Exodontia

Alveoloplasty-the oral surgeons

point of view
Irving Meyer, D..Sf.D., JlSc., D.Rc.,* Springfield, Mass.

A lveolectomy has been defined as the surgical removal of a portion of the

alveolar process.7 Alveoloplmty is a newer and better term, for, technically,
alveolectomy would have us cut off the entire alveolus.
ThornaG has stated that some form of alveoloplasty is indicated in nearly
every instance of multiple extractions and frequently even in single extractions.
Alveoloplasty, whether simple or extensive, is perhaps the most common surgical
procedure used to prepare the jaws to receive a prosthesis. While performing
extractions, whether of one or many teeth, the oral surgeon should at all times
consider the bone and/or soft-tissue procedures needed to leave the mouth in
the best possible condition for future prosthrtic replacement.
Alveoloplasty often facilitates t,he construction of a better-fitting and more
esthetically pleasing denture. Among the factors which the oral surgeon must
consider in evaluating this procedure arc the patients desire for improvement
in his or her dental appearance and the patients comfort in wearing the
dental prosthesis, whether it is an immediate denture or one fabricated after a
delay of 3 or 4 months. There are few things more painful than wearing a
denture on a ridge with many sharp spicules or severe undercuts of bone.

HISTORY
IIistoricall>~, alveolec*tomy (or alveoloplasty) has lIeen known for more than
a century. In 1853 A. T. Willard of Chclsea, Massachusetts, advocated reduc-
tion of the alveolar process in ord~~r to nc~romplish c+omplete approximation of
soft tissues over the ridge.
In 1876 W. G. Bearce of Xontrcal, Canada, described what he called the
heroic treatment of alvcolectomy to help hature remodel and reshape the
dental arch.

Part of a syuposium on alvroloplasty preswlt.ed at the forty-seventh annual meeting of

the American Society of Oral Surgeons, I)envw, Cola., Nov. 3, 1965.
Associate Xeseareh Professor of Oral Pathologp, Tufts University School of Dental
Medicine.

441
 OS., O.M. & O.P.
October, 1966

In 1905 W. Shearers 3 of Omaha, Nebraska, advocated and described alveo-

lectomy as a procedure similar to the one carried out today. He employed
alveolectomy to eliminate alveolar and gingival pathosis as well as to provide
a base for the prosthodontist to construct a denture.
In 1936 0. T. Dean4 in the Journal of the American Dental Association,
described the intra-septal alveolectomy. An improvement of Deans pro-
cedure, with a description of its use for immediate dentures, was presented by
Donald R. MaeKay at the forty-fourth annual meeting of the American
Society of Oral Surgeons in 1962; this was published in the Journal of the
American Dental Association in April, 1964.

OBJECTIVES AND INDICATIONS FOR ALVEOLECTOMY

The oral surgeon must start with the maxim that bone is precious and must
not be wasted. Conservation of bone is most desirable, wherever and whenever
possible.
Bone is a living dynamic tissue. Osteoblastic and osteoclastic activity takes
place in response to stimulation or stress, as the case may be. Different local
situations will bring forth different reactions of the bone. For example, (1)
loss of the opposing teeth of the mandible often results in elongation of opposite
teeth of the maxilla with their surrounding alveolar bone, and vice versa; (2)
atrophy of the alveolus occurs under a poorly fitting denture; (3) abnormal
occlusal relationships of dentures often cause atrophy and loss of alveolar bone
height as well as changes in the shape and function of the temporomandibular
joints; and (4) periodontal destruction of alveolar bone results in marked
abnormalities of the jaws.
The primary purpose of the alveolar bone is to support the dental apparatus.
This is not a static function, however, but rather a dynamic vital one. Following
Wolffs 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. Whether immediate dentures delay or enhance this recon-
structive process has not been fully and scientifically demonstrated, although
numerous papers on this subject have been presented.
Systemic factors influence the alveolar bone. Generalized diseases, including
diabetes, certain anemias (thalassemia) , Pagets disease, fibrous dysplasia,
syphilis, and hormonal dysfunctions, often present problems for the oral surgeon
and the prosthodontist. Debilitation and alveolar atrophy, so often seen in the
geriatric patient, are frequently difficult to manage.
A major consideration is also whether or not, in view of his medical history,
a patient can tolerate any extensive surgical procedure. Obviously, a seriously
ill patient should be subjected to as little surgical intervention as possible.
In view of the necessity of giving the prosthodontist the very best base
possible for the retention of a denture, all surgical procedures must be planned
in advance. Dental extractions must be done carefully so as to avoid either
needless loss of bone by careless fracturing of the cortical plates or tearinp of the
Volume 22 Alveoloplasty 443
Number 4

