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.
After having a tooth extracted, there will be an empty “socket” where the tooth used to be. If the socket is not kept stimulated, the bone that used to support the tooth starts to resorb and becomes thin and shallow. This can cause a problem when we look at possible treatment options to replace the gap with a partial denture, bridge or dental implant. Socket preservation is the act of minimising bone shrinkage, and therefore preserving the bone’s depth and height to allow for a better outcome for a future denture, bridge or implant.
How does it work?
Once the tooth has been extracted, a bone graft material is inserted inside the socket. At Rainbird House Dental Practice we use BioOss™ bone graft material – A natural, porous bone mineral matrix, produced by the removal of all organic components from bovine (cow) bone. Due to its natural structure, BioOss™ is physically and chemically comparable to the mineralized matrix of human bone.
This bone graft material will harden over time and become part of the jaw bone structure, ensuring provision of sufficient foundation for placement of future implants, bridges and dentures.
After insertion of the bone graft material, a collagen membrane is placed on top to cover the graft material and allow good healing of the gum tissue. The collagen membrane is sutured into the socket.
Socket preservation after having a tooth extracted has several advantages:
Prevents the bone from shrinking therefore maintaining horizontal facial bone structure. · Less likely for a replacement denture or reline to be needed, as less bone and gum shrinkage. · Reduced gap formation under the pontic (part of bridge replacing a missing tooth) of a bridge. · Better bone depth and height and therefore a better prognosis when placing a dental implant and less need for future bone graft.
Saves 6 months healing time to have immediate bone grafting compared to having bone graft once socket has healed and shrunk.
Biomaterial (granulated) bone: This is “artificial bone” from bovine origin. We also use collagen membrane (from porcine origin) and tacks to secure the membrane. The graft is positioned and allowed to heal for SIX months before implants are placed.
Cost of biomaterial graft: £350.00
PRP treatment for extraction sites.
In combination with socket grafting, we also add PRP treatment.
A recent study has found that applying platelet-rich plasma to the site of tooth extraction significantly improves the healing process. Platelets are cells in the blood that are responsible for helping the blood clot after injury.
Bone loss is a common result after tooth extraction surgery. Because bone formation is a slow process, it normally takes about sixteen weeks for the socket to heal completely, according to researchers. And if the site doesn’t heal properly, it can lead to expensive reconstructive surgery, especially when implants are planned.
The research team followed participants who underwent wisdom tooth extraction. They applied PRP to one side of the mouth and left the other side untreated, which served as a control. At various intervals in the 24-week follow-up period, the team x-rayed the patients to measure the changes in their jaw bone density, as well as other factors like inflammation, pain, and bleeding.
The results were promising. Rutkowski and his team write that “PRP accelerated bone formation and decreased the time necessary to return to full function.” How much faster did the PRP-treated side heal? The authors say: “It required 6 weeks for control extraction sites to reach comparable bone density that PRP treated sites achieved at week 1,” which is a considerable acceleration in the healing process. The treatment didn’t seem to affect other variables, like inflammation or pain.
The authors sum up their findings by saying that “The results of this study suggest that the use of a simple, cost-effective BC-PRP method to increase the rate of bone formation and decrease healing time in the initial 2 weeks following oral surgery may be beneficial.”
Cost of PRP during extraction: £100.00
Who’s at risk for increased bleeding after an extraction?
The following circumstances could interfere with the proper healing of the tooth and may lead to more bleeding.
People with Bleeding Disorders
At the top of the list of people prone to serious bleeding from an extraction or other surgical procedure are those suffering from some form of bleeding disorder. The bleeding disorder may be acquired, inherited or drug-induced (see below). Common inherited bleeding disorders include Von Willebrand’s disease, known for affecting proper platelet function and Hemophilia A and Hemophilia B Thrombocytopathy and Von Willebrand which can be inherited or acquired (more rarely). Other acquired disorders that can lead to problematic bleeding issues include Vitamin K deficiency, severe liver disease and some rare disorders such as mandibular arteriovenous malformation.
People on anticoagulant drugs
Always make sure your dentist or oral surgeon is aware of you taking anticoagulant drugs. Commonly known as “blood thinners” these drugs are often taken by people who have cardiovascular problems. Examples of people using anticoagulants are those who have mechanical heart valves or suffer from secondary myocardial infarction, cerebral vascular accidents, or thrombophlebitis. Commonly prescribed anticoagulants include Coumadin, Plavix or Heparin. Another category of people at risk are those on anti-platelet therapy for cardiovascular disorders or inflammatory joint disorders.
People on Aspirin and other NSAID’s
It is a well-known fact that aspirin thins the blood and can cause excessive bleeding during and after a surgical procedure. If you are taking aspirin or other NSAID’s, let your dentist know. These medications take a while to get out of the bloodstream so stopping them just the night before will not suffix. According to Ear, Nose and Throat Alliance Hearing & Balance Centre, these drugs may have effect for even 1 to 2 weeks! Please see the list on the above website for a list of medications you should avoid taking 10 days prior to surgery. There are several medications such as Pepto-Bismol and sinus or migraine medication that contain aspirin. Always inform your dentist or oral surgeon about any medications you are taking before the procedure.
