A retrospective evaluation of 128 socket-shield cases in the esthetic zone and posterior sites: Partial extraction therapy with up to 4 years follow-up

Modified Surgical Guide for Root Sectioning in the Socket Shield Technique-In Vitro Study

OBJECTIVE

This in vitro study aimed to evaluate the effectiveness of a printed surgical guide for root sectioning in the socket-shield technique.

MATERIALS AND METHODS

A typodont model of the maxilla with augmented filler was used for the upper right central incisor, and CBCT images were obtained. Two types of vertical root sectioning guides were tested: one with a buccal sleeve (Group A, n = 10) and another with a buccal orientation slit (Group B, n = 10). Control group (n = 10) performed freehand cuts on printed models. After crown cutting with diamond burs, root sectioning was conducted using an ultrasonic tip with the guides. Mean and standard deviation were calculated for the remaining root length, width, and volume. Data were analyzed using the Kruskal-Wallis test and Dunn's post hoc test.

RESULTS

Statistical analysis showed significant differences in root width between the control group (2.0 mm) and both Groups A (2.655 mm; p < 0.0001) and B (2.460 mm; p < 0.0001). Group B (5.585 mm) also showed a significant difference in root remnant compared with the control (13.880 mm; p < 0.0043). Groups A and B did not differ significantly from each other.

CONCLUSIONS

The socket shield technique is safe and effective, this study aimed to add improvements through the introduction of surgical guides, facilitating the root section, which is the critical phase so that the parameters that are requisite for success are achieved in terms of width, length, and volume of the root remnant. Both guided techniques effectively facilitated root sectioning, maintaining satisfactory root thickness and length.

CLINICAL SIGNIFICANCE

Sectioning the root is challenging for the correct angulation to remove the palatal portion in the socket shield technique. Therefore, modifying this technique with the use of the presented guides, it is possible to prevent damage to the soft tissues and to plan the surgery with the help of cone beam computed tomography (CBCT) scans to remove the root apex and maintain the root remnant with a thickness greater than 1.5 mm, making the socket-shield technique more predictable.

Effect of Sagittal Root Position, Angle, and Bone Thickness on Peri-implant Tissue Phenotype and Bone Level in Socket Shield Technique: A Retrospective Case Series

There were only a few studies investigating the effect of sagittal root position (SRP), sagittal root angle (SRA), and buccal bone thickness (BBT) on peri-implant tissues using the socket shield technique (SST). This retrospective case series aimed to evaluate the SRP, SRA, and BBT in socket shield cases and examine the effect of these anatomical factors on the peri-implant tissue phenotype and bone level. Data from 27 patients (14 women, 13 men) treated with SST in the maxillary esthetic region between July 2019 and September 2021 were included. Clinical indices (modified plaque and bleeding indices, probing depth, keratinized mucosa width, mucosal thickness) and periapical radiographic recordings (marginal bone level) taken immediately after permanent prosthesis placement and 1 year later were used. Cone beam computerized tomography images were used to examine BBT, SRP, and SRA before implant placement and horizontal and vertical bone levels before implant placement and 1 year after prosthetic rehabilitation. The data were divided into groups based on BBT (<1 and ≥1 mm) and SRA values (<10° and ≥10°). There were no significant differences in 1-year clinical factors between the SRA <10° and SRA ≥10° groups. However, higher vertical bone loss was found in the SRA ≥10° group (P = .01, d = 0.53). There were no significant differences in clinical or radiographic factors between the BBT <1 mm and BBT ≥1 mm groups. In conclusion, BBT showed no significant effect on tissue phenotype and bone level, but SRA affected bone level in socket shield cases.

Immediate implant placement in extraction sockets with buccal bone dehiscence: A case study

BACKGROUND

Immediate implant placement (IIP) has been associated with a higher risk of esthetic complications and particularly buccal mucosal recession, which can be more pronounced in non-intact sockets or in the presence of thin phenotype in the esthetic zone. Nevertheless, multiple techniques have been published to address IIP in non-intact alveolar sockets with favorable outcomes. The purpose of this study is to present an approach on IIP in sites with buccal bone dehiscence.

METHODS

Three patients requiring extraction of one or multiple teeth in the presence of buccal bone dehiscence were treated with flapless extractions, IIP, guided bone regeneration (GBR), and connective tissue grafting (CTG) through a tunneling approach with a simultaneous use of custom healing abutments.

RESULTS

All sites exhibited 1-2 mm of buccal bone thickness at the level of the implant platform, as well as significant buccal soft tissue thickness with no recession and a favorable development of the emergence profile at 4 months to a year post implant placement.

CONCLUSIONS

IIP in sockets with buccal bone dehiscence can be managed by means of a flapless extraction, GBR and CTG through a tunneling approach exhibiting favorable hard and soft tissue responses.

KEY POINTS

When placing immediate implants in non-intact sockets, simultaneous connective tissue grafting is recommended, especially in the esthetic zone. Bone grafting in immediate implants in sockets with buccal bone dehiscence can be performed through a tunneling approach without the need for open flap approaches. Placement of CHAs over immediate implants may help promote maintenance of the buccolingual ridge contours and overall hard and soft tissue responses.

PLAIN LANGUAGE SUMMARY

Placing dental implants right after tooth extraction can lead to more visible aesthetic issues, especially gum recession. This is more common when the tooth socket is not intact or the gum tissue is thin. However, several techniques have shown good results even in these challenging situations. This study explores a method for implant placement right after tooth extraction in cases where there is bone missing on the socket. Three patients who needed teeth extracted and had bone loss on the outer side of their tooth sockets were treated. The treatment included: Extracting the teeth without cutting the gums, placing implants immediately, using GBR to help regrow bone, adding connective tissue grafts, and using custom healing cups to shape the gum tissue. After treatment, all the sites showed 1-2 mm of new bone on the outer side of the implants and thicker gum tissue without any recession. The gum and bone around the implants looked good 4 months to a year later. In conclusion, IIP in sockets with bone loss on the outer side can be effectively managed with this method, leading to good bone and gum tissue outcomes.

Comparing the modified socket-shield technique with the conventional immediate implantation technique in the anterior dentition: A 5-year retrospective clinical study

AIMS

The aim of this retrospective clinical study was to compare the 5-year radiological and clinical outcomes of patients undergoing immediate implantation with or without the modified socket-shield technique.

