Figure 7 - uploaded by Haseeb Aldary
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The periapical radiograph after final prosthesis delivery, note the good bone level at the implant abutment interface.
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To avoid tissue alterations of the ridge after tooth extraction, the socket shield technique was first introduced in 2010 by Hurzeler. It was suggested that instead of extracting the whole tooth, the buccal aspect of the root could be left intact to preserve the buccal plate of bone and prevent post extraction resorption, at the same time an immedi...
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The removal of the central incisor of the upper jaw is a challenging process, since the restoration of a single implant in the esthetic zone is of great responsibility. When tooth extraction with immediate implant placement is not possible, modern protocols imply the use of the socket preservation technique. This method of preserving socket propert...
Citations
... The alveolar process is a tissue dependent on the presence of the tooth, where its development follows the stages of tooth eruption [1]. The volume and shape of the alveolar process are determined by the shape of the tooth, its axis of eruption and eventual inclination [2]. ...
One of the most common dental procedures is tooth extraction; however, the bone defect resulting from the process is only partially restored, leading to considerable bone loss. To rehabilitate a fully or partially edentulous patient, we must handle these sites with delicate surgical procedures. There is a large literature presenting attempts to overcome the negative effects of a dental extraction, with the aim of reducing tissue volume loss or restoring the alveolar architecture. In this context, Partial Extraction Therapy (PET) represents a subgroup of interventions to prevent bone loss after extraction using the tooth itself to prevent alveolar bone loss. This literature review aims to make a survey of the published articles on PET, with an emphasis on socket shield technique, and to explain the other techniques such as root burial, pontic-shield and proximal socket-shield, their indications and counter indications in order to deepen the knowledge of these techniques. To identify the included or considered studies, we adopted a detailed search strategy for MEDLINE and Cochrane Library focused in the last 31 years, whose language was English, Spanish or Portuguese. This text presents an analysis of current data regarding the alternatives for alveolar preservation and the installation of immediate implants in these areas, presenting the possibility of a different surgical technique. However, due to the immaturity and lack of conclusive scientific evidence regarding the predictability of the procedures, it is considered that the use of the socket shield technique must be done in an extremely cautious way.
Indexing terms
Alveolar bone loss; Bone resorption; Dental implantation; Tooth socket
... The concept of PET is composed of four different techniques that aim to preserve slice of the tooth in the bone, thereby minimizing the loss of the bone vasculature and periodontal ligament attachment, thus eliminating the remodeling and resorption of both hard and soft tissues associated with tooth removal. gluckman et al. (2016a), and Shaheen (2021) found that partial extraction therapy (PET) includes root submergence (RST), socket shield (SST), proximal socket shield (PSST), and pontic-shield (PST) (buSER et al. 2000;Abadzhiev et al. 2014;Troiano et al. 2014;Al-dary and Al Hadidi 2015;durrani et al. 2017;Mitsias et al. 2017;Aldary and Alsayed 2017;(durrani et al. 2017;Esteve-Pardo and Polis-yanes et al. 2020;Abd-Elrahman et al. 2020). bioSciEncE bioTEcHnology RESEARcH coMMunicATionS These systems have provided excellent mechanical, biological, and esthetic outcomes in the hands of experienced operators with meticulous treatment planning and case selection. ...
Hürzeler presented the socket-shield technique (SST) more than 10 years ago. The partial extraction therapy (PET), a collective concept of utilizing the patient's own tooth root to preserve the periodontium and peri-implant tissue, has been remarkably developed. PET comprises a group of novel techniques for post-extraction implant placement. Several modifications of PET and simultaneous implant placement have been presented since its inception. Since its origin, several alterations have been employed in the methodology of partial extraction of the root and the simultaneous implant placement. A repeatable, predictable protocol is needed to provide tooth replacement in esthetic dentistry. Moreover, a standardized procedure provides a good framework for clinicians to report data relating to the technique with procedural consistency. This review aims to illustrate a reproducible and systematic protocol for the PET techniques with immediate implant placement at the aesthetic zone. The most used technique is the socket-shield technique, which is potentially offers promising results, minimizing the necessity for invasive bone grafts round implants in the aesthetic area, clinical data to support this is very inadequate. The limited research data existing is cooperated by a deficiency of well-designed prospective randomized controlled investigations. The present case studies and techniques are of actual incomplete technical value. Retrospective studies published in limited records but are of inconsistent plan. At this point, it is indistinct whether the socket-shield technique will offer a stable long-time outcome or not.
