Socket Shield Research Articles

Comparison of soft tissue volumetric changes and pink aesthetics in immediate implant placement by socket shield and conventional technique: A randomized controlled trial.

The purpose of this study was to compare soft tissue volumetric changes on buccal aspect and pink aesthetics score in immediate implant placement by socket shield and conventional technique. This parallel-arm, randomized controlled trial included 22 participants requiring replacement of single maxillary incisor by immediate implant placement. Immediate implants were placed with socket shield technique (SST) and conventional technique (CT) in respective two groups after randomization. All implants were immediately loaded by immediate loading protocol. Definitive crowns were placed 6 months after implant placement. Scans of casts were recorded by using a digital white light scanner before implant placement and at the end of 12 months. Volumetric soft tissue changes on the buccal aspect was assessed by the superimposition of scanned cast. Esthetic evaluation of soft tissue was done by using pink esthetic score (PES) before implant placement, 6 months, and 12 months after implant placement. Statistical analysis of the data was performed using statistical software (Stata 16.0; Stata Corp LLC). The mean soft tissue volumetric change on the buccal aspect at the end of 12 months in the SST group was -0.1520 ±0.86 mm, and in the CT group was -0.643 ±0.35 mm and the difference was statistically significant (P=.001). Higher PES was observed in the SST group when compared to the CT group at all time intervals. The difference was statistically significant at 6 months (P=.001) and 12 months (P=.007). The results of the study show less volumetric change on the buccal aspect and higher PES in SST when compared to CT. Int J Prosthodont 2023. doi: 10.11607/ijp.8063.

The modified socket shield technique with immediate implant placement-A case report with procedural tips

The tooth root always aids in preserving the surrounding hard and soft tissues, favouring their functionality and aesthetics. Resorption of the alveolar bone following tooth extraction leads to deficits in both the hard and soft tissues. In order to prevent resorption after extraction, immediate implant placement, the use of graft materials, and the use of barrier membranes have all been reported in the literature. Despite different degrees of cortical bone preservation, none of these procedures completely avoided mid-facial recession after immediate implant placement. The socket shield technique can be used to prevent this. Here, in this clinical case report we present “the modified socket shield technique” in achieving successful aesthetic and functional outcome with procedural tips.

HTA177 The Safety and Effectiveness of Root Membrane Technique (Socket Shield Technique)

HTA177 The Safety and Effectiveness of Root Membrane Technique (Socket Shield Technique)

Immediate Implant Placement Using the Socket Shield Technique: Clinical, Radiographic, and Volumetric Results Using 3D Digital Techniques-A Case Series.

Extraction-site alveolar remodeling is a major concern due to negative volumetric hard and soft tissue changes that inevitably limit rehabilitation options and diminish esthetic outcomes. Surgical techniques employed to minimize alveolar dimensional changes are not always predictable. Utilizing a socket shield with an immediate surgical implant procedure helps maintain a thin portion of the root in the vestibular area and thus minimizes bone resorption, especially at the coronal cortical aspect. This case series assesses the dimensional changes in peri-alveolar structures via superimposition of the preoperative and 6-month postoperative 3D digital quantification of soft tissue. Fifty patients with 50 sites fulfilled the inclusion criteria. Implant survival was 100%, with no incidence of complications. Tissue changes were as follows: -0.85 mm at the mesial papilla, -0.95 mm at the distal papilla, -0.7 mm at both the vertical and horizontal central margins, -0.21 mm at a distance 4 mm from the margin, and -0.64 mm at the palatal central margin. The buccal contour was clinically convex in all cases. The site with highest frequency of > 1 mm of dimensional loss was the distal papilla (42% of sites), and the site with the lowest frequency was the point 4 mm from the midfacial margin (0% of sites).

Immediate Tooth Replacement in the Esthetic Zone with the Socket Shield Technique and a Novel Body-Shift Implant: A Pilot Study with Up to 3 Years of Follow-up.

