Guide to Alveoloplasty (Alveoplasty) –

What is alveoloplasty?

This procedure (also referred to as alveoplasty) is a dental surgery procedure that’s used to smooth and idealize the shape of a patient’s alveolar ridge (jawbone) in areas where teeth have been extracted or otherwise lost.

Why is alveoloplasty needed?

Indications for having alveoloplasty vary among patients but, generally, the need for having this procedure has to do with the following two situations:

1. It may be needed to optimize the shape of the patient’s alveolar ridge (jawbone) in preparation for the placement of some type of dental prosthesis (replacement teeth).

   This could be in preparation for a partial or complete denture, a dental implant, or a dental bridge. Idealizing the jaw bone’s shape helps to avoid complications with the new appliance’s insertion, comfort, maintenance, stability, and/or retention.

2. When performed in conjunction with tooth extraction(s), this procedure creates a smoothly contoured ridge in the area of the extraction site, which aids the healing and bone repair process that follows.

What is the meaning of the word “alveoloplasty”?

The suffix “plasty” refers to performing “surgical repair.” The root term “alveolo” indicates that this repair (recontouring) involves alveolar bone (the bone in which a person’s teeth are or once were held) and the area around the alvoli (tooth sockets).

What does the word “alveoplasty” mean?

This term is alternatively used to refer to the same procedure as alveoloplasty.

Quick answers to questions about alveoloplasty.

Here’s a list of questions that people frequently have. Our answers here are brief. We explain all of these issues in more detail in the text that follows this Q&A section.

How/When is alveoloplasty performed?

This procedure is performed either as: a) A part of the tooth extraction process or b) 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 area’s jaw bone tissue quality, quantity, and contours. The purpose for this is as follows:

• For all extractions, leaving a smooth, rounded ridge in the area of the surgical site helps to ensure faster healing and helps to reduce the potential for complications.
• When any tooth is removed, a dentist must always plan for how that tooth will be (might be) replaced. An important part of this planning involves evaluating the contours of the jawbone ridge in the immediate area of the extraction site (and also jaw bone quality and quantity) and determining how suitable they are for denture, bridge, or implant placement.
• The dentist must also keep the patient’s medical status in mind and the way it might (either now or in the future) affect the patient’s dental treatment.

  For example, cancer patients often undergo chemotherapy and radiation during their treatment. In anticipating that this will take place, it would be to the patient’s advantage to have their alveoloplasty performed at the same time as their tooth extractions, rather than as a separate procedure at a later date that would be complicated by their medical treatments.

With multiple-extraction cases.

Avoidance of a second surgery.

b) Alveoloplasty as a separate procedure.

It’s common that at the time of new dental appliance construction (e.g. partial or complete denture, dental implant, dental bridge), a dentist may identify jawbone ridge irregularities that are likely to interfere with the appliance’s insertion, comfort, maintenance, stability, and/or retention. If so, plans will need to be made to perform alveoloplasty as a stand-alone procedure.

Examples of some of the types of problems that may exist.

• It may be that the surface of the patient’s jaw bone is not smooth and even. Ridge bumps and high points will constantly be irritated by the hard denture surface that fits over them resulting in persistent tissue sore spots.
• A denture, which is a hard, non-flexible object, must be able to slip over the jaw for which it’s been made.

  If the jaw’s anatomy has “undercuts” (for example, a region where the side of the ridge is excessively concave), these obstacles must be corrected so it’s possible to insert and fully seat the appliance.

• With dental implant placement, the shape of the bone in which it’s been positioned can affect how natural the tooth (dental crown) that’s placed on it will appear. The contours of the implant’s surrounding bone tissue can also affect how easily it can be cleaned and maintained.
• Similar appearance and maintenance issues exist with dental bridges. Also, idealizing the shape of the ridge underneath a bridge’s artificial teeth can help minimize the potential for debris accumulation in this area.

The need for a stand-alone procedure 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 surgery is now needed can be disappointing, it doesn’t mean that your dentist lacked proper foresight.

• In some instances, it may be that the healing and subsequent jawbone remodeling (natural reshaping) that occurred took place differently than originally anticipated.
• In cases where teeth have been removed piecemeal over a number of years, a result where the ridge’s 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.

  Even in the case where a problematic or challenging alveolar 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?

• In other cases, the existing problem may be one that can only be approached as a separate procedure because no tooth extractions are needed. 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 jaw skeletal irregularity.

Is having alveoloplasty always necessary before dentures can be made?

No, there’s no hard and fast requirement for it. The need to perform this surgery simply depends upon the specific conditions with which the patient presents.

• In situations where the shape of the patient’s ridge(s) will clearly prevent a denture from seating or contain a prominent point(s) that will constantly be irritated by the denture, then yes.
• But for relatively minor discrepancies, for new appliances of all types (denture, bridge, implant), justifying the need to subject the patient to an additional surgical procedure (and expense) may be 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, the concerns they have.

How involved is having an alveoloplasty procedure?

There is no question that this is oral surgery and a true surgical event. But the extent of what takes place and the degree to which it affects you will most likely hinge on whether your procedure is performed in conjunction with tooth extractions or as a stand-alone step.

a) When performed at the time of tooth removal –

In the case where this procedure is incorporated into your 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 just add a minor amount of additional procedure time. (Especially when compared to accomplishing the same goals as 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.

b) When performed as a stand-alone procedure.

In the case where this procedure is performed on its own, it’s typically considered “minor” dental surgery. (On the same order as having a few or several teeth removed.)

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

How painful is having alveoloplasty?

No, there’s nothing exceptionally painful about having this procedure performed, however, without question, this is a form of oral surgery and therefore you will need to be numbed up for it. (Maintaining patient comfort during your procedure is as vital for your dentist as it is for you.)

