, you may wonder why the corrections you require weren't made at the time of the original extractions (as discussed above). While finding out that an alveoloplasty is needed can be disappointing, it doesn't mean that your dentist lacked proper foresight.
- In some instances, it may be that healing and subsequent jawbone remodeling (natural reshaping) has progressed differently than originally anticipated.
- In cases where teeth have been removed sporadically over a number of years, a outcome where the resulting ridge shape is not ideal is not that uncommon.
It's harder for the dentist to envision, or have control over, the grander scheme when just individual teeth, or multiple isolated teeth, are removed piecemeal.
Even in the case where a difficult ridge form seems to be developing, when a dentist is extracting an individual tooth should they significantly expand the size of the extraction site to make a correction now? Even before the patient has expressed an interest in proceeding with tooth replacement?
- With other cases, the existing problem may be one that was always best approached using a separate alveoloplasty procedure. This can include situations where the patient has exostoses or tori (additional lumps of bone found on the jaw or hard palate), or some type of skeletal irregularity with their jawbones.
How much does the alveoloplasty procedure cost?
The fee associated with a patient's work is typically determined by two primary factors:
- The percentage of the jawbone that's treated. - For billing purposes, this is typically referenced in terms of quadrants (upper left, lower right, etc...).
(For insurance purposes, the definition of treating a quadrant is sometimes only met when 4 or more tooth spaces require the alveoloplasty process.)
- When the procedure is performed. - Either in association with tooth extractions or as a stand-alone procedure.
(Stand-alone procedures can be expected to cost 50% more.)
An example fee.
Due to the above stipulations, the simplest and therefore least expensive procedure would be one where at the time of having teeth extracted just one quadrant of the patient's jawbone also required alveoloplasty. As a rough low-end estimate, the fee involved could be expected to run on the order of $250.
How is the alveoloplasty procedure performed?
This is a surgical procedure. In the case where it's incorporated into your tooth extraction process:
- It will add some but possibly not a significant amount of complexity or time to your procedure. It simply depends on how large of an expanse and what degree of correction is involved.
- The big advantage of having it done in conjunction with tooth removal is that it doesn't significantly alter the normal healing timeline involved for extractions.
In the case where alveoloplasty is performed on its own, it's typically considered a "minor" surgical procedure (on the order of having teeth removed).
The overall extent and complexity of the process will, once again, simply depend on where the needed corrections are made [such as: one side (unilateral), right and left sides (bilateral), upper and/or lower ridges, hard palate (torus removal)] and the degree of difficulty associated with them (see below).
The steps (as a stand-alone procedure).
Your dentist will need to anesthetize (numb up) the bone and overlying gum tissue in the region where the alveoloplasty will be performed.
In most cases, the use of a local anesthetic will suffice (standard dental "shots"). If the procedure will be extensive, or if the patient simply prefers, some type of additional sedation can be used.
2) Exposing the bone.
The dentist will need to create gum tissue flaps and reflect them back to expose the underlying bone that needs to be trimmed and adjusted. We outline the flap procedure here.
3) Recontouring the bone.
Bone trimming is typically accomplished via the use of bone files, rongeurs (dental "pliers" used to snip bone) and/or dental drills.
Trimming is always accompanied with copious irrigation with fluids (water or saline solution). This both washes away debris and helps to keep the bone tissue moist/hydrated and cool. (The use of a dental drill especially can heat up and damage live bone tissue.)
Small lumps and bumps may just be trimmed from the surface of the jawbone. Larger protrusions may involve removing sections of bone. In some cases, a protruding ridge may be weakened internally and then compressed so to give it its needed shape. (See diagrams below.)
4) Closing the surgical site.
Once the dentist is satisfied that they have made the necessary corrections, the surgical site is flushed with water or saline solution and then the reflected flaps are positioned back and tacked into place with stitches. (See "flap" link above for details.)
5) Post-op healing.
Non-resorbing stitches are typically removed after 7 to 10 days. (The gums have significantly healed by this point.)
Examples of alveoloplasty procedures.
a) With single teeth.
When just a single, isolated tooth has been extracted, it's common that the treating dentist will remove aspects of jaw ridge immediately adjacent to the tooth's socket.
Doing so helps to create a smoother, more even post-operative ridge that's more favorable for tooth replacement. It also helps to facilitate the healing process. (Sharp protruding bone remnants may become dental sequestra.)
b) Alveolar bone removal.
With some cases, a prominent portion of the jawbone (alveolar bone) may pose a protuberance or undercut over which fitting or wearing a denture may be difficult, or even impossible. If so, that portion of the ridge will need to be removed.
The disadvantage of this procedure is that cortical bone (the dense outer layer of bone, see below) is sacrificed.
c) Interradicular/Compression procedure.
The surface layer of the jawbone is termed its "cortical plate," and there are reasons why it is advantageous for the patient that this layer of bone is preserved.
When possible, a dentist may perform an alveoloplasty in a fashion where the bone is compressed and collapsed on itself (often after removing some interior bone tissue). Using this process, the shape of the offending ridge is corrected, without sacrificing cortical bone.
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