Socket Preservation

By Catherine M. Fascilla, D.D.S.

When you need to have a tooth pulled, whether it be due to decay, abscess, gum disease or injury, it is important to do so in a manner which preserves as much of your underlying jawbone as possible. There is a special type of bone surrounding your dentition called alveolar bone. Its sole purpose is to support your teeth. From the moment your teeth are extracted, this type of bone begins to degenerate. It resorbs or shrinks. This occurs in two dimensions. First and most severely, it shrinks in width. That is, bone mass diminishes from the palate or tongue side towards your cheek. Then it begins to resorb vertically reducing the height of the bone.

The consequences of bone loss affects future restorations, particularly implant restorations, where optimal bone mass is critical for implant success. But bone loss also affects the fit of dentures and the esthetics and function of bridges. Loose dentures can irritate the gums and inhibit your ability to chew and speak properly and loss of bone under a bridge creates spaces that are unsightly and can trap food or affect speech.

There are two important steps that can be taken to reduce the amount of resorption and preserve the socket. The first is the method that is used to extract the tooth. This relies on the skill of the surgeon to remove the tooth as carefully as possible so as not to fracture the delicate plate of bone covering the facial root of the tooth. The second step is a procedure called socket preservation or bone grafting. A bone replacement material is added to the extraction site. The socket is filled with bone or bone substitute. It is then covered with gum, artificial membrane, or tissue stimulating proteins to encourage the body’s natural ability to repair the socket. The bone graft maintains the space of the extraction socket during healing while acting as a scaffold for new bone formation. The socket then heals with minimal shrinkage and collapse of surrounding gum and facial tissue.

Socket preservation helps maintain alveolar architecture. It reduces loss of ridge width and height following tooth removal. The result is that more costly ridge augmentation procedures are generally not necessary. The site will be more ideal for implant placement. Minimizing post extraction bone loss also results in better esthetics whether the area is restored with an implant or with a traditional fixed bridge.

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