4) Socket shield technique prosthodontics

4) Socket shield technique prosthodontics

1. shield Alveolar bone SOCKET SHIELD TECHNIQUE GUIDED BY PRESENTATION BY DR. M.BHARATHI DR.G.PRIYANKA HOD AND PROFESSOR I I MDS 1

2. Introduction Socket healing after tooth loss results in altered dimensions of the alveolar ridge due to remodeling and tooth-dependent alveolar process. The degree of alterations varies and it can result in the loss of ridge volume and changes in ridge shape, with up to 3.8 mm horizontal and 1.24 mm vertical reduction. 2

3. Moreover, the greatest loss occur on the buccal aspect, which is related to a thinner bone wall composed of large amounts of bundle bone primarily vascularized by the periodontal tooth membrane and particularly susceptible to surgical trauma and resorption. 3

4. Indications The anterior areas of both jaws (and particularly for the anterior maxilla) Teeth that cannot be restored due to traumas (crown fractures) or destructive caries. In cases with a vertical root fracture. 4

5. Contra- indications Cannot be applied to teeth with present (or past) periodontal disease. To teeth with mobility or widening of the periodontal ligament. To teeth with horizontal fractures below bone level, or to teeth with external/internal resorptions. 5

6. Technique Step 1: Cut the crown horizontally at the gingival level; Horizontally section of the crown at gingival level. Step 2: Bisect the root vertically in such a manner that palatal half is removed along with the apex. The length of the shield should be kept at two-third of the root length. The buccal part is then reshaped such that the shield width is about 1.5–2 mm. Step 3: Placement of implant in correct three-dimensional (3D) position. 6

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8. The optimum space between shield and implant is 1.5 mm or more. A bone graft is suggested if the gap is more than 3 mm. 8

9. Classification Type I : Buccal shield (the shield lies only in buccal part of the socket, between proximal line angles of tooth) Indication: Single edentulous site with both mesial and distal tooth present. 9

10. Type II : Full C buccal shield when the shield lies in buccal part and the interproximal part on both sides of the socket. Indication: 1. Existing implant on either side of the proposed site. 2. Missing tooth on either side without an implant. 3. Having implant on one side and missing tooth on the other side. 10

11. Type III : Half C buccal shield Indication: when there is tooth on one side and implant or a missing tooth on the other side 11

12. Type IV : Interproximal shield Indication: when there is buccal bone resorption requiring graft, and there is an adjacent side with missing tooth or an implant. 12

13. Type V: Lingual -Palatal shield Indication: Maxillary molars 13

14. Type VI : Multiple buccal shield Indication: when it has two or more shield in the socket. It is indicated in cases with a vertical root fracture. There is evidence to show bone deposition in between fractured roots which could assist in holding the two fragments in place. 14

15. Advantages Minimally invasive surgical procedure aimed at preserving a part of the root to help in maintaining hard and soft-tissue contours. Minimizes the need of grafting procedures. The interdental papilla can be preserved by preparing interdental socket shield. Protects the intergrity of bundle bone. Acts as guidance for implant placement Cost effective. 15

16. Limitations Technique sensitive requires highly trained operators. Patience to avoid mobility of the shield. Risk of displacement of root fragments. 16

17. Effectiveness of the socket shield technique in dental implant: A systematic review J Prosthodont Res . 2022; 66(1): 12–18 17

18. Aim The aim of the present systematic review was to systematically analyze the literature to understand the viability of the socket shield technique and to draw conclusions about its clinical outcome . The primary objective was to determine whether the socket shield technique achieves long-term clinical success in implant treatment. The secondary objective was to determine whether the socket shield technique improves the esthetics of the anterior area in fixed dental prosthesis treatment 18

19. Population: Subjects with immediate implant placement in the maxilla or mandible using the socket shield technique, with follow-up after implant placement. Intervention or exposure: Dental implant therapy using the socket shield technique. Comparison: Other implant placement methods not using the socket shield technique. Outcome: Survival of the implant and adverse effects of the socket shield technique 19

