Preprosthetic Alveoloplasty

Preprosthetic alveoloplasty refers to a group of surgical procedures performed on the alveolar ridge to create an optimal foundation for prosthetic rehabilitation. Indications include sharp or irregular bony spicules following multiple extractions, prominent buccal or lingual undercuts that interfere with denture insertion or stability, tori (mandibular and palatal), genial tubercle reduction, mylohyoid ridge reduction, sharp mental nerve area, and severely resorbed or knife-edge alveolar ridges requiring augmentation strategy planning.

The procedure can be classified as: simple alveoloplasty (digital compression and minor trimming after extraction), intraseptal alveoloplasty (Dean's technique — removing interradicular bone after multiple extractions and collapsing the buccal cortical plate inward), radical alveoloplasty (extensive recontouring with osteotomies and bone removal), and segmental procedures (Obwegeser, sub-apical osteotomies for severe ridge atrophy or unfavorable jaw relationships requiring repositioning).

Surgical principles include preserving as much bone as possible (especially in implant candidates), avoiding excessive periosteal stripping that compromises healing, smoothing all bony edges with rongeurs and bone files, copious irrigation, and primary mucosal closure when feasible. Postoperative healing typically takes 6-8 weeks before final impressions for prosthesis fabrication, although immediate dentures can be relined as bone remodels. Complications include excessive bone removal compromising future implant placement, neurosensory disturbance (mental nerve), wound dehiscence, and unanticipated bone loss requiring later augmentation.