Tooth loss has a direct impact on the patient’s quality of life, potentially inhibiting mastication, speech, and even socialisation, which is why minimising these inhibitions is critical for all clinicians.[i] The residual ridge resorption of alveolar bone after tooth extraction is a biological inevitability which can lead to consequential challenges in implant dentistry.[ii]
Socket preservation is a dental procedure principally designed to minimise both bone and soft tissue loss post-extraction.[iii] This technique helps maintain bone volume whilst also encouraging new bone growth.[iv] The latest research and recent developments behind socket preservation allows clinicians to achieve both functional and aesthetic targets with their patient, longitudinally.
Advantages
Though the skill-set requirements are complex, the procedure of preserving the socket is relatively minimally invasive and offers patients an abundance of advantages. Not only is bone loss kept at a minimum, but the support for future implants and protection of adjacent teeth allows for patient assurance.[v] The professional consensus indicates that adequate alveolar bone volume and complementary architecture of the alveolar ridge are vital in attaining both aesthetic reconstruction and functionality following implant therapy.[vi]
Initiating disuse atrophy of the surrounding alveolar bone, tooth extraction leads to a ridge width reduction of approximately 50% within 3 to 12 months, i.e., from 12.0 to 5.9 mm.[vii] The consequential volume deficit, particularly regarding the buccal area of the maxilla, leads to an undesirable reshaping of the alveolar ridge as the positioning of the dental implants is compromised.[viii] One particular meta-analysis reported a significant 1.47 mm gain in ridge height when socket preservation is used as opposed to when it is not.[ix]
The overall outcome of treatment is also dependent upon which graft material is used (autograft, xenograft, allograft, or alloplast)[x]. One particular study demonstrates that each material has various levels of efficacy in preserving the socket.[xi] This means that specific solutions can be used to provide adequate bone preservation both horizontally and vertically, tailoring the treatment to the functional and aesthetic requirements of each patient as well as their budget.[xii]
Considerations
Socket preservation shows success in the maintenance and growth of alveolar ridge volume, which, in turn, increases the chance of implant survival.[xiii] Other key patient factors have an influence too. For example, a systematic review and meta-analysis found that smokers saw a 140.2% higher risk of failure than non-smokers.[xiv] Patients who have undergone head or neck irradiation demonstrate reduced implant survival rates. Additionally, radiation therapy to the head and neck can damage the jaw’s blood vessels and bone cells, inhibiting both the quality and quantity of bone available.[xv] Furthermore, uncontrolled metabolic disorders such as diabetes mellitus can cause higher implant failure rates due to diminished healing and increased complication risk.[xvi] Thorough attention and review of current medication, clinical and radiographic information, and medical history should also be explored.[xvii]
Postoperative care is imperative in maintaining patient health and care. Reinforcing important instructions to the patient is imperative to avoid adverse effects and complications. These include smoking cessation and avoiding disturbance of the surgical site with food and hygiene activities.[xviii]
Limitations
Despite the general high success rate of socket preservation regarding bone volume, clinicians should be aware of certain limitations surrounding it, both for themselves and the patient. Although socket preservation can successfully reduce bone loss, it does not have the ability to completely prevent it.[xix] Potential problems for the clinician include an initial lack of adequate apical bone for primary anchorage of the implant; the buccal socket wall lacking in volume; potential requirement to postpone treatment for aesthetics or health purposes after extraction; inability of patient to cover the cost.[xx][xxi]
Though extreme complications are rare, they do occur. Systematic research on alveolar preservation finds that more than 33% of studies demonstrate postoperative complications.[xxii] Within the first two weeks were some reports of infection[xxiii][xxiv][xxv], membrane exfoliation[xxvi][xxvii], and extravasation of bone graft particles.[xxviii][xxix] Bleeding,[xxx] persistent mucosal ulceration,[xxxi] and loss of keratinised mucosal width[xxxii][xxxiii] presented as delayed adverse complications. Hence, a very meticulous exploration into the patient’s medical history and current health is heavily reiterated to prevent and avoid post and intra-operative impediments.
