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Dental Cavitations and Osteonecrosis

Ozone, curettage, and laser repairs for infected, unhealed, or avascular tooth extraction sites.

Why Do Cavitations Form?

Approximately 200 million Americans are missing at least a tooth.

Once a tooth is lost, most individuals believe that the entire tooth was removed, and in many cases, this is true. However, sometimes the soft tissue or bacteria associated with the tooth can create a barrier or a void in jaw bone healing. These voids in the jaw, called cavitations can cause issues with restoring the site in the future.

When removing teeth, it is common to just pull the tooth, place a gauze over the site, and leave the body to cope with the trauma. However, removal of the soft tissue surrounding the tooth is critical as well. The periodontal ligament (PDL) are strong bands of fibrous tissue that attach teeth to the surrounding jawbone.

Usually, these ligaments are removed to a large enough degree along with the tooth, but sometimes enough fragments are left behind to cause cavitations. These voids in the bone, can develop into persistent inflammation (1), infections (2), cysts (3), and even avascular bony spaces (1) (4) (5). Extractions are not the only cause of cavitations. Deep tooth infections or recurrent infections around root canal treated teeth can lead to issues with jaw healing.

How are Cavitations Treated?

In their early stages, cavitations are often difficult to diagnose, but as time passes they diverge from normal bony structure and are easily visible on 3 dimensional x-ray images. The method used to treat the cavitation depends on several factors, specifically its location close to critical anatomic structures like nerves. Each treatment plan will depend on the patient’s unique restorative requests.

Sometimes debridement and surgical remove of the pocket is best, and in other cases, repair to the infected bone with ozone in combination with a graft is best, especially if a dental implant is being considered.

Examples of Residual PDL Long After Tooth Extraction

Bone in the jaw is constantly remodeling, but improperly cleaned extraction sites have a higher potential to create barriers to proper healing. For example, below are the outlines of extracted roots taken years after the extraction of the tooth.

These outlines are areas of tooth related tissues that have prevented complete bony turnover and compromised the health of the jaw for any future restorative options in that site.

Known Risk Factors that Increase the Risk for Osteonecrosis

If you have any of the risk factors below, let your dentist know before scheduling a tooth extraction, as the following can increase your risk of improper jaw healing.

  • Undergoing Chemotherapy
  • Medications for Arthritis
  • Smoking or Tobacco Use
  • Use of Bisphosonates (Fosamax, Alendronate, etc)

We also Practice a Complete Dental Extraction Philosophy

This means that we take extra time to ensure the dental extraction cleaned properly. In order to minimize the risk improper bony healing from occurring, we practice the philosophy that disinfection and adequate blood flow must be restored to the area. We do so by the following technique:

  • The soft tissue, or periodontal ligament, lining the socket are be removed through thorough debridement with hand instruments or handpieces. If the periodontal ligament remains, it can sometimes block the infill of bone into the extraction site.
  • The dense, cortical, bone lining the extraction site must be removed to allow for adequate blood flow to the area. We use handpieces or laser debridement to disrupt cortical barriers and ensure proper clot formation
  • Bacteria in the socket must be removed to prevent cyst formation and promote a proper environment for healing. We utilize sterile saline, platelet rich fibrin, and gaseous ozone to cleanse the extraction sites of harmful bacteria.

Further Information

At Dakota Dental and Wellness Center, we are passionate about your overall oral health, and offer complimentary consultations to discuss and evaluate your unique condition. We will consult you on the risks, benefits and alternatives of aiding the proper turnover of your jaw bone. We may then clean the site to ensure healthy blood flow and bony turnover is had.

If you have had a tooth extracted or a root canal, it is important to have regular evaluations of the surrounding bone and tissue to help spot bony pathology at its earliest stages. Having routine dental cleanings and x-rays will be helpful in making sure you get ideal care as quickly as possible.

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  1. Lechner J, Schuett S, von Baehr V. Asecptic-avascular Osteonecrosis: Local “Silent Inflammation” in the Jawbone and RANTES/CCL5 Overexpression. Clin Cosmet Investig Dent. [Online] Nov 9, 2017. [Cited: January 13, 2019.] https://www.ncbi.nlm.nih.gov/pubmed/29184447.
  2. Nelson S, Thomas G. Bacterial Persistence in Dentoalveolar Bone Following Extraction: A Microbiological Study and implications for Dental Implant Treatment. Clin Implant Dent Relat Res. [Online] 12(4);306-14, Dec 12, 2010. [Cited: January 13, 2019.] https://www.ncbi.nlm.nih.gov/pubmed/19438939.
  3. Anshuman J, Gopakumar N, Madhur K, Neeta S, and Arya K. Localization of a Peripheral Residual Cyst: Diagnostic Role of CT Scan. Case Reports in Dentistry. [Online] 2012. [Cited: January 13, 2019.] https://www.ncbi.nlm.nih.gov/pubmed/22567458.
  4. implants, Neuralgia-inducing cavitational osteonecrosis in a patient seeking dental. Natl J Maxillofacial Surg. 3(1):84-86. [Online] January 2012. [Cited: January 13, 2019.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513818/.
  5. Maxillofacial Osteonecrosis in a Patient with Multiple “Idiopathic” Facial Pains. J Oral Pathol Med. [Online] 28(9):423-32, Oct 1999. [Cited: January 13, 2019.] https://www.ncbi.nlm.nih.gov/pubmed/10535367.