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Abstract
Aim: Tooth loss and subsequent ridge collapse continue to burden restorative implant treament. Careful management
of the post-extraction tissues is needed to preserve the alveolar ridge. In-lieu of surgical augmentation to correct a
ridge defect, the socket-shield technique offers a promising solution. As the root submergence technique retains the
periodontal attachment and maintains the alveolar ridge for pontic site development, this case report demonstrates
the hypothesis that retention of a prepared tooth root section as a socket-shield prevents the recession of tissues
buccofacial to an immediately placed implant. Materials and Methods: An adult male patient had a ferrule-less
central maxillary incisor sectioned to prepare a socket-shield at implant placement. The implant was provisionalized
and immediately loaded until definitive restoration at 4 months of healing. Results: The implant osseointegrated
successfully and without complication. Immediate postoperative as well as the 1 year follow up demonstrated a
functional and aesthetic outcome of the treatment. The socket-shield technique in conjunction with immediate placement
and provisionalization positively supported the ridge facial to the implant. Conclusions: The socket-shield technique
is a highly promising addition to clinical implant dentistry and this case report is among the first to demonstrate the
procedure in clinical practice with a 1-year follow up.
Keywords: Socket-shield technique, dental implant, ridge preservation, immediate placement
Introduction
1
CLINICAL
Case report
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Figure 8: The 1
week follow up.
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Figure 11: 3 Months postop with the facial ridge very well
maintained.
12
13
Figure 15: CBCT at the 1 year follow up. Note the bulk of tissue facial to the
implant.
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Table 1: Comparative tabulation of procedures to manage the effects of post-extraction resorption adjunct to
implant therapy
Disadvantages
Advantages
GBR
Tissues gains
Technique sensitive
Additional healing time
Additional co-morbidity
Additional expense (xeno / allograft)
Additional risk of infection / complication
Vertical gains are challenging
Sub-epithelial connective tissue graft
Reliable, predictable
Technique sensitive
No co-morbidity
Single surgery
Technique sensitive
Discussion
The results from the case reported here are consistent with
the original report by Hrzeler and coworkers, that retention
of the buccofacial root section at immediate implant
placement achieved osseointegration without resorptive
response of the ridge buccofacial to the implant.4 The
technique offers a viable solution when managing the postextraction ridge and its complications associated with
immediately placed implants. Prior to the SS technique, the
implant surgeon conventionally was to select between an
immediate placement protocol with an augmentation of the
jump gap, with or without bulking of the buccofacial soft
tissues, or a delayed approach with additional surgical
intervention to correct an existing ridge defect.5 Overbuilding
the ridge buccal / facial to the implant by guided bone
regeneration and soft tissue augmentation can only partly
compensate. A wealth of literature supports these ridge
management techniques but an amount of shrinkage with
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Author(s)
Study
2015*
Bumer et al.5
2014*
Siormpas et al.13
46 Case series of the root-membrane technique with follow up varying 2-5 years
2014
2014*
Holbrook
29
15
2014*
Glocker et al.
2013*
12
2013
2010
16
Hrzeler et al.
Animal histology of 1 case of socket-shield technique, & 1 human clinical case of implant
restoration with socket-shield
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Concluding remarks
The SS technique offers a promising solution to the difficulties
encountered when managing the post-extraction tissues. This
case report of immediate placement simultaneous to the SS
technique is among the first to demonstrate with a 1 year
follow up successful preservation of post-extraction tissues
coinciding with successful restorative implant treatment. The
void in the literature reporting on the techniques long-term
success requires prudent participation of clinicians to
contribute to the knowledge base before the procedure can
be routinely prescribed for ridge preservation simultaneous
to immediate implant placement. At present the technique is
highly promising and holds significant potential for the field
of aesthetic and restorative implant dentistry.
Declaration
The authors declare no conflict of interest.
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