Dr. Giorgio Petricca
BSc, MSc, DMD, Dip. Perio. MSC, FRCD(C)
Certified Specialist in Periodontics
To help preserve and restore oral health, Periodontal & Implant Clinic provides tooth extractions for patients in Nanaimo and surrounding areas.
Immediate Implant without Contour Augmentation. Titanium implant is also clearly visible through the gumline
14-X Cantilever FPD
Extracted several years ago without socket preservation
Extraction of a tooth ALWAYS leads to bone loss regardless of how careful or how well a tooth is extracted. This process is known as bone resorption or bone remodeling.
Within the first 12 months following an extraction, up to 50% of the width/thickness of bone can be loss, while two thirds of this is within the first 3 months alone.
In the esthetic zone (which is the gumline around a tooth visible to another person when a patient smiles), shrinkage of the bone after an extraction can have dramatic visual consequences, namely the final tooth on the implant can end up being larger than the preceding natural tooth. The average thickness of the outer wall of bone (face of the tooth) in the esthetic zone (incisor, canine, premolar) is less than 1mm more than 60% of the time! This is a healthy bone! This thin outer bone further deteriorates following an extraction.
Techniques and materials are available to:
Research has proven that despite our best efforts at preserving the bone of a socket, one can expect the final crown on an implant to be up to 1mm longer (at the gumline).
A tooth that has had a long-standing history of infection (i.e. multiple failing root canal treatments, a non-vital/death tooth that went unnoticed or left in-place because the absence of symptoms) can require longer healing periods, and multiple grafting procedures and materials to compensate.
Before You Have Your Tooth Extracted, You May Consider “Socket Preservation”
A landmark study by L. Schropp and Company in 2003 showed that following a single-tooth extraction the width of bone reduced by up to 50% and that two thirds of this shrinkage occurred within the first 3 months following the extraction. As well, the height of bone was reduced up to 1mm during this 12 month period. This “shrinkage” is also known as bone resorption. Studies by S. Chen and Company showed that this loss of bone is most commonly on the face of the socket and it is unavoidable. However there are techniques to minimize this “shrinkage,” known today as socket preservation. Socket preservation (or site preservation) may include both bone grafting and/or soft tissue grafting at the time of extraction or immediate implant placement.
Above is an example of ridge resorption (“shrinkage”) of a socket, which presented years after the extraction and resulted in a large gap under a bridge that was made to replace the lost tooth. This “shrinkage” can have unaesthetic consequences and may also make implant placement difficult or perhaps not possible.
For a cartoon-like video on the socket preservation procedure, watch this short YouTube video provided by Geistlich Pharma (a common source for bone grafting materials).
“My dentist told me I don’t have enough bone for an implant” – Really?
Here we have a fractured root and tooth with severe bone loss accumulated from years of gum disease resulting in little bone available below the sinus (floor of sinus seen as white line above root tips).
By employing “socket preservation” (above) during the extraction process, enough bone was regenerated to allow placement of an implant without having to do a sinus lift procedure (right).
Implant with crown in place 3 years after placement.