Clinical management of complicated tooth extractions and alveolar bone preservation

Management of complicated tooth extractions has become increasingly relevant, as clinicians are expected to minimise surgical complications while preserving the alveolar ridge for predictable implant rehabilitation across a broader range of anatomically and biologically compromised sites. This research aimed to systematise current evidence on risk-adapted extraction strategies and alveolar ridge preservation methods, with emphasis on their translation into implant-oriented clinical outcomes. A comparative analytical literature review was conducted using recent peer-reviewed studies on radiographic planning, coronectomy, socket sealing, ridge preservation, early-healing adjuncts, and perioperative antimicrobial prophylaxis. The synthesis shows that cone-beam computed tomography improves treatment selection for mandibular third molars suspected of proximity to the inferior alveolar nerve, especially when panoramic radiography suggests overlap or contact. It supports the use of coronectomy in selected high-risk cases to reduce neurosensory complications. Evidence on alveolar ridge preservation indicates reduced post-extraction dimensional collapse, with the clearest clinical gains in ridge width and in posterior maxillary sites where preservation lowers the future need for sinus floor augmentation. Socket sealing with n-butyl-2-cyanoacrylate provides outcomes comparable to collagen membrane sealing in selected clinical situations while simplifying handling. Platelet-rich fibrin improves early recovery indicators, particularly pain and mucosal healing, whereas effects on hard-tissue dimensional outcomes remain inconsistent across protocols. Antibiotic prophylaxis provides limited absolute benefit and supports a selective, risk-based prescribing approach consistent with antimicrobial stewardship. The practical value of this review lies in presenting an integrated clinical pathway that links radiographic risk stratification, selection of extraction technique, ridge preservation, and adjunctive measures to implant-stage feasibility and patient recovery