In the North America alone, thousands of teeth are extracted anually, primarily because of decay, severe periodontal disease, infection, or trauma. The jaw bone that supports the teeth, "alveolar bone" which is genrally soft and vasular, often melts away or resorbs after tooth removal. Such bone resorption can result in significant cosmetic or functional defects, including the loss of surrounding gum tissue. Today, however, bioengineering has led to simple but effective surgical techniques that can either totally prevent or greatly reduce the bone and soft tissue loss that normally occurs following tooth extraction. This section of our web site will introduce you to a simple yet effective procedure that will help prevent such tissue loss from occurring following tooth extraction.

Without Technique

Fig. 1A - Gum tissue has receded resulting in abnormal appearance of front teeth.
Fig. 1B - Gum tissue has receded resulting in gaps between teeth.

With Technique

Fig. 2A - Gum tissue is preserved resulting in normal appearance.
Fig. 2B - Procedure maintains normal gum contour.

What generally occurs to the surrounding bone and gum tissue following tooth extraction?

Tooth extraction is one of the most common dental procedures. Healing of the resulting extraction socket normally occurs uneventfully. However, even with completely normal healing, there is generally some resorption or melting away of the surrounding bone, resulting in less height and width than were present prior to tooth extraction. In addition, as bone resorbs the overlying gum tissue also tends to lose both volume and its normal anatomic form. These changes occur anywhere but the most severe loss of bone and gum tissue tends to occur following removal of incisor teeth located in the front of the mouth.

Why is preserving bone and surrounding gum tissue important?

Loss of bone and gum tissue following tooth extraction often results in both functional and cosmetic defects. Such tissue loss often results in an unsightly collapsed appearance, especially in the front of the mouth where proper mainenance of tissue health is critical to normal esthetics. In addition, loss of bone and gum tissue often compromise the dentist's ability to adequately replace the missing tooth or teeth with either conventional removable or fixed bridgework or with a dental implant supported restoration. Sometimes the loss of bone is so severe that additional surgical procedures are required to prepare the site prior to replacing the missing tooth.

How can bone and gum tissue by preserved following tooth extraction?

Today, as a result of advances in periodontal surgical procedures and bioengineering, bone and gum tissue loss following tooth removal can either be greatly reduced or completely eliminated.

Following removal of the tooth a specially bioengineered graft material that helps support bone formation is placed within the extraction socket. The bone graft material has similar structure to human bone, and not only supports new bone growth but also has been shown to preserve bone and overlying soft tissue following tooth removal. The graft material is then covered with a natural fiber material, collagen, to protect both the graft and newly forming bone as well as to help support and guide new soft tissue growth. This system helps prevent bone and gum loss following tooth removal.

What are the step-by-step procedures required to preserve bone and gum tissue following tooth extraction?

Step 1 - Diagnosis of a tooth requiring extraction.

Step 2 - Extraction of the tooth using a gentle surgical technique.

Step 3 - Placement of the bone graft material into the extraction socket.

Step 4 - Placement of the resorbable collagen dressing in densely packed layers over the bone graft and suturing.

Step 5 - Temporary restoration to replace missing tooth and specially shaped to help support healing of the gum tissue.

Step 6 - Final prosthetic result with fixed bridgework or dental implant and preserved surrounding bone and gum tissue.

Are tooth extractions and bone preservation procedures painful?

These procedures are usually done in our office under local anesthesia or local anesthesia with oral or intravenous sedation. The procedures themselves are without pain. Post-operatively there may be some swelling and mild to moderate discomfort. I will prescribe an oral analgesic to help relieve your discomfort.

Can dental implants be used in conjunction with the bone and gum tissue preservation technique?

Today, instead of replacing missing teeth with conventional fixed or removable prostheses dental implant supported restorations are often considered as superior alternatives. Depending on the condition of the remaining extraction socket, an implant may be placed immediately into the extraction socket following tooth removal or may be placed three or four months later. In either case, preserving the surrounding bone and soft tissue with placement of a graft and resorbable collagen membrane can be performed in a manner similar to the procedure used with conventional fixed or removable tooth replacements. When a dental implant is placed into the extraction socket immediately following tooth removal, the graft material is carefully packed between the metal implant and the inner socket walls. In this position the graft helps support bone growth needed to stabilize the dental implant, while at the same time helping to preserve the surrounding bone and gum tissue.

What special care is required after grafting the tooth socket?

Generally, the same prudent care required after any periodontal surgical procedure will be sufficient following tooth extraction and bone preservation procedures. The area must be kept clean, often with the help of a prescribed mouth rinse. An antibiotic, if prescribed, must be taken as directed. Antibiotics, however, are not always required. Undue pressure over the graft extraction site must be avoided until new bone is well on its way to being formed. And finally, brush and floss your teeth and gums as you normally do. However, avoid the gum tissues surrounding the extraction socket until they are well healed (usually about six weeks).