surrounding soft tissues. Often the judicious use of a surgical technique to

remove a deeply rooted or ankylosed tooth will, in the long run, preserve bone;
this is especially true with respect to removal of the multirooted maxillary
molars where the tuberosity may easily be lost. In exodontia, skill is far more
important than brawn.
Soft-tissue surgical procedures should hc performed whenever they will help
cithcr conserve bone by avoiding extensive alveoloplasty or make better use of
the existing alveolar bone which may he diminished in quantity as a result of
atrophy or long absence of teeth.
There are a number of sound indications for alveoloplasty and soft-tissue
surgical procedures in the preparation of the jaws for prostheses. These are as
follows :
1. Single and multiple extractions with surrounding irregularities of
the alveolar bone
2. Tori mandibulari and palatinus; exostoses; osteomas
3. Bulging or enlarged alveolar processes and tuberosities
4. Knifelike ridges or alveolar crest ; sharp edges
5. Anterior maxillary protrusion
6. Soft-tissue abnormalities
A. Redundant, pendulous tissue; granuloma fissuratum
B. Loss of depth of the mucobuccal or lingual sulcus
C. High frenum of muscle attachments; scar tissue
D. Fibromatosis of maxillary tuberosities or mandibular retro-
molar pad
7. Ankylosed teeth with loss of cortical plate or tuberosityfi, 7
Despite these indications for alveoloplasty, the oral surgeons judgment is
and must be influenced by the desires and requirements of each prosthodontist
with whom he is working. These requirements vary greatly from prosthodontist
to prosthodontist. Some want a ridge that is absolutely smooth, with elimination
of all undercuts, rolls, exostoses, and even the mylohyoid ridge; others want
absolutely nothing done to the ridge after the dental extractions are completed.
Where does the answer lie? Which one is correct? I believe that neither extreme
is correct but that the correct procedure is somewhere in the middle. However,
so long as the prosthodontists cannot decide among themselves just what is
best., the oral surgeon must, adapt. the alvcoloplasty for each individual prostho-
dontist with whom he works.
In a recent survey of many oral surgeons in Minnesota, 1)onald K. Mac.Kay
of St. Iaul asked what were the five most c'onuno~~ iaiiures ohserved in surgery
for prosthetics. Their ansurers revealed the following :
1. Inadequate surgical preparation of the maxillary posterior tuber-
osity a.nd inadequate extension of t,hc denture periphery in the area
2. Faulty cast trimming by the laboratory; the prosthodontist should
survey and trim his own impression casts in consultation with the oral
surgeon
3. Inadequate periphery extension of the maxillary denture, particu-
larly in the post-dam area
444 Jfcyer O.S., O.M. & O.P.
October, 1966

