Glossary

There are three primary types of oral mucosa: lining mucosa, masticatory mucosa, and specialized mucosa. Of the types of lining mucosa, there are three kinds: alveolar mucosa, labial mucosa, and buccal mucosa. Alveolar mucosa is the soft, thin mucous membrane that sits above the marginal gingiva and the attached gingiva, and continues across the floor of the mouth, cheeks, and lips. It is bright red in color due to being rich with blood vessels, and is shiny and smooth in appearance. It is made up of nonkeratinized stratified squamous epithelium, making it delicate and sometimes difficult to work with. In oral implantology, it’s crucial to keep the alveolar mucosa intact, particularly when implants are done in the front of the mouth. Disruption of the alveolar mucosa can impact the aesthetic results of the procedure, leading to implant failure. The buccal flap should be made carefully so as to keep the alveolar mucosa intact.

The alveolar nerve inferior, which is also called the inferior dental nerve, plays an important role in implant dentistry. It is a part of the mandibular nerve and supplies sensation to the lower teeth, lower lip, and chin. There are two critical factors when considering the alveolar nerve during a dental implant procedure. The treating physician must ensure that the nerve is sufficiently numbed so the implant procedure isn’t painful for the patient, and that the nerve is not injured as the buccal flap is made and the implant is placed. An inferior alveolar nerve block can help numb the teeth, lower lip, chin, and the front 2/3 of the tongue. The posterior superior alveolar nerve must be avoided during surgery to prevent permanent loss of sensation or chronic pain. Injuries to the alveolar nerve are risky, because they may or may not resolve. Chronic pain or loss of sensation may result in implant failure.

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.