Extraction Site Preservation

Why

Teeth are removed for a variety of reasons. Most commonly, teeth are extracted when they are loose, broken down (gross decay), infected, or traumatized. When teeth are removed, the supporting jawbone starts to resorb (shrink) away.  Typically, bone shrinks horizontally 25% within the first year and continues at a slower pace after that. Bone also shrinks vertically over time as well.

This shrinkage can be become problematic in terms of tooth replacement and/or a patient’s aesthetic appearance. Should tooth replacement be a treatment option, careful consideration must be given regarding preserving as much bone as possible. If enough bone is lost in a vertical dimension, tooth replacements such as implants may be hindered, as there may not be enough bone remaining (without doing further procedures).

Loss of bone width can also hinder tooth replacements such as implants that require bone to be stabilized. There are procedures that successfully redevelop the resorbed bone, but it is always easier to try and preserve bone before it is lost.

Cosmetic consequences also exist if the bone shrinks. For example, if a tooth or teeth are to be replaced by a bridge, in order to achieve a natural look, bone and gum tissue must exist under the “fake” teeth (“Pontics”) in the bridge. If a gap is present between the teeth and the gum beneath, an unaesthetic result may occur.




How

In order to preserve as much bone as possible, whenever circumstances permit, we try to remove teeth without opening the gum tissue. Even with perfectly atraumatic extractions, bone will shrink in time. There are a number of ways to help preserve the bone structure at the time of tooth extraction.

Placing “Bone Grafts” (typically like a powder) in the empty tooth socket can help maintain bone levels. A number of types of grafts are available, Dr. Cohen will review with you the most appropriate types for the presenting treatment area. Often times, a “Membrane” or barrier is also utilized to help keep the graft in place during its initial maturation.

It is important to note that socket bone preservation is not indefinite. After approximately 6-9 months, bone resorption will begin to occur. Therefore, if tooth replacements such as implants are to be used, they should be initiated during this time period.

Clinical research has also demonstrated that placing dental implants into extraction sites AT THE TIME OF TOOTH EXTRACTION may in fact prevent this bone loss from occurring. In essence, the body still thinks a tooth is present. Placement of an implant at the time of tooth extraction depends on a number of factors. Palm Beach Center for Periodontics & Implant Dentistry, currently has a grant to do cutting edge research on placing implants immediately into extraction sockets (along with providing a “Crown” at the same time). Dr. Cohen will be happy to discuss your particular situation and whether you are a candidate for this type of procedure.