extractions Flashcards
Describe the wound healing of the extraction sockets
(Amler 1969) - within the first 24 hours
blood clot formation (fibrin, blood cells)
Describe the wound healing of the extraction sockets
(Amler 1969) - within 2-3 days:
the blood clot is gradually replaced with granulation tissue
Describe the wound healing of the extraction sockets
(Amler 1969) - after 4 days:
there is the first evidence of epithelium proliferating from the wound margins, young connective tissue has started to form at the apical portion of the socket, the blood clot and granulation tissue are still present
Describe the wound healing of the extraction sockets
(Amler 1969) - after 7 days:
the granulation tissue has replaced the blood clot entirely, epithelium continues to migrate, and young connective tissue and osteoid formation is seen in the apical portion of socket
Describe the wound healing of the extraction sockets
(Amler 1969) - after 3 weeks:
epithelium has nearly fused over the socket, granulation tissue has been replaced by connective tissue, and there are signs of mineralized osteoid starting apically and continuing coronally
Describe the wound healing of the extraction sockets
(Amler 1969) - after 24-35 days
there is generally complete epithelial closure over the socket
Describe the wound healing of the extraction sockets
(Amler 1969) - after 6 weeks,
two thirds of the socket is filled with new trabecular bone (day 38) and the remaining connective tissue continues to be replaced by osteoid and bone
What are the expected dimensional changes of the ridge after tooth extraction?
(Schropp 2003)
- reduction in width by 50% within 12 months after extraction, with two thirds of the reduction occurring in the first 3 months
- loss of <1mm in soft tissue height by 12 months after extraction
- bone level generated into the extraction socket never reached levels at adjacent tooth surfaces, bone level at adjacent teeth almost corresponded to level of bone at extraction socket suggests that bone level present at the time of extraction dictate the level to which the bone will heal, not the height of bone at the adjacent teeth
What are the expected dimensional changes of the ridge after tooth extraction?
(Tan 2011)
performed a systematic review assessing post-extraction dimensional changes:
- after 6 months the mean dimensional changes were:
- horizontal width reduction ranged from 29-63% or mean of 3.79mm
- vertical height reduction ranged from 11-22% or mean of 1.24mm buccally, 0.84mm mesial, and 0.80mm distal
- soft tissues showed 0.4-0.5mm gain in thickness buccally and lingually in one study
- dimensional changes occurred most rapidly in the first 3-6 months followed by only gradual reductions thereafter and continuing throughout life
what is the effect of attachment loss on distal of 7s after 8s are extracted?
Krausz: Extraction of an impacted third molar resulted in a significant GAIN of alveolar bone height on the distal aspect of the adjacent second molar on the test side, whereas slight bone loss was noted on the control side. better access for plaque control
when would you get a defect with extraction of an 8
mesioangular impacted 8 would leave a defect
stages of wound healing
- hemostasis (1 day)
- inflammatory (2-4 days)
3.proliferative (4-21 days) - maturation/remodeling (21 days to months)
stage 1: hemostasis
-platelet plug + fibrin clot
stage 2: inflammatory
-neutrophil migration
-phagocytosis
-release of infl cytokines
-removal of bacteria and cellular debris
stage 3: proliferative
-macrophages release GFs
-fibroblast proliferation
-re-epithelialization
-angiogenesis by endothelial cells
-new vascularization
-granulation tissue formation
