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Immediate management of the single-unit extracted tooth in the anterior aesthetic zone – temporizing/stabilizing tissues Graeme E Bryce Neil D MacBeth Ken W Hemmings Dental Update 2024 44:9, 707-709.
Authors
Graeme EBryce
BDS, MSc, MEndo RCS(Edin), MRD RCPSG
Specialist Registrar in Restorative Dentistry, Eastman Dental Hospital, 256 Gray's Inn Road, London WC1X 8LD, UK
The loss of a tooth within the aesthetic zone presents surgical and restorative challenges to the clinician. The immediate management of the extraction site must meet the patients' aesthetic aspirations whilst optimizing the healing of the alveolar bone and gingival tissues, to facilitate future definitive prosthetic replacement. Arrays of clinical approaches have been proposed to promote optimal tissue healing with these techniques often combining alveolar ridge preservation techniques, soft tissue grafting and transitional prosthodontic stages. The aim of this article is to update the dental clinician on the socket-healing process, provide guidance on the surgical and prosthodontic options available to the clinician and offer insight into differences in outcome.
CPD/Clinical Relevance: This article is relevant to dental clinicians aiming to extract and restore single-tooth units.
Article
The physiological effects of tooth loss on the alveolar bone and mucosal tissues have been studied extensively. Following extraction, blood fills the socket and clots via both intrinsic and extrinsic clotting cascades. Organization of the blood clot commences after 24 hours, following vasodilation of approximating blood vessels, migration of inflammatory cells and formation of a fibrin clot. By the end of the first week, the socket wound will be partially epithelialized and osteoclastic cell action will have initiated resorption of the alveolus and bundle bone. By week two, angiogenesis will have resulted in blood vessel penetration to the centre of the clot, with the instigation of osteoid matrix formation around the socket periphery. By week four, the socket wound will be completely epithelialized and filled with both granulation tissue and poorly calcified osteoid matrix.
Further tissue remodelling causes greater dimensional change to the buccal alveolar bone socket margin, with an equilibrium achieved 3–4 months post-extraction (Figure 1). The mean vertical reduction in the buccal alveolar bone is estimated to be 1.24 mm, with a width reduction of 3.8 mm.1 After 6 months of healing, horizontal- and vertical-bone resorption has been estimated at 29–63% and 11–22%, respectively.2 The extent of the alveolar bone remodelling is influenced by the morphology of the peripheral bone wall, traumatic injury at the time of tooth extraction, the presence of infection, systemic disease, periodontal disease and the proximity of adjacent anatomical structures. The bone changes are accompanied by alterations to the surrounding gingival tissues, with a reduction in the gingival tissue thickness and width of the keratinized mucosa reported.3
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