Elimination of sharp bone edges and alveolectomy
Sharp contours of the alveolar ridge often traumatize the mucous membrane, causing pain and forming a painful groove upon palpation. To eliminate them prior to prosthetics, an incision is made (either linear or forming a trapezoidal/triangular mucoperiosteal flap). Prominent areas are excised with bone rongeurs or a bur, and minor irregularities are smoothed with a surgical mallet. The intervention is completed by approximating the wound edges and placing interrupted sutures.
Sometimes, due to prolonged tooth loss, the interalveolar space is critically reduced, making denture design impossible. As a forced measure, an alveolectomy is performed:
- An incision is made along the crest and the gingiva is elevated.
- The bone is evenly ground down with a bur (mandatory water cooling is required).
- The resulting excess gingiva is excised and the wound is sutured.
In cases of complete adentia, the surgery is performed simultaneously on both jaws, whereas if teeth are present on one jaw, only the edentulous one is operated on.
Materials for jaw augmentation
Tooth loss triggers secondary atrophy processes, which proceed significantly faster and more pronouncedly in the mandible than in the maxilla. Various materials are used to improve the parameters of the prosthetic bed:
- Autogenous bone: biologically the optimal choice. Harvesting is performed from the mental region, retromolar region, or iliac crest. Disadvantages: the need for an additional surgery and the risk of complete resorption.
- Allogenic bone: successfully used only for small defects; for extensive plastics, there is a high risk of exposure and graft loss.
- Cartilage tissue: patient's own cartilage is rarely used due to complications; stable lyophilized tissue is preferred.
Isolating membranes are used to isolate the bone defect. Resorbable ones are made of collagen, while non-resorbable ones (made of polytetrafluoroethylene) require a second surgery for removal after bone engraftment.
Sandwich osteotomy
Patients with severe resorption of the maxillary alveolar process and a significant reduction in the vestibular vaults are indicated for a complex reconstruction — a sandwich osteotomy.
Stages of surgery:
- Performing an osteotomy of the alveolar process and displacing it inferiorly.
- Placement of autogenous bone blocks (harvested from the rib or iliac crest) into the formed gap.
- Filling voids with minced bone or osteoplastic material.
- Rigid fixation of jaw fragments with titanium plates.
The method provides a predictable outcome, excellent blood supply, and minimal resorption, as well as corrects soft tissues. However, the surgery is extremely complex and traumatic. Since it is mostly needed by elderly patients, the presence of age-related comorbidities often makes this method contraindicated.
Hydroxyapatite augmentation
If the goal of the intervention is to prepare the alveolar process for dental implantation, the administration of hydroxyapatite granules (a biocompatible material of natural or artificial origin) is widely used.
The procedure is minimally invasive, therefore performed on an outpatient basis and under local anesthesia. The surgeon creates tunnels strictly subperiosteally and injects the granules into them under pressure from a syringe. Hydroxyapatite practically does not resorb. During the healing process, it becomes covered with fibrous tissue forming a capsule. Full consolidation occurs in about 3 months.
Briefly: answers to topical questions
What instruments are used for the excision and smoothing of bone tissue during alveoloplasty?
Various surgical instruments are used for the excision and smoothing of bone tissue.
- Bone rongeurs (forceps) — used to excise prominent areas and level sharp socket edges.
- Bur — used for even grinding and smoothing of bone irregularities with mandatory cooling.
- Surgical mallet — used to smooth small sharp edges by tapping.
- Bone rasp — intended for smoothing sharp edges and modeling the bone surface.
- Chisels and osteotomes — used to smooth sharp bone edges.
What are the indications for alveolectomy?
Indications for alveolectomy are conditions requiring surgical correction of the alveolar process.
- Presence of sharp socket edges — removal of prominent bone areas to eliminate pain syndrome and prepare for orthopedic treatment.
- Critical reduction of the interalveolar space — used as a forced measure to create conditions for prosthetics with prolonged tooth loss, when modeling antagonist teeth is impossible.
- Smoothing of the alveolar ridge — performed as part of pre-prosthetic preparation.
From which anatomical regions is autogenous bone harvested for jaw augmentation?
Autogenous bone harvesting for jaw augmentation is performed from the following donor sites:
- Mental region.
- Retromolar region.
- Iliac crest.
- Rib — used as a donor site in sandwich osteotomy.
What materials are used to make isolating membranes for guided bone regeneration?
Isolating membranes for guided bone regeneration are made from resorbable and non-resorbable materials.
- Collagen — used to create resorbable membranes (including synthetic collagen).
- Resorbable polymer — used to manufacture biodegradable membranes.
- Freeze-dried bone — serves as a material for resorbable membranes.
- Polytetrafluoroethylene — used to produce non-resorbable membranes.
- Pure titanium — used to create non-resorbable membranes that require subsequent removal.
What are the contraindications for sandwich osteotomy?
Direct absolute contraindications to sandwich osteotomy are not listed in the sources. The following limitations and disadvantages are indicated:
- specialized and complex nature of the surgery;
- need for additional surgery at the donor site to harvest the autograft;
- presence of comorbidities in elderly patients, which imposes strict limitations on the choice of complex surgical techniques.
What complications can occur after alveolectomy?
The primary complication cited in the sources following alveolectomy is the deterioration of the retention of the future removable laminar denture. Therefore, alveolectomy for reducing the interalveolar space is used as a forced measure in the absence of other ways to create conditions for prosthetics.
What classes of osteoplastic materials are used for jaw augmentation?
The following classes of osteoplastic materials are used for jaw augmentation:
- Autogenous bone tissue (Autograft) — the patient's own bone, which is the most biologically acceptable option.
- Allogeneic bone tissue — donor bone tissue of the same biological species.
- Alloplastic materials — biocompatible materials of artificial or natural origin (e.g., hydroxyapatite granules).
- Cartilage tissue — used in the form of a freeze-dried cartilage allograft, yielding a stable result.
To memorize the main donor sites of autogenous bone, use the rule of three "C"s: Chin, Crest of ilium, Current (retromolar) area.
Class and exam questions
How to prevent resorption of the autograft?
This requires the most precise adaptation of the bone graft to the recipient bed and its rigid fixation with microscrews.
Why do non-resorbable membranes create additional inconveniences?
They are made of polytetrafluoroethylene and require mandatory re-intervention for their removal after bone healing.
What belongs to promising but rarely used methods of osteoplasty?
These techniques include distraction osteogenesis and autotransplantation with simultaneous revascularization using microsurgical techniques.
What else to study on this topic
- Technique of mucoperiosteal flap formation
- Principles of working with non-resorbable polytetrafluoroethylene membranes
- Distraction osteogenesis of the jaws
- Microsurgical autotransplantation with revascularization
Master the entire topic in the course "Surgical Dentistry"
This is a summary. The course covers everything tested in classes and exams.
- Full textbook on "Alveoloplasty" and 866 more pages of the subject
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- AI tutor answers questions on the topic anytime
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Other topics in "Chapter 16. Surgical Preparation of the Oral Cavity for Prosthetic Treatment (A.V. Shchipsky)"
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