The Alveolar Socket Wall Is Already Altered at the Time of Tooth Extraction: A Retrospective Clinical, Radiological and Histopathological Study

Background/Objectives: After extraction, the crest may close before the socket has mineralised, leaving a covered socket residuum that may enclose the tissue lining the socket. We examined the socket wall histologically at the moment of extraction and compared it with the periapical region and the socket walls on preoperative cone-beam computed tomography (CBCT). Methods: Retrospective single-centre study of teeth extracted by one surgeon for a clinical indication in routine care. Before decortication according to the ARENA-Protocol® (Alveolar Ridge Epithelialization after Non-viable Bone Debridement and Augmentation), a trephine core was taken along the long axis of the socket wall; soft tissue was submitted when present. Each specimen received a leading diagnosis from a predefined hierarchy. Results: Sixty-six specimens from 41 sockets in 23 patients were examined. Thirty-eight sockets (92.7%) were altered. Bone showed mainly chronic inflammation and marrow fibrosis, soft tissue mainly florid inflammation. The radiographic lesion lay periapically and was visible on CBCT and its three-dimensional visualisation, whereas the lateral wall from which the core was taken showed no distinct change on either and was nevertheless altered, also in all three sockets without a periapical finding. All 14 root-filled and 24 of 27 non-root-filled sockets were altered. Conclusions: In this cohort, the socket wall was altered at extraction in almost every case, and the alteration along the long axis of the socket was detected only histologically. If the crest closes over such a wall, a residuum may enclose altered tissue. Controlled studies are needed to test this.