Preservation of the tooth socket after extraction (1098) - Surgery

According to antiplagiat.ru, the uniqueness of the text as of October 16, 2018 is 90.3%.

Key words, tags: tooth extraction, wisdom tooth, bone tissue, implant installation, augmentation, implantation.

Despite the rapid development of modern dentistry, tooth extraction is still a very common operation. When a doctor removes a tooth, be it a dystopic wisdom tooth or a severely rotted molar, in its place there remains a hole, a cavity, which is called the alveolar socket. Previously, the affected tooth was simply removed, and the resulting cavity, the socket, healed on its own, with a significant decrease in bone tissue. But today, when talking about qualified dental care, we should talk about preserving the alveoli in its original state, even in the absence of a tooth.

Anatomy of the alveolar process

The alveolar, or dental, process (from Latin - processus alveolaris) is the part of the upper and lower jaws that extends from their bodies and contains teeth. The development and normal functioning of this structure is ensured by the roots of the teeth located in it. The alveolar process appears only after teeth erupt and almost completely disappears with their loss. After a tooth is removed, the corresponding area undergoes resorption (resorption). Dental alveoli, or sockets, are individual cells of the alveolar process in which teeth are located. They are separated from each other by bony interdental (interalveolar) partitions. Inside the alveoli of multi-rooted teeth there are also internal (intra-alveolar) interradicular septa, which extend from the bottom of the alveoli and divide the alveoli into chambers (according to the number of roots). The alveolar socket of the tooth has clear, defined boundaries, and it has all the conditions for bone regeneration; you just need to help it maintain its contour.

Hole preservation procedure

Preservation of the socket of an extracted tooth is a fairly simple and effective operation for preserving bone volume and maximizing the preservation of the natural contours of the alveolar socket. This surgical procedure is performed under local anesthesia and does not pose any risk.

Usually the operation is carried out in several stages:

treatment of the hole after tooth extraction with special antiseptic compounds;
installation of a membrane to protect the vestibular wall;
filling the socket cavity with granular bone-forming substance;
fixation of the operating surface by tensioning the free edges of the connective tissue;
applying a bandage or a thin, neat suture.

Complete healing of the postoperative area occurs by the fourth week, and after 3–4 months, in some cases 6 months, if the condition is satisfactory, this area can be used to install an implant.

General overview

From a technical point of view, socket curettage is a procedure for mechanical cleaning of the inner surface of the alveolar bed. The use of special instruments allows you to prevent the development of a pathological condition, remove foreign objects and deep deposits characteristic of periodontitis. During the planned removal of elements of the dentition characterized by the presence of cystic formations, as well as with diagnosed periodontitis, the procedure is included in the general protocol and is carried out immediately after extraction, eliminating the possibility of side effects.

Treatment quality criteria

The main criterion for the quality of an alveolar socket preservation operation is its independent complete healing and maximum preservation of bone tissue, preservation of the natural contour and volume of the alveolar ridge, improvement of the condition of soft tissues and simplification of further stages of treatment. If the operation is successful, there will be enough bone tissue in the socket to install a dental implant. Separately, it is worth highlighting the advantages of condomization for the doctor and the patient - this is improved long-term treatment results, more predictable aesthetics and, of course, saving time for the doctor and the patient.

Our doctors

Clinic director, implant surgeon, orthopedist

Berezin Pavel Nikolaevich

Chief physician, therapist, periodontist

Sakhnova Galina Leonidovna

all Doctors

Indications for condom

Preservation of the socket of an extracted tooth is indicated for everyone who in the future wants to install a dental implant in its place. The process of loss and resorption of the jaw bone at the site of the extracted tooth begins immediately after the operation. In the first year, bone tissue resorption will be 25% in volume, and over the next 3 years the loss in width will be 40 - 60%. In the case of socket preservation after tooth extraction, a larger volume of bone tissue in the jaw and the most natural contours of the alveolar process are preserved. And then, subsequently, the likelihood of such a complex operation as alveolar bone augmentation when installing an implant will most likely not be required.

Bone atrophy after tooth extraction: causes

Dental bone is a connective tissue formed by special cells (osteocytes and osteoclasts), as well as intercellular substance. The structure of the bone and its ability to perform the necessary protective and supporting functions depend on how well the proportions between tissue elements are maintained.