4. Incomplete surgical preparation and extension of the denture in

t,he posterior lingual region of the mandible
5. Faulty bite registration

SURGICAL PROCEDURES
Alveoloplasty
Simple alaeoZopZusty. The ideal situation is that in which the oral surgeon
is able to 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. Some cases lend themselves to this basic
simple alveoloplasty procedure; when they do, all concerned (the oral surgeon,
the prosthodontist, and, above all, the patient), are delighted.
Radicab alveoloplasty. The radical alveoloplasty consists of extensive excision
of alveolar bone and may be performed on either the alveolar ridge with teeth
or the endentulous ridge. The radical alveoloplasty of the alveolus with teeth
consists of extracting the teeth and carrying out the excision of bone. Some sur-
geons prefer to do the extractions first and then reflect the mucoperiosteum;
others reflect the mucoperiosteum first, cut awa.y the heavy bone over the
cuspids and molars to facilitate the extractions, and then extract the teeth.
The latter believe that this procedure of first cutting away the heavy bone pre-
vents fra,cture of the alveolar cortical bone and subsequently leads to conserva-
tion of bone.
Generally, the mucoperiosteum should be elevated as conservatively as
possible, certainly no further than the estimated level of the middle third of
the root. This helps maintain the depth of the mucobuccal or labial sulcus.
Where prominent protrusion of the anterior maxillary bone is present, the
labial cortical alveolar plate is often excised with ronguers to a position decided
upon in the preoperative planning. This permits the prosthodontist to give
the patient a much better esthetic result (Fig. 1). Whether or not placing an
immediate full maxillary denture over this area results in excessive loss of
bone, as some authors claim, is a debatable question, which will be considered
further in a discussion of immediate dentures.
Excessive undercuts of the tuberosities are excised in the ra.dical alveoloplasty
(Fig. 2). When there are bilateral tuberosity undercuts, frequently only one
side need be excised and the prosthodontist can construct the denture so that
it is inserted over the one undercut. He should instruct the patient in how
to do this. When the buccal tuberosity bulges are excised, the cortical plate
should be shaped vertically rather than slanted inwardly; this will give the
denture greater stability. Although some prosthodontists prefer to leave both
bulging tuberosities and end their flange periphery at the most outward level
of the bony protuberance, most do not and want the undercuts removed.
Exostoses and minor irregularities of the alveolar buccal bone are often
troublesome and painful to the patient when dentures are placed on them. It
is a simple surgical procedure to excise them with ronguers or with mallet and
chisel.
Torus palatinus and torus mandibularis are bone exostoses and should also
Volume 22 Aheolopl.asty 445
Number 4

Pig. 1. Pro- and postoperative views of patient with marked maxillary protrusion and
closed bite.

Fi{ I. m. Pi Y - an ma xillary
tuber01 sities . !Ih ese hit !d soft
tissues and ah W 71opl

be removed t,o aid in the fabrication of dentures. These massive csostoses arc
of no value to the prosthodontist and should be removed by any of the well-
known surgical techniques (Figs. 3 and 4).
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. Occasionally, how-
ever, it will cause sufficient pain that it becomes necessary to remove it. The
area is exposed through reflection of the lingual mucoperiostcum, after which
 Fig. 3. Pre- and postoperative views of large torus palatinus treated 1)~ excision. Closure
was obtained by relaxing lateral incisions to permit sliding of palatal flaps containing palatal
blood vessels together in midline.

Fig. 4. Preoperative and operative views showing large bilateral tori mandibulari and
their removal.
Volume 22 Alveoloplasty 447
Number 4

