Author: Dr Fazeela Khan-Osborne
Implant placement is an advanced form of treatment for the edentulous patient. Managing the biological site of a restoration is key to successful outcomes. Luckily, in many cases, tooth loss and the resulting socket can be prepared through surgical extraction, and, in select cases, the same appointment can be used to optimise the site.
When a tooth is removed from the jaw, clinicians need to ensure a number of steps are taken to maximise healing prior to implant placement. Typically, the socket would form a blood clot, which would need to be preserved to protect the wound. In addition, the hard tissue can undergo atrophy, with change to the vertical and horizontal width of the alveolar ridge known to occur over just a short period.[i]
The latter aspect is of particular concern for implant care; placement of dental implants in sites with poor bone quality leads to decreased primary stability and consequently increases the risk of treatment failure.[ii] In this case, clinicians may not want to let the socket simply form a blood clot, and undergo unassisted healing – instead, socket preservation techniques that use tissue augmentation may tilt the chances for success in their favour.
What is socket preservation?
Socket preservation, sometimes seen in the literature as alveolar ridge preservation or socket grafting, aims to support the hard and soft tissues after extraction, maximising bone volume for optimal functional and aesthetic results.[iii] It is carried out immediately after tooth extraction, and is regarded by the literature as a key element of successful care.iii
It’s important to note that different approaches fall under the term ‘socket preservation’. Typically, it will involve a hard tissue grafting procedure, but can be performed with a variety of techniques and materials.
In the first six months following tooth extraction, sockets with unassisted healing experience an average horizontal and vertical bone resorption of 3.79mm and 1.24mm respectively.[iv] The literature features many successes of socket preservation, with a potential preservation of approximately 1.31mm to 1.54mm of bone width and 0.95mm to 1.12mm of bone height in the same timeframe.[v] However, this still shows that a degree of ridge volume loss is expected, and the literature attributes this to the potential influence of local and systemic factors that are not yet fully understood.[vi]
The power of action
Clinicians will typically place a bone graft into the socket following extraction, sealing the site with a barrier to aid healing and minimise infection. A 2023 randomised clinical trial[vii] compared the following approaches:
- Group A: Cancellous bone allograft sealed with a collagen sponge.
- Group B: Cancellous bone allograft sealed with an autogenous soft tissue punch.
- Group C: Demineralised bovine bone mineral xenograft sealed with an autogenous soft tissue punch.
- Group D: Autogenous soft tissue punch only.
The results create a clear picture; with the inclusion of bone augmentation material, resorption is greatly reduced. In vertical measurements, Group D saw a median value of resorption at the central buccal site of 2.92mm – the next highest was Group A, with a value of 0.85mm. At the horizontal level, resorption at a 2mm reference point in Group D had a median value of 3.35mm, where the next highest was in Group B at a value of 1.03mm.vii
Performing hard tissue augmentation to preserve alveolar sockets is no simple feat. Clinicians must first have the clinical confidence required for the extraction of the tooth, and then the competence to choose the best augmentation material for a patient, deploy it to the extraction site, and ensure it is safely managed throughout the healing process. Where socket preservation is appropriate for the patient, only a clinician who is appropriately trained and competent can provide care; this may require a referral to another professional where it is in the patient’s best interests.[viii]
Love to learn
For clinicians considering a career in implant dentistry, socket preservation is a necessary skill to develop for predictable outcomes. It is, after all, a key element near the start of many treatment plans, and can have an incredibly significant impact on outcomes, as the figures on resorption rates show.
Seeking out educational opportunities dedicated to implant dentistry also ensures the knowledge gained and techniques used are applicable to these treatment needs.
The PG Diploma in Implant Dentistry from One to One Implant Education provides the ideal entry into the world of implant dentistry, covering socket preservation and bone regeneration techniques for confidence in a variety of cases. Led by Dr Fazeela Khan-Osborne, founder of One to One Implant Education and renowned clinical educator, delegates work in a peer-mentored programme that encourages collaboration, communication and learning through hands-on sessions.
Socket preservation is just one skill needed for successful implant treatment, but its completion sets the pace for ensuing care. With confidence in modern tissue augmentation techniques, socket preservation can be used predictably for aesthetic and functional outcomes that last a very, very long time.
To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000.
[i] Hong, C. E., Lee, J. Y., Choi, J., & Joo, J. Y. (2015). Prediction of the alveolar bone level after the extraction of maxillary anterior teeth with severe periodontitis. Journal of Periodontal & Implant Science, 45(6), 216-222.
[ii] Reddy, G. M., Vamsi Krishna, C. H., Lakshmi, S., Aditya, V., Sekhar, N. C., & Shastry, Y. M. (2014). Evaluation of bone density around the implants placed using drilling technique and bone expansion technique: an in vivo study. The Journal of Indian Prosthodontic Society, 14(2), 172-178.
[iii] Yankov, Y. G. (2023). Socket preservation and guided bone regeneration: prerequisites for successful implant dentistry. Cureus, 15(11).
[iv] Tan, W. L., Wong, T. L., Wong, M. C., & Lang, N. P. (2012). A systematic review of post‐extractional alveolar hard and soft tissue dimensional changes in humans. Clinical oral implants research, 23, 1-21.
[v] Beretta, M., Maiorana, C., Manfredini, M., Signorino, F., Poli, P. P., & Vinci, R. (2021). Marginal bone resorption around dental implants placed in alveolar socket preserved sites: a 5 years follow-up study. Journal of Maxillofacial and Oral Surgery, 20(3), 381-388.
[vi] Avila-Ortiz, G., Elangovan, S., Kramer, K. W. O., Blanchette, D., & Dawson, D. (2014). Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. Journal of dental research, 93(10), 950-958.
[vii] El-Sioufi, I., Oikonomou, I., Koletsi, D., Bobetsis, Y. A., Madianos, P. N., & Vassilopoulos, S. (2023). Clinical evaluation of different alveolar ridge preservation techniques after tooth extraction: a randomized clinical trial. Clinical Oral Investigations, 27(8), 4471-4480.
[viii] General Dental Council, (2019). Standards for the dental team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed July 2025]