Progression Skills
Ultimately, socket preservation requires an extensive understanding of biological principles. To efficiently manage the intricacies of socket preservation and optimise implant outcomes, advanced theoretical and practical training is vital. Assisting experienced implant dentists in integrating cutting-edge innovation is specialist oral surgeon, Professor Cemal Ucer. At the ICE Postgraduate Dental Institute, delegates are offered an experiential approach in socket augmentation and alveolar ridge preservation, immediate single implant placement, and loading protocols in fresh extraction sockets.[xxxiv]
The comprehensive and advanced training grants clinicians the optimisation of patient outcomes while augmenting surgical efficiency with minimally-invasive techniques. Professor Cemal Ucer’s socket preservation techniques not only allow for the clinicians to advance their practices and practice, but adheres to the aesthetic expectations of the patient.
Please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co
01612 371842
Cemal Ucer
[i] Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. (2010). Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes 8:126
[ii] Atieh MA, Alsabeeha NHM, Payne AGT, Ali S, Faggion CM Jr, Esposito M. (2021) Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD010176. DOI: 10.1002/14651858.CD010176.pub3.. https://doi.org/10.1111/j.1600-051X.2005.00642.x
[iii] Fee, L. Socket preservation. Br Dent J 222, 579–582 (2017). https://doi.org/10.1038/sj.bdj.2017.355
[iv] Ebenezer, Elsie Sunitha; Muthu, Jananni; Balu, Pratebha; Kumar, R. Saravana. Socket preservation techniques: An overview with literature review. SRM Journal of Research in Dental Sciences 13(3):p 115-120, Jul–Sep 2022. | DOI: 10.4103/srmjrds.srmjrds_79_22
[v] Chappuis V, Engel O, Reyes M, Shahim K, Nolte L P, Buser D . Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res 2013; 92 (12 Suppl): 195S–201S
[vi] Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth retention and tooth loss in the pe rmanent dentition of adults: Uni ted St ates, 1988 –1991. J D ent Res 1996; 75(Spec no.):68 4–95
[vii] Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23:313–23
[viii] Wang, H. L., & Tsao, Y. P. (2017). Classification and treatment of extraction sockets. Dental Clinics of North America, 61(4), 843-858
[ix] Avila-Ortiz, G., Elangovan, S., Kramer, K. W., Blanchette, D., & Dawson, D. V. (2014). Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. Journal of dental research, 93(10), 950–958. https://doi.org/10.1177/0022034514541127
[x] Avila-Ortiz, G., Elangovan, S., Kramer, K. W., Blanchette, D., & Dawson, D. V. (2014). Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. Journal of dental research, 93(10), 950–958. https://doi.org/10.1177/0022034514541127
[xi] Alenazi, A., Alotaibi, A. A., Aljaeidi, Y., & Alqhtani, N. R. (2022). The need for socket preservation: a systematic review. Journal of medicine and life, 15(3), 309–312. https://doi.org/10.25122/jml-2021-0308
[xii] Alenazi, A., Alotaibi, A. A., Aljaeidi, Y., & Alqhtani, N. R. (2022). The need for socket preservation: a systematic review. Journal of medicine and life, 15(3), 309–312. https://doi.org/10.25122/jml-2021-0308
[xiii] Lubis FR, Ervina I, Amalia M. EFFECTIVENESS OF SOCKET PRESERVATION IN MAINTAINING ALVEOLAR BONE VOLUME: A SYSTEMATIC REVIEW. interdental [Internet]. 2024 Apr. 21 [cited 2025 May 30];20(1):133-8. Available from: https://e-journal.unmas.ac.id/index.php/interdental/article/view/8640
[xiv] Mustapha, A. D., Salame, Z., & Chrcanovic, B. R. (2021). Smoking and Dental Implants: A Systematic Review and Meta-Analysis. Medicina (Kaunas, Lithuania), 58(1), 39. https://doi.org/10.3390/medicina58010039
[xv] Schiegnitz, E., Reinicke, K., Sagheb, K., König, J., Al-Nawas, B., & Grötz, K. A. (2022). Dental implants in patients with head and neck cancer—A systematic review and meta-analysis of the influence of radiotherapy on implant survival. Clinical Oral Implants Research, 33, 967–999. https://doi.org/10.1111/clr.13976
[xvi] Wagner, J., Spille, J.H., Wiltfang, J. et al (2022).. Systematic review on diabetes mellitus and dental implants: an update. Int J Implant Dent 8, 1 https://doi.org/10.1186/s40729-021-00399-8
[xvii] Barootchi S, Tavelli L, Majzoub J, Stefanini M, Wang H-L, Avila-Ortiz G. Alveolar ridge preservation: Complications and cost-effectiveness. Periodontol 2000. 2023; 92: 235-262. doi: 10.1111/prd.12469
[xviii] Barootchi S, Tavelli L, Majzoub J, Stefanini M, Wang H-L, Avila-Ortiz G. Alveolar ridge preservation: Complications and cost-effectiveness. Periodontol 2000. 2023; 92: 235-262. doi: 10.1111/prd.12469
[xix] Hämmerle CH, Araújo MG, Simion M; Osteology Consensus Group 2011. Evidence-based knowledge on the biology and treatment of extraction sockets. Clin Oral Implants Res. 2012;23 Suppl 5:80-82. doi:10.1111/j.1600-0501.2011.02370.x
[xx] Irinakis, Tassos. (2007). Rationale for socket preservation after extraction of a single-rooted tooth when planning for future implant placement. Journal (Canadian Dental Association). 72. 917-22.