the mylohyoid muscle is stripped off and the ridge is excised with ronguers,
chisels, or burs. The mucoperiosteum can be sutured along the crest, or deep
lingual sutures can be placed through the mylohyoid muscle to the skin in order
to maintain the newly created lingual sulcus depth. This and similar techniques
have been described by Caldwell, Trauner, and others.-I2
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 by the techniques described by Shea and Wolford and
others.
The alveolar ridge of the cdentulous mandible which has a marked roll of
crestal bone producing a definite undercut is anot,her problem about which
there are differences of opinion among prosthodontists. Some want the roll of
crestal bone removed and an inverted U produced; others want the roll left
intact and decry any attempt by the oral surgeon to eliminate the undercut.
Again, this is a matter for the individual prosthodontist and oral surgeon to
settle between themselves; it is not a major technical problem, and the surgeon
can give the prosthodontist exactly what he wants.
Radical alveoloplasty with the extraction of all teeth in the area should be
performed when the mouth is being prepared for radiation therapy in the case
of oral malignancy. This radical alveoloplasty consists of excising the inter-
dental and interradicular septa and smoothing all sharp edges of cortical bone
in order to leave an absolutely smooth alveolar ridge. If t.he septa are not
removed, they may eventually pierce through the overlying mucoperiosteum and
act as a starting focus for the development of osteoradionecrosis (Fig. 5).
With the advent of cobalt-60 and the other megavoltage modalities of radia-
tion therapy, these requirements of radical alvcwloplasty seem to be less strin-
gent. However, we have not as yet accumulated a sufficient number of cases
to make a categorical statement to this effect.
The fabrication of dentures should be delayed for at least 6 months, and
preferably even longer, in these patients who rcquirc radiat.ion t,reatment.l*
Intraseptal cdzwjloplasty or ah*eolotomy. The technique of intraseptal
alveolotomy provides for the reduction of prominent undercuts or the reduction
of a prominent. premaxilla without loss of the labial or buccal cortical plate.
When the technique is employed in the anterior maxilla, 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 first reflecting
the mnc~operiostruln and extraat.ing the terth and then excising the interdental
septa to their very depth wi-ith rongeur forcel)s. A V-shaped wedge is cut in the
premolar or cuspid buccal cortical bone on each side. A small chisel is intro-
duced 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 toward
the palate by squeezing it between the thumb and first finger. Forcible reduc-
tion of this anterior external cortical plate without separating it from the
remainder of the boric with a chisel through the socket will often result in its
springing back to its original position, causing a pressure necrosis of the bone
with sloughing of the soft tissues.5
 448 Meye O.S., O.M. & O.P.
October, 1966

EXTRACTED TEETH OF
MAXILLA TO CWPID

REFLECTIOtd Of .CaL
UICOPERIOETEUM
B

NAWDISLE TO MIDLINE

C D
SUTURED

AFTERRouGERO~O
/ T.L.F
f(LLr*T-

Fig. 5. Diagrammatic views demonstrating preradiation radical alveolectomy with elimi-

nation of interdental septa.

The amount of maxillary alveolar bone lost beneath immediate full dentures
in the radical labial alveoloplasty and in the intraseptal alveoloplasty was stud-
ied in ten patients by Gazabatt and associates.15 Intraseptal alveolotomy was
performed on one side of the arch and labial alveolectomy was performed on
the other; impressions were made at intervals up to 13 months, and the changes
between the sides were recorded. The studies indicated that the intraseptal
alveolotomy procedure showed a slight advantage over the labial alveoloplasty
procedure. Since the series included only ten patients, however, the findings
are not conclusive.
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. The procedure
consists of reflecting the alveolar mucosa and excising any residual sharp edges
or undercuts. It has the distinct disadvantage of subjecting the patient to a
second surgical procedure, to which many patients strenuously object.

Soft-tissue surgery
An evaluation of alveoloplasty must include mention of some of the soft-
tissue techniques which are used either in conjunction with bone surgery or
alone.
Ridge extension. Kazanjians ridge extension technique is well known and
quite effective (Fig. 6). It has been modified in its various technical aspects
by different surgeons. In general, the mucosa is taken from either the labial-
Volume 22 Alveoloplasty 449
Number 4

Pig. 6. A, Preoperative views of gxtensive granuloma fissuratum and hyperplasia of

alveolar soft tissues. B, Postoperative view following excision of redundant soft tissues and
ridge extension employing technique of Kazanjian.

