Socket preservation or alveolar ridge preservation is a procedure to reduce
bone
A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
loss after
tooth extraction
A dental extraction (also referred to as tooth extraction, exodontia, exodontics, or informally, tooth pulling) is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reason ...
.
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
The gums or gingiva (plural: ''gingivae'') consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.
Structure
The gums are part of the soft tissue l ...
. 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.
[
]
Medical Uses
After tooth extraction, the alveolar ridge
The alveolar process () or alveolar bone is the thickened ridge of bone that contains the tooth sockets on the jaw bones (in humans, the maxilla and the mandible). The structures are covered by gums as part of the oral cavity.
The synonymous ...
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
Dentures (also known as false teeth) are prosthetic devices constructed to replace missing teeth, and are supported by the surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable ( removable partial denture o ...
. Advances in osseointegration
Osseointegration (from Latin ''osseus'' " bony" and ''integrare'' "to make whole") is the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant ("load-bearing" as defined by Albrekt ...
have expanded the need of the procedure to maintain ridge
A ridge or a mountain ridge is a geographical feature consisting of a chain of mountains or hills that form a continuous elevated crest for an extended distance. The sides of the ridge slope away from the narrow top on either side. The line ...
width and height for dental implant
A dental implant (also known as an endosseous implant or fixture) is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodo ...
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.[
]
Risks and complications
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
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...
, or in an area that has previously had osteomyelitis
Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the ...
. Other considerations to bone healing include the concurrent use of bisphosphonate
Bisphosphonates are a class of drugs that prevent the loss of bone density, used to treat osteoporosis and similar diseases. They are the most commonly prescribed drugs used to treat osteoporosis. They are called bisphosphonates because they ...
, and denosumab
Denosumab (trade names Prolia and Xgeva) is a human monoclonal antibody for the treatment of osteoporosis, treatment-induced bone loss, metastases to bone, and giant cell tumor of bone.
Denosumab is contraindicated in people with low blood calci ...
, smoking
Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have b ...
, diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...
, immunocompromise
Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...
, and infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
.[
Another consideration is the risk of bone and soft tissue loss on the subsequent implant in the long-term. Socket preservation has been associated with a greater risk of marginal bone loss]
Technique
Socket preservation is completed at the time of extraction. After removal of the tooth, the gum is elevated away from the bone, the socket is thoroughly cleansed, and antibiotic powder may be used. A barrier membrane is then fastened to the gum, the socket is packed with bone grafting material and the wound closed over the barrier membrane. Where the barrier membrane does not dissolve, it is removed approximately 30 days after placement,[ and the graft becomes incorporated into the healing bone between 3–9 months later.
]
Material types
Bone grafting materials can be divided into several categories. Autograft
Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek).
The autologous tissue (also called autogenous, autogen ...
(bone harvested from patient’s own body) is considered the gold standard
A gold standard is a monetary system in which the standard economic unit of account is based on a fixed quantity of gold. The gold standard was the basis for the international monetary system from the 1870s to the early 1920s, and from th ...
, and all other materials are generally compared to it.[ Other types of grafting material include ]xenograft
Xenotransplantation (''xenos-'' from the Greek meaning "foreign" or strange), or heterologous transplant, is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenograf ...
(bone grafts or collagen from bovine
Bovines (subfamily Bovinae) comprise a diverse group of 10 genera of medium to large-sized ungulates, including cattle, bison, African buffalo, water buffalos, and the four-horned and spiral-horned antelopes. The evolutionary relationship betwe ...
or porcine
The pig (''Sus domesticus''), often called swine, hog, or domestic pig when distinguishing from other members of the genus '' Sus'', is an omnivorous, domesticated, even-toed, hoofed mammal. It is variously considered a subspecies of ''Sus ...
origin), allograft
Allotransplant (''allo-'' meaning "other" in Greek) is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the same species. The transplant is called an allograft, allogeneic transplant, o ...
(block bone graft from a cadaver
A cadaver or corpse is a dead human body that is used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Stud ...
), and alloplast (synthetic biomaterials such as fibrin scaffold A fibrin scaffold is a network of protein that holds together and supports a variety of living tissues. It is produced naturally by the body after injury, but also can be engineered as a tissue substitute to speed healing. The scaffold consists of n ...
s, PLGA
PLGA, PLG, or poly(lactic-''co''-glycolic acid) is a copolymer which is used in a host of Food and Drug Administration (FDA) approved therapeutic devices, owing to its biodegradability and biocompatibility. PLGA is synthesized by means of ring-op ...
, synthetic biodegradable polymer, hydroxyapatite, tricalcium phosphate
Tricalcium phosphate (sometimes abbreviated TCP) is a calcium salt of phosphoric acid with the chemical formula Ca3(PO4)2. It is also known as tribasic calcium phosphate and bone phosphate of lime (BPL). It is a white solid of low solubility. Mo ...
, bioglass
Bioglass 45S5 or calcium sodium phosphosilicate, is a bioactive glass specifically composed of 45 wt% SiO2, 24.5 wt% CaO, 24.5 wt% Na2O, and 6.0 wt% P2O5. Typical applications of Bioglass 45S5 include: bone grafting biomaterials ...
).
Barrier membranes can be either resorbable, or non-resorbable. The standard non-resorbable membrane is expanded polytetrafluoroethylene
Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene that has numerous applications. It is one of the best-known and widely applied PFAS. The commonly known brand name of PTFE-based composition is Teflon by Chemo ...
(ePTFE) which was first used in 1984, when it was found to be biocompatible
Biocompatibility is related to the behavior of biomaterials in various contexts. The term refers to the ability of a material to perform with an appropriate host response in a specific situation. The ambiguity of the term reflects the ongoing de ...
. There are a variety of resorbable membranes, including collagen, and synthetic resorbable (lactic acid or glycolic acid).
Benefits
Socket preservation procedure prevents immediate bone resorption
Bone resorption is resorption of bone tissue, that is, the process by which osteoclasts break down the tissue in bones and release the minerals, resulting in a transfer of calcium from bone tissue to the blood.
The osteoclasts are multi-nuclea ...
after extraction thus keeping the contour and integrity of the socket with a successful and natural-looking appearance for tooth restorative procedures. All dental prosthesis
A dental prosthesis is an intraoral (inside the mouth) prosthesis used to restore (reconstruct) intraoral defects such as missing teeth, missing parts of teeth, and missing soft or hard structures of the jaw and palate. Prosthodontics is the den ...
requires good jaw bone support for it to be successful in the long run. Without socket preservation, residual bones could lose volume resulting in loss of facial vertical and horizontal dimension and changes in facial soft tissues aesthetics.
Socket preservation does indeed improve the height and width, compared to extraction without socket preservation, but there is insufficient data to conclude that it decreases implant failures, improves aesthetics, or that one grafting material is any better than another.
See also
*Guided bone and tissue regeneration
Guided bone regeneration (GBR) and guided tissue regeneration (GTR) are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiv ...
* Tooth regeneration
References
External links
Bone augmentation and ridge preservation
{{DEFAULTSORT:Socket Preservation
Dentistry