Ridge alterations following tooth extraction with and without flap elevation: an experimental study in the dog

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Different approaches were advocated to preserve or improve the dimension and contour of the ridge following tooth extraction. In some of studies, socket 'flapless extraction' apparently had a successful outcome. The objective of the present experiment was to compare hard tissue healing following tooth extraction with or without the prior elevation of mucosal full-thickness flaps. Five mongrel dogs were used. The two second mandibular premolars ((2)P(2)) were hemi-sected. The mesial roots were retained. By random selection the distal root in one side was removed after the elevation of full-thickness flaps while on the contralateral side, root extraction was performed in a flapless procedure. The soft tissue wound was closed with interrupted sutures. After 6 months of healing, the dogs were euthanized and biopsies were sampled. From each experimental site, four ground sections - two from the mesial root and two from the healed socket - were prepared, stained and examined in the microscope. The data showed that the removal of a single tooth (root) during healing caused a marked change in the edentulous ridge. In the apical and middle portions of the socket site minor dimensional alterations occurred while in the coronal portion of the ridge the reduction of the hard tissue volume was substantial. Similar amounts of hard tissue loss occurred during healing irrespective of the procedure used to remove the tooth was, i.e. flapless or following flap elevation. Tooth loss (extraction) resulted in marked alterations of the ridge. The size of the alveolar process was reduced. The procedure used for tooth extraction - flapless or following flap elevation - apparently did not influence the more long-term outcome of healing.