buccal areas or from the alveolus, depending on which technique is followed,

and is repositioned to give a new sulcus depth. It is maintained in position by
means of a rubber tube or stent sutured into the sulcus. Modifications of this
technique include circumferential wiring of a lower denture with the flanges
cxt,ended by dental compound or periodontal pack to the mandible. A maxillary
splint can be wired to the zygomatic arches, but often it can be maintained in
position with just the use of dent,ure adhesive. These splints, which can be lined
with a,ny of the accepted surgical packs of tissue conditioners, are kept in place
for 10 to 14 days. In mandibular ridge extension the mental foramen is fre-
quently the limit.ing margin of the ridge extension, but in certain cases the open-
ing may be lowered by careful use of a bone bur (Fig. 7).
Alt,hough placing a skin graft on a newly crcat,ed sulcus is advocated by
some ( ObwegcserS and others), 1 do not, believe that this is generally necessary,
inasmuch as epithclization will follow the margins as outlined and maintained
by the surgical splint. in approximately 2 weeks.
Ridge extensions for the lingual area of the mandible have been described
by Trauner, 0 ~aldwrll J and othersl~ I6 and consist essentially of transferring
t,he attachments of themylohyoid muscle to a lower position along the lingual
inferior border of the mandible. This technique has limited use, and it does
expose tile floor of the mouth and its spaces to postoperative sequelae.
Redur&ant or pendulous tbsue; g~mndoma~ fissurntu.m. The redundant,
multiple folds of heavy granulation tissue so often seen in the sulcus of both
the maxilla and the mandible pose a problem for the oral surgeon and the
 450 Me?/t?, O.S., O.M. & O.P.
October, 1966

c D

Fig. 7. A to D, Preoperative, operative, and postoperative views of redundant maxillary

alveolar soft tissues. C illustrates use of old denture with its flanges extended with dental com-
pound and surgical pack. E to Z, Preoperative, operative, and postoperative views of redundant
mandibular alveolar soft tissues. G illustrates circumferential wiring of old denture to man-
dible; here also flanges are extended with compound and surgical pack.
 Volume 22 Alveoloplasty 451
Number 4

prosthodont.ist. When t,hese are excised, there is often a loss of sulcus height;
the use of the old denture with its flanges built up as a splint will help preserve
t,he sulcus and often extend it to a greater depth (Fig. 7).
Electrosurgery has also proved helpful in removing these masses of redun-
dant tissue. This technique has the advantage of providing hemostasis, but it
also has the dissiivantage of causing an unpleasant odor plus, occasionally, a
pa.inful postoperative ronrsc associated with necrotic burnt tissue or exposed
bone (Fig. 8).

Fig. 8. A and I?, Pre- and postoperative views of excision of extensive granuloma fissuratum
by electrosurgical technique. G shows surgical specimen. Old denture, with its flanges built up
with compound and surgical pack, was used as splint to preserve new depth of sulcus. D
shows a 3 weeks postoperative view; tab of recurrent granulation tissue of right sulcus was
re-excised with cautcry just prior to starting impressions for new denture.

Fig. 9. Clinical photograph of massive palafal and tuberosity hyperplasia and exostosis.
This \vas treated surgically by extensive alveolectomy and submucous resection of soft tissues.
452 Meyer O.S., O.M. & O.P.
October, 1966

Fibromafosir of the tubewsity CLII~ r&onzoler pads. Submucous resection

of the heavy, pendulous fibromatous mass of the maxillary tubcrosity or
retromolar pad of the mandible has been described by Thorns and others. This
procedure consists of excising the underlying heavy fibrous tissue but leaving
the surface epithelium intact (Fig. 9), and it is often combined with excision
of a concomitant bone bulge, so that both the undercut and the pendulous mass
are removed at the same time.

PROSTHETIC CONSIDERATIONS
The oral surgeon must know and appreciate the problems of the prostho-
dentist.. We must have knowledge of both the newer techniques and the materials
used in prosthetic dentistry. Often our training programs are deficient in teach-
ing students alveoloplasty and soft-tissue techniques. Perhaps a year or two
in general dentistry, or a rotating internship, would be helpful in teaching
the trainee the procedures needed for prosthodontics.

