Alveoplasty

Alveoplasty


What Is It?
An alveoplasty is a type of surgery that smoothes the jawbone. It is also called an alveoloplasty. This procedure is done in areas where teeth have been removed or lost. Alveoplasty can be done alone, but is usually done at the same time that teeth are extracted.

Oral and maxillofacial surgeons usually perform alveoplasties, but some general dentists also do them.
What It's Used For




When a tooth is lost or extracted, it leaves a hole in the jawbone. Even after the gums have healed, there will be high and low points in the bone. This can make it difficult to fit a denture properly. The denture base can rub against the high points. The rubbing may cause sore spots and a bad fit.

Some people who have been missing teeth for many years have lost quite a bit of bone from their jaws. The top of the jawbone becomes very thin. Dentists call this area the ridge. Other people may have a lip of bone that juts out from the rest of the jaw. In these cases, a denture will not fit properly.

Dentists use alveoplasty to smooth lumps in the jawbone or to flatten or taper the jaw's ridge. The amount of bone removal is balanced by the need to maintain bone height. Adequate bone height is necessary to place implants and fit dentures.

Usually, alveoplasty is not done if only one tooth is being extracted. In this case, the area will heal normally on its own. However, if a sharp edge of bone remains after the tooth is removed, alveoplasty can be done to remove it.

Besides smoothing the jawbone, alveoplasty also speeds healing after multiple teeth are extracted. If your dentist removes a tooth, he or she leaves an open socket that fills with a blood clot. Eventually, the gum heals over the socket. An alveoplasty allows the gums to be stitched closed over the hole. This causes quicker healing. It also allows for better control of bleeding because there is no open socket.

Faster healing is important for certain people, such as cancer patients. They may need to have decayed teeth extracted before they receive chemotherapy or radiation therapy to the head or neck. Radiation can dry up the salivary glands and reduce blood flow to the jaw. Both of these problems can increase the risk of further decay.

Once the teeth are removed, radiation therapy cannot begin until the sockets are healed. Alveoplasty will help the area heal faster so therapy is not delayed. In this case, alveoplasty may need to be done even if only a single tooth is removed. In these cases, radiation therapy can usually begin 7 to 10 days after the surgery.
Preparation




Preparation before alveoplasty is different for each person. Some people may be asked to rinse with an antimicrobial mouthwash before surgery. Some also may receive antibiotics or pain medicine before surgery.

In some cases, a dentist will make a model of the jaw. This model will show the surgeon where to remove bone and how much to remove. To make a model, the dentist first takes an impression of the teeth and jaw. This is used to create a cast. The cast is ground down in areas where bone should be removed. Then a plastic model of the cast, called a stent, is made. The stent looks like a denture base, except it is clear. The oral surgeon will use the stent during surgery to make sure the right amount of bone has been removed.
How It's Done




Alveoplasty usually is performed in the office. Sometimes only local anesthesia is used. Some people also may be sedated with medicine given through a vein (intravenous). Others may require general anesthesia in a hospital.

If the alveoplasty is done along with extractions, the teeth will be removed first.

To start the alveoplasty, the surgeon makes a cut in the gum and peels it back to expose the bone. The surgeon then uses tools and possibly a rotary drill to remove the necessary bone. A file is used to smooth it.

Once the bone has been smoothed, the surgeon squirts water across the area to remove bits of bone. If a stent is required, the surgeon replaces the gum tissue over the bone and sets the stent on top. This helps the surgeon tell whether the correct amount of bone was removed. If the stent does not fit well, more bone will be removed. Then the bone will be reshaped until the stent fits, much like a denture. Then the gum tissue will be replaced and stitched closed. In some cases, a temporary, immediate denture will be inserted at the time of surgery.
Follow-Up




After alveoplasty, the area probably will be sore for about a week. For the first day or two, you may be given narcotic pain medicine. After that, you can use over-the-counter medicine, such as acetaminophen (Tylenol and others) or ibuprofen (Advil, Motrin and others).

You may have some swelling. This should peak after about 24 hours and then taper off. You can use ice on your face to keep the swelling down. You also may notice bruising. Where the bruises appear will depend on the location of the surgery. They may be under your jaw line, on your chin and cheeks, or inside your mouth.

Your surgeon may prescribe antibiotics to prevent infection. An antibacterial rinse may be provided. You also can rinse with a saline (salt water) solution.

Until the stitches dissolve or are removed, you should eat a soft diet. Also avoid using a straw because the suction can encourage bleeding.

After 7 to 10 days, the surgeon will look at your mouth again to see how the area is healing.
Risks




The risks of alveoloplasty include:

Excessive bleeding — This is rare. The area may have some oozing for the first 24 hours after surgery, but then should taper off.
Infection — Because the mouth contains many bacteria, there is always a risk of infection after surgery. This risk is relatively low, however. Your surgeon may prescribe antibiotics to help prevent infection.
The wound opening — The stitches may come loose. This can open the wound and expose the bone. If this occurs, contact your surgeon.
Trauma to the nerve that provides feeling to the lips and chin — This is very rare, but can occur when alveoplasty is done on the lower jaw. If the nerve is bruised, your lip and chin may feel numb long after the local anesthetic wears off. Your lip will not droop. No one else will be able to tell that your nerve is bruised. Nerves heal slowly. In a very small percentage of people, there may be some permanent numbness.
When To Call A Professional




After alveoplasty, contact your surgeon if you have:
Significant bleeding or increased swelling after the first 24 hours
Any indication of an infection, such as fever, chills or inflammation of the area
Loosening of stitches or opening of the wound to expose the bone