Minimally invasive tooth extraction: the science and clinical strategies of socket preservation: a comprehensive review.

Introduction: Tooth extraction inevitably initiates alveolar socket remodeling and resorption, particularly of the buccal bone, which may compromise future implant placement and esthetic outcomes. Methods: This narrative review synthesized current evidence on post-extraction socket healing, alveolar ridge preservation, and minimally invasive tooth extraction techniques aimed at reducing surgical trauma and maintaining hard and soft tissue integrity. Results: The literature demonstrates that significant dimensional changes occur following tooth extraction, with the greatest bone loss occurring in the buccal aspect during the early healing phase. Minimally invasive approaches, including periotomes, piezotomes, magnetic mallets, sonic instruments, physics forceps, vertical extraction systems, vestibular root extraction, enzymatically assisted extraction, socket-shield techniques, and root sectioning methods, have shown varying degrees of effectiveness in preserving alveolar bone, reducing postoperative pain and complications, and facilitating immediate implant placement. Adjunctive socket preservation strategies, such as alveolar ridge preservation and soft tissue grafting, further enhance maintenance of ridge dimensions and esthetic outcomes. Conclusion: Atraumatic extraction is a critical component of socket preservation and successful implant therapy. While several minimally invasive techniques have demonstrated promising clinical benefits in reducing tissue trauma and preserving alveolar architecture, the quality and quantity of evidence vary among techniques. Further well-designed clinical studies are required to establish standardized protocols and strengthen evidence-based clinical decision-making for minimally invasive extraction and socket preservation.