What is Alveoloplasty?
Alveoloplasty, also widely known as alveoplasty is a surgical dental procedure for smoothing and reshaping the jawbone of a patient in areas of the mouth, where the teeth have been either extracted or lost in a different way.
Why is Alveoloplasty Performed?
- The procedure is typically performed for one of the following reasons:It can be used for optimizing the shape of the jawbone of a patient to prevent complications when it comes to the insertion, stability, comfort, or retention of an appliance when it is performed prior to complete or partial construction of dentures.
- It can be used for establishing the shape of a jawbone that will facilitate the subsequent healing process when it is performed in association with the extraction of a tooth.
When is Alveoloplasty Performed?
Alveoloplasty can be performed either as a stand-alone procedure or as part of the process of extracting a tooth as suggested above. Here is a more detailed explanation of the two situations.
Alveoloplasty as Part of the Tooth Extraction Process
It is usually routine that once a tooth has been extracted but prior to the ‘closing’ of the extraction site, the dentist will assess the bone tissue’s contours in the surrounding area. This is done for several reasons:
- Once a tooth is removed, the dentist should always have a clear idea of how the tooth may or will be replaced. A key component of this planning is comprised of the contours of the jawbone in the surrounding area.
- Once a smooth and rounded bone surface is left whether the gum tissue flap is raised during the procedure helps ensure that the subsequent healing process will be uneventful as possible.
Multiple Extraction Cases
The likelihood of alveoloplasty as part of the extraction process is increased, if and when, there is a need for multiple consecutive teeth to be extracted. The reason for this being that it is much easier for the dentist to identify irregularities in the ridges as well as potential problems and have the access required to improve them substantially.
Avoiding a Second Surgery
If the dentist plans ahead and actually takes the necessary time to include alveoloplasty as part of the extraction process for his or her patient, the dentist might help the patient avoid a separate and possibly extensive surgical procedure down the road.
Alveoloplasty as a Stand-Alone Procedure
At the time of the initial construction of the dentures, it is quite commonplace for dentists to identify irregularities in the ridges, which are likely to interfere with complete or partial insertion of dentures, retention, stability, and comfort. If this is the case plans will have to be made so that alveoloplasty is performed as a stand-alone procedure.
Here are some of the problems that might be apparent:
- It could be that the surface of the jawbone of the patient is not even and smooth. The denture surface that lies over any part of the ridge that either protrudes or is sharp could easily become irritated.
- A denture, which is usually a non-flexible and hard object should be able to easily glide over the jawbone for which it is made.
In case the ridge of the jaw has “undercuts” (areas where the ridge is either excessively concave or areas with a divergent form in comparison to other aspects of the jawbone) they have to be corrected so that the appliance can be inserted and worn.
The Need for Stand-Alone Alveoloplasty Might Be Unavoidable
Patients might sometimes wonder why the necessary corrections were not made at the time of the original extractions. While it can be disappointing to find out that alveoloplasty is necessary, it does not mean that your dentist did not have the proper foresight.
It could be that the healing coupled with the subsequent remodeling or natural reshaping of the jawbone has progressed in a different way than was originally expected.
In situations where the teeth of the patient have been sporadically removed over several years an outcome whereby the resulting shape of the ridge is far from ideal is not all that uncommon.
It is impossible for the dentist to either foresee or have control over the grand scheme of things when individual teeth or multiple segregated teeth are extracted in a random manner.
Even in cases where it is clear that a difficult ridge form seems to be under development, it is almost impossible for the dentist to decide whether he or she should inflate the size of the extraction site when extracting an individual tooth to make a correction now. The dentist cannot do anything before the patient has articulated interest regarding tooth replacement.
Often times, the problem may be one that is best tackled using a stand-alone alveoloplasty procedure with other cases. Two widely-known example include exostoses or tori (extra lumps of bone found on either the hard palate or jaw), or a different type of skeletal irregularity with his or her jawbones.
Examples of Alveoloplasty Procedures
With Single Teeth
If it is just one isolated tooth that has been extracted, you can expect the treating dentist to remove aspects of the jaw ridge, which are immediately adjacent to the socket of the tooth.
This helps create a more even and smoother post-operative ridge, which is more favorable for tooth replacement. It is also important for facilitating the process of healing since sharp and protruding bone remnants could easily become dental sequestra.
Alveolar Bone Removal
The alveolar bone, which is a prominent portion of the jawbone will in some cases be an undercut or protuberance over which wearing or fitting a denture may be hard if not impossible. If this is the situation, that portion of the ridge will have to be removed.
The only major drawback with this procedure is that the cortical bone, which is the dense outer layer of bone will have to be sacrificed.
Compression/Interradicular Procedure
The jawbone’s surface layer is referred to as its “cortical plate” and there are reasons why preservation of this layer of bone is beneficial to the patient.
