What is socket preservation (ridge preservation)?
Socket preservation means that the tooth socket is filled with bone material and covered immediately after the tooth is removed; it is also called ridge preservation. According to a clinical overview on the blog of the International Team for Implantology (ITI, Balcázar and Sánchez, 2022), the aim is to keep the loss of the outer bone wall after extraction as small as possible and to support bone formation inside the socket.
According to the ITI and the Italian Academy of Osseointegration (2022), the procedure usually runs like this:
- The tooth is removed and the bone walls of the socket are checked for damage.
- The socket is cleaned of inflamed tissue.
- Bone material is placed in the socket.
- The material is covered with a membrane or with the patient’s own soft tissue.
- The site heals for several months; then the implant is placed.
According to the ITI, these techniques suit sockets with intact bone walls; if a wall is missing, guided bone regeneration with a membrane is more appropriate. What to bear in mind after an extraction in general is explained in our guide after a tooth extraction; the procedure itself is described on our tooth extraction page.
How much bone is lost after a tooth extraction?
In the first months after an extraction, the jaw loses width and height. According to the systematic review by Tan and colleagues in Clinical Oral Implants Research (2012), bone width decreased by an average of 3.79 millimetres within six months and height on the cheek side by 1.24 millimetres. The loss of width reached 32 percent after three months; the fastest change occurred in the first three to six months.
In the front of the mouth the loss can be more pronounced. Chappuis and colleagues (Journal of Dental Research, 2013) followed 39 patients with CBCT scans for eight weeks after removal of a visible front tooth. Where the bone wall in front of the tooth was 1 millimetre thick or less, the median vertical bone loss was 7.5 millimetres; with a thicker wall, 1.1 millimetres. What this means for an implant in the visible area is explained in our guide dental implants for front teeth.
Who benefits from socket preservation?
Socket preservation is not done routinely after every extraction; it is considered when the implant cannot be placed in the same operation or is to be postponed. The Italian Academy of Osseointegration recommends it above all:
- for extractions in the visible, aesthetically important area
- near the sinus in the upper jaw, and near the nerve canal or the nerve exit at the chin in the lower jaw
- when the treatment plan provides for a later implant
- when the patient wants to postpone the implant for any reason
The ITI overview names reasons that can make a later implant necessary: purulent infection, too little bone beyond the root tip and large lesions at the root tip; adolescence, pregnancy and uncontrolled general conditions. The 2019 European Workshop in Periodontology (Tonetti and colleagues) recommends weighing six points: infection, whether the implant can be placed firmly in the right position straight away, damage to the socket, gum and bone type, aesthetic demands and general health.
When is socket preservation not needed?
If the implant can be placed in the same operation as the extraction, separate socket preservation is often unnecessary. According to the ITI, immediate placement with a temporary tooth or a customised healing abutment is the preferred route in suitable cases. The ITI consensus report by Hämmerle and colleagues (2004) adds that an implant should not be placed at extraction if the remaining bone cannot hold it firmly in the ideal position, and that thin gum types with a lost outer bone wall should be grafted first. The conditions are explained in our guide same-day dental implants.
Tonetti and colleagues also stress that the available studies mostly concern single extractions and that caution is needed with several teeth.
What does the Cochrane review say about effectiveness?
Socket preservation can reduce bone loss, but the certainty of the evidence is very low. The Cochrane review updated in 2021 (Atieh and colleagues) analysed 16 randomised controlled trials with 426 adults and 524 extraction sockets:
- With animal-derived material, socket preservation reduced the loss of width after six months by about 1.2 millimetres and of height by about 1.4 millimetres compared with leaving the socket to heal.
- With synthetic material, a single trial with only 15 participants found about 3.7 millimetres less height loss.
- Whether socket preservation makes additional bone grafting before the implant less likely, or reduces implant losses, could not be shown.
- Individual participants reported delayed healing, pain, swelling or redness; serious adverse events did not occur in most trials.
The authors describe the trials as contradictory and often unclear in method; the effect on implant success and appearance has barely been studied.
What does socket preservation do for the implant?
The aim is for the implant to be placed later where the tooth belongs, not where bone happens to remain. According to the ITI, socket preservation is recommended when a later implant is planned, to preserve the dimensions and allow prosthetically driven positioning. The Italian consensus report considers it particularly suitable in the visible area.
The Cochrane review could not show, however, that it removes the need for additional grafting at implant placement; the CBCT scan before the procedure shows whether bone must be added.
How long until the implant, and how many stays are needed?
According to the Italian consensus report, the implant is usually placed 4 to 6 months after socket preservation; the Cochrane review included trials with at least six months of follow-up. Even without filling the socket, the ITI consensus report by Hämmerle and colleagues describes early placement after partial bone healing at 12 to 16 weeks and placement in a healed site after more than 16 weeks. How the waiting time after an extraction fits into the overall timeline is explained in our guide How long does dental implant treatment take?
For the period after the procedure, the ITI overview says the stitches are usually removed after 10 to 15 days and a collagen dressing over the socket dissolves within about 14 days. In the first days, a few granules of material may come out into the mouth; what is normal and what to watch for is covered in our guide healing after a bone graft.
For international patients, extraction with socket preservation and implant placement therefore usually fall into separate stays, followed by the healing time before the teeth. Ask before booking whether the stitches will be removed before your flight or by your dentist at home.
Extraction at home, implant in Türkiye: how does that fit together?
Many patients have a tooth that cannot be saved removed at home and plan the implant for Türkiye. Raise socket preservation with your dentist at home before the extraction, because according to the ITI it is only possible at or immediately after removal. Helpful for planning are the extraction date, X-rays from before and after, and details of the material and membrane used.
You can send us these documents and current photos on WhatsApp for a preliminary assessment; the first stay can then be timed for when the socket is expected to have healed. The plan is confirmed after the examination on site. Which documents to bring in general is covered in our guide documents for dental treatment in Türkiye.
How do we plan extraction and implant at Rönesans?
At our clinic in Serdivan, the bone walls around the tooth and the distance to the sinus and nerve canal are assessed on a cone-beam CT (CBCT) scan before an extraction where needed. We carry out bone grafting at the clinic, under general anaesthesia if required. Whether socket preservation in the same session as the extraction makes sense for you is assessed at the examination.
Our dentists discuss your case together, and one dentist accompanies you throughout. Before treatment starts you receive a written treatment and cost plan with the procedures for each tooth and the planned stays. During the implant’s healing period a temporary tooth is fitted depending on your case. We answer questions beforehand in English or German on WhatsApp at +90 532 363 49 54; how stays are organised is described on our page dental treatment in Türkiye.