Healing After Extraction

Wound healing following dental extraction occurs in several stages, each crucial to preparing the site for potential dental implant therapy:

1. Blood Clot Formation: Within the first 2–3 days after extraction, a blood clot forms to protect the underlying bone and initiate healing.
2. Granulation Tissue Formation: By days 4–5, granulation tissue, which contains new capillaries and fibroblasts, begins to develop in the extraction socket.
3. Young Connective Tissue/Osteoid Formation: After approximately one week, young connective tissue and osteoid start forming, laying the foundation for future bone development.
4. Osteoid Mineralisation and Epithelial Coverage: Around 3 weeks post-extraction, the osteoid starts to mineralise, and epithelial coverage of the socket begins.
5. Bone Formation: By 6 weeks, new bone formation is evident, although this process continues to evolve over time.

 

Bone Resorption Following Tooth Extraction

After a tooth is extracted, the alveolar bone undergoes significant resorption, which can impact future implant placement. The width of the alveolar bone may shrink by approximately 30% within the first 3 months and up to 50% within 12 months following extraction (Schropp et al., 2003). The buccal bone often resorbs more significantly than the lingual or palatal walls, which can complicate implant therapy due to insufficient bone volume.

A systematic review reported that horizontal bone loss ranges from 29% to 63%, while vertical bone loss ranges from 11% to 22% within the first 6 months after extraction (Tan et al., 2012).

 

Techniques to Minimise Ridge Resorption

Various techniques have been proposed to minimise alveolar ridge resorption after tooth extraction, including:

• Flap Elevation: Promotes complete soft tissue closure over the extraction site.
• Placement of Connective Tissue Grafts: Enhances soft tissue thickness and coverage over the extraction site.
• Use of Bone Grafts: Fills the socket to maintain bone volume.
• Barrier Membranes: Prevents soft tissue invasion into the socket, promoting bone regeneration (Masaki et al., 2015).

 

Limitations of Socket Preservation Techniques

Despite their benefits, socket preservation techniques using bone grafts and membranes have several limitations:

• Extended Healing Time: Requires a longer healing period before proceeding with implant therapy.
• Invasiveness and Technique Sensitivity: These methods are often invasive and require a high level of surgical expertise.
• Challenges in Achieving Soft Tissue Coverage: Failure to achieve adequate soft tissue coverage can result in compromised aesthetic outcomes.
• High Cost: The procedures can be costly, which may limit their accessibility.
• Incomplete Prevention of Ridge Resorption: Even with these techniques, complete prevention of ridge resorption is not possible (Horvath et al., 2013).

 

Soft Tissue Management Following Extraction

Soft tissue collapse after extraction can be mitigated by the immediate placement of an ovate pontic. This prosthetic approach supports the soft tissues and can be particularly advantageous in cases of multiple extractions, helping to maintain tissue contours and optimise aesthetic outcomes.