MATERIALS AND METHODS

Patients who underwent anterior tooth replacement via the modified socket-shield technique (MSST) or the conventional immediate implantation technique (CIIT) between 2016 and 2017 were included. The labial bone thickness was assessed at different measurement levels (0, 2, 4 and 6 mm apical to the implant shoulder (IS)) postoperatively (T1), 6 months postoperatively (T2) and 5 years postoperatively (T3). The pink aesthetic score (PES) was evaluated before surgery (T0) and at T2 and T3. Implant success, complications and patient satisfaction were evaluated at every visit.

RESULTS

Thirty-six patients (18 in the MSST group) underwent follow-up for 5 years, with no cases of implant failure. Two cases of exposure were detected in the MSST group, but there were no significant effects on hard or soft tissue. Patients in the MSST group showed less and more stable bone resorption than did those in the CIIT group at any measurement level and any time. A higher PES was achieved in the MSST group. Patient satisfaction was similar in both groups.

CONCLUSIONS

The MSST is a reliable immediate implantation method because of its ability to preserve the alveolar bone and provide superior recovery of aesthetics.

Failure Rate of Dental Implants in the Esthetic Zone: A Systematic Review and Meta-Analysis

The present systematic review and meta-analysis has systematically reviewed and analyzed dental implant failure for the implants placed in the esthetic zone. An electronic database search was performed in PubMed and ScienceDirect, including a manual search through the references using appropriate keywords and the PICO (population, intervention, control, and outcomes) format for the inclusion criteria. A total of 11 relevant articles were included. The quality of the randomized controlled trial (RCT) studies was assessed using the Cochrane Risk of Bias tool while the quality of non-randomized studies was assessed using the Newcastle Ottawa scale. Of the 11 articles included, 5 were RCTs, and 6 were non-randomized. The overall failure rate was found to be 2% (95% CI; 0.00-0.03%). The percentage marginal bone loss was estimated to be 1% (95% CI; 0.00 - 0.02%) and the mean and proportion pink esthetic scores were approximately 11.75 (0.43%) with 2% mid-facial soft tissue recession and the mesial and distal papillary recession was 0.02% and 0.01%, respectively. Based on this systematic review and meta-analysis, the rate of dental implant failure for implant placement in the esthetic zone was minimal. In addition, 1% proportional marginal bone loss and moderately high esthetic scores were found.

Soft and hard tissue evaluation of guided socket shield implant cases

BACKGROUND

The socket-shield (SS) technique results in long-term functional osseo- and dento-integration, preserving the dimensional stability of hard and soft tissues over time. This study aimed to describe the successful implementation of a surgical technique to facilitate "SS" cases.

METHODS

The cases included males and females aged 32-81 years consecutively treated between 2020 and 2023 (longest follow-up, 3.5 years). For each case, pre- and post-operative cone-beam computed tomography (Digital Imaging and Communications in Medicine files) and intraoral optical scans (IOS; STL files) were performed. Digital immediate implant placement and simultaneous tooth extraction and SS production were planned using an implant planning software. Implants were planned considering sagittal-ridge and tooth-root angular-configuration. Surgical guides were used to perform the digitally-supported SS technique. All cases were planned and surgically performed by one operator (Pedro M. Trejo). Preoperative digital IOS-models were superimposed to post-operative models to assess soft-tissue changes. Pre and post sagittal views were used to assess the radiographic buccal-plate thickness at various healing times. An investigator not involved with case planning or treatment performed measurements.

RESULTS

Results reflected soft-tissue stability with minimal mean thickness change at 0-, 1-, 2-, and 3-mm measurement levels of 0.03, -0.2, 0.14, -0.07, and 0.04 mm, respectively, with a mean gingival-margin change of 0.04 mm. The free gingival-margin change ranged from a 0.58-mm gain in height to a -0.57-mm loss. The mean radiographic buccal-plate thickness post-operatively was 2.04 mm (range, 0.7-2.9 mm).

CONCLUSION

The digitally-supported guided SS technique enables predictable immediate implant-placement positions and stable buccal peri-implant soft and hard tissues over time.

KEY POINTS

Why are these cases new information? The uniqueness of the surgical technique described herein is that it results in favorable positions of immediate, socket-shielded (SSed), implant placements, with soft- and hard-tissue stability as the byproduct. What are the keys to successful management of these cases? Digitally, plan for the best possible implant position within the alveolar housing to satisfy prosthetic requirements, and then adjust this position to accommodate the socket shield dimensions. Digitally, provide a space/gap between the future dentinal shield and the implant. Clinically, allow for time to carve the final position and dimensions of the shield. Plan ahead the extent of the apical third of the SS, and the removal of the apex, if dealing with a long root. What are the primary limitations to success in these cases? Inadequate use of digital technology; case-sensitive technique requires proper execution of each digital and technical clinical step.

Preserving Peri-Implant Soft Tissue Health: A Case Report on Immediate Implant Placement Using the Socket Shield Technique

Alveolar bone resorption is a natural occurrence following tooth extraction, complicating the process of prosthetic rehabilitation with implants. Techniques such as socket preservation, atraumatic extraction, and immediate implant placement are employed to reduce the dimensional changes associated with extraction. The socket shield technique (SST) is effective in preserving the alveolar ridge's contour, enhancing the aesthetic results of rehabilitation by maintaining the integrity of the bundle bone complex even when the buccal bone is less than 1mm.  This case report presents a 23-year-old female patient with a fractured upper central incisor. The socket shield technique was chosen based on the clinical findings from the cone beam computed tomography (CBCT) scan. Immediate temporization was provided to preserve soft tissue integration. A comparison of the initial and subsequent cone beam computed tomography (CBCT) scans, along with clinical observations, suggests that the socket shield technique is a viable method for preserving both hard and soft tissue structures in the anterior dental region, thereby improving aesthetic outcomes.

Five-Year Clinical, Radiographic, and Cone-Beam Follow-Up of Socket Shield Technique in Two Cases Treated with a Split Mouth Design

The two presented cases of socket shield technique were done following a split mouth protocol in two patients, each received an immediate implant inserted conventionally on maxillary one side and another implant inserted applying the socket shield technique on the contralateral side. The outcomes including soft and hard tissue changes were compared clinically and radiographically. The four implants were followed for 5 years, and the outcomes were successful.

Dual-guide template-guided socket-shield preparation and immediate implantation in maxillary anterior region implant surgery

For immediate implants in the anterior region, the socket-shield technique has received much attention in recent years. However, this technique is technically sensitive and root preparation is difficult. It is also difficult to obtain the ideal three-dimensional position for implant placement in the anterior region. This paper reports a clinical case in which socket-shield preparation and implant cavity preparation were performed with the aid of a dual guide in implant surgery. The dual guide surgical preparation technique was used to reduce the difficulty of socket-shield preparation and to achieve restoration-orientated implant placement with satisfactory clinical results.