Immediate dentures
There are several approaches to the insertion of immediate dentures. The
classic technique is to extract the posterior teeth, allow the ridges to heal, and
then insert the immediate denture at the time the remaining six anterior
teet.h are extracted.
There are variations of this procedure. Some dentists prefer to have all the
teeth of both jaws removed and immediate dentures inserted in both jaws at
the same sitting. Although it seems that this should be extremely painful, it is
surprising how well the patients tolerate it (Fig. 10).
Some prosthodontists have found the new soft acrylics which become pliable
in ordina,ry hot tap water of immeasurable help in their immediate dentures;
others would not consider using this material under any circumstances.
Some prefer to make the immediate denture without a labial flange and
butt the teeth directly into the sockets. Others leave the labial flange off but
employ a thin hornlike extension from the flange margins in the cuspid areas
of each side; these horns rest high in the labial sulcus and aid in retention of
these open-faced dentures.
Heartwell and Salisbury17 have listed the advantages of the immediate
denture as follows :
1. The immediate denture acts as a splint to control bleeding.
2. The immediate denture promotes healing by protecting the exposed
sockets.
3. The patient with an immediate denture does better in speech, de-
glutition, and mastication than the patient who is without a denture for
even a short period of time.
4. The patient more readily accepts extraction of diseased teeth.
5. The patient can continue in business.
6. Psychologically, the patients are happier.
These authors also recommend careful evaluation of the following advantages :
1. The vertical dimension is retained.
Volume 22 Alveoloplasty 453
Number 4

Z;ii/. 10. A and II, PIP- and postoperative views of extraction of all mnsilhy teeth and in-
srrtion of denture. (, taken 5 days post,operatively, shows maxillary ridge following suture I?
moval.

2. Teeth in the immediate denture can be placed in the same posit,ion

as the natural denture.
3. Rone is contonred by the immediate denture.
This latter point has been qnestioned by some inwstigatuw, who believe
that osteoclastic activity is greater in unhealed l)one and that pressure changes
of the immediate denture map cause too great a resorption of bone.2uC3
The prosthodontist ean help tilt? 0l2t.C SLll+W~l I)lY+pMlt llie Jjiiticiii S ja?TX

for the immrdiate denture by sending along surgical guides. These include :I
cdlra,r acrylic surgical tray, stone models of t,he patient (both before a11cl after
the reqursted surgical pracedurc) , and, above all, (lither written or vcl*bal
directions (preferably written).

Implants, magnets, and grafts

Implants, magnets, and bone grafts are some of t,he news approaches to
the problem of making prostheses for patients who have had repeated denture
454 Mege? O.S.,O.M.&O.P.
October, 1966

failures for one reason or another. The most common cause of failure in these
patients is the atrophic, thin, edentulous mandible.
Implant dentures, although fairly successful in some patients, have not as
yet proved universally satisfactory. Obwegeser reported that of thirty-five
implants inserted in thirty-three patients, two-thirds had definite complications
after 1 to 3 years. Others have reported similar poor results, but still others
have claimed great success for this method. In our practice the implant denture
has not proved successful. We believe that this lack of success is due to the
seepage and infection around the posts, because the tissue obviously cannot
attach to the metal.
Behrman2 has discussed the successful use of magnets in denture retention
in a large series of patients; others have not been able to duplicate his good
results. We have not had any experience with this technique.
Bone grafts, using either the patients own crest of ilium, bank bone, or
freeze-dried bone, have not worked out too well so far. These grafts, though
meticulously handled and placed generally have not fared well beneath the
dentures but have resorbed. Several successful cases hare been reported, but
there is necessity for further investigation in this field. Obwegeser? has recently
demonstrated excellent results employing autogenous bone grafts of both crest
of ilium and ribs.

SUMMARY AND CONCLUSION

In this article the problems of alveoloplasty have been presented from the
oral surgeons point of view. In essence, the oral surgeon has at his disposal
many surgical techniques based on sound principles. However, he must depend
on the prosthodontists directions to determine exactly what has to be done.
Until such time as the prosthodontists have somewhat standardized their
techniques, and as long as there is variation among patients, the oral surgeons
relationship to the prosthodontist must continue to be on an individual basis.

