The document discusses the socket shield technique for implant placement, which preserves a portion of the tooth root to minimize tissue alterations post-extraction. It outlines the process, indications, and contraindications for this technique while highlighting its advantages and potential disadvantages. The technique is particularly beneficial for preserving the buccal bone in cases of thin cortical plates, making it a viable alternative to other surgical augmentations.

1. SOCKET SHIELD TECHNIQUE IN
IMPLANT PLACEMENT
PRESENTED BY-ANDREW GNANAMUTTU/CRI
GUIDED BY-DR VIJAY EBENEZER,
DR BALAKRISHNAN RAMALINGAM,
DR BANU SARGUNAR
SREE BALAJI DENTAL COLLEGE AND HOSPITAL

2. TRADITIONAL BRANEMARK’S
PROTOCOL

3. HEALING OF EXTRACTION
SOCKET

4. TISSUE CHANGES AFTER TOOTH
EXTRACTION
 Following an extraction thereis a 25% decreasein the width of the alveolar bone during first
year and an average4mm decrease in height during the first year following multiple
extractions(Carlson 1967)
 Tatum and Misch have observed a 40%-60% decrease in alveolarbone width after the first 2-3
years post extraction.
 Christensen reports an annual resorption rate of at least 0.5% - 1% during the remainder forthe
rest of a patientslife
 Schropp et al (2003) most of the bone gain in the socket occurred in the first 3 months

5. SOFT TISSUE CHANGES
AFTER EXTRACTION
HARD TISSUE
CHANGES AFER
EXTRACTION

6. IMMEDIATE IMPLANT PLACEMENT?
Immediate implant placement, defined as the placement of dental implant
immediately into fresh extraction socket site after tooth extraction, has been
considered a predictable and acceptable procedure (Schwartz et al., 2000).

7. WHY IMMEDIATE IMPLANT
PLACEMENT?
Patients acceptability
Reduces treatment time
Socket as a guide for determination of parallelism and alignment
Surgeon can position the implant more favourably than the original position
Facilitates final restoration and minimizes need for severely angled
abutments
Implants in extraction sites can be placed in the same position as the
extracted teeth

8. 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

9. PRINCIPLE OF SOCKET SHIELD
TECHNIQUE
• 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

10. INDICATIONS OF SOCKET SHIELD
TECHNIQUE???
• The ideal extraction site for immediate implant placement
Little or no periodontal bone loss on the tooth that is to be
extracted ,such as tooth being extracted due to
1)Endodontic involvement
2)Root fracture,root resorption
3)Periapical pathology
4)Root perforation
5)Unfavorable crown to root ratio
6)Residual deciduous tooth
• A minimum of 4-5mm bone width at the alveolar crest and at least
10mm bone length from the alveolar crest to a safe distance above
closest anatomical structures are recommended(WORTHINGTON
2004)

12. CONTRAINDICATIONS OF SOCKET
SHIELD TECHNIQUE
Presence of pus
Lack of bone beyond the apex
Close proximity to anatomical vital structures
Clinical conditions preventing primary closure

13. ADVANTAGES OF SOCKET
SHIELD TECHNIQUE
 Alveolar ridge atrophy after tooth extraction has a negative impact on implant
restoration. The buccal portion of the bone which is more prone to atrophy was
preserved by retaining a part of buccal root segment which shields PDL on
buccofacial aspect of the implant.
 Especially in canine and premolars where the buccal cortical plate is thin and are
more prone to fracture which makes it an unfavourable environment for implant
placement which also requires a secondary grafting procedure. So as to overcome
this difficulty this technique is used.
 No additional material cost, No co-morbidity , Single surgery ,Applicable in sites
with endodontic apical pathology
THIN BUCCAL
CORTICAL PLATE

14. DISADVANTAGES OF SOCKET SHIELD
TECHNIQUE
• Not yet reliable or predictable
• No long-term data yet
• Technique sensitive

15. THE RULE OF 5 TRIANGLES
• The presence of a buccal plate
• Primary stability where there is existing apical bone
• Implant design
• Filling of the gap between the buccal plate and the
implant(JUMPING DISTANCE)
• Tissue biotype.
OF THE RULE OF 5 TRIANGLES ,
THE PRESENCE OF BUCCAL
PLATE CAN WELL BE
PRESERVED USING SOCKET
SHIELD TECHNIQUE

16. PROCEDURE
A 30-year-old malepatient was treated with
a single tooth implantin the maxillarypremolar region. The patient was a
non-smoker and did not present relevant medical conditions. The primary
indication for tooth extraction was an endodontic treatmentfailure.
OCCLUSAL
AND
BUCCAL
VIEW

17. Without lifting a mucoperiosteal flap or affecting the marginal
gingiva,the tooth was carefully decoronated using a diamond bur.
A 1–2mmthick tooth fragment in the buccal area of the extraction
socket was separated from the rest of the tooth using rotating
tungstencarbide instrumentswith sterilewater irrigation.
Particularattentionwas taken to avoid damage to the bone walls
of the extractionsocket. Following preparation of the implantbed
in the lingualpart of the root, all residualtooth fragments were
completelyremoved. A careful curettage of the extractionsocket
was performed to remove granulationtissue.The buccal fragment
of the root was preserved 1mm coronally to the buccal bone plate
SHIELD WAS
PREPARED

18. The implant was placed in the lingual part
of the extraction socket, without contact
with the retained root fragment
Radiographic view after
implant placement

19. Follow-up examinationswere performed
after surgery at follow-up intervals. The
implant site showed uneventful healing.No
socket-shieldexposure was observed.
The final restoration– a screw-retainedceramic-to-
metal implantsingle crown – was delivered four
months after implant placement.It was fixed witha
torque-controldevice using a titaniumscrew.
Functional capabilitieswere checked .

20. FINAL RESTORATION

21. CONCLUSION
Tooth loss and subsequent ridge collapse continue to burden restorativeimplant treatment.Especiallyin canine and
premolarswherethe buccal corticalplate is thin and are more prone to fracture which makes it an unfavourable
environment for implantplacement which also requires a secondary grafting procedure. In-lieuof surgical
augmentation to correct a ridge defect, the socket shieldtechnique offers a promising solution.
REFERENCE
1)TANUM, NEHASM,WAKINDERB,ACHYUTS,ANIMESHB,PRATEEKT SOCKETSHIELD
TECHNIQUE.INDIANDENTALJOURNAL2015:7; 31-34
2)HOWARDG,JONATHANDT,MAURICES THE SOCKETSIELD TECHNIQUETO SUPPORT THEBUCCO
FACIALTISSUES AT IMMEDIATEIMPLANT PLACEMENT.INTERNATIONALDENTISTRY-AFRICAN
EDITION2011 :5;6-14