Design and application of modified CAD/CAM socket-shield preparation template in immediate implantation in the esthetic area

OBJECTIVE

Designed and applicated a modified customized CAD-CAM socket-shield preparation guide template in immediate implant and followed up for 3 years.

CLINICAL CONSIDERATIONS

Socket-shield technique could improve the esthetic effect of immediate implant restorations by preserving the labial fascicular bone-periodontal complex at the implant site. While the socket-shield technique is highly technique-sensitive. A modified customized CAD/CAM guided template was designed and fabricated by 3D printing. The movement of the carbide bur during preparing the socket-shield was limited by the socket-shield preparation template. In this case report, the socket-shield preparation template was used for preparing the socket-shield in the tooth root with irregular morphology and the case was followed up for 3 years.

CONCLUSIONS

The modified CAD/CAM socket-shield preparation template effectively improved the accuracy and efficiency of preparing the socket-shield by limiting the movement of the high-speed carbide bur in both in both lip-to-palatal and crown-to-root orientation. The socket-shield with accurate morphology could effectively maintain the gingival marginal level and contour.

CLINICAL SIGNIFICANCE

The modified CAD/CAM socket-shield preparation template with the depth-locking ring effectively reduced the technique sensitivity and time consumption of the socket-shield technique, especially for tooth roots with irregular morphology.

Digital workflow for image-guided immediate implant placement by using the socket-shield technique and custom abutment in the esthetic area

Marginal bone loss around immediately placed implants may compromise esthetic outcomes in the anterior maxilla. The relatively recent socket-shield technique of partial extraction therapy has been described as being useful to maintain the structure of peri-implant tissues. The present technique report introduced a digital workflow to perform image-guided implant placement after partial extraction therapy. In this technique, digital 3-dimensional images are used to plan and orient the flapless surgical procedure and to digitally design a custom abutment based on the natural emergence profile as segmented from the tooth to be extracted.

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.

Clinical outcomes of retention of the buccal root section combined with immediate implant placement: A systematic review of longitudinal studies

INTRODUCTION

Immediate implant placement in conjunction with partial extraction therapy has been shown to result in functional osseo- and dento-integration with partial preservation of the periodontal ligament (PDL) in humans. Strategic buccal root retention for PDL preservation is a biologically driven procedure that maintains alveolar ridge dimensions and esthetics, while allowing for implant placement. The aim of this study was to conduct a systematic review of longitudinal clinical outcomes of PDL-mediated ridge preservation in conjunction with implant placement in adults, compared with conventional immediate implant placement with total extractions. The primary outcome for this study was marginal bone level (MBL) changes after strategic buccal root retention implant placement techniques.

MATERIALS AND METHODS

To address a predefined PICOS question, a systematic search of randomized clinical trials and cohort studies with at least 10 participants per group and a minimum 12-month follow-up was conducted. A two-phase systematic selection strategy, data extraction, and risk of bias assessment, was performed independently and in duplicate. Randomized trials were quantitatively analyzed in a meta-analysis.

RESULTS

Ten human studies fulfilled the predefined criteria and were included; three clinical trials and seven cohort studies, for a total of 506 patients and 587 implants. PDL-mediated implant placement of single-rooted periodontally healthy teeth was found to reduce marginal peri-implant bone loss and buccal plate changes as compared to conventional immediate implants across studies, while implant survival and success rates were comparable between the two procedures. A meta-analysis found that bone changes were significantly less when retention of the buccal root section was performed as compared to total extractions (standardized mean difference: [-4.53, -0.11]); the three clinical trials were, however, largely heterogeneous (I2 : 93.1%; Q = 28.98, p < 0.001).

CONCLUSION

Strategic retention of the buccal root section has a benefit in terms of dimensional ridge stability over conventional immediate implantation when implemented in carefully selected cases of single-rooted teeth.

The Socket-Shield Technique: Digital Planning, Guided Surgery, and Immediate Implant Loading—2-Year Follow-Up

Anterior aesthetic zone implant placement and tooth restoration can be a quite challenging procedure. Modern technology offers new tools that can help maximize results in both aesthetic and functional ways. The socket-shield technique, as described by Hürzeler et al., boosted with the 3D diagnostics, digital planning, and 3D printing, could provide a valuable alternative to traditional approaches. This case report describes a clinical workflow for an efficient anterior implant-prosthetic restoration.

Comparing Dual-Zone Immediate Implant Placement and Socket Shield Technique for Ridge Width Changes in the Maxilla: A Prospective Cohort Study

PURPOSE

The aim of this prospective cohort study was to assess the facial-palatal ridge dimensional changes that occurred at 8-10 months following flapless dual-zone (DZ) immediate implant placement and socket-shield (SS) immediate placement in the maxilla.

MATERIALS AND METHODS

A total of 19 patients who received 20 implants were included, with 10 implants (MegaGen AnyRidge) placed for each treatment, DZ and SS. Cast models were made at 8-10 months after implant placement to assess the dimensional ridge changes by measuring the facial-palatal ridge width on implant sites (T) at six designated points starting from the gingival margin (0, 1, 2, 3, 5 and 7) and comparing it with the corresponding measurement on the contralateral tooth site (C).

RESULTS

All 20 implants demonstrated successful osseointegration at 8-10 months follow-up (survival rate 100%). Two out of ten cases of SS group presented with minor manageable complications of external shield exposure. DZ group showed an average of 0.3 mm facial-palatal ridge width reduction, while SS group revealed a mean gain in ridge width of approximately 0.2 mm at 8-10 months follow-up.

CONCLUSION

When comparing between two treatments, there was a significant difference in ridge width change at 8-10 months following implant placement, indicating better preservation of the ridge contour for socket shield technique.

Partial Extraction Therapy with Early Implant Placement in the Esthetic Zone: A Clinical Case Report

Immediate replacement of teeth designated for extraction is an appealing treatment rationale for both the patient and the operator. However, it has been associated with a greater risk of facial recession and compromised soft-tissue esthetics. Partial extraction therapy (PET) or synonymously socket shield technique (SST) or root membrane technique (RMT) has been proposed to conserve the facial alveolar contour and soft-tissue esthetics. In this article, a special case is described where a root membrane was used to prevent the modeling of the facial aspect of the extraction socket. Partial extraction was performed allowing the socket with the facial root membrane in situ to partially heal for 8 weeks before implant placement. Successful integration and restoration were achieved with very minimal hard- and soft-tissue changes, accentuating satisfactory esthetic results as dictated by objective esthetic assessment. PET with early implant placement may be considered a viable treatment option for selected cases.

