The best time to think about the bone under a tooth is before that tooth comes out. Once it is removed, the ridge of jawbone that held it begins to remodel, and it does so fastest in the first few months. That is ordinary healing, not a sign that anything went wrong, but it can narrow your options for replacing the tooth later.
Width is lost faster than height
The bone around a tooth, called alveolar bone, is there to hold the tooth. When the root is gone, the socket fills in with new bone, but the ridge as a whole also shrinks, particularly on the cheek side, where the outer wall of bone is often very thin.
Pooling human studies, a 2012 systematic review (Tan and colleagues, Clinical Oral Implants Research) reported that by six months the ridge had narrowed by 29% to 63% and lost 11% to 22% of its height. The changes were quickest in the first three to six months and slowed after that. An earlier prospective study of 46 patients who had a premolar or molar removed (Schropp and colleagues, International Journal of Periodontics and Restorative Dentistry, 2003) likewise found that the major changes to an extraction site happened within the first year.
Every extraction site is different. A tooth with a thick wall of bone, removed cleanly, may change less than one lost to infection or gum disease, where bone was already missing before the extraction.
A narrower ridge shows up later
The effects tend to appear when the gap is eventually filled.
- Implants need enough height and width of bone to be placed and to stay stable. If too much has been lost, grafting may be needed first, adding time and cost.
- Bridges can look less natural over a shrunken ridge, because the replacement tooth may appear longer or leave a dark space near the gum.
- Dentures rely on the shape of the ridge for support, and a flatter ridge can make them less stable.
At the front of the mouth, even a small hollow in the gum line can be visible. Our guide to implant, bridge and denture options describes how each choice relates to the bone you have.
Ridge preservation can reduce the shrinkage, but the evidence has limits
Ridge preservation, also called socket preservation, is done at the same appointment as the extraction. The empty socket is packed with graft material that acts as a framework for new bone, and it is usually covered with a membrane or the gum while it heals.
A 2021 Cochrane review (Atieh and colleagues) concluded that these techniques may reduce the loss of ridge height and width at six months, but described the evidence as very uncertain. It found no clear evidence that preservation changed the need for further grafting when an implant was placed, or affected implant failure or appearance, largely because long-term data are lacking. It also found no clear difference between graft materials.
Put simply, preservation is a reasonable way to keep more bone at a site where an implant is planned, but it does not freeze the ridge in place and it does not guarantee that no more grafting will be needed. If a larger rebuild is required later, our article on bone grafts and sinus lifts explains those procedures.
When it is worth raising before an extraction
Ridge preservation is not needed for every tooth. It is most worth discussing when:
- you are likely to want an implant in that spot,
- the tooth is at the front of the mouth, where the shape of the gum shows,
- a 3D X-ray shows the bone wall on the cheek side is already thin, or
- the implant cannot be placed soon after the extraction.
If you plan to leave the gap, or a denture is the likely replacement, preservation may matter less. It is also worth asking whether the tooth can be saved at all, and our comparison of root canal treatment and extraction sets out that decision.
Healing well helps the socket
Whatever is decided, the socket heals best when the first clot is protected. Avoid rinsing hard, smoking and drinking through a straw in the first day, and follow your dentist's instructions. Our extraction recovery guide covers the first days and weeks.
Common questions
Can I still have an implant years after losing a tooth?
Often, yes. More bone may have been lost, so a graft is more likely to be needed. A 3D scan shows how much height and width remain.
Is ridge preservation painful?
It is done under the same local anaesthetic as the extraction. Most people find recovery similar to an extraction alone, though there may be a little more swelling.
Does the bone keep shrinking forever?
The fastest change happens in the first months and then slows a great deal. Some gradual remodelling can continue over the years where no tooth or implant is present.
If a tooth needs to come out and you want to keep your future options open, talk to us before the extraction. At Lumi Dental in Melrose Park, we can assess the bone with a 3D X-ray and explain whether ridge preservation makes sense for you, and implant consultations are free. Learn more on our dental implants page, see the current offers or get in touch through our contact page.
