Extractions and Bone (Socket) Preservation
When you need to have a tooth or teeth extracted—whether it be due to decay, abscess, gum disease or injury—it is usually in your best interest to do so in a manner which preserves as much of your underlying jawbone as possible. From the time the teeth are removed, significant resorption of the surrounding bone begins to take place. The amount of shrinkage is unpredictable. Many times the amount of remaining bone shrinks rapidly at first, followed by a more slowly progressing shrinking that occurs over the years afterwards. This shrinking is a natural process, but it is an undesirable result of tooth removal.
You have many options to prevent the rapid initial loss of bone, and it is important that you consider them BEFORE any teeth are removed. Some of these procedures are best performed at the time the tooth is removed. Drs. Ira Levenson and Lori Little-Levenson are periodontal specialists who specialize in jawbone preservation and dental implant placement after the tooth is removed.
To minimize the rapid shrinking of bone, a bone graft can be placed in the socket at the time of tooth removal – this is called ridge preservation because the goal is to preserve the ridge that is present at the time of extraction so that no resorption (shrinkage) occurs following the extraction. This type of bone graft is straightforward and produces little and in some cases no discomfort. A ridge preservation bone graft can often prevent the need for major bone grafting later on and is a benefit in the placement of an implant either at the time of the extraction or at a future time.
The slowly progressive shrinking that happens over time is really only prevented by replacing the missing tooth with a dental implant. The rate of this bone loss is difficult to predict and is influenced by several factors including genetics and health of the patient. https://journals.sagepub.com/doi/10.1177/0022034514541127
What Happens When a Tooth is Removed?
There is a special type of bone surrounding your teeth. This bone is called alveolar bone, and exists solely to support your teeth. When a tooth is lost for whatever reason, the body’s natural response is to begin resorbing or getting rid of the bone in the area because it is no longer needed to hold the tooth in place. This “melting away” of bone occurs in two dimensions. The first is loss of horizontal width caused by the collapse of the bone surrounding the socket. This makes the remaining ridge narrower than when the tooth was present. The second is a loss of vertical height. This makes the remaining bone less “tall.” This process can be faster in areas where you wear a partial or complete denture or where there was an infection or the bone was thin at the time of extraction.
Why is it Important to Preserve The Bone?
You will have several choices of how you can replace the newly missing tooth/teeth. All of the options rely on bone support and bone contour, number and condition of remaining teeth, systemic health, and esthetics. Here is a list of the possible options:
- Dental Implant: You may choose to replace your missing tooth/teeth with dental implants. Dental implants are the standard of care in dentistry. Dental implants are root-shaped supports that hold your replacement tooth/teeth. The more bone support you have, the stronger the will be you implant replacement.
- Fixed Bridge: You may choose to replace the missing teeth with a “fixed bridge.” This is a restoration that is supported by the teeth on each side of the missing tooth space. These teeth are ground down to accommodate a crown restoration that holds the replacement tooth (or pontic) and spans across the space. If the bone is deficient in the space of the missing tooth, there will be an unsightly indentation in the gums and jawbone at/or under the pontic that will trap food. This indentation depending on where it is located in the mouth and can affect your speech. In the front of the mouth, filling the space with a tooth restoration where vertical loss of bone has occurred results in a crown that appears too long when compared with the adjacent teeth and almost always affects your speech.
- Partial Denture: Other replacement alternatives include removable partial dentures or complete dentures. Both of these options often perform better with more supporting bone following extractions.
How Can The Bone Be Preserved?
There are two important phases in retaining your alveolar ridge (bone supporting the tooth) during and after the tooth extraction. Not all extraction techniques are the same, some can be rather destructive of the bone around the roots. Drs. Ira and Lori use the most up to date and careful techniques to extract the teeth while preserving as much bone as possible. Second—and key to preventing the collapse of the socket—is the addition of bone replacement material to the extraction socket – this is called socket preservation. After the tooth is extracted, the socket will be inspected for infection and then be packed with a bone replacement material and covered with a small barrier material that protects the bone and assists in bone growth. Sutures will then be placed to close the site. Early on, the grafting material will support the tissue surrounding the socket, and in time will be replaced by new alveolar bone. Postoperative recovery following this procedure is usually no more complicated than that following the removal of the tooth without ridge or socket preservation.
Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely. Placing dental implants four to twelve months after the extraction and socket grafting will provide the best long-lasting support for preserving your jawbone and for proper function. Otherwise the graft may “melt away” or resorb over time. A special bone graft can be used that will not melt away if a dental implant is not going to be placed. This kind of bone graft will aid in esthetics for a “fixed” bridge or a removable denture. These options will be discussed with you at your appointment.
Immediate Dental Implant Placement
In some selected cases it is possible to actually extract the tooth and place the dental implant at the same time. We call that immediate implantation. If you are interested in replacing your tooth with an implant and want to be considered for immediate implantation, please call our team at Levenson Periodontal Associates for a consultation prior to your extraction.