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Extraction and Socket Grafting: Part 2 — Extraction Site Healing (1 CE Credit)

Launch Course

Course Objectives (1 CE Credit)

Randolph R. Resnik, DMD, MDS

Dentists have seen significant advancements in the understanding of bone healing at the cellular and molecular level, which has led to techniques that have expanded the scope of oral implantology. In most cases, the extraction process will initiate a sequence of bony resorptive morphologic changes that may negatively alter the alveolar ridge. These changes are variable and, if significant, can eliminate the possibility of future implant placement. Therefore, it is crucial to understand the processes of repair and regeneration, and to apply their concepts to diagnosis and treatment planning with respect to the treatment of extraction sites. In this article, Dr. Resnik discusses extraction site healing, along with indications and contraindications for socket grafting. Topics include:

  • Terminology used to describe the healing of bone tissue
  • Classifying the extraction site based on the number of walls remaining
  • How to determine if bone grafting is indicated
  • Treatment options determined by extraction socket walls
  • Predictable treatment of extraction sockets
  • The five stages of extraction socket healing
  • Contraindications to socket grafting


A classification of the indications for socket grafting has been discussed with regard to the socket walls remaining after tooth extraction. When bony walls are thick in a five-walled extraction socket, grafting is optional. However, when all walls of the socket are present but one or more walls are thin, socket grafting is indicated. When additional walls are missing, socket grafting is highly recommended. In general, the more walls compromised or missing, the greater the need for grafting. When clinicians thoroughly understand how bone healing occurs, treatment of the extraction site can be more predictable and successful for patients.

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