By David Hudnall, DMD
How many times have you noticed patients that look prematurely old because they have missing teeth and have lost lip and facial support? Maintaining bone levels as patients mature is an ongoing battle in dentistry. After tooth extraction, bone height and width diminish precipitously, creating a dilemma for future aesthetics and restoration stability.
The key to maintaining a more age-appropriate appearance and offering better restorative options is maintaining more bone before it has the opportunity to resorb.
What is Socket Preservation in Dentistry?
A socket preservation procedure is the process of filling fresh extraction sites with bone or synthetic graft material that promotes new bone formation immediately after tooth removal.
The bone that supports the teeth has already suffered trauma caused by extraction and healing factors are being dispatched to the site via the blood supply, making it even easier for new bone to be generated. This form of oral and maxillofacial surgery makes way for simple bone healing and controls bone resorption.
Why Do Dentists Perform Socket Preservation?
After patients fully heal from extractions, it is not uncommon for the supporting alveolar bone to shrink 50% or more of its pre-extraction width. Once the tooth is removed, the surrounding socket remodels and resorbs because it no longer has a purpose.
The main objective of alveolar ridge preservation is to prevent both the collapse of buccal-lingual bone width and the reduction of bone height as an extraction site heals, improving the quantity of bone available for dental implant stabilization.
When is Socket Preservation Needed for Patients?
If patients are having teeth extracted and plan to replace their missing teeth within the near future, this dental bone grafting procedure is always an appropriate consideration. It is far easier to preserve bone with small grafts than to allow the ridge to erode only to require more invasive bone grafting for implant placement. A greater quantity of bone increases the success rate of implants and allows for better ridge contour and restorative options.
This concept is important for all dental implants but is an especially important consideration when front teeth are removed. In the anterior, a reduction of healed bone height or thickness can result in a poor aesthetic outcome. By preserving and augmenting bone at the time of extraction, the dentist improves future implant stability while simultaneously improving the emergence profile of final restorations, making them appear much more like their natural counterparts.
FAQs About Socket Preservation
Avoiding excessive bone loss and ensuring proper dental implant placement is simpler after a successful socket preservation procedure. Below are the answers to common patient questions:
What is the socket preservation procedure?
Socket preservation is a dental procedure designed to maintain the bone volume and shape after a tooth extraction, ensuring a suitable site for future dental implants.
Here’s an expanded look at the steps involved for patient treatment:
1. Extraction and Cleaning
After a tooth is extracted, the empty socket is thoroughly cleaned to remove any debris or infection. This is crucial for preventing complications during the healing process.
2. Grafting Material Placement
The empty socket is slightly overfilled with a socket preservation graft material. This material is typically composed of bone particles or synthetic substitutes that support new bone growth. Overfilling ensures that as the material settles, it maintains the natural crestal bone height, preventing the usual bone loss and depression that often occur during healing.
3. Membrane Application
A resorbable membrane is then placed over the graft material. This membrane serves multiple purposes:
- It stabilizes and maintains the soft tissue contour of the graft material.
- It acts as a barrier to prevent the rapid growth of gum tissue (epithelial cells) into the graft area, which can interfere with proper bone regeneration.
4. Suturing
The site is closed with sutures to secure the membrane and graft material in place. Suturing helps protect the site from infection and ensures that the healing process begins properly, thus improving implant treatment outcomes.
5. Post-Operative Care
The patient is typically scheduled to return within 10 days for a follow-up appointment. During this visit, the dentist will remove any sutures and assess the healing process to ensure everything is progressing as expected.
6. Healing Period
Over the next 3 to 4 months, the graft material will integrate with the existing bone, promoting new bone growth and maintaining the socket’s structure. This period is essential for the site to become stable and ready for any further dental procedures.
7. Implant Placement
After the healing period, the dentist will evaluate the site to confirm sufficient bone regeneration. At this stage, there are multiple ideal locations for placing dental implants, thanks to the maintained bone volume and structure achieved through the socket preservation process.
Are socket preservation techniques effective?
Most patients are good candidates for socket preservation techniques and should seriously consider this option before undergoing tooth extractions. Socket preservation grafts help the patient avoid potential long-term issues caused by bone deterioration. Without socket preservation, adjacent teeth are more prone to shifting and gums may recede, leading to fewer restorative options and undesirable aesthetic consequences in the future.
What are the socket preservation materials used?
Usually, freeze-dried bone sourced from a cadaver is the material of choice for socket preservation bone grafts. Freeze-dried bone is shelf-stable and supplied in vials in various quantities that allow for single-site grafts or full-arch preservation. It is easy to place when mixed into a slurry with sterile saline.
What can be done with leftover bone?
From a practical standpoint, when patients are having full-arch extractions, we quote the patient for 3 or 4 key sites per arch. Because opened freeze-dried bone cannot be saved, we fill as many extraction sites as the excess bone in the vial allows at no additional charge. Filling additional sockets in a full-arch case takes no additional time and offers lasting benefits for your patient!
What does socket preservation cost?
The cost of a socket preservation bone graft depends on a variety of factors, including the amount of bone grafting material needed, auxiliary materials, and overall complexity. Patients should expect to spend $200-$300 per site on average for socket preservation performed immediately after extractions.
There is a socket preservation ADA code and dental insurance may help with a portion of the cost. Although the socket preservation code exists, many insurance policies do not pay for socket preservation or other bone grafting procedures. This sends the wrong message to patients and often requires providers to justify the benefits and necessity of socket preservation bone grafts to their patients.
How does socket preservation help the dental implant process?
Socket preservation can make it easier and quicker to place dental implants. Socket preservation techniques often eliminate the need for more invasive bone grafting surgery at a later time. Most patients are ready for implant placement 3 to 4 months after dental socket preservation. Having a separate grafting surgery is invasive and takes additional time for new bone to form before an implant can be placed.
Can socket preservation grafts fail?
Anything is possible. Bone grafting enjoys a success rate greater than 99%. Because socket preservation uses such a small quantity of material and the matrix is completely surrounded by healing bone that contains a vital blood supply, the chances for failure are very slim.
Make Restorations a Breeze With Socket Preservation
Socket preservation is a simple procedure that offers big benefits for everyone involved. The patient benefits from restorations with a better appearance. The clinician benefits by having more bone that allows for higher-quality restorative solutions. And your lab technician will love you because there is sufficient bone and tissue to support the ideal restoration that you want while making it look great!
Stomadent Dental Lab understands how bone grafting opens up restorative opportunities that were not previously possible. More useful bone allows Stomadent to help you realize your restorative dream!
See the variety of Stomadent’s tooth-replacement solutions and contact us today!
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