Answer: (b)
Four stages of wound healing: inflammation, epithelialization, fibroplasia, and remodeling.
Immediately the socket fills with blood, which coagulates and seals bone from air.
Inflammatory - week 1: WBCs remove bacteria and break down debris
Fibroplasia occurs along with Epithelialization – week 1 to 3:
Fibroplasia consists of the ingrowth of fibroblasts and capillaries. Osteoclasts accumulate along the lamina dura. Granulation tissue develops and an osteoid material is laid down starting at the socket wall.
Epithelialization consists of the migration of gingival/mucosa from the boarders of the wound into the socket and over the granulation tissue. The duration is dependent on how large the secondary healing site is, but usually complete be week 3 or 4
Remodeling starts from week 5 to 6 months. Osteoclasts resorb the cortical bone lining the socket, and together with osteoblasts reorganize the haphazard pattern laid down earlier into regular bone with the reestablishment Haversian canal systems. As bone fills the socket, the epithelial covering is raised to a level that roughly equates to the surrounding tissues.
Callous formation only occurs when medulary bone is forced to heal by secondary intention as in a fractured long bone where the ends are not approximated. Fibroblasts and osteoblasts quickly produce so much fibrous matrix, the healing tissue extends circumferentially beyond the free ends of bone.
Peterson, Ellis, Hupp, Tucker, Contemporary Oral and Maxillofacial Surgery. Mosby 1998, pages 163-166
Myron Nevins, James Mellonig, Periodontal Therapy: Clinical Approaches and Evidence of Success. Quintessence Books. Page 242
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