Successful rehabilitation of the anterior maxilla remains a challenge, primarily due to postextraction ridge collapse, which can lead to gingival recession and a nonesthetic appearance. The socket shield technique presents a viable alternative for immediate dental implant placement in the esthetic zone. This pilot study aimed to evaluate the survival, complication rates, and marginal bone loss around body-shift implants placed in fresh extraction sockets with the socket shield technique to replace maxillary incisors. After socket shield preparation, 14 hopeless incisors were extracted and immediately replaced by a body-shift implant (Inverta, Southern Implants) at baseline. Patients were followed up for 12 to 39 months (mean: 18.1 ± 8.2 months). The average age was 52.3 ± 16.9 years, and the survival rate was 100%. One socket shield presented minimal internal exposure that was successfully treated with a connective tissue graft. The mean PES score was 12.9 ± 1.2. Mean interproximal marginal bone loss was -0.4 ± 0.5 mm. Body-shift implants can be a promising alternative for immediate tooth replacement combined with the socket shield technique. The superior esthetic outcomes remained stable, suggesting that the extra space created by the narrow cervical portion of the implant is beneficial for preserving the alveolar bone and limiting internal shield exposure.

Standardization of vertical root resection during socket shield technique in immediate implant placement

Objectives. The aim of the present study was to standardize an accurate and significant technique of root separation during socket shield technique. Patients and methods. Two phases of the study were conducted. In vitro study was performed on 20 extracted single-rooted anterior teeth. The second phase was clinical application of the new technique on 10 patients seeking to restore their badly decayed anterior teeth in the esthetic area with immediate implant placement utilizing the socket shield technique. Decoronation was done. The root canal was mechanically enlarged by means of manual assorted files. Canals were further enlarged with Gates Glidden drills. Peeso Reamer drills were used till the root was entirely separated into two parts (buccal & palatal). The palatal root was cautiously removed when the labial and palatal root halves were sufficiently separated. In case the root to be removed was endodontically treated, Gutta-percha was mechanically removed using Gates Glidden, & Gutta-percha solvent to remove the coronal and apical parts. Outcomes. Using manual endodontic K-files, Gates Glidden burs, and Peeso Reamer’s drills in separating the single-rooted teeth into two halves is a reproducible, and reliable procedure during socket shield technique. Conclusions. This technique prevents possible complications of root sectioning during socket shield technique with immediate implant placement. It preserves surrounding soft tissue structures, and labial shield during shield preparations, maintains the integrity of the labial plate of bone during extraction. Additionally, it offers total root apex removal by entirely separating the palatal portion from the labial shield.

Self-designed surgical guides for accurate socket shield preparation: An in vitro evaluation supported by a clinical report.

To achieve accurate socket shield preparation with newly proposed guides that are based on guiding rails and to investigate the effect of rail format (unilateral or bilateral) and rail height on the accuracy and efficiency of the guides. Two surgical guides based on grooved rails to guide the rotary instruments were produced. The first guide was used to cut the root into a labial shield with a pre-designed form and a lingual one, while the second guide was used to reduce the socket shield to the alveolar bone crest. The CBCT and intraoral scan data were first obtained and superimposed using the software. After isolating the root which would be used as a socket shield, grooved rails were designed on two separate guide templates according to the chosen rotary instruments to obtain a labial shield with a pre-designed form. An in vitro study was then conducted based on four cases in each group to determine the accuracy, efficiency, and optimal parameters of the guides, which was then verified with a clinical report. Comparisons between groups were performed with a one-way analysis of variance (ANOVA, for comparison between multiple groups) and the Student-Newman-Keuls test (for comparison between two groups). With these two guides, the root can be divided into two pieces, including a palatal one and a labial one with a pre-designed form within a short time. Guide templates with bilateral rails more than 7mm in height and those with unilateral rails 9mm in height significantly increased the surgery accuracy, showing accurate shield preparation and decreased bone injury. Moreover, the guides with bilateral rails of more than 5mm significantly decreased the surgery time for shield preparation. The presented case further verified the accuracy and efficiency of the guides. The newly proposed guides can help to accurately prepare the socket shield, resulting in long-term stability of peri-implant tissues. Moreover, bilateral guiding rails with a height of 7-9mm are recommended in such a guided socket shield surgery.

Novel immediate implantation approach using socket shield with dentin graft.

Novel immediate implantation approach using socket shield with dentin graft.

Partial Extraction Therapy (Part 2): Complication Management in Full-Arch Dental Implant Therapy.

