Wisdom Tooth Extraction is usually a surgical procedure as most Wisdom teeth are Impacted in one form or the other – Classification of Wisdom Tooth Impaction. And with a surgical procedure there is need to remove bone and Incise Soft tissue which means it increases the time to heal as compared to normal tooth extraction. Healing of a socket includes multiple phases before the hole or socket tends to full in. Healing of a socket changes with the type of Extraction of Third Molar – Surgical Removal requires more time to heal while normal extraction requires less time to heal.
Closure of Extraction socket or hole is divided into four stages based on duration:
- First 24 to 48 hours after Extraction
- First 1-2 weeks
- Weeks 2-4
- 2-4 months (Complete hole closure)
So in general it takes a total of 1-2 months for the soft tissue healing to close the socket while the bone formation and maturation of the bone can take anywhere between 2-4 months.
Factors altering Healing time after Wisdom Teeth removal:
Size of the Wound: Healing process directly depends on the size of the wound. Healing process and time is much shorter in normal extraction while time taken is much higher is Surgical extractions involving bone cutting (Horizontal, Vertical, Distoangular Impactions) as the surgical sites are larger, wider and deeper which need more time to heal.
Tissues damaged while Extraction: If there is bone cutting to expose the Impacted Third molar it increases the time of healing directly.
External Factors: There are factors such as underlying health conditions which can affect heling – Uncontrolled diabetes, Smoking (personal habits), gum diseases, poor oral hygiene maintenance.
Post Extraction maintenance of Wound: It is important that proper post extraction tips are followed, if the instructions are not maintained it can lead to delay in healing along with formation of secondary infections. In some cases it can cause Dry Socket. If the socket is not cleaned properly or the patient smokes after the extraction it can lead to delay in healing or formation of dry socket.
First 24 to 48 hours after Extraction:
The first 24 to 48 hours after extraction is the most important as it the time when the Blood clot forms in the socket to stop bleeding which initiates the healing process. If the blood clot is dislodged during this period it can delay the initiation of the healing process.
The socket is filled with a combination of Platelets + Fibrin gel + RBC + WBC + Plasma which give it the consistency to fill in the socket. To prevent the dislodgement of this clot post extraction instructions are given. In case the clot is dislodged it leads to Dry Socket. Clot preservation and hygiene maintenance for the first two days is critical in the healing process. As the sockets tend to start closing after 48 hours.
First 1 – 2 weeks:
The 7-14 days after tooth extraction we usually see healing of Soft tissue or the Gums. Major portion of soft tissue healing is done in 7-14 days. As the blood supply to Oral tissues is higher in comparison to the skin healing is faster in the oral tissue. During this period, granulation tissue starts filling in the socket space and starts to develop blood vessels as it is rich in collagen. The initiation of the formation of bone tissue starts now with the stem cells or mesenchymal cells begin to form a network within the granulation tissue.
Removal of stitches is done after 7 days as the majority of soft tissue on the surface is done by that time. After the first week the soft tissue starts to look normal with either no opening or a small opening on the soft tissue surface. Soft tissue after extraction of single rooted teeth usually close by this time while multi rooted teeth tend to take more time.
It is important to note that you should be careful not to chew on sharp or hard substances from this region as little trauma can lead to bleeding due to the high vasculature in the tissue.
Weeks 2 – 4:
This is the phase when most of the soft tissue healing has been completed and the bone formation and maturation is under process. In appearance the socket is mostly closed with just a small indentation seen on the surface.
The granulation tissue is now being replaced slowly with the mesenchymal cells, the mesenchymal cells transform into bone cells slowly overtime. The bone formation starts at the buccal and lingual sides and the floor of the socket and progresses to the top of the socket. The socket closes from the side and slowly grows to the top.
2-4 Months after Wisdom tooth removal:
This is the stage when the Bone formation starts to fill in the socket completely, for the complete formation of bone and maturation of the bone it takes a total of 6 to 8 months for the bone to resemble adjacent bone. Bone formation begins at around 1 week after tooth removal and is completed around 4 months.
The bone starts to mature in the socket slowly and is fully matured to reach the density of the adjacent bone in about 4 months time.
So for the complete healing process to complete of Soft tissue and Bone it take a total of 4 months.