Healing Of Extraction Socket

Healing of an extraction socket is an example of healing by secondary intention.

Immediately after removal of tooth, the blood fills the extraction site and both extrinsic and intrinsic pathways of clotting are activated. This results in formation of fibrin meshwork that contains entrapped RBCs and helps seal of the torn blood vessels and reduces the size of extraction wound.

Clot organization begin 24-48 hours after extraction with:

-          Engorgement and dilatation of blood vessels within PDL remnants

-          Followed by  leukocytic migration and

-          Formation of a fibrin layer.

1^st Week:

-          The clot forms a temporary scaffold upon which inflammatory cells migrate.

-          Epithelium at the wound periphery grows over the surface of the organizing clot.

-          Osteoclasts accumulate along the alveolar bone crest setting the stage for active crestal resorption.

-          Angiogenesis proceeds in the remnants of the periodontal ligaments.

2^nd Week:

-          The clot continues to get organized through fibroplasia and new blood vessels that begin to penetrate towards the center of the clot.

-          Trabeculae of osteoid slowly extend into the clot from the alveolus, and osteoclastic resorption of the cortical margin of the alveolar socket is more distinct.

3^rd Week:

-          The extraction socket is filled with granulation tissue and poorly calcified bone forms at the wound perimeter.

-          The surface of the wound is completely reepithelialized with minimal or no scar formation.

Active bone remodeling by deposition and resorption continues for several more weeks.

Radiographic evidence of bone formation does not become apparent until the sixth to eighth weeks following tooth extraction. Due to the ongoing process of bone remodeling the final healing product of the extraction site may not be discernible on radiographs after 4 to 6 months.

REFERENCE: Peterson’s Principle Of Oral And Maxillofacial Surgery, 2^nd Edition

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This Article has been shared by: Dr. Hira Marteen

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