HEALING OF EXTRACTION

SOCKET
PRESENTED BY:
JAGRITI RIJAL(619)

JAY PRAKASH YADAV(620)

PRESENTED TO:
Dr.ASHISH SHRESTHA
Dr.SHASHI KESHWAR
Dept.of oral
pathology,BPKIHS
CONTENTS

Sequence of healing of extraction wound

Complications in the healing of extraction
wound.
Fibrous healing of extraction wound.
Dry sockect
Summary
HEALING OF EXTRACTION WOUND

The sequence of healing

of extraction wound are:
1. Immediate reaction
2. First week wound
3. Second week wound
4. Third week wound
5. Fourth week wound
IMMEDIATE REACTION

Blood which fills the socket coagulates

RBC fibrin meshwork and torn blood vessels
become sealed off
Vasodilatation and engorgement of blood
vessels.
Mobilization of leucocytes

Blood clot covered by layer of fibrin

Contraction of clot
FIRST WEEK WOUND

Proliferation of fibroblast and epithelial cells

Fibroblast begins to grow into clot around the
entire periphery and cells associated with
healing process migrate.
Clot is gradually replaced by granulation tissue

Neck of the socket exhibits osteoclastic activity

Endothelial cells proliferate in PDL area

SECOND WEEK WOUND

Organization of clot(fibroblast growth,capillaries

penetrate at the centre)
Gradual degeneration of the PDL remnant
Extensive epithelial proliferation occur over the
surface of the wound.
Margin of alveolar socket exhibit prominent
osteoclastic resorption.
Fragment of necrotic bone undergo in the
process of resorption sequestration.
THIRD WEEK WOUND

Maturation of the granulation tissue

Formation of young trabeculae of osteoid or
uncalcified bone around the socket wall
Original cortical bone of alveolar socket
undergo remodeling
Rounding of crest of alveolar bone by
osteoclastic resorption.
Complete epithelialization
FOURTH WEEK WOUND

Begin the final stage of healing

Deposition and remodeling resorption of bone

The early bone formed is poorly calcified.

Radiographic evidence of bone formation is not

prominent until sixth or eighth week.
COMPLICATIONS IN HEALING OF EXTRACTION
WOUND
1. Fibrous healing of extraction wound
2. Dry socket
FIBROUS HEALING OF EXTRACTION WOUND

It occurs by the loss of both the buccal and the

lingual cortical plates of bone and the loss of
periosteum
On a radiograph the lesion appers a well
circumscribed radiolucent area in the site of a
previous extraction wound
The areas of fibrous healing consists of dense
bundles of collagen fibrils with occasional
fibrocytes and few blood vessels the lesion is a
fibrous scar tissue with little or no evidence of
ossification.
HISTOLOGIC FEATURES

Dense bundles of collagen fibres

Fibrocytes and few blood vessels

Treatment and prognosis

Excision of lesion
DRY SOCKET

Most common and painful complication of

tooth extraction is alveolar osteitis.
It is a focal osteomyelitis in which blood clot is
disintegrated or lost with the production of foul
odor and severe pain of throbbing type but no
suppuration.
PATHOGENESIS OF FIBRINOLYTIC ALVEOLITIS
RISK FACTOR
Women(than men)
Tobacco users
Difficult or traumatic extraction(impacted
mandibular 3rd molar)
Pagets disease
Patient undergoing radiotherapy(ischemia of bone
caused by endarteritis)
Oral contraceptives(estrogen-fibrinolytic activity)
Fracture of tooth during extraction
Depression of alveolar socket
CLINICAL FEATURES
Age group(40-45)years
Mandible is more affected
Usually starts by 2nd or 3rd post operative day and
lasts for 7-10 days
Extremely painful
May be associated with ipsilateral
lymphadenopathy
Low grade fever
The exposed bone is necrotic and sequestration of
fragment.
PREVENTION AND MANAGEMENT
By care exercised in handling the living tissue
Keep extraction socket clean
Irrigate with mild warm antiseptic
Then filled with obtundent dressing
Change dressing every day by zinc oxide eugenol and
iodoform gauze
Most patients symptom free after one or two dressing
Other agent inserted into socket at the time of extraction
like sulfanilamide-sulfathiazole,tetracycline
hydrochloride,aureomycin in the wound of socket.
 SUMMARY

COMPLICATION
Fibrous healing of extraction socket
Dry socket
REFERENCES