Extraction/Socket Preservation

Tooth extraction is one of the most common dental procedures. Healing of the resulting extraction socket normally occurs uneventfully. However, even with completely normal healing, there is often some resorption or melting away of the surrounding bone, resulting in less height and width than were present prior to tooth extraction. In addition, as bone resorbs the overlying gum tissue also tends to lose both volume and its normal anatomic form. These changes can occur anywhere but the most severe loss of bone and gum tissue tends to occur following removal of incisor teeth located in the front of the mouth.

When infection is present and a tooth is extracted, the site becomes very frail. If the site is not thoroughly and completely cleaned and debrided, infection will linger and greatly impede your body from filling the extraction site normally and fully. Although the site looks healed from the outside appearance and even on x-ray analysis, the sites often times heal poorly with a scar-tissue type bone rather than solid jawbone. Upon entry for implant placement, this fibrous tissue has to be removed which will basically leave the original extraction site visible. Sometimes the implant can still be placed with additional grafting to get the site to fill properly with bone so the implant will osseointegrate. Unfortunately, at times, this doesn’t allow for implant placement due to primary instability of the implant fixture and necessitates a staged procedure with grafting and later implant placement.

Loss of bone and gum tissue following tooth extraction often results in both functional and cosmetic defects. Such tissue loss often results in an unsightly collapsed appearance, especially in the front of the mouth where proper maintenance of tissue health is critical to normal esthetics. In addition, loss of bone and gum tissue often compromise the dentist’s ability to adequately replace the missing tooth or teeth with either conventional removable or fixed bridgework or with a dental implant supported restoration. Sometimes the loss of bone is so severe that additional surgical procedures are required prior to replacing the missing tooth with either a conventional or implant supported restoration.

Today, because of advances in dental surgical procedures and bioengineering, bone and gum tissue loss following tooth removal can either be greatly reduced or completely eliminated. Following removal of the tooth by our doctors, a specially bio engineered graft material that helps support bone formation is placed within the extraction socket.

This bone graft material, Bio-Oss, with structure similar to human bone, not only supports new bone growth but also has been shown to preserve bone and overlying soft tissue following tooth removal. The Bio-Oss graft material is then covered with a natural fiber material, collagen, to protect both the graft and newly forming bone as well as to help support and help guide new soft tissue growth. Together, the Bio-Oss/Collagen system helps prevent bone and gum loss following tooth removal.

However the gold standard for any grafting material is either an autograft or an allograft. An autograft is bone taken from another site in your own body. Typically, Dr. Culley will use some autograft bone if it can be harvested from the site that is already having surgery. If not, another site must undergo surgery in order to get access to your own bone. This can be done, but it increases the chances of complications, increases the cost of additional surgery and increases your level of post-operative discomfort. We prefer to use allografts. An allograft is a type of bone graft that transplants bone from one person to another. In dentistry, this type of graft is often used to enhance an area of the mouth in preparation for dental implant placement. Allografts are taken from human cadaver tissue in a process that is highly regulated by the United States Food and Drug Administration and the American Association of Tissue Banks. Allografts are carefully processed to prevent any transmission of disease and are completely safe.

The type of graft used will depend on a number of factors including, but not limited to, the type of surgery being performed, your age, medical history, and bone quantity/quality. A prescription is required, and you should always consult your surgeon to understand which bone graft is right for you, as well as for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

XENOGRAFT TISSUE

Xenograft is bone taken from an animal source and transplanted into your body.

Benefits:

  • Commonly used in surgery
  • Not human derived
  • Readily available
  • Well documented success
  • May heal small defects by itself
  • Portions of the graft may turn into your own bone

Drawbacks:

  • Low risk of disease transmission
  • Does not stimulate your body’s cells to form bone
  • Portions of the graft may remain in your body for years to come
  • Limited in its ability to heal large defects by itself

ALLOPLAST BONE GRAFT

Alloplast is synthetically made material to be used in your body as a bone graft alternative.

Benefits:

  • Commonly used in surgery
  • Not human derived
  • Readily available
  • Well documented success
  • May heal small defects by itself
  • Portions of the graft may turn into your own bone
  • No risk for disease transmission

Drawbacks:

  • Does not stimulate your body’s cells to form bone
  • Portions of the graft may remain in your body for years to come
  • Limited in its ability to heal large defects by itself

AUTOGRAFT TISSUE

Autograft is bone taken surgically from one part of your body and transplanted to another part.

Benefits:

  • No potential for immune reaction or disease transmission
  • Commonly used in surgery
  • Well documented success
  • May heal large or small defects by itself
  • Transplanting your own bone forming cells to help heal the defect

Drawbacks:

  • Risk of pain and/or infection at harvest site which may last for a long time
  • Additional surgery and anesthesia are required
  • May not be an option for some patients

ALLOGRAFT TISSUE

Allograft tissue is generously donated by the family of a deceased loved one to enhance the life of another individual.

Benefits:

  • Commonly used in surgery
  • Well documented success
  • May heal small defects by itself
  • Most, if not all of the graft, will turn into your own bone

Drawbacks:

  • Minimal risk for disease transmission*
  • Does not stimulate your body’s cells to form bone
  • Limited in its ability to heal large defects by itself

*Freeze-dried bone allograft (FDBA) and demineralized freeze-dried bone allograft (DFDBA) materials are widely used in periodontal therapy, and there are no reports of disease transmission during the 30-year history of using FDBA according to the Centers for Disease Control (CDC).

These procedures are usually done in our office under local anesthesia with I.V. sedation. The procedures themselves are without pain. Post-operatively there may be some swelling and mild to moderate discomfort. Pain medication and antimicrobial medications will be prescribed for your comfort and to help reduce the chances of post-op complications such as infection, which is extremely rare.

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