In severe cases of tooth decay, abscess, gum disease or injury; it may be necessary to extract one or more teeth. When doing so, it is wise to ensure the procedure preserves as much underlying jawbone as possible. As soon as teeth are removed, dramatic degeneration of surrounding bone begins. While the amount of degeneration varies and it is a natural process, it is not a desired outcome. Sometimes the bone shrinks rapidly at first and then more slowly in ensuing years. Either way, it is difficult to predict and made more so by genetic influence of a patient.
The good news is patients have an array of options that will help prevent rapid bone loss, some of which are best initiated before tooth extraction. One of these procedures is called ridge preservation, or socket preservation, which is a type of bone graft in a straightforward surgery with little or no discomfort.
Ridge Preservation Explained
Resorption of bone following tooth extraction can present issues in subsequent restorative surgery. To alleviate the amount of bone loss, ridge preservation is conducted in which the tooth socket is grafted immediately after extraction and typically prevents the need for major bone grafting in the future.
The only way to prevent the progressive shrinking of bone over time is to replace the missing tooth with a dental implant. The bone surrounding your teeth is called alveolar bone. Its sole purpose is to support your teeth but when a tooth is lost or extracted, your body instinctively responds by starting resorb, or get rid of, bone in that area because it is not needed any longer. The bone in effect melts away through a two-step process:
Loss of horizontal width
The collapsing bone surrounding the socket causes the remaining ridge to narrow, filling in the space of the now-missing tooth and reducing the area’s horizontal width.
Loss of vertical height
Simply stated, this step of the process makes remaining bone shorter. Keep in mind that this occurs faster in places where a patient wears dentures.
Is it Necessary to Preserve the Bone?
Replacement of missing teeth is accomplished through several different means, all of which rely on bone support and contour for the best end result of function and appearance.
Some patients choose dental implants to replace missing or lost teeth. Implants are supports to hold replacement teeth in place and the more support from bone, the stronger the implant will be. If the bone degenerates too much, however, more involved bone grafting might be needed.
In other cases, fixed bridges are used as restoration supported by adjacent teeth. This is called a pontic and spans the space left by a missing tooth. With deficient bone, an indentation will appear in the gums and jawbone in the space where vertical bone loss has occurred. When this happens, a subsequent crown will look too long compared to adjacent teeth.
How is Bone Preserved?
Ridge preservation techniques to retain the alveolar ridge during tooth extraction must be carefully performed to avoid further destruction of remaining bone around the roots. One critical element to this process to prevent collapsing of the tooth socket is adding bone replacement material. With the tooth extracted, the socket is packed with a special material and covered with a protective barrier, or stiches.
The grafting material provides support to the surrounding socket tissue and eventually be replaced by new alveolar bone. On a very positive note, recovery following this procedure is similar to traditional tooth removal. Keep in mind that new bone created through socket grafting is not a forever solution. The best strategy is to place dental implants four months to a year after extraction and grafting to reap the most effective and long-lasting jawbone support, while allowing normal oral function.
In regard to the material used to rebuild the boney ridge, several are available. Autogenous grafts use tissue from the patient’s body. Allografts incorporate material from a human donor. Alloplasts are synthetic bone grafts and another option is xenografts, which are natural tissue from another species.
Remember, it is important to consider ridge preservation procedures before teeth are extracted or lost.
For more information about ridge preservation, contact Andrew Satlin Periodontics at (310) 826-7863 or westlosangelesperio.com.