[xxi] Barootchi S, Tavelli L, Majzoub J, Stefanini M, Wang H-L, Avila-Ortiz G. Alveolar ridge preservation: Complications and cost-effectiveness. Periodontol 2000. 2023; 92: 235-262. doi: 10.1111/prd.12469
[xxii] Barootchi S, Tavelli L, Majzoub J, Stefanini M, Wang H-L, Avila-Ortiz G. Alveolar ridge preservation: Complications and cost-effectiveness. Periodontol 2000. 2023; 92: 235-262. doi: 10.1111/prd.12469
[xxiii] Cook DC, Mealey BL. Histologic comparison of healing following tooth extraction with ridge preservation using two different xenograft protocols. J Periodontol. 2013; 84: 585-594.
[xxiv] Corning PJ, Mealey BL. Ridge preservation following tooth extraction using mineralized freeze-dried bone allograft compared to mineralized solvent-dehydrated bone allograft: a randomized controlled clinical trial. J Periodontol. 2019; 90: 126-133
[xxv] Thoma DS, Bienz SP, Lim HC, Lee WZ, Hammerle CHF, Jung RE. Explorative randomized controlled study comparing soft tissue thickness, contour changes, and soft tissue handling of two ridge preservation techniques and spontaneous healing two months after tooth extraction. Clin Oral Implants Res. 2020; 31: 565-574.
[xxvi] Barone A, Toti P, Piattelli A, Iezzi G, Derchi G, Covani U. Extraction socket healing in humans after ridge preservation techniques: comparison between flapless and flapped procedures in a randomized clinical trial. J Periodontol. 2014; 85: 14-23.
[xxvii] Fotek PD, Neiva RF, Wang HL. Comparison of dermal matrix and polytetrafluoroethylene membrane for socket bone augmentation: a clinical and histologic study. J Periodontol. 2009; 80: 776-785.
[xxviii] Eskow AJ, Mealey BL. Evaluation of healing following tooth extraction with ridge preservation using cortical versus cancellous freeze-dried bone allograft. J Periodontol. 2014; 85: 514-524.
[xxix] Hoang TN, Mealey BL. Histologic comparison of healing after ridge preservation using human demineralized bone matrix putty with one versus two different-sized bone particles. J Periodontol. 2012; 83: 174-181.
[xxx] Lee JH, Kim DH, Jeong SN. Comparative assessment of anterior maxillary alveolar ridge preservation with and without adjunctive use of enamel matrix derivative: a randomized clinical trial. Clin Oral Implants Res. 2020; 31: 1-9.
[xxxi] Toloue SM, Chesnoiu-Matei I, Blanchard SB. A clinical and histomorphometric study of calcium sulfate compared with freeze-dried bone allograft for alveolar ridge preservation. J Periodontol. 2012; 83: 847-855.
[xxxii] Brkovic BM, Prasad HS, Rohrer MD, et al. (2012) Beta-tricalcium phosphate/type I collagen cones with or without a barrier membrane in human extraction socket healing: clinical, histologic, histomorphometric, and immunohistochemical evaluation. Clin Oral Investig. 16: 581-590
[xxxiii] Walker CJ, Prihoda TJ, Mealey BL, Lasho DJ, Noujeim M, Huynh-Ba G. Evaluation of healing at molar extraction sites with and without ridge preservation: a randomized controlled clinical trial. J Periodontol. 2017; 88: 241-249.
[xxxiv] https://icedentalimplants.co.uk/management-of-tooth-loss/