Partial extraction therapy (PET) is a group of surgical techniques that preserves the periodontium and peri-implant tissues during restorative and implant therapy by conserving a portion of the patient's own root structure to maintain blood supply derived from the periodontal ligament complex. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield (PtST), and root submergence technique (RST). Although their clinical success and benefits have been demonstrated, several studies report possible complications. The focus of this article is to highlight management strategies for the most common complications associated with PET including internal root fragment exposure, external root fragment exposures, and root fragment mobility.

SOCKET SHIELD TECHNIQUE FOR PRESERVING ALVEOLAR SOFT TISSUES DURING IMMEDIATE IMPLANT PLACEMENT

This article provides information on the use and importance of the socket shield technique in preserving alveolar soft tissues during implant placement. It discusses a new technique that allows aesthetic preservation of the original state of alveolar soft tissues during the installation of a dental implant.

Efficacy of Socket Shield Technique for Immediate Implant Placement in Maxillary Anterior Region – A Case Series with Review.


 
 The socket-shield technique is the most crucial treatment modality for esthetic enhancement and ridge preservation technique but it has been less discussed and documented. This case series describes the placement of implants immediately following extraction of a non-restorable which are all fractured and hopeless maxillary teeth and using this technique and functional and esthetic outcomes of the treatment was a successful event.
 In this review, immediate implant were placed using socket shield protocol to treat ten patients with non-restorable teeth. Dissection was performed along the long axis of the roots in a mesiodistal direction; and atraumatically the buccal fragment of the root was left attached to the bone while the palatal fragment was extracted. Implants were placed after sequential osteotomy drilling. A customized healing abutment was fabricated chairside to create an emergence profile. During the prosthetic phase, patients had follow-up visits after 4 weeks and after 6 months. The definitive prosthesis was cemented using a cement-retained porcelain fused to metal.
 

Inter-implant Papilla Changes Following Anterior Immediate Tooth Replacement with Socket Shields: A 1- to 10-Year Retrospective Study.

This retrospective study investigates the efficacy of the socket shield (SS) in preserving inter-implant papilla and bone in anterior adjacent implant sites. Clinical and radiographic records of 23 patients were evaluated. A total of 31 implants were placed immediately into extraction sockets with SS, resulting in 26 inter-implant sites, and 7 implants were placed without SS. After a mean follow-up of 41.5 months (range: 12 to 124 months), 30/31 (96.8%) implants with SS and 7/7 (100%) implants without SS were clinically successful. The mean changes in inter-implant papilla and bone heights were -0.40 mm and -0.46 mm, respectively. The effects of implant placement timing and the socket shield number, shape, and crestal level on inter-implant tissue height changes were found to be insignificant (P > .05). Supracrestal shield level (31.6% vs 16.6% in equicrestal), U-shape shield (41.2% vs 7.1% in C-shape), and shield-to-implant contact (40.0% vs 12.5% in no contact) were associated with increased occurrence of exposures. The application of SS in adjacent anterior implant situations is a viable treatment option for maintaining inter-implant papilla.

Socket shield technique: Stress distribution analysis.

To analyze through finite element analysis the stress distribution in peri-implant bone tissues, implants, and prosthetic components induced by the socket shield (SS) technique in comparison to other techniques used to treat tooth loss. A three-dimensional model of a superior central incisor crown supported by implant was modeled and three different placement conditions were simulated: SS - 2.0-mm-thick root dentin fragment positioned between the alveolar buccal wall and implant; heterologous bone graft (HBG) - bovine bone graft positioned the alveolar buccal wall and implant; and control (C) - implant fully placed in bone tissue of a healed alveolus. The model was restricted at the lateral surfaces of the bone tissue and the following loads were simulated: Both oblique (45°) loads of 100 N on the lingual surface of the crown (maximal habitual intercuspation) and 25.5 N on the incisal edge of the crown (tooth contact during mandibular protrusion) were simultaneously applied. Tensile stress, shear stress, compression, and displacement were analyzed in the cortical bone, trabecular bone, dentin root fragment, and bone graft; while equivalent von Mises stresses were quantified in the implant and prosthetic components. Stress values of SS and HBG in the bone tissues were higher than C, while slight differences within models were observed for dentin root fragment, bone graft, implant, and prosthetic components. The SS technique presented the highest stress concentration in the peri-implant tissues.

