Ronald C. Kobernick, DDS, MScD, PA
Periodontics
10601 Seminole Blvd, Largo, FL & 111 2nd Avenue NE, St. Petersburg, FL
727-397-8503

Extraction Site Preservation

The bone surrounding your teeth is a special type of bone (alveolar ridge bone) that exists solely to support your teeth. As soon as a tooth is removed, this bone begins to degenerate, causing the extraction site (the ridge) to “shrink” The overlying gum tissue also diminishes as the ridge flattens. This occurs in two dimensions. The first is the loss of horizontal width, creating a narrower remaining ridge than when the tooth was present. The second is the loss of vertical height, making the ridge less "tall." This process accelerates in areas where you wear a partial or complete denture.

You have many options to prevent this, and it is important that you consider them BEFORE any teeth are extracted. Most of these procedures are best performed at the time the tooth is removed.

Whenever a tooth is to be extracted, socket site preservation is recommended to maintain as much of your underlying jawbone as possible to optimize the future restoration. You will have several choices for replacing the newly missing teeth. All of the restorative replacements rely on the ridge having adequate bone support and contour for the best function and esthetics. The possible options include:

  • Dental implants: These are root-shaped “anchors” onto which replacement teeth are secured. The more bone support there is for the implants, the stronger the implant replacements and the better the esthetics of the replacement. In some cases, the bone can degenerate to a point where implants can no longer be placed without having more complex bone grafting procedures to create the necessary support. Dr. Kobernick would always prefer to preserve ridge dimension rather than having to rebuild the ridge, because preventing bone loss is much easier, and less expensive, than recreating the bone later.
  • Fixed bridge: This is a restoration that has crowns (caps) placed on the teeth adjacent to the missing tooth. The replacement tooth (the pontic) spans across the space. If the bone is deficient, there will be an unsightly space under the pontic that may trap food and compromise esthetics.
  • Other replacement alternatives include removable partial dentures or full dentures. These often are more comfortable the greater the supporting bone present, because there is added support against dislodgement.

There are two important aspects of retaining adequate ridge dimension. Non-traumatic extraction techniques are essential in preserving as much bone as possible, a consideration that will also reduce post-extraction discomfort. Molars are divided into component sections to reduce the forces necessary for their removal and to place less pressure on the surrounding socket bony walls.

In addition to non-traumatic extractions, the second aspect in preventing the collapse of the socket is the placement of bone grafting material into the socket at the time of the extraction.

After the tooth is extracted, the socket will have bone incrementally added and covered with an absorbable membrane. Early on, the grafting material will support the socket dimension; in time, your own bone will replace it. With the ridge dimension secured, the area potentially will be an excellent site for dental implant-supported replacement teeth. In some cases, additional bone grafting may be necessary prior to implant placement, especially if the extraction site is near the upper sinuses.

Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely. Placing dental implants approximately six months after the socket grafting will provide the best long-lasting support for preserving the dimension of the ridge, allowing you to function as before the extraction. Otherwise the graft may resorb (diminish) over time.

When a patient is seen for an extraction, Dr. Kobernick's emphasis is always on preserving every millimeter of socket bone to preserve ridge dimension, not on merely removing the tooth.

10601 Seminole Blvd., Largo, FL 33778 P: 727-397-8503 F: 727-398-2679

390 4th Street North, St. Petersburg, FL 33701 P: 727-397-8503