POSTEXTRACTION CARE OF TOOTH SOCKET
Once the tooth has been removed from the socket, it is necessary to provide proper care the socket should be debrided only if necessary If a periapical lesion is visible on the preoperative radiograph and there was. no granuloma attached to the tooth when it was removed, the periapical region should be carefully curetted to remove the granuloma or cyst. If any debris is obvious, such as calculus, amalgam, or tooth fragment remaining in the socket, it should be gently removed with a curette or suction tip (Fig. 7-72). However, if neither periapical lesion· nor debris’ is present, the socket should not be curetted.
The remnants of the periodontal ligament and the bleeding bony walls are in the best condition to provide for rapid healing. Vigorous curettage of the socket wall mereIy produces additional injury and may delay healing.
The expanded buccolingual plates’ should be compressed back to their original configuration. Finger pressure should be applied to the buccolingual cortical plate to gently but firmly compress the plates to their original position or approximate them even more closely if possible. This helps prevent bony undercuts that may have been caused by excessive expansion of the buccocortical plate, especially after first molar extraction.
If the teeth were removed because of periodontal disease there may be an accumulation of excess granulation tissue around the gingival cuff. If this is the case, special attention should be given to removing this granulation tissue with a curette or hemostat. The arterioles of granulation tissue have little or no capacity to retract and constrict, which leads to bothersome bleeding if excessive granulation tissue is left.
Finally, the bone should be palpated through the overlying mucosa to check for any sharp, bony projections.If any exist, the mucosa should be reflected and the sharp edges smoothed judiciously with a bone file.
To gain initial control of hemorrhage a moistened 2×2 inch gauze is placed over the extraction socket the gauze should be positioned so that when patient closes the teeth together, it fits into the space previously occupied by. the crown of the tooth. The pressure of biting the teeth together is placed on the gauze and is transmitted to the socket. This pressure results in hemostasis. If the gauze is simply placed on the occlusal table, the pressure applied to the bleeding socket is insufficient to achieve adequate hemostasis (Fig. 7-73). A larger gauze sponge (4 x 4 Inch) may be required if multiple teeth have been extracted or if the opposing arch is edentulous.
The extraction of multiple teeth at one sitting is a more involved and complex procedure. It is discussed in Chapter 8.