Extraction Site Preservation
Normal marginal gingiva ( gum tissue around the teeth ) and interdental papillae are very important for achieving esthetic restorations and optimal emergence profiles ( the appearance of the crown of a tooth as it appears to come out of the gum tissue) following tooth removal from either maxilla or mandible. Maintenance of adequate soft tissue anatomy is predicated upon maintaining an adequate volume of supporting alveolar bone.
Frequently, however, crestal bone loss following tooth extraction disturbs the critical balance between underlying crestal bone and overlying soft tissues, resulting in gingival recession, distortion, and loss of interdental papillae.( triangular pink soft tissue between the teeth )Multiple studies have documented predictable 3-4 millimeters of buccolingual and apicocoronal ridge resorption within the first six months following tooth extraction in the anterior esthetic zone. ( Loss of underlying bone in three dimensions ) Without further treatment, up to 50% buccolingual ridge will occur, dramatically reducing the potential for an optimal esthetic outcome.
As a consequence of such bone loss, negative soft tissue changes will predictably occur resulting in a reduction or loss of keratinized marginal gingiva and disappearance of interdental papillae. It is well understood that immediate grafting of extraction sockets ( site preservation ), especially in the esthetic zone of the upper jaw, will compensate for post-extraction bone loss and its associated esthetic challenges.
There are two critical phases in retaining alveolar ridge during and after tooth extraction.
Non-traumatic extraction procedures have been developed to preserve as much of the surrounding bone as possible. This helps to keep the existing bone around the root area.
Grafting the extraction site with bone or bone replacement materials. There are several types of bone grafting materials available, including using a patient’s own bone.
Following gentle tooth removal with non-traumatic techniques, bone or bone substitute material will be placed within the extraction site. Sometimes additional “membranes” or “barriers” are placed to help protect the grafted material from ingrowth of fibrous soft tissue and oral fluids and flora. The grafted material will support the surrounding tissue, and in time will be replaced by new alveolar bone. This bone will then provide adequate ridge shape and contour for implant placement or prosthetic restoration. This preservation will not last indefinitely, however. Placing dental implants 3 – 12 months after grafting will provide the best long-lasting support for the alveolar ridge. Otherwise, the graft material may slowly resorb and disappear over time.
In many cases, it is possible to remove a tooth and place a dental implant with grafting at the same time.
Drs. Shall, Ziegler, and Mayer, can best discuss what will work best in your individual case. Treatment options will be discussed, including differences in cost, healing time, and longterm outcomes.