 Renkinographic examination in this 38-year-old white man discloses moderately advanced periodontosis, involving three of his five remaining teeth. The molars appear to be only slightly involved by the pathology. Removal of all remaining maxillary teeth is the treatment indicated. Difficulty may be expected in removing the molar teeth if attempted by other than surgical methods. Upon clinical examination, broad prominent ridges supporting the teeth are suggestive of exostosis. The edentulous portions of the ridge have resorbed normally. Forceps extraction of any of these teeth may cause fracture of adjacent bony structures. To prevent excessive loss of bone by forceful forceps extraction, surgical removal is indicated. The gingival margins and interdental papilla are incised with a scalpel to facilitate reflection of the soft tissue. The small end of a periosteal elevator is introduced into the incision and the buckle soft tissue is raised using care to include the periosteum. The sharper, broad-bladed molt number 4 curette assures elevation of the periosteum without tearing. A broad blunt elevator, molt number 9, is used to retract the flap, exposing the assi structure. A long beveled number 52 bone chisel is used to remove the buckle cortical plate from over the teeth. Sharp, long beveled chisels are necessary to ensure that the bone is cut as intended. Dull or short beveled chisels tend to fracture portions of bone rather than cut them. Bone is thus removed to the desired degree and the danger of uncontrolled fracture is practically eliminated. Bone chips are removed from the operative field. Sufficient bone has been removed from the buckle aspect of the teeth to permit their removal to the buckle without fear of tooth or bone fracturing. Mobility of this bicuspid is due to pathologic loss of supporting alveolus, which makes it easy to remove. Excision of bone over the labial aspect of the canine and lateral incisor teeth permits their easy removal without fracture of the teeth or adjacent assi structure. Soft tissue trimming enables the operator to produce more perfect contouring of the ridge. Inflammatory elements of the soft tissue are also eliminated. Parts to be removed are incised with a scalpel. Removal of the soft tissue can be completed with any suitable instrument. A rangure is useful for this purpose. Final contouring of the bony ridge is completed with a rangure. Care is exercised to avoid excessive bone excision since it is usually desirable to preserve as much of the process as possible. The sharp long bevel chisel is useful in removing undercuts which are not easily accessible with the rangure. Occasionally the palatal tissue must be reflected to gain access to sharp projections of alveolar process and other irregularities, which if left would interfere with comfortable fitting of dentures. These irregularities are shaved away with the chisel and a gently rounding ridge is produced. Here of the wound is with interrupted sutures, a very important feature of the procedure. Tissues heal in almost the exact position in which they are placed. The needle is passed through only one flap at a time. Note particularly that as the needle is inserted into the palatal tissue, it is just under the mucosa. It is then passed horizontally into the deeper stroma and makes exit about one-quarter inch from the wound margin. This careful placement of the suture rolls the palatal tissue over and produces a broader rounded ridge, more suitable for prosthesis than a peaked ridge of flabby tissue. Note again this method of suture placement to roll the palatal tissue over the ridge. A well-contoured ridge can thus be produced in cases where isolated teeth must be removed. A single tooth in an otherwise edentulous ridge is removed in the same manner. Incisions are made to permit reflection of the mucoperiosteal flap. The flap is reflected carefully. This tissue is frequently thin and friable, easily torn. Small, delicate, sharp elevators placed in close contact with the bone assure elevation of the periosteum without tearing. The broad blunt retractor, molt number nine, protects the delicate flap as the buckle process is excised with the chisel. The tooth is removed to the buckle without fracture following partial excision of the buckle process. Contouring of the ridge follows the extraction. A small wedge of tissue is excised from the buckle incision so that slack in the buckle flap will be taken up with suturing. The wound is closed in the same manner as previously shown. Again there is no attempt made at complete closure of the sockets by close approximation of the soft tissue margins. It's post-operative. The extraction wounds have healed and the patient is ready for prosthetic appointments. Although somewhat irregular, the ridge is well rounded free of undercuts of an average height and will provide a firm denture foundation.