SOCKET SHIELD TECHNIQUE BY G R PRAVEEN RAJ

1. Socket shield
technique
By
Dr. G.R.PRAVEEN RAJ

2. INTRODUCTION
PRESERVATION OF WHAT
REMAINS RATHER THAN
METICULOUS REPLACEMENT OF
WHAT IS MISSING -
PRESERVATION OF ALVEOLAR RIDGES
-- M.M.DEVAN DICTUM
Basic principles in impression making Devan, M.M. Journal of Prosthetic Dentistry,
Volume 93, Issue 6, 503 - 508

3. Prof. Per Ingvar Branemark
Post Extraction 6 To8 Months Healing
3 To6 Months Stress Free Healing Period
For Osseointegration
Placing Machined Titanium implants In a
2-stage Approach
Prof. Devorah Schwartz-Arad
Extraction of teeth
Placing implant immediately into
the extraction socket
Immediate provisional loading of implant
Preserving the soft tissue contour
Osseointegration and its experimental background - , Per Ingvar Branemark Journal
of Prosthetic Dentistry, Volume 50, Issue 3, 399 - 410

4. II. Primary stability
I. The presence of buccal plate
IV. Jumping distance
distance
V. Tissue biotype
III. Implant design.
García J, Sanguino D. A new protocol for immediate implants. The rule of
the 5 triangles: A case report. Clin Oral Implants Res 2014;21:4-5
RULE OF 5 TRIANGLES

5. STUDIES
Lindhe and araujo 2005 : After xn decrease 25% in the width, and 4 mm decrease in height
Hezami 2008 : Blood supply loss in socket shows more resorption in buccal than palatal
Lindhe and araujo 2007 : Bundle bone plays a vital role in soft tissue architecture
Salama et al 2007 : Root submergence preserve alveolar bone width and height.
Hurzeler et al 2010 : Animal study : proof of principle with enamel matrix derivative
Kan et al at 2013 : Socket shield to maintain interdental soft tissue in esthetic zone.
Glocker 2014 : Socket shield with delayed implant placement.
Gluckman 2016 : Classified and coined partial extraction therapy.

6. PARTIAL EXTRACTION THERAPY
Partial extraction therapies denote a collective term used to describe
the maintenance of a root or a part of the root with the aim of
preserving the natural contours of bone and soft tissue around
implant-retained restorations.
ROOT SUBMERGENCE
TECHNIQUE
PONTIC-SHIELD
TECHNIQUE
SOCKET-SHIELD
TECHNIQUE
Ref : Gluckman H, Salama M, Du Toit J. Partial Extraction Therapies (PET) Part 1: Maintaining Alveolar Ridge
Contour at Pontic and Immediate Implant Sites. Int J Periodontics Restorative Dent. 2016 Sep-Oct;36(5):681-7.

7. Socket shield technique
• In 2010, Hürzeler et al. introduced a new method, the socket shield
technique, in which a partial root fragment was retained around an
immediately placed implant with the aim of avoiding tissue
alterations after tooth extraction
Ref : Hürzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. The socket-shield technique: a proof-
of-principle report. J Clin Periodontol. 2010 Sep;37(9):855-62.

8. Principle of SST
• Preparation of root in such a way that buccal/facial section remains
in-situ with buccal plate intact
• Tooth root sections periodontal attachment apparatus remains vital and
undamaged to prevent the expected post extraction socket remodeling and
to support buccal/facial tissues – “ Biologic cheating”.
Ref : Gluckman H, Salama M, Du Toit J. Partial Extraction Therapies (PET) Part 1: Maintaining Alveolar Ridge
Contour at Pontic and Immediate Implant Sites. Int J Periodontics Restorative Dent. 2016 Sep-Oct;36(5):681-7.