REFERENCES
1. Hayward, J. R., and Thompson, S.: Principles of Alveoleetomy, J. Oral Surg. 16: 101,
1958.
2. Shearer, W. L.: History of Alveolectomy and Partial Alveolectomy and Management
of Pathological Condition of the Jaws, Chron. Omaha D. Sot. 13: 127, 129-135, 146,
1950.
3. Shearer, W. L.: Alveolectomy, Chron. Omaha D. Sot. 16: 247-252, 1953.
4. Dean, D. T.: Surgery for the Denture Patient, J. Am. Dent. A. 23: 2124, 1936.
5. MaeKay, D. R.: Intraseptal Alveolectomy for Immediate Dentures, J. Am. Dent. A.
68: 549, 1964.
6. iigy;4; K. H.: Oral Surgery, ed. 3, St. Louis, 1955, The C. V. Mosby Company, pp.

7. Goodsell, J. 0.: Surgical Aids to Intraoral Prosthesis, J. Oral Surg. 13: 8, 1955.
8. MacKay, D. R.: Personal Communication.
9. Caldwell, J. S.: Lingual Ridge Extension, J. Oral Surg. 13: 287, 1955.
10. Trauner, 11.: slveoloplasty With Ridge Extensions on the Lingnal Side of the Lower
Jaw to Solve the Problem of a Lower Dental Prosthesis, ORAL SUFG., ORAL MED. &
ORAL PATH.~: 340,1952.
11. Goodsell, J. O., and Morin, G. E.: Abnormalities of the Mouth. In Kruger, G. 0.:
Textbook of Oral Surgery, St. Louis, 1959, The C. V. Mosby Company, Chap. 6, pp.
121-145.
12. Kruger, G. 0. : Ridge Extension: Review of Indications and Technics, J. Oral Sure;.
16: 191, 1958.
Volume 22 Alueoloplasty 455
Number 4

13. Shea, C. R., and Wolford, D. R.: Removal of Genial Tubercle for Prosthesis, ORAL
SURG., ORAL MED. & ORAL PATH. 8: 1044, 1955.
14. Xiyer, I.: Osteoradionecrosis of the Jaws, Chicago, 1958, The Yearbook Publishers,

15. Gazabatt, C., Parra, N., and Meissner, E.: A Comparison of Bone Resorption Follow-
ing Intraseptal Alveolotomy and Labial Alreolectomy, J. Pros. Dent. 15: 435, 1965.
16. Molt, F. F.: Surgical Preparation of the Mouth, J. Oral Surg. 7: 20, 1949.
li. Heartwell, D. M., Jr., and Sali;bury, F. I\.: Tmmediate Complete Dentures; an
Evaluationl ,T. Pros. Dent. 15: 615. 1965.
18. Schlosser. It. D.: (Conservative Procedures in Complete 1)enture Prosthesis, Northwest.
l?niv. Hull. 40: 3, 1940.
19. I,isoa-ski, 0. R.: A Comparative Stud\- of the Resorption of Alveolar Ridge Tissue
Ender Immediate Dentures, Northwest. Univ. Rull. 45: il, 1945.
20. Simpson, H. E.: Experimental Investigation Into the Healing of Extraction Wounds
in Ma.caous rhesus Monkeys, J. Oral Surg., Anesth. & Hosp. I>. Serv. 18: 391, 1960.
21. Simpson, II. E., Healing of Surgic.al Extraction \Vounds in Xecaczls rhesus Monkeys,
J. Oral Hurg., Anesth. & Hosp. I). Serv. 19: 3-9, 277.231, 1961.
22. ~vO,:,$~;. R.: Clinical Study of R epair of Bone After Alveolectomy, J. Oral Surg.
r
23. Simp)son, H. E.: Effects of Suturing Extraction \\ounds in Jfacac~s rl~s::s Monkeys,
J. Oral Surg., Anesth. & Hosp. I). Serv. 18: 461, 1960.
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26. Behrman, S. : Personal communication.

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