INTRODUCTION TO SOCKET SHIELD

Why & When Socket Sheild?

Can we predict the collapse ?

Can we stop the collapse?

Even if we follow the parameters for immediate implant, is it enough?

According to this paper, bone loss is almost guaranteed in most of your cases.

Total tooth extraction leads to some level of bone loss especially when we consider the bundle bone of the buccal cortical plate (Araujo & Lindhe)

Consequences :

1.Gingival retraction

2. Buccal defect

3. Poor Implant aesthetic (grey)

4. Future potential peri-implantitis

Current alternatives

Hard & Soft tissue augmentation :

Bone grafting for hard tissue and connective tissue grafting for soft tissue/gums. Surgical?

So, what is socket shield?

Rather than removing the entire tooth, a buccal fragment of the tooth is left on purpose, and the implant is placed lingual to it, so the tooth acts as a shield

When tooth is extracted the PDL comes with it, this PDL provides the vascularization for the bone of the buccal cortical plate.

So, by maintaining the buccal tooth fragment, the periodontium is maintained and thus the vascularization of the keratinized gingiva is also maintained

Objectives

Risk Assessment

Case selection

Parameters

Steps

If anytime the buccal shield is mobile, then you must extract and you must do conventional

Note: Removal of apical tip of the socket shield

Important to take a second radiograph after removal of palatal fragment, to confirm no Gutta-Percha or other remains

First PET Consensus, Madrid 2017, that the Socket shield should be cut at crestal level

Complications

(gluckmann 2017 et al, retrospective of 128 cases)

Advantages

Disadvantages

Conclusion

Thank You

Malaysian Oral Implant Association Monthly Webinar #3 ( MAy )

Giveaway seats or

Rm50 per webinar or

MOIA member (Rm100/year) free webinar every month

15th May 2024 Wednesday 8.30pm on Zoom

Speaker : Dr. Neoh Leong Seng

Title: Oh, no! What to do now? Management of mishaps in implant dentistry

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774056/#:~:text=Age%2C%20length%20of%20implant%2C%20diameter,III%20bone%20showed%20maximum%20failures.

  2. https://restorativedentistry.org/wp-content/uploads/2019/01/IJPRDGLUCKMAN2016-PartialExtractionTherapiesPETPart1.pdf

  3. https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.16-0810

  4. https://www.researchgate.net/profile/Jonathan-Du-Toit/publication/341764243_A_decade_of_the_socket-shield_technique_a_step-by-step_partial_extraction_therapy_protocol/links/5ede7933a6fdcc47688ee883/A-decade-of-the-socket-shield-technique-a-step-by-step-partial-extraction-therapy-protocol.pdf

  5. Gluckman H, Du Toit J, Salama M. The pontic-shield: Partial extraction therapy for ridge preservation and pontic site development. Int J Periodontics Restorative Dent. 2016;36:417–23.

  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009166/

  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9651231/

all images and information can be found online, i am only sharing information in regards to what is already available online.