9. ADVANTAGES
Optimal soft tissue esthetics
Socket as a guide for determination of parallelism and alignment
Can position the implant in favourable position
Facilitates final restoration
Patients acceptability & Reduces treatment time
Preservation of bone at the site of implantation
Werbitt & Goldberg 1992; Barzilay 1993; Schwartz-Arad & Chaushu 1997a; Mayfi eld
1999; Hammerle et al. 2004)

10. INDICATIONS
• The ideal extraction site for immediate implant
placement little or no periodontal bone loss on the
tooth that is to be extracted, such as a tooth being
extracted due to
THIN LABIAL PLATE
FRACTURED TEETH,
GROSSLY DECAYED TEETH
ROOT PERFORATION,
ENDODONTIC TREATED TEETH
Partial Extraction Therapy in Implant Dentistry - Udatta Kher Ali Tunkiwala ISBN
978-3-030-33609-7

11. CONTRAINDICATIONS
Presence
of
infection
and
mobility
Lack of
bone in
labial or
buccal
plate
Close
proximity
to
anatomical
vital
structures
Malaligned
teeth
Partial Extraction Therapy in Implant Dentistry - Udatta Kher Ali Tunkiwala ISBN
978-3-030-33609-7

12. ARMAMENTARIUM
1. Long shank carbide bur on
high-speed air turbine drill.
2. Long shank round diamond
bur of various diameters.
3. Football-shaped diamond
bur.
4. Zekrya gingival retractor.
5. Fine-tipped elevators.
6. Curved artery forceps.
7. Bone curettes.
Customized kits
1. PET kit (Brassler).
2. Root membrane kit (Megagen)
3. Socket shield kit (Komet)
4. PET kit (Megagen).
Partial Extraction Therapy in Implant Dentistry - Udatta Kher Ali Tunkiwala ISBN 978-3-030-33609-7

13. IDEAL SHIELD REQUIREMENT
Partial Extraction Therapy in Implant Dentistry - Udatta Kher Ali Tunkiwala ISBN
978-3-030-33609-7

14. PROCEDURE
Sectioning of the root
Shield preparation
Implant placement
Management of the gap
closure

15. Provisional
Maintain atleast 1.5 mm space between shield and provisional
Shape and cervical contour of the provisional is governed by the implant trajectory and
takes a gradual ‘S’ shape
If the implant placed more labial more concave the emergence profile, If the implant
is more palatal more convex the emergence profile
Place the provisional 3mm below the facial crest of the free gingival margin
Provisional must not be in any occlusal contact
Partial Extraction Therapy in Implant Dentistry - Udatta Kher Ali Tunkiwala ISBN
978-3-030-33609-7

16. Trouble shooting
Improper Sectioning
Mobility of the labial shield
Labial fenestration
Inadequate stability for the implant
Spinning implant
Partial Extraction Therapy in Implant Dentistry - Udatta Kher Ali Tunkiwala ISBN 978-3-
030-33609-7

17. CASE REPORT
PRE - OP SECTIONING OF TOOTH
REMOVAL OF SECTIONED TOOTH

18. CASE REPORT
BUCCAL SOCKET SHIELD IMPLANT PLACEMENT
IMPLANT 3D POSITION COVER SCREW PLACED

19. CASE REPORT
RESIN RETAINED TEMPORIZATION EMERGENCE PROFILE
ABUTMENT PLACEMENT FINAL PROSTHESIS

20. CASE REPORT
PRE - OP OPG
POST - OP OPG

21. Fate of the shield
• Mitsias et al – histological human study
– Bone formation between implant and shield.
– Shield and buccal plate shows no resorption
– In coronal part of implant - shield connective
tissue without inflamation
– In apical part of implant – shield cementum
migration from root shield to implant surface.
The Root Membrane Technique: Human Histologic Evidence after Five Years of Function
Miltiadis E. Mitsias, et al. Hindawi BioMed Research International Volume 2017, Article ID
7269467, 8 pages

22. conclusion
• In a retrospective study conducted by gluckman in
128 socket shield cases in esthetic zone for 6
years followup with success rates of 123 cases
shows the importance of this technique. but…..
• Highly sensitive technique.
• Careful pre operative assessment needed.When
executed correctly, the postoperative morbidity
and complication rates are low and can be
managed easily by conventional procedures
Prosthetic management of implants placed with the socket-shield technique Gluckman,
Howard et al.Journal of Prosthetic Dentistry, April 2019 Volume 121, Issue 4, 581 - 585