After multiple extractions, or before a denture is fitted, the alveolar ridge often has sharp edges or undercuts. Smoothing these is called alveoloplasty, and the two key hand instruments are the rongeur and the bone file.
Rongeurs
A rongeur is a spring-loaded forceps with sharp, cup-shaped beaks that bite off small pieces of bone. Also, the spring opens the beaks automatically between bites, which makes repeated cutting fast and less tiring.
Single-action vs double-action
- Single-action rongeurs have one hinge and are simpler and lighter.
- Double-action rongeurs have compound joints that multiply cutting force, making them better for dense bone and reducing hand strain.
Beak styles
Side-cutting beaks remove bone from the edges of the ridge; end-cutting beaks remove bone from the crest. In addition, many clinicians keep one of each.
Bone files
A bone file has fine serrations on its working ends. Additionally, it smooths the bone after the rongeur, producing a rounded ridge that will not irritate the overlying tissue. Also, bone files cut on the pull stroke only; pushing them burnishes bone and clogs the serrations.
A simple alveoloplasty sequence
- Reflect the flap with a periosteal elevator.
- Generally, remove sharp spicules and undercuts with the rongeur.
- Smooth the surface with a bone file, using pull strokes.
- Irrigate, palpate through the tissue to check for remaining sharp areas and close.
What to look for when buying
- Beaks that meet cleanly with no gap when closed.
- A spring strong enough to open the beaks reliably but not so stiff that it tires the hand.
- In general, bone files with deep, even serrations.
- Generally, joints that can be opened fully for cleaning.
Cleaning tips
In general, bone debris collects inside rongeur cups and between file serrations. Brush these areas before ultrasonic cleaning and open the rongeur fully during sterilisation. Lubricate the joint and spring regularly.
Generally, rongeurs and bone files are included in the Aurix Surgical Extraction & Bone Management System.
