ALVEOLOPLASTY

AND FRENECTOMY

Seminar
Dr. Saurabh Jain
MDS PART I
 ALVEOLOPLASTY

 Alveolectomy has been defined as “the surgical removal of a portion of the

alveolar process”. Alveoloplasty is a newer and better term, for, technically,

alveolectomy would have us cut off the entire alveolus.

 Alveoloplasty, whether simple or extensive, is perhaps the most common surgical

procedure used to prepare the jaws to receive a prosthesis.

 OBJECTIVE

 The primary purpose of the alveolar bone is to support the dental

apparatus. Following Wolff’s Law of bone adaptation, alveolar bone

remodels itself in response to each new situation of pressure. It will heal

after dental extractions, and it will usually attempt to adapt itself to the

general configuration of the rest of the alveolar arch. Alveolar Cortical bone

will re-form in approximately 3 months, more or less.

 INDICATIONS
 Single and multiple extractions with surrounding irregularities of the alveolar

bone.

 Tori mandibularis and palatinus; exostoses; osteomas

 Bulging or Enlarged alveolar processes and tuberosities.

 Knifelike ridges or alveolar crest; sharp edges

 Anterior maxillary protrusion

 SIMPLE ALVEOLOPLASTY

 The ideal situation to carry this surgical procedure is when the oral surgeon has

limit himself to extracting the teeth, elevating the mucoperiosteum 1 or 2 mm,

excising the sharp edges of alveolar occlusal bone, filing and suturing the soft

tissues back into position.

 RADICAL ALVEOLOPLASTY
 The radical alveoloplasty of the alveolus with teeth consists of extracting the teeth

and carrying out the excision of the bone. Some prefer to do the extractions first and

then reflect the mucoperiosteum; others reflect the mucoperiosteum first, cut away

the heavy bone over the cuspids and the molars to facilitate the extractions, and then

extract the teeth.

 The mucoperiosteum shouldn’t be elevated no further than the middle third of the

root to maintain the depth of the muco-buccal or labial sulcus.

 RADICAL ALVEOLOPLASTY IN
DIFFERENT SITUATIONS

 In anterior maxillary bone protrusion cases, the labial cortical alveolar

plate is often excised with ronguers to a position decided upon in the

preoperative planning.
 RADICAL ALVEOLOPLASTY IN
DIFFERENT SITUATIONS

 Excessive undercuts of the tuberosities are excised in the radical alveoloplasty. When

there are bilateral tuberosity undercuts, frequently only one side need be excised so

that the denture to be made can be inserted over the one undercut.

 Torus palatinus and torus mandibularis are bone exostoses and should also be removed

to aid in the fabrication of dentures.

 RADICAL ALVEOLOPLASTY IN
DIFFERENT SITUATIONS

 Sharp, knifelike alveolar ridges often have to be rounded over because of pain caused

when the denture presses down during mastication.

 Elimination of the mylohyoid ridge is rarely necessary. The area is exposed through

reflection of lingual periosteum and the mylohyoid muscle is stripped off and the ridge

is excised with ronguers, chisels or burs.

 RADICAL ALVEOLOPLASTY IN
DIFFERENT SITUATIONS

 In rare instances in which the mandible has atrophied greatly, the genial tubercles of the

mandible may present a pain problem. In such cases the tubercles are excised.

 In patients undergoing radiation therapy for oral malignancies, the excising of interdental

and interradicular septa and smoothening of all sharp edges of cortical bone is necessary

in order to prevent any formation of starting focus for the development of

osteoradionecrosis.
 INTRASEPTAL ALVEOLOPLASTY-
DEAN’S ALVEOLOPLASTY

 It mainly provides for the reduction of prominent undercuts or the reduction of

prominent premaxilla without loss of the labial or buccal cortical plate.

 In this technique, the cortical plate extending from the cuspid-premolar area of

one side to the same position on the other becomes a tension-free onlay bone

graft.

 This is done by reflecting the mucoperiosteum and extracting the teeth and then
 INTRASEPTAL ALVEOLOPLASTY-
DEAN’S ALVEOLOPLASTY

 A V shaped wedge is cut in the premolar or cuspid buccal cortical bone on

each side. A small chisel is introduced to the depth of each socket and the

labial cortical bone is cracked from within the socket; this permits the large

cortical fragment to be pushed towards the palate by squeezing between the

thumb and the first finger.

