Bone Modeling Following Extraction

The healing of an extraction socket has been evaluated in multiple animal and human studies.^8-11 Extraction of the tooth results in formation of a socket that soon fills in with a blood clot. A provisional matrix replaces the coagulum, in about 7 days. This matrix forms a framework for woven bone that is formed between 14-30 days post extraction. Organization of woven bone, increase in marrow spaces and remodeling eventually results in lamellar appearance of the bone.⁹

These histologic events in an extraction socket are accompanied by changes in residual ridge dimensions. The inner surface of the alveolus is almost consistently lined with bundle bone. Thus, following tooth removal, this bundle bone is lost together with proportions of adjacent socket wall. This modeling results in substantial diminution of the edentulous ridge.¹² Van der Weijden et al, in a systematic review showed a mean clinical mid buccal height loss of 1.67 mm and a reduction in width of about 3.87 mm.¹³ Approximately two thirds of these dimensional changes occur in the first 3 months after the extraction of the tooth.¹⁰