... [35][36][37][38] These implant technique advancements and modifications of SST made it popular for its widespread use among clinicians for restoration irrespective of the arch. [39][40][41][42][43][44][45][46] However, owing to the scarcity of the literature documentation on SST, little is known about the survival or/and success rates, complications, and failures associated with it. 35,36,38,43,46 Therefore, the present systematic review was carried out to summarize the effectiveness of the SST as a treatment of choice for the stabilization of the soft and hard tissues in the extraction site. ...
... [39][40][41][42][43][44][45][46] However, owing to the scarcity of the literature documentation on SST, little is known about the survival or/and success rates, complications, and failures associated with it. 35,36,38,43,46 Therefore, the present systematic review was carried out to summarize the effectiveness of the SST as a treatment of choice for the stabilization of the soft and hard tissues in the extraction site. Further, the study is also aimed to assess whether there is any association between patient gender, age, arch, region, and position of the IIP with SST. ...
Aim: The present study is aimed to evaluate the effectiveness of the socket shield technique (SST) and immediate implant placement (IIP) as the treatment of choice for the stabilization of soft and hard tissues at the extraction site and correlate with patient-related and implant-related factors.. The search terms used were "socket shield technique, " "modified SST, " "root membrane technique, " "pontic shield technique, " and "immediate implant. " Case report and case series, both retrospective and prospective in nature, where SST procedures were done with IIP after tooth extraction were considered for the study. However, clinical trials on animals and studies with less than 3-month follow-up after implant placement were not considered for the study. The studies were collected, analyzed, and tabulated for further analysis to evaluate the aim and objectives of the study. Results: Preliminary search identified through databases resulted in 350 articles, which on further screening led to exclusion of 299 articles based on the selection criteria. Therefore, 51 articles were considered for the final analysis which comprised 11 case studies and 40 case reports. With a wide age-group, the maxillary anterior region was the site of choice for the SST with IIP when compared to the posterior region. Better adaptability, maintenance of ridge contour, and good success rate followed by limited complications were observed among case series and reports. Conclusion: SST was successful in providing stability, esthetics, with lesser marginal bone loss and higher pink esthetic scores. However, well-designed prospective case series are few in number; thereby insufficient data on its reliability and longtime stability limit its application. Clinical significance: SST provides a promising result and better esthetic outcome with minimal requirement of soft tissue grafts, thereby increasing its popularity and its application. However, further studies with a larger sample size and effective clinical research designs with a follow-up period are a requirement to establish the procedure and its reliability.
... [35][36][37][38] These implant technique advancements and modifications of SST made it popular for its widespread use among clinicians for restoration irrespective of the arch. [39][40][41][42][43][44][45][46] However, owing to the scarcity of the literature documentation on SST, little is known about the survival or/and success rates, complications, and failures associated with it. 35,36,38,43,46,47 Therefore, the present systematic review was carried out to summarize the effectiveness of the SST as a treatment of choice for the stabilization of the soft and hard tissues in the extraction site. ...
... [39][40][41][42][43][44][45][46] However, owing to the scarcity of the literature documentation on SST, little is known about the survival or/and success rates, complications, and failures associated with it. 35,36,38,43,46,47 Therefore, the present systematic review was carried out to summarize the effectiveness of the SST as a treatment of choice for the stabilization of the soft and hard tissues in the extraction site. Further, the study is also aimed to assess whether there is any association between patient gender, age, arch, region, and position of the IIP with SST. ...
