Socket preservation is a term that encompasses techniques used by dentists to preserve the dimensions of bone after the removal of a tooth. This can be useful for a variety of reasons, mostly because it improves the chances of having a successful restoration procedure in the future that works aesthetically. Without socket preservation after tooth extraction, alveolar bone loss occurs and the jaw bone may be permanently altered before an implant can be placed.
Is Socket Preservation Necessary?
Socket preservation has not always been the standard after tooth extraction. As the American Academy of Dental Consultants concluded in its position statement, “The AADC Positions Committee therefore recognizes the value of socket preservation by bone graft for esthetic and dimensional maintenance of the alveolar ridge. However, it is important to note that current scientific evidence does not support routine use of the procedure. As such, the clinical indications and applications for socket preservation must be carefully evaluated on a case by case basis.” Basically this means that not every tooth extraction requires socket preservation. However most dentists agree that there are many cases that benefit from this technique, especially when there is advanced periodontal disease.
Research has shown that while socket preservation with bone grafts may not always prevent resorption, it does maintain the vertical and horizontal dimensions of the alveolar ridge. Alveolar bone resorption may be up to 40% in height and 60% in width after tooth extraction. The bone resorption and changing of dimension that occurs is part of the natural healing process. However this loss can significantly decrease the effectiveness of an implant and its long-term success. Because of this, many dentists now use a combination of bone graft material with a bone binder to help maintain the dimensions of the bone and improve the success of future implants after extraction.
Bone Graft Materials
There a few different types of bone materials that may be used for socket preservation. Bone may be taken from the patient (autograft), taken from a cadaver source (allograft), or taken from a pig or cow (xenograft). Synthetic materials are also made that are alternatives to actual bone. There has not been extensive research on which bone graft material is best for socket preservation. Until there is clearer evidence that one material is better than another, dentists choose the material that works best for them.
Our compounding pharmacy prepares binders to be used with bone graft materials for socket preservation. Fusion bone binder and Garg bone binder are two different formulations used for the same purpose. These materials are mixed with a bone graft material of the dentist’s choice to form a moldable form that is inserted into the socket. The goal is to encourage growth of new bone while supporting the structure of existing bone and preserving the dimensions of the alveolar ridge.
A Fusion bone binder kit includes calcium sulfate and carboxymethylcellulose in one syringe with gentamicin 3% in a second syringe. The syringes are mixed together then combined with a bone graft material. It is easily moldable to conform to any type of socket or defect. Garg bone binder comes in a single syringe that contains carboxymethylcellulose and glycerin which is mixed with a bone graft in the same way as Fusion. It also forms a moldable putty material that is easy to work with.
Bone Binder Ingredients
Carboxymethylcellulose (CMC) is a natural, plant-derived material that helps provide excellent handling characteristics to the graft. This is a non-toxic material that is bio-compatible and easy to mold. CMC is found in both Fusion bone binder and Garg bone binder. Fusion Bone Binder contains calcium sulfate, in particular calcium sulfate hemihydrate, which is also sometimes called Plaster of Paris. This material has good handling properties and is resorbable. The gentamicin is added to Fusion as an antibiotic to reduce infection in the socket. In Garg bone binder, the CMC is combined with glycerin, which acts as a binder and helps improve handling of the bone graft material. Glycerin is another non-toxic substance, most often derived from plant sources, which is bio-compatible.
Future Research on Socket Preservation
Research continues to be done on socket preservation techniques to determine how effective they are and what materials are superior. The majority of research shows, however, that socket preservation improves aesthetic outcomes of implants when teeth are extracted. Bone binders from our compounding pharmacy can be a useful addition to any socket preservation protocol.
Surgical protocols for ridgepreservation after tooth extraction.A systematic review – Clinical Oral Implants Research
Rationale for Socket Preservation after Extraction of a Single-Rooted Tooth when Planning for Future Implant Placement – Journal of the Canadian Dental Association
Alveolar Ridge Preservation After Tooth Extraction with DFDBA and Platelet Concentrates: A Radiographic Retrospective Study – Open Dentistry Journal (PMC)
Socket Preservation by Bone Grafting Position Statement – American Academy of Dental Consultants