RECONTOURING OF ALVEOR RIDGES Medical Assignment Help

RECONTOURING OF ALVEOR RIDGES

Irregularities of the alveolar bone found either at the time of tooth extraction or after a period of initial healing require recontouring before final prosthetic construction. The objectives of this recontouring should be to provide the best possible tissue contour for prosthesis support while maintaining as much bone and soft tissue as possible. Simple Alveoloplasty Associated with Removal of Multiple Teeth The Simplest form of alveolopl, “consists of the compression of the lateral walls of tne extractlon socket after simple tooth removal. In many cases of singte tooth extraction, digital compression of the extraction site adequately contours the underlying bone, provided no gross irregularities of bone contour are found in the area after extraction. However, when multiple irregularities exist, more extensive recontouring often is necessary. A conservative alveoloplasty in combination with multiple extractions is carried out after  ll of the teeth in the arch have been removed as described in Chapter 8. The specific areas requiring alveolar recontouring are obvious if this sequence is followed. Whether alveolar ridge recontouring is performed at the time of tooth extraction or .after a period of. healing, ‘the technique is essentially  the same. Bony areas requiring recontouring should be exp osed using an envelope type of flap. A mucoperiosteal incision along the crest of the ridge, with adequate extension anteroposterior to the area to be exposed, and flap ,  reflection allow adequate visualization and access to the
alveolar ridge. Where adequate exposure is not possible, small vertical-releasing incisions may be necessary. . The primary objectives of mucoperiosteal flap reflection are to allow for adequate visualization and access to the bony structures that require recontouring and to protect
soft tissue adjacent to this area during the procedure. AIthough’ releasing incisions often, create more discomfort during the-healing period, this technique is certainly preferred to the possibility of an unanticipated tear in the edges of a flap when inadequate exposure could not be achieved with an envelope flap. Regardless of flap design, the mucoperiosteum Should be reQected only to the extent that adequate exposure to the area of bony irregularity can be achieved. Excessive flap reflection may result
in devitalized areas of bone, which will resorb more rapidly after surgery, and a diminished soft tissue adaptation to the alveolar ridge area. Depending on the degree of irregularity of the alveolar ridge  rea, recontouring can be accomplished with a

FIG. 13-6 Simple alveoloplasty eliminates buccal irregularities and undercut areas by removing labiocortical bone. A. Elevation of mucoperiosteal flap, exposure of irregularities of alveolar ridge, and . removal of gros~ irregularity with rongeur. B, Bone bur in rotating handpiece can also be used to remove bone and smooth labiocortical surface. C, Use of bone file to smooth irregularities and achieve

FIG. 13-6 Simple alveoloplasty eliminates buccal irregularities and undercut areas by removing labiocortical
bone. A. Elevation of mucoperiosteal flap, exposure of irregularities of alveolar ridge, and
. removal of gros~ irregularity with rongeur. B, Bone bur in rotating handpiece can also be used to
remove bone and smooth labiocortical surface. C, Use of bone file to smooth irregularities and achieve

rongeur, -a bone file, or a bone bur in a handpiece, alone or in combination (Fig. 13-6). In any case, copious saline irrigation should be used throughout the recontouring procedure to avoid overheating and bone necrosis. After
recontouring, the flap should be reapproximated by digital bpressure and the ridge palpated to ensure that all irregularities have been removed (Fig. 13-7). After copious irrigation, the edges of the flaps can be trimmed to
remove excess tissue  and sutured with interrupted or continuous sutures. If an extensive incision has been made, continuous suturing ‘tends to be less annoying to the patient and provides for easier postoperative hygiene
because of the elimination of knots and loose-suture ends  along the incision line. When a sharp knife-edge ridge exists in the mandible, the sharp superior portion of the alveolus can be removed in a manner similar to that described for simple alveoloplasty. After local anesthesia is obtained, a crestal incision rongeur, -a bone file, or a bone bur in a handpiece, alone
or in combination (Fig. 13-6). In any case, copious saline irrigation should be used throughout the recontouring procedure to avoid overheating and bone necrosis. After recontouring, the flap should be reapproximated by digital pressure and the ridge palpated to ensure that all  rregularities have been removed (Fig. 13-7). After copious irrigation, the edges of the flaps can be trimmed to remove excess tissue and sutured with interrupted or continuous sutures. If an extensive incision has been made,  ontinuous suturing ‘tends to be less annoying to the patient and provides for easier postoperative hygiene because of the elimination of knots and loose-suture ends along the incision line.  When a sharp knife-edge ridge exists in the mandible,  the sharp superior portion of the alveolus can be re oved
in a manner similar to that described for simple alveoloplasty. After local anesthesia is obtained, a crestal incision

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