Socket Bone Graft (Alveolar Ridge Preservation Graft)

A socket bone graft, or alveolar ridge preservation graft, is a bone grafting procedure performed after a tooth is lost or extracted to fill the void (extraction socket). Socket bone grafts (socket preservation) are done to reduce jawbone loss and preserve the integrity of the dental alveolus, or tooth socket, for a subsequent dental implant. When a tooth is extracted or lost, the jawbone quickly begins the process of resorption, the breakdown of bone which is then absorbed into the body. This occurs naturally because the alveolar ridge of the jaw which surrounds the tooth’s roots is no longer fulfilling its sole purpose – to support the tooth. Without the stimulation provided by the tooth itself, the alveolar ridge, which contains the sockets of the teeth, will atrophy, much like a muscle that is not used. The Pacific Oral Surgeons provide educational content about jaw bone health and conditions that contribute to jawbone deterioration or loss.

When an immediate dental implant placement cannot be performed after extraction, often due to an infection or sizing discrepancy between the implant and the socket, a socket bone graft (alveolar ridge preservation graft) will be placed to fill the space left by the extracted tooth. Socket bone grafting for dental implants is a common surgical procedure performed by the Pacific Oral Surgeons.

Socket Bone Graft Purpose

• Hold the socket shape during the healing process
• Prevent resorption of the jawbone until implant is placed
• Promote bone proliferation

The Importance of Alveolar Ridge Preservation

Preserving the alveolar ridge is the simplest, least invasive way to keep the jawbone intact for your future dental implant. Once a tooth is removed, the tooth socket begins to lose both height and volume. First, the bone around the socket collapses, creating a narrower ridge, and then the bone begins to resorb vertically, making it shorter. While this shrinkage of the jawbone varies depending on the individual patient, studies show that alveolar height can decrease by 40% and width by 60% in the first six months after extraction. After the alveolar bone is completely lost, the basal bone beneath it will begin to resorb as well.

Once bone is lost, it cannot be regained naturally. Without adequate alveolar tissue, more major grafting procedures will most likely be required to place your implant. Ridge preservation can prevent the need for these other types of grafting later in the implant process.

Benefits of a Socket Bone Graft (Alveolar Ridge Preservation Graft)

Socket grafting can be performed at the time the tooth is extracted. This prevents the jawbone resorption from transpiring. Research indicates that extraction performed without ridge preservation results in a more challenging implant placement.

Benefits of socket bone grafting include:

• Relatively simple procedure
• Little to no discomfort
• Less expensive than major grafting procedures
• Effective in preserving bone volume (jaw shape and size)
• Contributes to successful dental implant placement
• Retains aesthetics and symmetry of facial features
• Improved overall dental health

Many patients experience a faster recovery after socket grafting than a routine extraction due to the gums being sutured rather than relying on a blood clot to form.

Consequences of tooth extraction without ridge preservation can include:

• 

  Bone and gum shrinkage/accelerated bone loss

• Sunken cheeks and lips (especially with multiple extractions or front teeth)
• Movement of adjacent teeth
• More difficult implant placement
• Reduced treatment options

Learn more about the importance of good jaw bone health.

Socket Bone Graft Procedure

Socket grafting is recommended to preserve the tooth socket for a dental implant after a tooth has been extracted. Extraction may be necessary due to:

• Pain
• Decay
• Injury or fractured tooth
• Abscess or infection
• Gum disease/bone loss
• Preparation for restorative treatment

After the tooth is carefully extracted, the socket is immediately filled with bone grafting material which, over the next few months, will be absorbed into your natural bone, strengthening it. This newly formed bone will provide the foundation for the dental implant that will be placed once healing is complete.

Bone grafting materials that may be used include:

• Autogenous graft: Harvested from within the patient’s own body
• Allograft: Bone taken from human cadavers
• Xenograft: Bone graft or collagen derived from bovines (cows)
• Alloplast: Graft derived from synthetic biomaterials, such as calcium phosphates or bioactive glass

Because autogenous grafts require a secondary surgical site, other grafts have become more widely used and have proven to be extremely safe and successful. Xenograft (BioOss) is most commonly used in ridge preservation. BioOss, which is harvested from healthy cows, undergoes a freeze-drying process which sterilizes it and reduces it to only the mineral content of the bone. The BioOss is in granular form (much like sand) when it is introduced to the extraction site.

Once the grafting material is inserted into the extraction socket, it is often sealed with a protective membrane which secures the graft during the healing process and keeps gum tissue out of the socket. The protective membrane material stimulates bone growth and eventually dissolves as healing progresses. The wound is then closed off and sutured with gum tissue.

Over the next few months, new alveolar bone will grow in place of the grafting material which is absorbed into the body. Dental implants should be placed once healing is complete, as resorption will eventually still occur if the strengthened socket is left unfilled for an extended period.

Recovering from Socket Bone Grafting

Initial recovery from a socket graft procedure is similar to the healing time after a routine extraction alone. Healing time will depend on:

• Type of grafting material used
• Location of socket graft
• Volume of graft

The healing process following a socket graft will typically take 3-6 months to allow the new bone to solidify.

The extraction site should be kept clean and rinsed with antibiotic mouth rinse which your surgeon will prescribe and instruct you on when and how to use. You may also be given an oral antibiotic to fight infection. Avoid pressure to the extraction site until your oral surgeon advises you that it is safe to do so. Normal brushing and flossing is usually allowed with special care around the grafted extraction socket.

It is normal for some granules of your bone graft to become dislodged in the first few days. Follow these tips to minimize loose graft material:

• Leave the wound undisturbed (do not touch)
• Avoid spitting and rinsing the first 2 days after the grafting procedure
• Do not smoke
• Do not pull or lift lip to view sutures
• Avoid putting any type of pressure on the extraction site

Your oral surgeon will give you detailed surgery instructions on when to begin normal oral care.

Pacific Oral Surgery board certified oral surgeons specialize in oral, maxillofacial and dental implant surgery with offices located in Ventura, Thousand Oaks and Simi Valley, California. If you are in need of a tooth extraction, contact our office to discuss the benefits of socket grafting for dental implants.

At Pacific Oral Surgery, oral and maxillofacial surgeons, Drs. James Jacobs, John Webb, and Sebastian Carlson perform all manners of socket bone grafting surgery. Many bone grafting procedures utilize local anesthesia or IV sedation in a comfortable outpatient setting. Through the use of advanced technologies, bone grafting has become an innovative option which enables many more patients to enjoy the benefits of dental implants.

If you have questions concerning socket bone grafting or are interested in finding out more about the bone grafting procedures available to you, contact our office for a consultation. Please submit an online appointment request or call one of our Pacific Oral Surgery offices located in Ventura, Thousand Oaks and Simi Valley.