Is socket shielding an option in esthetic region?

The implant cannot preserve the surrounding bone from resorption when placed in the extraction socket. After teeth extraction, a change in the bony architecture of the anterior region makes oral rehabilitation difficult by an implant. This leads us to explore such a critical issue and the relevant data were collected from Pubmed, Google Scholar, and Cochrane database and reviewed. Socket shielding technique is intentional retention of the buccal segment of root fragment during the implant placement in the extraction socket. Socket shielding is an effective procedure in minimizing the buccal bone resorption along with minimizing the buccal contour changes it is minimally invasive as the bone graft is optional thus reducing the cost of the treatment procedure. The limited studies were available to support the routine clinical use of the socket shielding technique. Socket shielding seems to become the non-invasive technique for the preservation of hard and soft tissue by dental implant especially in the esthetic zone in the future. Therefore studies should be carried out on a large population to obtained more précised results related to the socket shielding technique.

Evaluation of soft tissue and labial plate of bone stability with immediate implant in direct contact versus gap with socket shield: A randomized clinical trial with 1 year follow-up

OBJECTIVE

In the anterior region, the resorption of the buccal plate of bone after tooth extraction leads to contraction of the overlying soft tissues, resulting in an esthetic problem. In the socket shield technique, the buccal root section of the tooth is maintained, to preserve the buccal bone for immediate implant placement. The aim of this randomized clinical trial was to investigate the effect of leaving a gap or not between implant and retained root fragment on bone dimensions and soft tissue esthetics.

METHODS

This was a two armed parallel group randomized clinical trial with allocation ratio 1:1. Patients were eligible in case they needed immediate implant replacing teeth in esthetic zone with sufficient buccal bone support. CBCT was performed immediately after the intervention and 12 months later.

RESULTS

Forty six patients (26 females and 20 males) were enrolled in the study with 23 of them placed in contact with shield and 23 were placed palatal leaving a gap to graft with a xenograft. After 12 months, excellent soft tissue stability was reported (mean pink esthetic score at placement group A: 12.00 ± 1.60 after 12 months 12.90 ± 1.69, group B 12.62 ± 2.07 and after 12 months 12.38 ± 2.20) Using both surgical techniques. Radiographic crestal bone level changes mean for group A was -0.26 ± 0.52 and for group B -0.34 ± 0.31. There was a strong positive correlation between clinical and radiographic bone width values which was statistically significant (r = 0.782, p < 0.001). Width and thickness of keratinized gingiva showed no significant difference between values measured in both groups. Nonsignificant difference between studied groups according to the labial plate of bone clinical and radiographic changes after immediate implantation.

CONCLUSION

Within the limitations of this study, the present data seem to support that the clinical outcome of the socket shield technique with immediate implant placement placed in contact or leaving a gap gave excellent esthetic results.

Immediate implant placement with socket shield technique in the maxilla: a prospective case series evaluation at 1-year follow-up

Background

The aims of this case series were to investigate the clinical, radiographic, implant success, complication incidence, esthetic, and patient-reported outcomes of 10 immediately placed implants associated with the socket shield technique at 12 months post-loading and to assess the ridge width changes that occurred at 8 months following implant placement.

Methods

A total of 10 patients received 10 socket shield immediate implants (MegaGen AnyRidge). At 8 months postimplantation, casts were made to assess the ridge width changes by measuring the ridge width at the implant sites and comparing them with the corresponding measurements at the contralateral tooth site. At 12 months post-loading, clinical indices, marginal bone loss, pink esthetic score, and patient-assessed outcomes were evaluated. The mean, standard deviation and median were calculated for all continuous variables.

Results

All implants demonstrated a 100% success rate, while 2 implants presented with external shield exposure that was managed successfully. The mean marginal bone loss was 0.08 ± 0.14 mm mesially and 0.21 ± 0.23 mm distally. Esthetic evaluation yielded an average modified pink esthetic score of 8.65. A mean gain of 0.17 mm in the facial-palatal ridge width was recorded at 8 months postimplantation.

Conclusions

The socket shield technique enhanced the functional and esthetic results by preserving the alveolar bone and peri-implant soft tissues. However, this is a sensitive technique and still needs more robust evidence before it can be recommended for everyday clinical practice.

A Novel Approach to Immediate Implants: The CastleWall Surgical Technique

Objective: The purpose of this study was to investigate the volumetric stability around immediate implants, in which a 360-degree socket-shield was retained using the CastleWall Surgical Technique (CWST). Material and methods: This retrospective study examined the results of the CWST used for 25 consecutive patients, involving 31 immediate implants. Silicone impressions taken prior to extraction, and at a review appointment were converted to STL files and compared. The median follow-up time was 14.2 ± 5.5 months. Volumetric changes and gingival recession on both buccal and lingual sites were measured. Papillary height changes were also evaluated from available photographs taken before and after treatment. Patients in the study completed a Visual Analogue Scale (VAS) for evaluation of post-operative discomfort and overall satisfaction with this procedure. Results: All implants integrated successfully without complications. Mean loss of buccal and lingual tissue was 0.30 ± 0.32 mm and 0.17 ± 0.27 mm, respectively. Mean recession at the mid-buccal and mid-lingual gingival margin was 0.66 ± 0.64 mm and 0.87 ± 0.84 mm, respectively. Mean recession of the mesial and distal papilla was 0.26 ± 0.55 mm and 0.29 ± 0.52 mm, respectively. Patients reported 97.74 ± 5.60% satisfaction with this procedure using the Visual Analogue Scale (VAS), with minimal post-operative discomfort. Conclusions: The results of this study showed excellent soft tissue stability and aesthetics were achieved using the CWST, with minimal postoperative pain. The other main advantage of retaining a 360-degree socket-shield, is there is more available surface area to lock the implant to the shield to prevent shield migration over time.

