When a tooth can’t be saved, the conversation often focuses on removing it. But removal is also the start of healing. How the area is checked and cared for can affect the surrounding tissues and future treatment options.

The way dentists and oral surgeons care for the area after an extraction continues to evolve. In some cases, care may include checking the socket carefully, removing leftover tissue that may interfere with healing, supporting healthy blood flow or placing bone-graft material to help support the site. These steps depend on the patient and what the clinician finds.

If an extraction site does not heal as expected, it may need further evaluation, especially if symptoms continue or a dental implant is being considered. In my practice, lab reports from tissue samples taken from selected areas have included findings described as Lyme-associated, parasitic or bacterial. Those findings need to be considered alongside a patient’s symptoms, examination and other test results. A lab finding alone does not prove there is an active infection or explain what is causing someone’s symptoms.

Understanding Cavitations

Some patients may know the term “cavitations” for areas of concern in the jawbone. The term has been used in different ways. In the Ghanaati Education framework, Covered Socket Residuum (CSR) is a more specific, updated term for an imaging pattern that may appear at a former extraction site. It describes an area where the bone appears not to have fully formed beneath a thin layer of bone near the gumline. The term gives clinicians a way to describe and evaluate what they see on imaging.

CSR is a description of an imaging finding. By itself, it is not a diagnosis of disease or infection, and it does not automatically mean surgery is needed. Its significance—and whether it may be related to symptoms or overall health—is still being studied. Some patients I have treated have reported improvements in their symptoms and well-being. Those experiences matter, but they do not prove what caused the improvement.

I look forward to participating in a planned study with colleagues who have also completed advanced Ghanaati Education training. Beginning in early 2027, the study is expected to include a broad set of blood tests before and after treatment for selected CSR cases. The goal is to learn more about healing and patient outcomes. 

The training also covers the ARENA Protocol® and an earlier approach called Guided Open Wound Healing (GOWHR®). These are frameworks for selected regenerative procedures. Depending on the patient and the site, care may include three-dimensional imaging, preparing the bone, bone-graft material or platelet-rich fibrin (PRF)—a healing material made from a patient’s own blood. The approach also encourages clinicians to consider factors such as nutrition, hydration and overall health when planning care.

Supporting Healing Before, During and After Extraction

For me, good surgical care starts before a tooth is removed. I review the patient’s health history, examine the area and use imaging when appropriate. Professor Shahram Ghanaati puts the principle this way: “Tooth surgery is as important as heart surgery.” I perform surgical extractions in a sterile operatory—a treatment room prepared for surgery—using sterile instruments and technique. I hold tooth-removal surgery to the same serious standard of sterility we expect in procedures such as orthopedic surgery. I would not perform surgical tooth removal in a nonsterile environment.

During surgery, my goal is to remove the tooth carefully while protecting healthy tissue around it. I then assess the socket and decide whether any additional care is appropriate for that patient.

We believe emotional comfort matters in healing, too. After surgery, patients who would like a little extra comfort are welcome to spend time with Manchego, our loving office emotional-support dog.

Patients can ask: Why does this tooth need to be removed? What should I expect as the bone and gum heal? Are there options to preserve the site? What follow-up will I need? These questions can help make a difficult decision feel more informed.

Tooth removal is one step in a larger plan—one that should consider healing, function and the individual sitting in the chair.

Dr. Holly Thompson, DDS, is a biologic dentist and surgical provider at Natural Smiles Dental Care in Shoreview, Minnesota

She has completed advanced education and assessment through Ghanaati Education, with a focus on jawbone biology, healing after extractions and regenerative oral surgery. Thompson is among approximately 150 dentists and oral surgeons worldwide with this specialized training. She is also one of 10 Swiss Dental Solutions (SDS) ambassadors in the United States and among the 10 clinicians nationwide who have placed the most SDS nonmetal zirconia implants.