Osteocytes (osteoblasts) are responsible for the production of collagen, calcium and phosphorus salts, and general mineralization. The cells form bone, stimulate its growth and maintain volume stability.
Osteoclasts destroy damaged or worn-out cells, making room for new tissue.

As a person ages, regenerative abilities decrease, and the influence of osteoclasts on the formation of jaw structures increases. In case of injury, tooth loss or extraction, the socket cavity is not completely filled with new material, and in the absence of the necessary loads, serious atrophy begins.

Why does tooth extraction cause rapid bone loss?

Everything in the human body is balanced. As long as an organ or part of the body functions normally, the tissues receive the necessary nutrition and energy. If systems become unusable, support will be automatically cancelled.

The fact that the jaw bone tissue is working in the correct mode is “informed” by the dental roots. They accept and redistribute the chewing load, confirming functionality. When a tooth is removed, the load on the jaw area disappears. And quite quickly the blood vessels responsible for feeding the bone atrophy, and the bone itself sharply decreases in size.

To prevent this, dentists recommend restoring the integrity of the dentition as quickly as possible - implantation or prosthetics after removal.

Contraindications

Preservation surgery is subject to the same restrictions as any osteoplastic surgery. Separately, I would like to note that it is not recommended to preserve a hole after tooth extraction in a state of acute pain, since the risk of complications increases. But in each specific clinical case, the actions of a professional dentist are strictly individual. Sometimes situations arise when you have to take risks, but this is due solely to medical indications. In any case, it is necessary to understand that performing a tooth extraction operation and subsequent preservation on a planned basis is better than as part of emergency care.

Restrictions

It is logical to perform a preservation operation after the removal of permanent molars, within the so-called sevens, second molars (except for wisdom teeth, eights), since when baby teeth fall out, bone tissue does not resorption. There is no upper age limit for performing an operation aimed at preserving the natural contours of the alveolar process.

How to relieve pain and inflammation?

The body experiences stress during surgery, so it is recommended to take a couple of days off to rest. Active pastime and stress are strictly prohibited.

To muffle the pain and relieve swelling, you should periodically apply a cold compress to the cheek for 15-20 minutes. The main thing is not to overdo it with cold, so as not to provoke inflammation.

In case of severe pain, it is necessary to take an anesthetic. If the pain intensifies on the second day, and the drug used does not have the desired effect, you need to contact the clinic.

Price

According to the classifier of surgical interventions in the oral cavity, condomation is not among the standard surgical interventions and this, of course, affects the cost of its implementation. In addition, the price of osteoplastic materials and related products is quite high. Some materials are used only in conjunction with a special membrane to avoid ingrowth of soft tissue into the alveolar socket. The price is also affected by the method of tooth extraction. Removal of a tooth or tooth root is sometimes still a traumatic procedure, leading to direct loss of alveolar bone and soft tissue. With atraumatic removal, the alveolar bone is preserved in a larger volume, which reduces the final cost of the operation.

Preservation of the socket after tooth extraction is an important procedure when planning the installation of an implant. Timely preservation of the socket will allow you to preserve such valuable bone tissue and avoid a much more complex and expensive operation to build it up - augmentation, as well as significantly reduce the overall treatment time. The cost of preserving the natural contours of the alveolar socket pays off, because you thereby provide the teeth surrounding it with a reliable position, and as a result, during implantation, you get an imitation of the removed tooth root. This procedure applies even to those patients who do not intend to restore or replace a lost tooth with an implant, because in this case the gingival contour will have the most aesthetic appearance, without failures, and will allow for the most aesthetic bridge prosthetics. Therefore, reservation is gaining increasing popularity in dental dentistry.

According to antiplagiat.ru, the uniqueness of the text as of October 16, 2018 is 90.3%.

Key words, tags: tooth extraction, wisdom tooth, bone tissue, implant installation, augmentation, implantation.

*Images: Astra Tech Dentsply Implants; Principles of hard tessue regeneration and implant therapy.

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Medical preventive purposes, establishing a medical diagnosis, providing medical services;
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Responsible for organizing the processing of personal data at Dental Implantation Center LLC is Andrey Aleksandrovich Morzhuev.