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:

1. 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.
2. When performed in association with tooth extractions, it also establishes a jawbone shape that helps to facilitate the healing process that follows.

When is the procedure 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) Alveoloplasty in conjunction with extractions.

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) As a separate procedure (alveoloplasty without extractions).

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.

Examples.

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.

Is alveoloplasty always necessary before denture construction?

No, there's no hard and fast requirement for it. The need to perform this procedure simply depends upon the specific conditions with which the patient has presented.

• In situations where the shape of the patient's ridge(s) will clearly prevent a denture from seating, or contains a prominent point that will constantly be irritated by the denture, then yes.
  
• But for relatively minor discrepancies, justifying the need to subject the patient to an additional surgical procedure (and expense) is debatable.

Obviously, you'll simply need to defer to the judgment of your dentist. In most cases, it should be fairly simple for them to show you, either directly in your mouth or via plaster casts, what concerns they have.

How much does the alveoloplasty procedure cost?

The fee associated with a patient's work is typically determined by two primary factors:

1. 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.)

2. 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.

When performed at the time of tooth removal -

In the case where this procedure is incorporated into your tooth extraction process:

• While adding some amount of complexity to your case, the added steps needed for routine/minor cases can usually be completed quickly and will add little extra time to your overall procedure (especially as compared to the time needed to perform two separate surgeries).
• Of course, the really big advantage of having this procedure performed at the same time as your extractions is that you'll avoid needing to have a second surgical procedure performed at a later date, and undergoing two separate healing periods.
  
• FYI: As opposed to complicating an extraction site's healing timeline, by performing alveoloplasty and therefore insuring a proper smooth bone surface, the healing environment for the wound is optimized.

When performed as a stand-alone procedure.

In the case where alveoloplasty is performed on its own, it's typically considered a "minor" surgical procedure. (On the same order as having a few teeth removed.)

Of course, the extent of the procedure (unilateral [one side], bilateral [both sides], upper & lower ridges, length of each surgical area) will play a big role in how much of an ordeal you find it to be.

The steps of the procedure.

1) Anesthesia

Your dentist will need to anesthetize (numb up) the bone and overlying gum tissue in the region where the alveoloplasty will be performed. In the case where this procedure is combined with performing tooth extractions, the anesthetic given for their removal may be all that is required.

The use of a local anesthetic (standard dental "shots") is typically all that will be required. If the procedure is expected to be extensive or to run long, or if the patient simply prefers, some type of sedation can be used.

2) Exposing the jawbone ridge.

The dentist will need to create a gum tissue flap and reflect it back to expose the underlying bone that needs to be trimmed and adjusted. We outline the flap procedure here.

Even when combined with performing multiple extractions in a row, performing alveoloplasty still typically requires the creation of a flap in order for the dentist to have the access and visibility they need.

3) Recontouring the bone.

Bone trimming is typically accomplished via the use of bone files (files rubbed across the bone's surface to smooth it), rongeurs (dental "pliers" used to snip off pieces of bone) and/or dental drills.

• Trimming is always accompanied by copious irrigation (flushing) with fluids. Water, or preferably saline solution, is used. Surgical site irrigation both washes away debris and helps to keep the bone tissue moist/hydrated.
  
• When a dental drill is used, irrigation also helps to keep the bone being trimmed from becoming over heated. (Bone is a living tissue and is easily damaged if exposed to elevated temperatures.)

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 animations below.)

4) Checking the bone for smoothness.

Once the dentist feels they have accomplished the needed jaw ridge changes, they'll run their finger across their work area to make sure its surface is smooth. Any rough areas will be further smoothed out using a bone file.

Once satisfied, the dentist will flush the surgical site with saline solution to remove any remaining debris.

5) Repositioning the gum tissue flaps.

The tissue flaps that have been created are now positioned back into place and evaluated. If enough bone has been removed that they now overlap, the dentist will trim them back with scissors so their edges just meet. The flaps are then tacked into place with stitches. (See "flap" link above for details about sutures.)

▲ Section references - Fragiskos, Rahn

Following the above procedure:

• If non-resorbing (dissolving) stitches have been placed, they are typically removed after 7 to 10 days. (The specific time frame used is entirely up to the discretion of your dentist.)
  
• It's common that 4 to 6 weeks of healing are allowed before denture construction is begun.

Examples of alveoloplasty procedures.

Example #1 - The goal here is to create a flatter, more even jawbone ridge.

#1) With routine tooth extractions.

As a part of the process of closing a tooth extraction surgical site (single or multiple teeth), a dentist will evaluate the contours of the jawbone in the region with concerns about how its shape might affect the subsequent placement of replacement teeth.

Their overall goal will be to leave a jawbone ridge shape that transitions smoothly from edentulous (toothless) to tooth-borne areas. And that the shape of the bone in edentulous regions is evenly and gently contoured so it won't interfere with placing/making or wearing the prosthesis (denture, partial, implant, etc...).

Leaving a smoothly contoured ridge shape will also help to facilitate the healing process. (For example, sharp protruding bone remnants may become dental sequestra.)

Any trimming that's required will simply be performed at the tail end of the patient's procedure. In cases just requiring a bare minimum of bone recontouring, the wound that has resulted from extracting the teeth might possibly provide adequate access. When more extensive alveoloplasty is required, the wound will need to be expanded by way of creating and raising a gum tissue flap.

▲ Section references - Koerner

Example #2 - The prominent portion of bone is removed, giving the jawbone ridge a more rounded shape.

#2) Alveolar bone removal.

With some cases, a portion of the patient's jawbone (alveolar bone) may have a shape (such as a protuberance or undercut) over which fitting or wearing a full or partial denture may be difficult, if not impossible.

When this situation exists, the portion of the ridge that creates the obstacle will need to be removed before the patient's new prosthesis can be made.

To do so, the dentist will create a gum tissue flap, so they can access the offending area of bone tissue underneath. That portion is then trimmed away either using rongeurs (bone tissue clippers/nippers) or else the dentist's drill.

The disadvantages of performing an alveoloplasty in this way (as compared to the method described next) is that some cortical bone (the dense outer layer of bone, see below) is sacrificed. Also, typically the use of this method results in the loss of a greater amount of jawbone ridge height.

▲ Section references - Wray

Example #3: - Instead of trimming away the cortical bone, it's instead compressed into the socket.

Example #3) Interradicular/Compression procedure.

A jawbone's dense surface layer of bone tissue is termed its "cortical plate." And there are reasons why it's beneficial for the patient if this layer can be preserved.

Toward this goal, an alveoloplasty may be performed in a fashion where instead of trimming away cortical plate, it is instead undermined and then compressed/collapsed in on itself. When performing this process:

• The bone tissue occupying the space between tooth sockets is trimmed away.
• With this interior trough of bone now removed, the prominent portions of the ridge can then be fractured and compressed in using finger pressure.
  
• This results in creating the needed corrected ridge shape, without the need to sacrifice cortical bone.

▲ Section references - Wray

Update log -

07/31/2019 - Minor revision. Content and resource link added.

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Topic Menu ▶  Tooth Extractions

• The extraction process -
  
  • Preparing for your extraction. - Evaluating your tooth. / Medical issues & considerations. / Pre-op infection.
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  • Alveoloplasty (jawbone reshaping).
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  • Topic: Wisdom Teeth
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