Socket preservation

Socket preservation or alveolar ridge preservation is a procedure to reduce bone loss after tooth extraction. After tooth extraction, the jaw bone has a natural tendency to become narrow, and lose its original shape because the bone quickly resorbs, resulting in 30–60% loss in bone volume in the first six months. Bone loss, can compromise the ability to place a dental implant (to replace the tooth), or its aesthetics and functional ability. Socket preservation attempts to prevent bone loss by bone grafting the socket immediately after extraction. With the procedure, the gum is retracted, the tooth is removed, material (usually a bone substitute) is placed in the tooth socket, it is covered with a barrier membrane, and sutured closed. Roughly 30 days after socket preservation, the barrier membrane is either removed, or it resorbs, and the callous of bone covers with new gingiva. While there is good evidence that socket preservation prevents bone loss, there is no definitive proof that this leads to higher implants success or long-term health. After tooth extraction, the alveolar ridge has a mean loss of width of 3.8mm, and a height loss of 1.24mm within six months. This loss of bone volume, can cause a denture to be loose, or an inadequate amount of bone width to place an implant. Historically, alveolar preservation was used to provide a base to retain conventional dentures. Advances in osseointegration have expanded the need of the procedure to maintain ridge width and height for dental implant placement. In some cases, where a tooth requires removal when other teeth still need to erupt, socket preservation may be used to maintain bone for the formative tooth to erupt into. While there are no absolute contraindications to socket preservation, many of the same cautions that apply to surgery on the jaws still apply to this procedure. Significant caution is required in an area previously exposed to radiation treatment, or in an area that has previously had osteomyelitis.