Extraction of Maxillary Anterior Dentition, Alveolectomy, Gingivectomy

Preoperative 2D rendering.

Pt was referred by UW Kaiser clinic.

Plan is for extraction of maxillary dentition, Alveolectomy, and gingivectomy.

#28 to be removed at later date per patient.

Patient profile: note extruded position of anterior complex and supporting alveolar bone

Anterior view

Excessive vertical overlap as a result of anterior complex extrusion

This slide and next:• Green line denotes improved gingival margin and incisal

position. • Patient will require wax-up to determine final vdo and tooth

position.• However proper prosthetic tooth position will be

IMPOSSIBLE without adequate Alveolectomy. ~ 3-4mm to compensate for superior tooth position and ~ 1- 2mm for acrylic base thickness

New anterior view with teeth digitally moved superiorly by about 3-4mm

Yellow arrows indicate direction the anterior complex needs to be shifted.

The green line approximates the outline of a wax rim assuming the vdo will have remained the same

Full thickness approach.

Crevicular incision around the buccal of the teeth

Next two slides:

Using an opposing thumb or finger as a fulcrum allows for controlled elevation of a full thickness flap.

Note curvilinear vertical release begins a few millimeters distal to the end of the surgery site (tooth #5).

Continual use of throat pack

1.improves patients comfort 2. minimizes heme accumulation in the back of the throat3. Reduces risk of aspiration of bone, tooth, and tissue

Use of gauze to quickly strip full thickness flap from the alveolus

Create a vertical corticotomy around The mesial and distal of the roots. This creates a good purchase point for elevators

Remove buccal alveolar bone

Use surgical handpiece with 557 surgical bur

Counter-clockwise rotation with apically directed pressure to dilate socket.

Thumb and forefinger provide stabilization of beaks on root surface

Clockwise rotation with apically directed pressure to dilate socket.

Thumb and forefinger provide stabilization of beaks on root surface

Correct hand position. Middle finger provides attenuation of grip pressure applied to forceps.

All roots removed intact

Planned Alveolectomy

Piezo-electric handpiece and saw tip

Alveolectomy incision

Separating sectioned alveolus

Sectioned alveolus

Rounding corners of the surgery site

Removing excess tissue

Untensioned primary closure. Note wound margin eversion.