Aim:
The present study is aimed to evaluate the effectiveness of the socket-shield technique (SST) and immediate implant placement (IIP) as the treatment of choice for the stabilization of soft and hard tissues at the extraction site and correlate with patient-related and implant-related factors.
Methodology:
An electronic search was performed on Cochrane, EBSCO host, Medline/PubMed, Scopus, Wiley Library, Google website search, and Web of Science databases from January 2010 to September 2021. The search terms used were "socket-shield technique," "modified SST," "root membrane technique," "pontic shield technique," and "immediate implant." Case report and case series, both retrospective and prospective in nature, where SST procedures were done with IIP after tooth extraction were considered for the study. However, clinical trials on animals and studies with less than 3-month follow-up after implant placement were not considered for the study. The studies were collected, analyzed, and tabulated for further analysis to evaluate the aim and objectives of the study.
Results:
Preliminary search identified through databases resulted in 350 articles, which on further screening led to exclusion of 299 articles based on the selection criteria. Therefore, 51 articles were considered for the final analysis which comprised 11 case studies and 40 case reports. With a wide age-group, the maxillary anterior region was the site of choice for the SST with IIP when compared to the posterior region. Better adaptability, maintenance of ridge contour, and good success rate followed by limited complications were observed among case series and reports.
Conclusion:
SST was successful in providing stability, esthetics, with lesser marginal bone loss and higher pink esthetic scores. However, well-designed prospective case series are few in number; thereby insufficient data on its reliability and longtime stability limit its application.
Clinical significance:
SST provides a promising result and better esthetic outcome with minimal requirement of soft tissue grafts, thereby increasing its popularity and its application. However, further studies with a larger sample size and effective clinical research designs with a follow-up period are a requirement to establish the procedure and its reliability.
... Thereafter, a study by Christian et al. also does not clearly shows whether the socket shield technique will provide a stable long term outcome. [1] Baumer et al. [6] Likewise, similar outcome was reported by Chen et al, [10] Mitsias et al, [11] Lagas et al, [12] Engelke et al, [13] Al Dary et al. [14] Anas et al. reported SS technique to be fruitful in esthetically challenging areas. [3] ...
... A total of 20 studies were included in the present systematic review. Regarding the distribution of the available literature in accordance with the hierarchy of evidence, one was a randomized controlled trial (RCT) [22], two were cohort studies [13,17], 14 were clinical human case reports [2,9,12,[14][15][16][18][19][20][21][23][24][25][26], and three were retrospective case series [11,27,28]. Details of the studies are provided in Table 1. ...
... Thirteen articles included in the present review were case reports of only one patient each [2,9,12,[14][15][16][19][20][21][23][24][25][26]. Therefore, case selection bias is likely to have occurred, where the authors may have only presented cases with successful outcomes. ...
... Therefore, case selection bias is likely to have occurred, where the authors may have only presented cases with successful outcomes. Nine of the included case reports had a short follow-up of < 12 months [9,12,13,16,18,[21][22][23][24], which does not enable the complete evaluation of failures and complications of the socket shield technique. Thus, there is a high possibility that the number of complications, adverse effects, and failures is under-reported. ...
Purpose: Dental implant therapy is a common clinical treatment for missing teeth. However, the esthetic result is not as satisfactory as expected in some cases, especially in the anterior maxillary area. Poor esthetic results are caused by inadequate preparation of the hard and soft tissues in this area before treatment. The socket shield technique may be an alternative for a desirable esthetic outcome in dental implant treatments.
Study selection: In the present systematic review, PubMed-Medline, Google Scholar, and ScienceDirect were searched for clinical studies published from January 2000 to December 2018.
Results: Twenty studies were included, comprising one randomized controlled trial, two cohort studies, 14 clinical human case reports, and three retrospective case series. In total, 288 patients treated with the socket shield technique with immediate implant placement and follow-up between 3–60 months after placement were included. A quality assessment showed that 12 of the 20 included studies were of good quality. Twenty-six of the 274 (9.5%) cases developed complications or adverse effects related to the socket shield technique. Most studies reported implant survival without the complications (90.5%); most of the cases that were followed up for more than 12 months after implant placement achieved a good esthetic appearance. The failure rate was low without the complications, although there were some failures due to failed implant osseointegration, socket shield mobility and infection, socket shield exposure, socket shield migration, and apical root resorption.
