Healing of extraction wound

A brief presentation on healing after tooth extraction.
Reference: Peterson's Principles of oral and maxillofacial surgery, 2nd edition.

1. Healing Of Extraction Wound By : E-Dental Facebook page: https://www.facebook.com/pages/E-Dental-For-Sisters-Only/291308300898932?ref=hl Reference: Peterson’s Principles of oral and maxillofacial surgery, 2 nd edition Reference: Peterson’s Principles of oral and maxillofacial surgery, 2nd edition

2. Introduction The healing of an extraction socket is a specialized example of healing by second intention . Reference: Peterson’s Principles of oral and maxillofacial surgery, 2nd edition

3. Steps Immediately after the removal of the tooth from the socket, blood fills the extraction site. Both intrinsic and extrinsic pathways of the clotting cascade are activated . The resultant fibrin meshwork containing entrapped red blood cells seals off the torn blood vessels and reduces the size of the extraction wound . Organization of the clot begins within the first 24 to 48 hours with engorgement and dilation of blood vessels within the periodontal ligament remnants , followed by leukocytic migration and formation of a fibrin layer . Reference: Peterson’s Principles of oral and maxillofacial surgery, 2nd edition

4. By 1 st week T he clot forms a temporary scaffold upon which inflammatory cells migrate. Epithelium at the wound periphery grows over the surface of the organizing clot. Osteoclasts accumulate along the alveolar bone crest setting the stage for active crestal resorption . Angiogenesis proceeds in the remnants of the periodontal ligaments. Reference: Peterson’s Principles of oral and maxillofacial surgery, 2nd edition

5. By 2 nd Week T he clot continues to get organized through fibroplasia and new blood vessels that begin to penetratetowards the center of the clot. Trabeculae of osteoid slowly extend into the clot from the alveolus , and osteoclastic resorption of the cortical margin of the alveolar socket is more distinct. Reference: Peterson’s Principles of oral and maxillofacial surgery, 2nd edition

6. By 3 rd Week The extraction socket is filled with granulation tissue and poorly calcified bone forms at the wound perimeter. The surface of the wound is completely re-epithelialized with minimal or no scar formation. Reference: Peterson’s Principles of oral and maxillofacial surgery, 2nd edition

7. Active bone remodeling by deposition and resorption continues for several more weeks . Radiographic evidence of bone formation does not become apparent until the sixth to eighth weeks following tooth extraction . Due to the ongoing process of bone remodeling the final healing product of the extraction site may not be discernible on radiographs after 4 to 6 months. Reference: Peterson’s Principles of oral and maxillofacial surgery, 2nd edition

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