Clinical + Histological aspects of socket healing Flashcards
What leads to platelet activation after an extraction?
Exposure of platelets to collagen
What do platelets release to promote the aggregation of more platelets?
Stored granules
How long do we expect before a patient begins to clot?
5-10 mins
What are the stages that occur during clot formation?
1 - Fibrinogen converted to fibrin
- Fibrin mesh formed
- Mesh traps more platelets
- Clot formation
Histologically, what do we see on the clot periphery?
Loose aggregate of erythrocytes
Why is the blood clot vulnerable to detachment in the initial stages?
There is weak adherence of the clot to the PDL.
How do we encourage clot formation to prevent reactionary haemorrhage?
Placement of cellulose matrix, placing sutures, tranexamic acid on a gauze.
How many days after extraction does the blood clot begin to breakdown?
2 days
What enzyme breaks down the fibrin blood clot?
Plasmin
How does transexamic acid work?
By preventing the activation of plasminogen to plasmin to prevent clot degradation.
What 4 steps do we need to take after an extraction to optimise healing?
1) Check the whole tooth has been removed, flush socket and remove roots
2) Remove apical pathology such as cysts.
3) Curettage and saline flush to remove any debris
4) Pack socket with a haemostatic agent and place a suture.
What is dry socket and when does it occur?
Dislodging of the blood clot leading to throbbing radiating pain 2-3 days after removal.
Can occur is the blood clot gets knocked out the socket or if there is early and excessive fibrinolysis.
What increases the chances of getting a dry socket?
- Female
- Mandibular tooth
- Excessive rinsing
- Smoking
- Single extractions
How do we manage patient with dry socket?
- Reassure them
- Flush socket out, place a dressing
- Pain control
- No antibiotics given
What is the name of a common dressing used for dry socket?
Alvogyl
How can dry socket be prevented?
- Good post-operative instructions
- Minimally invasive surgery
- Transexamic acid
- Primary closure of socket
What do we expect 4 days post-extraction?
- Formation of granulation tissue
- Stable clot
- Reduced risk of dry socket
- Debris above clot
- Epithelium at gingival margin beginning to grow over socket base
What do we expect to see 8 days after extraction?
- Socket filled with granulation tissue with superficial inflammatory cell layer
What can lead to secondary haemorrhage and how do we manage it?
- Due to secondary infection of socket
- Due to increases inflammation and vascularity in region
- Due to small vessels that have eroded and resulted in bleeding
- Due to a sudden rise in INR
- Trauma leading to clot dislodgement
Management:
- Give LA
- Curettage, flush out socket, bite on gauze
- Consider antibiotics if area in infected
What occurs during late healing (18 days)?
- Socket is filled with granulation tissue
- Woven bone begins to fill socket
- Epithelization of socket surface is complete
What is the main difference between woven and lamellae bone?
Lamellae bone is more dense.
Name some local and patient factors that can affect wound healing?
Local:
- Difficulty of extraction
- Mandibular tooth
- If the tooth was infected
- Associated pathology such as tumours
- Post operative dry socket
Patient:
- Smoking
- Alcohol
- Immunocompromised
- Age
- Oral hygiene maintenance
- Bisphosphonate treatment
- Radiotherapy
