Immediate management of the single-unit extracted tooth in the anterior aesthetic zone – temporizing/stabilizing tissues

The physiological effects of tooth loss on the alveolar bone and mucosal tissues have been studied extensively. Following extraction, blood fills the socket and clots via both intrinsic and extrinsic clotting cascades. Organization of the blood clot commences after 24 hours, following vasodilation of approximating blood vessels, migration of inflammatory cells and formation of a fibrin clot. By the end of the first week, the socket wound will be partially epithelialized and osteoclastic cell action will have initiated resorption of the alveolus and bundle bone. By week two, angiogenesis will have resulted in blood vessel penetration to the centre of the clot, with the instigation of osteoid matrix formation around the socket periphery. By week four, the socket wound will be completely epithelialized and filled with both granulation tissue and poorly calcified osteoid matrix.

Further tissue remodelling causes greater dimensional change to the buccal alveolar bone socket margin, with an equilibrium achieved 3–4 months post-extraction (Figure 1). The mean vertical reduction in the buccal alveolar bone is estimated to be 1.24 mm, with a width reduction of 3.8 mm.¹ After 6 months of healing, horizontal- and vertical-bone resorption has been estimated at 29–63% and 11–22%, respectively.² The extent of the alveolar bone remodelling is influenced by the morphology of the peripheral bone wall, traumatic injury at the time of tooth extraction, the presence of infection, systemic disease, periodontal disease and the proximity of adjacent anatomical structures. The bone changes are accompanied by alterations to the surrounding gingival tissues, with a reduction in the gingival tissue thickness and width of the keratinized mucosa reported.³