Glossary

Alveolar preservation, also called alveolar ridge preservation or preservation of the maxillary alveolar ridge, is a procedure used to reduce the amount of bone loss that can occur after extracting a tooth. This procedure is typically done when a tooth is extracted with the intention of placing an implant at a later date. Because of the risk of bone loss after the extraction of a tooth (between 30-60% is expected), it’s important to be proactive if you are confident that an implant will be placed. The procedure involves placing a platelet-rich fibrin (PRF) into the empty socket after the tooth is removed. PRF contains a high concentration of platelets, which are the body’s natural healing mechanism. Additionally, a periodontist can choose to use a scaffold or bone grafting material instead of PRF. Without alveolar preservation, the alveolar ridge will not maintain proper shape and the tissue can become contoured in a way that makes placing an implant challenging.

The alveolar processes are arguably the most crucial anatomical structure in the dental implant industry. The alveolar process is the thick ridge of bone in the jaw that holds the dental alveoli, or tooth sockets. The dental alveoli hold the roots of the teeth in place, and in case of a dental implant, the alveolar process holds implant hardware in place. There are two alveolar processes — the alveolar process of maxilla is on the top part of the mouth, just under the maxillary sinus, and the alveolar process of mandible is on the lower part of the mouth, just above the jawbone. Healthy, strong alveolar processes are crucial to successful dental implants, and in cases of tooth extraction, this bone can be reduced between 30-60%. When there’s not enough bone to support implant hardware in the alveolar process, bone grafting is typically done. Often, alveolar preservation will be used after an extraction when an implant is imminent.

The maxillary sinus is the largest air sinus in the human body, and it has three recesses. The Infraorbital recess is superiorly towards the eye, the zygomatic recess is pointed laterally towards the ear, and the alveolar recess pointed inferiorly towards the upper part of the jaw. It is this specific recess that is critical when considering tooth extraction and tooth implantation. Essentially, the alveolar recess is a depression or cavity in the floor of the maxillary sinus, formed by a septum. When placing a dental implant, the goal is to avoid coming into contact with the alveolar recess of the maxillary sinus, however, due to its close proximity to the roots of maxillary premolars and molars, this can prove to be a significant challenge. A periodontist must accurately assess the distance between the maxillary alveolar ridge and the alveolar recess in order to prevent serious complications during the dental implant process.

The alveolar ridge is an extension of the maxilla (the upper part of the jaw) and the mandible (the lower part of the jaw) and is a bony ridge that holds the sockets of the teeth. The alveolar ridge is a critical anatomical structure for healthy teeth and successful dental implants. When a tooth is extracted from the maxillary alveolar ridge or the lower alveolar ridge, bone loss typically occurs. Bone loss, or alveolar ridge resorption, can be as much as 30-60% of bone. Without enough dense bone in the alveolar ridge, placing implant hardware can be a challenge. This is particularly true in the case of maxillary alveolar ridge implants, which is very close to the alveolar recess of the maxillary sinus. Often, in cases of severe resorption or alveolar ridge fracture, bone grafting will be necessary to ensure that there is enough dense, quality bone to successfully hold implant hardware.

The augmentation of the alveolar ridge, or the bony ridge of the upper and lower jaws that hold the sockets and roots of teeth, is a process that can help prepare the bone for a dental implant. An alveolar ridge augmentation procedure helps to improve the shape and size of the ridge, so it can better retain dental implant hardware. In some cases where only one tooth is being replaced, it may be done in an individual socket only. Or, bone grafting and augmentation of the alveolar ridge may involve a large part of the ridge or the entire ridge itself. Alveolar ridge augmentation can help recreate the natural shape of the ridge after the removal of one or more teeth and after bone loss or resorption has occurred. Not only does this procedure help anchor dental implants, it can help restore aesthetics, particularly in cases where the work is done in the front of the mouth.

When teeth are extracted, a certain amount of bone loss or resorption occurs, usually about 30-60%. This loss is typically three-dimensional in nature, with width loss or horizontal deficiency developing to a greater extent than other types of deficiencies. An alveolar defect can be classified as the loss of labial or buccal cortical or medullary bone. In some cases, both exist. Although all alveolar defects present challenges when planning a dental implant procedure, if the defect is in the buccal cortex or cortical plate after tooth extraction, this can create significant difficulties in the reconstruction of a dental implant. Bone loss or bone augmentation techniques have been developed to counteract alveolar defects, such as guided bone regeneration, onlay block bone grafting, ridge/split bone grafting, and alveolar distraction osteogenesis. These procedures can help improve an alveolar defect and prepare the alveolar ridge for a successful dental implant.

Alveolar ridge resorption following tooth extraction is an extremely common and generally inevitable side effect of removing a tooth from its socket in the alveolar ridge. Between 30-60% of bone is typically “lost” or resorb into the alveolar ridge, which unfortunately gives periodontists little to work with when planning a dental implant procedure. However, many techniques have been developed to reduce the amount of bone loss immediately after a tooth extraction if it is known that a dental implant will be placed there at a later date. In cases where a tooth has been removed and has healed with bone loss, one or more bone grafting procedures may be done to improve the density and amount of bone available in the alveolar ridge before the implantation procedure. Alveolar ridge resorption can pose a challenge for dental implant care plans, however, skilled periodontists have a wealth of tools at their disposal to counteract this common but difficult problem.

The body has multiple different types of septums, which are generally defined as a partition or “wall” that divides a cavity or a space in the body. Some septums are made from cartilage or membranes, while others are considered “osseous”, or made of bone. The alveolar septum is also called the interalveolar septum or the interradicular septum, and is one of the very thin plates of bone that separates the alveoli or tooth sockets in the teeth from one another in both the maxillary alveolar ridge and the lower alveolar ridge. Ideally, the alveolar septum would be allowed to remain intact after a dental implant procedure and the implant hardware would rest in the middle of the alveoli or tooth socket similar to the root of a natural tooth, between the two alveolar septums on either side of it.

An alveolectomy is an invasive yet effective surgical dental procedure that helps to remove some or all of the alveolar bone that encapsulates a tooth and to recreate the surface and shape of the jawbone. This is typically done as a preparatory surgery prior to dental implant procedures, but can also be done on its own in case of removing severely infected teeth directly from the roots. There is a low rate of severe complications with an alveolectomy procedure, and the number of successes with this surgery is high. It’s important that periodontists bill a patient’s insurance with the proper alveolectomy ADA code, or the alveolectomy dental code, or insurance may decline to make payment on the account. Although several weeks of healing is needed after an alveolectomy before a dental implant procedure can be done, it is often the best choice to prepare the alveolar ridge when more than one dental implant is needed.

What is alveoloplasty and how does it differ from other procedures done on the alveolar ridge? The alveoloplasty definition is a surgical procedure that is done, typically at the same time as tooth extraction, to smooth and contour the jawbone of the patient within the alveoli, or the sockets of the teeth. This is done so that a subsequent dental implant has a higher chance of success, retention, comfort, and stability. However, alveoloplasty does not need to be done solely in conjunction with tooth extraction — it can be done after extraction, or even well after a tooth is lost. Alveoloplasty cost is affected by numerous factors, including how much of the jawbone needs to be treated and if the procedure is done as a standalone procedure or in conjunction with tooth extraction. Typically, alveoloplasty that is done as a standalone procedure costs more than one done in conjunction with extraction.