# Postextraction Ridge Width Alterations Following Socket Seal Surgery--A Retrospective Study
###### Abstract  
_Background and objectives_: Preservation of alveolar ridge contour following tooth extraction is important to allow for restoration with prosthetics and implants. Socket seal surgery was introduced more than two decades ago for preservation of the form, volume and bone quality of the postextraction ridge. The aim of this retrospective study was to assess the changes in alveolar ridge contour following socket seal surgery and to evaluate the survival of the soft tissue grafts sealing the extraction site. _Materials and Methods_: Digital images of the extraction sites treated with the socket seal surgery were obtained immediately after extraction and after a healing time of 6 months to measure the changes in the alveolar width. In addition, the sites were photographed 1 week postsurgery to evaluate the vitality of the soft tissue grafts. _Results_: The overall mean loss of buccal width following socket seal surgery was 5.3% (SD = 13.4%). The mean change in width at the incisor area (1.5% \(\pm\) 13.1) was significantly lesser than those in the canine area (\(-\)17.0% \(\pm\) 2.1, \(p\) < 0.01) or premolar area (\(-\)10.5% \(\pm\) 11.2, \(p\) < 0.01). One-week post-surgery 69% of the grafts were vital, and 31% were partially vital. Complete necrosis of the grafts did not occur. _Conclusions_: Our results suggest that socket seal surgery has a beneficial effect on alveolar dimensional changes 6 months following tooth extraction and that the teeth that benefit mostly from socket seal surgery are incisors. Different treatment modalities have been proposed to prevent postextraction ridge deformation and reduce the need for additional ridge augmentation procedures. These include Guided Bone Regeneration (GBR) techniques [11; 12], grafting bone-substitute materials [13; 14], overbuilding of the facial bony wall [15], immediate implant placement [16], the use of platelet concentrate [17], partial extraction protocols [18] and forced orthodontic extraction [19]. Most of the methods proposed to prevent postextraction ridge deformation were primarily aimed at preserving bone tissue [20]. However, techniques to achieve primary soft tissue wound closure have also been developed, mainly related to immediate implant placement, such as coronally repositioned flap [21] and rotated palatal flap [22]. It is still not clear which of the proposed materials for socket preservation are the most suitable: autogenous [23], allogenic [24; 25] or alloplastic [26]. Moreover, the relative importance of bone grafts, membrane or soft tissue graft in the success of socket preservation still needs to be determined [27]. Other important factors influencing the choice of a grafting material include cost-effectiveness, as well as the influence of the biomaterial on the final implant outcomes [28]. Socket seal surgery (SSS), a simplified, minimally invasive regenerative approach, was introduced more than two decades ago as a tool for optimizing the preservation of the hard and soft tissue components of the alveolar ridge immediately following tooth extraction [29]. This approach involves the placement of free gingival graft to cover the augmented alveolar socket and may be suitable for immediate or delayed implant placement, as well as for the achievement of an esthetically pleasing pontic site [29; 30]. It was proposed that stabilizing the soft tissue architecture with SSS minimizes soft tissue shrinkage [31]. Studies in dogs demonstrated that placing a deproteinized bovine bone material (DBBM) into the extraction socket and sealing the socket with a free gingival graft was beneficial in limiting the volumetric shrinkage [20; 32]. However, due to the limited blood supply there is a risk of incomplete wound healing and necrosis of the soft tissue graft [33].