Conclusions: The socket shield technique can be used in dental implant treatment, but it remains difficult to predict the long-term success of this technique until high-quality evidence becomes available.
... Hurzeler et al. postulated that leaving a 1.5-mm-thick root fragment on the buccal aspect of the proposed implant site [1] would leave sufficient space for optimal placement of the dental implant as well as maintain the buccal plate. Figures 2,3,4,5,6,7,8,9,10,11,12, and 13 illustrate the socket-shield technique as per Hurzeler et al. In addition to the beagle dog histology provided by Hurzeler [1], Schwimer et al. [2] provided human histology showing bone formation between the remaining dentin of the socket shield and the implant surface. ...
... Three studies analysed the volumetric changes by means of 3-dimensional scans [7,8,23], one study evaluated the buccal bone by means of taking post-operative CBCT scans [5], whereas others used the pink aesthetic score [4,16], and finally, some studies did not specify how the outcome was measured at all [1, 10-14, 17, 19, 22, 25, 26] and merely stated a good outcome was achieved. ...
Introduction:
Dental implants have become a standard treatment in the replacement of missing teeth. After tooth extraction and implant placement, resorption of buccal bundle bone can pose a significant complication with often very negative cosmetic impacts. Studies have shown that if the dental root remains in the alveolar process, bundle bone resorption is very minimal. However, to date, the deliberate retention of roots to preserve bone has not been routinely used in dental implantology.
Material and methods:
This study aims to collect and evaluate the present knowledge with regard to the socket-shield technique as described by Hurzeler et al. (J Clin Periodontol 37(9):855-62, 2010). A PubMed database search ( www.ncbi.nlm.nih.gov/pubmed ) was conducted to identify relevant publication.
Results:
The initial database search returned 229 results. After screening the abstracts, 13 articles were downloaded and further scrutinised. Twelve studies were found to meet the inclusion and exclusion criteria.
Conclusion:
Whilst the socket-shield technique potentially offers promising outcomes, reducing the need for invasive bone grafts around implants in the aesthetic zone, clinical data to support this is very limited. The limited data available is compromised by a lack of well-designed prospective randomised controlled studies. The existing case reports are of very limited scientific value. Retrospective studies exist in limited numbers but are of inconsistent design. At this stage, it is unclear whether the socket-shield technique will provide a stable long-time outcome.
... Another case report conducted by same author he used a bone trephine was used to take out the remaining root, leaving an organized rounded section of the palatal/lingual extraction site with a semi lunar internal shape of the buccal aspect of the root that will receive an implant. He concluded that preparing the shield with a trephine may be of a great advantage than using fissure bur [27]. ...
Dental implant restoration is challenging procedure when it involve the esthetics zone, and since implant dentistry is prosthodontically driven procedure, care were practice in restoration of missing teeth in esthetics area which will fulfill the objective. Extraction of teeth leave buccal plate bone unsupported and decrease the blood supply and since this plate is very thin resorption will be expected. Different attempt was done in order to prevent this sequence and create natural emergence profile around dental implant prosthesis. Socket preservation procedures were introduced, however in case of ridge deficiencies, hard and soft tissue augmentation procedures are indicated. Socket shield technique meets the demands of minimal invasion, tissue preservation, and no need of bone substitute materials. And can be applied not only for maintaining buccal contour of an edentulous ridge but also for keeping the inter-implant soft and hard tissue In this review paper we present different articles and case report using socket shield technique as treatment protocols and try to explore different protocol are practice in order to achieve high treatment out come with optimal success.
