Bone Regeneration: Understanding Tooth Extraction Recovery
If you’re undergoing a tooth extraction, you may be worried about the extraction site recovery, along with the pain and discomfort that comes with it. However, did you know that some of the common practices used by dentists can actually hinder the healing process of your bone and prolong the pain? In this article, we’ll discuss how dentists routinely compromise the health of your bone during an extraction and what can be done to avoid killing bone regeneration.
The Importance of Biocompatibility for Bone Regeneration
Bone cells live in a protected environment encased in thick cortical bone that is never exposed to the surrounding environment. This environment protects bone cells from thermal shocks, physical trauma, pressure gradients, and maintains a controlled environment of pH, salinity, hydration, and nutrients. If this protected environment is breached, the regenerative cells in your bone are easily killed.
For healthy tissue to grow, it must do so in an inflammatory-free environment. Inflammation triggers bone resorption, not an infection. Therefore, it is important to avoid inflammation during the healing process.
Socket Grafting and Bone Regeneration
Socket grafting is a common procedure after a tooth is extracted. Socket grafting is a bone grafting procedure where the socket, or “hole” in your jawbone, is filled with a graft material to prevent the area from shrinking and preserve the site for a dental implant. A tooth is often extracted because it is found to be a focal point of an infection. After the tooth and affected granulation tissue are removed, the entire infection is now removed. Although the bone in the socket is not infected, the bone regeneration process can be indirectly inhibited by an infection.
In the presence of infection, the body generates an inflammatory response. It is this inflammatory response that triggers bone resorption, not the infection. Bone resorption is a process where bone is broken down and absorbed by the body. The bone resorption from inflammatory response occurs before the bacterial infection has a chance to reach it, preventing the rest of the body from becoming infected. There are very rare instances that bacteria reaches the bone, causing osteomyelitis, which is a surprisingly rare occurrence in the jaws.
The exposed bone can become contaminated with bacteria after an extraction if your dentist is too vigorous while removing the granulation tissue from the socket. However, a simple rinsing of the socket with sterile saline reduces residual bacteria by 60%.
For normal healthy bone to grow, the bone should not be tampered with after tooth and granulation tissue removal, nor should medications or antiseptics ever be introduced into the socket other than a gentle sterile saline rinse. This is not taught by dental professors and lecturers who usually only have experience using cadaver bone grafts and have no experience regenerating normal healthy bone with science-based bone grafts.
The Risks of Cadaver Bone Grafts
Professors and lecturers who only use cadaver bone grafts commonly teach aggressive post-extraction debridement, often combined with the application of local antimicrobial treatment because of the potential of infection of cadaver bone grafts. Not only is infection of cadaver bone graft common, but infection of cadaver grafts can go unnoticed.
After a socket has been filled with mineralized cadaver material, the only thing that is seen on a radiograph is the dead bone of the graft that blends in with the existing bone. You cannot see if mineralization is actually occurring or if infection is present. Cadaver bone grafts all have a very porous structure that makes the particles ideal for bacteria to colonize in an isolated environment, protected from both antibiotics and the host immune system.
Due to the potential for infection, many clinicians who use cadaver bone grafts will choose to not graft an infected extraction socket at the time of extraction, but instead wait until the socket has time to resolve the infection first. These clinicians are primarily those who only know how to use cadaver bone grafts and are not trained in science-based grafts that are bacterially resistant. There is no reason to subject a patient to a second surgery to graft an infected socket.
Avoiding Delayed Bone Formation
A routine procedure after extraction is to use burs to remove granulation tissue and to puncture the sides of the socket to purposely induce bleeding. Dental burs are strong, typically steel, cutting tools. However, any cutting, grinding, or scraping of bone will kill the remaining bone cells of the socket.
Dentists are taught that you must create bleeding in the socket to facilitate mineralization, but again, this is only because they are using cadaver bone grafts. Vascular supply is necessary for cadaver bone graft mineralization to occur because cadaver bone grafts mineralize as a result of the inflammatory response to the foreign proteins in the graft and it is the vascular supply that transports the inflammatory cells.
The inflammation produced by the cadaver bone grafts interrupts the natural bone formation process where your bone regeneration cells (osteoblasts and osteoclasts) work in unison to grow and remodel bone. The natural bone in your body is constantly remodeling. However, the unnatural disruption of the bone regeneration process ultimately produces sclerotic bone and once it is formed, it never remodels.
Conclusion
To avoid killing regeneration and extraction socket pain, it is important for dentists to use science-based bone grafts that are bacterially resistant and they should also avoid aggressive post-extraction debridement and local antimicrobial treatment. Dentists should also avoid cutting, grinding, or scraping of bone to prevent killing remaining cells and delaying bone formation.
By following these guidelines, patients can ensure a smoother, faster healing process and avoid prolonged pain and discomfort.
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