Extraction socket healing

 Secondary intention
 Intramembranous bone healing

1. Granulation stage (immediate-5 days)

 Hemostasis
 Inflammation
 Granulation tissue
o Start from the base of the socket, extending cretally along the
socket wall
o Blood clot occupy central portion
o Osteoclast accumulate along alveolar bone crest

2. Initial angiogenic stage (1st week)

 Angiogenesis
o Start at the base of socket + PDL at cribiform plate (lamina
dura)
 Because of the thick and strong trabeculae and capillary
plexus
o New sinusoids fills up 2/3 of the socket
 Sinusoids = irregular trabecular space for passage of
blood
 Active bone resorption
o Mainly at crestal bone and cortical margin of alveolar socket

3. New bone formation (2nd week)

 Osteoid trabeculae (from base and sides of socket) slowly extends into
clot
 Anastomosing sinusoids  new bone trabeculae (governed by
expansion and location of the sinusoids)
 Woven bone formation (incompletely ossified)

4. Bone growth stage (4th-5th week)

 Deposit additional trabeculae
 Thickened socket base and wall  fill up 2/3 of original socket volume

5. Bone reorganization stage (6th week)

 From primary spongiosa (spongy cancellous bone)  secondary
spongiosa (irregular and larger framework)

6. Remodelling (3rd week onwards)

 A series of bone deposition and resorption
 6th-8th week: apparent radiographic evidence of bone formation
 4th-6th month: complete healing on radiograph