Management of extraction sites: From biological principles to clinical practice

OBJECTIVES: To provide a concise overview of the biological events and dimensional changes following tooth extraction and to summarize current therapeutic strategies for extraction site management, including alveolar ridge preservation (ARP), alveolar ridge reconstruction (ARR), partial extraction therapies (PET), and tooth autotransplantation (TAT). MATERIALS AND METHODS: This narrative review summarizes the biological mechanisms underlying post-extraction healing and evaluates evidence-based approaches for extraction site management. Clinical decision-making is discussed according to hard and soft tissue integrity. RESULTS: Tooth extraction initiates a physiological remodeling process that frequently results in alveolar ridge resorption, potentially compromising subsequent prosthetic rehabilitation. To minimize post-extraction changes and establish a favorable biological foundation for tooth replacement, treatment should be tailored to site-specific characteristics. ARP is generally effective in limiting dimensional changes in sockets with intact alveolar walls, whereas ARR aims to restore ridge architecture in sites with substantial hard tissue defects, such as buccal dehiscences. PET and TAT are also viable alternatives for preserving alveolar ridge dimensions in selected cases. When indicated, immediate implant placement combined with interceptive therapies, including ARP, ARR, or PET, represents a feasible approach to shorten total treatment time. Careful clinical and radiographic assessment is essential to make sound decisions in commonly encountered clinical scenarios: (1) intact hard and soft tissues; (2) damaged alveolar bone without soft tissue dehiscence; and (3) combined hard and soft tissue deficiencies. CONCLUSIONS: ARP, ARR, PET, and TAT are predictable, evidence-based treatment modalities for the management of extraction sites. Optimal treatment planning should be based on site-specific characteristics and patient-related factors to maximize clinical outcomes and minimize postoperative complications.