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From Willard to Dehn: How Amazing Is the Evolution of Dentoalveolar Orthopedics?
Dental reshaping is a surgical procedure designed to facilitate the removal of teeth and to reshape or reshape the jawbone for future dentures or cosmetic purposes. This procedure involves the smoothing, reshaping or recontouring of the bony margins of the alveolar ridge and its surrounding structures to enable the creation of a denture or dental implant that is well fitting, comfortable and aesthetically pleasing. This pre-operative procedure, which may include bone grafting, is designed to improve the condition and quality of the supporting structures to provide better support, retention, and stability for the denture.
Historical BackgroundAfter tooth extraction, residual alveolar ridge irregularities, grooves, or bone spurs must be removed as they may interfere with the placement of a prosthetic device.
The history of this procedure dates back to 1853 when Willard described the contouring of the alveolar bone and mucosa to achieve primary wound healing prior to future denture placement. He mentioned that the purpose of this procedure is to promote faster healing of the patient’s bones and tissues. However, by 1876, Beers described a technique for acute alveolar resection using cutting forceps, but this technique fell out of favor due to excessive bone loss after the procedure. In 1919, Armin Wald became the first oral and maxillofacial surgeon in the United States to successfully perform the operation, and his procedure quickly became widely accepted.
Then in 1923, Dehn stated that his technique was aimed at preserving the labial cortex and remodeling the intraradicular bone. Dehn's technique does not involve surgical removal of the mucosa, so the patient experiences less pain, swelling, and bone resorption. In 1976, Michael and Barsoum studied patients undergoing immediate dentures and compared the amount of bone loss caused by different surgical techniques, including extraction without alveolar reshaping, labial alveolectomy, and Dehn's 1923 method. Interradicular alveolar orthopedics described in . The results of the study showed that labial alveolar reshaping resulted in the highest amount of bone loss.
Indications
The primary goal of dentoalveolar orthopedics is to reshape and rebuild the alveolar bone to provide a functional skeletal relationship. Its indications mainly include alveolar bone remodeling or shaping during tooth extraction surgery. For example, if the alveolar bone has sharp edges after tooth extraction, the bone surface needs to be smoothed to promote the healing process of the alveolar bone and avoid painful or long-lasting wounds. Additionally, dentoalveolar reshaping can be performed as a stand-alone surgical procedure, usually prior to any denture treatment plan.
The essence of alveolar plastic surgery is to maintain the width and height of the alveolar ridge in order to provide stability and fixation for dentures and dental implants, for example.
Contraindications and limitations
Contraindications to alveolar reshaping include situations where the removal of bone structure could damage vital structures, such as nerve bundles, blood vessels, or important teeth. Nerve damage can lead to adverse consequences such as paresthesia and neuropathic pain. Furthermore, dentoalveolar reshaping is not recommended if there is a decrease in bone mass or abnormal structure.
The procedure should also be avoided by patients undergoing radiation therapy to the head and neck or those at risk for complications from certain medical conditions, such as uncontrolled bleeding, a poor healing response, or being immunocompromised.
Weapons and Equipment
The equipment required for alveolar plastic surgery includes bone forceps, bone files, rotary files and hand-held power tools. These tools can assist in the efficient removal of large amounts of bone during surgery, or for final, delicate smoothing.
Preoperative Planning
The clinical examination focuses on the identification of bony prominences and grooves, large palatine and mandibular masses, and other obvious dentoalveolar abnormalities. The clinician should assess the three dimensions of arch relationships and perform adequate treatment planning when treating patients with dentures. Additionally, X-rays are essential for any retained root apices, impacted teeth, bone pathology, etc.
Various alveolar plastic surgery techniques
Alveolar reshaping can be subdivided into various techniques, such as simple alveolar reshaping, interradicular alveolar reshaping, maxillary fossa reduction, etc. Each technology has its scope of application and operation method. Among them, simple alveolar reshaping can be performed at the same time as tooth extraction to remove any obvious irregularities in the bone after tooth extraction.
Interradicular alveolar reshaping, also known as the Dehn technique, focuses on removing interradicular bone rather than excessive labial cortical bone.
Clinical surgical process
When performing simple alveolar orthopaedics, slight digital compression of the bone wall may be performed if there is no significant bone irregularity. For more obvious bone irregularities, other surgical techniques may be required. In addition, the patient's postoperative healing condition needs to be carefully considered after surgery, including pain, swelling, infection, and bleeding.
Ultimately, alveolar reshaping has shown amazing progress and evolution for both cosmetic and functional purposes. With the continuous advancement of technology, how alveolar plastic surgery will develop and improve in the future is worthy of our in-depth thinking and discussion. Do you hold the same idea?
