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J Periodontal Implant Sci. 2017 Jun;47(3):143-153. doi: 10.5051/jpis.2017.47.3.143. Epub 2017 Jun 28.

Periodontal and endodontic pathology delays extraction socket healing in a canine model.

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Department of Periodontology and Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea.
US Army Advanced Education Program in Periodontics, Ft. Gordon, GA, USA.
Department of Periodontology, Dankook University College of Dentistry, Cheonan, Korea.
Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Augusta University Dental College of Georgia, Augusta, GA, USA.



The aim of the present exploratory study was to evaluate extraction socket healing at sites with a history of periodontal and endodontic pathology.


The mandibular 4th premolar teeth in 5 adult beagle dogs served as experimental units. Periodontal and endodontic lesions were induced in 1 premolar site in each animal using wire ligatures and pulpal exposure over 3 months (diseased sites). The contralateral premolar sites served as healthy controls. The mandibular 4th premolar teeth were then extracted with minimal trauma, followed by careful wound debridement. The animals were sacrificed at days 1, 7, 30, 60, and 90 post-extraction for analysis, and the healing patterns at the healthy and diseased extraction sites were compared using radiography, scanning electron microscopy, histology, and histometry.


During the first 7 days of healing, a significant presence of inflammatory granulation tissue was noted at the diseased sites (day 1), along with a slightly accelerated rate of fibrin clot resolution on day 7. On day 30, the diseased extraction sites showed a greater percentage of persistent fibrous connective tissue, and an absence of bone marrow formation. In contrast, healthy sites showed initial signs of bone marrow formation on day 30, and subsequently a significantly greater proportion of mature bone marrow formation on both days 60 and 90. Radiographs exhibited sclerotic changes adjoining apical endodontic lesions, with scanning electron microscopy showing collapsed Volkmann canals protruding from these regions in the diseased sites. Furthermore, periodontal ligament fibers exhibited a parallel orientation to the alveolar walls of the diseased sites, in contrast to a perpendicular arrangement in the healthy sites.


Within the limitations of this study, it appears that a history of periodontal and endodontic pathology may critically affect bone formation and maturation, leading to delayed and compromised extraction socket healing.


Biological models; Bone marrow; Histology; Wound healing

Conflict of interest statement

Conflict of Interest: The authors declare no conflict of interest related to this study. The opinions expressed in this article do not represent the views of the US Department of Defense, the Department of the Army, or the US Army Dental Corps. Use of any commercial products in this project does not imply endorsement by the US Government.

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