Dimensional Changes in the Alveolus after a Combination of Immediate Postextraction Implant and Connective Grafting and/or Socket Shield Technique

Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar survival rates to late implant placement procedures. However, placing an implant immediately after dental extraction does not counteract the physiological remodeling of alveolar bone. For this reason, additional surgical techniques have been developed, such as the placement of a connective tissue graft (CTG) or the socket shield technique (SST). Dimensional changes in the peri-implant tissues were observed after placement of immediate implants following the extraction and CTG and/or SST. A total of 26 surgical interventions were carried out in which dimensional change variables of peri-implant tissues were analyzed. The preoperative state and immediate postoperative situation were compared with the situation after one year. Measurements were taken at 3, 5, and 7 mm from the gingival margin and analyzed in this CBCT radiological study (Planmeca Promax 3D). The implant platform was used as a reference point for the measurement of changes in alveolar crest height. One year after performing either of the two techniques (CTG and/or SST), a significant increase in the gingiva thickness and vestibular cortex occurred at 5 mm (0.65 ± 1.16 mm) and 7 mm (0.95 ± 1.45 mm) from the gingival margin. Additionally, an increase in thickness of palatal bone was registered at 3 mm (0.48 ± 0.90 mm). The graft placement group showed an increase in thickness of peri-implant tissue in the vestibular area after one year, although CTG and SST groups were clinically similar. The implementation of SST revealed promising results regarding the buccal thickness of hard and soft tissues after one year. A significant increase in vestibular cortical bone thickness, as well as the overall mucosa thickness and buccal bone at 3 mm from the gingival margin, was observed. A significant reduction in the distance from the bone crest to the platform was detected in both techniques. Both techniques (CTG and SST) are appropriate to provide sufficient volume to peri-implant tissues in the vestibular area of anterior maxillary implants. Some limitations were detected, such as the lack of an aesthetic analysis or small sample size, so results should be interpreted with caution. Future studies are necessary to further evaluate the long-term predictability of these techniques.

Navigation guided socket-shield technique for implant and pontic sites in the esthetic zone: A proof-of-concept 1-year prospective study with immediate implant placement and loading

OBJECTIVE

To assess clinical, radiological performance of novel navigation guided socket-shield technique (NSS) with immediate implant placement and loading.

MATERIALS AND METHODS

Eighteen patients (12 females; age 52.54 ± 4.92; 33-72) treated between January 2018 and June 2019, were investigated, and followed for at least 1 year after definitive prosthesis placement (mean 20.1 months, 18-23). Primary outcomes: implant and prosthetic success rates, surgical, biologic, prosthetic complications.

SECONDARY OUTCOMES

marginal bone loss (MBL), implant stability quotient (ISQ), pink esthetic score (PES), plaque and bleeding indexes.

RESULTS

Sixty-nine navigation guided socket-shield procedures were performed (27 implant-sites and 42 pontic-sites) and 27 implants (NobelParallel, NobelBiocare AG) positioned and immediately loaded. Mean insertion torque and ISQ at implant positioning were 49 ± 5.34 Ncm (36-74), 73 ± 5.72 (68-81). No implant failure was experienced. Two root-shield exposures with mucositis, ulceration and bleeding were reported at two pontic-sites (2.9%) and successfully treated. No complications were experienced at implant-site leading to an overall NSS success-rate of 100%. No prosthetic complications occurred. Mean MBL was -0.72 ± 0.26 mm (-0.42 to -1.06 mm). PES final at the last follow-up 12.84 ± 0.92. The plaque and bleeding scores were 18.5 ± 6.12 and 3.15 ± 2.21.

CONCLUSIONS

Within study limitations, dynamic navigation was effective to streamline execution of socket-shield technique at implant and pontic sites, shortening treatment time and reducing complications. Navigation guided socket-shield technique was reliable to achieve digitally planned shield-to-implant distance, facilitate immediate implant placement and loading and establish the mucosal dimension needed for underlying bone-to-implant protection and esthetic integration.

CLINICAL SIGNIFICANCE

The investigated NSS technique overcomes the difficulties related to root preparation at implant and pontic-sites, facilitating immediate implant placement and loading. Dynamic guided surgery contributed to make socket-shield technique less technical-sensitive, shortening time for execution, reducing complication rate.

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

PURPOSE

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

TRIAL REGISTRATION

PROSPERO Identifier: CRD42020180637.

Radiographic and Esthetic Evaluation Following Immediate Implant Placement with or without Socket Shield and Delayed Implant Placement Following Socket Preservation in the Maxillary Esthetic Region - A Randomized Controlled Clinical Trial

OBJECTIVE

The purpose of this study was assessment of the changes in soft and hard tissues in the esthetic zone of maxilla following immediate implant placement (IIP) with and without the socket shield technique (SST) and placement of implants 4 months following socket preservation (DIP) in terms of alterations in crestal bone thickness (CBT) and soft tissue changes evaluated by means of pink esthetic scores (PES) following placement of implants in the esthetic zone of maxilla.

MATERIALS AND METHODS

In the maxillary esthetic region, 75 dental implants were placed totally, with 25 implants each in the SST, IIP, and DIP groups. All participants were subjected to undergo CBCT for assessing the variations in thickness of crestal aspect of facial/buccal/labial alveolar bone (CBT). PES and PROMS (patient-related outcome measures) were assessed using VAS for pain threshold and esthetic satisfaction following implant placement and after 6th post-operative month.

RESULTS

The mean reduction in CBT showed a statistically significant difference between and within the groups, in comparison to IIP and DIP groups, which demonstrated an average reduction in CBT 0.4 ± 0.1 and 0.2 ± 0.1 at 6 months following implant placement, respectively. The SST group showed a significantly lesser reduction in CBT of 0.05 ± 0.02. However, the mean difference in PES within and among the groups showed no significant difference statistically at P < 0.05. On comparison of individual scores of PES between the groups, the results showed significant difference statistically at P < 0.001.

CONCLUSION

The SST group demonstrated minimal reduction in CBT and a superior PES at the end of 6 months compared with the IIP and DIP groups.

Immediate Implants in the Aesthetic Zone: Is Socket Shield Technique a Predictable Treatment Option? A Narrative Review

(1) Background. Dental implant placement in the anterior region requires extreme precision due to relatively high aesthetic demand. This narrative review aimed to analyse some of the available clinical studies of the socket-shield technique and determine its viability for dental implant survival/success and complication rates. (2) Methods. An electronic search for publications was performed using the Cochrane, PubMed-MEDLINE, Web of Science, and Google Scholar databases. All electronic searches included human clinical and animal studies and were performed by three independent examiners. (3) Results. A total of 1383 records were identified with the initial search strategies, but only 25 full texts + five abstracts clinical studies were kept after the recruitment criteria screening. The technical details, advantages, and limitations of the techniques were illustrated. (4) Conclusion. Within the limitations of the present review, it would be merely justified that immediate dental implant placement in conjunction with the socket-shield technique can be a promising strategy for dental implant therapy.

Socket shield technique: A systemic review and meta-analysis

PURPOSE

The aim of the present study was to evaluate the clinical feasibility of the socket shield technique (SST).