Partial Extraction Therapy (Part 1): Applications in Full-Arch Dental Implant Therapy.

Partial extraction therapy (PET) is a set of surgical techniques that preserve a portion of the patient's own root structure to maintain blood supply derived from the periodontal ligament complex in order to maintain the periodontium and peri-implant tissues during restorative and implant therapy. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield technique (PtST), and root submergence technique (RST). In a traditional hybrid technique, total extraction and full-arch dental implant therapy often require significant bone reduction and palatal/lingual implant placement. In addition, postextraction preservation of the ridge architecture is a major challenge. This case series demonstrates the use of a combination of PET techniques with digital implant planning and guided implant surgery to achieve highly esthetic outcomes in full-arch implant therapy.

Minimally invasive management of a socket shield technique complication: A clinical report

The socket shield technique has been used to optimize the esthetic outcome of anterior immediate implant treatment. However, complications have been reported, including internal or external shield exposure, implant failure, and infection. The key to the surgical management of shield exposure is to avoid a full-thickness flap because of the risk of losing soft tissue volume. For this patient, a flapless approach was used to extract the exposed root shield, followed by a simultaneous connective tissue graft. A satisfactory esthetic outcome was observed at the 20-month follow-up after the surgical intervention.

Socket Shield Technique to Improve the Outcomes of Immediate Implant: A Systematic Review and Meta-Analysis

Background: The socket shield technique (SST) could address the challenges in immediate implant placement by minimizing post-extraction bone resorption while maintaining soft tissue levels. This study aimed to summarize the available evidence and systematically assess the effectiveness of SST immediate implant placement regarding all outcomes (bone loss, esthetics, implant stability, probing depth, complications, and survival rate). Methods: We searched seven electronic databases through April 2023 to identify randomized clinical trials that assessed the effect of immediate implant placed with SST (test group) versus other implant placement protocols without SST. The risk of bias was assessed using Cochrane’s randomized trial quality assessment Tool (RoB 2.0). Random-effects meta-analysis was conducted, with mean difference and 95% confidence intervals (MD, 95% CI) as effect estimates. We used the GRADE approach to assess the certainty of evidence. Results: Twelve RCTs, involving 414 immediate implants, placed in 398 patients, were included. Meta-analyses revealed that the immediate implants placed with SST had a statistically significant decrease in horizontal (MD = −0.28, 95% CI [−0.37, −0.19], p < 0.0001), vertical (MD = −0.85, 95% CI [−1.12, −0.58], p < 0.0001), and crestal (MD = −0.35, 95% CI [−0.56, −0.13], p = 0.002) bone loss, as well as probing depth (MD = −0.64, 95% CI [−0.99, −0.29], p = 0.0003). Additionally, SST had a significant increase in implant stability (MD = 3.46, 95 % CI [1.22, 5.69], p = 0.002) and pink esthetic score (MD = 1.60, 95% CI [0.90, 2.30], p < 0.0001). Only two studies reported shield exposure incidences in the SST group; however, all studies revealed no implant failure and a 100% survival rate. The evidence certainty was assessed as very low. Conclusions: Based on limited evidence, SST was more effective in minimizing bone resorption and improving implant stability and esthetic outcomes than conventional immediate implant placement. Still, SST could not be recommended as a routine clinical protocol due to the lack of a standardized surgical approach; thus, further high-quality RCTs are required to support this conclusion.

