A tooth-stabilized surgical template

for alveolectomy
Matilda Dhima, DMD, MS,a Sreenivas Koka, DDS, MS, PhD,b and
Kevin L. Rieck, DDS, MDc
Mayo Clinic, Rochester, Minn
The supraeruption of teeth and bone in patients with long-standing partial edentulism often results in compromised interarch
distance. A method is presented for the fabrication and predictable use of a tooth-stabilized surgical template for alveo-
lectomy in instances where teeth are present. (J Prosthet Dent 2013;110:529-531)

When planning the extraction of all

remaining teeth and alveolectomy,1-3
measuring the appropriate amount of
bone to be removed is difcult once the
ap is reected and the soft tissue
landmarks are lost. In treatment plans
involving dental implant placement,4
appropriate vertical bone reduction
has been shown to optimize the anat-
omy, implant position, angulation, and
initial implant xation.5 The advantages
of this technique are ease of fabrication
and use, maintenance of landmarks
once ap reection is complete, ease of
1 Line drawn on cast reects necessary alveolectomy.
clinical use, no need for additional in-
struments, and decreased surgical time
because of the stability of the template
on the remaining teeth. The limitations
include additional laboratory time,
increased initial costs for surgical tem-
plate fabrication, and a requirement of
multiple teeth in the arch.
Instead of extracting all of the teeth
immediately after ap reection, they
are extracted after the surgical template
is seated on the teeth and the amount
of alveolectomy is marked on the bone.
In addition to the conventional
asking method for surgical template
fabrication, additional simpler and less
time-consuming fabrication methods 2 Surgical template is seated on cast after processing to
include a sprinkle-on method and a ensure adequate seating. Extended border of template is
vacuum-form shell. Caution is advised noted to allow nishing to marked line.

a
Assistant Professor, Mayo Clinic College of Medicine; and Chief Resident, Prosthodontics and Maxillofacial Prosthetics, Department of
Dental Specialties, Division of Prosthetic and Esthetic Dentistry.
b
Professor, Mayo Clinic College of Medicine; and Consultant, Department of Dental Specialties, Division of Prosthetic and Esthetic
Dentistry.
c
Assistant Professor, Mayo Clinic College of Medicine; and Consultant, Department of Surgery, Division of Oral and Maxillofacial Surgery.

Dhima et al
530 Volume 110 Issue 6

3 Surgical template ready for use. 4 Adequate seating is veried intraorally.

5 Anatomic structures such as mental nerve are identied 6 Marked line is obtained by tracing border of surgical
after full-thickness ap is reected. guide. Teeth are extracted and reference line for alveolectomy
remains intact.

when using a vacuum form shell with
short clinical crowns and teeth with
increased mobility and depressability, as
the shell may not be sufciently stable
and rigid when used clinically. In the
method presented, conventional asking
was used to ensure the stability and ri-
gidity of the surgical template because of
the increased mobility and depressability
of remaining teeth. A sprinkle-on method
would have also been appropriate.
TECHNIQUE
1. Mount denitive casts in a semi-
adjustable articulator (Hanau 96H2;
Whip Mix Corp).
2. Complete centric relation records,
face-bow transfer, and determination
of vertical dimension of occlusion by
using acrylic resin bases (Hygon Fast
The Journal of Prosthetic Dentistry
Curing Custom Tray Acrylic resin pow-
der/liquid; Lang Dental) with wax rims
(True Wax Baseplate wax; Dentsply
Intl).
3. Determine the appropriate inter-
arch distance on the mounted deni-
tive casts and draw this distance on the
cast planned for tooth extractions and
alveolectomy. Complete the outline of
the needed reduction for the template on
the cast (Fig. 1).
4. Duplicate the cast and block any
undercuts on the cast (True Wax Base-
plate wax; Dentsply Intl). Adapt 2 sheets
of wax (True Wax Baseplate wax, Dentsply
Intl) over the teeth and extending 5 mm
beyond the marked line (Fig. 2). Fabricate
a clear heat-processed acrylic resin surgi-
cal guide (Lucitone Clear Dental Resin;
Dentsply Intl) by asking and processing
in the usual way (Fig. 3). Trim any areas
extended beyond the marked line (Fig. 4)
with a tungsten carbide acrylic resin
adjustment bur (H251-070 carbide bur;
Brasseler).
5. Place the template on the teeth to
ensure adequate seating (Fig. 5). Reect
a full-thickness mucoperiosteal ap to
gain access to the underlying bone and
visualize anatomic areas such as the
mental nerve (Fig. 6).
6. Seat the surgical template on the
remaining teeth. Mark the outline of
the alveolectomy on the bone by tracing
the border of the surgical template with
a pencil and complete the extraction of
teeth (Fig. 7).
7. Perform the alveolectomy with
a surgical saw (Dental Surgical Instru-
ments, W&H GmbH) (Fig. 7) and pro-
ceed with implant placement procedure
or wound closure (Fig. 8).
Dhima et al
December 2013
7 A, Completed alveolectomy shows consistency with planned alveolectomy during treatment planning. B, Removed
osseous tissue.
8 Wound sutured after completion of alveolectomy.
SUMMARY
The use of a tooth-stabilized surgical
template was presented where remain-
ing teeth stabilized the surgical guide
without relying on soft tissue land-
marks. Incorporating remaining teeth
into the design of the surgical template
Dhima et al
provides a stable stop for the seating of
the guide intraoperatively. The seating
of the surgical template does not rely
on soft tissue landmarks, the determi-
nation of the alveolectomy is guided
solely by the teeth, minimizing errors in-
troduced by the loss of soft tissue land-
marks once a ap is reected.
531
REFERENCES
1. Jung SR, Bashutski JD. A bone-level stabilized
surgical template to manage enlarged non-
restorable maxillary tuberosities. J Prosthet
Dent 2010;103:319-20.
2. Crabtree DG, Bell DH Jr, Alexander JM. Sur-
gical template as a guide for reduction of
maxillary tuberosities. J Prosthet Dent
1986;55:137-9.
3. Hillerup S. Preprosthetic surgery in the elderly.
J Prosthet Dent 1994;72:551-8.
4. Costello BJ, Betts NJ, Barber HD,
Fonseca RJ. Preprosthetic surgery for the
edentulous patients. Dent Clin North Am
1996;40:19-38.
5. Jensen OT, Adams MW, Cottam JR, Parel SM,
Phillips WR 3rd. The all on 4 shelf: mandible.
J Oral Maxillofac Surg 2011;69:175-81.
Corresponding author:
Dr Matilda Dhima
Mayo Clinic
200 First Street SW
Rochester, MN 55905
E-mail: Dhima.matilda@mayo.edu
Copyright 2013 by the Editorial Council for
The Journal of Prosthetic Dentistry.