STUDY SELECTION

An electronic search of the PubMed, Cochrane Central Register of Controlled Trials, and Wiley Online Library databases, and a manual reference search for articles published up to September 2020 was conducted. Meta-analysis was performed to estimate marginal bone loss (MBL), changes in buccal bone width (cBBW), pink esthetic score (PES), implant stability quotient (ISQ), implant failure rate, and complication rate between SST and conventional immediate implant placement (IIP). All pooled analyses were based on random effects models.

RESULTS

Sixteen relevant studies were ultimately selected by two independent reviewers: four randomized clinical trials (RCTs), four case-control studies, and eight retrospective studies. Meta-analysis revealed a trend toward lower MBL and cBBW and higher PES in the SST group. ISQ, implant failure rate, and complication rate were similar between the groups.

CONCLUSIONS

The included studies provided evidence that SST may be a feasible treatment option. However, this technique should not be used as a routine clinical protocol due to the lack of evidence-based consensus guidelines, large-scale RCTs, and long-term follow-up data. Therefore, there is an urgent need for well-conducted RCTs in this field.

The socket shield technique for immediate implant placement: A systematic review and meta-analysis

BACKGROUND

Immediate implant placement with socket shield technique (SST) may maintain the buccal bone plate and soft tissue levels, however, the potential clinical benefits of SST lack strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the effects of SST on dimensional changes of hard tissues, esthetic outcomes, implant stability, complication, and implant failure rates.

METHODS

Electronic databases were searched to identify randomized controlled trials (RCTs) that compared immediate implant placement with and without SST. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program.

RESULTS

A total of 982 studies were identified, of which, seven RCTs with 206 immediately placed dental implants in 191 participants were included. Overall meta-analysis showed significant differences in the changes in buccal bone plate width (mean difference (MD) -0.22; 95% confidence interval (CI) -0.30 to -0.15; p < 0.0001) and height (MD -0.52; 95% CI -0.85 to -0.18; p = 0.002) in favor of SST. The use of SST was also associated with significantly less changes in peri-implant marginal bone levels and better pink esthetic score than immediately placing implants without SST. The differences in implant stability, complication and implant failure rates were not statistically significant between immediate implant placement with or without SST.

CONCLUSIONS

The short-term complication and implant failure rates following immediate implant placement with or without SST were comparable. The SST has short-term positive effects on the changes in width and height of buccal bone plate, peri-implant marginal bone levels and esthetic outcomes. Further evidence from long-term RCTs are still required to substantiate the current findings.

CLINICAL SIGNIFICANCE

SST can reduce changes in buccal plate width and height and improve the soft tissue profile following immediate implant placement in esthetic zone.

Failure Rate, Marginal Bone Loss, and Pink Esthetic with Socket-Shield Technique for Immediate Dental Implant Placement in the Esthetic Zone. A Systematic Review and Meta-Analysis

Aim: To compare the failure rate, marginal bone loss, and pink esthetic for the socket-shield technique and the conventional technique for immediate dental implant placement in the esthetic zone. Material and methods: A systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the failure rate, marginal bone loss, and pink esthetic with the socket-shield technique for immediate dental implant placement in the esthetic zone was performed. A total of 4 databases were consulted in the literature search: PubMed-MEDLINE, Scopus, Embase, and Web of Science. After eliminating duplicated articles and applying the inclusion criteria, 16 articles were selected for the qualitative and quantitative analysis. Results: Four randomized controlled trials, five prospective clinical studies, four retrospective studies, and three case series were included in the meta-analysis. The dental implant failure rate for the socket-shield technique for immediate dental implant placement was 1.37% (95% CI, 0.21-2.54%); however, no statistically significant differences between the conventional and socket-shield technique were found. The estimated mean difference in the marginal bone loss for the socket-shield technique was -0.5 mm (95% CI, -0.82 to -0.18) and statistically significant (p < 0.01), with a high heterogeneity (I² = 99%). The mean pink esthetic score was 12.27 (Q test = 4.47; p-value = 0.61; I² = 0%). The difference in pink esthetic between the conventional (n = 55) and socket-shield techniques (n = 55) for immediate dental implant placement was 1.15 (95% CI, 0.73-1.58; Q test = 8.88; p value = 0.11; I² = 44%). The follow-up time was found to be significant (beta coefficient = 0.023; R² = 85.6%; QM = 3.82; p = 0.049) for the PES for the socket-shield technique. Conclusions: Within the limitations of this systematic review with meta-analysis, the dental implant failure rate did not differ between the socket-shield technique and conventional technique for immediate implant placement in the esthetic zone. However, a lower marginal bone loss and higher pink esthetic scores were found for the socket-shield technique compared to the conventional technique.

Socket shield technique: A systematic review of human studies

BACKGROUND AND PURPOSE

Alveolar bone resorption after dental extraction frequently leads to situations in which long-term function and esthetic success of rehabilitations with dental implants is a challenge. Socket shield has been described as an alternative technique to maintain the alveolar ridge when placing immediate implants. The aim of this review is to evaluate the medium- and long-term clinical outcomes of the socket shield technique in human studies.

MATERIAL AND METHODS

This review was conducted according to PRISMA guidelines. An electronic search was conducted in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL). The Cochrane Collaboration tool, the Newcastle-Ottawa Quality Assessment Scale and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed.

RESULTS

Six articles were included in this review. The studies analysed showed lower rates of horizontal and vertical alveolar bone resorption, better maintenance of the buccal plate, less marginal bone loss and better esthetic results than simple placement of immediate implants. However, a lack of homogeneity was found in evaluation methods of the different outcomes, surgical procedures and prosthetic management.

CONCLUSIONS

Based on the results of this review, it is possible to suggest that socket shield technique could be a good alternative in terms of alveolar bone maintenance, marginal bone stability and aesthetic outcomes in immediate implant treatment. However, it is not possible to recommend this technique as an alternative treatment with the same long-terms predictability as conventional immediate implants.

Comparison of the soft and hard peri-implant tissue dimensional changes around single immediate implants in the esthetic zone with socket shield technique versus using xenograft: A randomized controlled clinical trial

OBJECTIVE

Compare the dimensional changes of the peri-implant soft and hard tissues clinically and radiographically around single immediate implants in the esthetic zone with socket shield technique versus filling the buccal gap with xenograft.

MATERIALS AND METHODS

Forty-two patients with a single non-restorable tooth in the esthetic zone replaced with an immediate implant were randomly assigned either to the socket shield technique (test) or to grafting the buccal gap with xenograft (control). The vertical and horizontal buccal bone resorption were measured 6-months following implant placement. The esthetic outcomes were evaluated by assessing the Pink Esthetic Score (PES) and the amount of midfacial mucosal alteration, in addition to patient satisfaction assessment through a Visual Analogue Scale (VAS) based questionnaire 1-year following implant restoration.

