What is the purpose and procedure of alveoplasty after tooth extraction?

Alveoplasty After Tooth Extraction

Alveoplasty is a surgical bone contouring procedure performed during or after tooth extraction to smooth and reshape the alveolar ridge, creating an optimal foundation for prosthetic rehabilitation or implant placement by eliminating sharp bony edges and irregularities.

Purpose of Alveoplasty

The primary goals of alveoplasty include:

• Smoothing sharp bony projections and irregular contours that naturally occur after tooth extraction, which can interfere with denture fit or cause soft tissue irritation 1
• Creating a more favorable ridge morphology for future prosthetic treatment by recontouring the alveolar bone to eliminate undercuts and achieve proper ridge form 2
• Facilitating primary soft tissue closure over extraction sites, particularly important in patients at elevated risk for complications such as medication-related osteonecrosis of the jaw (MRONJ) 1
• Reducing the need for future bone augmentation procedures by optimizing the existing bone architecture at the time of extraction 3

Clinical Indications

Alveoplasty is particularly indicated in several specific scenarios:

• High-risk MRONJ patients where achieving primary closure is critical to prevent exposed bone and subsequent osteonecrosis 1
• Multiple adjacent extractions where significant ridge irregularities are anticipated 2
• Immediate denture fabrication requiring smooth, uniform ridge contours for optimal prosthetic fit 2
• Sites with prominent bony septa or exostoses that would compromise future implant or prosthetic placement 1

Surgical Procedure

The alveoplasty technique involves systematic steps:

Timing and Approach

• Performed at the time of extraction or as a secondary procedure after initial healing, though concurrent execution is preferred to minimize surgical interventions 1
• Requires flap elevation to visualize the bony architecture adequately, unlike socket preservation techniques that may use flapless approaches 4

Technical Steps

• Careful tooth extraction with minimal trauma to preserve maximum bone volume 4
• Bone recontouring using rotary instruments (burs) or bone files to smooth sharp edges and create gradual contours 1
• Removal of interdental and interradicular bone as needed to eliminate undercuts and achieve uniform ridge height 2
• Copious irrigation during bone removal to prevent thermal injury and remove bone debris 1
• Primary soft tissue closure achieved through careful flap management and tension-free suturing 1

Critical Technical Considerations

• Preserve maximum bone volume while achieving smooth contours—excessive bone removal compromises future implant placement 3, 2
• Avoid creating concave defects that would require future augmentation 4
• Maintain adequate keratinized tissue for optimal soft tissue healing and future prosthetic success 4

Distinction from Ridge Preservation

It is essential to differentiate alveoplasty from alveolar ridge preservation (ARP):

• Alveoplasty removes bone to create smooth contours, accepting some dimensional loss 1, 2
• Ridge preservation adds grafting material to minimize the physiologic resorption that occurs after extraction, maintaining bone volume for future implant placement 5, 3
• Ridge preservation reduces horizontal and vertical bone loss by 50% or more compared to unassisted healing, whereas alveoplasty intentionally reduces bone height 3

Special Populations: MRONJ Risk

In patients taking bisphosphonates or other antiresorptive medications, a specific protocol is warranted:

• Pre-operative CBCT imaging to assess bone quality and plan the procedure 1
• Alveoplasty with primary closure is strongly recommended to prevent exposed bone 1
• Post-operative prophylactic antibiotics should be administered 1
• Delay recommencement of bone-modifying agents until complete soft tissue healing is confirmed 1
• This approach resulted in 0% MRONJ development in a cohort of 46 high-risk patients undergoing 124 extractions 1

Common Pitfalls to Avoid

• Excessive bone removal that compromises future implant placement—remove only what is necessary for smooth contours 3, 2
• Creating tension during closure which can lead to dehiscence and exposed bone 4, 1
• Inadequate irrigation during bone contouring leading to thermal necrosis 1
• Failing to assess baseline bone thickness before deciding between alveoplasty alone versus combined ridge preservation, as thin buccal bone (<1mm) predicts significant resorption 4

Integration with Implant Planning

When future implant placement is anticipated:

• Consider ridge preservation instead of alveoplasty alone if adequate bone volume exists, as preservation reduces the need for future augmentation from 48% to 12% of cases 3
• For esthetic zone extractions with thin facial bone walls (<1mm), early implant placement (4-8 weeks) with contour augmentation is preferred over immediate alveoplasty 4
• Alveoplasty may be appropriate when immediate denture placement is required and implant therapy is not planned in the near term 2