Healing Of Extraction

Wound
Reference: Petersons Principles of oral and
maxillofacial surgery, 2nd edition

Introduction
The healing of an extraction socket is a specialized example of healing
by second intention.

Reference: Petersons Principles of oral and maxillofacial surgery, 2nd edition

Reference: Petersons Principles of

oral and maxillofacial surgery, 2nd
edition

Steps
1. Immediately after the removal of the tooth from
the socket, blood fills the extraction site.
2. Both intrinsic and extrinsic pathways of the clotting
cascade are activated.
3. The resultant fibrin meshwork containing entrapped red
blood cells seals off the torn blood vessels and reduces
the size of the extraction wound.

4. Organization of the clot begins within the first 24 to

48 hours with engorgement and dilation of blood

vessels within the periodontal ligament remnants, followed
by leukocytic migration and formation of a fibrin layer.

Reference: Petersons Principles of

oral and maxillofacial surgery, 2nd
edition

By 1st week
The clot forms a temporary scaffold upon which inflammatory
cells migrate.
Epithelium at the wound periphery grows over the surface of
the organizing clot.
Osteoclasts accumulate along the alveolar bone crest setting
the stage for active crestal resorption.
Angiogenesis proceeds in the remnants of the periodontal
ligaments.

Reference: Petersons Principles of

oral and maxillofacial surgery, 2nd
edition

By 2nd Week
The clot continues to get organized through fibroplasia and
new blood vessels that begin to penetratetowards the center
of the clot.
Trabeculae of osteoid slowly extend into the clot from the
alveolus, and osteoclastic resorption of the cortical margin of
the alveolar socket is more distinct.

Reference: Petersons Principles of

oral and maxillofacial surgery, 2nd
edition

By 3rd Week
The extraction socket is filled with granulation tissue and
poorly calcified bone forms at the wound perimeter.
The surface of the wound is completely re-epithelialized with
minimal or no scar formation.

Reference: Petersons Principles of

oral and maxillofacial surgery, 2nd
edition

Active bone remodeling by deposition and resorption

continues for several more weeks.
Radiographic evidence of bone formation does not become
apparent until the sixth to eighth weeks following tooth
extraction.
Due to the ongoing process of bone remodeling the final
healing product of the extraction site may not be discernible
on radiographs after 4 to 6 months.

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