Whenever possible, the dentist will perform the alveoloplasty in situations where the bone has been compressed and has collapsed on itself, which is usually after the removal of interior bone tissue. Using this process, it is possible to correct the shape of the offending ridge without the need to sacrifice cortical bone.
How is Alveoloplasty Performed?
This is a surgical dental procedure as described above. In case it is incorporated into the tooth extraction process it is likely to increase the complexity or the amount of time required to complete the procedure. It will depend on the degree of correction and the size of area.
The key benefit of having it done when combined with tooth removal is that it won’t alter the normal healing timeline involved in extractions in a major way. If the alveoloplasty is performed as a stand-alone procedure, it is usually considered a ‘minor’ surgical procedure.
The complexity and overall extent of the process depends on where the corrections needed are to be made lower and/or upper ridges, left and right sides (bilateral), one side (unilateral), hard palate (torus removal), as well as the level of difficulty associated with them.
Steps for Alveoloplasty When Performed as a Stand-Alone Procedure
Anesthesia
The dentist will start by anesthetizing or numbing up the bone along with the overlying gum tissue in the area where the alveoloplasty is to be performed. A local anesthetic will be enough in most cases. In case the procedure is extensive or if it is the wish of the patient, some type of additional sedation may be used.
Exposing the Bone
The dentist will then have to create gum tissue flaps and peel them back to expose underlying bone, which requires some trimming and adjustment.
Recontouring the Bone
The trimming of the bone is usually done using dental drills, bone files, or rongeurs, which are dental “pliers” used for snapping bone.
Trimming is usually accompanied by copious irrigation using fluids (saline solution or water). This helps to wash away the debris and keeps the tissue of the bone cool and hydrated. This is important since the dental drill can heat up or even damage bone tissue.
Small bumps and lumps are simply trimmed from the surface of the jawbone. Larger protrusions might involve the removal of sections of bone. Protruding ridges may sometimes be weakened internally and eventually compressed to give it the required shape.
Closing the Surgical Site
Once the dentist is sure that all the necessary corrections have been made, the surgical site is then flushed with either saline solution or water and the peeled back flaps are positioned back and set in place using stitches.
Post-Operation Healing
The non-resorbing stitches are usually removed after 7 to 10 days since the gums will have healed significantly at this point. However, 4 to 6 weeks of healing are allowed before the construction of dentures can begin.
What to Expect After the Procedure?
Patients can expect the affected area to feel tender and sore for about one week. The dentist might prescribe strong painkillers for the first few days, but over-the-counter medications can be used after that. Swelling can be expected for the first one or two days but should subside within 36 to 48 hours. An ice pack can be quite useful for this.
Patients may also need to take antibiotics. Antibiotic rinses can help reduce the risk of infection. The dentist will take out the stitches unless dissolvable stitches were used. In either case, the patient will be required to continue consuming soft foods and drink via a straw until the stitches have disappeared completely.
How Much Does Alveoloplasty Cost?
- The costs associated with alveoloplasty are determined by 2 primary factors:The percentage of the jawbone to be treated. In terms of billing, it is usually referenced in terms of quadrants (lower left, upper right, etc.) For insurance purposes, the threshold for treating a quadrant is sometimes only achieved if 4 or more tooth spaces require alveoloplasty.
- Whether the procedure is to be performed as a stand-alone procedure or in association with a tooth extraction. The stand-alone procedure can cost as much as 50 percent more.
Cost Example
The simplest and by extension the cheapest procedure would be one where teeth in just one quadrant of the jawbone of the patient require alveoloplasty. A rough estimate would put the cost involved to reach about $250.
Author: Peter Mayhew
Peter is a dental hygienist in the city of Chicago, IL. In his free time he likes to write blogs and product reviews on anything dental health related.
Thanks for the great article! I have a situation regarding a second alveoplasty where I’m wondering if it’s really necessary. Four months ago I had 11 teeth removed in preparation for partial dentures (both top and bottom). My regular dentist wanted to wait 6 weeks for healing before taking impression, which made sense, and also fill a few small cavities at that time. While working on the fillings she noticed a protrusion on my bottom gum and sent me back to the oral surgeon, explaining that alveoplasty was needed so that my partials would fit correctly. So at this point of course I was already healed from the extractions, swelling gone etc. She examined my mouth thoroughly to be sure it was just that area, as my gums seemed pretty lumpy. She said other spots were fine. So I had the procedure done, it healed, I got the impressions etc. My flexible partials arrived, bottoms fit beautifully, no issues. The top is another story. After about 4 adjustments to the extremely tight top, the dentist tells me she tells me Sorry it’s not the partial, it’s bones protruding on the top, and I’ll need to go back to surgeon and have both sides shaved down. I’m horrified and honestly just think she did a shoddy job with the impression and doesn’t want to deal with fixing it. Sorry for the lengthy story, but my question is: is this second (and third) procedure really necessary? If the bone on my upper gum was an issue why wasn’t it mentioned before now? There has been no change since she noticed the bottom protrusion,my gums were already healed at that point. Also the oral surgeon never mentioned the top, and he too had examined my entire mouth prior to the alveoplasty. What the heck do I do????!!! Why can’t the upper partial be adjusted or worst case scenario remade? Am I being ridiculous?
