Alveolar socket healing: what can we learn? M AURICIO G. A RA  UJO ,C L  EVERSON O. S ILVA ,M ^ ONICA M ISAWA &F LAVIA S UKEKAVA In current dentistry, the healing process of the socket following tooth extraction has become an important topic of research, study and discussion. The reason for this relies mainly on the fact that after tooth extraction several changes can occur in the alveolar process, which may prevent or render difficult implant installation in a prosthetically dri- ven position (23). In addition, the increasing demand for esthetics in dentistry highlights the importance of maintaining adequate ridge volume in order to achieve a long-term esthetically accept- able implant-support prosthesis (42). Thus, it is increasingly expected that the results of the healing process should promote the formation of an alveo- lar ridge with a sufficient volume of hard and soft tissues to allow an ideal implant-supported restor- ative outcome. Tooth extraction was once described as a tissue amputation that may lead to functional, psychologi- cal, postural and local changes (14). Indeed, tooth extraction is initially perceived purely as tooth loss, but local changes arise and promote hard- and soft-tissue alterations. The process of local changes that take place in order to close the wound and restore tissue homeostasis is called “socket healing”. Thus, the aims of the present review were two-fold: first, to describe the socket-healing process; and, sec- ond, to discuss what is to be learned from that healing process that may improve the treatment outcome. The alveolar process In order to understand the socket-healing process and its clinical implications, it is pivotal to know the characteristics of the tissues that comprise the alveo- lar process. Thus, a brief anatomic and histologic description of such tissues is provided below (for detailed review, see 7, 65). Anatomic considerations The alveolar process may be defined as the bone tis- sue that surrounds a fully erupted tooth and it is formed in harmony with the development and erup- tion of the teeth (Fig. 1). It is limited coronally by the bone margins of the socket walls, whilst an imaginary line that cuts the bottom of the socket in a perpendic- ular direction to the long axis of the root, limits it api- cally. Beyond such a line, the basal bone of the mandible or the maxilla can be found. The morphologic characteristics of the alveolar process are related to: (i) the size and shape of the tooth; (ii) the site of tooth eruption; and (iii) the incli- nation of the erupted tooth. In general, teeth tend to erupt and incline to a position outside the center of the basal bone (62). In a recent clinical study, Janua- rio et al. (46) described some of the morphological Fig. 1. Cone-beam tomographic image representing the alveolar process at the maxillary lateral incisor region. The alveolar process is the bone that surrounds the root. 122 Periodontology 2000, Vol. 68, 2015, 122–134 © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Printed in Singapore. All rights reserved PERIODONTOLOGY 2000