In recent years, and especially after the introduction of dental implants, one of the most important issues following tooth extraction has been regarding the body’s regenerative capabilities and the healing process that follows a tooth extraction. This is owing to the fact that whatever method is being used to pull a tooth that is beyond repair, even considering atraumatic methods, it is rather impossible not to subject the surrounding tissues and bone to some level of trauma that can be interpreted as a significant alteration to the soft and hard tissues. The reason why such emphasis has been placed on the healing process is due to the bone loss that accompanies a tooth extraction. In case of severe bone loss, a patient would be at risk of becoming an unsuitable candidate for dental implants as well. To better understand the body’s healing process following a tooth extraction it would be helpful to know the exact processes that it goes through after a tooth is pulled out of the socket.
- Bone Retention & Resorption
A minimally invasive method of tooth extraction would focus, as far as possible, on leaving behind an intact buccal plate as it would be detrimental to the success of implants later on. Bundle bone appears to be the first bone that is resorbed following a tooth extraction, whereas alveolar bone resorption is more gradual occurring throughout one’s life. In comparison to the original tooth position, the remodeling process results in a ridge morphology that is lower in vertical height and has become more palatal. After the resorption woven bone replaces the bundle bone which would result in a reduction in height. The key factors that play a part in this bone resorption are a decreased blood supply, inflammation of the location of the extraction, and atrophy.
- Extracted Teeth’s Socket Healing
It goes without saying that after a tooth extraction takes place bleeding would be observed in the alveolar socket which would later form a clot. It is important for this clot not to be dislodged as it would later form the granulation tissue. At this stage, it is possible to intervene with the process in order to induce a guided bone regeneration where barrier membranes are used to direct the growth of new bone and gingival tissue at the locations where bone or gingiva volumes or dimensions are insufficient for proper function, esthetics, or prosthetic restoration. It is important to note that the guided regeneration process cannot be applied to the socket as tooth sockets tend to heal through regenerating bone.
The barrier membranes previously discussed would minimize the amount of resorption. The use of resorbable membranes would also eliminate the need for a second removal surgery that could cause further trauma to the site. As it has been pointed out none of the current methods employed in tooth extraction could be called noninvasive. What the dentist can do, however, is to opt for methods that are less invasive in order to minimize the amount of trauma dealt that would result in bone resorption and general deformity of the site. It is important however to be able to use the body’s own regenerative capabilities in order to avoid the necessity of grafts so that one could move on to having a dental implant as soon and as painlessly as possible.
How Atraumatic Tooth Extraction Is Done
In an atraumatic tooth extraction operation, the first step to be taken is to sever the connective tissue fibers that would result in less damage to the surrounding soft tissue. To do so the periotome is inserted into the periodontal ligament and severs the tissue connected to the tooth that is being extracted. The periotome is then left in place to allow the occurrence of biomechanical creep that would ease the extraction as a result of the consequent bone expansion. The instrument is then gently moved further down up to the crestal one-third of the tooth being extracted at which point the tooth would be somewhat mobile. Thereafter, using the mechanics of levers, M=Fd to be precise (which basically points to the fact that with creating an appropriate amount of distance a lesser magnitude of force is needed), and using the periotome as a lever, would create a greater distance from the fulcrum which would result in less amount of force being used to extract the tooth. However, the force must be applied gently and with great care in order to avoid the possibility of fracturing the tip of the root leaving fragments in the socket. As mobility increases, the periotome is moved apically toward the root apex resulting in a successful extraction.