Extraction and Ridge Preservation: Making the Right Call
Deciding when to graft after a tooth extraction is a question many clinicians weigh carefully. The short answer? In an ideal treatment plan, extraction and alveolar ridge preservation go hand in hand. Pairing the two protects your patient's long-term outcomes and sets the stage for whatever comes next.
Why Grafting Belongs in Your Treatment Plan
When you remove a tooth, you also open the door to bone loss. Without preservation, the ridge can lose volume, making future prosthetic work more difficult. That loss can also create periodontal problems for the adjacent teeth.
Grafting at the time of extraction helps you avoid these issues. It maintains bone volume, simplifies secondary treatment, and supports the health of adjacent teeth.
For these reasons, many clinicians now include ridge preservation in their treatment plan for every patient losing a tooth.
The Power of Patient Education
Of course, recommending a graft and gaining patient acceptance are two different things. This is where education makes the difference.
Be clear about what you're trying to accomplish: preserving bone volume and protecting future treatment options. Explain the risks of declining treatment: bone loss and more difficult, costly procedures later.
Even if a patient waits to move forward with implant or prosthetic treatment, some resorption will likely occur. But they'll be in a far better position than if nothing had been done at all. That's the value of acting now. When patients understand these ramifications, they make more informed decisions.
When to Wait
Depending on the clinical presentation, immediate grafting isn't always the right move. In cases of large chronic infection with purulence, it's often better to remove the source of infection and degranulate as the first stage. From there, either allowing the site to heal or delaying grafting until the infection is no longer there.
Moving Toward a Standard of Care
The concept isn't new. In 2012, Gordon Christensen discussed ridge preservation as a standard of care approach. While the field hasn't formally arrived at that designation yet, it's getting close.
When he was in private practice, Dr. Schlesinger made ridge preservation standard for every patient losing a tooth. He treatment-planned extraction and grafting together automatically. Today, many clinicians follow this same approach.
The trajectory is clear: for practices focused on long-term patient outcomes, grafting at the time of extraction has become routine.
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