RESULTS

The present study showed that the socket shield group yielded significantly less vertical and horizontal buccal bone resorption of 0.35 (±0.62) mm and 0.29 (±0.34) mm compared to 1.71 (±1.02) mm and 1.45 (±0.72) mm in the xenograft group respectively. Also, there was a significantly greater midfacial mucosal recession in the xenograft group of 0.466 (±0.58) mm compared to midfacial mucosal coronal migration of 0.45 (±0.75) mm in the socket shield group. However, there was no statistically significant difference regarding the total PES and patient satisfaction in both treatment groups.

CONCLUSION

The socket shield technique can preserve hard and soft peri-implant tissues following immediate implant placement. (ClinicalTrials.gov Identifier: NCT03684356).

Effectiveness of the Socket Shield Technique in Dental Implant: A Systematic Review

PURPOSE

Dental implant therapy is a common clinical treatment for missing teeth. However, the esthetic result is not as satisfactory as expected in some cases, especially in the anterior maxillary area. Poor esthetic results are caused by inadequate preparation of the hard and soft tissues in this area before treatment. The socket shield technique may be an alternative for a desirable esthetic outcome in dental implant treatments.

STUDY SELECTION

In the present systematic review, PubMed-Medline, Google Scholar, and ScienceDirect were searched for clinical studies published from January 2000 to December 2018.

RESULTS

Twenty studies were included, comprising one randomized controlled trial, two cohort studies, 14 clinical human case reports, and three retrospective case series. In total, 288 patients treated with the socket shield technique with immediate implant placement and follow-up between 3-60 months after placement were included. A quality assessment showed that 12 of the 20 included studies were of good quality. Twenty-six of the 274 (9.5%) cases developed complications or adverse effects related to the socket shield technique. Most studies reported implant survival without the complications (90.5%); most of the cases that were followed up for more than 12 months after implant placement achieved a good esthetic appearance. The failure rate was low without the complications, although there were some failures due to failed implant osseointegration, socket shield mobility and infection, socket shield exposure, socket shield migration, and apical root resorption.

CONCLUSIONS

The socket shield technique can be used in dental implant treatment, but it remains difficult to predict the long-term success of this technique until high-quality evidence becomes available.

Predictable immediate implant placement and restoration in the esthetic zone

This article describes a comprehensive step-by-step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long-term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence.

The socket-shield technique: a critical literature review

Introduction

Dental implants have become a standard treatment in the replacement of missing teeth. After tooth extraction and implant placement, resorption of buccal bundle bone can pose a significant complication with often very negative cosmetic impacts. Studies have shown that if the dental root remains in the alveolar process, bundle bone resorption is very minimal. However, to date, the deliberate retention of roots to preserve bone has not been routinely used in dental implantology.

Material and methods

This study aims to collect and evaluate the present knowledge with regard to the socket-shield technique as described by Hurzeler et al. (J Clin Periodontol 37(9):855-62, 2010). A PubMed database search (www.ncbi.nlm.nih.gov/pubmed) was conducted to identify relevant publication.

Results

The initial database search returned 229 results. After screening the abstracts, 13 articles were downloaded and further scrutinised. Twelve studies were found to meet the inclusion and exclusion criteria.

Conclusion

Whilst the socket-shield technique potentially offers promising outcomes, reducing the need for invasive bone grafts around implants in the aesthetic zone, clinical data to support this is very limited. The limited data available is compromised by a lack of well-designed prospective randomised controlled studies. The existing case reports are of very limited scientific value. Retrospective studies exist in limited numbers but are of inconsistent design. At this stage, it is unclear whether the socket-shield technique will provide a stable long-time outcome.

Influence of Socket-shield technique on the biomechanical response of dental implant: three-dimensional finite element analysis

This study evaluated the bone microstrain, displacement, and stress distribution according to the surgical technique (conventional or Socket-shield) and evaluation period (immediately after implant installation or after healing). Each condition was modeled for the finite element analysis, totaling four groups, with a morse-taper implant and a cemented prosthesis. The maximum displacement, von Mises stress, and bone microstrain yielded higher values during the immediate stage, without a difference between Socket-shield and conventional treatments. The use of the Socket-shield technique does not negatively impact the biomechanical behavior of an implant-supported prosthesis immediately after healing from the implant installation.

The (in)adequacy of translational research in dentistry

Translational research, as the name suggests, "translates" research findings into clinical practice to improve the health of human beings. The translational process builds on information from experiments conducted at a basic level (i.e., in vitro and/or animal studies) and progresses over experimental human studies for efficacy, efficiency, and safety to implementation. Therefore, all steps in the process should be based on studies conducted with the highest methodological quality possible in order to provide accurate and useful information. Furthermore, the systematic dissemination of new procedures/techniques should be done only when they have been proven to be effective and safe. This focus article describes examples of new techniques/procedures in dentistry that have not resulted from an adequate translational research process since the initial evidence was published. These procedures are generally characterised by lack of good evidence, particularly on their potential harms, and lack of adequate chronological order, regarding the translational research process (i.e., human research being conducted before animal research). Even so, they seem to be widely disseminated, and their promotion involves a wide range of sources, including social media. Some guidance is proposed to improve the quality of the translational research process in dentistry, as well as the level of awareness of all parties involved with the use of this research: clinicians, researchers, and patients. By improving the translational research process, optimization of the application and use of these resources, with less risk to the patients, is expected.

Guided residual root preparation for socket-shield procedures: A clinical report

Tooth extraction in the esthetic area is usually accompanied by hard- and soft-tissue changes. The socket-shield technique is an effective method for preventing these undesirable changes. However, difficulty in preparing the socket shield and controlling the implant position might increase the complication rate along with the time needed for the surgery, limiting its widespread use. This clinical report demonstrates a digital protocol for accurate and rapid socket-shield preparation and implant placement with surgical guides.

[Clinical evaluation of the socket-shield technique for immediate implantation in the maxillary anterior region]

OBJECTIVE

This study aimed to evaluate the clinical effect of the socket-shield technique in the maxillary anterior region at one year after implant placement.

METHODS

Ten patients with maxillary anterior teeth that cannot be reserved were enrolled. Implants were installed following the socket-shield technique and restored six months after the surgery. The thickness of the labial maxillary bone of the implant was compared before and one year after the surgery. At one year follow-up, the reten-tion rate of the implants, Jemt classification, and pink and white aesthetic scores were evaluated. Postoperative complications and patient satisfaction were also analyzed.

