Alveolar socket remodeling: The tug-of-war model

Bone change after tooth extraction has been well documented by different studies. Tooth extraction is followed by loss in height and width of the alveolar process. After tooth loss, the natural healing process is governed by the formation of the blood clot, which is stabilized by a fibrin bridge, the starting structure for new bone apposition. The hematoma is then replaced by the granulation tissue which is rich in fibroblasts that synthesize the extra-cellular matrix. The adjoining of wound edges requires further contraction of the healing tissue which is exerted by myofibroblasts. Excessive myofibroblasts contraction at the early stage of healing might explain, in part, the pathophysiology of alveolar bone resorption. The authors advocate the use of collagen right after tooth extraction to sustain the soft tissue and releasing the tension at the most coronal portion of the wound, thus preventing excessive detrimental myofibroblasts contraction.