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Oral Surgery & ImplantsIntermediate

Healing after an extraction

After an extraction, the socket fills with blood clot → granulation tissue → immature bone → mature bone.
Dry socket after an extraction: the arrow points to the socket that lost its blood clot. Normally the clot fills it and protects it while it heals.
Dry socket after an extraction: the arrow points to the socket that lost its blood clot. Normally the clot fills it and protects it while it heals.Photo: James Heilman, MD · CC BY-SA 3.0, Wikimedia Commons

What you need to know

  • The blood clot is key. If it breaks down, dry socket develops.
  • Dry socket: pain from exposed bone that starts on the 2nd or 3rd day and can spread to the ear. It's more common when removing lower molars, especially third molars.
  • Things that raise the risk: smoking, oral contraceptives, age and a weakened immune system.
  • The facial bone wall, which is thinner, is lost more than the lingual one. The greatest bone loss happens in the first 3 months.

Timeline (in humans, approximate)

WhenWhat's in the socket
Day 0Blood clot
First weekThe clot is almost entirely replaced by granulation tissue
Following weeksProvisional matrix (connective tissue with blood vessels)
6–8 weeks≈60% provisional matrix and ≈35% immature (woven) bone
12–24 weeksMature (lamellar) bone and marrow; at 16 weeks, ≈60–65%
9–12 monthsThe cortical bone (the hard outer layer of the bone) finishes forming

Terms in plain words

SocketThe hole in the bone where the root used to be.
Granulation tissueNew tissue with lots of blood vessels that replaces the clot.
Woven boneImmature bone that is later replaced by lamellar bone.
Dry socketIntense pain when the clot is lost and the bone is left exposed.

For the exam

What complication appears if the clot is lost?

Show answerHide answer

Dry socket: intense pain from exposed bone, starting on the 2nd or 3rd day.

Sources

  1. Gomes PS, et al. Molecular and Cellular Aspects of Socket Healing in the Absence and Presence of Graft Materials and Autologous Platelet Concentrates: a Focused Review. J Oral Maxillofac Res. 2019. View source
  2. Safar J. Postextraction Problems. MSD Manual, Professional Version (2026 revision). View source
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