# Postextraction Ridge Width Alterations Following Socket Seal Surgery--A Retrospective Study
## 4 Discussion  
Numerous studies have examined the spontaneous post-extraction healing of alveolar bone [1; 2; 3; 4; 5]. According to these studies, the resorption of the ridge is more pronounced in the buccal aspect of the socket than in its lingual aspect [2; 4]. Therefore, this retrospective analysis focused on the dimensional changes of the buccal aspect of the healing sockets. In this study, the average loss of buccal width at 6 months postextraction was about 5%. However, different areas showed different magnitudes of change in buccal dimensions. Incisor sites treated with SSS did not lose any buccal width, while the loss of width \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Location** & **Number** & \
\begin{tabular}{c} **Mean T6 Width/T0** \\ **Width (\%)** \\ \end{tabular} &
\begin{tabular}{c} **Mean Change** \\ **in Width (\%)** \\ \end{tabular} & **SD** \\ \hline Incisors & 18 & 101.5 & 1.5 & 13.1 \\ Canines & 4 & 83.0 & \(-\)17.0 & 2.1 \\ Premolars & 14 & 89.5 & \(-\)10.5 & 11.2 \\ Total & 36 & 94.7 & \(-\)5.3 & 13.4 \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Mean and SD of changes in the alveolar width in the different treated sites. \begin{table}
\begin{tabular}{c c} \hline \hline  & **Invaginations** \\ \hline Incisors & 1 (5.5\%) \\ Canines & 0 (0\%) \\ Premolars & 4 (28.5\%) \\ Total & 5 (13.9\%) \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Distribution of invaginations by site. amounted to about 10% at the premolar sites and around 17% at canine sites. The results of the present study should be firstly compared with a healing process without external influences, i.e., untreated extraction alveoli. When the natural course of healing was monitored, an overall reduction in width of the ridge ranges from 25% after 6 months for incisors [37] to 50% in premolars and molars [3]. Moreover, ridge alterations in the esthetic zone may be more pronounced in thin-walled phenotypes [38]. We found an overall mean reduction of 5% in buccal width when SSS was applied, suggesting this technique has a beneficial effect on the dimensional changes 6 months following tooth extraction. This may be explained by: a. presence of bone graft material in the healing socket; b. superior stabilization of soft tissue margins of the socket at the initial healing phase and prevention of the soft tissue collapse; and c. efficient containment and protection of the bone graft particles resulting in minimal volumetric changes, minimizing the need for further soft and hard tissue augmentation procedures. Our results also suggest that the teeth that gain most from SSS are incisors. The slighter reduction in width of the ridge after extraction of incisors may be attributed to the lower buccolingual diameter and cross sectional area of the root of incisors close to alveolar crest compared to amines, pre-molars and molars [39]. Thus the total area and the buccolingual diameter of the post-extraction alveolar socket orifice is lesser in the incisors compared to other types of teeth and the reduction in width of the ridge is less pronounced. Many clinicians have used immediate implant placement as a technique for alveolar ridge preservation [16; 40; 41]. While immediate implant placement reduces the number of surgeries and saves time, it fails to prevent the horizontal and vertical ridge alterations that follow tooth extraction [8; 42]. This may cause soft tissue recessions and should not be recommended when aesthetics are important [43]. Immediate implant placement should also be avoided at extraction sites in which achievement of primary implant stability requires positioning of the implant in a prosthetically incorrect position [44]. In such cases, SSS may be strongly considered. According to a recent systematic review [45], xenografts are the most suitable grafting material for ridge preservation and prevention of alveolar bone resorption, when compared to allografts or alloplastic materials or to natural healing.