I had this exact same issue except I got full dentures and had several extractions at once. The way it was explained to me was that “in some cases” a dentist or surgeon can’t know for certain if another round of alveoplasty would be necessary until after your initial surgery is done and your gums begin to heal. It is different for every patient depending on their healing patterns and bone structure. The bone or bone spurs may begin to protrude after the initial surgery which can cause your dentures or partials to sit wrong (or uneven) and be painful as well. Mine for instance looked fine right after the initial surgery but about a week and a half later the bone started to shift and protrude and became very painful to the point I couldn’t wear my dentures at all. I finally went back and had the 2nd round of alveoplasty and its finally started to heal correctly and my dentures are far more comfortable than before, plus they sit much mor level. Hope thus helps! Good luck!
I just read about your situation. If I had seen this in a timely manner, seeing an oral surgeon would be top of my list.
Can you please share what happened?
How painful was this b4 and after? I have to have this done next week
After reading this and knowing that my dentist does not offer anything more than Halcion as a sedative and no pain meds after, not even Tylenol 3, if I need the procedure, which was added to my estimate, I will go somewhere with IV sedation and where they prescribe pain meds. I need 17 teeth extracted and dentures fit. I already have a partial for my lower jaw and six teeth remaining reason for it on the bottom at all. Affordable Dentures already tried to scare me into a cosmetic procedure that would total 800 dollars, that being bone grafting. I can’t afford this and I think it was the letter FSA that made them ok with padding my bill.
Mu comment is about the cost of alveoloplasty and the unwillingness for oral surgeons to give ball park estimates so one can gage whether or not it fits a budget. This site says one quadrant where no teeth lay should be around $250. The oral surgeon I was referred to wouldn’t give me an estimate but gave the dentist an estimate of $431 to $502. What gives?
I have a question, maybe a few, lol. Anywho, I am 38, and on Sept. 13th 2018 I had All the teeth on top and both back molars removed due to accelerated bone loss…. The initial discussion with the dentist that would be preforming the work was that they would remove the teeth and level the bone in the same procedure, I would have a denture for 6 months + or -, then would be getting something like an “all on four” implant…. At the last meeting, a week or two before the procedure, the story changed, and we were told the bone leveling would happen at the time of the implants…… Strange but ok, “whatever”……. I just went in for the firt follow up this Thursday Sept. 27th 2018, and I pointed out that the (painfully obvious, both literally and figuratively!) lack of a level surface, with sharp points feeling like they could puncture the gum was causing a lot of problems with the denture being painful and not fitting well or staying in place, particularly when trying to chew anything…. In the back especially, one side is Much lower than the other too… (Yet the work was noted as done, and was part of the charge.) I was told, first, that (Understandably..) ‘you’ want to preserve as much bone as possible……..but that the work was done… Which I found a bit confusing, So in an attempt not to be confrontational, but still get an explanation that made sense, I asked if the idea must then be to bring down the low side with bone grafting, as apposed too raising the high side, and she said yes…. (this was an assistant doing the follow up, not the dentist…) Bone grafting was NEVER discussed, and would obviously change the final price of the full process from removal to implants… Which btw, has now changed at least twice… I then ask what the sharp peaks are if the leveling was indeed done and she proceeds to give a quite condescending explanation of how between each tooth is a peak…… At which point I just did the good old nod and smile, because; A; I clearly wasn’t going to get satisfactory answers… And B; I, to my everlasting frustration, struggle with emotional regulation, Especially under even slight pressure, and I tend to freeze, mentally, and often just make things worse if I try to continue.. Oh, and; C; Because my this is actually my father’s dentist whom he’s been with for years and I already embarrassed him at the meeting before the procedure due to being upset and emotional about the whole situation, he’s the one being generous enough to pay for this work, and I didn’t want to cause him more trouble than I thought necessary… Anywho, 🙂 My questions are; Is it possible that the work was done, but so minimally that the peaks are still too sharp? Because as I understand it, these shouldn’t be present if it Was done… Am I miss informed? Is there maybe a ‘lesser’ version of this procedure that may have been done instead? I have an audio recording of the procedure, is there any way to tell audibly if it was done? Can I request xrays from before and after to review? If I am able to prove somehow the work wasn’t done, how can I go about TACTFULLY approaching the subject and somehow “enforcing” the refunding of the charge for work not done? And finally, why do you think bone grafting wasn’t mentioned if it was a possible necessity?