20. Results Twenty studies were included out which 12 were of good quality. 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. 20

21. 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. 21

22. Socket shield technique vs conventional immediate implant placement with immediate temporization. Randomized clinical trial J Prosthodont Res . 2022; 66(1): 12–18 22

23. They compared the vertical and horizontal changes of the buccal cortical bone plates, encountered after utilizing the socket shield technique with immediate temporization vs an immediate implant placement with immediate temporization, and analyzing the differences of the implant stability and pink esthetic score evaluation between both techniques. 23

24. 20 implants were placed using the socket shield technique with immediate temporization 24

25. 20 implants were placed immediately with immediate temporization; the control group. 25

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27. Results : The horizontal bone loss; ranged from 0 to0.26 (0.15) mm and 0.03 to0.44 (0.32) mm for the study and control groups, respectively. The vertical bone loss; ranged from 0.11 to 0.55 (0.31) mm and 0.25 to 1.51 (0.7) mm for the study and control groups, respectively 27

28. Conclusion The socket shield technique with immediate temporization is a reliable method to reduce the labial bone loss following teeth extraction. However, further studies are required to investigate the effect of grafting the jumping gaps, to evaluate the graft contribution in further reduction of the bone loss. 28

29. The socket-shield technique at molar sites: A proof-of principle technique report. Schwimer et al. The socket-shield technique at molar sites: A proof-of-principle technique report. J Prosthet Dent 2018. 29

30. Preoperative presentation of nonrestorable maxillary left second molar planned for extraction . Root trunk and buccal root trunk sectioned consecutively. Palatal portions of buccal roots split. 30

31. Fully prepared socket-shields of buccal roots. All other root portions, with apical lesions and endodontic obturation fully removed and sockets rinsed. Cross-sectional diagram of coronal portion of socket-shield reduced to crestal bone level with internal beveled chamfer. 31

32. Implants inserted. First molar site fully healed, delayed loading. Second molar site, immediate placement at socket-shields. Socket filled with xenograft . Transgingival healing abutments secured to implants. Site sutured and closed. 32

33. Molar site healing by secondary intention, after 2 weeks of healing . Fully healed sites at 4 months. Scannable abutments secured to implants. 33

34. Definitive screw-retained restorations. A, Occlusal view. B, Buccal view. 34

35. Postoperative cone beam computed tomography radial plane views (above) and preoperative views (below). 35

36. The socket-shield technique as a partial extraction therapy to preserve buccofacial tooth structure and maintain the ridge at anterior implant sites has received much attention in recent years. However, the significance of ridge collapse at posterior sites is often overlooked. From the technique presented in this report, socket-shields may help maintain the alveolar ridge at immediate molar implant placement sites. The authors strongly encourage additional reports to further elucidate the procedure. 36

37. Summary Socket shield technique is cost effective but still technique-sensitive, success require a unique case selection to achieve desirable output. Moreover, appropriate surgical treatment, restorative procedures, and clinical experience are essential when performing immediate instalment of implants. The SST is gaining popularity among the clinicians across the world. The technique is very promising for the preservation of hard and soft tissues in cases of post extraction immediate implant placement 37

38. References Socket shield technique: A systematic review of human studies Luis Miguel Sáez-Alcaidea et al- Annals of Anatomy 2021 Effectiveness of the socket shield technique in dental implant: A systematic review Toru Ogawa et al- J Prosthodont Res . 2022; 66(1): 12–18 Socket shield technique vs conventional immediate implant placement with immediate temporization. Randomized clinical trial-Received: November 2019 Revised: 29 June 2020 Accepted: 2 July 2020 DOI: 10.1111/cid.1293 Clinical Benefits of the Immediate Implant Socket Shield Technique-Journal of Esthetic and Restorative Dentistry 2017 The socket-shield technique: a critical literature review- Blaschke and Schwass International Journal of Implant Dentistry (2020) 6:52 Schwimer et al. The socket-shield technique at molar sites: A proof-of-principle technique report. J Prosthet Dent 2018. 38

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