... In opposition to the mentioned studies M. Anthony Pogrel, mentioned that late migration of the root fragment does appear to occur in some cases, but is unpredictable [22]. In this case presented the shield preparation was performed using diamond burs, the use of bone trephine was reported in a previous case report [23]. The use of one piece implant in this case may be advantageous to reduce inflammation in peri-implant tissues, an experimental study conducted by Hermann., et al. showed that significantly increased amounts of crestal bone loss around two-piece vs. one-piece implants, which result in a significant more apical position of the gingival margin, also, the degree of inflammation in peri-implant tissues is less around one-piece implants compared to two-piece implants. ...
Tooth extraction is often accompanied by resorption of surrounding tissues, immediate implant protocols after extraction can provide a pleasing aesthetic result with good function in selected situations, but not on a predictable basis and have a higher risk for mucosal recession and volume loss, This is where the socket shield technique was introduced to keep from the remodeling of hard and soft tissues after extraction by keeping them attached to the socket shield, in other words keeping the structures which are the components of periodontium in the buccal aspect of tooth or root undamaged when planning to extract the tooth and placing the implant, so implant would be inserted behind the buccal tooth fragment which is left intact to the buccal plate of bone, the thing that would enhance the aesthetic outcome of implant borne prosthesis.
The technique seems to have positive results, it has not been documented sufficiently. In this case report illustrated an implant was placed immediately after extraction with the technique, the report is documenting the follow up of more than 5 years of a stable aesthetic outcome.
... Description of the various case series and reports based on the socket-shield technique and their complications are seen in Table 1. A majority of case reports documented this technique for single implant restorations in the anterior esthetic region [33][34][35][36][37][38] and involved immediate implant placement at the time of preparation of the socket-shields. Some clinicians made modifications to the original technique in terms of time of implant placement 20 and location of the shield 17,22 but followed the same principle. ...
... Thirteen case reports and abstracts published the findings of only 1 patient each (Table 1). 6,16,17,19,[33][34][35][36][37][38][39][40][41] Thus, the possibility of case selection bias cannot be ruled out, wherein the authors might have presented only those cases with successful outcomes. Sixteen clinical human studies show short-term followup of 12 months (Table 1). 1 Such short periods are insufficient to effectively demonstrate the failures and complications of this technique. ...
... Abadzhiev et al. 32 References 6,16,17,19,20,22,31,[33][34][35][36][37][39][40][41][42] ...
The recently popularized socket-shield technique involves intentional retention of a section of the remnant root at the time of immediate implant placement, thereby preserving the buccal/proximal bone from resorption. The objective of this systematic review was to assess the literature available on the socket-shield technique and weigh its biological plausibility and long-term clinical prognosis. A systematic search was performed on PubMed-Medline, Embase, Web of Knowledge, Google Scholar, and Cochrane Central for clinical/animal studies from January 1970 to April 2017. Twenty-three studies were assessed: 1 clinical case-control study, 4 animal histological reports, 1 clinical abstract, and 17+2* case reports. Eighteen out of the 23 studies had a duration of ≤12 months. A quality assessment of 5 studies (4 animal histologic and 1 clinical case-control) performed using the modified Animal Research: Reporting of In Vivo Experiments guidelines revealed that 4/5 studies had low scores. Fifty-eight out of 70 (82.86%) implants from 4 animal histological studies had complications; buccal/crestal bone loss (54.55%) and failure of osseointegration (27.27%) were the most common. Thirty-three out of 136 (24.26%) implants from 19+2 (2 studies had both histologic and clinical components, which are assessed separately) clinical studies had complications; buccal/crestal bone loss (78.78%) and shield exposure/failure (12.12%) were the most common. Other complications recorded were periodontal ligament and cementum formation on implant surfaces, pocket formation, inflammation, mucositis, and peri-implantitis. However, some clinical reports indicated stable results at 12 months. It would be difficult to predict the long-term success of this technique until high-quality evidence becomes available.
A video abstract is available for viewing at https://youtu.be/lNMeUxj2XPA?list=PLvRxNhB9EJqbqjcYMbwKbwi8Xpbb0YuHI.