More likely, anyone asking this question is really more curious about what level of pain they might experience afterward. In that sense, this is clearly a surgical event and any procedure that involves handling or trimming bone tissue to any extent must be considered significant.

While only your dentist can provide you with any specific insight about what you’re likely to experience, here are some examples of influencing factors for this procedure.

a) Pain with stand-alone alveoloplasty compared to tooth extractions.

After having a tooth removed, the healing process that then follows Healing timeline. is categorized as “secondary intention.” This term refers to the situation where the edges of a wound don’t touch (like those exposed edges of gums surrounding the empty tooth socket) and therefore new tissue must form and fill in this gap before the wound can heal over.

In comparison, with stand-alone alveoloplasty procedures, the gums are usually stitched back together in direct contact (primary intention). And since no gap exists that must fill in first, the healing process can proceed just that much more quickly and easily.

b) Pain with alveoloplasty performed in conjunction with tooth extractions.

Performing this procedure at the same time as having teeth extracted may mean that the closure of the surgical site can be transformed from a secondary to a primary one (the more favorable situation). But …

• The extent of bone recontouring that’s needed may significantly increase the overall size of the surgical site, and therefore increase the total amount of surgical trauma that’s created.
• The process of performing the procedure (see below) may necessitate raising a gum tissue flap. If so, a higher level of surgical trauma will be created vs. having a simple tooth extraction.

Who performs alveoloplasty?

Your procedure might be performed by either an oral surgeon or your regular general dentist. The deciding factor will most likely be the extent to which changes are needed.

• When implemented in conjunction with removing teeth, that same provider (general dentist or oral surgeon) will perform the bone reshaping too.
• As a stand-alone procedure, if just one or a few isolated areas of your jaw’s ridge require recontouring, your regular dentist may feel qualified to provide your services.

  With more extensive stand-alone cases, the experience and expertise of an oral surgeon may be required.

Is dental sedation used with alveoloplasty?

Just like with any form of oral surgery, maintaining patient comfort during alveoloplasty is an important consideration. And for some people, the added psychological benefit of having conscious sedation administered during their procedure (in addition to a local anesthetic that is used with all cases) can help to ensure this.

Sedation is typically an option that the patient chooses, often due to elevated anxiety about having their procedure. However, the extensiveness of the dental work that will be performed can also play a role in opting for sedation.

For stand-alone cases.

When performed as a separate procedure, and especially if an extensive portion of your upper and/or lower jaws required treatment, you may find being sedated for your procedure comforting and beneficial.

If instead your procedure is limited to just one or a few isolated areas, what you experience might be similar to having one or a few teeth extracted, with your decision for a desire to be sedated based on that comparison.

When performed with tooth extractions.

Accomplishing this procedure in conjunction with tooth removal usually adds only a minor amount of surgical time or difficulty. If you usually tolerate extractions well, you’ll probably do fine without being sedated.

FYI: We cover the topic of Dental Sedation Methods here.

How much does alveoloplasty 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 met when just 4 tooth spaces have been treated. A quadrant has 8 teeth or tooth spaces in total.)

2. When/how the procedure is performed. – Either in association with tooth extractions or as a stand-alone procedure. Stand-alone cases can be expected to cost 50% more.

An example fee.

How is the alveoloplasty procedure performed?

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 your procedure will be performed. In the case where it is combined with tooth extractions, the anesthetic given for their removal may already be all that is required.

The use of a local anesthetic (standard dental “shots” Which ones tend to hurt most?) is typically all that will be required. If the procedure is expected to be extensive or prolonged, or if the patient simply prefers, some type of sedation Common options. can be used.

2) Exposing the jawbone ridge.

Your dentist will need to create a gum tissue flap to expose the underlying bone that needs to be trimmed and adjusted during your alveoloplasty procedure. To do so, they’ll make incisions in your gums and then reflect the freed tissues back. We detail the gum flap procedure here. The steps.

Even when combined with performing multiple extractions in a row, your procedure may still require creating a tissue flap so your dentist has 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 overheated. (Bone is living tissue and is easily damaged if subjected to elevated temperatures.)

Small lumps and bumps may just be shaved off 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 alveolar 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.

▲ Section references – Fragiskos, Rahn

Aftercare following your procedure:

Postoperative directions.

Your dentist will give you aftercare instructions to follow. They will be similar in nature to those given to patients who have had teeth removed. They will include details about controlling bleeding, the use of medications, like ibuprofen (Motrin®, Advil®) or aspirin, to control pain, and the application of ice packs to minimize swelling.

For specific instructions, please refer to our   Post-tooth extraction instructions pages –  First 24 hours. Next day and beyond.

How long will your stitches stay in?

If your dentist has placed non-resorbing (non-dissolving) stitches, they’ll usually have you back to remove them after 7 to 10 days.

How long does healing take following alveoloplasty?

Soft tissue healing can be expected to be substantially complete after 3 weeks or so. The process of bone repair takes longer. It’s common that 4 to 6 weeks of healing are allowed before new dental appliance construction is begun.

Even beyond that time frame, subtle changes will continue to take place with your jaws as the bone healing process continues. The specific time period that’s required before new dental appliance construction is begun will vary according to your dentist’s interpretation of the needs of your case.

Examples of alveoloplasty procedure techniques.

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

#1) With routine tooth extractions.

Their overall goal will be one where the ridge transitions smoothly from edentulous (toothless) to tooth-borne areas. And that its shape in edentulous regions is optimal for placing/making or wearing the prosthesis (denture, partial, implant, etc…).

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

▲ Section references – Koerner

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

#2) Alveolar bone removal.

▲ Section references – Wray

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

Example #3) Interradicular/Compression procedure.

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

▲ Section references – Wray