Socket and Ridge Augmentation is a common dental procedure that typically follows a tooth extraction. This process helps recreate the natural contour of the gums and jaw that may have been lost as a result of a periodontal disease, surgical procedure or tooth extraction. For example, when a tooth is removed, an empty socket is left in the alveolar ridge bone (the bone that surrounds the roots of the teeth). In this case when the tooth is removed and the surrounding bone of the socket breaks, it is unable to heal and begins to deteriorate.
Socket and Ridge Augmentation relates to the following procedures:
Periodontal Bone Grafting/Guided Tissue Regeneration
In the last 10-15 years, extensive research has developed techniques that re-grow some or all of the supporting bone around the teeth destroyed as a result of periodontal disease. Although not applicable in all cases, these procedures have increased the number of teeth saved and our ability to successfully treat moderate to advanced periodontal disease.
Performed at the same time as osseous surgery, the lost bone is replaced with synthetic, naturally derived, or combination of bone grafting materials. They act as a “scaffold” for the patient’s own bone to “regenerate” and are usually reabsorbed by the body.
Many regeneration techniques utilize “membranes” which are inserted over the bone defects. This guides the growth of bone by excluding the more rapidly healing gum tissue. Some of these membranes dissolve while others are easily removed. Other regenerative procedures involve the use of bioactive gels, such as Emdogain, which stimulate the body’s own cells to form new tissues.
Hard Tissue Ridge Augmentation
After a tooth is lost, the jawbone begins to shrink. The shrinkage is most rapid over the first year following extraction. Up to 60% of the original width and 40% of the height of the bone can be lost during this period. Bone atrophy usually continues and in certain cases where all the teeth are missing, can even lead to jaw fracture!
This loss of bone often leaves a condition of poor quality and quantity of bone, which is unsuitable for placement of dental implants, permanent bridgework, or to support dentures. In many cases, we now have the ability to grow bone where needed. This gives us the opportunity to place implants of proper length and width. By rebuilding lost jawbone, we can also provide better support for removable dentures and more cosmetic permanent bridgework
Extraction Site Preservation
After tooth extraction, the jawbone begins to shrink. The shrinkage is most rapid over the first year following extraction. Up to 60% of the original width and 40% of the height of the bone can be lost during this period. Replacement of the lost tooth with an implant may be impossible or impractical if the extraction socket is left to heal on its own.
If permanent bridgework is planned, uncontrolled shrinkage can result in a very long and unsightly false tooth which can be very difficult to clean underneath. To prevent this, we often recommend extraction site preservation.
This technique involves very careful extraction to prevent damage to the surrounding bone, and filling the socket with various types of bone grafting materials. Often this is done in conjunction with membranes to prevent the gum tissue from filling the space before bone can form. Proactive treatment will allow us to control and minimize shrinkage after extraction. This results in more predictable and cosmetic results. Treating the problem before it occurs is always preferable.
Soft Tissue Ridge Augmentation
When teeth are extracted without extraction site preservation, the bone often shrinks during healing and leaves a depression in the gum. When a permanent, non-removable bridge is placed, this concavity prevents the artificial tooth from looking real — it’s too long and out of proportion. In other words, it looks “fake”. By repairing the jaw defect with soft tissue ridge augmentation, the artificial tooth now looks like it is growing out of the gum and cannot be distinguished from the natural teeth.
Utilizing a combination of gingival grafts and connective tissue grafts, the defective area is built up to match the surrounding tissue levels. Depending on the size of the defective area and the thickness of the available donor tissue, several procedures may be necessary to obtain the optimum result.
The best way to treat a ridge deficiency is to prevent it from occurring. Performing extraction site preservation at the time of extraction can minimize the amount of bone loss from an extraction.
