ORS03 - Lecture 10 - Socket Healing Flashcards
What are the 5 stages of socket healing? (detailed)
Hours after post op -> early clot formation
Ustable, not well anchored, can lead to reactionary haemorrhage
Encourage clot formation -> local haemostatic agent (i.e. surgical/curacel) or sutures
Prevent clot breakdown -> Tranexamic acid (prevents conversion of plasminogen to plasmin)
2 days -> Fibrinolysis of clot
This is where plasminogen within the clot converts -> enzyme plasmin
Plasmin breaks down the clot to prevent it from growing and being problematic
However - excessive fibrinoolysis -> dry socket (alveolar osteitis)
Bone will be exposed in the socket -> trap food debris (yellow slough), halistosis and thrombing pain
4 days - Formation of granulation tissue
The stable clot is fixed to the socket wall
Clot appears white and porous (containing superficial bacteria)
Epithelium at the gingival margin grows over base of socket
8 days - Socket filled with granulation tissue
Has a superficial inflammatory cell layer
Appears as red granulations in the socket
However, there is a risk of secondary haemorrhage via secodary infection, sudden rise in INR (warfarin), dislodgement of clot via trauma.
Managed -> currettage out granulation contents, identify bleed and arrest, local haemostatic measures (new clot formation), antibiotics
Late healing
18 days - collagent network -> granulation tissue fills socket
6 weeks - woven bone fills socket -> resolves the hole
3 months - alveolus + lamellar bone remodelling