Socket Shield Technique and Immediate Implant Placement – A Systematic Review

<p>Purpose: A novel method, socket shield technique (SST), preserving the peri-implant tissue dimensions by retaining the buccal aspect of root was published by Hurzeler et al in 2010. Our study aims to compare the clinical and radiographic outcomes between conventional immediate implantation and socket shield technique (SST) based on prospective clinical trials. Also, we will discuss the different protocols and modifications of the socket shield technique. Material and methods: A PubMed, Cochrane Library, Embase database search was conducted to identify relevant publication up to March 2022. Result: 7 articles were included in our systemic review. The follow-up periods of the included literature ranged from 6 months to 4 years and contained 106 cases of socket shield technique (Test group) and 112 cases of conventional immediate implantation technique (Control group). None of the implants failed to have osseointegration. The horizontal bone loss at the crestal area in test group and control group ranged from 0.12~0.29mm and 0.29~1.45mm half a year post-operatively on CBCT, respectively. On the other hand, the vertical bone loss in test group and control group ranged from 0.28~0.36mm and 0.77~1.71mm half a year after operation on CBCT. All the results showed the socket shield techniques had less tissue alterations compared to the conventional immediate implantation with statistical significance. The overall Pink Esthetic Score (PES) of the test group (Socket shield technique) in the included studies ranged from 12.0 to 13.25 postoperatively, comparing to those ranging from 8.85 to 12.60 for the control group. Conclusion: All the included clinical trials showed promising results of socket shield technique in respect of less bone and soft tissue volume changes than the conventional immediate implantation. However, it is still unclear whether the socket shield technique will provide a stable long-term outcome in this stage.</p> <p> </p>

Management of Root Sensitivity following Socket Shield Technique with Anterior Single Immediate Implant Placement and Provisionalization.

Maintaining facial soft tissue contour and inter-implant papilla are challenging for implants in the esthetic zone. To counteract the inevitable hard and soft tissue changes after tooth extraction, the socket shield technique (SST) has been advocated as means to maintain the facial and/or interproximal osseous and gingival architecture. Because SST is a technique-sensitive procedure, various complications related to SST have been reported. This article presents a unique complication after a socket shield procedure and a novel management of the complication. Int J Periodontics Restorative Dent 2023;43:157-165. doi: 10.11607/prd.5426.

Autogenous dentin graft versus alloplastic graft combined with socket shield for pre-implant socket preservation: a split-mouth randomized clinical trial

After tooth extraction, alveolar bone resorption and labial bone plate thinning occur due to the lack of periodontal ligaments. The socket shield method was developed to preserve the alveolar ridge. A split-mouth study was performed in which eight patients were treated using alloplast with socket shield on one side (alloplast group, control) and autogenous dentin graft with socket shield on the contralateral side (dentin group, test). After 3 months, a trephine bone core was collected from all sites and evaluated by histological, histomorphometric, and radiographic analysis. Thin bony trabeculae were formed surrounding the residual alloplast, while thicker trabeculae of bone formed and fused to the autogenous dentin. The percentage of newly formed bone was significantly higher in the dentin group when compared to the alloplast group (P = 0.020). Radiographically, there was no significant difference in the mean percentage increase in bone density from preoperative to post-grafting between the two groups. Moreover, when comparing the change in labial bone level from preoperative to 3 months post-grafting between the two groups, there was no significant difference. The autogenous dentin graft combined with socket shield could be a promising technique for socket preservation.

The socket shield technique and its complications, implant survival rate, and clinical outcomes: a systematic review.

The aim of this systematic review was to evaluate the effectiveness of the socket shield technique (SST), an innovative surgical method introduced in 2010, for reducing buccal bone plate resorption. The review was conducted following the PRISMA guidelines. Clinical studies conducted in humans and investigating the SST were searched on PubMed (MEDLINE), Embase, Web of Knowledge, and Google Scholar in November and December 2021. The implant survival rate, percentage of complications, and clinical parameters (marginal bone loss [MBL], pink esthetic score [PES], and buccal bone plate resorption [BBPR]) were analyzed using the collected data. The initial search resulted in 132 articles. After article screening, the full texts of 19 studies were read and 17 articles were finally included in the review. In total, 656 implants were installed with the SST. Nine of the 656 implants experienced failure, resulting in an implant survival rate of 98.6%. The percentage of complications was about 3.81%. The analysis of clinical parameters (MBL, PES, and BBPR), showed favorable results for the SST. The mean MBL in implants placed with the SST was 0.39±0.28 mm versus 1.00±0.55 mm in those placed without the SST. PES had a better outcome in the SST group, with an average of 12.08±1.18 versus 10.77±0.74. BBPR had more favorable results in implants placed with the SST (0.32±0.10 mm) than in implants placed with the standard technique (1.05±0.18 mm). The SST could be considered beneficial for preserving the buccal bone plate. However, since only 7 of the included studies were long-term randomized controlled trials comparing the SST with the standard implant placement technique, the conclusions drawn from this systematic review should be interpreted with caution. PROSPERO Identifier: CRD42020180637.