Socket preservation or alveolar ridge preservation (ARP) is a procedure to reduce bone loss after tooth extraction to preserve the dental alveolus (tooth socket) in the alveolar bone. A platelet rich fibrin (PRF) membrane containing bone growth enhancing elements is placed in the wound or a bone grafting material or scaffold is placed in the socket of an extracted tooth at the time of extraction. The socket is then directly closed with stitches or covered with a non-resorbable or resorbable membrane and sutured.
After extraction, jaw bone has to be preserved to keep the socket in its original shape. Without socket preservation, the bone quickly resorbs resulting in 30-60% loss in bone volume in the six months after dental extraction. The jaw bone will never revert to its original shape once bone is lost and tissue contour has changed.
The human body reduces the amount of bone that is not sufficiently used with a daily stress; without the strain stimulus, the jaw bone behaves (with or without socket preservation) as if the space occupied by the tooth and periodontal ligament was empty.
A platelet rich fibrin membrane is a membrane to prevent epithelial cell migration into the grafted area, it prevents bacterial colonization, contains growth factors (PDGF, IGF-I, VEGF, and TGFb) and living cells and allow perfusion of gases and recruitment of stem cells from periosteum. PRF is a second generation autologous platelet derivative of platelet-rich plasma.
- Autograft – Bone harvested from patient’s own body.
- Xenograft – Bone grafts or collagen from bovine or porcine origin.
- Allograft – Block bone graft from cadaver.
- Alloplast – Synthetic biomaterials such as fibrin scaffolds, PLGA, synthetic biodegradable polymer, hydroxyapatite, tricalcium phosphate, bioglass – ceramics etc.
Socket preservation differs from ridge augmentation; in socket preservation, the graft or scaffold is placed inside the tooth socket immediately after extraction, whereas the ridge augmentation grafting procedure is done to bring back the lost bone after the bone has resorbed and there is insufficient ridge height or width for further treatment procedure.
Socket preservation procedure prevents immediate bone resorption after extraction thus keeping the contour and integrity of the socket with successful and natural looking appearance for tooth restorative procedures. All dental prosthesis requires good jaw bone support for it to be successful in the long run. Without socket preservation, residual bones could lose volume resulting in loss of facial vertical and horizontal dimension and changes in facial soft tissues aesthetics.
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- Khiste, Sujeet Vinayak; Naik Tari, Ritam (2013). "Platelet-Rich Fibrin as a Biofuel for Tissue Regeneration". ISRN Biomaterials. 2013: 1–6. doi:10.5402/2013/627367. ISSN 2314-4025.
- Tassos Irinakis, Rationale for Socket Preservation after Extraction of a Single-Rooted Tooth when Planning for Future Implant Placement, Journal of Canadian Dental Association 2006; 72(10):917–922
- Fickl, Stefan; Zuhr, Otto; Wachtel, Hannes; Stappert, Christian F. J.; Stein, Jamal M.; Hürzeler, Markus B. (2008). "Dimensional changes of the alveolar ridge contour after different socket preservation techniques". Journal of Clinical Periodontology. 35 (10): 906–913. doi:10.1111/j.1600-051X.2008.01305.x. ISSN 0303-6979.
- Extraction socket preservation: The time is now
- Hansson, S.; Halldin, A. (2012). "Alveolar ridge resorption after tooth extraction: A consequence of a fundamental principle of bone physiology". Journal of Dental Biomechanics. 3 (0). doi:10.1177/1758736012456543. ISSN 1758-7360.
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