RESULTS

One year after installation, the retention rate of the implant was 100%. The thickness of the maxillary bone at the neck, central, and root section of the implant reduced to (0.27±0.21), (0.19±0.20), and (0.28±0.29) mm, respectively, compared with the values immediately after the operation. The thickness of the labial maxillary bone at the three measurement points immediately after and one year after the operation was statistically significant (P<0.05). No significant difference (P>0.05) of the difference thickness between immediate and one year after operation at the three measurement points. The pink esthetic scores of the implant prosthesis was 9.10±0.54, and the white esthetic scores was 9.00±0.63. No complications were observed, and the patients had a high degree of satisfaction.

CONCLUSIONS

The socket-shield technique could provide acceptable treatment results but cannot completely avoid the reconstruction of the labial maxillary bone of the implants. The technique exhibits favo-rable short-term aesthetic result, but its long-term clinical effect and aesthetic problems need to be further studied.

CAD-CAM titanium preparation template for the socket-shield technique

The socket-shield technique can be challenging and time-consuming. This article presents a digital approach to fabricating a computer-aided design and computer-aided manufacturing (CAD-CAM) titanium preparation template for the socket-shield technique. Preoperative cone beam computed tomography (CBCT) was used to map the remaining root, and the desired shape of buccal fragment of the root was determined as the socket shield. A CAD-CAM titanium preparation template was fabricated to facilitate root sectioning and the preparation procedure for forming an adequate socket shield.

Socket-shield technique for implant placement to stabilize the facial gingival and osseous architecture: A systematic review

The aim of the present study was to establish the efficacy of the socket-shield technique (SST) for the stabilization of the facial gingival and osseous architecture. An electronic search including the Cochrane databases, EBSCOhost, Medline/PubMed and Web of Science was performed. Articles related to SST for placing dental implants were included. Articles and abstracts not written in English were excluded. The initial literature search resulted in 113 articles related to questions raised. Hand searching of the journals related to implants and cross-referencing related to SST within the selected articles resulted in 1 more paper. Finally, 20 full texts and abstract of 1 article were included in the present systematic review: 11 case reports, 6 case series, 1 human randomized control trial (RCT), 1 technical report and 2 animal RCT. Recent modifications in SST, along with long follow-up studies with increased sample size, provided promising results. This systematic review still recommends that SST should not be used in routine clinical practise until a higher level of evidence established. Further RCT on SST are required to establish the clinical efficacy of this technique.

The Root Membrane Technique: A Retrospective Clinical Study With Up to 10 Years of Follow-Up

PURPOSE

Immediate implant placement in conjunction with intentional root retention is a recently introduced technique, but the majority of existing documentation is limited to short-term reports with low level of evidence. Hence, the aim of this study was to document the long-term clinical and radiographic results of the root membrane technique.

METHODS

This retrospective study reports on clinical results of the root membrane technique for periodontal ligament-mediated immediate implant placement with up to 10 years of follow-up from 3 private dental practices. Anterior implants placed with immediate loading from January 2006 to December 2016 were assessed. Kaplan-Meier estimators were computed for reporting of implant success and survival.

RESULTS

A sample of 182 patients (82 men and 100 women, age range: 18-83 years) received 250 immediate implants (230 maxilla, 20 mandible) after the root membrane concept and followed-up for a mean of 49.94 months (±32.5). Overall, 5 implant failures were recorded for a 10-year cumulative patient-level implant survival rate of 96.5%. Considering mechanical and biological complications, the 10-year cumulative implant success rate was 87.9%.

CONCLUSIONS

Within the limits of the retrospective design, the root membrane technique showed long-term success rates comparable to those of conventional immediate implants.

Osseous Remodeling Around Dental Implants

Adequate bone remodeling may be a primary parameter for long-term successful complication-free dental implant treatment. A 1.8-mm osseous thickness around dental implants is thought to be the minimum thickness for adequate vasculature for osteocyte nutrition and function. A dental implant does not provide progenitor cells or angiogenic or osteogenic factors. Thus, the surrounding bone may need to have a 1.8-mm thickness to accommodate the vasculature necessary for nutrients for appropriate remodeling. Additionally, the 1.8-mm dimension may provide for mechanical load resistance. There is no evidence to illustrate the physiologic need for the 1.8-mm dimension. This dimension requirement is based on clinical outcome observations. Basic science research for bone survival around dental implants is needed.

[Immediate implantation following tooth extraction in fresh maxillary molar socket with poor bone quality]

OBJECTIVE

To explore the feasibility of immediate implantation after tooth extraction in the maxillary molar socket with poor bone quality beneath the sinus.

METHODS

We collected the data from the patients undergoing extraction of maxillary molars with poor bone quality between the sockets and sinuses. Sinus lifting and immediate implant following the extraction were performed simultaneously in these cases, and the primary stability of the implants, wound healing, and changes of the sinus were observed. At 6 months after the operations, the crowns were installed on the implants. The masticatory function was observed, and the growth of the alveolar bones and their changes after the operations were examined using microcomputed tomography (MCT).

RESULTS

We analyzed 32 extraction cases with immediate implantation in the maxillary molar sockets with poor bone quality beneath the sinus. The average age of the patients was 59.8 years, and the length and diameter of the implant ranged from 8.5 to 10 mm and from 4.5 to 5.5 mm, respectively. The torque force of the implants varied from the minimum (in which cases the implants remained fixed after insertion with fingers) to the maximum of 30 N·cm. The postoperative recovery was uneventful in all the cases and no failed or movable implants were found. At 6 months after the operation, none of the patients showed abnormalities in the sinus, and in all the cases the crowns were successfully installed on the implants with good recovery of the masticatory functions. Follow-up of the patients for 12 to 96 months after the operation showed successful immediate implantation in all the cases. After the operation, the changes of the mean alveolar ridge heights on the buccal, palatal, mesial, and distal sides of the patients were 0.8069±0.6253 mm (t=1.2904, P&gt;0.1), 0.5272± 0.3331 mm (t=1.5836, P&gt;0.05), 0.5416±0.4048 mm (t=1.3379, P&gt;0.05), and 0.5172±0.3874 mm (t=1.3351, P&gt;0.05), respectively; the change of the alveolar ridge width was 0.5522±0.4381 mm (t=1.2604, P&gt;0.1) mm. The dimension of the alveolar bone underwent no significant changes after the operation in these patients.

CONCLUSIONS

Immediate implantation in the maxillary extraction socket with a poor bone quality can avoid damages to the sinus and achieve good outcomes with such advantages of less trauma, full use of the innate gingiva and alveolar ridge, and well preserved morphology of the alveolar ridge as compared with delayed implantation.