DEAN’S ALVEOLOPLASTY
DEAN’S ALVEOLOPLASTY
 OBWEGESER’S MODIFICATION
 After cutting the intra-septal bone, an inverted cone vulcanite bur is used to widen the

socket at the base. With small disk or bur, horizontal cuts are made at the base of the

extraction sockets in the labial and palatal cortices

 With a straight fissure bur, vertical cuts are then made bilaterally in both labial and

palatal cortices in the area distal to canine sockets With digital pressure, both labial

and palatal cortices are compressed together and sutures given.

OBWEGESER’S MODIFICATION
OBWEGESER’S MODIFICATION
 SECONDARY ALVEOLOPLASTY

 Many oral surgeons prefer to perform a secondary alveoloplasty several weeks

after the teeth have been removed.

 This technique helps to conserve alveolar bone, especially in the lower jaw.
 FRENECTOMY

The frenum is characterized as pathogenic and is indicated for removal when

 An aberrant frenal attachment is present, which causes a midline diastema.

 A flattened papilla with the frenum closely attached to the gingival margin is present,

which causes a gingival recession and a hindrance in maintaining the oral hygiene.

 An aberrant frenum with an inadequately attached gingiva and a shallow vestibule is

seen.
 TECHNIQUES

 Conventional (Classical) frenectomy

 Miller’s Technique

 V-Y Plasty

 Z Plasty

 Frenectomy with Electrocautery

CLASSICAL FRENECTOMY

[Table/Fig-1]: Pre-operative papilla type

of frenal attachment
[Table/Fig-2]: Frenum held with
hemostat
[Table/Fig-3]: Frenum excised
[Table/Fig-4]: Sutures placed
[Table/Fig-5]: One month post-operative
 MILLER’S TECHNIQUE
 The ideal time for performing this surgery is after the orthodontic movement

is complete and about 6 weeks before the appliances are removed.

 Excision of the frenulum and exposure of the labial alveolar bone in the

midline. A horizontal incision was made to separate the frenulum from the

interdental papilla.

 A laterally positioned pedicle graft (split thickness) was obtained and it was

sutured across the midline.

MILLER’S TECHNIQUE

[Table/Fig-6]: Pre-operative
attached type of frenal attachment
[Table/Fig-7]: Frenum excised
[Table/Fig-8]: Lateral pedicle graft
obtained
[Table/Fig-9]: Graft sutured across
the midline
[Table/Fig-10]: 2 weeks post-
operative
 Z-PLASTY

 This is indicated when there is hypertrophy of the frenum with a low insertion.

 The length of the frenum was incised with the scalpel and at each end, limbs at

between 60º and 90º angulation, incisions were made in equal length to that of the

band. The submucosal tissues were dissected beyond the base of each flap, into the

loose non-attached tissue planes. The resultant flaps which were created were

mobilized and transposed through 90º to close the vertical incisions horizontally.
Z-PLASTY

[Table/Fig-11]: Pre-operative attached type of

frenal attachment
[Table/Fig-12]: Incision given through the
frenum
[Table/Fig-13]: Incision given at both ends of the
frenum to obtain 2 triangular flaps
[Table/Fig-14]: Flaps transposed across the
midline sutured in the form of Z
[Table/Fig-15]: 1 month post-operative
 V-Y PLASTY

 V-Y plasty can be used for lengthening the localized area, like the broad frena in the

premolar-molar area.

 The frenum is held with the haemostat and an incision is made in the form of V on the

undersurface of the frenal attachment. The frenum is relocated at an apical position

and the V shaped incision is converted into a Y and is sutured with 4-0 silk sutures.
V-Y PLASTY

[Table/Fig-16]: Pre-operative papilla

type of frenal attachment
[Table/Fig-17]: Frenum held with
hemostat
[Table/Fig-18]: Frenum incised by V-
shaped incision
[Table/Fig-19]: V-shaped incision
sutured in the form of Y
[Table/Fig-20]: 1 month post operative
 REFERENCES

 Textbook of Oral & Maxillofacial Surgery- Neelima Malik

 Devishree et al., Frenectomy: A Review with the Reports of Surgical Techniques

 Alveoloplasty-the oral surgeon’s point of view, Irving Meyer, D..Sf.D., JlSc.,

D.Rc.,* Springfield, Mass