People on Supplements
Supplements may seem innocuous because over the counter, but several may cause increased bleeding. According to Ear, Nose and Throat Alliance Hearing & Balance Centre you should avoid taking any of these supplements at least one week prior the procedure: chondroitin, echinacea, ephedra, garlic, ginger, ginkgo biloba, ginseng, glucosamine, goldenseal, kava, milk thistle, niacin, saw palmetto, St. John’s Wort and high doses of vitamin E. Also, turmeric may interfere with proper blood clotting and should be stopped several days prior to any surgical procedure, consult with your dentist.
People who do not Follow Directions
There is a reason why the dentist office gives you post-op directions after your instructions. Following the directions will help prevent problems. It’s very important to follow these directions which aren’t that difficult to follow. Those who follow them are gifted with shorter recovery times and less complications. One of most important directions to follow is to consult with your dentist if the bleeding seems to persist and is in copious amounts despite your attempts to minimize it. A piece of advice: It’s best to have extractions done early in the morning so you have all the rest of the day to contact your doctor if you are concerned. Also, best to avoid Friday’s as you’re then left with the week-end when most offices are closed. Always keep an emergency dentist number handy for after hours.
Reducing bleeding after a tooth extraction
Everybody will bleed after an extraction, this is inevitable. However, some may bleed more and some may bleed less. There are people who stop bleeding just a few minutes after leaving the dentist’s office after putting pressure on the gauze for a few minutes, there are people who despite the pressure will continue to bleed for hours and the area will still weep days later. In some cases, the bleeding may stop and then resume later. According to Studio Dentaire, it’s not unusual to wake up the next morning with a little blood in your mouth. Generally, bleeding should stop after 6 hours, and seeing small amounts of blood in the first 48 hours is normal. If the bleeding is consistent though or comes out like a water valve, it should be checked out immediately.
Luckily, there are many things to do to reduce bleeding once you are sent home after the extraction. These post-extraction instructions are likely given to you when you leave the dental office, but it never hurts to read more about them so to be prepared. It’s stunning the amount of people who are given instructions who go home and then start spitting the blood in the sink or start using a straw to drink. These are big no-nos that may lead to increased bleeding and slower healing times! One important consideration: when you experience bleeding after a tooth extraction, it may look like a whole lot of blood is being lost. Doctor of Dental Surgery Ramsey A. Amin claims “It doesn’t take but a few drops of blood to mix in with your saliva to make it look like the area is bleeding a lot.”
Bite that gauze! Your dentist will often provide you with loads of gauze to get you through the evening and next day. Bite firmly with steady pressure, at least for 30 to 60 minutes. Don’t feel tempted to remove it every few minutes to take a look! That may cause the bleeding that may have slowed down to re-occur! Do the 30 to 60 minutes biting for at least the first 3 to 5 hours, until the bleeding stops. Be consistent and patient. Watch a movie to let this time go by:
Get some tea. If you are still bleeding after the gauze trick, you may find relief by using a regular black tea bag. Wet it up and then bite on it for at least 30 minutes. The tannin in the bag should help slow down the bleeding.
Avoid spitting! This one of the biggest mistakes people make when they are bleeding. They will often spit the blood out. What this may do is dislodge the blood clot that has formed that ultimately is what causes healing. Dislodging the blood clot will cause bleeding again, until the next clot forms. Worse of all, dislodging the blood clot may cause a dry socket.
Don’t use straws. I often see people on forums suggesting to use a straw to eat liquid foods. This may sound logic to prevent warm liquids from going to the extraction area, but sucking through a straw, just like spitting, may dislodge the blood clot.
Refrain from activity. Try to avoid bending down or lifting and other activity that may interfere with the blood clotting process. Calm activities during the first 24-48 hours will help keep the blood pressure low which reduces bleeding. Watching a movie, reading a book or listening to music are calm options.
Don’t smoke or drink alcohol. Smoking promotes bleeding, slows down healing and can predispose to a dry socket. Drinking alcohol may also interfere with healing, not to mention that alcohol should not be taken with pain medication. The video below also recommends not drinking carbonated drinks as the fuzz interferes with the healing process.
Don’t bother the area. It’s tempting to want to touch the area with your tongue, but don’t. After the extraction, blood must flush to the area to expedite healing, try your best to not interfere with the process by repeatedly touching the area with your tongue or fingers. Only gauze should be allowed in that area. This also means not brushing over the area or rinsing the mouth with mouthwash.
Use several pillows for sleeping. The elevated position of your head will reduce bleeding. It’s wise to keep a towel on the pillow to capture any blood that may seep through your mouth during the night.
Avoid hot drinks. You need to be careful not to drink hot beverages or hot soups. The heat may dislodge the delicate blood clot.
Don’t blow balloons or play musical instruments for obvious reasons.