The Extraction Socket Management Continuum: A Hierarchical Approach to Dental Implant Site Development

Abstract

Focused Clinical Question How should clinicians manage dental extraction sockets when immediate implant placement is contraindicated, and alveolar ridge preservation is expected to result in inadequate bone volume for implant placement? Summary Three fundamental options for extraction socket management form a hierarchical continuum in sites where dental implant placement is planned: place an immediate implant, perform ridge preservation, or perform ridge augmentation. The available volume and quality of bone and keratinized mucosa are the primary considerations driving the decision, and each tier in the continuum encompasses a variety of techniques with attendant advantages and disadvantages. Conclusions Some immediate implant protocols require no mucoperiosteal flap and possibly produce the most favorable clinical and patient‐centered outcomes compared with other extraction socket management approaches. Conversely, guided bone regeneration at dental extraction sites can result in substantial gains in alveolar ridge dimensions, although this treatment may adversely influence mucosal architecture and carry increased risk of postoperative morbidity. When favorable bone and mucosa are present at a dental extraction site, immediate implant placement may be the treatment of choice, barring unusual circumstances. Ridge preservation, typically associated with minimal postoperative morbidity, is a rational second choice when acceptable ridge dimensions are anticipated after healing.

Effect of osseodensification on the increase in ridge thickness and the prevention of buccal peri-implant defects: an in vitro randomized split mouth pilot study

“…The evolution of dental implant procedures has improved patients’ postoperative outcomes and implant survival [ 26 , 27 ]. In the present study, while osseodensification was able to improve the ridge thickness, it should be acknowledged that its combination with a tapered implant also positively influenced the outcome [ 28 ].…”

Impact of Osseodensification in the Increase of Ridge Thickness and in the Prevention of Buccal Peri-implant Defects: an Animal Randomized Split Mouth Study

“…The evolution of dental implant procedures has improved the patient's postoperative outcomes and implant survival 26,27 . In the present study, while osseodensi cation was able to improve the ridge thickness, it needs to be acknowledged that its combination with a tapered implant also positively in uenced the outcome 28 .…”

Effectiveness of the Use of Simultaneous Connective Tissue Grafts and Immediate Post-Extraction Implant Placement: A Literature Review

“…Most of the palatal walls (63%) were thin (<1 mm) at point A and thick (1 mm) at points B (98%) and C (99%). Cheng et al [17] determined an intact buccal plate to be a more critical feature than thickness. Based on available literature, buccal plate evaluation can be summarized as thick when is > 1 mm and intact buccal plate is better than thin and intact, which, in turn, is better than buccal dehiscence socket morphology.…”