The disclosure relates, in some embodiments, to a bone foundation guide configured to guide alteration of an alveolar ridge. A bone foundation guide may include a body with (a) a first end of a buccal wall and a first end of a lingual wall each connected to a first end of the body and (b) a second end of the buccal wall and a second end of the lingual wall each connected to a second end of the body such that the buccal wall is substantially parallel to the lingual wall and a space between the buccal wall and the lingual wall defines an open surgical space. A body may be configured to sit adjacent to a tissue spacing gasket having a thickness equivalent to a gum tissue that would normally cover the bone segment.