JOURNAL CLUB-SOCKET SHIELD TECHNIQUE

1. Dr. sangeeta poriya

2.  In 2010, Hürzeler et al. introduced , the
socket shield technique- partial root
fragment retained around an immediately
placed implant*.
Hurzeler MB, Zuhr O, Schupbach P, Rebele Sf et al socket-shield technique: a proof-of-principle report. J Clin Periodontol 2010; 37: 855-62.

3.  Principle-
the buccal portion of the root is
retained to preserve the periodontal
ligament and bundle bone.
 objective-
 to gain more insight regarding the
safety of the technique with regard to
biological and implant-related long-term
complications
 to observe the clinical appearance of
the peri-implant tissues.
 to evaluate volumetric changes of
the affected facial contours in long-term and
the esthetic outcomes.

4.  the loss of a tooth
 triggers a remodeling reaction as part of the
healing process,
 involving various degrees of alveolar bone
resorption, especially affecting the buccal
lamella

5.  The bundle bone is primarily vascularized by
the periodontal membrane of the tooth.
 Therefore, bone is compromised by
extraction, to such an extent that the buccal
lamella is insufficiently nourished,
 leading to its total or partial resorption .

6.  Total socket shield cases-128
a. female-70
b. male-58
c. Age range:24-71(mean-39)years
d. Distribution sites-
maxillary
incisors
premolars
canines
14%
64%22%

7. •89.9%maxilla
•10.1%mandible

8. Conservative extraction of the palatal root
fragment with periotome and forceps
socket debrided gently and irrigated with
normal saline
Implant bed preparation at the palatal wall of
the socket performed
rootform implant was placed without contact
to the shield;apico-coronal position of the
implant platform situated 1mm apical to the
palatal marginal gingiva
gap between the shield and implant surface
was left to enable blood clot formation

9. Preparation steps of the socket-shield

10.  Complications rate-25/128(19.5%)
 5-fail to osseointegrate, removed.
 20-managed/observed without management
with implant at mid term follow up
 16-exposure
 3- infection
 1- migrated/overerupted

11. Exposure-16
Implant faliure-5
Infection-3
Migration-
1

12.  Implant Failure-
 Not possible to determine why implants
failed to osseointegrate .
 3- s-s still intact and uninfected- The sites
were cleaned and the failed implant
replaced in two of the cases. Both implants
osseointegrated and restored.
 1- implant removed, the site converted to a
pontic shield.
 In 2- both s-s and implant removed, and the
patients opted for a FPD and RPD
respectively

13. Implant removed. Socket-shield
checked, immobile,
intact, site cleaned, rinsed with saline,
and new implant placed

14.  Infection-
 3 S s Mobile and developed an infection
 1- mobile s-s and removed, the site exposed
and cleared, the exposed surface of the
implant decontaminated,grafted with a GBR
procedure, and later restored.
 1- the site healed, another implant placed,
osseointegrated, and restored.
 1- the site was grafted as a ridge
preservation and later restored with a FPD.

15. Infection at site 21. Restoration removed, socket-
shield
was mobile and thus removed. GBR procedure
was done, implant
restored and in function 4-years

16.  Socket-shield exposure-
•coronal portion of the s-s
perforating the soft tissue
internal
•toward the oral cavity
external

17. External exposure, site 33
Internal exposure

18. Internal
exposure(12)
Either no treatment
Or reduction of exposed
root portion with
diamond bur
External
exposure(4)
Reducing coronal aspect
of soft tissue closure
CTG augmentation to
assist soft tissue healing
s.S reduced,allowing soft
tissue to heal

19.  MIGRATION-
 Restored both implant and S.S without
reduction of s.s and monitored without
additional complication.

20. Purpose-
Retaining this carefully designed and
prepared facial root section to maintain the
root’s periodontal attachment to the facial
bundle bone that is prone to collapse post-
extraction.

21.  Conventional implant treatment also incurs a
degree of complication and failure.
 Augmentation itself has drawbacks.
 It is an invaluable addition to implant
dentistry with sound long-term data.

22.  Most common complication- internal
exposure of S.S
cause- lack of adequate space between the
coronal edge of the shield and the
subgingival contour the crown.
 The potential for tissue inflammation is not
ideal and as yet the long-term effects are
not known.
 Management-acceptable way to perform a s.s
& advised to add a small connective tissue
graft into the sulcus to assist soft tissue
closure(not always necessary)

23.  second most common complication- external
exposure
 cause- over extension of the shield’s coronal
aspect, or the sharp coronal aspect that
perforates the overlying soft tissue, and
more likely at sites inherently deficient in
facial bone (lower anterior, cuspids, previous
orthodontic treatment)
 Management-a micro flap, reduction of the
perforating shield, and in most cases a soft
tissue graft to close the exposure

24.  Occurrence of these complications has lead
to a change perform the technique.
 We originally described preparing the shield
to 1 mm above bone crest: rationale -
maintenance of the periodontal fibers
 As a result of the experience the socket-
shield to bone crest level,
 observed best results when a chamfer is
created in the crestal 2 mm of the shield,
thinning it slightly and providing additional
and critical prosthetic space of 2–3 mm
between the subgingival crown contour and
the shield for soft tissue

25.  Results support this paradigm change toward
tooth root tissue preservation.
 These modifications of the technique has
lead to an almost total elimination of either
of these complications.